Uncertainty-Guided Active Learning for Access Route Segmentation and Planning in Transcatheter Aortic Valve Implantation

Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure for treating severe aortic stenosis, where optimal vascular access route selection is critical to reduce complications. It requires careful selection of the iliac artery with the most favourable anatomy, specifically, one with the largest diameters and no segments narrower than 5 mm. This process is time-consuming when carried out manually. We present an active learning-based segmentation framework for contrast-enhanced Cardiac Magnetic Resonance (CMR) data, guided by probabilistic uncertainty and pseudo-labelling, enabling efficient segmentation with minimal manual annotation. The segmentations are then fed into an automated pipeline for diameter quantification, achieving a Dice score of 0.912 and a mean absolute percentage error (MAPE) of 4.92%. An ablation study using pre- and post-contrast CMR showed superior performance with post-contrast data only. Overall, the pipeline provides accurate segmentation and detailed diameter profiles of the aorto-iliac route, helping the assessment of the access route.