Beyond Benchmarks of IUGC: Rethinking Requirements of Deep Learning Methods for Intrapartum Ultrasound Biometry from Fetal Ultrasound Videos

A substantial proportion (45\%) of maternal deaths, neonatal deaths, and stillbirths occur during the intrapartum phase, with a particularly high burden in low- and middle-income countries. Intrapartum biometry plays a critical role in monitoring labor progression; however, the routine use of ultrasound in resource-limited settings is hindered by a shortage of trained sonographers. To address this challenge, the Intrapartum Ultrasound Grand Challenge (IUGC), co-hosted with MICCAI 2024, was launched. The IUGC introduces a clinically oriented multi-task automatic measurement framework that integrates standard plane classification, fetal head-pubic symphysis segmentation, and biometry, enabling algorithms to exploit complementary task information for more accurate estimation. Furthermore, the challenge releases the largest multi-center intrapartum ultrasound video dataset to date, comprising 774 videos (68,106 frames) collected from three hospitals, providing a robust foundation for model training and evaluation. In this study, we present a comprehensive overview of the challenge design, review the submissions from eight participating teams, and analyze their methods from five perspectives: preprocessing, data augmentation, learning strategy, model architecture, and post-processing. In addition, we perform a systematic analysis of the benchmark results to identify key bottlenecks, explore potential solutions, and highlight open challenges for future research. Although encouraging performance has been achieved, our findings indicate that the field remains at an early stage, and further in-depth investigation is required before large-scale clinical deployment. All benchmark solutions and the complete dataset have been publicly released to facilitate reproducible research and promote continued advances in automatic intrapartum ultrasound biometry.

Semi-Supervised 3D Medical Segmentation from 2D Natural Images Pretrained Model

This paper explores the transfer of knowledge from general vision models pretrained on 2D natural images to improve 3D medical image segmentation. We focus on the semi-supervised setting, where only a few labeled 3D medical images are available, along with a large set of unlabeled images. To tackle this, we propose a model-agnostic framework that progressively distills knowledge from a 2D pretrained model to a 3D segmentation model trained from scratch. Our approach, M&N, involves iterative co-training of the two models using pseudo-masks generated by each other, along with our proposed learning rate guided sampling that adaptively adjusts the proportion of labeled and unlabeled data in each training batch to align with the models' prediction accuracy and stability, minimizing the adverse effect caused by inaccurate pseudo-masks. Extensive experiments on multiple publicly available datasets demonstrate that M&N achieves state-of-the-art performance, outperforming thirteen existing semi-supervised segmentation approaches under all different settings. Importantly, ablation studies show that M&N remains model-agnostic, allowing seamless integration with different architectures. This ensures its adaptability as more advanced models emerge. The code is available at https://github.com/pakheiyeung/M-N.

Automated Fetal Biometry Assessment with Deep Ensembles using Sparse-Sampling of 2D Intrapartum Ultrasound Images

The International Society of Ultrasound advocates Intrapartum Ultrasound (US) Imaging in Obstetrics and Gynecology (ISUOG) to monitor labour progression through changes in fetal head position. Two reliable ultrasound-derived parameters that are used to predict outcomes of instrumental vaginal delivery are the angle of progression (AoP) and head-symphysis distance (HSD). In this work, as part of the Intrapartum Ultrasounds Grand Challenge (IUGC) 2024, we propose an automated fetal biometry measurement pipeline to reduce intra- and inter-observer variability and improve measurement reliability. Our pipeline consists of three key tasks: (i) classification of standard planes (SP) from US videos, (ii) segmentation of fetal head and pubic symphysis from the detected SPs, and (iii) computation of the AoP and HSD from the segmented regions. We perform sparse sampling to mitigate class imbalances and reduce spurious correlations in task (i), and utilize ensemble-based deep learning methods for task (i) and (ii) to enhance generalizability under different US acquisition settings. Finally, to promote robustness in task iii) with respect to the structural fidelity of measurements, we retain the largest connected components and apply ellipse fitting to the segmentations. Our solution achieved ACC: 0.9452, F1: 0.9225, AUC: 0.983, MCC: 0.8361, DSC: 0.918, HD: 19.73, ASD: 5.71, $\Delta_{AoP}$: 8.90 and $\Delta_{HSD}$: 14.35 across an unseen hold-out set of 4 patients and 224 US frames. The results from the proposed automated pipeline can improve the understanding of labour arrest causes and guide the development of clinical risk stratification tools for efficient and effective prenatal care.

Geometric Transformation Uncertainty for Improving 3D Fetal Brain Pose Prediction from Freehand 2D Ultrasound Videos

Accurately localizing two-dimensional (2D) ultrasound (US) fetal brain images in the 3D brain, using minimal computational resources, is an important task for automated US analysis of fetal growth and development. We propose an uncertainty-aware deep learning model for automated 3D plane localization in 2D fetal brain images. Specifically, a multi-head network is trained to jointly regress 3D plane pose from 2D images in terms of different geometric transformations. The model explicitly learns to predict uncertainty to allocate higher weight to inputs with low variances across different transformations to improve performance. Our proposed method, QAERTS, demonstrates superior pose estimation accuracy than the state-of-the-art and most of the uncertainty-based approaches, leading to 9% improvement on plane angle (PA) for localization accuracy, and 8% on normalized cross-correlation (NCC) for sampled image quality. QAERTS also demonstrates efficiency, containing 5$\times$ fewer parameters than ensemble-based approach, making it advantageous in resource-constrained settings. In addition, QAERTS proves to be more robust to noise effects observed in freehand US scanning by leveraging rotational discontinuities and explicit output uncertainties.