Shir Goldfinger

Zaiyang Guo, Jessie N. Dong, Filippos Bellos et al.

Point-of-care transthoracic echocardiography (TTE) makes it possible to assess a patient's cardiac function in almost any setting. A critical step in the TTE exam is acquisition of the apical 4-chamber (A4CH) view, which is used to evaluate clinically impactful measurements such as left ventricular ejection fraction (LVEF). However, optimizing transducer pose for high-quality image acquisition and subsequent measurement is a challenging task, particularly for novice users. In this work, we present a multi-task network that provides feedback cues for A4CH view acquisition and automatically estimates LVEF in high-quality A4CH images. The network cascades a transducer pose scoring module and an uncertainty-aware LV landmark detector with automated LVEF estimation. A strength is that network training and inference do not require cumbersome or costly setups for transducer position tracking. We evaluate performance on point-of-care TTE data acquired with a spatially dense "sweep" protocol around the optimal A4CH view. The results demonstrate the network's ability to determine when the transducer pose is on target, close to target, or far from target based on the images alone, while generating visual landmark cues that guide anatomical interpretation and orientation. In conclusion, we demonstrate a promising strategy to provide guidance for A4CH view acquisition, which may be useful when deploying point-of-care TTE in limited resource settings.

Zaiyang Guo, Ningjun J Dong, Harold Litt et al.

The bicuspid aortic valve (BAV) is the most prevalent congenital heart defect and may require surgery for complications such as stenosis, regurgitation, and aortopathy. BAV repair surgery is effective but challenging due to the heterogeneity of BAV morphology. Multiple imaging modalities can be employed to assist the quantitative assessment of BAVs for surgical planning. Contrast-enhanced 4D computed tomography (CT) produces volumetric temporal sequences with excellent contrast and spatial resolution. Segmentation of the aortic cusps and root in these images is an essential step in creating patient specific models for visualization and quantification. While deep learning-based methods are capable of fully automated segmentation, no BAV-specific model exists. Among valve segmentation studies, there has been limited quantitative assessment of the clinical usability of the segmentation results. In this work, we developed a fully automated multi-label BAV segmentation pipeline based on nnU-Net. The predicted segmentations were used to carry out surgically relevant morphological measurements including geometric cusp height, commissural angle and annulus diameter, and the results were compared against manual segmentation. Automated segmentation achieved average Dice scores of over 0.7 and symmetric mean distance below 0.7 mm for all three aortic cusps and the root wall. Clinically relevant benchmarks showed good consistency between manual and predicted segmentations. Overall, fully automated BAV segmentation of 3D frames in 4D CT can produce clinically usable measurements for surgical risk stratification, but the temporal consistency of segmentations needs to be improved.

Aparna Nair-Kanneganti, Trevor J. Chan, Shir Goldfinger et al.

Despite huge advances, LLMs still lack convenient and reliable methods to quantify the uncertainty in their responses, making them difficult to trust in high-stakes applications. One of the simplest approaches to eliciting more accurate answers is to select the mode of many responses, a technique known as ensembling. In this work, we expand on typical ensembling approaches by looking at ensembles with a variable voting threshold. We introduce a theoretical framework for question answering and show that, by permitting ensembles to "abstain" from providing an answer when the dominant response falls short of the threshold, it is possible to dramatically increase the trustworthiness of the remaining answers. From this framework, we derive theoretical results as well as report experimental results on two problem domains: arithmetic problem solving and clinical-note question-answering. In both domains, we observe that large gains in answer trustworthiness can be achieved using highly restrictive voting ensembles, while incurring relatively modest reductions in response yield and accuracy. Due to this quality, voting ensembles may be particularly useful in applications - such as healthcare and data annotation - that require a high degree of certainty but which may not require that every question receive an automated answer.