Ultrasound Image Segmentation

Accurate cardiac ultrasound segmentation is essential for reliable assessment of ventricular function in intelligent healthcare systems. However, echocardiographic images are challenging due to low contrast, speckle noise, irregular boundaries, and domain shifts across devices and patient populations. Existing methods, largely based on appearance-driven learning, often fail to preserve boundary precision and structural consistency under these conditions. To address these issues, we propose a Contour-Guided Query Refinement Network (CGQR-Net) for boundary-aware cardiac ultrasound segmentation. The framework integrates multi-resolution feature representations with contour-derived structural priors. An HRNet backbone preserves high-resolution spatial details while capturing multi-scale context. A coarse segmentation is first generated, from which anatomical contours are extracted and encoded into learnable query embeddings. These contour-guided queries interact with fused feature maps via cross-attention, enabling structure-aware refinement that improves boundary delineation and reduces noise artifacts. A dual-head supervision strategy jointly optimizes segmentation and boundary prediction to enforce structural consistency. The proposed method is evaluated on the CAMUS dataset and further validated on the CardiacNet dataset to assess cross-dataset generalization. Experimental results demonstrate improved segmentation accuracy, enhanced boundary precision, and robust performance across varying imaging conditions. These results highlight the effectiveness of integrating contour-level structural information with feature-level representations for reliable cardiac ultrasound segmentation.

Accurate and temporally consistent segmentation of the left ventricle from echocardiography videos is essential for estimating the ejection fraction and assessing cardiac function. However, modeling spatiotemporal dynamics remains difficult due to severe speckle noise and rapid non-rigid deformations. Existing linear recurrent models offer efficient in-context associative recall for temporal tracking, but rely on unconstrained state updates, which cause progressive singular value decay in the state matrix, a phenomenon known as rank collapse, resulting in anatomical details being overwhelmed by noise. To address this, we propose OSA, a framework that constrains the state evolution on the Stiefel manifold. We introduce the Orthogonalized State Update (OSU) mechanism, which formulates the memory evolution as Euclidean projected gradient descent on the Stiefel manifold to prevent rank collapse and maintain stable temporal transitions. Furthermore, an Anatomical Prior-aware Feature Enhancement module explicitly separates anatomical structures from speckle noise through a physics-driven process, providing the temporal tracker with noise-resilient structural cues. Comprehensive experiments on the CAMUS and EchoNet-Dynamic datasets show that OSA achieves state-of-the-art segmentation accuracy and temporal stability, while maintaining real-time inference efficiency for clinical deployment. Codes are available at https://github.com/wangrui2025/OSA.

Segmenting fetal head structures from prenatal ultrasound remains a practical bottleneck in obstetric imaging. The current state-of-the-art baseline, proposed alongside the published dataset, adapts the Segment Anything Model with per-class Dice and Lovász losses but still depends on bounding-box prompts at test time. We build a prompt-free pipeline on top of YOLO26-Seg that jointly detects and segments three structures, Brain, Cavum Septi Pellucidi (CSP), and Lateral Ventricles (LV), in a single forward pass. Three modifications are central to our approach: (i) a composite BCE-Dice-Lovász segmentation loss with inverse-frequency class weighting, injected into the YOLO26 training loop via runtime monkey-patching; (ii) domain-guided copy-paste augmentation that transplants minority-class structures while respecting their anatomical location relative to the brain boundary; and (iii) inter-patient stratified splitting to prevent data leakage. On 575 held-out test images, the composite loss variant reaches a mean Dice coefficient of 0.9253, exceeding the baseline (0.9012) by 2.68 percentage points, despite reporting over three foreground classes only, whereas the baseline's reported mean includes the easy background class. We further ablate each component and discuss annotation-quality and class-imbalance effects on CSP and LV performance.

