Alberto Gómez

Hadrien Reynaud, Mengyun Qiao, Mischa Dombrowski et al.

Image synthesis is expected to provide value for the translation of machine learning methods into clinical practice. Fundamental problems like model robustness, domain transfer, causal modelling, and operator training become approachable through synthetic data. Especially, heavily operator-dependant modalities like Ultrasound imaging require robust frameworks for image and video generation. So far, video generation has only been possible by providing input data that is as rich as the output data, e.g., image sequence plus conditioning in, video out. However, clinical documentation is usually scarce and only single images are reported and stored, thus retrospective patient-specific analysis or the generation of rich training data becomes impossible with current approaches. In this paper, we extend elucidated diffusion models for video modelling to generate plausible video sequences from single images and arbitrary conditioning with clinical parameters. We explore this idea within the context of echocardiograms by looking into the variation of the Left Ventricle Ejection Fraction, the most essential clinical metric gained from these examinations. We use the publicly available EchoNet-Dynamic dataset for all our experiments. Our image to sequence approach achieves an $R^2$ score of 93%, which is 38 points higher than recently proposed sequence to sequence generation methods. Code and models will be available at: https://github.com/HReynaud/EchoDiffusion.

Xi Jia, Alexander Thorley, Alberto Gomez et al.

U-Net style networks are commonly utilized in unsupervised image registration to predict dense displacement fields, which for high-resolution volumetric image data is a resource-intensive and time-consuming task. To tackle this challenge, we first propose Fourier-Net, which replaces the costly U-Net style expansive path with a parameter-free model-driven decoder. Instead of directly predicting a full-resolution displacement field, our Fourier-Net learns a low-dimensional representation of the displacement field in the band-limited Fourier domain which our model-driven decoder converts to a full-resolution displacement field in the spatial domain. Expanding upon Fourier-Net, we then introduce Fourier-Net+, which additionally takes the band-limited spatial representation of the images as input and further reduces the number of convolutional layers in the U-Net style network's contracting path. Finally, to enhance the registration performance, we propose a cascaded version of Fourier-Net+. We evaluate our proposed methods on three datasets, on which our proposed Fourier-Net and its variants achieve comparable results with current state-of-the art methods, while exhibiting faster inference speeds, lower memory footprint, and fewer multiply-add operations. With such small computational cost, our Fourier-Net+ enables the efficient training of large-scale 3D registration on low-VRAM GPUs. Our code is publicly available at \url{https://github.com/xi-jia/Fourier-Net}.

Alberto Gomez, Mihaela Porumb, Angela Mumith et al.

We propose a new method to automatically contour the left ventricle on 2D echocardiographic images. Unlike most existing segmentation methods, which are based on predicting segmentation masks, we focus at predicting the endocardial contour and the key landmark points within this contour (basal points and apex). This provides a representation that is closer to how experts perform manual annotations and hence produce results that are physiologically more plausible. Our proposed method uses a two-headed network based on the U-Net architecture. One head predicts the 7 contour points, and the other head predicts a distance map to the contour. This approach was compared to the U-Net and to a point based approach, achieving performance gains of up to 30\% in terms of landmark localisation (<4.5mm) and distance to the ground truth contour (<3.5mm).

David Stojanovski, Mariana da Silva, Pablo Lamata et al.

We investigate the utility of diffusion generative models to efficiently synthesise datasets that effectively train deep learning models for image analysis. Specifically, we propose novel $Γ$-distribution Latent Denoising Diffusion Models (LDMs) designed to generate semantically guided synthetic cardiac ultrasound images with improved computational efficiency. We also investigate the potential of using these synthetic images as a replacement for real data in training deep networks for left-ventricular segmentation and binary echocardiogram view classification tasks. We compared six diffusion models in terms of the computational cost of generating synthetic 2D echo data, the visual realism of the resulting images, and the performance, on real data, of downstream tasks (segmentation and classification) trained using these synthetic echoes. We compare various diffusion strategies and ODE solvers for their impact on segmentation and classification performance. The results show that our propose architectures significantly reduce computational costs while maintaining or improving downstream task performance compared to state-of-the-art methods. While other diffusion models generated more realistic-looking echo images at higher computational cost, our research suggests that for model training, visual realism is not necessarily related to model performance, and considerable compute costs can be saved by using more efficient models.

