Overview

Ultrasound imaging studies how to form and interpret images of the body using reflected sound, including B-mode, Doppler, contrast-enhanced, and volumetric scans. Machine-learning approaches range from U-Net-style segmentation and video models to self-supervised and vision-language foundation models, evaluated on tasks such as cardiac function, fetal plane detection, and breast-lesion classification. Physics-informed reconstruction and denoising, alongside robotic scanning and probe guidance, aim to improve image quality and make examinations more consistent and accessible. A central challenge is maintaining reliable performance across devices, hospitals, operators, and patient groups while meeting clinical needs for interpretability, external validation, and efficient deployment.

Latest papers

150 papers16 papers in the last four weeks, down 11% on the four weeks before. 0.1% of all new papers.

Mar 28, 2026

Follow Your Heart: Landmark-Guided Transducer Pose Scoring for Point-of-Care Echocardiography

Point-of-care transthoracic echocardiography (TTE) makes it possible to assess a patient's cardiac function in almost any setting. A critical step in the TTE exam is acquisition of the apical 4-chamber (A4CH) view, which is used to evaluate clinically impactful measurements such as left ventricular ejection fraction (LVEF). However, optimizing transducer pose for high-quality image acquisition and subsequent measurement is a challenging task, particularly for novice users. In this work, we present a multi-task network that provides feedback cues for A4CH view acquisition and automatically estimates LVEF in high-quality A4CH images. The network cascades a transducer pose scoring module and an uncertainty-aware LV landmark detector with automated LVEF estimation. A strength is that network training and inference do not require cumbersome or costly setups for transducer position tracking. We evaluate performance on point-of-care TTE data acquired with a spatially dense "sweep" protocol around the optimal A4CH view. The results demonstrate the network's ability to determine when the transducer pose is on target, close to target, or far from target based on the images alone, while generating visual landmark cues that guide anatomical interpretation and orientation. In conclusion, we demonstrate a promising strategy to provide guidance for A4CH view acquisition, which may be useful when deploying point-of-care TTE in limited resource settings.
Mar 27, 2026

External Benchmarking of Lung Ultrasound Models for Pneumothorax-Related Signs: A Manifest-Based Multi-Source Study

Background and Aims: Reproducible external benchmarks for pneumothorax-related lung ultrasound (LUS) AI are scarce, and binary lung-sliding classification may obscure clinically important signs. We therefore developed a manifest-based external benchmark and used it to test both cross-domain generalization and task validity. Methods: We curated 280 clips from 190 publicly accessible LUS source videos and released a reconstruction manifest containing URLs, timestamps, crop coordinates, labels, and probe shape. Labels were normal lung sliding, absent lung sliding, lung point, and lung pulse. A previously published single-site binary classifier was evaluated on this benchmark; challenge-state analysis examined lung point and lung pulse using the predicted probability of absent sliding, P(absent). Results: The single-site comparator achieved ROC-AUC 0.9625 in-domain but 0.7050 on the heterogeneous external benchmark; restricting external evaluation to linear clips still yielded ROC-AUC 0.7212. In challenge-state analysis, mean P(absent) ranked absent (0.504) > lung point (0.313) > normal (0.186) > lung pulse (0.143). Lung pulse differed from absent clips (p=0.000470) but not from normal clips (p=0.813), indicating that the binary model treated pulse as normal-like despite absent sliding. Lung point differed from both absent (p=0.000468) and normal (p=0.000026), supporting its interpretation as an intermediate ambiguity state rather than a clean binary class. Conclusion: A manifest-based, multi-source benchmark can support reproducible external evaluation without redistributing source videos. Binary lung-sliding classification is an incomplete proxy for pneumothorax reasoning because it obscures blind-spot and ambiguity states such as lung pulse and lung point.
Mar 26, 2026

Automated Quality Assessment of Blind Sweep Obstetric Ultrasound for Improved Diagnosis

Blind Sweep Obstetric Ultrasound (BSOU) enables scalable fetal imaging in low-resource settings by allowing minimally trained operators to acquire standardized sweep videos for automated Artificial Intelligence(AI) interpretation. However, the reliability of such AI systems depends critically on the quality of the acquired sweeps, and little is known about how deviations from the intended protocol affect downstream predictions. In this work, we present a systematic evaluation of BSOU quality and its impact on three key AI tasks: sweep-tag classification, fetal presentation classification, and placenta-location classification. We simulate plausible acquisition deviations, including reversed sweep direction, probe inversion, and incomplete sweeps, to quantify model robustness, and we develop automated quality-assessment models capable of detecting these perturbations. To approximate real-world deployment, we simulate a feedback loop in which flagged sweeps are re-acquired, showing that such correction improves downstream task performance. Our findings highlight the sensitivity of BSOU-based AI models to acquisition variability and demonstrate that automated quality assessment can play a central role in building reliable, scalable AI-assisted prenatal ultrasound workflows, particularly in low-resource environments.
Mar 22, 2026