Cardiac ultrasound diagnosis is critical for cardiovascular disease assessment, but acquiring standard views remains highly operator-dependent. Existing medical segmentation models often yield anatomically inconsistent results in images with poor textural differentiation between distinct feature classes, while autonomous probe adjustment methods either rely on simplistic heuristic rules or black-box learning. To address these issues, our study proposed an anatomical prior (AP)-driven framework integrating cardiac structure segmentation and autonomous probe adjustment for standard view acquisition. A YOLO-based multi-class segmentation model augmented by a spatial-relation graph (SRG) module is designed to embed AP into the feature pyramid. Quantifiable anatomical features of standard views are extracted. Their priors are fitted to Gaussian distributions to construct probabilistic APs. The probe adjustment process of robotic ultrasound scanning is formalized as a reinforcement learning (RL) problem, with the RL state built from real-time anatomical features and the reward reflecting the AP matching. Experiments validate the efficacy of the framework. The SRG-YOLOv11s improves mAP50 by 11.3% and mIoU by 6.8% on the Special Case dataset, while the RL agent achieves a 92.5% success rate in simulation and 86.7% in phantom experiments.

Thyroid ultrasound is the first-line exam for assessing thyroid nodules and determining whether biopsy is warranted. In routine reporting, radiologists produce two coupled outputs: a nodule contour for measurement and a TI-RADS risk category based on sonographic criteria. Yet both contouring style and risk grading vary across readers, creating inconsistent supervision that can degrade standard learning pipelines. In this paper, we address this workflow with a clinically guided multitask framework that jointly predicts the nodule mask and TI-RADS category within a single model. To ground risk prediction in clinically meaningful evidence, we guide the classification embedding using a compact TI-RADS aligned radiomics target during training, while preserving complementary deep features for discriminative performance. However, under annotator variability, naive multitask optimization often fails not because the tasks are unrelated, but because their gradients compete within the shared representation. To make this competition explicit and controllable, we introduce RLAR, a representation-level adversarial gradient regularizer. Rather than performing parameter-level gradient surgery, RLAR uses each task's normalized adversarial direction in latent space as a geometric probe of task sensitivity and penalizes excessive angular alignment between task-specific adversarial directions. On a public TI-RADS dataset, our clinically guided multitask model with RLAR consistently improves risk stratification while maintaining segmentation quality compared to single-task training and conventional multitask baselines. Code and pretrained models will be released.

Medical ultrasound image segmentation faces significant challenges due to limited labeled data and characteristic imaging artifacts including speckle noise and low-contrast boundaries. While semi-supervised learning (SSL) approaches have emerged to address data scarcity, existing methods suffer from suboptimal unlabeled data utilization and lack robust feature representation mechanisms. In this paper, we propose Switch, a novel SSL framework with two key innovations: (1) Multiscale Switch (MSS) strategy that employs hierarchical patch mixing to achieve uniform spatial coverage; (2) Frequency Domain Switch (FDS) with contrastive learning that performs amplitude switching in Fourier space for robust feature representations. Our framework integrates these components within a teacher-student architecture to effectively leverage both labeled and unlabeled data. Comprehensive evaluation across six diverse ultrasound datasets (lymph nodes, breast lesions, thyroid nodules, and prostate) demonstrates consistent superiority over state-of-the-art methods. At 5% labeling ratio, Switch achieves remarkable improvements: 80.04% Dice on LN-INT, 85.52% Dice on DDTI, and 83.48% Dice on Prostate datasets, with our semi-supervised approach even exceeding fully supervised baselines. The method maintains parameter efficiency (1.8M parameters) while delivering superior performance, validating its effectiveness for resource-constrained medical imaging applications. The source code is publicly available at https://github.com/jinggqu/Switch

