Ultrasound B-mode imaging commonly suffers from speckle noise and artifacts, requiring a delicate balance between contrast, resolution, and preservation of anatomical structures. Although recently developed despeckling methods have achieved some progress, supervised learning approaches remain fundamentally limited by the ground truth paradox, which arises from the absence of noise-free, ground truth reference images in in vivo scenarios. Existing unsupervised diffusion-based methods typically enforce data consistency directly in the nonlinear log-compressed domain, which can disproportionately amplify background artifacts when mapped back to the envelope domain. To overcome these limitations, we propose an uncertainty-guided null-space diffusion (UGNS) framework, a novel label-free solution that enforces consistency correction on a stabilized positive-envelope proxy obtained via inverse log compression. The proposed UGNS introduces several technical novelties: (a) extraction of a structural prior in the stabilized envelope domain to produce a robust signal envelope that preserves anatomical structure, (b) development of an adaptive range-null reconstruction mechanism that uses an adaptive weight mask to preserve tissue regions via range-space projection, and (c) introduction of uncertainty-guided fusion in an adaptive way to mitigate sampling variability. Extensive and comparative experiments were conducted using the PICMUS benchmark and in vivo datasets. The results demonstrate that UGNS achieves competitive generalized contrast-to-noise ratio (gCNR) values across diverse datasets. In addition, it is successfully validated that UGNS effectively suppresses speckle noise while preserving fine spatial resolution. Code is available at https://github.com/yousirong/UGNS.git.
In medical imaging, it is common to use learned perceptual image patch similarity (LPIPS) to compare images semantically in feature space. Although backbones pretrained on natural images are widely used for LPIPS computation, B-mode ultrasound images possess distinct speckle patterns and acoustic-specific image statistics that are fundamentally different from natural images and even from other images in radiology. Consequently, we propose that domain-specific models are needed to measure perceptual similarity in ultrasound data, a finding which is not necessarily the case for other imaging modalities. We compare LPIPS metrics across downstream tasks like classification, segmentation and reconstruction using natural image, medical generalist and ultrasound backbone models and show that selection of LPIPS backbone is a non-trivial design choice. In particular, the ultrasound backbone models were more correlated with downstream performance of supervised models than classical and natural image models, and optimization of the LPIPS loss with an ultrasound backbone achieved a strong balance between reconstruction quality and realism. Our code is available at https://github.com/talg2324/UltraPIPS and introduces the UltraPIPS library, a set of LPIPS metrics based on the open-source foundation models analyzed in this paper.
Recovering the full 3D spine anatomy from intraoperative ultrasound is an ill-posed inverse problem, as the complete structure must be inferred from incomplete and noisy observations. Acoustic occlusions and limited field of view create large unobserved regions, while view-dependent artifacts lead to variability in expert annotations of the visible anatomy. Current supervised ultrasound shape completion methods rely on synthetically generated incomplete-complete paired data to learn conditional mappings under a predefined distribution of simulated occlusions. However, real intraoperative occlusions do not necessarily follow this distribution, which can limit generalization to patient data. As a result, accurate and robust completion from noisy partial observations remains an unsolved problem. We propose a zero-shot shape completion framework that reconstructs the entire lumbar spine from partial ultrasound observations without relying on simulated training data. To accommodate unseen and irregular patterns of missing structures, we introduce blended completion, a mechanism that integrates the learned anatomical prior with incoming partial geometry at inference time. The method learns a generative diffusion prior over full anatomical shapes represented in an adaptive octree structure, enabling efficient modeling of the complete spine in a single forward pass. Validation on phantom and volunteer data shows that decoupling completion from a predefined corruption distribution improves generalisation under real occlusions, outperforming a fully supervised variant by 22% on HD95 completion error. Code and data are available at https://github.com/miruna20/ZODIAC.
Alisher Myrgyyassov, Zhen Song, Bruce Xiao Wang +4cs.CV cs.AI
Ultrasound tongue contour segmentation remains challenging under cross-dataset domain shift, where limited annotations, probe variability, and acquisition noise often degrade model generalization. We present a source-free domain adaptation framework for robust ultrasound tongue segmentation built on a lightweight UltraUNet backbone. Starting from a checkpoint pretrained on only five labeled source images, simulating an underfitted constrained source model, the proposed method adapts to a fully-unlabeled target domain by iteratively refining pseudo-labels, filtering unreliable masks with a contour-based quality-control module, and generating target-style synthetic image-mask pairs through a segmentation-guided conditional GAN. The student model is then trained on a mixture of clean pseudo-labeled target images, noisy pseudo-labels with consistency regularization, and synthetic samples, enabling closed-loop adaptation without access to source data. We evaluate the method on 12 source-target transfer pairs across eight ultrasound tongue imaging datasets, and conduct source-size scaling experiments and ablation studies. Across all comparisons, the proposed framework improves segmentation overlap and contour accuracy over the baselines, including supervised ones. These results suggest that task-specific pseudo-label refinement and synthetic target-style augmentation can substantially improve source-free adaptation for ultrasound tongue imaging.
