Model checking for trigger loss detection during Doppler ultrasound-guided fetal cardiovascular MRI

  • Sven-Thomas AntoniEmail author
  • Sascha Lehmann
  • Maximilian Neidhardt
  • Kai Fehrs
  • Christian Ruprecht
  • Fabian Kording
  • Gerhard Adam
  • Sibylle Schupp
  • Alexander Schlaefer
Review Article



Ultrasound (US) is the state of the art in prenatal diagnosis to depict fetal heart diseases. Cardiovascular magnetic resonance imaging (CMRI) has been proposed as a complementary diagnostic tool. Currently, only trigger-based methods allow the temporal and spatial resolutions necessary to depict the heart over time. Of these methods, only Doppler US (DUS)-based triggering is usable with higher field strengths. DUS is sensitive to motion. This may lead to signal and, ultimately, trigger loss. If too many triggers are lost, the image acquisition is stopped, resulting in a failed imaging sequence. Moreover, losing triggers may prolong image acquisition. Hence, if no actual trigger can be found, injected triggers are added to the signal based on the trigger history.


We use model checking, a technique originating from the computer science domain that formally checks if a model satisfies given requirements, to simultaneously model heart and respiratory motion and to decide whether respiration has a prominent effect on the signal. Using bounds on the physiological parameters and their variability, the method detects when changes in the signal are due to respiration. We use this to decide when to inject a trigger.


In a real-world scenario, we can reduce the number of falsely injected triggers by 94% from more than 87% to less than 5%. On a subset of motion that would allow CMRI, the number can be further reduced to below 0.2%. In a study using simulations with a robot, we show that our method works for different types of motions, motion ranges, starting positions and heartbeat traces.


While DUS is a promising approach for fetal CMRI, correct trigger injection is critical. Our model checking method can reduce the number of wrongly injected triggers substantially, providing a key prerequisite for fast and artifact free CMRI.


Fetal Heart MRI Cardiovascular Triggering Model checking 


Compliance with ethical standard

Conflict of interest

K. Fehrs, F. Kording and C. Ruprecht are the founders of the company northh medical GmbH. The other authors declare that they have no conflict of interest.

Informed consent

For this type of study, formal consent is not required.


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Copyright information

© CARS 2018

Authors and Affiliations

  • Sven-Thomas Antoni
    • 1
    Email author
  • Sascha Lehmann
    • 2
  • Maximilian Neidhardt
    • 1
  • Kai Fehrs
    • 3
  • Christian Ruprecht
    • 3
  • Fabian Kording
    • 3
  • Gerhard Adam
    • 3
  • Sibylle Schupp
    • 2
  • Alexander Schlaefer
    • 1
  1. 1.Institute of Medical TechnologyHamburg University of TechnologyHamburgGermany
  2. 2.Institute for Software SystemsHamburg University of TechnologyHamburgGermany
  3. 3.Center for Radiology and EndoscopyMedical Center Hamburg-EppendorfHamburgGermany

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