A machine learning algorithm supports ultrasound-naïve novices in the acquisition of diagnostic echocardiography loops and provides accurate estimation of LVEF

• Published in: International journal of cardiac imaging Vol. 37; no. 2; pp. 577 - 586
• Main Authors: Schneider, Matthias, Bartko, Philipp, Geller, Welf, Dannenberg, Varius, König, Andreas, Binder, Christina, Goliasch, Georg, Hengstenberg, Christian, Binder, Thomas
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.02.2021; Springer Nature B.V
• Subjects: Adult; Aged; Algorithms; Artificial intelligence; Cardiac Imaging; Cardiology; Chambers; Clinical Competence; Colleges & universities; Diagnostic systems; Echocardiography; Female; Heart; Heart Diseases - diagnostic imaging; Heart Diseases - physiopathology; Humans; Image acquisition; Image Interpretation, Computer-Assisted; Image quality; Imaging; Learning algorithms; Machine Learning; Male; Mathematical analysis; Medical imaging; Medical students; Medicine; Medicine & Public Health; Middle Aged; Original Paper; Physicians; Pilot Projects; Predictive Value of Tests; Radiology; Reproducibility of Results; Stroke Volume; Students; Students, Medical; Ultrasonic imaging; Ultrasound; Ventricle; Ventricular Function, Left; LVEF; Echocardiography; Artificial intelligence; Machine learning; Left ventricular function
• ISSN: 1569-5794; 1875-8312; 0167-9899; 1573-0743; 1573-0743; 1875-8312
• DOI: 10.1007/s10554-020-02046-6

Left ventricular ejection fraction (LVEF) is the most important parameter in the assessment of cardiac function. A machine-learning algorithm was trained to guide ultrasound-novices to acquire diagnostic echocardiography images. The artificial intelligence (AI) algorithm then estimates LVEF from the captured apical-4-chamber (AP4), apical-2-chamber (AP2), and parasternal-long-axis (PLAX) loops. We sought to test this algorithm by having first-year medical students without previous ultrasound knowledge scan real patients. Nineteen echo-naïve first-year medical students were trained in the basics of echocardiography by a 2.5 h online video tutorial. Each student then scanned three patients with the help of the AI. Image quality was graded according to the American College of Emergency Physicians scale. If rated as diagnostic quality, the AI calculated LVEF from the acquired loops (monoplane and also a “best-LVEF” considering all views acquired in the particular patient). These LVEF calculations were compared to images of the same patients captured and read by three experts (ground-truth LVEF [GT-EF]). The novices acquired diagnostic-quality images in 33/57 (58%), 49/57 (86%), and 39/57 (68%) patients in the PLAX, AP4, and AP2, respectively. At least one of the three views was obtained in 91% of the attempts. We found an excellent agreement between the machine’s LVEF calculations from images acquired by the novices with the GT-EF (bias of 3.5% ± 5.6 and r = 0.92, p < 0.001 in the “best-LVEF” algorithm). This pilot study shows first evidence that a machine-learning algorithm can guide ultrasound-novices to acquire diagnostic echo loops and provide an automated LVEF calculation that is in agreement with a human expert.