Ultrasound is the primary imaging modality for assessing thyroid nodules, and the ACR TI-RADS framework standardizes diagnosis through five ultrasound feature categories that are aggregated into five risk levels (TR1-TR5). Although widely adopted in clinical practice, most deep learning approaches focus on binary malignancy classification, while multi-class prediction and explicit utilization of feature-level supervision remain underexplored, largely due to limited annotated data. In this study, we introduce the STN dataset of 600 thyroid nodules with paired transverse and longitudinal ultrasound images, bounding box annotations, and complete labels for all five TI-RADS feature categories. Following the clinical decision process, we investigate how structured feature information can guide representation learning during training while requiring only images at inference. We demonstrate that text embeddings derived from standardized feature descriptions form a stable surrogate representation for TI-RADS risk levels. Based on this observation, we propose CMCNet, which aligns image embeddings to fixed textual embeddings via a Center-Margin Contrastive Loss that simultaneously promotes intra-class compactness and inter-class separation. Experimental results show that this embedding alignment strategy is more data-efficient and robust than direct multitask learning, and consistently outperforms InfoNCE, center loss, a strong multitask baseline, and a VQA-style multimodal model, particularly in imbalanced settings. The dataset is freely available at doi: 10.5281/zenodo.19125693 and the source code is available at: https://www.healthinformaticslab.org/supp/.
Rehan Ahmad, Gousia Habib, Muhammad Shaban +1cs.CV
Chronic kidney disease (CKD) is a silent disease. Its progression may not significantly hamper a person's daily routine. Human kidney function can be classified as normal or as one of the five stages of CKD. Early detection of the CKD stage can help patients understand the functional status of their kidneys and follow medical advice to slow CKD progression. In this paper, we propose XEns-CKD, a novel ensemble vision transformer-based scheme for CKD stage classification using ultrasound images. Three ViTs were trained on a private ultrasound image dataset using different training parameters. The performance of each ViT was evaluated using macro sensitivity, macro specificity, macro precision, macro F1-score, macro Youden index, the Matthews correlation coefficient (MCC), and macro balanced accuracy. The ensemble model achieved an overall classification accuracy of 86.36%. This work also emphasizes identifying and interpreting kidney regions affected by CKD progression. Explainable artificial intelligence techniques, including LIME, LRP, Attention-Min, and Attention-Max, were used to improve model transparency and clinical trust. An attention map combining the Attention-Min and Attention-Max results effectively identified and interpreted kidney regions affected during CKD progression from one stage to another. The attention map also highlighted the effects of CKD progression in these regions. Compared with existing methods, the proposed method classified the five CKD stages and normal kidney status with a 4% improvement in accuracy.
The speed of sound in tissue is a prerequisite for well-focused imaging and has diagnostic value, but recovering it from raw pulse-echo channel data is fundamentally a nonlinear inverse problem. Learned solvers are fast yet label hungry. Simulated sound-speed labels are expensive, while abundant real channel data is unlabeled. We propose IQ-JEPA to exploit both data types. An encoder is pretrained without labels to predict the latent representation of masked in-phase and quadrature (IQ) regions from visible context, then fine-tuned on simulated maps. Sound speed appears in the IQ signal as a phase difference, invariant to the constant phase offset. The encoder is a Hermitian vision transformer that operates on the complex signal directly. Its attention is equivariant to that phase and its conjugate-product feed-forward is invariant to it, so the encoder reads a quantity analogous to the one classical coherence methods use. On 79,293 Fullwave 2.5 simulations at 2.5 MHz, pretraining on the 63,435 unlabeled acquisitions reaches 15.60 m/s at 10,000 labels. This is a roughly threefold gain in label efficiency over supervised training, growing to over fourfold at 1,000 labels. It is about 2.2x below an InversionNet baseline, and 8.71 m/s at full labels. The gain still grows with more unlabeled pretraining data. Our comparisons point to self-supervision as the dominant factor. The same encoder transfers. Its frozen features expose sound speed and attenuation, and cross-distribution pretraining between layered and abdominal phantoms costs little accuracy. We see this as a first step toward a foundation model for quantitative ultrasound.
