The complex structure of the heart leads to significant challenges in echocardiography, especially in acquisition cardiac ultrasound images. Successful echocardiography requires a thorough understanding of the structures on the two-dimensional plane and the spatial relationships between planes in three-dimensional space. In this paper, we innovatively propose a large-scale self-supervised pre-training method to acquire a cardiac structure-aware world model. The core innovation lies in constructing a self-supervised task that requires structural inference by predicting masked structures on a 2D plane and imagining another plane based on pose transformation in 3D space. To support large-scale pre-training, we collected over 1.36 million echocardiograms from ten standard views, along with their 3D spatial poses. In the downstream probe guidance task, we demonstrate that our pre-trained model consistently reduces guidance errors across the ten most common standard views on the test set with 0.29 million samples from 74 routine clinical scans, indicating that structure-aware pre-training benefits the scanning.

Transesophageal echocardiography (TEE) plays a pivotal role in cardiology for diagnostic and interventional procedures. However, using it effectively requires extensive training due to the intricate nature of image acquisition and interpretation. To enhance the efficiency of novice sonographers and reduce variability in scan acquisitions, we propose a novel ultrasound (US) navigation assistance method based on contrastive learning as goal-conditioned reinforcement learning (GCRL). We augment the previous framework using a novel contrastive patient batching method (CPB) and a data-augmented contrastive loss, both of which we demonstrate are essential to ensure generalization to anatomical variations across patients. The proposed framework enables navigation to both standard diagnostic as well as intricate interventional views with a single model. Our method was developed with a large dataset of 789 patients and obtained an average error of 6.56 mm in position and 9.36 degrees in angle on a testing dataset of 140 patients, which is competitive or superior to models trained on individual views. Furthermore, we quantitatively validate our method's ability to navigate to interventional views such as the Left Atrial Appendage (LAA) view used in LAA closure. Our approach holds promise in providing valuable guidance during transesophageal ultrasound examinations, contributing to the advancement of skill acquisition for cardiac ultrasound practitioners.

To facilitate diagnosis on cardiac ultrasound (US), clinical practice has established several standard views of the heart, which serve as reference points for diagnostic measurements and define viewports from which images are acquired. Automatic view recognition involves grouping those images into classes of standard views. Although deep learning techniques have been successful in achieving this, they still struggle with fully verifying the suitability of an image for specific measurements due to factors like the correct location, pose, and potential occlusions of cardiac structures. Our approach goes beyond view classification and incorporates a 3D mesh reconstruction of the heart that enables several more downstream tasks, like segmentation and pose estimation. In this work, we explore learning 3D heart meshes via graph convolutions, using similar techniques to learn 3D meshes in natural images, such as human pose estimation. As the availability of fully annotated 3D images is limited, we generate synthetic US images from 3D meshes by training an adversarial denoising diffusion model. Experiments were conducted on synthetic and clinical cases for view recognition and structure detection. The approach yielded good performance on synthetic images and, despite being exclusively trained on synthetic data, it already showed potential when applied to clinical images. With this proof-of-concept, we aim to demonstrate the benefits of graphs to improve cardiac view recognition that can ultimately lead to better efficiency in cardiac diagnosis.

Surgical treatment of complicated knee fractures is guided by real-time imaging using a mobile C-arm. Immediate and continuous control is achieved via 2D anatomy-specific standard views that correspond to a specific C-arm pose relative to the patient positioning, which is currently determined manually, following a trial-and-error approach at the cost of time and radiation dose. The characteristics of the standard views of the knee suggests that the shape information of individual bones could guide an automatic positioning procedure, reducing time and the amount of unnecessary radiation during C-arm positioning. To fully automate the C-arm positioning task during knee surgeries, we propose a complete framework that enables (1) automatic laterality and standard view classification and (2) automatic shape-based pose regression toward the desired standard view based on a single initial X-ray. A suitable shape representation is proposed to incorporate semantic information into the pose regression pipeline. The pipeline is designed to handle two distinct standard views simultaneously. Experiments were conducted to assess the performance of the proposed system on 3528 synthetic and 1386 real X-rays for the a.-p.

Ultrasound (US) imaging is commonly used to assist in the diagnosis and interventions of spine diseases, while the standardized US acquisitions performed by manually operating the probe require substantial experience and training of sonographers. In this work, we propose a novel dual-agent framework that integrates a reinforcement learning (RL) agent and a deep learning (DL) agent to jointly determine the movement of the US probe based on the real-time US images, in order to mimic the decision-making process of an expert sonographer to achieve autonomous standard view acquisitions in spinal sonography. Moreover, inspired by the nature of US propagation and the characteristics of the spinal anatomy, we introduce a view-specific acoustic shadow reward to utilize the shadow information to implicitly guide the navigation of the probe toward different standard views of the spine. Our method is validated in both quantitative and qualitative experiments in a simulation environment built with US data acquired from 17 volunteers. The average navigation accuracy toward different standard views achieves 5.18mm/5.25deg and 12.87mm/17.49deg in the intra- and inter-subject settings, respectively. The results demonstrate that our method can effectively interpret the US images and navigate the probe to acquire multiple standard views of the spine.