diff --git a/monai/transforms/intensity/array.py b/monai/transforms/intensity/array.py
index d5a90e1964..cdcada6dda 100644
--- a/monai/transforms/intensity/array.py
+++ b/monai/transforms/intensity/array.py
@@ -17,7 +17,7 @@
 from abc import abstractmethod
 from collections.abc import Callable, Iterable, Sequence
 from functools import partial
-from typing import Any
+from typing import Any, Tuple, Literal
 from warnings import warn
 
 import numpy as np
@@ -37,6 +37,10 @@
 from monai.utils.type_conversion import convert_data_type, convert_to_dst_type, convert_to_tensor, get_equivalent_dtype
 
 skimage, _ = optional_import("skimage", "0.19.0", min_version)
+cv2, _ = optional_import("cv2")
+Oct2Py, _ = optional_import("oct2py", "5.6.0", min_version, "Oct2Py")
+csc_matrix, _ = optional_import("scipy.sparse", "1.7.1", min_version, "csc_matrix")
+hilbert, _ = optional_import("scipy.signal", "1.7.1", min_version, "hilbert")
 
 __all__ = [
     "RandGaussianNoise",
@@ -77,6 +81,7 @@
     "RandIntensityRemap",
     "ForegroundMask",
     "ComputeHoVerMaps",
+    "UltrasoundConfidenceMap",
 ]
 
 
@@ -2577,3 +2582,306 @@ def __call__(self, mask: NdarrayOrTensor):
 
