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Left-ventricular ejection fraction (LVEF) is an important indicator of heart failure. Existing methods for LVEF estimation from video require large amounts of annotated data to achieve high performance, e.g. using 10,030 labeled echocardiogram videos to achieve mean absolute error (MAE) of 4.10. Labeling these videos is time-consuming however and limits potential downstream applications to other heart diseases. This paper presents the first semi-supervised approach for LVEF prediction. Unlike general video prediction tasks, LVEF prediction is specifically related to changes in the left ventricle (LV) in echocardiogram videos. By incorporating knowledge learned from predicting LV segmentations into LVEF regression, we can provide additional context to the model for better predictions. To this end, we propose a novel Cyclical Self-Supervision (CSS) method for learning video-based LV segmentation, which is motivated by the observation that the heartbeat is a cyclical process with temporal repetition. Prediction masks from our segmentation model can then be used as additional input for LVEF regression to provide spatial context for the LV region. We also introduce teacher-student distillation to distill the information from LV segmentation masks into an end-to-end LVEF regression model that only requires video inputs. Results show our method outperforms alternative semi-supervised methods and can achieve MAE of 4.17, which is competitive with state-of-the-art supervised performance, using half the number of labels. Validation on an external dataset also shows improved generalization ability from using our method. IEEE

Automatic surgical phase recognition plays a vital role in robot-assisted surgeries. Existing methods ignored a pivotal problem that surgical phases should be classified by learning segment-level semantics instead of solely relying on frame-wise information. This paper presents a segment-attentive hierarchical consistency network (SAHC) for surgical phase recognition from videos. The key idea is to extract hierarchical high-level semantic-consistent segments and use them to refine the erroneous predictions caused by ambiguous frames. To achieve it, we design a temporal hierarchical network to generate hierarchical high-level segments. Then, we introduce a hierarchical segment-frame attention module to capture relations between the low-level frames and high-level segments. By regularizing the predictions of frames and their corresponding segments via a consistency loss, the network can generate semantic-consistent segments and then rectify the misclassified predictions caused by ambiguous low-level frames. We validate SAHC on two public surgical video datasets, i.e., the M2CAI16 challenge dataset and the Cholec80 dataset. Experimental results show that our method outperforms previous state-of-the-arts and ablation studies prove the effectiveness of our proposed modules. Our code has been released at: https://github.com/xmed-lab/SAHC. IEEE