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Automatic extraction of hiatal dimensions in 3-D transperineal pelvic ultrasound recordings
Ultrasound in Medicine and Biology
  • Helena Williams, University Hospitals Leuven & King's College London & KU Leuven
  • Laura Cattani, University Hospitals Leuven & Mohamed bin Zayed University of Artificial Intelligence
  • Dominique Van Schoubroeck, University Hospitals Leuven & Mohamed bin Zayed University of Artificial Intelligence
  • Mohammad Yaqub, Mohamed Bin Zayed University of Artificial Intelligence
  • Carole Sudre, King's College London
  • Tom Vercauteren, King's College London
  • Jan D'Hooge, Departement Cardiovasculaire Wetenschappen
  • Jan Deprest, University Hospitals Leuven & Mohamed bin Zayed University of Artificial Intelligence
Document Type

The aims of this work were to create a robust automatic software tool for measurement of the levator hiatal area on transperineal ultrasound (TPUS) volumes and to measure the potential reduction in variability and time taken for analysis in a clinical setting. The proposed tool automatically detects the C-plane (i.e., the plane of minimal hiatal dimensions) from a 3-D TPUS volume and subsequently uses the extracted plane to automatically segment the levator hiatus, using a convolutional neural network. The automatic pipeline was tested using 73 representative TPUS volumes. Reference hiatal outlines were obtained manually by two experts and compared with the pipeline's automated outlines. The Hausdorff distance, area, a clinical quality score, C-plane angle and C-plane Euclidean distance were used to evaluate C-plane detection and quantify levator hiatus segmentation accuracy. A visual Turing test was created to compare the performance of the software with that of the expert, based on the visual assessment of C-plane and hiatal segmentation quality. The overall time taken to extract the hiatal area with both measurement methods (i.e., manual and automatic) was measured. Each metric was calculated both for computer–observer differences and for inter-and intra-observer differences. The automatic method gave results similar to those of the expert when determining the hiatal outline from a TPUS volume. Indeed, the hiatal area measured by the algorithm and by an expert were within the intra-observer variability. Similarly, the method identified the C-plane with an accuracy of 5.76 ± 5.06° and 6.46 ± 5.18 mm in comparison to the inter-observer variability of 9.39 ± 6.21° and 8.48 ± 6.62 mm. The visual Turing test suggested that the automatic method identified the C-plane position within the TPUS volume visually as well as the expert. The average time taken to identify the C-plane and segment the hiatal area manually was 2 min and 35 ± 17 s, compared with 35 ± 4 s for the automatic result. This study presents a method for automatically measuring the levator hiatal area using artificial intelligence-based methodologies whereby the C-plane within a TPUS volume is detected and subsequently traced for the levator hiatal outline. The proposed solution was determined to be accurate, relatively quick, robust and reliable and, importantly, to reduce time and expertise required for pelvic floor disorder assessment.

Publication Date
  • Automatic clinical workflow,
  • Deep learning,
  • Levator hiatus,
  • Segmentation,
  • Transperineal ultrasound,
  • Ultrasound

IR Deposit conditions:

  • OA version (pathway b)
  • Accepted version: 12 month embargo
  • Must link to publisher version with DOI
Citation Information
H. Williams et al., "Automatic extraction of hiatal dimensions in 3-D transperineal pelvic ultrasound recordings", Ultrasound in Medicine & Biology, vol. 47, no. 12, pp. 3470-3479, 2021. Available: 10.1016/j.ultrasmedbio.2021.08.009