Hiu Ching Cheung, Wenchao Yue, Zhengran Han +4eess.IV cs.CV cs.RO
Tracheostomy requires precise localization of the tracheal incision site; however, conventional manual palpation is subjective and often unreliable, while ultrasound utility remains operator-dependent. This work presents a learning-based framework for hierarchical tracheal anatomy understanding, designed specifically for ultrasound-guided robotic systems. We propose a two-stage perception pipeline integrating a YOLOv8n localization backbone with a sparse, prompt-optimized SAM2 decoder to achieve high-fidelity segmentation from sparse surgical annotations. Our hybrid training strategy, bridging curated laboratory data with unconstrained sequences, ensures clinical robustness. Experimental benchmarks demonstrate that this decoupled architecture effectively balances generalization, precision, and efficiency. The YOLOv8n and SAM2 framework achieves a consistent Mean Dice Similarity Coefficient (DSC) of 0.777 across both controlled and generalized domains. This significantly outperforms U-Net baselines, which often suffer from anatomical fragmentation and performance degradation (Generalization DSC $\le$ 0.494). By constraining mask decoding to targeted, sparse regions of interest, our model achieves a throughput of 6.92 FPS, which is vital for closed-loop robotic teleoperation. This study confirms that a robust hierarchical understanding of tracheal anatomy can be derived by coupling lightweight localization with foundation-scale visual models. Our framework establishes a scalable foundation for standardized, autonomous surgical assistance, effectively navigating the variability of real-world ultrasound to enhance the safety and precision of robotic-assisted tracheostomy.
Ultrasound image classification is essential for computer-aided diagnosis. However, current methods often neglect clinical priors, leading to poor generalization in challenging scenarios and a lack of interpretability that limits clinical adoption. To address these issues, we aim to develop a medical-prior module that can be seamlessly integrated into existing pipelines to enhance both diagnostic performance and interpretability. In this paper, we propose an attribute-guided dual-branch framework for ultrasound classification that introduces domain-agnostic medical attribute priors, improving generalization while offering interpretable evidence. Specifically, a baseline branch follows conventional architectures and predicts image categories via a fully connected classifier. An attribute-guided branch injects domain-agnostic attributes as priors and produces human-interpretable decision cues. Finally, an adaptive decision module fuses the two branches in a data-dependent manner to yield the final prediction. Experiments across diverse ultrasound classification tasks demonstrate that our approach can be integrated into multiple backbones and state-of-the-art methods with low overhead, consistently improving accuracy and interpretability. Code is available at: https://github.com/zhaobo253-crypto/AttrGuide.
Prenatal anomaly classification and localization is of critical importance for fetal health and pregnancy management. Although ultrasound (US) is the primary modality for prenatal screening, accurate diagnosis remains challenging due to the low prevalence and high heterogeneity of anomalies. Existing deep learning methods for prenatal tasks rely on large-scale annotated datasets, which are difficult to obtain in practice. Although few-shot learning alleviates data scarcity, it typically requires fine-tuning for new categories, limiting its practicality in resource-limited clinical settings. To address these challenges, we propose a training-free framework for multi-class prenatal US anomaly classification and localization that operates with only a few reference images per class, representing the first exploration of this setting. Our framework comprises three key components: (1) a memory bank with multi-granular prototypes that explicitly models both class-level semantics and anomaly characteristics; (2) a prototype-driven soft merging mechanism that aggregates discriminative features to detect the anomaly region; and (3) a class-aware refinement strategy that leverages prototype consistency to improve category prediction. Extensively validated on a multi-center prenatal US dataset containing 1,149 cases, with a total of 2,357 images and 9 categories, our proposed method outperforms the competitors.
