Artificial intelligence (AI) techniques have been proposed for automating analysis of short axis (SAX) cine cardiac magnetic resonance (CMR), but no CMR analysis tool exists to automatically analyse large (unstructured) clinical CMR datasets. We develop and validate a robust AI tool for start-to-end automatic quantification of cardiac function from SAX cine CMR in large clinical databases. Our pipeline for processing and analysing CMR databases includes automated steps to identify the correct data, robust image pre-processing, an AI algorithm for biventricular segmentation of SAX CMR and estimation of functional biomarkers, and automated post-analysis quality control to detect and correct errors. The segmentation algorithm was trained on 2793 CMR scans from two NHS hospitals and validated on additional cases from this dataset (n=414) and five external datasets (n=6888), including scans of patients with a range of diseases acquired at 12 different centres using CMR scanners from all major vendors. Median absolute errors in cardiac biomarkers were within the range of inter-observer variability: <8.4mL (left ventricle volume), <9.2mL (right ventricle volume), <13.3g (left ventricular mass), and <5.9% (ejection fraction) across all datasets. Stratification of cases according to phenotypes of cardiac disease and scanner vendors showed good performance across all groups. We show that our proposed tool, which combines image pre-processing steps, a domain-generalisable AI algorithm trained on a large-scale multi-domain CMR dataset and quality control steps, allows robust analysis of (clinical or research) databases from multiple centres, vendors, and cardiac diseases. This enables translation of our tool for use in fully-automated processing of large multi-centre databases.

We present a Machine Learning (ML) study case to illustrate the challenges of clinical translation for a real-time AI-empowered echocardiography system with data of ICU patients in LMICs. Such ML case study includes data preparation, curation and labelling from 2D Ultrasound videos of 31 ICU patients in LMICs and model selection, validation and deployment of three thinner neural networks to classify apical four-chamber view. Results of the ML heuristics showed the promising implementation, validation and application of thinner networks to classify 4CV with limited datasets. We conclude this work mentioning the need for (a) datasets to improve diversity of demographics, diseases, and (b) the need of further investigations of thinner models to be run and implemented in low-cost hardware to be clinically translated in the ICU in LMICs. The code and other resources to reproduce this work are available at https://github.com/vital-ultrasound/ai-assisted-echocardiography-for-low-resource-countries.

Surface reconstruction from magnetic resonance (MR) imaging data is indispensable in medical image analysis and clinical research. A reliable and effective reconstruction tool should: be fast in prediction of accurate well localised and high resolution models, evaluate prediction uncertainty, work with as little input data as possible. Current deep learning state of the art (SOTA) 3D reconstruction methods, however, often only produce shapes of limited variability positioned in a canonical position or lack uncertainty evaluation. In this paper, we present a novel probabilistic deep learning approach for concurrent 3D surface reconstruction from sparse 2D MR image data and aleatoric uncertainty prediction. Our method is capable of reconstructing large surface meshes from three quasi-orthogonal MR imaging slices from limited training sets whilst modelling the location of each mesh vertex through a Gaussian distribution. Prior shape information is encoded using a built-in linear principal component analysis (PCA) model. Extensive experiments on cardiac MR data show that our probabilistic approach successfully assesses prediction uncertainty while at the same time qualitatively and quantitatively outperforms SOTA methods in shape prediction. Compared to SOTA, we are capable of properly localising and orientating the prediction via the use of a spatially aware neural network.