Kit M. Bransby, Woo-jin Cho Kim, Jorge Oliveira et al.

Building an echocardiography view classifier that maintains performance in real-life cases requires diverse multi-site data, and frequent updates with newly available data to mitigate model drift. Simply fine-tuning on new datasets results in "catastrophic forgetting", and cannot adapt to variations of view labels between sites. Alternatively, collecting all data on a single server and re-training may not be feasible as data sharing agreements may restrict image transfer, or datasets may only become available at different times. Furthermore, time and cost associated with re-training grows with every new dataset. We propose a class-incremental learning method which learns an expert network for each dataset, and combines all expert networks with a score fusion model. The influence of ``unqualified experts'' is minimised by weighting each contribution with a learnt in-distribution score. These weights promote transparency as the contribution of each expert is known during inference. Instead of using the original images, we use learned features from each dataset, which are easier to share and raise fewer licensing and privacy concerns. We validate our work on six datasets from multiple sites, demonstrating significant reductions in training time while improving view classification performance.

Alexander Thorley, Agis Chartsias, Jordan Strom et al.

Video transformers have recently demonstrated strong potential for echocardiogram (echo) analysis, leveraging self-supervised pre-training and flexible adaptation across diverse tasks. However, like other models operating on videos, they are prone to learning spurious correlations from non-diagnostic regions such as image backgrounds. To overcome this limitation, we propose the Video Anatomically Constrained Transformer (ViACT), a novel framework that integrates anatomical priors directly into the transformer architecture. ViACT represents a deforming anatomical structure as a point set and encodes both its spatial geometry and corresponding image patches into transformer tokens. During pre-training, ViACT follows a masked autoencoding strategy that masks and reconstructs only anatomical patches, enforcing that representation learning is focused on the anatomical region. The pre-trained model can then be fine-tuned for tasks localized to this region. In this work we focus on the myocardium, demonstrating the framework on echo analysis tasks such as left ventricular ejection fraction (EF) regression and cardiac amyloidosis (CA) detection. The anatomical constraint focuses transformer attention within the myocardium, yielding interpretable attention maps aligned with regions of known CA pathology. Moreover, ViACT generalizes to myocardium point tracking without requiring task-specific components such as correlation volumes used in specialized tracking networks.

Hadrien Reynaud, Alberto Gomez, Paul Leeson et al.

Advances in deep learning have significantly enhanced medical image analysis, yet the availability of large-scale medical datasets remains constrained by patient privacy concerns. We present EchoFlow, a novel framework designed to generate high-quality, privacy-preserving synthetic echocardiogram images and videos. EchoFlow comprises four key components: an adversarial variational autoencoder for defining an efficient latent representation of cardiac ultrasound images, a latent image flow matching model for generating accurate latent echocardiogram images, a latent re-identification model to ensure privacy by filtering images anatomically, and a latent video flow matching model for animating latent images into realistic echocardiogram videos conditioned on ejection fraction. We rigorously evaluate our synthetic datasets on the clinically relevant task of ejection fraction regression and demonstrate, for the first time, that downstream models trained exclusively on EchoFlow-generated synthetic datasets achieve performance parity with models trained on real datasets. We release our models and synthetic datasets, enabling broader, privacy-compliant research in medical ultrasound imaging at https://huggingface.co/spaces/HReynaud/EchoFlow.

Zhe Li, Hadrien Reynaud, Alberto Gomez et al.

