Despite many uses of ultrasound, some pathologies such as breast cancer still cannot reliably be diagnosed in either conventional B-mode ultrasound imaging nor with more recent ultrasound elastography methods. Speed-of-sound (SoS) is a quantitative imaging biomarker, which is sensitive to structural changes due to pathology, and hence could facilitate diagnosis. Full-angle ultrasound computed tomography (USCT) was proposed to obtain spatially-resolved SoS images, however, its water-bath setup involves practical limitations. To increase clinical utility and for widespread use, recently, a limited-angle Fourier-domain SoS reconstruction was proposed, however, it suffers from significant image reconstruction artifacts. In this work, we present a SoS reconstruction strategy, where the forward problem is formulated using differential time-of-flight measurements based on apparent displacements along different ultrasound wave propagation paths, and the inverse problem is solved in spatial-domain using a proposed total-variation scheme with spatially-varying anisotropic weighting to compensate for geometric bias from limited angle imaging setup. This is shown to be robust to missing displacement data and easily allow for incorporating any prior geometric information. In numerical simulations, SoS values in inclusions are accurately reconstructed with 90% accuracy up to a noise level of 50%. With respect to Fourier-domain reconstruction, our proposed method improved contrast ratio from 0.37 to 0.67 for even high noise levels such as 50%. Numerical full-wave simulation and our preliminary in vivo results illustrate the clinical applicability of our method in a breast cancer imaging setting. Our proposed method requires single-sided access to the tissue and can be implemented as an add-on to conventional ultrasound equipment, applicable to a range of transducers and applications.

Ultrasound (US) beamforming is the process of reconstructing an image from acquired echo traces on several transducer elements. Typical beamforming approaches, such as delay-and-sum, perform simple projection operations, while techniques using statistical information also exist, e.g., adaptive, phase coherence, delay-multiply-and-sum, and sparse coding approaches. Inspired by the feasibility and success of inverse problem (IP) formulations in several image reconstruction problems, such as computed tomography, we herein devise an IP approach for US beamforming. We define a linear forward model for the synthesis of the beamformed image, and solve its IP thanks to several intuitive and physics-based constraints and regularization terms proposed. These reflect the prior knowledge about the spectra of carrier signal and spatial coherence of modulated signal. These constraints admit effective formulation through sparse representations. Our proposed method was evaluated for plane-wave imaging (PWI) that transmits unfocused waves, enabling high frame rates with large field of view at the expense of much lower image quality with conventional beamforming techniques. Results are evaluated in numerical simulations, as well as tissue-mimicking phantoms and in vivo data provided by PWI challenge in medical US. The best results achieved by our proposed techniques are 0.39-mm full-width at half-maximum for spatial resolution and 16.3-dB contrast-to-noise ratio, using a single plane-wave transmit.

Appendicitis is among the most frequent reasons for pediatric abdominal surgeries. Previous decision support systems for appendicitis have focused on clinical, laboratory, scoring, and computed tomography data and have ignored abdominal ultrasound, despite its noninvasive nature and widespread availability. In this work, we present interpretable machine learning models for predicting the diagnosis, management and severity of suspected appendicitis using ultrasound images. Our approach utilizes concept bottleneck models (CBM) that facilitate interpretation and interaction with high-level concepts understandable to clinicians. Furthermore, we extend CBMs to prediction problems with multiple views and incomplete concept sets. Our models were trained on a dataset comprising 579 pediatric patients with 1709 ultrasound images accompanied by clinical and laboratory data. Results show that our proposed method enables clinicians to utilize a human-understandable and intervenable predictive model without compromising performance or requiring time-consuming image annotation when deployed. For predicting the diagnosis, the extended multiview CBM attained an AUROC of 0.80 and an AUPR of 0.92, performing comparably to similar black-box neural networks trained and tested on the same dataset.

Pulmonary hypertension (PH) in newborns and infants is a complex condition associated with several pulmonary, cardiac, and systemic diseases contributing to morbidity and mortality. Thus, accurate and early detection of PH and the classification of its severity is crucial for appropriate and successful management. Using echocardiography, the primary diagnostic tool in pediatrics, human assessment is both time-consuming and expertise-demanding, raising the need for an automated approach. Little effort has been directed towards automatic assessment of PH using echocardiography, and the few proposed methods only focus on binary PH classification on the adult population. In this work, we present an explainable multi-view video-based deep learning approach to predict and classify the severity of PH for a cohort of 270 newborns using echocardiograms. We use spatio-temporal convolutional architectures for the prediction of PH from each view, and aggregate the predictions of the different views using majority voting. Our results show a mean F1-score of 0.84 for severity prediction and 0.92 for binary detection using 10-fold cross-validation and 0.63 for severity prediction and 0.78 for binary detection on the held-out test set. We complement our predictions with saliency maps and show that the learned model focuses on clinically relevant cardiac structures, motivating its usage in clinical practice. To the best of our knowledge, this is the first work for an automated assessment of PH in newborns using echocardiograms.

Current machine learning methods for medical image analysis primarily focus on developing models tailored for their specific tasks, utilizing data within their target domain. These specialized models tend to be data-hungry and often exhibit limitations in generalizing to out-of-distribution samples. In this work, we show that employing models that incorporate multiple domains instead of specialized ones significantly alleviates the limitations observed in specialized models. We refer to this approach as multi-domain model and compare its performance to that of specialized models. For this, we introduce the incorporation of diverse medical image domains, including different imaging modalities like X-ray, MRI, CT, and ultrasound images, as well as various viewpoints such as axial, coronal, and sagittal views. Our findings underscore the superior generalization capabilities of multi-domain models, particularly in scenarios characterized by limited data availability and out-of-distribution, frequently encountered in healthcare applications. The integration of diverse data allows multi-domain models to utilize information across domains, enhancing the overall outcomes substantially. To illustrate, for organ recognition, multi-domain model can enhance accuracy by up to 8% compared to conventional specialized models.