Patent Publication Number: US-2022211347-A1

Title: Method and system for automatically detecting an apex point in apical ultrasound image views to provide a foreshortening warning

Description:
FIELD 
     Certain embodiments relate to ultrasound imaging. More specifically, certain embodiments relate to a method and system for providing a foreshortening warning in apical ultrasound image views by automatically detecting an apex point in the apical ultrasound image views. 
     BACKGROUND 
     Ultrasound imaging is a medical imaging technique for imaging organs and soft tissues in a human body. Ultrasound imaging uses real time, non-invasive high frequency sound waves to produce a series of two-dimensional (2D) and/or three-dimensional (3D) images. 
     During an echocardiogram ultrasound imaging procedure, an ultrasound operator may acquire apical views of the heart over a time period, such as one or more cardiac cycles. The apical ultrasound image views may be used to perform various measurements, such as an ejection fraction measurement, among other things. However, foreshortening of apical ultrasound image views may cause inaccurate measurements that may lead to an incorrect diagnosis. 
     Foreshortening of apical views is a common problem in echocardiography that typically results in an abnormally thick false apex and a shortened left ventricular (LV) long axis. Foreshortening refers to a situation where the ultrasound plane does not cut through the true apex of the left ventricle but transects above and anterior of the true apex. Foreshortened apical ultrasound image views provide a geometric distortion of the image of the left ventricle, making the apex look “rounded” instead of the normal “bullet” shape. As a result, the long axis of the left ventricle appears shorter and the false apex is thicker and apparently hyper-contractile resulting in an overestimation of both global and regional LV function and an underestimation of LV volume and length. In addition, apical thrombus or infarction can be missed in a foreshortened view. 
     Currently, foreshortening may be manually determined by an experienced ultrasound operator viewing the acquired apical ultrasound views. For less experienced operators or if the experienced ultrasound operator does not recognize the foreshortening, the determination may not be made until measurements are performed, if at all. For example, an ultrasound operator may determine that foreshortening is present based on unusual measurements, such as an ejection fraction measurement that appears overly low. 
     Further limitations and disadvantages of conventional and traditional approaches will become apparent to one of skill in the art, through comparison of such systems with some aspects of the present disclosure as set forth in the remainder of the present application with reference to the drawings. 
     BRIEF SUMMARY 
     A system and/or method is provided for automatically detecting an apex point in apical ultrasound image views to provide a foreshortening warning, substantially as shown in and/or described in connection with at least one of the figures, as set forth more completely in the claims. 
     These and other advantages, aspects and novel features of the present disclosure, as well as details of an illustrated embodiment thereof, will be more fully understood from the following description and drawings. 
    
    
     
       BRIEF DESCRIPTION OF SEVERAL VIEWS OF THE DRAWINGS 
         FIG. 1  is a block diagram of an exemplary ultrasound system that is operable to automatically detect an apex point in apical ultrasound image views to provide a foreshortening warning, in accordance with various embodiments. 
         FIG. 2  is a display of an exemplary electrocardiogram (ECG) and an exemplary apical ultrasound image view having an apical point marker identifying an apex of a heart, in accordance with various embodiments. 
         FIG. 3  is a display of an exemplary ECG and an exemplary apical ultrasound image view having a first apical point marker identifying an apex of a heart of the current apical ultrasound image view and a second apical point marker identifying a location of the apex in an apical ultrasound image view acquired at a different time, in accordance with various embodiments. 
         FIG. 4  is a display of an exemplary foreshortening warning message, an exemplary ECG, and an exemplary apical ultrasound image view having a first apical point marker identifying an apex of a heart of the current apical ultrasound image view, a second apical point marker identifying a location of the apex in an apical ultrasound image view acquired at a different time, and a distance marker illustrating a distance between the first and second apical point markers, in accordance with various embodiments. 
         FIG. 5  is a flow chart illustrating exemplary steps that may be utilized for automatically detecting an apex point in apical ultrasound image views to provide a foreshortening warning, in accordance with various embodiments. 
     
    
    
     DETAILED DESCRIPTION 
     Certain embodiments may be found in a method and system for automatically detecting an apex point in apical ultrasound image views to provide a foreshortening warning. Aspects of the present disclosure have the technical effect of presenting the apex point for the user on apical ultrasound image views as a visual support in addition to a foreshortening warning message. Various embodiments have the technical effect of automatically detecting the apical point using, for example, artificial intelligence and/or other image processing techniques. Certain embodiments have the technical effect of providing foreshortening warnings by either, for example, comparing the apical points at end diastole and end systole and showing both apical points overlaid on the apical ultrasound image view to visualize the distance, or by plotting on all frames so that the user can see the motion over the cycle. Aspects of the present disclosure have the technical effect of presenting the automatically detected apex point on apical ultrasound image views to demonstrate potential foreshortening. Various embodiments have the technical effect of addressing the challenge of providing feedback to the user live or post-acquisition of an automatically detected foreshortened acquisition, without crowding or cluttering the user interface. Certain embodiments have the technical effect of providing immediate user feedback of foreshortened views. 
     The foregoing summary, as well as the following detailed description of certain embodiments will be better understood when read in conjunction with the appended drawings. To the extent that the figures illustrate diagrams of the functional blocks of various embodiments, the functional blocks are not necessarily indicative of the division between hardware circuitry. Thus, for example, one or more of the functional blocks (e.g., processors or memories) may be implemented in a single piece of hardware (e.g., a general-purpose signal processor or a block of random access memory, hard disk, or the like) or multiple pieces of hardware. Similarly, the programs may be stand alone programs, may be incorporated as subroutines in an operating system, may be functions in an installed software package, and the like. It should be understood that the various embodiments are not limited to the arrangements and instrumentality shown in the drawings. It should also be understood that the embodiments may be combined, or that other embodiments may be utilized, and that structural, logical and electrical changes may be made without departing from the scope of the various embodiments. The following detailed description is, therefore, not to be taken in a limiting sense, and the scope of the present disclosure is defined by the appended claims and their equivalents. 