Representation-Level Adversarial Regularization for Clinically Aligned Multitask Thyroid Ultrasound Assessment

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.
Mar 20, 2026

A Unified Platform and Quality Assurance Framework for 3D Ultrasound Reconstruction with Robotic, Optical, and Electromagnetic Tracking

Three-dimensional (3D) Ultrasound (US) can facilitate diagnosis, treatment planning, and image-guided therapy. However, current studies rarely provide a comprehensive evaluation of volumetric accuracy and reproducibility, highlighting the need for robust Quality Assurance (QA) frameworks, particularly for tracked 3D US reconstruction using freehand or robotic acquisition. This study presents a QA framework for 3D US reconstruction and a flexible open source platform for tracked US research. A custom phantom containing geometric inclusions with varying symmetry properties enables straightforward evaluation of optical, electromagnetic, and robotic kinematic tracking for 3D US at different scanning speeds and insonation angles. A standardised pipeline performs real-time segmentation and 3D reconstruction of geometric targets (DSC = 0.97, FPS = 46) without GPU acceleration, followed by automated registration and comparison with ground-truth geometries. Applying this framework showed that our robotic 3D US achieves state-of-the-art reconstruction performance (DSC-3D = 0.94 +- 0.01, HD95 = 1.17 +- 0.12), approaching the spatial resolution limit imposed by the transducer. This work establishes a flexible experimental platform and a reproducible validation methodology for 3D US reconstruction. The proposed framework enables robust cross-platform comparisons and improved reporting practices, supporting the safe and effective clinical translation of 3D ultrasound in diagnostic and image-guided therapy applications.
Mar 19, 2026

AURORA: Adaptive Unified Representation for Robust Ultrasound Analysis

Ultrasound images vary widely across scanners, operators, and anatomical targets, which often causes models trained in one setting to generalize poorly to new hospitals and clinical conditions. The Foundation Model Challenge for Ultrasound Image Analysis (FMC-UIA) reflects this difficulty by requiring a single model to handle multiple tasks, including segmentation, detection, classification, and landmark regression across diverse organs and datasets. We propose a unified multi-task framework based on a transformer visual encoder from the Qwen3-VL family. Intermediate token features are projected into spatial feature maps and fused using a lightweight multi-scale feature pyramid, enabling both pixel-level predictions and global reasoning within a shared representation. Each task is handled by a small task-specific prediction head, while training uses task-aware sampling and selective loss balancing to manage heterogeneous supervision and reduce task imbalance. Our method is designed to be simple to optimize and adaptable across a wide range of ultrasound analysis tasks. The performance improved from 67% to 85% on the validation set and achieved an average score of 81.84% on the official test set across all tasks. The code is publicly available at: https://github.com/saitejalekkala33/FMCUIA-ISBI.git
Mar 16, 2026

UNICORN: Ultrasound Nakagami Imaging via Score Matching and Adaptation for Assessing Hepatic Steatosis

Ultrasound imaging is an essential first-line tool for assessing hepatic steatosis. While conventional B-mode ultrasound imaging has limitations in providing detailed tissue characterization, ultrasound Nakagami imaging holds promise for visualizing and quantifying tissue scattering in backscattered signals, with potential applications in fat fraction analysis. However, existing methods for Nakagami imaging struggle with optimal window size selection and suffer from estimator instability, leading to degraded image resolution. To address these challenges, we propose a novel method called UNICORN (Ultrasound Nakagami Imaging via Score Matching and Adaptation), which offers an accurate, closed-form estimator for Nakagami parameter estimation based on the score function of the ultrasound envelope signal. Unlike methods that visualize only specific regions of interest (ROI) and estimate parameters within fixed window sizes, our approach provides comprehensive parameter mapping by providing a pixel-by-pixel estimator, resulting in high-resolution imaging. We demonstrated that our proposed estimator effectively assesses hepatic steatosis and provides visual distinction in the backscattered statistics associated with this condition. Through extensive experiments using real envelope data from patient, we validated that UNICORN enables clinical detection of hepatic steatosis and exhibits robustness and generalizability.
Mar 11, 2026

UltrasoundAgents: Hierarchical Multi-Agent Evidence-Chain Reasoning for Breast Ultrasound Diagnosis

