Andrew King

Miguel Xochicale, Louise Thwaites, Sophie Yacoub et al.

We present a Machine Learning (ML) study case to illustrate the challenges of clinical translation for a real-time AI-empowered echocardiography system with data of ICU patients in LMICs. Such ML case study includes data preparation, curation and labelling from 2D Ultrasound videos of 31 ICU patients in LMICs and model selection, validation and deployment of three thinner neural networks to classify apical four-chamber view. Results of the ML heuristics showed the promising implementation, validation and application of thinner networks to classify 4CV with limited datasets. We conclude this work mentioning the need for (a) datasets to improve diversity of demographics, diseases, and (b) the need of further investigations of thinner models to be run and implemented in low-cost hardware to be clinically translated in the ICU in LMICs. The code and other resources to reproduce this work are available at https://github.com/vital-ultrasound/ai-assisted-echocardiography-for-low-resource-countries.

Jorge Mariscal-Harana, Clint Asher, Vittoria Vergani et al.

Artificial intelligence (AI) techniques have been proposed for automating analysis of short axis (SAX) cine cardiac magnetic resonance (CMR), but no CMR analysis tool exists to automatically analyse large (unstructured) clinical CMR datasets. We develop and validate a robust AI tool for start-to-end automatic quantification of cardiac function from SAX cine CMR in large clinical databases. Our pipeline for processing and analysing CMR databases includes automated steps to identify the correct data, robust image pre-processing, an AI algorithm for biventricular segmentation of SAX CMR and estimation of functional biomarkers, and automated post-analysis quality control to detect and correct errors. The segmentation algorithm was trained on 2793 CMR scans from two NHS hospitals and validated on additional cases from this dataset (n=414) and five external datasets (n=6888), including scans of patients with a range of diseases acquired at 12 different centres using CMR scanners from all major vendors. Median absolute errors in cardiac biomarkers were within the range of inter-observer variability: <8.4mL (left ventricle volume), <9.2mL (right ventricle volume), <13.3g (left ventricular mass), and <5.9% (ejection fraction) across all datasets. Stratification of cases according to phenotypes of cardiac disease and scanner vendors showed good performance across all groups. We show that our proposed tool, which combines image pre-processing steps, a domain-generalisable AI algorithm trained on a large-scale multi-domain CMR dataset and quality control steps, allows robust analysis of (clinical or research) databases from multiple centres, vendors, and cardiac diseases. This enables translation of our tool for use in fully-automated processing of large multi-centre databases.

Andrew Bell, Yan Kit Choi, Steffen E Petersen et al.

Automatic quantification of intramyocardial motion and strain from tagging MRI remains an important but challenging task. We propose a method using implicit neural representations (INRs), conditioned on learned latent codes, to predict continuous left ventricular (LV) displacement -- without requiring inference-time optimisation. Evaluated on 452 UK Biobank test cases, our method achieved the best tracking accuracy (2.14 mm RMSE) and the lowest combined error in global circumferential (2.86%) and radial (6.42%) strain compared to three deep learning baselines. In addition, our method is $\sim$380$\times$ faster than the most accurate baseline. These results highlight the suitability of INR-based models for accurate and scalable analysis of myocardial strain in large CMR datasets. The code can be found at https://github.com/andrewjackbell/Displacement-INR

Riccardo Cavarra, Lupo Lovatelli, Shaheim Ogbomo-Harmitt et al.

Myocardial infarction (MI) is a leading cause of death, and its adverse outcomes are urgent to predict. Yet ECG-based prognostic models underperform because deep learning requires large, labelled datasets, which are scarce in medicine. Foundation models can learn from unlabelled ECGs via selfsupervision, but medically relevant training strategies remain underexplored. We propose a pretrained artificial intelligence model that combines patient-specific temporal information using contrastive learning with supervised multitask heads, then fine-tunes on post-MI outcome prediction. The proposed model outperformed a model trained from scratch (0.794 vs 0.608 AUC) showing that clinically structured ECG modelling improves classification in limited data regimes.

Mehmet Yigit Avci, Akshit Achara, Andrew King et al.

Demographic attributes such as age, sex, and race can be predicted from medical images, raising concerns about bias in clinical AI systems. In brain MRI, this signal may arise from anatomical variation, acquisition-dependent contrast differences, or both, yet these sources remain entangled in conventional analyses. Without disentangling them, mitigation strategies risk failing to address the underlying causes. We propose a controlled framework based on disentangled representation learning, decomposing brain MRI into anatomy-focused representations that suppress acquisition influence and contrast embeddings that capture acquisition-dependent characteristics. Training predictive models for age, sex, and race on full images, anatomical representations, and contrast-only embeddings allows us to quantify the relative contributions of structure and acquisition to the demographic signal. Across three datasets and multiple MRI sequences, we find that demographic predictability is primarily rooted in anatomical variation: anatomy-focused representations largely preserve the performance of models trained on raw images. Contrast-only embeddings retain a weaker but systematic signal that is dataset-specific and does not generalise across sites. These findings suggest that effective mitigation must explicitly account for the distinct anatomical and acquisition-dependent origins of the demographic signal, ensuring that any bias reduction generalizes robustly across domains.

Mubaraq Yakubu, Navodini Wijethilake, Jonathan Shapey et al.

Purpose: Accurate segmentation of both the pituitary gland and adenomas from magnetic resonance imaging (MRI) is essential for diagnosis and treatment of pituitary adenomas. This systematic review evaluates automatic segmentation methods for improving the accuracy and efficiency of MRI-based segmentation of pituitary adenomas and the gland itself. Methods: We reviewed 34 studies that employed automatic and semi-automatic segmentation methods. We extracted and synthesized data on segmentation techniques and performance metrics (such as Dice overlap scores). Results: The majority of reviewed studies utilized deep learning approaches, with U-Net-based models being the most prevalent. Automatic methods yielded Dice scores of 0.19--89.00\% for pituitary gland and 4.60--96.41\% for adenoma segmentation. Semi-automatic methods reported 80.00--92.10\% for pituitary gland and 75.90--88.36\% for adenoma segmentation. Conclusion: Most studies did not report important metrics such as MR field strength, age and adenoma size. Automated segmentation techniques such as U-Net-based models show promise, especially for adenoma segmentation, but further improvements are needed to achieve consistently good performance in small structures like the normal pituitary gland. Continued innovation and larger, diverse datasets are likely critical to enhancing clinical applicability.

Katarína Tóthová, Sarah Parisot, Matthew Lee et al.

Surface reconstruction from magnetic resonance (MR) imaging data is indispensable in medical image analysis and clinical research. A reliable and effective reconstruction tool should: be fast in prediction of accurate well localised and high resolution models, evaluate prediction uncertainty, work with as little input data as possible. Current deep learning state of the art (SOTA) 3D reconstruction methods, however, often only produce shapes of limited variability positioned in a canonical position or lack uncertainty evaluation. In this paper, we present a novel probabilistic deep learning approach for concurrent 3D surface reconstruction from sparse 2D MR image data and aleatoric uncertainty prediction. Our method is capable of reconstructing large surface meshes from three quasi-orthogonal MR imaging slices from limited training sets whilst modelling the location of each mesh vertex through a Gaussian distribution. Prior shape information is encoded using a built-in linear principal component analysis (PCA) model. Extensive experiments on cardiac MR data show that our probabilistic approach successfully assesses prediction uncertainty while at the same time qualitatively and quantitatively outperforms SOTA methods in shape prediction. Compared to SOTA, we are capable of properly localising and orientating the prediction via the use of a spatially aware neural network.