     As used herein, an element or step recited in the singular and preceded with the word “a” or “an” should be understood as not excluding plural of said elements or steps, unless such exclusion is explicitly stated. Furthermore, references to “an exemplary embodiment,” “various embodiments,” “certain embodiments,” “a representative embodiment,” and the like are not intended to be interpreted as excluding the existence of additional embodiments that also incorporate the recited features. Moreover, unless explicitly stated to the contrary, embodiments “comprising”, “including”, or “having” an element or a plurality of elements having a particular property may include additional elements not having that property. 
     Also as used herein, the term “image” broadly refers to both viewable images and data representing a viewable image. However, many embodiments generate (or are configured to generate) at least one viewable image. In addition, as used herein, the phrase “image” is used to refer to an ultrasound mode such as B-mode (2D mode), M-mode, three-dimensional (3D) mode, CF-mode, PW Doppler, CW Doppler, Contrast Enhanced Ultrasound (CEUS), and/or sub-modes of B-mode and/or CF such as Harmonic Imaging, Shear Wave Elasticity Imaging (SWEI), Strain Elastography, TVI, PDI, B-flow, MVI, UGAP, and in some cases also MM, CM, TVD where the “image” and/or “plane” includes a single beam or multiple beams. 
     Furthermore, the term processor or processing unit, as used herein, refers to any type of processing unit that can carry out the required calculations needed for the various embodiments, such as single or multi-core: CPU, Accelerated Processing Unit (APU), Graphic Processing Unit (GPU), DSP, FPGA, ASIC or a combination thereof. 
     It should be noted that various embodiments described herein that generate or form images may include processing for forming images that in some embodiments includes beamforming and in other embodiments does not include beamforming. For example, an image can be formed without beamforming, such as by multiplying the matrix of demodulated data by a matrix of coefficients so that the product is the image, and wherein the process does not form any “beams”. Also, forming of images may be performed using channel combinations that may originate from more than one transmit event (e.g., synthetic aperture techniques). 
     In various embodiments, ultrasound processing to form images is performed, for example, including ultrasound beamforming, such as receive beamforming, in software, firmware, hardware, or a combination thereof. One implementation of an ultrasound system having a software beamformer architecture formed in accordance with various embodiments is illustrated in  FIG. 1 . 
       FIG. 1  is a block diagram of an exemplary ultrasound system  100  that is operable to automatically detect an apex point in apical ultrasound image views to provide a foreshortening warning, in accordance with various embodiments. Referring to  FIG. 1 , there is shown an ultrasound system  100  and a training system  200 . The ultrasound system  100  comprises a transmitter  102 , an ultrasound probe  104 , a transmit beamformer  110 , a receiver  118 , a receive beamformer  120 , A/D converters  122 , a RF processor  124 , a RF/IQ buffer  126 , a user input device  130 , a signal processor  132 , an image buffer  136 , a display system  134 , and an archive  138 . 
     The transmitter  102  may comprise suitable logic, circuitry, interfaces and/or code that may be operable to drive an ultrasound probe  104 . The ultrasound probe  104  may comprise a two dimensional (2D) array of piezoelectric elements. The ultrasound probe  104  may comprise a group of transmit transducer elements  106  and a group of receive transducer elements  108 , that normally constitute the same elements. In certain embodiment, the ultrasound probe  104  may be operable to acquire ultrasound image data covering at least a substantial portion of an anatomy, such as the heart, a blood vessel, or any suitable anatomical structure. 
     The transmit beamformer  110  may comprise suitable logic, circuitry, interfaces and/or code that may be operable to control the transmitter  102  which, through a transmit sub-aperture beamformer  114 , drives the group of transmit transducer elements  106  to emit ultrasonic transmit signals into a region of interest (e.g., human, animal, underground cavity, physical structure and the like). The transmitted ultrasonic signals may be back-scattered from structures in the object of interest, like blood cells or tissue, to produce echoes. The echoes are received by the receive transducer elements  108 . 
     The group of receive transducer elements  108  in the ultrasound probe  104  may be operable to convert the received echoes into analog signals, undergo sub-aperture beamforming by a receive sub-aperture beamformer  116  and are then communicated to a receiver  118 . The receiver  118  may comprise suitable logic, circuitry, interfaces and/or code that may be operable to receive the signals from the receive sub-aperture beamformer  116 . The analog signals may be communicated to one or more of the plurality of A/D converters  122 . 
     The plurality of A/D converters  122  may comprise suitable logic, circuitry, interfaces and/or code that may be operable to convert the analog signals from the receiver  118  to corresponding digital signals. The plurality of A/D converters  122  are disposed between the receiver  118  and the RF processor  124 . Notwithstanding, the disclosure is not limited in this regard. Accordingly, in some embodiments, the plurality of A/D converters  122  may be integrated within the receiver  118 . 
     The RF processor  124  may comprise suitable logic, circuitry, interfaces and/or code that may be operable to demodulate the digital signals output by the plurality of A/D converters  122 . In accordance with an embodiment, the RF processor  124  may comprise a complex demodulator (not shown) that is operable to demodulate the digital signals to form I/Q data pairs that are representative of the corresponding echo signals. The RF or I/Q signal data may then be communicated to an RF/IQ buffer  126 . The RF/IQ buffer  126  may comprise suitable logic, circuitry, interfaces and/or code that may be operable to provide temporary storage of the RF or I/Q signal data, which is generated by the RF processor  124 . 
     The receive beamformer  120  may comprise suitable logic, circuitry, interfaces and/or code that may be operable to perform digital beamforming processing to, for example, sum the delayed channel signals received from RF processor  124  via the RF/IQ buffer  126  and output a beam summed signal. The resulting processed information may be the beam summed signal that is output from the receive beamformer  120  and communicated to the signal processor  132 . In accordance with some embodiments, the receiver  118 , the plurality of A/D converters  122 , the RF processor  124 , and the beamformer  120  may be integrated into a single beamformer, which may be digital. In various embodiments, the ultrasound system  100  comprises a plurality of receive beamformers  120 . 