Breast ultrasound diagnosis typically proceeds from global lesion localization to local sign assessment and then evidence integration to assign a BI-RADS category and determine benignity or malignancy. Many existing methods rely on end-to-end prediction or provide only weakly grounded evidence, which can miss fine-grained lesion cues and limit auditability and clinical review. To align with the clinical workflow and improve evidence traceability, we propose a hierarchical multi-agent framework, termed UltrasoundAgents. A main agent localizes the lesion in the full image and triggers a crop-and-zoom operation. A sub-agent analyzes the local view and predicts four clinically relevant attributes, namely echogenicity pattern, calcification, boundary type, and edge (margin) morphology. The main agent then integrates these structured attributes to perform evidence-based reasoning and output the BI-RADS category and the malignancy prediction, while producing reviewable intermediate evidence. Furthermore, hierarchical multi-agent training often suffers from error propagation, difficult credit assignment, and sparse rewards. To alleviate this and improve training stability, we introduce a decoupled progressive training strategy. We first train the attribute agent, then train the main agent with oracle attributes to learn robust attribute-based reasoning, and finally apply corrective trajectory self-distillation with spatial supervision to build high-quality trajectories for supervised fine-tuning, yielding a deployable end-to-end policy. Experiments show consistent gains over strong vision-language baselines in diagnostic accuracy and attribute agreement, together with structured evidence and traceable reasoning.
Mar 10, 2026

CycleULM: A unified label-free deep learning framework for ultrasound localisation microscopy

Super-resolution ultrasound via microbubble (MB) localisation and tracking, also known as ultrasound localisation microscopy (ULM), can resolve microvasculature beyond the acoustic diffraction limit. However, significant challenges remain in localisation performance and data acquisition and processing time. Deep learning methods for ULM have shown promise to address these challenges, however, they remain limited by in vivo label scarcity and the simulation-to-reality domain gap. We present CycleULM, the first unified label-free deep learning framework for ULM. CycleULM learns a physics-emulating translation between the real contrast-enhanced ultrasound (CEUS) data domain and a simplified MB-only domain, leveraging the power of CycleGAN without requiring paired ground truth data. With this translation, CycleULM removes dependence on high-fidelity simulators or labelled data, and makes MB localisation and tracking substantially easier. Deployed as modular plug-and-play components within existing pipelines or as an end-to-end processing framework, CycleULM delivers substantial performance gains across both in silico and in vivo datasets. Specifically, CycleULM improves image contrast (contrast-to-noise ratio) by up to 15.3 dB and sharpens CEUS resolution with a 2.5{\times} reduction in the full width at half maximum of the point spread function. CycleULM also improves MB localisation performance, with up to +40% recall, +46% precision, and a -14.0 μm mean localisation error, yielding more faithful vascular reconstructions. Importantly, CycleULM achieves real-time processing throughput at 18.3 frames per second with order-of-magnitude speed-ups (up to ~14.5{\times}). By combining label-free learning, performance enhancement, and computational efficiency, CycleULM provides a practical pathway toward robust, real-time ULM and accelerates its translation to clinical applications.
Mar 10, 2026

FetalAgents: A Multi-Agent System for Fetal Ultrasound Image and Video Analysis

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.
Mar 9, 2026

OSCAR: Occupancy-based Shape Completion via Acoustic Neural Implicit Representations

Accurate 3D reconstruction of vertebral anatomy from ultrasound is important for guiding minimally invasive spine interventions, but it remains challenging due to acoustic shadowing and view-dependent signal variations. We propose an occupancy-based shape completion method that reconstructs complete 3D anatomical geometry from partial ultrasound observations. Crucially for intra-operative applications, our approach extracts the anatomical surface directly from the image, avoiding the need for anatomical labels during inference. This label-free completion relies on a coupled latent space representing both the image appearance and the underlying anatomical shape. By leveraging a Neural Implicit Representation (NIR) that jointly models both spatial occupancy and acoustic interactions, the method uses acoustic parameters to become implicitly aware of the unseen regions without explicit shadowing labels through tracking acoustic signal transmission. We show that this method outperforms state-of-the-art shape completion for B-mode ultrasound by 80% in HD95 score. We validate our approach both in-silico and on phantom US images with registered mesh models from CT labels, demonstrating accurate reconstruction of occluded anatomy and robust generalization across diverse imaging conditions. Code and data will be released on publication.
Mar 6, 2026

Match4Annotate: Cross-Video Annotation Transfer in Ultrasound via Implicit Feature Flow-Guided Matching

