Connor Lau

Danielle L. Ferreira, Connor Lau, Zaynaf Salaymang et al.

Segmentation and measurement of cardiac chambers is critical in cardiac ultrasound but is laborious and poorly reproducible. Neural networks can assist, but supervised approaches require the same laborious manual annotations. We built a pipeline for self-supervised (no manual labels) segmentation combining computer vision, clinical domain knowledge, and deep learning. We trained on 450 echocardiograms (93,000 images) and tested on 8,393 echocardiograms (4,476,266 images; mean 61 years, 51% female), using the resulting segmentations to calculate biometrics. We also tested against external images from an additional 10,030 patients with available manual tracings of the left ventricle. r2 between clinically measured and pipeline-predicted measurements were similar to reported inter-clinician variation and comparable to supervised learning across several different measurements (r2 0.56-0.84). Average accuracy for detecting abnormal chamber size and function was 0.85 (range 0.71-0.97) compared to clinical measurements. A subset of test echocardiograms (n=553) had corresponding cardiac MRIs, where MRI is the gold standard. Correlation between pipeline and MRI measurements was similar to that between clinical echocardiogram and MRI. Finally, the pipeline accurately segments the left ventricle with an average Dice score of 0.89 (95% CI [0.89]) in the external, manually labeled dataset. Our results demonstrate a manual-label free, clinically valid, and highly scalable method for segmentation from ultrasound, a noisy but globally important imaging modality.

Nikolina Tomic Roshni Bhatnagar, Sarthak Jain, Connor Lau et al.

Deep learning (DL) has the potential to revolutionize image acquisition and interpretation across medicine, however, attention to data imbalance and missingness is required. Ultrasound data presents a particular challenge because in addition to different views and structures, it includes several sub-modalities-such as greyscale and color flow doppler (CFD)-that are often imbalanced in clinical studies. Image translation can help balance datasets but is challenging for ultrasound sub-modalities to date. Here, we present a generative method for ultrasound CFD-greyscale video translation, trained on 54,975 videos and tested on 8,368. The method developed leveraged pixel-wise, adversarial, and perceptual loses and utilized two networks: one for reconstructing anatomic structures and one for denoising to achieve realistic ultrasound imaging. Average pairwise SSIM between synthetic videos and ground truth was 0.91+/-0.04. Synthetic videos performed indistinguishably from real ones in DL classification and segmentation tasks and when evaluated by blinded clinical experts: F1 score was 0.9 for real and 0.89 for synthetic videos; Dice score between real and synthetic segmentation was 0.97. Overall clinician accuracy in distinguishing real vs synthetic videos was 54+/-6% (42-61%), indicating realistic synthetic videos. Although trained only on heart videos, the model worked well on ultrasound spanning several clinical domains (average SSIM 0.91+/-0.05), demonstrating foundational abilities. Together, these data expand the utility of retrospectively collected imaging and augment the dataset design toolbox for medical imaging.