     The user input device  130  may be utilized to input patient data, scan parameters, settings, select protocols and/or templates, and the like. In an exemplary embodiment, the user input device  130  may be operable to configure, manage and/or control operation of one or more components and/or modules in the ultrasound system  100 . In this regard, the user input device  130  may be operable to configure, manage and/or control operation of the transmitter  102 , the ultrasound probe  104 , the transmit beamformer  110 , the receiver  118 , the receive beamformer  120 , the RF processor  124 , the RF/IQ buffer  126 , the user input device  130 , the signal processor  132 , the image buffer  136 , the display system  134 , and/or the archive  138 . The user input device  130  may include button(s), rotary encoder(s), a touchscreen, motion tracking, voice recognition, a mousing device, keyboard, camera and/or any other device capable of receiving a user directive. In certain embodiments, one or more of the user input devices  130  may be integrated into other components, such as the display system  134  or the ultrasound probe  104 , for example. As an example, user input device  130  may include a touchscreen display. 
     The signal processor  132  may comprise suitable logic, circuitry, interfaces and/or code that may be operable to process ultrasound scan data (i.e., summed IQ signal) for generating ultrasound images for presentation on a display system  134 . The signal processor  132  is operable to perform one or more processing operations according to a plurality of selectable ultrasound modalities on the acquired ultrasound scan data. In an exemplary embodiment, the signal processor  132  may be operable to perform display processing and/or control processing, among other things. Acquired ultrasound scan data may be processed in real-time during a scanning session as the echo signals are received. Additionally or alternatively, the ultrasound scan data may be stored temporarily in the RF/IQ buffer  126  during a scanning session and processed in less than real-time in a live or off-line operation. In various embodiments, the processed image data can be presented at the display system  134  and/or may be stored at the archive  138 . The archive  138  may be a local archive, a Picture Archiving and Communication System (PACS), or any suitable device for storing images and related information. 
     The signal processor  132  may be one or more central processing units, microprocessors, microcontrollers, and/or the like. The signal processor  132  may be an integrated component, or may be distributed across various locations, for example. In an exemplary embodiment, the signal processor  132  may comprise an apical point detection processor  140 , an apex movement detection processor  150 , and a foreshortening warning processor  160 . The signal processor  132  may be capable of receiving input information from a user input device  130  and/or archive  138 , generating an output displayable by a display system  134 , and manipulating the output in response to input information from a user input device  130 , among other things. The signal processor  132 , apical point detection processor  140 , apex movement detection processor  150 , and foreshortening warning processor  160  may be capable of executing any of the method(s) and/or set(s) of instructions discussed herein in accordance with the various embodiments, for example. 
     The ultrasound system  100  may be operable to continuously acquire ultrasound scan data at a frame rate that is suitable for the imaging situation in question. Typical frame rates range from 20-120 but may be lower or higher. The acquired ultrasound scan data may be displayed on the display system  134  at a display-rate that can be the same as the frame rate, or slower or faster. An image buffer  136  is included for storing processed frames of acquired ultrasound scan data that are not scheduled to be displayed immediately. Preferably, the image buffer  136  is of sufficient capacity to store at least several minutes&#39; worth of frames of ultrasound scan data. The frames of ultrasound scan data are stored in a manner to facilitate retrieval thereof according to its order or time of acquisition. The image buffer  136  may be embodied as any known data storage medium. 
     The signal processor  132  may include an apical point detection processor  140  that comprises suitable logic, circuitry, interfaces and/or code that may be operable to analyze acquired apical ultrasound image views, such as an apical two chamber (2CH) or four chamber (4CH) view, to automatically identify an apical point in the apical ultrasound image views. The apical point detection processor  140  may include image analysis algorithms, artificial intelligence algorithms, one or more deep neural networks (e.g., a convolutional neural network) and/or may utilize any suitable form of image analysis techniques or machine learning processing functionality configured to analyze acquired apical ultrasound image views to automatically identify an apical point in the apical ultrasound image views. The apical point detection processor  140  may be configured to provide the locations of the apical points in the apical ultrasound image views to the apex movement detection processor  150  and/or the foreshortening warning processor  160 . The apical point detection processor  140  may additionally and/or alternatively store the apical point locations at archive  138  and/or any suitable data storage medium. 
     The apical point detection processor  140  may comprise suitable logic, circuitry, interfaces and/or code that may be operable to analyze acquired apical ultrasound image views to identify an apical point. In various embodiments, the apical point detection processor  140  may be provided as a deep neural network that may be made up of, for example, an input layer, an output layer, and one or more hidden layers in between the input and output layers. Each of the layers may be made up of a plurality of processing nodes that may be referred to as neurons. For example, the apical point detection processor  140  may include an input layer having a neuron for each pixel or a group of pixels from a scan plane of an apical view of the heart. The output layer may have a neuron corresponding to an apical point. Each neuron of each layer may perform a processing function and pass the processed ultrasound image information to one of a plurality of neurons of a downstream layer for further processing. As an example, neurons of a first layer may learn to recognize edges of structure in the ultrasound image data. The neurons of a second layer may learn to recognize shapes based on the detected edges from the first layer. The neurons of a third layer may learn positions of the recognized shapes relative to landmarks in the ultrasound image data. The processing performed by the apical point detection processor  140  deep neural network (e.g., convolutional neural network) may identify an apical point in ultrasound image data with a high degree of probability. 
     The signal processor  132  may include apex movement detection processor  150  that comprises suitable logic, circuitry, interfaces and/or code that may be operable to determine whether the apical point identified by the apical point detection processor  140  is moving in the apical ultrasound image views over a time period (e.g., a cardiac cycle). For example, the apex movement detection processor  150  may be configured to determine distances between the apical points in successive frames and/or pre-defined frames (e.g., between current view and end diastole view, between current view and end systole view, between end diastole view and end systole view, or the like). The apex movement detection processor  150  may be configured to determine whether the determined distance exceeds a threshold. The threshold may correspond to no and/or negligible apex movement. The apex movement detection processor  150  may be configured to provide the determined amount of movement to the foreshortening warning processor  160 . The apex movement detection processor  150  may additionally and/or alternatively store the determined amount of movement at archive  138  and/or any suitable data storage medium. 
