Hybrid Attention for Automatic Segmentation of Whole Fetal Head in Prenatal Ultrasound Volumes

Background and Objective: Biometric measurements of fetal head are important indicators for maternal and fetal health monitoring during pregnancy. 3D ultrasound (US) has unique advantages over 2D scan in covering the whole fetal head and may promote the diagnoses. However, automatically segmenting the whole fetal head in US volumes still pends as an emerging and unsolved problem. The challenges that automated solutions need to tackle include the poor image quality, boundary ambiguity, long-span occlusion, and the appearance variability across different fetal poses and gestational ages. In this paper, we propose the first fully-automated solution to segment the whole fetal head in US volumes. Methods: The segmentation task is firstly formulated as an end-to-end volumetric mapping under an encoder-decoder deep architecture. We then combine the segmentor with a proposed hybrid attention scheme (HAS) to select discriminative features and suppress the non-informative volumetric features in a composite and hierarchical way. With little computation overhead, HAS proves to be effective in addressing boundary ambiguity and deficiency. To enhance the spatial consistency in segmentation, we further organize multiple segmentors in a cascaded fashion to refine the results by revisiting context in the prediction of predecessors. Results: Validated on a large dataset collected from 100 healthy volunteers, our method presents superior segmentation performance (DSC (Dice Similarity Coefficient), 96.05%), remarkable agreements with experts. With another 156 volumes collected from 52 volunteers, we ahieve high reproducibilities (mean standard deviation 11.524 mL) against scan variations. Conclusion: This is the first investigation about whole fetal head segmentation in 3D US. Our method is promising to be a feasible solution in assisting the volumetric US-based prenatal studies.