These authors contributed equally to this work Abstract: Liver disease is a major global health burden. While ultrasound is the first-line diagnostic tool, liver sonography requires locating multiple non-continuous planes from positions where target structures are often not visible, for biometric assessment and lesion detection, requiring significant expertise. However, expert sonographers are severely scarce in resource-limited regions. Here, we develop an autonomous lightweight ultrasound robot comprising an AI agent that integrates multi-modal perception with memory attention for localization of unseen target structures, and a 588-gram 6-degrees-of-freedom cable-driven robot. By mounting on the abdomen, the system enhances robustness against motion. Our robot can autonomously acquire expert-level standard liver ultrasound planes and detect pathology in patients, including two from Xining, a 2261-meter-altitude city with limited medical resources. Our system performs effectively on rapid-motion individuals and in wilderness environments. This work represents the first demonstration of autonomous sonography across multiple challenging scenarios, potentially transforming access to expert-level diagnostics in underserved regions. One-Sentence Summary: The lightweight robot enables autonomous liver non-continuous standard plane sonography across multiple scenarios. Main Text: INTRODUCTION Liver disease represents a major global health burden, accounting for over two million deaths annually--approximately 4% of worldwide mortality. Cirrhosis and hepatocellular carcinoma constitute the predominant causes of liver-related fatalities. Meanwhile, parasitic infections pose additional challenges, particularly in resource-limited settings ( 1-3).

The International Society of Ultrasound advocates Intrapartum Ultrasound (US) Imaging in Obstetrics and Gynecology (ISUOG) to monitor labour progression through changes in fetal head position. Two reliable ultrasound-derived parameters that are used to predict outcomes of instrumental vaginal delivery are the angle of progression (AoP) and head-symphysis distance (HSD). In this work, as part of the Intrapartum Ultrasounds Grand Challenge (IUGC) 2024, we propose an automated fetal biometry measurement pipeline to reduce intra- and inter-observer variability and improve measurement reliability. Our pipeline consists of three key tasks: (i) classification of standard planes (SP) from US videos, (ii) segmentation of fetal head and pubic symphysis from the detected SPs, and (iii) computation of the AoP and HSD from the segmented regions. We perform sparse sampling to mitigate class imbalances and reduce spurious correlations in task (i), and utilize ensemble-based deep learning methods for task (i) and (ii) to enhance generalizability under different US acquisition settings. Finally, to promote robustness in task iii) with respect to the structural fidelity of measurements, we retain the largest connected components and apply ellipse fitting to the segmentations. Our solution achieved ACC: 0.9452, F1: 0.9225, AUC: 0.983, MCC: 0.8361, DSC: 0.918, HD: 19.73, ASD: 5.71, $Δ_{AoP}$: 8.90 and $Δ_{HSD}$: 14.35 across an unseen hold-out set of 4 patients and 224 US frames. The results from the proposed automated pipeline can improve the understanding of labour arrest causes and guide the development of clinical risk stratification tools for efficient and effective prenatal care.

Echocardiography is the only technique capable of real-time imaging of the heart and is vital for diagnosing the majority of cardiac diseases. However, there is a severe shortage of experienced cardiac sonographers, due to the heart's complex structure and significant operational challenges. To mitigate this situation, we present a Cardiac Copilot system capable of providing real-time probe movement guidance to assist less experienced sonographers in conducting freehand echocardiography. This system can enable non-experts, especially in primary departments and medically underserved areas, to perform cardiac ultrasound examinations, potentially improving global healthcare delivery. The core innovation lies in proposing a data-driven world model, named Cardiac Dreamer, for representing cardiac spatial structures. This world model can provide structure features of any cardiac planes around the current probe position in the latent space, serving as an precise navigation map for autonomous plane localization. We train our model with real-world ultrasound data and corresponding probe motion from 110 routine clinical scans with 151K sample pairs by three certified sonographers. Evaluations on three standard planes with 37K sample pairs demonstrate that the world model can reduce navigation errors by up to 33\% and exhibit more stable performance.

Obstetric ultrasound image quality is crucial for accurate diagnosis and monitoring of fetal health. However, producing high-quality standard planes is difficult, influenced by the sonographer's expertise and factors like the maternal BMI or the fetus dynamics. In this work, we propose using diffusion-based counterfactual explainable AI to generate realistic high-quality standard planes from low-quality non-standard ones. Through quantitative and qualitative evaluation, we demonstrate the effectiveness of our method in producing plausible counterfactuals of increased quality. This shows future promise both for enhancing training of clinicians by providing visual feedback, as well as for improving image quality and, consequently, downstream diagnosis and monitoring.

Standard plane localization is crucial for ultrasound (US) diagnosis. In prenatal US, dozens of standard planes are manually acquired with a 2D probe. It is time-consuming and operator-dependent. In comparison, 3D US containing multiple standard planes in one shot has the inherent advantages of less user-dependency and more efficiency. However, manual plane localization in US volume is challenging due to the huge search space and large fetal posture variation. In this study, we propose a novel reinforcement learning (RL) framework to automatically localize fetal brain standard planes in 3D US. Our contribution is two-fold. First, we equip the RL framework with a landmark-aware alignment module to provide warm start and strong spatial bounds for the agent actions, thus ensuring its effectiveness. Second, instead of passively and empirically terminating the agent inference, we propose a recurrent neural network based strategy for active termination of the agent's interaction procedure. This improves both the accuracy and efficiency of the localization system. Extensively validated on our in-house large dataset, our approach achieves the accuracy of 3.4mm/9.6{\deg} and 2.7mm/9.1{\deg} for the transcerebellar and transthalamic plane localization, respectively. Ourproposed RL framework is general and has the potential to improve the efficiency and standardization of US scanning.

