Ultrasound Operator Guidance Using World Modeling and Retrieval Based Action Planning

Noortje I.P. Schueler, Hans van Gorp, and Ruud J.G. van Sloun, “Ultrasound Operator Guidance Using World Modeling and Retrieval Based Action Planning,” arXiv preprint, October 2026. [pdf]

Ultrasound is widely used, but acquisition quality is heavily dependent on the operator’s knowledge and expertise. With demand for examinations outpacing the supply of trained sonographers, operator-guidance systems aim to close this gap by instructing a less trained user how to move the probe toward a target view. In this paper, we propose a retrieval-induced latent transition model for ultrasound acquisition dynamics, formulating ultrasound operator guidance as multi-step planning and retrieval in a world model. Using a V-JEPA 2.1 backbone, observations are first encoded into a latent space where anatomically related views lie close together. We then retrieve similar views from a reference database containing encoded latent states and corresponding probe positions and orientations. Rather than learning a parametric transition function, we directly use physically executed transitions from the database to establish our nonparametric, retrieval-induced transition model that supports receding-horizon planning. At deployment, guidance is generated from the live ultrasound image feed alone, without any probe tracking hardware. Applied to carotid ultrasound, the proposed planner reaches the target view in 86\% of retrospective closed-loop episodes, versus 52\% and 43\% for representative baselines, outperforming both on every target view, including the challenging longitudinal internal and external carotid artery views. A prospective feasibility study on unseen volunteers, run in real time on a CPU using distillation, reaches 83\% target-view reachability. Because planning is driven by proximity to any encodable goal latent, the same world model can navigate back to any previously acquired, patient-specific frame, supporting reproducible longitudinal imaging for e.g. perioperative or follow-up monitoring.