Owing to the inconsistent image quality existing in routine obstetric ultrasound (US) scans that leads to a large intraobserver and interobserver variability, the aim of this study is to develop a quality-assured, fully automated US fetal head measurement system. A texton-based fetal head segmentation is used as a prerequi- site step to obtain the head region. Textons are calculated using a filter bank designed specific for US fetal head structure. Both shape- and anatomic-based features calculated from the segmented head region are then fed into a random forest classifier to determine the quality of the image (e.g., whether the image is acquired from a correct imaging plane), from which fetal head measurements [biparietal diameter (BPD), occipital–frontal diam- eter (OFD), and head circumference (HC)] are derived. The experimental results show a good performance of our method for US quality assessment and fetal head measurements. The overall precision for automatic image quality assessment is 95.24% with 87.5% sensitivity and 100% specificity, while segmentation performance shows 99.27% (`0.26) of accuracy, 97.07% (`2.3) of sensitivity, 2.23 mm (`0.74) of the maximum symmetric contour distance, and 0.84 mm (`0.28) of the average symmetric contour distance. The statistical analysis results using paired t-test and Bland–Altman plots analysis indicate that the 95% limits of agreement for inter observer variability between the automated measurements and the senior expert measurements are 2.7 mm of BPD, 5.8 mm of OFD, and 10.4 mm of HC, whereas the mean differences are −0.038 ` 1.38 mm, −0.20 ` 2.98 mm, and −0.72 ` 5.36 mm, respectively. These narrow 95% limits of agreements indicate a good level of consistency between the automated and the senior expert’s measurements.
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