Echocardiography playing a critical role in the diagnosis and monitoring of cardiovascular diseases as a non-invasive real-time assessment of cardiac structure and function. However, the growing scale of echocardiographic video data presents significant challenges in terms of storage, computation, and model training efficiency. Dataset distillation offers a promising solution by synthesizing a compact, informative subset of data that retains the key clinical features of the original dataset. In this work, we propose a novel approach for distilling a compact synthetic echocardiographic video dataset. Our method leverages motion feature extraction to capture temporal dynamics, followed by class-wise graph construction and representative sample selection using the Infomap algorithm. This enables us to select a diverse and informative subset of synthetic videos that preserves the essential characteristics of the original dataset. We evaluate our approach on the EchoNet-Dynamic datasets and achieve a test accuracy of \(69.38\%\) using only \(25\) synthetic videos. These results demonstrate the effectiveness and scalability of our method for medical video dataset distillation.

Kit Mills Bransby, Arian Beqiri, Woo-Jin Cho Kim et al.

Neural networks can learn spurious correlations that lead to the correct prediction in a validation set, but generalise poorly because the predictions are right for the wrong reason. This undesired learning of naive shortcuts (Clever Hans effect) can happen for example in echocardiogram view classification when background cues (e.g. metadata) are biased towards a class and the model learns to focus on those background features instead of on the image content. We propose a simple, yet effective random background augmentation method called BackMix, which samples random backgrounds from other examples in the training set. By enforcing the background to be uncorrelated with the outcome, the model learns to focus on the data within the ultrasound sector and becomes invariant to the regions outside this. We extend our method in a semi-supervised setting, finding that the positive effects of BackMix are maintained with as few as 5% of segmentation labels. A loss weighting mechanism, wBackMix, is also proposed to increase the contribution of the augmented examples. We validate our method on both in-distribution and out-of-distribution datasets, demonstrating significant improvements in classification accuracy, region focus and generalisability. Our source code is available at: https://github.com/kitbransby/BackMix

Hadrien Reynaud, Qingjie Meng, Mischa Dombrowski et al.

To make medical datasets accessible without sharing sensitive patient information, we introduce a novel end-to-end approach for generative de-identification of dynamic medical imaging data. Until now, generative methods have faced constraints in terms of fidelity, spatio-temporal coherence, and the length of generation, failing to capture the complete details of dataset distributions. We present a model designed to produce high-fidelity, long and complete data samples with near-real-time efficiency and explore our approach on a challenging task: generating echocardiogram videos. We develop our generation method based on diffusion models and introduce a protocol for medical video dataset anonymization. As an exemplar, we present EchoNet-Synthetic, a fully synthetic, privacy-compliant echocardiogram dataset with paired ejection fraction labels. As part of our de-identification protocol, we evaluate the quality of the generated dataset and propose to use clinical downstream tasks as a measurement on top of widely used but potentially biased image quality metrics. Experimental outcomes demonstrate that EchoNet-Synthetic achieves comparable dataset fidelity to the actual dataset, effectively supporting the ejection fraction regression task. Code, weights and dataset are available at https://github.com/HReynaud/EchoNet-Synthetic.

Thierry Judge, Olivier Bernard, Woo-Jin Cho Kim et al.

Echocardiography plays a fundamental role in the extraction of important clinical parameters (e.g. left ventricular volume and ejection fraction) required to determine the presence and severity of heart-related conditions. When deploying automated techniques for computing these parameters, uncertainty estimation is crucial for assessing their utility. Since clinical parameters are usually derived from segmentation maps, there is no clear path for converting pixel-wise uncertainty values into uncertainty estimates in the downstream clinical metric calculation. In this work, we propose a novel uncertainty estimation method based on contouring rather than segmentation. Our method explicitly predicts contour location uncertainty from which contour samples can be drawn. Finally, the sampled contours can be used to propagate uncertainty to clinical metrics. Our proposed method not only provides accurate uncertainty estimations for the task of contouring but also for the downstream clinical metrics on two cardiac ultrasound datasets. Code is available at: https://github.com/ThierryJudge/contouring-uncertainty.

Zhen Yuan, David Stojanovski, Lei Li et al.

