Ece Ozkan

Ričards Marcinkevičs, Patricia Reis Wolfertstetter, Ugne Klimiene et al. · eth-zurich

Appendicitis is among the most frequent reasons for pediatric abdominal surgeries. Previous decision support systems for appendicitis have focused on clinical, laboratory, scoring, and computed tomography data and have ignored abdominal ultrasound, despite its noninvasive nature and widespread availability. In this work, we present interpretable machine learning models for predicting the diagnosis, management and severity of suspected appendicitis using ultrasound images. Our approach utilizes concept bottleneck models (CBM) that facilitate interpretation and interaction with high-level concepts understandable to clinicians. Furthermore, we extend CBMs to prediction problems with multiple views and incomplete concept sets. Our models were trained on a dataset comprising 579 pediatric patients with 1709 ultrasound images accompanied by clinical and laboratory data. Results show that our proposed method enables clinicians to utilize a human-understandable and intervenable predictive model without compromising performance or requiring time-consuming image annotation when deployed. For predicting the diagnosis, the extended multiview CBM attained an AUROC of 0.80 and an AUPR of 0.92, performing comparably to similar black-box neural networks trained and tested on the same dataset.

Ričards Marcinkevičs, Ece Ozkan, Julia E. Vogt · eth-zurich

Deep neural networks for image-based screening and computer-aided diagnosis have achieved expert-level performance on various medical imaging modalities, including chest radiographs. Recently, several works have indicated that these state-of-the-art classifiers can be biased with respect to sensitive patient attributes, such as race or gender, leading to growing concerns about demographic disparities and discrimination resulting from algorithmic and model-based decision-making in healthcare. Fair machine learning has focused on mitigating such biases against disadvantaged or marginalised groups, mainly concentrating on tabular data or natural images. This work presents two novel intra-processing techniques based on fine-tuning and pruning an already-trained neural network. These methods are simple yet effective and can be readily applied post hoc in a setting where the protected attribute is unknown during the model development and test time. In addition, we compare several intra- and post-processing approaches applied to debiasing deep chest X-ray classifiers. To the best of our knowledge, this is one of the first efforts studying debiasing methods on chest radiographs. Our results suggest that the considered approaches successfully mitigate biases in fully connected and convolutional neural networks offering stable performance under various settings. The discussed methods can help achieve group fairness of deep medical image classifiers when deploying them in domains with different fairness considerations and constraints.

Ričards Marcinkevičs, Ece Ozkan, Julia E. Vogt · eth-zurich

Many modern research fields increasingly rely on collecting and analysing massive, often unstructured, and unwieldy datasets. Consequently, there is growing interest in machine learning and artificial intelligence applications that can harness this `data deluge'. This broad nontechnical overview provides a gentle introduction to machine learning with a specific focus on medical and biological applications. We explain the common types of machine learning algorithms and typical tasks that can be solved, illustrating the basics with concrete examples from healthcare. Lastly, we provide an outlook on open challenges, limitations, and potential impacts of machine-learning-powered medicine.

Hanna Ragnarsdottir, Laura Manduchi, Holger Michel et al.

Pulmonary hypertension (PH) in newborns and infants is a complex condition associated with several pulmonary, cardiac, and systemic diseases contributing to morbidity and mortality. Therefore, accurate and early detection of PH is crucial for successful management. Using echocardiography, the primary diagnostic tool in pediatrics, human assessment is both time-consuming and expertise-demanding, raising the need for an automated approach. In this work, we present an interpretable multi-view video-based deep learning approach to predict PH for a cohort of 194 newborns using echocardiograms. We use spatio-temporal convolutional architectures for the prediction of PH from each view, and aggregate the predictions of the different views using majority voting. To the best of our knowledge, this is the first work for an automated assessment of PH in newborns using echocardiograms. Our results show a mean F1-score of 0.84 for severity prediction and 0.92 for binary detection using 10-fold cross-validation. We complement our predictions with saliency maps and show that the learned model focuses on clinically relevant cardiac structures, motivating its usage in clinical practice.

Ece Ozkan, Thomas M. Sutter, Yurong Hu et al.