The current approach to fetal anomaly screening is based on biometric measurements derived from individually selected ultrasound images. In this paper, we introduce a paradigm shift that attains human-level performance in biometric measurement by aggregating automatically extracted biometrics from every frame across an entire scan, with no need for operator intervention. We use a convolutional neural network to classify each frame of an ultrasound video recording. We then measure fetal biometrics in every frame where appropriate anatomy is visible. We use a Bayesian method to estimate the true value of each biometric from a large number of measurements and probabilistically reject outliers. We performed a retrospective experiment on 1457 recordings (comprising 48 million frames) of 20-week ultrasound scans, estimated fetal biometrics in those scans and compared our estimates to the measurements sonographers took during the scan. Our method achieves human-level performance in estimating fetal biometrics and estimates well-calibrated credible intervals in which the true biometric value is expected to lie.

Ultrasound (US) imaging is widely used for biometric measurement and diagnosis of internal organs due to the advantages of being real-time and radiation-free. However, due to inter-operator variations, resulting images highly depend on the experience of sonographers. This work proposes an intelligent robotic sonographer to autonomously "explore" target anatomies and navigate a US probe to a relevant 2D plane by learning from the expert. The underlying high-level physiological knowledge from experts is inferred by a neural reward function, using a ranked pairwise image comparisons approach in a self-supervised fashion. This process can be referred to as understanding the "language of sonography". Considering the generalization capability to overcome inter-patient variations, mutual information is estimated by a network to explicitly disentangle the task-related and domain features in latent space. The robotic localization is carried out in coarse-to-fine mode based on the predicted reward associated with B-mode images. To validate the effectiveness of the proposed reward inference network, representative experiments were performed on vascular phantoms ("line" target), two types of ex-vivo animal organs (chicken heart and lamb kidney) phantoms ("point" target) and in-vivo human carotids, respectively. To further validate the performance of the autonomous acquisition framework, physical robotic acquisitions were performed on three phantoms (vascular, chicken heart, and lamb kidney). The results demonstrated that the proposed advanced framework can robustly work on a variety of seen and unseen phantoms as well as in-vivo human carotid data.

Ultrasound is the primary modality to examine fetal growth during pregnancy, while the image quality could be affected by various factors. Quality assessment is essential for controlling the quality of ultrasound images to guarantee both the perceptual and diagnostic values. Existing automated approaches often require heavy structural annotations and the predictions may not necessarily be consistent with the assessment results by human experts. Furthermore, the overall quality of a scan and the correlation between the quality of frames should not be overlooked. In this work, we propose a reinforcement learning framework powered by two hierarchical agents that collaboratively learn to perform both frame-level and video-level quality assessments. It is equipped with a specially-designed reward mechanism that considers temporal dependency among frame quality and only requires sparse binary annotations to train. Experimental results on a challenging fetal brain dataset verify that the proposed framework could perform dual-level quality assessment and its predictions correlate well with the subjective assessment results.

Confounding information in the form of text or markings embedded in medical images can severely affect the training of diagnostic deep learning algorithms. However, data collected for clinical purposes often have such markings embedded in them. In dermatology, known examples include drawings or rulers that are overrepresented in images of malignant lesions. In this paper, we encounter text and calipers placed on the images found in national databases containing fetal screening ultrasound scans, which correlate with standard planes to be predicted. In order to utilize the vast amounts of data available in these databases, we develop and validate a series of methods for minimizing the confounding effects of embedded text and calipers on deep learning algorithms designed for ultrasound, using standard plane classification as a test case.

Developing innovative informatics approaches aimed to enhance fetal monitoring is a burgeoning field of study in reproductive medicine. Several reviews have been conducted regarding Artificial intelligence (AI) techniques to improve pregnancy outcomes. They are limited by focusing on specific data such as mother's care during pregnancy. This systematic survey aims to explore how artificial intelligence (AI) can assist with fetal growth monitoring via Ultrasound (US) image. We used eight medical and computer science bibliographic databases, including PubMed, Embase, PsycINFO, ScienceDirect, IEEE explore, ACM Library, Google Scholar, and the Web of Science. We retrieved studies published between 2010 to 2021. Data extracted from studies were synthesized using a narrative approach. Out of 1269 retrieved studies, we included 107 distinct studies from queries that were relevant to the topic in the survey. We found that 2D ultrasound images were more popular (n=88) than 3D and 4D ultrasound images (n=19). Classification is the most used method (n=42), followed by segmentation (n=31), classification integrated with segmentation (n=16) and other miscellaneous such as object-detection, regression and reinforcement learning (n=18). The most common areas within the pregnancy domain were the fetus head (n=43), then fetus body (n=31), fetus heart (n=13), fetus abdomen (n=10), and lastly the fetus face (n=10). In the most recent studies, deep learning techniques were primarily used (n=81), followed by machine learning (n=16), artificial neural network (n=7), and reinforcement learning (n=2). AI techniques played a crucial role in predicting fetal diseases and identifying fetus anatomy structures during pregnancy. More research is required to validate this technology from a physician's perspective, such as pilot studies and randomized controlled trials on AI and its applications in a hospital setting.