Splenomegaly, the enlargement of the spleen, is an important clinical indicator for various associated medical conditions, such as sickle cell disease (SCD). Spleen length measured from 2D ultrasound is the most widely used metric for characterising spleen size. However, it is still considered a surrogate measure, and spleen volume remains the gold standard for assessing spleen size. Accurate spleen volume measurement typically requires 3D imaging modalities, such as computed tomography or magnetic resonance imaging, but these are not widely available, especially in the Global South which has a high prevalence of SCD. In this work, we introduce a deep learning pipeline, DeepSPV, for precise spleen volume estimation from single or dual 2D ultrasound images. The pipeline involves a segmentation network and a variational autoencoder for learning low-dimensional representations from the estimated segmentations. We investigate three approaches for spleen volume estimation and our best model achieves 86.62%/92.5% mean relative volume accuracy (MRVA) under single-view/dual-view settings, surpassing the performance of human experts. In addition, the pipeline can provide confidence intervals for the volume estimates as well as offering benefits in terms of interpretability, which further support clinicians in decision-making when identifying splenomegaly. We evaluate the full pipeline using a highly realistic synthetic dataset generated by a diffusion model, achieving an overall MRVA of 83.0% from a single 2D ultrasound image. Our proposed DeepSPV is the first work to use deep learning to estimate 3D spleen volume from 2D ultrasound images and can be seamlessly integrated into the current clinical workflow for spleen assessment.

Alberto Gomez, Jorge Oliveira, Ramon Casero et al.

Ultrasound (US) machines display images on a built-in monitor, but routine transfer to hospital systems relies on DICOM. We propose a self-supervised pipeline to extract the US image from a photograph of the monitor. This removes the DICOM bottleneck and enables rapid testing and prototyping of new algorithms. In a proof-of-concept study, the rectified images retained enough visual fidelity to classify cardiac views with a balanced accuracy of 0.79 with respect to the native DICOMs.

David Stojanovski, Uxio Hermida, Pablo Lamata et al.

We propose a novel pipeline for the generation of synthetic ultrasound images via Denoising Diffusion Probabilistic Models (DDPMs) guided by cardiac semantic label maps. We show that these synthetic images can serve as a viable substitute for real data in the training of deep-learning models for ultrasound image analysis tasks such as cardiac segmentation. To demonstrate the effectiveness of this approach, we generated synthetic 2D echocardiograms and trained a neural network for segmenting the left ventricle and left atrium. The performance of the network trained on exclusively synthetic images was evaluated on an unseen dataset of real images and yielded mean Dice scores of 88.6 $\pm 4.91$ , 91.9 $\pm 4.22$, 85.2 $\pm 4.83$ \% for left ventricular endocardium, epicardium and left atrial segmentation respectively. This represents a relative increase of $9.2$, $3.3$ and $13.9$ \% in Dice scores compared to the previous state-of-the-art. The proposed pipeline has potential for application to a wide range of other tasks across various medical imaging modalities.

Hamideh Kerdegari, Phung Tran Huy Nhat, Angela McBride et al.

Lung ultrasound (LUS) imaging is becoming popular in the intensive care units (ICU) for assessing lung abnormalities such as the appearance of B-line artefacts as a result of severe dengue. These artefacts appear in the LUS images and disappear quickly, making their manual detection very challenging. They also extend radially following the propagation of the sound waves. As a result, we hypothesize that a polar representation may be more adequate for automatic image analysis of these images. This paper presents an attention-based Convolutional+LSTM model to automatically detect B-lines in LUS videos, comparing performance when image data is taken in Cartesian and polar representations. Results indicate that the proposed framework with polar representation achieves competitive performance compared to the Cartesian representation for B-line classification and that attention mechanism can provide better localization.

Qingjie Meng, Jacqueline Matthew, Veronika A. Zimmer et al.

