Chun Kit Wong

Chun Kit Wong, Manxi Lin, Alberto Raheli et al.

Examination of the umbilical artery with Doppler ultrasonography is performed to investigate blood supply to the fetus through the umbilical cord, which is vital for the monitoring of fetal health. Such examination involves several steps that must be performed correctly: identifying suitable sites on the umbilical artery for the measurement, acquiring the blood flow curve in the form of a Doppler spectrum, and ensuring compliance to a set of quality standards. These steps rely heavily on the operator's skill, and the shortage of experienced sonographers has thus created a demand for machine assistance. In this work, we propose an automatic system to fill the gap. By using a modified Faster R-CNN network, we obtain an algorithm that can suggest locations suitable for Doppler measurement. Meanwhile, we have also developed a method for assessment of the Doppler spectrum's quality. The proposed system is validated on 657 images from a national ultrasound screening database, with results demonstrating its potential as a guidance system.

Chun Kit Wong, Stephanie Marchesseau, Maria Kalimeri et al.

Objective: Medical image datasets with pixel-level labels tend to have a limited number of organ or tissue label classes annotated, even when the images have wide anatomical coverage. With supervised learning, multiple classifiers are usually needed given these partially annotated datasets. In this work, we propose a set of strategies to train one single classifier in segmenting all label classes that are heterogeneously annotated across multiple datasets without moving into semi-supervised learning. Methods: Masks were first created from each label image through a process we termed presence masking. Three presence masking modes were evaluated, differing mainly in weightage assigned to the annotated and unannotated classes. These masks were then applied to the loss function during training to remove the influence of unannotated classes. Results: Evaluation against publicly available CT datasets shows that presence masking is a viable method for training class-generic classifiers. Our class-generic classifier can perform as well as multiple class-specific classifiers combined, while the training duration is similar to that required for one class-specific classifier. Furthermore, the class-generic classifier can outperform the class-specific classifiers when trained on smaller datasets. Finally, consistent results are observed from evaluations against human thigh and calf MRI datasets collected in-house. Conclusion: The evaluation outcomes show that presence masking is capable of significantly improving both training and inference efficiency across imaging modalities and anatomical regions. Improved performance may even be observed on small datasets. Significance: Presence masking strategies can reduce the computational resources and costs involved in manual medical image annotations. All codes are publicly available at https://github.com/wong-ck/DeepSegment.

Manxi Lin, Jakob Ambsdorf, Emilie Pi Fogtmann Sejer et al.

We introduce the notion of semantic image quality for applications where image quality relies on semantic requirements. Working in fetal ultrasound, where ranking is challenging and annotations are noisy, we design a robust coarse-to-fine model that ranks images based on their semantic image quality and endow our predicted rankings with an uncertainty estimate. To annotate rankings on training data, we design an efficient ranking annotation scheme based on the merge sort algorithm. Finally, we compare our ranking algorithm to a number of state-of-the-art ranking algorithms on a challenging fetal ultrasound quality assessment task, showing the superior performance of our method on the majority of rank correlation metrics.

Chun Kit Wong, Mary Ngo, Manxi Lin et al.

Despite the rapid development of AI models in medical image analysis, their validation in real-world clinical settings remains limited. To address this, we introduce a generic framework designed for deploying image-based AI models in such settings. Using this framework, we deployed a trained model for fetal ultrasound standard plane detection, and evaluated it in real-time sessions with both novice and expert users. Feedback from these sessions revealed that while the model offers potential benefits to medical practitioners, the need for navigational guidance was identified as a key area for improvement. These findings underscore the importance of early deployment of AI models in real-world settings, leading to insights that can guide the refinement of the model and system based on actual user feedback.

Chun Kit Wong, Paraskevas Pegios, Nina Weng et al.

Deep learning models in medical imaging are susceptible to shortcut learning, relying on confounding metadata (e.g., scanner model) that is often encoded in image embeddings. The crucial question is whether the model actively utilizes this encoded information for its final prediction. We introduce Weight Space Correlation Analysis, an interpretable methodology that quantifies feature utilization by measuring the alignment between the classification heads of a primary clinical task and auxiliary metadata tasks. We first validate our method by successfully detecting artificially induced shortcut learning. We then apply it to probe the feature utilization of an SA-SonoNet model trained for Spontaneous Preterm Birth (sPTB) prediction. Our analysis confirmed that while the embeddings contain substantial metadata, the sPTB classifier's weight vectors were highly correlated with clinically relevant factors (e.g., birth weight) but decoupled from clinically irrelevant acquisition factors (e.g. scanner). Our methodology provides a tool to verify model trustworthiness, demonstrating that, in the absence of induced bias, the clinical model selectively utilizes features related to the genuine clinical signal.

Chun Kit Wong, Anders N. Christensen, Cosmin I. Bercea et al.

Reliable out-of-distribution (OOD) detection is important for safe deployment of deep learning models in fetal ultrasound amidst heterogeneous image characteristics and clinical settings. OOD detection relies on estimating a classification model's uncertainty, which should increase for OOD samples. While existing research has largely focused on uncertainty quantification methods, this work investigates the impact of the classification task itself. Through experiments with eight uncertainty quantification methods across four classification tasks, we demonstrate that OOD detection performance significantly varies with the task, and that the best task depends on the defined ID-OOD criteria; specifically, whether the OOD sample is due to: i) an image characteristic shift or ii) an anatomical feature shift. Furthermore, we reveal that superior OOD detection does not guarantee optimal abstained prediction, underscoring the necessity to align task selection and uncertainty strategies with the specific downstream application in medical image analysis.

Jakub Maciej Wiśniewski, Anders Nymark Christensen, Mary Le Ngo et al.

Cognitive demands of fetal ultrasound examinations pose unique challenges among clinicians. With the goal of providing an assistive tool, we developed an automated pipeline for predicting fetal orientation from ultrasound videos acquired following a simple blind sweep protocol. Leveraging on a pre-trained head detection and segmentation model, this is achieved by first determining the fetal presentation (cephalic or breech) with a template matching approach, followed by the fetal lie (facing left or right) by analyzing the spatial distribution of segmented brain anatomies. Evaluation on a dataset of third-trimester ultrasound scans demonstrated the promising accuracy of our pipeline. This work distinguishes itself by introducing automated fetal lie prediction and by proposing an assistive paradigm that augments sonographer expertise rather than replacing it. Future research will focus on enhancing acquisition efficiency, and exploring real-time clinical integration to improve workflow and support for obstetric clinicians.