FADA: Accessible fetal ultrasound interpretation and annotation with a selectively distilled unified vision-language model
Authors: Mahmood Alzubaidi, Uzair Shah, Raden Muaz, Ines Abbes, Nader Mohammed, Abdullatif Magram, Khalid Alyafei, Mowafa Househ, +1 more
Organizations: College of Science and Engineering , Hamad Bin Khalifa University,2026 Doha, Qatar. · Center for Clinical Precision Medicine and Genomics, HMC, Doha, Qatar.Jun · 3Advanced AlRazi Diagnostic Center, Al-Hodeidah, Yemen. · 4Sidra Medicine, Doha, Qatar.
Abstract
A global shortage of trained sonographers limits prenatal ultrasound screening in low- and middle-income countries, where over half of pregnant women receive no skilled sonography. Current deep learning approaches address detection, segmentation, or classification in isolation, each demanding a separate model and expert-specified labels at inference. We present FADA, a unified vision-language model built on Qwen3.5-VL that performs clinical interpretation, classification, detection, and segmentation through a single interpretation-first pipeline without external labels. FADA distills knowledge from four domain-specific foundation models (FetalCLIP, UltraSAM, USF-MAE, UltraFedFM) via offline pre-computed feature caching. Selective distillation, which applies feature alignment only to annotation tasks while interpretation relies on standard fine-tuning, consistently outperforms full distillation across most evaluation axes. The recommended variant, FADA-SKD, achieves 0.8820 mean Dice for segmentation, 0.7671 mAP@0.50 for detection, and 100% structured interpretation compliance. Expert sonographer validation across 237 images confirms clinically acceptable outputs in both autonomous and human-in-the-loop modes, with 73.5% of interpretations scoring perfectly under clinician guidance. The system is trainable on a single consumer GPU and deployable without cloud connectivity. We validate edge deployment by running the compressed 0.8B model on a commodity smartphone (Qualcomm Snapdragon 7 Gen 1, 12 GB RAM) using llama.cpp with GGUF quantization, completing the full 5-phase pipeline in approximately 60 seconds entirely offline. This establishes a practical pathway for integrating AI-assisted fetal assessment with portable ultrasound devices, directly addressing diagnostic access gaps in resource-constrained settings. Code, models, and data are available at https://github.com/mahmoodphd/FADA.
Vision-language foundation models have shown strong potential in medical image analysis. Although foundation models for ultrasound imaging have recently emerged, the domain remains particularly challenging due to severe speckle noise, acquisition variability, and subtle anatomical boundaries, leading to high inter-observer variability. Existing CLIP-based models rely primarily on global image-text alignment, limiting their sensitivity to clinically decisive local structures. We propose SonoCLIP, the first million-scale region-controllable fetal ultrasound vision-language foundation model that integrates segmentation masks as mask-channel visual prompts within the vision encoder, enabling joint global-local contrastive representation learning. To support scalable region-text alignment, we introduce a sigmoid-based pairwise contrastive loss that improves stability under large-scale supervision. We further curate a 1.44M-image multimodal fetal ultrasound dataset spanning 24 standard planes for large-scale pretraining. Extensive cross-center evaluations demonstrate that SonoCLIP achieves superior zero-shot transfer performance under both global and mask-guided inference, establishing a controllable and clinically oriented foundation model for fetal ultrasound analysis. Our code and data are available at https://github.com/Harrison-one/SonoCLIP.
Automated fetal ultrasound interpretation requires a workflow from visual perception, including plane recognition and anatomical segmentation, to clinical understanding, including biometric measurement and diagnostic reporting. However, the prevailing "one-task, one-model" paradigm limits systematic integration of evidence across this multi-step process. Although multimodal large language models (MLLMs) show promising visual understanding, their limited domain-specific grounding and hallucination risks restrict reliability in fetal ultrasound analysis. To address these limitations, we propose FetUSAgents, a tool-augmented multi-agent system for comprehensive fetal ultrasound interpretation, supporting visual question answering (VQA), report generation, image captioning, and video summarization. FetUSAgents coordinates task-specific visual tools through collaborative LLM agents and decomposes clinical queries into subtasks that progress from anatomical recognition to quantitative measurement. We further introduce Dual-Path Evidence Arbitration (DPEA), which integrates LLM-based deliberative reasoning with structured computational evidence from specialized visual tools. A retrieval-enhanced evidence bank consolidates intermediate findings to support traceable and clinically grounded conclusions. In addition, we construct FetUS-VQA, a dedicated VQA benchmark for fetal ultrasound, comprising 1,892 images and 3,205 question-answer pairs across 10 clinical tasks. Extensive out-of-distribution experiments show that FetUSAgents outperforms general and medical MLLMs, exceeding the strongest baseline by more than 25 percent in VQA accuracy. These results suggest a scalable route toward evidence-driven clinical assistants for prenatal imaging. Code is available.
Ultrasound is widely used in obstetric care due to its safety, accessibility, and real-time imaging. However, interpretation remains operator-dependent and susceptible to noise and artifacts. Deep learning models have shown strong performance to solve these problem, but they typically require large annotated datasets that are difficult to obtain in clinical ultrasound. Foundation models (FMs) offer an alternative, using a large number of ultrasound images to learn transferable representations that can generalize with limited labeled data. This work presents a comprehensive benchmark of ultrasound-specific FMs for fetal plane classification. We evaluated four ultrasound FMs (USFM, MOFO, UltraSAM, FetalCLIP) against two CNN baselines (ResNet50, EfficientNet-V2) and a ViT (DINOv3) pretrained on natural images. We trained all models under two complementary settings: full fine-tuning and linear probing with a frozen encoder. All models were trained using 5-fold patient-level cross-validation on a Spanish fetal ultrasound dataset and tested on both in-domain data and an external African cohort to assess cross-population generalization. We found that FetalCLIP achieved the best results in the linear probing setting (F1 = 0.9261 for in-domain, F1 = 0.9731 for out-of-domain), while USFM performed best in the full fine-tuning setting (F1 = 0.9476 for in-domain, F1 = 0.9515 for out-of-domain). MOFO and UltraSAM degraded most in both settings, underperforming natural image pretrained models in some cases. These findings highlight how the choice of pretrained model strongly affects fetal plane classification performance, since different pretraining objectives lead to different levels of transferability.