Automatic Quality Assessment of Echocardiograms Using Convolutional Neural Networks: Feasibility on the Apical Four-Chamber View

Echocardiography(echo) is a skilled technical procedure that depends on the experience of the operator. The aim of this paper is to reduce user variability in data acquisition by automatically computing a score of echo quality for operator feedback. To do this, a deep convolutional neural network model, trained on a large set of samples, was developed for scoring apical four-chamber (A4C) echo. In this paper, 6,916 end-systolic echo images were manually studied by an expert cardiologist and were assigned a score between 0 (not acceptable) and 5 (excellent). The images were divided into two independent training-validation and test sets. The network architecture and its parameters were based on the stochastic approach of the particle swarmoptimization on the training-validation data. The mean absolute error between the scores from the ultimately trained model and the expert's manual scores was 0.71 +/- 0.58. The reported error was comparable to the measured intra-rater reliability. The learned features of the network were visually interpretable and could be mapped to the anatomy of the heart in the A4C echo, giving confidence in the training result. The computation time for the proposed network architecture, running on a graphics processing unit, was less than 10 ms per frame, sufficient for real-time deployment. The proposed approach has the potential to facilitate the widespread use of echo at the point-of-care and enable early and timely diagnosis and treatment. Finally, the approach did not use any specific assumptions about the A4C echo, so it could be generalizable to other standard echo views.