Early detection of cardiac dysfunction through routine screening is vital for diagnosing cardiovascular diseases. An important metric of cardiac function is the left ventricular ejection fraction (EF), where lower EF is associated with cardiomyopathy. Echocardiography is a popular diagnostic tool in cardiology, with ultrasound being a low-cost, real-time, and non-ionizing technology. However, human assessment of echocardiograms for calculating EF is time-consuming and expertise-demanding, raising the need for an automated approach. In this work, we propose using the M(otion)-mode of echocardiograms for estimating the EF and classifying cardiomyopathy. We generate multiple artificial M-mode images from a single echocardiogram and combine them using off-the-shelf model architectures. Additionally, we extend contrastive learning (CL) to cardiac imaging to learn meaningful representations from exploiting structures in unlabeled data allowing the model to achieve high accuracy, even with limited annotations. Our experiments show that the supervised setting converges with only ten modes and is comparable to the baseline method while bypassing its cumbersome training process and being computationally much more efficient. Furthermore, CL using M-mode images is helpful for limited data scenarios, such as having labels for only 200 patients, which is common in medical applications.

Simon Böhi, Irene Cannistraci, Sergio Muñoz Gonzalez et al.

Echocardiography is a widely used modality for cardiac assessment due to its non-invasive and cost-effective nature, but the sparse and heterogeneous spatiotemporal views of the heart pose distinct challenges. Existing masked autoencoder (MAE) approaches typically process images or short clips independently, failing to capture the inherent multi-view structure required for coherent cardiac representation. We introduce Latent Attention Masked Autoencoder (LAMAE), a foundation model architecture tailored to the multi-view nature of medical imaging. LAMAE augments the standard MAE with a latent attention module that enables information exchange across frames and views directly in latent space. This allows the model to aggregate variable-length sequences and distinct views, reconstructing a holistic representation of cardiac function from partial observations. We pretrain LAMAE on MIMIC-IV-ECHO, a large-scale, uncurated dataset reflecting real-world clinical variability. To the best of our knowledge, we present the first results for predicting ICD-10 codes from MIMIC-IV-ECHO videos. Furthermore, we empirically demonstrate that representations learned from adult data transfer effectively to pediatric cohorts despite substantial anatomical differences. These results provide evidence that incorporating structural priors, such as multi-view attention, yields significantly more robust and transferable representations.

Moritz Vandenhirtz, Samuel Ruipérez-Campillo, Simon Böhi et al.

Electrocardiograms (ECGs) are among the most widely available clinical signals and play a central role in cardiovascular diagnosis. While recent foundation models (FMs) have shown promise for learning transferable ECG representations, most existing pretraining approaches treat leads as independent channels and fail to explicitly leverage their strong structural redundancy. We introduce the latent attention masked autoencoder (LAMAE) FM that directly exploits this structure by learning cross-lead connection mechanisms during self-supervised pretraining. Our approach models higher-order interactions across leads through latent attention, enabling permutation-invariant aggregation and adaptive weighting of lead-specific representations. We provide empirical evidence on the Mimic-IV-ECG database that leveraging the cross-lead connection constitutes an effective form of structural supervision, improving representation quality and transferability. Our method shows strong performance in predicting ICD-10 codes, outperforming independent-lead masked modeling and alignment-based baselines.

Ece Ozkan, Xavier Boix

Current machine learning methods for medical image analysis primarily focus on developing models tailored for their specific tasks, utilizing data within their target domain. These specialized models tend to be data-hungry and often exhibit limitations in generalizing to out-of-distribution samples. In this work, we show that employing models that incorporate multiple domains instead of specialized ones significantly alleviates the limitations observed in specialized models. We refer to this approach as multi-domain model and compare its performance to that of specialized models. For this, we introduce the incorporation of diverse medical image domains, including different imaging modalities like X-ray, MRI, CT, and ultrasound images, as well as various viewpoints such as axial, coronal, and sagittal views. Our findings underscore the superior generalization capabilities of multi-domain models, particularly in scenarios characterized by limited data availability and out-of-distribution, frequently encountered in healthcare applications. The integration of diverse data allows multi-domain models to utilize information across domains, enhancing the overall outcomes substantially. To illustrate, for organ recognition, multi-domain model can enhance accuracy by up to 8% compared to conventional specialized models.

Yves Stebler, Thomas M. Sutter, Ece Ozkan et al.