Carotid intima-media thickness (CIMT) measured from B-mode ultrasound is an established vascular biomarker for atherosclerosis and cardiovascular risk stratification. Although a wide range of computerized methods have been proposed for carotid boundary delineation and CIMT estimation, robust and transferable deep models that jointly address segmentation and measurement remain underexplored, particularly in the era of vision foundation models. Motivated by recent advances in adapting DINOv3 to medical segmentation and exploiting DINOv3 in test-time optimization pipelines, we investigate a DINOv3-based framework for carotid intima-media complex segmentation and subsequent CIMT measurement on the Carotid Ultrasound Boundary Study (CUBS) v1 dataset. Our pipeline predicts the intima-media band at a fixed image resolution, extracts upper and lower boundaries column-wise, corrects for image resizing using the per-image calibration factor provided by CUBS, and reports CIMT in physical units. Across three patient-level test splits, our method achieved a mean test Dice of 0.7739 $\pm$ 0.0037 and IoU of 0.6384 $\pm$ 0.0044. The mean CIMT absolute error was 181.16 $\pm$ 11.57 $μ$m, with a mean Pearson correlation of 0.480 $\pm$ 0.259. In a held-out validation subset ($n=28$), test-time threshold calibration reduced the mean absolute CIMT error from 141.0 $μ$m at the default threshold to 101.1 $μ$m at the measurement-optimized threshold, while simultaneously reducing systematic bias toward zero. Relative to the error ranges reported in the original CUBS benchmark for classical computerized methods, these results place a DINOv3-based approach within the clinically relevant $\sim$0.1 mm measurement regime. Together, our findings support the feasibility of using vision foundation models for interpretable, calibration-aware CIMT measurement.

Fetal ultrasound (US) is the primary imaging modality for prenatal screening, yet its interpretation relies heavily on the expertise of the clinician. Despite advances in deep learning and foundation models, existing automated tools for fetal US analysis struggle to balance task-specific accuracy with the whole-process versatility required to support end-to-end clinical workflows. To address these limitations, we propose FetalAgents, the first multi-agent system for comprehensive fetal US analysis. Through a lightweight, agentic coordination framework, FetalAgents dynamically orchestrates specialized vision experts to maximize performance across diagnosis, measurement, and segmentation. Furthermore, FetalAgents advances beyond static image analysis by supporting end-to-end video stream summarization, where keyframes are automatically identified across multiple anatomical planes, analyzed by coordinated experts, and synthesized with patient metadata into a structured clinical report. Extensive multi-center external evaluations across eight clinical tasks demonstrate that FetalAgents consistently delivers the most robust and accurate performance when compared against specialized models and multimodal large language models (MLLMs), ultimately providing an auditable, workflow-aligned solution for fetal ultrasound analysis and reporting.

Thyroid ultrasound (US) automation couples two competing requirements: global, geometry-driven reasoning for nodule delineation and local, texture-driven reasoning for malignancy risk assessment. Under cross-center domain shift, these cues degrade asymmetrically, yet most multi-task pipelines rely on a single shared backbone, often inducing negative transfer. In this paper, we characterize this interference across CNN (ResNet34) and medical ViT (MedSAM) backbones, and observe a consistent trend: ViTs transfer geometric priors that benefit segmentation, whereas CNNs more reliably preserve texture cues for malignancy discrimination under strong shift and artifacts. Motivated by this failure mode, we propose a lightweight family of decoder-side adapters, the Multi-Kernel Gated Adapter (MKGA) and a residual variant (ResMKGA), which refine multi-scale skip features using complementary receptive fields and apply semantic, context-conditioned gating to suppress artifact-prone content before fusion. Across two US benchmarks, the proposed adapters improve cross-center robustness: they strengthen out-of-domain segmentation and, in the CNN setting, yield clear gains in clinical TI-RADS diagnostic accuracy compared to standard multi-task baselines. Code and models will be released.

Semi-supervised learning (SSL) has emerged as a promising paradigm for breast ultrasound (BUS) image segmentation, but it often suffers from unstable pseudo labels under extremely limited annotations, leading to inaccurate supervision and degraded performance. Recent vision-language models (VLMs) provide a new opportunity for pseudo-label generation, yet their effectiveness on BUS images remains limited because domain-specific prompts are difficult to transfer. To address this issue, we propose a semi-supervised framework with training-free pseudo-label generation and label refinement. By leveraging simple appearance-based descriptions (e.g., dark oval), our method enables cross-domain structural transfer between natural and medical images, allowing VLMs to generate structurally consistent pseudo labels. These pseudo labels are used to warm up a static teacher that captures global structural priors of breast lesions. Combined with an exponential moving average teacher, we further introduce uncertainty entropy weighted fusion and adaptive uncertainty-guided reverse contrastive learning to improve boundary discrimination. Experiments on four BUS datasets demonstrate that our method achieves performance comparable to fully supervised models even with only 2.5% labeled data, significantly outperforming existing SSL approaches. Moreover, the proposed paradigm is readily extensible: for other imaging modalities or diseases, only a global appearance description is required to obtain reliable pseudo supervision, enabling scalable semi-supervised medical image segmentation under limited annotations.