Acquiring per-frame annotations for ultrasound videos is costly and requires clinical expertise, limiting learning-based analysis. We study cross-video annotation transfer: propagating user-specified annotations from a labeled ultrasound video to an independently acquired target video with no target-side labels or manual initialization. Video trackers and segmentation propagators rely on temporal continuity and require a prompt in every new sequence, whereas cross-image feature matching and one-shot segmentation estimate correspondences independently, without enforcing coherent deformations or supporting both point and mask annotations. We present Match4Annotate, a test-time framework with three stages. A spatiotemporal implicit feature representation lifts frozen vision foundation-model features into a continuous field over space and time, enabling queries beyond the backbone resolution. A continuous implicit feature flow then aligns the source and target fields under a smooth-deformation prior, estimating correspondence in feature space rather than relying on intensity consistency, which is often violated in ultrasound by speckle and acquisition-dependent appearance. Finally, flow-guided annotation transfer uses the estimated flow as a spatial prior over feature similarity. This formulation unifies sparse point and dense mask transfer and includes unconstrained feature matching and direct flow warping as limiting cases. On four clinical ultrasound datasets spanning echocardiography and musculoskeletal imaging, Match4Annotate achieves state-of-the-art annotation transfer, outperforming dense feature-matching baselines across PCK thresholds and one-shot segmentation methods in Dice score. It also demonstrates bidirectional transfer of left-ventricular annotations across datasets. It requires no task-specific training and adapts to each video in minutes on a single consumer GPU.
Mar 2, 2026

UltraStar: Semantic-Aware Star Graph Modeling for Echocardiography Navigation

Echocardiography is critical for diagnosing cardiovascular diseases, yet the shortage of skilled sonographers hinders timely patient care, due to high operational difficulties. Consequently, research on automated probe navigation has significant clinical potential. To achieve robust navigation, it is essential to leverage historical scanning information, mimicking how experts rely on past feedback to adjust subsequent maneuvers. Practical scanning data collected from sonographers typically consists of noisy trajectories inherently generated through trial-and-error exploration. However, existing methods typically model this history as a sequential chain, forcing models to overfit these noisy paths, leading to performance degradation on long sequences. In this paper, we propose UltraStar, which reformulates probe navigation from path regression to anchor-based global localization. By establishing a Star Graph, UltraStar treats historical keyframes as spatial anchors connected directly to the current view, explicitly modeling geometric constraints for precise positioning. We further enhance the Star Graph with a semantic-aware sampling strategy that actively selects the representative landmarks from massive history logs, reducing redundancy for accurate anchoring. Extensive experiments on a dataset with over 1.31 million samples demonstrate that UltraStar outperforms baselines and scales better with longer input lengths, revealing a more effective topology for history modeling under noisy exploration. Code is available at https://github.com/LeapLabTHU/UltraStar.
Mar 1, 2026

Adaptive Bidirectional Task Interaction for Joint Segmentation and Classification of Breast Ultrasound

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.
Mar 1, 2026

RAG-RUSS: A Retrieval-Augmented Robotic Ultrasound for Autonomous Carotid Examination

Robotic ultrasound (US) has recently attracted increasing attention as a means to overcome the limitations of conventional US examinations, such as the strong operator dependence. However, the decision-making process of existing methods is often either rule-based or relies on end-to-end learning models that operate as black boxes. This has been seen as a main limit for clinical acceptance and raises safety concerns for widespread adoption in routine practice. To tackle this challenge, we introduce the RAG-RUSS, an interpretable framework capable of performing a full carotid examination in accordance with the clinical workflow while explicitly explaining both the current stage and the next planned action. Furthermore, given the scarcity of medical data, we incorporate retrieval-augmented generation to enhance generalization and reduce dependence on large-scale training datasets. The method was trained on data acquired from 28 volunteers, while an additional four volumetric scans recorded from previously unseen volunteers were reserved for testing. The results demonstrate that the method can explain the current scanning stage and autonomously plan probe motions to complete the carotid examination, encompassing both transverse and longitudinal planes.
Mar 1, 2026

ConVibNet: Needle Detection during Continuous Insertion via Frequency-Inspired Features

Purpose: Ultrasound-guided needle interventions are widely used in clinical practice, but their success critically depends on accurate needle placement, which is frequently hindered by the poor and intermittent visibility of needles in ultrasound images. Existing approaches remain limited by artifacts, occlusions, and low contrast, and often fail to support real-time continuous insertion. To overcome these challenges, this study introduces a robust real-time framework for continuous needle detection. Methods: We present ConVibNet, an extension of VibNet for detecting needles with significantly reduced visibility, addressing real-time, continuous needle tracking during insertion. ConVibNet leverages temporal dependencies across successive ultrasound frames to enable continuous estimation of both needle tip position and shaft angle in dynamic scenarios. To strengthen temporal awareness of needle-tip motion, we introduce a novel intersection-and-difference loss that explicitly leverages motion correlations across consecutive frames. In addition, we curated a dedicated dataset for model development and evaluation. Results: The performance of the proposed ConVibNet model was evaluated on our dataset, demonstrating superior accuracy compared to the baseline VibNet and UNet-LSTM models. Specifically, ConVibNet achieved a tip error of 2.80+-2.42 mm and an angle error of 1.69+-2.00 deg. These results represent a 0.75 mm improvement in tip localization accuracy over the best-performing baseline, while preserving real-time inference capability. Conclusion: ConVibNet advances real-time needle detection in ultrasound-guided interventions by integrating temporal correlation modeling with a novel intersection-and-difference loss, thereby improving accuracy and robustness and demonstrating high potential for integration into autonomous insertion systems.
Mar 1, 2026

