Orientation-robust latent motion trajectory learning for annotation-free cardiac phase detection in fetal echocardiography.

Fetal echocardiography is essential for detecting congenital heart disease (CHD), facilitating pregnancy management, optimized delivery planning, and timely postnatal interventions. Among standard imaging planes, the four-chamber view (4CV) provides important information for CHD diagnosis, where clinicians carefully inspect the end-diastolic (ED) and end-systolic (ES) phases to evaluate cardiac structure and motion. Automated detection of these cardiac phases is thus a critical component towards fully automated CHD analysis. However, existing approaches typically rely on manual annotation of ED/ES frames, which is labour-intensive and time-consuming. We present ORBIT (Orientation-Robust Beat Inference from Trajectories), a self-supervised framework that identifies cardiac phases without manual annotations under various fetal heart orientation. ORBIT employs registration as self-supervision task and learns a latent motion trajectory of cardiac deformation, whose turning points capture transitions between cardiac relaxation and contraction, enabling accurate and orientation-robust localization of ED and ES frames across diverse fetal positions. Trained exclusively on normal fetal echocardiography videos, ORBIT achieves consistent performance on both normal (mean absolute error 1.9 frames for ED and 1.6 for ES) and CHD cases (mean absolute error 2.4 frames for ED and 2.1 for ES), outperforming existing annotation-free approaches constrained by fixed orientation assumptions. These results highlight the potential of ORBIT to facilitate robust cardiac phase detection directly from 4CV fetal echocardiography.