Ultrasound is a non-invasive, real-time, and cost-effective imaging technique widely used in clinical diagnosis. However, its diagnostic efficacy is often compromised by inherent speckle noise that degrades image quality and obscures underlying anatomical structures. Existing speckle reduction methods tend to over-smooth tissue boundaries and generalize poorly to heterogeneous noise levels. To address these limitations, we propose a Noise-Aware Boundary-Enhanced Generative Learning (NBGL) framework for ultrasound speckle reduction, which simultaneously preserves annotated anatomical boundaries and adapts to varying noise levels. The NBGL framework consists of a speckle reduction branch and a boundary enhancement branch. The former leverages generative learning to suppress speckle noise, while the latter learns boundary-sensitive representations to preserve target anatomical structures. Furthermore, a noise-aware interaction weight generation (NIWG) module estimates the speckle noise level via 3D Laplacian filtering and a median absolute deviation estimator, and translates it into an adaptive interaction weight. This weight is incorporated into a weighted feature-wise linear modulation (wFiLM) module to adaptively modulate cross-branch feature coupling, thereby improving robustness to varying noise levels. Extensive evaluations on 141 3D transvaginal ultrasound volumes demonstrate that NBGL consistently outperforms state-of-the-art methods in speckle reduction and structural preservation across six noise levels, while maintaining consistency with annotated anatomical boundaries.
Hussain Alasmawi, Numan Saeed, Soha Said +1cs.CV cs.LG
Preterm birth (PTB) prediction can enable targeted surveillance and timely intervention, yet most ultrasound-based models use a single selected transvaginal ultrasound (TVUS) frame per patient despite routine exams acquiring multiple cervical images. We formulate PTB prediction as a multiple instance learning (MIL) problem, representing each patient as a variable-sized bag of TVUS images with a single outcome label. To move beyond standard MIL aggregators that collapse a bag into a point estimate, we propose a Gaussian Mixture Model (GMM) pooling, which summarizes all images in a bag into a fixed-length representation by modeling their feature distribution. This design captures intra-patient variability. We evaluate the method on a private clinical cohort and on a public lymph node metastasis benchmark. For PTB prediction, GMM pooling improves over the instance-based model PR-AUC from 0.44 to 0.56. On the lymph node benchmark, it achieves state-of-the-art performance with 0.91 F1-score and 0.89 ROC-AUC for classification and 0.18 MAE for regression. The code is publicly available at https://github.com/HussainAlasmawi/GMM_Pooling.
Fangyijie Wang, Jianjun Yu, Wentao Shi +4cs.HC cs.AI
Clinician-centered evaluation is critical for validating medical AI systems, especially in ultrasound imaging where quantitative metrics do not always capture clinical usability. Existing medical image platforms primarily focus on dataset labeling. They lack integrated support for blinded model comparison and reproducible evaluation workflows. We present a clinician-centered pipeline for remote annotation and evaluation in ultrasound AI studies. The proposed pipeline uses a centralized server and lightweight browser interfaces to enable clinicians to perform annotation, blinded ranking, and review without local dataset downloads. The pipeline also supports multi-rater participation, centralized result aggregation, and automated statistical analysis. We validate the pipeline in a fetal ultrasound segmentation study with six raters spanning expert, generalist, and non-expert experience levels. The system automatically generated Spearman correlation, Kendall's $τ$, and top-1 selection statistics. Results indicated moderate to strong agreement across experts and other groups. The blinded evaluation results showed a tendency for later active learning models to be preferred. These outcomes suggest that the pipeline can support clinician-centered annotation and reproducible human-\ac{AI} evaluation studies in ultrasound imaging. The proposed pipeline is available on \href{https://github.com/13204942/SonoRate}{GitHub}.
Accurate segmentation of carotid arteries in ultrasound imaging is critical for stroke risk assessment. However, speckle noise, low contrast, and blurred boundaries remain major challenges. In this paper, we propose a Frequency-Spatial Synergy Network (FSS-Net) to achieve noise-robust and high-precision carotid artery segmentation. The network integrates wavelet transform, multi-domain attention, and edge enhancement into a unified encoder-decoder architecture. Specifically, a Channel-Spatial-Wavelet Attention (CSWA) module is designed to suppress noise and purify semantic features in the frequency domain. A Wavelet-Enhanced Bottleneck (WEB) module is introduced to capture long-range global dependencies efficiently. Furthermore, a Laplacian-Guided Adaptive Edge Fusion (LAEF) module compensates high-frequency details and maintains boundary continuity. Extensive experiments on carotid ultrasound datasets show that FSS-Net achieves a Dice score (DSC) of 96.46% and strong robustness under low SNR conditions, outperforming several state-of-the-art methods. This method realizes accurate segmentation of carotid artery in ultrasonic imaging, effectively identifies carotid atherosclerotic plaque, and is verified by other task (such as segmentation of breast cancer), suggesting that it has good clinical application potential in identifying abnormal tissue masses in ultrasonic images.