MLRecon: Robust Markerless Freehand 3D Ultrasound Reconstruction via Coarse-to-Fine Pose Estimation

Freehand 3D ultrasound (US) reconstruction promises volumetric imaging with the flexibility of standard 2D probes, yet existing tracking paradigms face a restrictive trilemma: marker-based systems demand prohibitive costs, inside-out methods require intrusive sensor attachment, and sensorless approaches suffer from severe cumulative drift. To overcome these limitations, we present MLRecon, a robust markerless 3D US reconstruction framework delivering drift-resilient 6D probe pose tracking using a single commodity RGB-D camera. Leveraging the generalization power of vision foundation models, our pipeline enables continuous markerless tracking of the probe, augmented by a vision-guided divergence detector that autonomously monitors tracking integrity and triggers failure recovery to ensure uninterrupted scanning. Crucially, we further propose a dual-stage pose refinement network that explicitly disentangles high-frequency jitter from low-frequency bias, effectively denoising the trajectory while maintaining the kinematic fidelity of operator maneuvers. Experiments demonstrate that MLRecon significantly outperforms competing sensorless and sensor-aided methods, achieving average position errors as low as 0.88 mm on complex trajectories and yielding high-quality 3D reconstructions with sub-millimeter mean surface accuracy. This establishes a new benchmark for low-cost, accessible volumetric US imaging in resource-limited clinical settings.
Feb 27, 2026

DiffSOS: Acoustic Conditional Diffusion Model for Speed-of-Sound Reconstruction in Ultrasound Computed Tomography

Accurate Speed-of-Sound (SoS) reconstruction from acoustic waveforms is a cornerstone of ultrasound computed tomography (USCT), enabling quantitative velocity mapping that reveals subtle anatomical details and pathological variations often invisible in conventional imaging. However, practical utility is hindered by the limitations of existing algorithms; traditional Full Waveform Inversion (FWI) is computationally intensive, while current deep learning approaches tend to produce oversmoothed results lacking fine details. We propose DiffSOS, a conditional diffusion model that directly maps acoustic waveforms to SoS maps. Our framework employs a specialized acoustic ControlNet to strictly ground the denoising process in physical wave measurements. To ensure structural consistency, we optimize a hybrid loss function that integrates noise prediction, spatial reconstruction, and noise frequency content. To accelerate inference, we employ stochastic Denoising Diffusion Implicit Model (DDIM) sampling, achieving near real-time reconstruction with only 10 steps. Crucially, we exploit the stochastic generative nature of our framework to estimate pixel-wise uncertainty, providing a measure of reliability that is often absent in deterministic approaches. Evaluated on the OpenPros USCT benchmark, DiffSOS significantly outperforms state-of-the-art networks, achieving an average Multi-scale Structural Similarity of 0.957. Our approach provides high-fidelity SoS maps with a principled measure of confidence, facilitating safer and faster clinical interpretation.
Feb 27, 2026

Experience-Guided Self-Adaptive Cascaded Agents for Breast Cancer Screening and Diagnosis with Reduced Biopsy Referrals

We propose an experience-guided cascaded multi-agent framework for Breast Ultrasound Screening and Diagnosis, called BUSD-Agent, that aims to reduce diagnostic escalation and unnecessary biopsy referrals. Our framework models screening and diagnosis as a two-stage, selective decision-making process. A lightweight screening clinic' agent, restricted to classification models as tools, selectively filters out benign and normal cases from further diagnostic escalation when malignancy risk and uncertainty are estimated as low. Cases that have higher risks are escalated to the diagnostic clinic' agent, which integrates richer perception and radiological description tools to make a secondary decision on biopsy referral. To improve agent performance, past records of pathology-confirmed outcomes along with image embeddings, model predictions, and historical agent actions are stored in a memory bank as structured decision trajectories. For each new case, BUSD-Agent retrieves similar past cases based on image, model response and confidence similarity to condition the agent's current decision policy. This enables retrieval-conditioned in-context adaptation that dynamically adjusts model trust and escalation thresholds from prior experiences without parameter updates. Evaluation across 10 breast ultrasound datasets shows that the proposed experience-guided workflow reduces diagnostic escalation in BUSD-Agent from 84.95% to 58.72% and overall biopsy referrals from 59.50% to 37.08%, compared to the same architecture without trajectory conditioning, while improving average screening specificity by 68.48% and diagnostic specificity by 6.33%.
Feb 26, 2026