     The signal processor  132  may include a foreshortening warning processor  160  that comprises suitable logic, circuitry, interfaces and/or code that may be operable to display indications of whether foreshortening is present in the acquired apical ultrasound image views. The foreshortening indications may comprise one or more of apical marker(s), a movement distance indicator, a foreshortening message, and/or any suitable warning indication. For example, the foreshortening warning processor  160  may display an apical point marker if foreshortening is present. The apical point marker may be overlaid at the apex or may be colorized pixels of the apex, for example. The apical point marker may be a shape, such as a dot, circle, star, square, box, arrow, and/or any suitable shape. The foreshortening warning processor  160  may be configured to position the apical point marker at locations identified by the apical point detection processor  140 . The apical point marker may be color-coded to define an amount of movement as indicated by the apex movement detection processor  150 . For example, a green apical marker may correspond with no or negligible apex movement, an orange apical marker may correspond with some apex movement, and a red apical marker may correspond with a large amount of apex movement. In various embodiments, an apical marker may not be presented by the foreshortening warning processor  160  when no or negligible movement is detected by the apex movement detection processor  150 . 
       FIG. 2  is a display  300  of an exemplary electrocardiogram (ECG)  320  and an exemplary apical ultrasound image view  310  having an apical point marker  312  identifying an apex of a heart, in accordance with various embodiments. Referring to  FIG. 2 , the display  300  may comprise an apical ultrasound image view  310  and an ECG  320 . The foreshortening warning processor  160  may be configured to colorize pixels of the apex and/or overlay an apical point marker  312  on the apical ultrasound image view  310  based on the apex location detected by the apical point detection processor  140 . The apical point marker  312  may be color-coded based on an amount of movement indicated by the apex movement detection processor  150 . Alternatively, an amount of movement may be distinguished based on different apical point marker shapes, labels, shading, or the like. The foreshortening warning processor  160  may be configured to identify the temporal location of the displayed apical ultrasound image view  310 . For example, the foreshortening warning processor  160  may be configured to colorize pixels or overlay an ECG marker  322  in the ECG  320  to identify the location of the apical ultrasound image view  310  in the cardiac cycle. 
     Referring again to  FIG. 1 , the foreshortening warning processor  160  may be configured to display multiple apical point markers in an apical ultrasound image view. For example, a first apical point marker may correspond with a location of the apex in the current apical ultrasound image view and a second apical point marker may correspond with an apex location of a previous frame and/or other pre-defined frame (e.g., end of diastole view, end of systole view, and/or the like). In certain embodiments, the foreshortening warning processor  160  may be configured to display a movement distance indicator. For example, the foreshortening warning processor  160  may display a line connecting multiple apical point markers, a distance measurement between apical point markers, and/or any suitable movement distance indication. 
       FIG. 3  is a display  300  of an exemplary ECG  320  and an exemplary apical ultrasound image view  310  having a first apical point marker  312  identifying an apex of a heart of the current apical ultrasound image view  310  and a second apical point marker  314  identifying a location of the apex in an apical ultrasound image view acquired at a different time, in accordance with various embodiments. Referring to  FIG. 3 , the display  300  may comprise an apical ultrasound image view  310  and an ECG  320 . The foreshortening warning processor  160  may be configured to colorize pixels of the apex and/or overlay apical point markers  312 ,  314  on the apical ultrasound image view  310  based on the apex location in the current view  310  and a previous or pre-defined view (e.g., end of diastole view, end of systole view, or the like) as detected by the apical point detection processor  140 . The apical point markers  312 ,  314  may be color-coded to distinguish between the different markers  312 ,  314  and/or based on an amount of movement indicated by the apex movement detection processor  150 . Alternatively, the different markers and/or amount of movement may be distinguished based on different apical point marker shapes, labels, shading, or the like. The foreshortening warning processor  160  may be configured to identify the temporal locations of the displayed apical ultrasound image view  310  and the image view corresponding with the second apical point marker  314 . For example, the foreshortening warning processor  160  may be configured to colorize pixels or overlay ECG markers  322 ,  324  in the ECG  320  to identify the location  322  of the apical ultrasound image view  310  and the location  324  of the previous apical ultrasound image view in the cardiac cycle. 
     Referring again to  FIG. 1 , the foreshortening warning processor  160  may be configured to present a foreshortening message. The foreshortening message may be in addition to or an alternative to the apical point marker(s) and/or the movement distance indication. The foreshortening message may be a visual warning, audio warning, and/or physical warning. The visual warning may be a visual message presented at the display system  134  or any suitable visual warning. For example, the visual warning may be a message stating, “Warning: foreshortened view detected.” The audible warning may be an alarm, message, or any suitable audible feedback. The physical warning may include causing the probe  104  to vibrate, or any suitable physical warning. 
       FIG. 4  is a display  300  of an exemplary foreshortening warning message  330 , an exemplary ECG  320 , and an exemplary apical ultrasound image view  310  having a first apical point marker  312  identifying an apex of a heart of the current apical ultrasound image view  310 , a second apical point marker  314  identifying a location of the apex in an apical ultrasound image view acquired at a different time, and a distance marker  316  illustrating a distance between the first  312  and second  314  apical point markers, in accordance with various embodiments. Referring to  FIG. 4 , the display  300  may comprise an apical ultrasound image view  310 , an ECG  320 , and a foreshortening warning message  330 . The foreshortening warning processor  160  may be configured to colorize pixels of the apex and/or overlay apical point markers  312 ,  314  on the apical ultrasound image view  310  based on the apex location in the current view  310  and a previous or pre-defined view (e.g., end of diastole view, end of systole view, or the like) as detected by the apical point detection processor  140 . The apical point markers  312 ,  314  may be color-coded to distinguish between the different markers  312 ,  314  and/or based on an amount of movement indicated by the apex movement detection processor  150 . Alternatively, the different markers and/or amount of movement may be distinguished based on different apical point marker shapes, labels, shading, or the like. The foreshortening warning processor  160  may be configured to identify the temporal locations of the displayed apical ultrasound image view  310  and the image view corresponding with the second apical point marker  314 . For example, the foreshortening warning processor  160  may be configured to colorize pixels or overlay ECG markers  322 ,  324  in the ECG  320  to identify the location  322  of the apical ultrasound image view  310  and the location  324  of the previous apical ultrasound image view in the cardiac cycle. The foreshortening warning processor  160  may be configured to present a distance marker  316  (also referred to as a movement distance indicator) illustrating an amount of movement. The distance marker  316  may include a line  316  connecting the apical point markers  312 ,  314 , labels, and/or any suitable movement distance indicator. The distance marker may be color-coded, shaded, or the like to provide additional information related to the amount of movement. For example, different colors, shading, or the like may correspond with different amounts of movement. The foreshortening warning processor  160  may be configured to provide a foreshortening message, such as a visual warning  330 , an audio warning, and/or a physical warning. 