Joint lesion segmentation and tissue classification in breast ultrasound are usually trained with a shared encoder, so the two branches stop exchanging information once their decoders separate. That is exactly where boundary detail and semantic evidence are most complementary. The proposed method restores this exchange during decoding and, because its value differs between images, lets the network decide per image how much to keep. A Task Interaction Module (TIM) at each of four decoder levels passes pooled boundary context into the classification representation and modulates decoder channels with class-conditioned priors. An Adaptive Interaction Weighting (AIW) unit then blends interacted and original features with a coefficient computed for each image and level. On BUSI the model reaches 74.19% IoU and 90.60% accuracy, and on BUSI-WHU 86.40% IoU and 95.00% accuracy, ahead of encoder-sharing multi-task, transformer segmentation and decoder-interaction baselines evaluated under the same protocol. The ablation shows that multi-scale context and cross-task exchange are not independent: applied separately they contribute 4.00 points of IoU in total, applied together 6.76. Adding the adaptive blend to task interaction alone raises AUC from 94.41% to 97.31%, indicating that the blend acts primarily on the classification branch. Code: https://github.com/C-loud-Nine/Adaptive-Task-Interaction-BUS.

Manual measurement of muscle morphology from ultrasound during speech is time-consuming and limits large-scale studies. We present SMMA, a fully automated framework that combines deep-learning segmentation with skeleton-based thickness quantification to analyze geniohyoid (GH) muscle dynamics. Validation demonstrates near-human-level accuracy (Dice = 0.9037, MAE = 0.53 mm, r = 0.901). Application to Cantonese vowel production (N = 11) reveals systematic patterns: /a:/ shows significantly greater GH thickness (7.29 mm) than /i:/ (5.95 mm, p < 0.001, Cohen's d > 1.3), suggesting greater GH activation during production of /a:/ than /i:/, consistent with its role in mandibular depression. Sex differences (5-8% greater in males) reflect anatomical scaling. SMMA achieves expert-validated accuracy while eliminating the need for manual annotation, enabling scalable investigations of speech motor control and objective assessment of speech and swallowing disorders.

Introduction: Deep learning-based segmentation models are increasingly integrated into clinical imaging workflows, yet their robustness to adversarial perturbations remains incompletely characterized, particularly for ultrasound images. We evaluated adversarial attacks and inference-time defenses for thyroid nodule segmentation in B-mode ultrasound. Methods: Two black-box adversarial attacks were developed: (1) Structured Speckle Amplification Attack (SSAA), which injects boundary-targeted noise, and (2) Frequency-Domain Ultrasound Attack (FDUA), which applies bandpass-filtered phase perturbations in the Fourier domain. Three inference-time mitigations were evaluated on adversarial images: randomized preprocessing with test-time augmentation, deterministic input denoising, and stochastic ensemble inference with consistency-aware aggregation. Experiments were conducted on a U-Net segmentation model trained on cine-clips from a database of 192 thyroid nodules. Results: The baseline model achieved a mean Dice similarity coefficient (DSC) of 0.76 (SD 0.20) on unperturbed images. SSAA reduced DSC by 0.29 (SD 0.20) while maintaining high visual similarity (SSIM = 0.94). FDUA resulted in a smaller DSC reduction of 0.11 (SD 0.09) with lower visual fidelity (SSIM = 0.82). Against SSAA, all three defenses significantly improved DSC after correction, with deterministic denoising showing the largest recovery (+0.10, p < 0.001), followed by randomized preprocessing (+0.09, p < 0.001), and stochastic ensemble inference (+0.08, p = 0.002). No defense achieved statistically significant improvement against FDUA. Conclusion: Spatial-domain adversarial perturbations in ultrasound segmentation showed partial mitigation with input preprocessing, whereas frequency-domain perturbations were not mitigated by the defenses, highlighting modality-specific challenges in adversarial robustness evaluation.