Deep neural networks exhibit limited generalizability across images with different entangled domain features and categorical features. Learning generalizable features that can form universal categorical decision boundaries across domains is an interesting and difficult challenge. This problem occurs frequently in medical imaging applications when attempts are made to deploy and improve deep learning models across different image acquisition devices, across acquisition parameters or if some classes are unavailable in new training databases. To address this problem, we propose Mutual Information-based Disentangled Neural Networks (MIDNet), which extract generalizable categorical features to transfer knowledge to unseen categories in a target domain. The proposed MIDNet adopts a semi-supervised learning paradigm to alleviate the dependency on labeled data. This is important for real-world applications where data annotation is time-consuming, costly and requires training and expertise. We extensively evaluate the proposed method on fetal ultrasound datasets for two different image classification tasks where domain features are respectively defined by shadow artifacts and image acquisition devices. Experimental results show that the proposed method outperforms the state-of-the-art on the classification of unseen categories in a target domain with sparsely labeled training data.

Simona Treivase, Alberto Gomez, Jacqueline Matthew et al.

Ultrasound (US) imaging is one of the most commonly used non-invasive imaging techniques. However, US image acquisition requires simultaneous guidance of the transducer and interpretation of images, which is a highly challenging task that requires years of training. Despite many recent developments in intra-examination US image analysis, the results are not easy to translate to a clinical setting. We propose a generic framework to extract the US images and superimpose the results of an analysis task, without any need for physical connection or alteration to the US system. The proposed method captures the US image by tracking the screen with a camera fixed at the sonographer's view point and reformats the captured image to the right aspect ratio, in 87.66 +- 3.73ms on average. It is hypothesized that this would enable to input such retrieved image into an image processing pipeline to extract information that can help improve the examination. This information could eventually be projected back to the sonographer's field of view in real time using, for example, an augmented reality (AR) headset.

Alberto Gomez, Cornelia Schmitz, Markus Henningsson et al.

Motion imaging phantoms are expensive, bulky and difficult to transport and set-up. The purpose of this paper is to demonstrate a simple approach to the design of multi-modality motion imaging phantoms that use mechanically stored energy to produce motion. We propose two phantom designs that use mainsprings and elastic bands to store energy. A rectangular piece was attached to an axle at the end of the transmission chain of each phantom, and underwent a rotary motion upon release of the mechanical motor. The phantoms were imaged with MRI and US, and the image sequences were embedded in a 1D non linear manifold (Laplacian Eigenmap) and the spectrogram of the embedding was used to derive the angular velocity over time. The derived velocities were consistent and reproducible within a small error. The proposed motion phantom concept showed great potential for the construction of simple and affordable motion phantoms

Shuangyi Wang, James Housden, Yohan Noh et al.

The development of robotic-assisted extracorporeal ultrasound systems has a long history and a number of projects have been proposed since the 1990s focusing on different technical aspects. These aim to resolve the deficiencies of on-site manual manipulation of hand-held ultrasound probes. This paper presents the recent ongoing developments of a series of bespoke robotic systems, including both single-arm and dual-arm versions, for a project known as intelligent Fetal Imaging and Diagnosis (iFIND). After a brief review of the development history of the extracorporeal ultrasound robotic system used for fetal and abdominal examinations, the specific aim of the iFIND robots, the design evolution, the implementation details of each version, and the initial clinical feedback of the iFIND robot series are presented. Based on the preliminary testing of these newly-proposed robots on 42 volunteers, the successful and re-liable working of the mechatronic systems were validated. Analysis of a participant questionnaire indicates a comfortable scanning experience for the volunteers and a good acceptance rate to being scanned by the robots.

Qingjie Meng, Matthew Sinclair, Veronika Zimmer et al.