     Referring again to  FIG. 1 , the display system  134  may be any device capable of communicating visual information to a user. For example, a display system  134  may include a liquid crystal display, a light emitting diode display, and/or any suitable display or displays. The display system  134  can be operable to present apical ultrasound image views  310 , an ECG  320 , visual foreshortening warnings  330 , and/or any suitable information. For example, the apical ultrasound image views  310 , ECG  320 , and visual foreshortening warnings  330  presented at the display system  134  may include one or more of apical marker(s)  312 ,  314 , a movement distance indicator  316 , a foreshortening message  330 , ECG marker(s)  322 ,  324 , and/or any suitable information. 
     The archive  138  may be one or more computer-readable memories integrated with the ultrasound system  100  and/or communicatively coupled (e.g., over a network) to the ultrasound system  100 , such as a Picture Archiving and Communication System (PACS), a server, a hard disk, floppy disk, CD, CD-ROM, DVD, compact storage, flash memory, random access memory, read-only memory, electrically erasable and programmable read-only memory and/or any suitable memory. The archive  138  may include databases, libraries, sets of information, or other storage accessed by and/or incorporated with the signal processor  132 , for example. The archive  138  may be able to store data temporarily or permanently, for example. The archive  138  may be capable of storing medical image data, data generated by the signal processor  132 , and/or instructions readable by the signal processor  132 , among other things. In various embodiments, the archive  138  stores ultrasound image data, apical point locations, apical point movement information, foreshortening warnings, apical point detection instructions, apex movement detection instructions, and foreshortening warning instructions, for example. 
     Components of the ultrasound system  100  may be implemented in software, hardware, firmware, and/or the like. The various components of the ultrasound system  100  may be communicatively linked. Components of the ultrasound system  100  may be implemented separately and/or integrated in various forms. For example, the display system  134  and the user input device  130  may be integrated as a touchscreen display. 
     Still referring to  FIG. 1 , the training system  200  may comprise a training engine  210  and a training database  220 . The training engine  160  may comprise suitable logic, circuitry, interfaces and/or code that may be operable to train the neurons of the deep neural network(s) (e.g., artificial intelligence model(s)) inferenced (i.e., deployed) by the apical point detection processor  140 . For example, the artificial intelligence model inferenced by the apical point detection processor  140  may be trained to automatically identify anatomical features (e.g., an apex) in ultrasound images (e.g., apical ultrasound image views  310 ). As an example, the training engine  210  may train the deep neural networks deployed by the apical point detection processor  140  using database(s)  220  of classified two chamber (2CH) and four chamber (4CH) apical ultrasound image views. The ultrasound images may include ultrasound images of a particular anatomical feature, such as apical ultrasound image views  310  having an apex, or any suitable ultrasound images and features. 
     In various embodiments, the databases  220  of training images may be a Picture Archiving and Communication System (PACS), or any suitable data storage medium. In certain embodiments, the training engine  210  and/or training image databases  220  may be remote system(s) communicatively coupled via a wired or wireless connection to the ultrasound system  100  as shown in  FIG. 1 . Additionally and/or alternatively, components or all of the training system  200  may be integrated with the ultrasound system  100  in various forms. 
       FIG. 5  is a flow chart  400  illustrating exemplary steps  402 - 424  that may be utilized for automatically detecting an apex point in apical ultrasound image views  310  to provide a foreshortening warning  312 ,  314 ,  316 ,  330 , in accordance with various embodiments. Referring to  FIG. 5 , there is shown a flow chart  400  comprising exemplary steps  402  through  424 . Certain embodiments may omit one or more of the steps, and/or perform the steps in a different order than the order listed, and/or combine certain of the steps discussed below. For example, some steps may not be performed in certain embodiments. As a further example, certain steps may be performed in a different temporal order, including simultaneously, than listed below. 
     At step  402 , an ultrasound system  100  acquires apical ultrasound image views  310  of a heart over a time period. For example, the ultrasound system  100  may acquire apical ultrasound image views  310 , such as apical two chamber (2CH) or four chamber (4CH) views, with an ultrasound probe  104  positioned at a scan position over a heart during a cardiac cycle. In various embodiments, the ultrasound system  100  may receive additional information, such as an ECG  320  and/or any suitable information. 
     At step  404 , a signal processor  132  of the ultrasound system  100  automatically detects an apical point in the acquired ultrasound image views  310 . For example, an apical point detection processor  140  of the signal processor  132  may be configured to analyze the acquired apical ultrasound image views  310  to automatically identify an apical point in the apical ultrasound image views  310 . The apical point detection processor  140  may include image analysis algorithms, artificial intelligence algorithms, one or more deep neural networks (e.g., a convolutional neural network) and/or may utilize any suitable form of image analysis techniques or machine learning processing functionality configured to analyze acquired apical ultrasound image views  310  to automatically identify the apical point in the apical ultrasound image views  310 . 