IRSDE-Despeckle: A Physics-Grounded Diffusion Model for Generalizable Ultrasound Despeckling

Ultrasound imaging is widely used for real-time, noninvasive diagnosis, but speckle and related artifacts reduce image quality and can hinder interpretation. We present a diffusion-based ultrasound despeckling method built on the Image Restoration Stochastic Differential Equations framework. To enable supervised training, we curate large paired datasets by simulating ultrasound images from speckle-free magnetic resonance images using the Matlab UltraSound Toolbox. The proposed model reconstructs speckle-suppressed images while preserving anatomically meaningful edges and contrast. On a held-out simulated test set, our approach consistently outperforms classical filters and recent learning-based despeckling baselines. We quantify prediction uncertainty via cross-model variance and show that higher uncertainty correlates with higher reconstruction error, providing a practical indicator of difficult or failure-prone regions. Finally, we evaluate sensitivity to simulation probe settings and observe domain shift, motivating diversified training and adaptation for robust clinical deployment.
Feb 23, 2026

Efficient endometrial carcinoma screening via cross-modal synthesis and gradient distillation

Early detection of myometrial invasion is critical for the staging and life-saving management of endometrial carcinoma (EC), a prevalent global malignancy. Transvaginal ultrasound serves as the primary, accessible screening modality in resource-constrained primary care settings; however, its diagnostic reliability is severely hindered by low tissue contrast, high operator dependence, and a pronounced scarcity of positive pathological samples. Existing artificial intelligence solutions struggle to overcome this severe class imbalance and the subtle imaging features of invasion, particularly under the strict computational limits of primary care clinics. Here we present an automated, highly efficient two-stage deep learning framework that resolves both data and computational bottlenecks in EC screening. To mitigate pathological data scarcity, we develop a structure-guided cross-modal generation network that synthesizes diverse, high-fidelity ultrasound images from unpaired magnetic resonance imaging (MRI) data, strictly preserving clinically essential anatomical junctions. Furthermore, we introduce a lightweight screening network utilizing gradient distillation, which transfers discriminative knowledge from a high-capacity teacher model to dynamically guide sparse attention towards task-critical regions. Evaluated on a large, multicenter cohort of 7,951 participants, our model achieves a sensitivity of 99.5%, a specificity of 97.2%, and an area under the curve of 0.987 at a minimal computational cost (0.289 GFLOPs), substantially outperforming the average diagnostic accuracy of expert sonographers. Our approach demonstrates that combining cross-modal synthetic augmentation with knowledge-driven efficient modeling can democratize expert-level, real-time cancer screening for resource-constrained primary care settings.
Feb 22, 2026

US-JEPA: A Joint Embedding Predictive Architecture for Ultrasound

Ultrasound (US) imaging poses unique challenges for representation learning due to its inherently noisy acquisition process. The low signal-to-noise ratio and stochastic speckle patterns hinder standard self-supervised learning methods relying on a pixel-level reconstruction objective. Joint-Embedding Predictive Architectures (JEPAs) address this drawback by predicting masked latent representations rather than raw pixels. However, standard approaches depend on hyperparameter-brittle and computationally expensive online teachers updated via exponential moving average. We propose US-JEPA, a self-supervised framework that adopts the Static-teacher Asymmetric Latent Training (SALT) objective. By using a frozen, domain-specific teacher to provide stable latent targets, US-JEPA decouples student-teacher optimization and pushes the student to expand upon the semantic priors of the teacher. In addition, we provide the first rigorous comparison of all publicly available state-of-the-art ultrasound foundation models on UltraBench, a public dataset benchmark spanning multiple organs and pathological conditions. Under linear probing for diverse classification tasks, US-JEPA achieves performance competitive with or superior to domain-specific and universal vision foundation model baselines. Our results demonstrate that masked latent prediction provides a stable and efficient path toward robust ultrasound representations.
Feb 22, 2026

GUIDE-US: Grade-Informed Unpaired Distillation of Encoder Knowledge from Histopathology to Micro-UltraSound

Purpose: Non-invasive grading of prostate cancer (PCa) from micro-ultrasound (micro-US) could expedite triage and guide biopsies toward the most aggressive regions, yet current models struggle to infer tissue micro-structure at coarse imaging resolutions. Methods: We introduce an unpaired histopathology knowledge-distillation strategy that trains a micro-US encoder to emulate the embedding distribution of a pretrained histopathology foundation model, conditioned on International Society of Urological Pathology (ISUP) grades. Training requires no patient-level pairing or image registration, and histopathology inputs are not used at inference. Results: Compared to the current state of the art, our approach increases sensitivity to clinically significant PCa (csPCa) at 60% specificity by 3.5% and improves overall sensitivity at 60% specificity by 1.2%. Conclusion: By enabling earlier and more dependable cancer risk stratification solely from imaging, our method advances clinical feasibility. Source code will be publicly released upon publication.
Feb 20, 2026