Detecting acoustic shadows in ultrasound images is important in many clinical and engineering applications. Real-time feedback of acoustic shadows can guide sonographers to a standardized diagnostic viewing plane with minimal artifacts and can provide additional information for other automatic image analysis algorithms. However, automatically detecting shadow regions using learning-based algorithms is challenging because pixel-wise ground truth annotation of acoustic shadows is subjective and time consuming. In this paper we propose a weakly supervised method for automatic confidence estimation of acoustic shadow regions. Our method is able to generate a dense shadow-focused confidence map. In our method, a shadow-seg module is built to learn general shadow features for shadow segmentation, based on global image-level annotations as well as a small number of coarse pixel-wise shadow annotations. A transfer function is introduced to extend the obtained binary shadow segmentation to a reference confidence map. Additionally, a confidence estimation network is proposed to learn the mapping between input images and the reference confidence maps. This network is able to predict shadow confidence maps directly from input images during inference. We use evaluation metrics such as DICE, inter-class correlation and etc. to verify the effectiveness of our method. Our method is more consistent than human annotation, and outperforms the state-of-the-art quantitatively in shadow segmentation and qualitatively in confidence estimation of shadow regions. We further demonstrate the applicability of our method by integrating shadow confidence maps into tasks such as ultrasound image classification, multi-view image fusion and automated biometric measurements.

Nicolas Toussaint, Bishesh Khanal, Matthew Sinclair et al.

This paper addresses the task of detecting and localising fetal anatomical regions in 2D ultrasound images, where only image-level labels are present at training, i.e. without any localisation or segmentation information. We examine the use of convolutional neural network architectures coupled with soft proposal layers. The resulting network simultaneously performs anatomical region detection (classification) and localisation tasks. We generate a proposal map describing the attention of the network for a particular class. The network is trained on 85,500 2D fetal Ultrasound images and their associated labels. Labels correspond to six anatomical regions: head, spine, thorax, abdomen, limbs, and placenta. Detection achieves an average accuracy of 90\% on individual regions, and show that the proposal maps correlate well with relevant anatomical structures. This work presents itself as a powerful and essential step towards subsequent tasks such as fetal position and pose estimation, organ-specific segmentation, or image-guided navigation. Code and additional material is available at https://ntoussaint.github.io/fetalnav

Bishesh Khanal, Alberto Gomez, Nicolas Toussaint et al.

Ultrasound (US) is the most widely used fetal imaging technique. However, US images have limited capture range, and suffer from view dependent artefacts such as acoustic shadows. Compounding of overlapping 3D US acquisitions into a high-resolution volume can extend the field of view and remove image artefacts, which is useful for retrospective analysis including population based studies. However, such volume reconstructions require information about relative transformations between probe positions from which the individual volumes were acquired. In prenatal US scans, the fetus can move independently from the mother, making external trackers such as electromagnetic or optical tracking unable to track the motion between probe position and the moving fetus. We provide a novel methodology for image-based tracking and volume reconstruction by combining recent advances in deep learning and simultaneous localisation and mapping (SLAM). Tracking semantics are established through the use of a Residual 3D U-Net and the output is fed to the SLAM algorithm. As a proof of concept, experiments are conducted on US volumes taken from a whole body fetal phantom, and from the heads of real fetuses. For the fetal head segmentation, we also introduce a novel weak annotation approach to minimise the required manual effort for ground truth annotation. We evaluate our method qualitatively, and quantitatively with respect to tissue discrimination accuracy and tracking robustness.

Alberto Gomez, Veronika A. Zimmer, Bishesh Khanal et al.

We propose a novel iterative method to adapt a a graph to d-dimensional image data. The method drives the nodes of the graph towards image features. The adaptation process naturally lends itself to a measure of feature saliency which can then be used to retain meaningful nodes and edges in the graph. From the adapted graph, we also propose the computation of a dual graph, which inherits the saliency measure from the adapted graph, and whose edges run along image features, hence producing an oversegmenting graph. The proposed method is computationally efficient and fully parallelisable. We propose two distance measures to find image saliency along graph edges, and evaluate the performance on synthetic images and on natural images from publicly available databases. In both cases, the most salient nodes of the graph achieve average boundary recall over 90%. We also apply our method to image classification on the MNIST hand-written digit dataset, using a recently proposed Deep Geometric Learning architecture, and achieving state-of-the-art classification accuracy, for a graph-based method, of 97.86%.