     At step  406 , the signal processor  132  of the ultrasound system  100  may determine whether the apical point has moved a threshold distance between acquired ultrasound image views over the time period. For example, the apex movement detection processor  150  of the signal processor  132  may be configured to determine whether the apical point identified by the apical point detection processor  140  at step  404  is moving in the apical ultrasound image views  310  over a cardiac cycle. The apex movement detection processor  150  may be configured to determine distances between the apical points in successive frames and/or pre-defined frames (e.g., between current view and end diastole view, between current view and end systole view, between end diastole view and end systole view, or the like). The apex movement detection processor  150  may be configured to determine whether the determined distance exceeds a threshold, which may correspond to no and/or negligible apex movement. The threshold may be user-defined or a default value. In various embodiments, the threshold may include multiple thresholds each corresponding to a different amount of movement (e.g., no movement, negligible movement, medium movement, large movement, and the like). 
     At step  408 , the process  400  may proceed to one or more of steps  410  through  416  if the signal processor  132  of the ultrasound system  100  determines the apical point has moved more than the threshold distance between acquired apical ultrasound image views  310  at step  406 . Additionally and/or alternatively, the process  400  may proceed to one of steps  420  or  422  if the signal processor  132  of the ultrasound system  100  determines the apical point has not moved more than the threshold distance between acquired apical ultrasound image views  310  at step  406 . 
     At step  410 , the signal processor  132  of the ultrasound system  100  may display an apical point marker  312 . For example, the foreshortening warning processor  160  of the signal processor  132  may display indications of whether foreshortening is present in the acquired apical ultrasound image views. The foreshortening indications may comprise an apical point marker  312  if foreshortening is present. The apical point marker  312  may be overlaid at the apex or may be colorized pixels of the apex, for example. The apical point marker may be a shape, such as a dot, circle, star, square, box, arrow, and/or any suitable shape. The foreshortening warning processor  160  may be configured to position the apical point marker  312  at locations identified by the apical point detection processor  140 . The foreshortening warning processor  160  may be configured to identify the temporal location of the displayed apical ultrasound image view  310 . For example, the foreshortening warning processor  160  may be configured to colorize pixels or overlay an ECG marker  322  in the ECG  320  to identify the location of the apical ultrasound image view  310  in the cardiac cycle. 
     At step  412 , the signal processor  132  of the ultrasound system  100  may display an apical point marker  312  indicating an amount of movement. For example, the foreshortening warning processor  160  of the signal processor  132  may display apical point markers  312  that are color-coded, shaded, shaped, labeled, or the like to indicate an amount of movement as determined by the apex movement detection processor  150 . As an example, an orange apical marker may correspond with some apex movement and a red apical marker may correspond with a large amount of apex movement. As another example, the apical point marker  312  may be labeled with an amount of movement. As a further example, different shapes of apical point markers  312  may be used based on the amount of movement as determined by the apex movement detection processor  150 . 
     At step  414 , the signal processor  132  of the ultrasound system  100  may display apical point markers  312 ,  314  indicating a current apical point and additional apical point(s) at additional time(s) in the time period. For example, the foreshortening warning processor  160  of the signal processor  132  may be configured to display multiple apical point markers  312 ,  314  in an apical ultrasound image view  310 . As an example, a first apical point marker  312  may correspond with a location of the apex in the current apical ultrasound image view  310  and a second apical point marker  314  may correspond with an apex location of a previous frame and/or other pre-defined frame (e.g., end of diastole view, end of systole view, and/or the like). In an exemplary embodiment, the foreshortening warning processor  160  may be further configured to display a movement distance indicator  316 . For example, the foreshortening warning processor  160  may display a line  316  connecting multiple apical point markers  312 ,  314 , a distance measurement between apical point markers, and/or any suitable movement distance indication. The foreshortening warning processor  160  may be configured to identify the temporal locations of the displayed apical ultrasound image view  310  and the image view corresponding with the second apical point marker  314 . For example, the foreshortening warning processor  160  may be configured to colorize pixels or overlay ECG markers  322 ,  324  in the ECG  320  to identify the location  322  of the apical ultrasound image view  310  and the location  324  of the previous apical ultrasound image view in the cardiac cycle. 
     At step  416 , the signal processor  132  of the ultrasound system  100  may display a foreshortening warning message  330 . For example, the foreshortening warning processor  160  of the signal processor  132  may be configured to present a foreshortening message  330 . The foreshortening message may be in addition to or an alternative to the apical point marker(s)  312 ,  314  and/or the movement distance indication  316  described above with respect to steps  410 - 414 . The foreshortening message  330  may be a visual warning  330 , audio warning, and/or physical warning. The visual warning  330  may be a visual message presented at the display system  134  or any suitable visual warning. For example, the visual warning  330  may be a message stating, “Warning: foreshortened view detected.” The audible warning may be an alarm, message, or any suitable audible feedback. The physical warning may include causing the probe  104  to vibrate, or any suitable physical warning 
     At step  418 , an ultrasound operator may reposition the ultrasound probe  104  of the ultrasound system  100 . For example, the ultrasound operator may move and/or rotate the ultrasound probe  104  of the ultrasound system in response to the foreshortening warning  312 ,  314 ,  316 ,  330  provided by the foreshortening warning processor  160  of the signal processor  132  of the ultrasound system  100 . The process  400  returns to step  402  and repeats steps  402 - 418  until the signal processor  132  of the ultrasound system  100  determines the apical point has not moved more than the threshold distance between acquired apical ultrasound image views  310  at step  406 , at which time, the process  400  proceeds to step  420  or  422 . 
     At step  420 , the signal processor  132  of the ultrasound system  100  may not display the apical point marker  312 . For example, the foreshortening warning processor  160  of the signal processor  132  may be configured to refrain from displaying the apical point marker  312  if the signal processor  132  of the ultrasound system  100  determines the apical point has not moved more than the threshold distance between acquired apical ultrasound image views  310  at step  406 . 
     At step  422 , the signal processor  132  of the ultrasound system  100  may display an apical point marker  312  indicating no or negligible movement. For example, the foreshortening warning processor  160  of the signal processor  132  may display apical point markers  312  that are color-coded, shaded, shaped, labeled, or the like to indicate an amount of movement as determined by the apex movement detection processor  150 . As an example, a green apical marker may correspond with no or negligible apex movement. As another example, the apical point marker  312  may be labeled with an amount of movement. As a further example, different shapes of apical point markers  312  may be used based on the amount of movement as determined by the apex movement detection processor  150 . 
