Interpretation of ultrasound videos of the fetal heart is crucial for the antenatal diagnosis of congenital heart disease (CHD). We believe that automated image analysis techniques could make an important contribution towards improving CHD detection rates. However, to our knowledge, no previous work has been done in this area. With this goal in mind, this paper presents a framework for tracking the key variables that describe the content of each frame of freehand 2D ultrasound scanning videos of the healthy fetal heart. This represents an important first step towards developing tools that can assist with CHD detection in abnormal cases. We argue that it is natural to approach this as a sequential Bayesian filtering problem, due to the strong prior model we have of the underlying anatomy, and the ambiguity of the appearance of structures in ultrasound images. We train classification and regression forests to predict the visibility, location and orientation of the fetal heart in the image, and the viewing plane label from each frame. We also develop a novel adaptation of regression forests for circular variables to deal with the prediction of cardiac phase. Using a particle-filtering-based method to combine predictions from multiple video frames, we demonstrate how to filter this information to give a temporally consistent output at real-time speeds. We present results on a challenging dataset gathered in a real-world clinical setting and compare to expert annotations, achieving similar levels of accuracy to the levels of inter- and intra-observer variation.
