Foundation Model-driven Key Anatomy Frame Selection for Blind-sweep Ultrasound Fetal Birth Weight Estimation

In low-resource settings, blind-sweep ultrasound provides a practical and accessible method for identifying fetal growth restriction. However, unlike freehand ultrasound which is subjectively controlled, detection of biometry plane in blind-sweep ultrasound is more challenging due to the uncontrolled fetal structure to be observed and the variaties of oblique planes in the scan. In this work, we propose a structure-augmented system to detect fetal abdomen plane, where the abdominal structure is highlighted using a segmentation prior. Since standard planes are emerging gradually, the decision boundary of the keyframes is unstable to predict. We thus aggregated the structure-augmented planes with a temporal sliding window to help stabilise keyframe localisation. Extensive results indicate that the structure-augmented temporal sliding strategy significantly improves and stabilises the detection of anatomically meaningful planes, which enables more reliable biometric measurements in blind-sweep ultrasound.

Automated frame selection for fetal biometry remains under addressed, with most prior work targeting generic quality assessment or downstream measurement pipelines that assume suitable frames are available. We introduce FetSelect, a task-specific framework that pairs a frozen vision foundation backbone with a hybrid multi-head design: a Task-Gated classification head and a Detection-derived quality head combined via learned fusion. We curate 6,486 expert-labeled frames across four targets: Crown-Rump Length (CRL), Nuchal Translucency (NT), Nasal Bone (NB), and Scalebar, and adapt the backbone with BYOL pretraining on 19,019 unlabeled images. On a held-out test set (974 frames), FetSelect achieves mean AUROC 0.956 and mean correlation 0.818 with expert quality annotations. Ablations confirm that hybrid fusion surpasses single-head variants, and ultrasound-specific self-supervision yields consistent gains. Evaluation on external clinical videos and 509 external CRL images demonstrates task-specific discrimination.

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.