     At step  424 , the process  300  may end when acquisition of apical ultrasound image views  310  having no or negligible movement is complete. The ultrasound operator and/or signal processor  132  of the ultrasound system  100  may use the apical ultrasound image views  310  not having foreshortening to perform measurements (e.g., an ejection fraction measurement), diagnosis, or the like. 
     Aspects of the present disclosure provide a method  400  and system  100  for automatically detecting an apex point in apical ultrasound image views  310  to provide a foreshortening warning  312 ,  314 ,  316 ,  330 . In accordance with various embodiments, the method  400  may comprise acquiring  402 , by an ultrasound system  100 , apical ultrasound image views  310  over a time period. The method  400  may comprise automatically detecting  404 , by at least one processor  132 ,  140 , an apical point in the apical ultrasound image views  310 . The method  400  may comprise determining  406 ,  408 , by the at least one processor  132 ,  150 , an amount of movement of the apical point in the apical ultrasound image views  310  over the time period. The method  400  may comprise causing  410 - 416 , by the at least one processor  132 ,  160 , a display system  134  to present the apical ultrasound image views  310  with a foreshortening warning  312 ,  314 ,  316 ,  300  when the amount of movement of the apical point in the apical ultrasound image views  310  over the time period exceeds a threshold. 
     In an exemplary embodiment, the foreshortening warning  312 ,  314 ,  316 ,  330  may comprise at least one apical point marker  312 ,  314  presented at the automatically detected apical point in the apical ultrasound image views  310 . In a representative embodiment, the at least one apical point marker  312 ,  314  may be one apical point marker  312  indicating the amount of movement based on color coding in one of a plurality of colors, where each of the plurality of colors corresponds with a different amount of movement. The one apical point marker  312  may additionally and/or alternatively indicate the amount of movement based on shading in one of a plurality of shades, where each of the plurality of shades corresponds to the different amount of movement. The one apical point marker  312  may additionally and/or alternatively indicate the amount of movement based on marker shape selection in one of a plurality of marker shapes, where each of the plurality of marker shapes corresponds to the different amount of movement. The one apical point marker  312  may additionally and/or alternatively indicate the amount of movement based on a label corresponding with the one apical point marker  312 , where the label identifies the amount of movement. In certain embodiments, the at least one apical point marker  312 ,  314  may comprise a first apical point marker  312  corresponding with a currently displayed apical ultrasound image view  310  and a second apical point marker  314  corresponding with a previous apical ultrasound image view in the time period. In various embodiments, the foreshortening warning  312 ,  314 ,  316 ,  330  may comprise a distance marker  316  corresponding to a distance between the first apical point marker  312  and the second apical point marker  314 . In an exemplary embodiment, the at least one apical point marker  312 ,  314  is one of colorized pixels  312 ,  314  of the apical ultrasound image views  310  or a marker  312 ,  314  overlaid on the apical ultrasound image views  310 . In a representative embodiment, the foreshortening warning  312 ,  314 ,  316 ,  330  may comprise a foreshortening warning message  330 . In certain embodiments, the method  400  may comprise causing  422 , by the at least one processor  132 ,  160 , the display system  134  to present the apical ultrasound image views  310  with at least one apical point marker  312 ,  314  provided at the automatically detected apical point in the apical ultrasound image views  310  when the amount of movement of the apical point in the apical ultrasound image views  310  over the time period does not exceed the threshold. The at least one apical point marker  312 ,  314  may indicate one or both of no movement or negligible movement. The method  400  may comprise causing  420 , by the at least one processor  132 ,  160 , the display system  134  to present the apical ultrasound image views  310  without the at least one apical point marker  312 ,  314  when the amount of movement of the apical point in the apical ultrasound image views  310  over the time period does not exceed the threshold. 
     Various embodiments provide a system  100  for automatically detecting an apex point in apical ultrasound image views  310  to provide a foreshortening warning  312 ,  314 ,  316 ,  330 . The system  100  may comprise an ultrasound system  100 , at least one processor  132 ,  140 ,  150 ,  160 , and a display system  134 . The ultrasound system  100  may be configured to acquire apical ultrasound image views  310  over a time period. The at least one processor  132 ,  140  may be configured to automatically detect an apical point in the apical ultrasound image views  310 . The at least one processor  132 ,  150  may be configured to determine an amount of movement of the apical point in the apical ultrasound image views  310  over the time period. The display system  134  may be configured to present the apical ultrasound image views  310  with a foreshortening warning  312 ,  314 ,  316 ,  330  when the amount of movement of the apical point in the apical ultrasound image views  310  over the time period exceeds a threshold. 
     In a representative embodiment, the foreshortening warning  312 ,  314 ,  316 ,  330  may comprise an apical point marker  312  presented at the automatically detected apical point in the apical ultrasound image views  310 . The apical point marker  312  may indicate the amount of movement based on color coding in one of a plurality of colors, where each of the plurality of colors corresponds with a different amount of movement. The apical point marker  312  may additionally and/or alternatively indicate the amount of movement based on shading in one of a plurality of shades, where each of the plurality of shades corresponds to the different amount of movement. The apical point marker  312  may additionally and/or alternatively indicate the amount of movement based on marker shape selection in one of a plurality of marker shapes, where each of the plurality of marker shapes corresponds to the different amount of movement. The apical point marker  312  may additionally and/or alternatively indicate the amount of movement based on a label corresponding with the apical point marker  312 , where the label identifies the amount of movement. In certain embodiments, the foreshortening warning  312 ,  314 ,  316 ,  330  may comprise a first apical point marker  312  corresponding with a currently displayed apical ultrasound image view  310  and a second apical point marker  314  corresponding with a previous apical ultrasound image view in the time period. In various embodiments, the foreshortening warning  312 ,  314 ,  316 ,  330  may comprise a distance marker  316  corresponding to a distance between the first apical point marker  312  and the second apical point marker  314 . In an exemplary embodiment, the foreshortening warning  312 ,  314 ,  316 ,  300  may comprise a foreshortening warning message  330 . In a representative embodiment, the display system  134  may be configured to present the apical ultrasound image views  310  with at least one apical point marker  312 ,  314  provided at the automatically detected apical point in the apical ultrasound image views  310  when the amount of movement of the apical point in the apical ultrasound image views  310  over the time period does not exceed the threshold. The at least one apical point marker  312 ,  314  may indicate one or both of no movement or negligible movement. Alternatively, the display system  134  may be configured to present the apical ultrasound image views  310  without the at least one apical point marker  312 ,  314  when the amount of movement of the apical point in the apical ultrasound image views  310  over the time period does not exceed the threshold. 