Clinical ultrasound images often contain artificial markers, such as measurement calipers and text, to assist diagnostic interpretation and comparison. However, these markers can introduce shortcut bias in downstream automated analysis, encouraging deep learning models to rely on marker-related cues rather than clinically meaningful anatomy. Existing marker removal methods are either mask-dependent and vulnerable to error propagation, or mask-free deterministic restorers that may over-smooth ultrasound texture and perturb unaffected background regions. To address these challenges, we present Echo-DM, a framework for ultrasound marker removal via conditional latent diffusion and region-aware fusion. Echo-DM follows a common encoder-diffusion-decoder pipeline, where a DiT-based conditional latent diffusion network performs global restoration and a region-aware fusion module enforces preservation-aware image-space refinement under end-to-end mask-free inference. Building on this fixed core design, we further instantiate Echo-DM-V and Echo-DM-R with VAE-based and RAE-based latent modules, respectively, which demonstrates that the Echo-DM architecture is compatible with diverse latent-module instantiations. Extensive experiments on Echo-PAIR, a large-scale paired clinical ultrasound dataset, demonstrate superior marker removal and strong anatomical fidelity compared with representative two-stage baselines, while providing favorable quality--efficiency trade-offs across deployment settings. Data, code and models will be released at https://github.com/MiliLab/Echo-DM.
We externally validated three deep learning models (DenseNet121, ViT-B/32, and ResNet50) for predicting mammographic breast density from breast ultrasound exams on an independent cohort. The external validation set comprised 2,000 ultrasound exams, including 500 cancer cases defined by an initial negative exam (BI-RADS 1 or 2) followed by a cancer diagnosis within 6 months to 10 years, and 1,500 negative controls matched by manufacturer and study year. Performance was measured using patient-level AUROC across four density categories: A (fatty), B (scattered), C (heterogeneous), and D (extremely dense). As a downstream assessment, we also evaluated 10-year risk prediction by incorporating age and AI-derived density into the Tyrer-Cuzick model and comparing performance against a reference model using age and mammography-reported density. All three models performed best in extremely dense breasts (AUROC 0.868-0.899), with strong performance in fatty (0.814-0.838) and scattered density (0.764-0.799), and lower performance in heterogeneously dense breasts (0.699-0.729). DenseNet121 achieved the highest overall performance (micro-averaged AUROC 0.885), and performance across categories was comparable between internal and external testing. For risk modeling, age combined with AI-derived density yielded a lower AUROC than age combined with mammography-reported density (0.541 vs. 0.570; p = 0.23), with no statistically significant difference. These findings indicate that deep learning models generalize well to external data with different racial composition for breast density assessment. While performance is strongest in extremely dense breasts, heterogeneously dense remains more challenging, highlighting the need for targeted optimization.
Zhuoyang Lyu, Yiyang Zhang, Tongxin Wang +1cs.CV cs.LG
Ultrasound foundation models have achieved strong performance on structured prediction tasks but remain exclusively vision-based, limiting zero-shot and few-shot transfer to novel tasks where task-specific annotation is scarce. We address this gap with EchoCare-CLIP, a CLIP-style dual-encoder contrastive framework that aligns ultrasound images with clinical text in a shared embedding space. We curate a multi-organ corpus of over 16K image-text pairs spanning breast, liver, lung, and thyroid, with over 78% of captions derived from expert-annotated reports, and complement the remainder with a three-tier template-based and LLM-based caption generation pipeline. We evaluate model configurations spanning two text encoder families (CLIP, BioClinicalBERT) and two caption strategies (template-based, LLM-generated) against OpenAI CLIP and BiomedCLIP baselines. Our trained models consistently improve cross-modal alignment over baselines, with the best configuration achieving a paired alignment score of 0.682. However, stronger alignment does not guarantee better downstream performance: CLIP-based variants with partial fine-tuning achieve the strongest zero-shot classification on external held-out datasets (0.709 on BUSI; 0.626 on AULI), while full end-to-end fine-tuning degrades transfer due to overfitting. On linear probing and few-shot adaptation, model rankings are dataset-dependent, reflecting a trade-off between domain adaptation and representational generalizability. We further show that template-based captions match or outperform LLM-generated captions, suggesting lexical diversity is not a proxy for caption quality. Taken together, our results demonstrate that ultrasound vision-language alignment is achievable from public data alone, but robust clinical transfer requires careful balancing of domain adaptation, encoder capacity, and caption supervision quality.