Optimizing Point-of-Care Ultrasound Video Acquisition for Probabilistic Multi-Task Heart Failure Detection

Purpose: Echocardiography with point-of-care ultrasound (POCUS) must support clinical decision-making under tight bedside time and operator-effort constraints. We introduce a personalized data acquisition strategy in which an RL agent, given a partially observed multi-view study, selects the next view to acquire or terminates acquisition to support heart-failure (HF) assessment. Upon termination, a diagnostic model jointly predicts aortic stenosis (AS) severity and left ventricular ejection fraction (LVEF), two key HF biomarkers, and outputs uncertainty, enabling an explicit trade-off between diagnostic performance and acquisition cost. Methods: We model POCUS as a sequential acquisition problem: at each step, a video selector (RL agent) chooses the next view to acquire or terminates acquisition. Upon termination, a shared multi-view transformer performs multi-task inference with two heads, ordinal AS classification, and LVEF regression, and outputs Gaussian predictive distributions yielding ordinal probabilities over AS classes and EF thresholds. These probabilities drive a reward that balances expected diagnostic benefit against acquisition cost, producing patient-specific acquisition pathways. Results: The dataset comprises 12,180 patient-level studies, split into training/validation/test sets (75/15/15). On the 1,820 test studies, our method matches full-study performance while using 32% fewer videos, achieving 77.2% mean balanced accuracy (bACC) across AS severity classification and LVEF estimation, demonstrating robust multi-task performance under acquisition budgets. Conclusion: Patient-tailored, cost-aware acquisition can streamline POCUS workflows while preserving decision quality, producing interpretable scan pathways suited to bedside use. The framework is extensible to additional cardiac endpoints and merits prospective evaluation for clinical integration.

ProtoASNet: Dynamic Prototypes for Inherently Interpretable and Uncertainty-Aware Aortic Stenosis Classification in Echocardiography

Aortic stenosis (AS) is a common heart valve disease that requires accurate and timely diagnosis for appropriate treatment. Most current automatic AS severity detection methods rely on black-box models with a low level of trustworthiness, which hinders clinical adoption. To address this issue, we propose ProtoASNet, a prototypical network that directly detects AS from B-mode echocardiography videos, while making interpretable predictions based on the similarity between the input and learned spatio-temporal prototypes. This approach provides supporting evidence that is clinically relevant, as the prototypes typically highlight markers such as calcification and restricted movement of aortic valve leaflets. Moreover, ProtoASNet utilizes abstention loss to estimate aleatoric uncertainty by defining a set of prototypes that capture ambiguity and insufficient information in the observed data. This provides a reliable system that can detect and explain when it may fail. We evaluate ProtoASNet on a private dataset and the publicly available TMED-2 dataset, where it outperforms existing state-of-the-art methods with an accuracy of 80.0% and 79.7%, respectively. Furthermore, ProtoASNet provides interpretability and an uncertainty measure for each prediction, which can improve transparency and facilitate the interactive usage of deep networks to aid clinical decision-making. Our source code is available at: https://github.com/hooman007/ProtoASNet.