Diagnostic Performance of Universal-Learning Ultrasound AI Across Multiple Organs and Tasks: the UUSIC25 Challenge

IMPORTANCE: Modern ultrasound systems are universal diagnostic tools capable of imaging the entire body. However, current AI solutions remain fragmented into single-task tools. This critical gap between hardware versatility and software specificity limits workflow integration and clinical utility. OBJECTIVE: To evaluate the diagnostic accuracy, versatility, and efficiency of single general-purpose deep learning models for multi-organ classification and segmentation. DESIGN: The Universal UltraSound Image Challenge 2025 (UUSIC25) involved developing algorithms on 11,644 images aggregated from 12 sources (9 public, 3 private). Evaluation used an independent, multi-center private test set of 2,479 images, including data from a center completely unseen during training to assess generalization. OUTCOMES: Diagnostic performance (Dice Similarity Coefficient [DSC]; Area Under the Receiver Operating Characteristic Curve [AUC]) and computational efficiency (inference time, GPU memory). RESULTS: Of 15 valid algorithms, the top model (SMART) achieved a macro-averaged DSC of 0.854 across 5 segmentation tasks and AUC of 0.766 for binary classification. Models demonstrated high capability in anatomical segmentation (e.g., fetal head DSC: 0.942) but variability in complex diagnostic tasks subject to domain shift. Specifically, in breast cancer molecular subtyping, the top model's performance dropped from an AUC of 0.571 (internal) to 0.508 (unseen external center), highlighting the challenge of generalization. CONCLUSIONS: General-purpose AI models can achieve high accuracy and efficiency across multiple tasks using a single architecture. However, significant performance degradation on unseen data suggests domain generalization is critical for future clinical deployment.