4D-UNet improves clutter rejection in human transcranial contrast enhanced ultrasound

Transcranial ultrasound imaging is limited by high skull absorption, limiting vascular imaging to only the largest vessels. Traditional clutter filters struggle with low signal-to-noise ratio (SNR) ultrasound datasets, where blood and tissue signals cannot be easily separated, even when the echogenicity of the blood is improved with contrast agents. Here, we present a novel 4D U-Net approach for clutter filtering in transcranial 3D Contrast Enhanced Ultrasound (CEUS) exploiting spatial and temporal information via a 4D-UNet implementation to enhance microbubble detection in transcranial data acquired in human adults. Our results show that the 4D-UNet improves temporal clutter filters. By integrating deep learning into CEUS, this study advances neurovascular imaging, offering improved clutter rejection and visualization. The findings underscore the potential of AI-driven approaches to enhance ultrasound-based medical imaging, paving the way for more accurate diagnostics and broader clinical applications.
Feb 19, 2026

The Sound of Death: Deep Learning Reveals Vascular Damage from Carotid Ultrasound

Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide, yet early risk detection is often limited by available diagnostics. Carotid ultrasound, a non-invasive and widely accessible modality, encodes rich structural and hemodynamic information that is largely untapped. Here, we present a machine learning (ML) framework that extracts clinically meaningful representations of vascular damage (VD) from carotid ultrasound videos, using hypertension as a weak proxy label. The model learns robust features that are biologically plausible, interpretable, and strongly associated with established cardiovascular risk factors, comorbidities, and laboratory measures. High VD stratifies individuals for myocardial infarction, cardiac death, and all-cause mortality, matching or outperforming conventional risk models such as SCORE2. Explainable AI analyses reveal that the model relies on vessel morphology and perivascular tissue characteristics, uncovering novel functional and anatomical signatures of vascular damage. This work demonstrates that routine carotid ultrasound contains far more prognostic information than previously recognized. Our approach provides a scalable, non-invasive, and cost-effective tool for population-wide cardiovascular risk assessment, enabling earlier and more personalized prevention strategies without reliance on laboratory tests or complex clinical inputs.
Feb 18, 2026

Towards Autonomous Robotic Kidney Ultrasound: Spatial-Efficient Volumetric Imaging via Template Guided Optimal Pivoting

Medical ultrasound (US) imaging is a frontline tool for the diagnosis of kidney diseases. However, traditional freehand imaging procedure suffers from inconsistent, operator-dependent outcomes, lack of 3D localization information, and risks of work-related musculoskeletal disorders. While robotic ultrasound (RUS) systems offer the potential for standardized, operator-independent 3D kidney data acquisition, the existing scanning methods lack the ability to determine the optimal imaging window for efficient imaging. As a result, the scan is often blindly performed with excessive probe footprint, which frequently leads to acoustic shadowing and incomplete organ coverage. Consequently, there is a critical need for a spatially efficient imaging technique that can maximize the kidney coverage through minimum probe footprint. Here, we propose an autonomous workflow to achieve efficient kidney imaging via template-guided optimal pivoting. The system first performs an explorative imaging to generate partial observations of the kidney. This data is then registered to a kidney template to estimate the organ pose. With the kidney localized, the robot executes a fixed-point pivoting sweep where the imaging plane is aligned with the kidney long axis to minimize the probe translation. The proposed method was validated in simulation and in-vivo. Simulation results indicate that a 60% exploration ratio provides optimal balance between kidney localization accuracy and scanning efficiency. In-vivo evaluation on two male subjects demonstrates a kidney localization accuracy up to 7.36 mm and 13.84 degrees. Moreover, the optimal pivoting approach shortened the probe footprint by around 75 mm when compared with the baselines. These results valid our approach of leveraging anatomical templates to align the probe optimally for volumetric sweep.
Feb 17, 2026