     Certain embodiments provide a non-transitory computer readable medium having stored thereon, a computer program having at least one code section. The at least one code section is executable by a machine for causing the machine to perform steps  400 . The steps  400  may comprise receiving  302  an ultrasound image  200 . The steps  400  may comprise receiving  402  apical ultrasound image views  310  over a time period. The steps  400  may comprise automatically detecting  404  an apical point in the apical ultrasound image views  310 . The steps  400  may comprise determining  406 ,  408  an amount of movement of the apical point in the apical ultrasound image views  310  over the time period. The steps  400  may comprise causing  410 - 416  a display system  134  to present the apical ultrasound image views  310  with a foreshortening warning  312 ,  314 ,  316 ,  330  when the amount of movement of the apical point in the apical ultrasound image views  310  over the time period exceeds a threshold. 
     In various embodiments, the foreshortening warning  312 ,  314 ,  316 ,  330  may comprise an apical point marker  312  presented at the automatically detected apical point in the apical ultrasound image views  310 . The apical point marker  312  may indicate the amount of movement based on color coding in one of a plurality of colors, where each of the plurality of colors corresponds with a different amount of movement. The apical point marker  312  may additionally and/or alternatively indicate the amount of movement based on shading in one of a plurality of shades, where each of the plurality of shades corresponds to the different amount of movement. The apical point marker  312  may additionally and/or alternatively indicate the amount of movement based on marker shape selection in one of a plurality of marker shapes, where each of the plurality of marker shapes corresponds to the different amount of movement. The apical point marker  312  may additionally and/or alternatively indicate the amount of movement based on a label corresponding with the apical point marker, where the label identifies the amount of movement. In an exemplary embodiment, the foreshortening warning  312 ,  314 ,  316 ,  330  may comprise a first apical point marker  312  corresponding with a currently displayed apical ultrasound image view  310  and a second apical point marker  314  corresponding with a previous apical ultrasound image view in the time period. In a representative embodiment, the foreshortening warning  312 ,  314 ,  316 ,  330  may comprise a distance marker  316  corresponding to a distance between the first apical point marker  312  and the second apical point marker  314 . In certain embodiments, the foreshortening warning  312 ,  314 ,  316 ,  330  may comprise a foreshortening warning message  330 . In various embodiments, the steps  400  may comprise causing  422  the display system  134  to present the apical ultrasound image views  310  with at least one apical point marker  312 ,  314  provided at the automatically detected apical point in the apical ultrasound image views  310  when the amount of movement of the apical point in the apical ultrasound image views  310  over the time period does not exceed the threshold. The at least one apical point marker  312 ,  314  may indicate one or both of no movement or negligible movement. The steps  400  may additionally and/or alternatively comprise causing  420  the display system  134  to present the apical ultrasound image views  310  without the at least one apical point marker  312 ,  314  when the amount of movement of the apical point in the apical ultrasound image views  310  over the time period does not exceed the threshold. 
     As utilized herein the term “circuitry” refers to physical electronic components (i.e. hardware) and any software and/or firmware (“code”) which may configure the hardware, be executed by the hardware, and or otherwise be associated with the hardware. As used herein, for example, a particular processor and memory may comprise a first “circuit” when executing a first one or more lines of code and may comprise a second “circuit” when executing a second one or more lines of code. As utilized herein, “and/or” means any one or more of the items in the list joined by “and/or”. As an example, “x and/or y” means any element of the three-element set {(x), (y), (x, y)}. As another example, “x, y, and/or z” means any element of the seven-element set {(x), (y), (z), (x, y), (x, z), (y, z), (x, y, z)}. As utilized herein, the term “exemplary” means serving as a non-limiting example, instance, or illustration. As utilized herein, the terms “e.g.,” and “for example” set off lists of one or more non-limiting examples, instances, or illustrations. As utilized herein, circuitry is “operable” and/or “configured” to perform a function whenever the circuitry comprises the necessary hardware and code (if any is necessary) to perform the function, regardless of whether performance of the function is disabled, or not enabled, by some user-configurable setting. 
     Other embodiments may provide a computer readable device and/or a non-transitory computer readable medium, and/or a machine readable device and/or a non-transitory machine readable medium, having stored thereon, a machine code and/or a computer program having at least one code section executable by a machine and/or a computer, thereby causing the machine and/or computer to perform the steps as described herein for automatically detecting an apex point in apical ultrasound image views to provide a foreshortening warning. 
     Accordingly, the present disclosure may be realized in hardware, software, or a combination of hardware and software. The present disclosure may be realized in a centralized fashion in at least one computer system, or in a distributed fashion where different elements are spread across several interconnected computer systems. Any kind of computer system or other apparatus adapted for carrying out the methods described herein is suited. 
     Various embodiments may also be embedded in a computer program product, which comprises all the features enabling the implementation of the methods described herein, and which when loaded in a computer system is able to carry out these methods. Computer program in the present context means any expression, in any language, code or notation, of a set of instructions intended to cause a system having an information processing capability to perform a particular function either directly or after either or both of the following: a) conversion to another language, code or notation; b) reproduction in a different material form. 
     While the present disclosure has been described with reference to certain embodiments, it will be understood by those skilled in the art that various changes may be made and equivalents may be substituted without departing from the scope of the present disclosure. In addition, many modifications may be made to adapt a particular situation or material to the teachings of the present disclosure without departing from its scope. Therefore, it is intended that the present disclosure not be limited to the particular embodiment disclosed, but that the present disclosure will include all embodiments falling within the scope of the appended claims.