Google Research

A mobile-optimized artificial intelligence system for gestational age and fetal malpresentation assessment

  • Ryan Gomes
  • Bellington Vwalika
  • Chace Lee
  • Angelica Willis
  • Marcin Sieniek
  • Joan T. Price
  • Christina Chen
  • Margaret P. Kasaro
  • James A. Taylor
  • Elizabeth M. Stringer
  • Scott Mayer McKinney
  • Ntazana Sindano
  • George Edward Dahl
  • William Goodnight, III
  • Justin Gilmer
  • Benjamin H. Chi
  • Charles Lau
  • Terry Spitz
  • T Saensuksopa
  • Kris Liu
  • Tiya Tiyasirichokchai
  • Jonny Wong
  • Rory Pilgrim
  • Akib Uddin
  • Greg Corrado
  • Lily Hao Yi Peng
  • Kat Chou
  • Daniel Tse
  • Jeffrey S. A. Stringer
  • Shravya Ramesh Shetty
Communications Medicine (2022)


Background Fetal ultrasound is an important component of antenatal care, but shortage of adequately trained healthcare workers has limited its adoption in low-to-middle-income countries. This study investigated the use of artificial intelligence for fetal ultrasound in under-resourced settings.

Methods Blind sweep ultrasounds, consisting of six freehand ultrasound sweeps, were collected by sonographers in the USA and Zambia, and novice operators in Zambia. We developed artificial intelligence (AI) models that used blind sweeps to predict gestational age (GA) and fetal malpresentation. AI GA estimates and standard fetal biometry estimates were compared to a previously established ground truth, and evaluated for difference in absolute error. Fetal malpresentation (non-cephalic vs cephalic) was compared to sonographer assessment. On-device AI model run-times were benchmarked on Android mobile phones.

Results Here we show that GA estimation accuracy of the AI model is non-inferior to standard fetal biometry estimates (error difference -1.4 ± 4.5 days, 95% CI -1.8, -0.9, n=406). Non-inferiority is maintained when blind sweeps are acquired by novice operators performing only two of six sweep motion types. Fetal malpresentation AUC-ROC is 0.977 (95% CI, 0.949, 1.00, n=613), sonographers and novices have similar AUC-ROC. Software run-times on mobile phones for both diagnostic models are less than 3 seconds after completion of a sweep.

Conclusions The gestational age model is non-inferior to the clinical standard and the fetal malpresentation model has high AUC-ROCs across operators and devices. Our AI models are able to run on-device, without internet connectivity, and provide feedback scores to assist in upleveling the capabilities of lightly trained ultrasound operators in low resource settings.

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