Karina V Bunting

Yuting Zhang, Boyang Liu, Karina V. Bunting et al.

The echocardiographic measurement of left ventricular ejection fraction (LVEF) is fundamental to the diagnosis and classification of patients with heart failure (HF). In order to quantify LVEF automatically and accurately, this paper proposes a new pipeline method based on deep neural networks and ensemble learning. Within the pipeline, an Atrous Convolutional Neural Network (ACNN) was first trained to segment the left ventricle (LV), before employing the area-length formulation based on the ellipsoid single-plane model to calculate LVEF values. This formulation required inputs of LV area, derived from segmentation using an improved Jeffrey's method, as well as LV length, derived from a novel ensemble learning model. To further improve the pipeline's accuracy, an automated peak detection algorithm was used to identify end-diastolic and end-systolic frames, avoiding issues with human error. Subsequently, single-beat LVEF values were averaged across all cardiac cycles to obtain the final LVEF. This method was developed and internally validated in an open-source dataset containing 10,030 echocardiograms. The Pearson's correlation coefficient was 0.83 for LVEF prediction compared to expert human analysis (p<0.001), with a subsequent area under the receiver operator curve (AUROC) of 0.98 (95% confidence interval 0.97 to 0.99) for categorisation of HF with reduced ejection (HFrEF; LVEF<40%). In an external dataset with 200 echocardiograms, this method achieved an AUC of 0.90 (95% confidence interval 0.88 to 0.91) for HFrEF assessment. This study demonstrates that an automated neural network-based calculation of LVEF is comparable to expert clinicians performing time-consuming, frame-by-frame manual evaluation of cardiac systolic function.

Yuting Zhang, Karina V. Bunting, Asgher Champsi et al.

Cardiovascular diseases (CVDs) remain the foremost cause of mortality worldwide, a burden worsened by a severe deficit of healthcare workers. Artificial intelligence (AI) agents have shown potential to alleviate this gap via automated early detection and proactive screening, yet their clinical application remains limited by: 1) prompt-based clinical role assignment that relies on intrinsic model capabilities without domain-specific tool support; or 2) rigid sequential workflows, whereas clinical care often requires adaptive reasoning that orders specific tests and, based on their results, guides personalised next steps; 3) general and static knowledge bases without continuous learning capability; and 4) fixed unimodal or bimodal inputs and lack of on-demand visual outputs when further clarification is needed. In response, a multimodal framework, CardAIc-Agents, was proposed to augment models with external tools and adaptively support diverse cardiac tasks. Specifically, a CardiacRAG agent generated general plans from updatable cardiac knowledge, while the chief agent integrated tools to autonomously execute these plans and deliver decisions. To enable adaptive and case-specific customization, a stepwise update strategy was proposed to dynamically refine plans based on preceding execution results, once the task was assessed as complex. In addition, a multidisciplinary discussion tool was introduced to interpret challenging cases, thereby supporting further adaptation. When clinicians raised concerns, visual review panels were provided to assist final validation. Experiments across three datasets showed the efficiency of CardAIc-Agents compared to mainstream Vision-Language Models (VLMs), state-of-the-art agentic systems, and fine-tuned VLMs.

Alexander Thorley, Xi Jia, Hyung Jin Chang et al.

Deterministic approaches using iterative optimisation have been historically successful in diffeomorphic image registration (DiffIR). Although these approaches are highly accurate, they typically carry a significant computational burden. Recent developments in stochastic approaches based on deep learning have achieved sub-second runtimes for DiffIR with competitive registration accuracy, offering a fast alternative to conventional iterative methods. In this paper, we attempt to reduce this difference in speed whilst retaining the performance advantage of iterative approaches in DiffIR. We first propose a simple iterative scheme that functionally composes intermediate non-stationary velocity fields to handle large deformations in images whilst guaranteeing diffeomorphisms in the resultant deformation. We then propose a convex optimisation model that uses a regularisation term of arbitrary order to impose smoothness on these velocity fields and solve this model with a fast algorithm that combines Nesterov gradient descent and the alternating direction method of multipliers (ADMM). Finally, we leverage the computational power of GPU to implement this accelerated ADMM solver on a 3D cardiac MRI dataset, further reducing runtime to less than 2 seconds. In addition to producing strictly diffeomorphic deformations, our methods outperform both state-of-the-art deep learning-based and iterative DiffIR approaches in terms of dice and Hausdorff scores, with speed approaching the inference time of deep learning-based methods.