Ultrasound (US) imaging is a critical tool in medical diagnostics, offering real-time visualization of physiological processes. One of its major advantages is its ability to capture temporal dynamics, which is essential for assessing motion patterns in applications such as cardiac monitoring, fetal development, and vascular imaging. Despite its importance, current deep learning models often overlook the temporal continuity of ultrasound sequences, analyzing frames independently and missing key temporal dependencies. To address this gap, we propose a method for learning effective temporal representations from ultrasound videos, with a focus on echocardiography-based ejection fraction (EF) estimation. EF prediction serves as an ideal case study to demonstrate the necessity of temporal learning, as it requires capturing the rhythmic contraction and relaxation of the heart. Our approach leverages temporally consistent masking and contrastive learning to enforce temporal coherence across video frames, enhancing the model's ability to represent motion patterns. Evaluated on the EchoNet-Dynamic dataset, our method achieves a substantial improvement in EF prediction accuracy, highlighting the importance of temporally-aware representation learning for real-time ultrasound analysis.

Max Krähenmann, Sergio Tascon-Morales, Fabian Laumer et al.

Volumetric ultrasound has the potential to significantly improve diagnostic accuracy and clinical decision-making, yet its widespread adoption remains limited by dependence on specialized hardware and restrictive acquisition protocols. In this work, we present a novel unsupervised framework for reconstructing 3D anatomical structures from freehand 2D transvaginal ultrasound (TVS) sweeps, without requiring external tracking or learned pose estimators. Our method adapts the principles of Gaussian Splatting to the domain of ultrasound, introducing a slice-aware, differentiable rasterizer tailored to the unique physics and geometry of ultrasound imaging. We model anatomy as a collection of anisotropic 3D Gaussians and optimize their parameters directly from image-level supervision, leveraging sensorless probe motion estimation and domain-specific geometric priors. The result is a compact, flexible, and memory-efficient volumetric representation that captures anatomical detail with high spatial fidelity. This work demonstrates that accurate 3D reconstruction from 2D ultrasound images can be achieved through purely computational means, offering a scalable alternative to conventional 3D systems and enabling new opportunities for AI-assisted analysis and diagnosis.

Lucas Erlacher, Samuel Ruipérez-Campillo, Holger Michel et al.

Pulmonary hypertension (PH) in newborns is a critical condition characterized by elevated pressure in the pulmonary arteries, leading to right ventricular strain and heart failure. While right heart catheterization (RHC) is the diagnostic gold standard, echocardiography is preferred due to its non-invasive nature, safety, and accessibility. However, its accuracy highly depends on the operator, making PH assessment subjective. While automated detection methods have been explored, most models focus on adults and rely on single-view echocardiographic frames, limiting their performance in diagnosing PH in newborns. While multi-view echocardiography has shown promise in improving PH assessment, existing models struggle with generalizability. In this work, we employ a multi-view variational autoencoder (VAE) for PH prediction using echocardiographic videos. By leveraging the VAE framework, our model captures complex latent representations, improving feature extraction and robustness. We compare its performance against single-view and supervised learning approaches. Our results show improved generalization and classification accuracy, highlighting the effectiveness of multi-view learning for robust PH assessment in newborns.

Alvaro Gomariz, Weiye Li, Ece Ozkan et al.

Image-guided radiation therapy can benefit from accurate motion tracking by ultrasound imaging, in order to minimize treatment margins and radiate moving anatomical targets, e.g., due to breathing. One way to formulate this tracking problem is the automatic localization of given tracked anatomical landmarks throughout a temporal ultrasound sequence. For this, we herein propose a fully-convolutional Siamese network that learns the similarity between pairs of image regions containing the same landmark. Accordingly, it learns to localize and thus track arbitrary image features, not only predefined anatomical structures. We employ a temporal consistency model as a location prior, which we combine with the network-predicted location probability map to track a target iteratively in ultrasound sequences. We applied this method on the dataset of the Challenge on Liver Ultrasound Tracking (CLUST) with competitive results, where our work is the first to effectively apply CNNs on this tracking problem, thanks to our temporal regularization.

Ece Ozkan, Gemma Roig, Orcun Goksel et al.

We show that the algorithm to extract diverse M -solutions from a Conditional Random Field (called divMbest [1]) takes exactly the form of a Herding procedure [2], i.e. a deterministic dynamical system that produces a sequence of hypotheses that respect a set of observed moment constraints. This generalization enables us to invoke properties of Herding that show that divMbest enforces implausible constraints which may yield wrong assumptions for some problem settings. Our experiments in semantic segmentation demonstrate that seeing divMbest as an instance of Herding leads to better alternatives for the implausible constraints of divMbest.