Blake VanBerlo

Background: Deep learning (DL) shows promise for interpretation of lung ultrasound (LUS) images in humans, but its performance in animals remains underexplored. Hypothesis/Objectives: Assess performance of a B-line detection algorithm (BLDA) trained on LUS images from humans when applied to images from dogs. Animals: A total of 1,950 clips collected from 201 LUS examinations in 90 dogs across 4 studies. Methods: Ultrasound clips were collated and labeled with A-line or B-line profiles by an expert reviewer. A DL model previously trained on LUS images from humans was applied to detect presence of B-lines at a framewise level. A clip classification algorithm was calibrated to maximize clip-level performance of the BLDA using a calibration data set. Performance of the DL model and BLDA was assessed on a held-out test set of LUS images. A heatmap-based explainability method was used to visualize regions most utilized by the model for predictions. Results: When applied to the test set, the BLDA showed an overall accuracy of 87%, with sensitivity of 73% and specificity of 93%. The algorithm performed best when identifying images with strong (versus weak) B-line profiles. Assessing raw model predictions, zero-shot performance for identification of B-lines was excellent (area under the curve, 0.96). Heatmaps suggested that the DL model utilized image areas that were plausibly relevant for LUS interpretation. Conclusions and clinical importance: A LUS model trained on images from humans maintained strong performance when applied to dogs, supporting cross-species generalization to accelerate veterinary diagnostic innovations.

Data augmentation is a central component of joint embedding self-supervised learning (SSL). Approaches that work for natural images may not always be effective in medical imaging tasks. This study systematically investigated the impact of data augmentation and preprocessing strategies in SSL for lung ultrasound. Three data augmentation pipelines were assessed: (1) a baseline pipeline commonly used across imaging domains, (2) a novel semantic-preserving pipeline designed for ultrasound, and (3) a distilled set of the most effective transformations from both pipelines. Pretrained models were evaluated on multiple classification tasks: B-line detection, pleural effusion detection, and COVID-19 classification. Experiments revealed that semantics-preserving data augmentation resulted in the greatest performance for COVID-19 classification—a diagnostic task requiring global image context. Cropping-based methods yielded the greatest performance on the B-line and pleural effusion object classification tasks, which require strong local pattern recognition. Lastly, semantics-preserving ultrasound image preprocessing resulted in increased downstream performance for multiple tasks. Guidance regarding data augmentation and preprocessing strategies was synthesized for developers working with SSL in ultrasound.

Deep learning (DL) models for medical image classification frequently struggle to generalize to data from outside institutions. Additional clinical data are also rarely collected to comprehensively assess and understand model performance amongst subgroups. Following the development of a single-center model to identify the lung sliding artifact on lung ultrasound (LUS), we pursued a validation strategy using external LUS data. As annotated LUS data are relatively scarce—compared to other medical imaging data—we adopted a novel technique to optimize the use of limited external data to improve model generalizability. Externally acquired LUS data from three tertiary care centers, totaling 641 clips from 238 patients, were used to assess the baseline generalizability of our lung sliding model. We then employed our novel Threshold-Aware Accumulative Fine-Tuning (TAAFT) method to fine-tune the baseline model and determine the minimum amount of data required to achieve predefined performance goals. A subgroup analysis was also performed and Grad-CAM++ explanations were examined. The final model was fine-tuned on one-third of the external dataset to achieve 0.917 sensitivity, 0.817 specificity, and 0.920 area under the receiver operator characteristic curve (AUC) on the external validation dataset, exceeding our predefined performance goals. Subgroup analyses identified LUS characteristics that most greatly challenged the model’s performance. Grad-CAM++ saliency maps highlighted clinically relevant regions on M-mode images. We report a multicenter study that exploits limited available external data to improve the generalizability and performance of our lung sliding model while identifying poorly performing subgroups to inform future iterative improvements. This approach may contribute to efficiencies for DL researchers working with smaller quantities of external validation data.

Self-supervised pretraining has been observed to be effective at improving feature representations for transfer learning, leveraging large amounts of unlabelled data. This review summarizes recent research into its usage in X-ray, computed tomography, magnetic resonance, and ultrasound imaging, concentrating on studies that compare self-supervised pretraining to fully supervised learning for diagnostic tasks such as classification and segmentation. The most pertinent finding is that self-supervised pretraining generally improves downstream task performance compared to full supervision, most prominently when unlabelled examples greatly outnumber labelled examples. Based on the aggregate evidence, recommendations are provided for practitioners considering using self-supervised learning. Motivated by limitations identified in current research, directions and practices for future study are suggested, such as integrating clinical knowledge with theoretically justified self-supervised learning methods, evaluating on public datasets, growing the modest body of evidence for ultrasound, and characterizing the impact of self-supervised pretraining on generalization.

In this study, we investigated whether self-supervised pretraining could produce a neural network feature extractor applicable to multiple classification tasks in B-mode lung ultrasound analysis. When fine-tuning on three lung ultrasound tasks, pretrained models resulted in an improvement of the average across-task area under the receiver operating characteristic curve (AUC) by 0.032 and 0.061 on local and external test sets respectively. Compact nonlinear classifiers trained on features outputted by a single pretrained model did not improve performance across all tasks; however, they reduced inference time by 49% compared to the serial execution of separate fine-tuned models. When training using 1% of the available labels, pretrained models consistently outperformed fully supervised models, with a maximum observed test AUC increase of 0.396 for the task of view classification. Overall, the results indicate that self-supervised pretraining is a useful strategy for producing initial weights for lung ultrasound classifiers.

Self-supervised pretraining has been observed to improve performance in supervised learning tasks in medical imaging. This study investigates the utility of self-supervised pretraining prior to conducting supervised fine-tuning for the downstream task of lung sliding classification in M-mode lung ultrasound images. We propose a novel pairwise relationship that couples M-mode images constructed from the same B-mode image and investigate the utility of data augmentation procedure specific to M-mode lung ultrasound. The results indicate that self-supervised pretraining yields better performance than full supervision, most notably for feature extractors not initialized with ImageNet-pretrained weights. Moreover, we observe that including a vast volume of unlabelled data results in improved performance on external validation datasets, underscoring the value of self-supervision for improving generalizability in automatic ultrasound interpretation. To the authors' best knowledge, this study is the first to characterize the influence of self-supervised pretraining for M-mode ultrasound.