Robust fine-grained echocardiographic view classification with supervised contrastive learning

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Outperformed cross-entropy and standard supervised contrastive baselines

• Primary Outcome: Superior classification performance using supervised contrastive learning framework

• Nnt Or Sensitivity: Feature space alignment stronger with anatomical structure than individual annotator styles

• Confidence Interval: Not reported

Clinical Application

High - builds on existing echo imaging infrastructure with software implementation Highly relevant for Australian cardiology practice; could support Medicare item 55113 (echo) quality assurance and standardisation across public/private sectors All patients undergoing transthoracic echocardiography requiring automated view classification

Abstract

Accurate classification of echocardiographic views is fundamental for automated cardiac analysis. However, clinical practice relies on a large, heterogeneous set of fine-grained acquisitions that introduce substantial inter-observer variability. Existing studies have primarily focused on limited view sets, often collapsing specialised views into broad categories, which limits their clinical relevance. We address this limitation by introducing TTE47, the first publicly available benchmark comprising 47 clinically meaningful views annotated independently by three experts. This dataset enables the rigorous quantification of inter-observer agreement and establishes a foundation for reproducible, clinically relevant evaluation. To tackle the dual challenges of subtle inter-class distinctions and structured label variability, we propose a novel supervised contrastive learning framework incorporating a tailored loss function. Our method outperforms cross-entropy and standard supervised contrastive baselines, achieving leading performance among evaluated methods on TTE47 and surpassing prior work on TMED-2 without dataset-specific pretraining, using a model pretrained on TTE47. Beyond accuracy, we introduce clustering-based metrics, Detection Rate and Label Recovery Precision, that measure semantic coherence and the model's ability to resist annotation variability. Results show that the learned feature space aligns more strongly with underlying anatomical structure than with any single annotator's style, enabling resilience to label shifts and maintaining robustness comparable to human-level disagreement. By integrating multi-expert evaluation, robust representation learning, and interpretable feature-space analysis, this work establishes a scalable and clinically relevant framework for fine-grained echo view classification. Our findings highlight the potential of contrastive pretraining to standardise interpretation, mitigate subjectivity, and enhance the reliability of AI-assisted echocardiography in diverse clinical settings.

References

1. 1.Naidoo, P., Fernandes, P., Dadashi Serej, N., Stowell, C. C., Manisty, C. H., Francis, D. P., & Zolgharni, M. (2026). Robust fine-grained echocardiographic view classification with supervised contrastive learning. Medical Image Analysis, 104006. https://doi.org/10.1016/j.media.2026.104006