Scaling Ultrasound Volumetric Reconstruction via Mobile Augmented Reality

Accurate volumetric characterization of lesions is essential for oncologic diagnosis, risk stratification, and treatment planning. While imaging modalities such as Computed Tomography provide high-quality 3D data, 2D ultrasound (2D-US) remains the preferred first-line modality for breast and thyroid imaging due to cost, portability, and safety factors. However, volume estimates derived from 2D-US suffer from high inter-user variability even among experienced clinicians. Existing 3D ultrasound (3D-US) solutions use specialized probes or external tracking hardware, but such configurations increase costs and diminish portability, constraining widespread clinical use. To address these limitations, we present Mobile Augmented Reality Volumetric Ultrasound (MARVUS), a resource-efficient system designed to increase accessibility to accurate and reproducible volumetric assessment. MARVUS is interoperable with conventional ultrasound (US) systems, using a foundation model to enhance cross-specialty generalization while minimizing hardware requirements relative to current 3D-US solutions. In a user study involving experienced clinicians performing measurements on breast phantoms, MARVUS yielded a substantial improvement in volume estimation accuracy (mean difference: 0.469 cm3) with reduced inter-user variability (mean difference: 0.417 cm3). Additionally, we prove that augmented reality (AR) visualizations enhance objective performance metrics and clinician-reported usability. Collectively, our findings suggests that MARVUS can enhance US-based cancer screening, diagnostic workflows, and treatment planning in a scalable, cost-conscious, and resource-efficient manner. Usage video demonstration available (https://youtu.be/m4llYcZpqmM).
Dec 6, 2025

Echo-CoPilot: A Multiple-Perspective Agentic Framework for Reliable Echocardiography Interpretation

Echocardiography interpretation requires integrating multi-view temporal evidence with quantitative measurements and guideline-grounded reasoning, yet existing foundation-model pipelines largely solve isolated subtasks and fail when tool outputs are noisy or values fall near clinical cutoffs. We propose Echo-CoPilot, an end-to-end agentic framework that combines a multi-perspective workflow with knowledge-graph-guided measurement selection. Echo-CoPilot runs three independent ReAct-style agents, structural, pathological, and quantitative, that invoke specialized echocardiography tools to extract parameters while querying EchoKG to determine which measurements are required for the clinical question and which should be avoided. A self-contrast language model then compares the evidence-grounded perspectives, generates a discrepancy checklist, and re-queries EchoKG to apply the appropriate guideline thresholds and resolve conflicts, reducing hallucinated measurement selection and borderline flip-flops. On MIMICEchoQA, Echo-CoPilot provides higher accuracy compared to SOTA baselines and, under a stochasticity stress test, achieves higher reliability through more consistent conclusions and fewer answer changes across repeated runs. Our code is publicly available at https://github.com/moeinheidari7829/Echo-CoPilot.
Mar 21, 2025

Echo-E3^3Net: Efficient Endocardial Spatio-Temporal Network for Ejection Fraction Estimation

Left ventricular ejection fraction (LVEF) is a primary marker of cardiac function. However, routine estimation from endocardial measurements requires manual delineation at end-diastole (ED) and end-systole (ES), a process that is time-consuming and subject to inter-observer variability. Reliable automation is especially valuable for point-of-care ultrasound (POCUS), where computational resources are limited and acquisition quality varies. We propose Echo-E3^3Net, an anatomy-guided spatio-temporal network that explicitly embeds cardiac anatomy into LVEF prediction. A dual-phase Endocardial Border Detector (E2^2CBD) uses phase-specific cross-attention to localize ED/ES endocardial landmarks and produce phase-aware landmark embeddings, while an Endocardial Feature Aggregator (E2^2FA) fuses these embeddings with global statistical descriptors of deep feature maps to refine EF regression. Training is guided by a lightweight geometric loss that uses ED and ES endocardial landmarks to regularize EF prediction. On EchoNet-Dynamic and a PSAX subset of EchoNet-Pediatric, Echo-E3^3Net attains competitive performance using only 1.55M parameters and 8.05 GFLOPs, an order-of-magnitude compute reduction versus recent baselines, supporting real-time deployment. Our code is publicly available at https://github.com/moeinheidari7829/Echo-E3Net.
Nov 14, 2023

Performance of Machine Learning Classification in Sonomammogram Images using BI-RADS

This research aims to investigate the classification accuracy of various state-of-the-art image classification models across different categories of breast ultrasound images, as defined by the Breast Imaging Reporting and Data System (BI-RADS). To achieve this, we used 2,945 sonomammogram images for training and 936 images for validation, with the source cohort reported as comprising 1,540 patients. In order to conduct a thorough analysis, we employed six advanced classification architecture families, including VGG19 \cite{simonyan2014very}, ResNet50 \cite{he2016deep}, GoogleNet \cite{szegedy2015going}, ConvNeXt \cite{liu2022convnet}, EfficientNet \cite{tan2019efficientnet}, and Vision Transformers (ViT) \cite{dosovitskiy2020image}, instead of traditional machine learning models. We evaluate models in three different settings: full fine-tuning, linear evaluation and training from scratch. Our findings demonstrate the effectiveness and capability of our Computer-Aided Diagnosis (CAD) system, with a remarkable accuracy of 76.39% and an F1 score of 67.94% in the full fine-tuning setting. Our findings indicate the potential for enhanced diagnostic accuracy in the field of breast imaging, providing a solid foundation for future endeavors aiming to improve the precision and reliability of CAD systems in medical imaging.