         hv_maps = convert_to_tensor(np.concatenate([h_map, v_map]), track_meta=get_track_meta())
         return hv_maps
+
+class UltrasoundConfidenceMap(Transform):
+    """Compute confidence map from an ultrasound image.
+    This transform uses the method introduced by Karamalis et al. in https://doi.org/10.1016/j.media.2012.07.005.
+    It generates a confidence map by setting source and sink points in the image and computing the probability
+    for random walks to reach the source for each pixel.
+
+    Args:
+        alpha (float, optional): Alpha parameter. Defaults to 2.0.
+        beta (float, optional): Beta parameter. Defaults to 90.0.
+        gamma (float, optional): Gamma parameter. Defaults to 0.05.
+        mode (str, optional): 'RF' or 'B' mode data. Defaults to 'B'.
+    """
+
+    def __init__(
+        self,
+        alpha: float = 2.0,
+        beta: float = 90.0,
+        gamma: float = 0.05,
+        mode: Literal["RF", "B"] = "B",
+    ):
+        
+        self.alpha = alpha
+        self.beta = beta
+        self.gamma = gamma
+        self.mode = mode
+
+        # The precision to use for all computations
+        self.eps = np.finfo("float64").eps
+
+        # Octave instance for computing the confidence map
+        self.oc = Oct2Py()
+
+    def sub2ind(self, size: Tuple[int], rows: np.ndarray, cols: np.ndarray) -> np.ndarray:
+        """Converts row and column subscripts into linear indices,
+        basically the copy of the MATLAB function of the same name.
+        https://www.mathworks.com/help/matlab/ref/sub2ind.html
+
+        This function is Pythonic so the indices start at 0.
+
+        Args:
+            size Tuple[int]: Size of the matrix
+            rows (np.ndarray): Row indices
+            cols (np.ndarray): Column indices
+
+        Returns:
+            indices (np.ndarray): 1-D array of linear indices
+        """
+        indices = rows + cols * size[0]
+        return indices
+
+    def get_seed_and_labels(self, data : np.ndarray) -> Tuple[np.ndarray, np.ndarray]:
+        """Get the seed and label arrays for the max-flow algorithm
+
+        Args:
+            data: Input array
+
+        Returns:
+            Tuple[np.ndarray, np.ndarray]: Seed and label arrays
+        """
+
+        # Seeds and labels (boundary conditions)
+        seeds = np.array([], dtype="float64")
+        labels = np.array([], dtype="float64")
+
+        # Indices for all columns
+        sc = np.arange(data.shape[1], dtype="float64")
+
+        # SOURCE ELEMENTS - 1st matrix row
+        # Indices for 1st row, it will be broadcasted with sc
+        sr_up = np.array([0])
+        seed = self.sub2ind(data.shape, sr_up, sc).astype("float64")
+        seed = np.unique(seed)
+        seeds = np.concatenate((seeds, seed))
+
+        # Label 1
+        label = np.ones_like(seed)
+        labels = np.concatenate((labels, label))
+
+        # SINK ELEMENTS - last image row
+        sr_down = np.ones_like(sc) * (data.shape[0] - 1)
+        seed = self.sub2ind(data.shape, sr_down, sc).astype("float64")       
+
+        seed = np.unique(seed)
+        seeds = np.concatenate((seeds, seed))
+
+        # Label 2
+        label = np.ones_like(seed) * 2
+        labels = np.concatenate((labels, label))
+
+        return seeds, labels
+
+    def normalize(self, inp: np.ndarray) -> np.ndarray:
+        """Normalize an array to [0, 1]"""
+        return (inp - np.min(inp)) / (np.ptp(inp) + self.eps)
+
+    def attenuation_weighting(self, A: np.ndarray, alpha: float) -> np.ndarray:
+        """Compute attenuation weighting
+
+        Args:
+            A (np.ndarray): Image
+            alpha: Attenuation coefficient (see publication)
+
+        Returns:
+            W (np.ndarray): Weighting expressing depth-dependent attenuation
+        """
+
+        # Create depth vector and repeat it for each column
+        Dw = np.linspace(0, 1, A.shape[0], dtype="float64")
+        Dw = np.tile(Dw.reshape(-1, 1), (1, A.shape[1]))
+
+        W = 1.0 - np.exp(-alpha * Dw)  # Compute exp inline
+
+        return W
+
+    def confidence_laplacian(
+        self, P: np.ndarray, A: np.ndarray, beta: float, gamma: float
+    ) -> csc_matrix: # type: ignore
+        """Compute 6-Connected Laplacian for confidence estimation problem
+
+        Args:
+            P (np.ndarray): The index matrix of the image with boundary padding.
+            A (np.ndarray): The padded image.
+            beta (float): Random walks parameter that defines the sensitivity of the Gaussian weighting function.
+            gamma (float): Horizontal penalty factor that adjusts the weight of horizontal edges in the Laplacian.
+
+        Returns:
+            L (csc_matrix): The 6-connected Laplacian matrix used for confidence map estimation.
+        """
+
+        m, _ = P.shape
+
+        P = P.T.flatten()
+        A = A.T.flatten()
+
+        p = np.where(P > 0)[0]
+
+        i = P[p] - 1  # Index vector
+        j = P[p] - 1  # Index vector
+        # Entries vector, initially for diagonal
+        s = np.zeros_like(p, dtype="float64")
+
+        vl = 0  # Vertical edges length
+
+        edge_templates = [
+            -1,  # Vertical edges
+            1,
+            m - 1,  # Diagonal edges
+            m + 1,
+            -m - 1,
+            -m + 1,
+            m,  # Horizontal edges
+            -m,
+        ]
+
+        vertical_end = None
+        diagonal_end = None
+
+        for iter_idx, k in enumerate(edge_templates):
+
+            Q = P[p + k]
+
+            q = np.where(Q > 0)[0]
+
+            ii = P[p[q]] - 1
+            i = np.concatenate((i, ii))
+            jj = Q[q] - 1
+            j = np.concatenate((j, jj))
+            W = np.abs(A[p[ii]] - A[p[jj]])  # Intensity derived weight
+            s = np.concatenate((s, W))
+
+            if iter_idx == 1:
+                vertical_end = s.shape[0]  # Vertical edges length
+            elif iter_idx == 5:
+                diagonal_end = s.shape[0]  # Diagonal edges length
+
+        # Normalize weights
+        s = self.normalize(s)
+
+        # Horizontal penalty
+        s[:vertical_end] += gamma
+        #s[vertical_end:diagonal_end] += gamma * np.sqrt(2) # --> In the paper it is sqrt(2) since the diagonal edges are longer yet does not exist in the original code
+
+        # Normalize differences
+        s = self.normalize(s)
+
+        # Gaussian weighting function
+        s = -(
+            (np.exp(-beta * s, dtype="float64")) + 1.0e-6
+        )  # --> This epsilon changes results drastically default: 1.e-6
+
+        # Create Laplacian, diagonal missing
+        L = csc_matrix((s, (i, j)))
+
+        # Reset diagonal weights to zero for summing
+        # up the weighted edge degree in the next step
+        L.setdiag(0)
+
+        # Weighted edge degree
+        D = np.abs(L.sum(axis=0).A)[0]
+
+        # Finalize Laplacian by completing the diagonal
+        L.setdiag(D)
+
+        return L
+
+    def confidence_estimation(self, A, seeds, labels, beta, gamma):
+        """Compute confidence map
+
+        Args:
+            A (np.ndarray): Processed image.
+            seeds (np.ndarray): Seeds for the random walks framework. These are indices of the source and sink nodes.
+            labels (np.ndarray): Labels for the random walks framework. These represent the classes or groups of the seeds.
+            beta: Random walks parameter that defines the sensitivity of the Gaussian weighting function.
+            gamma: Horizontal penalty factor that adjusts the weight of horizontal edges in the Laplacian.
+
+        Returns:
+            map: Confidence map which shows the probability of each pixel belonging to the source or sink group.
+        """
+
+        # Index matrix with boundary padding
+        G = np.arange(1, A.shape[0] * A.shape[1] + 1).reshape(A.shape[1], A.shape[0]).T
+        pad = 1
+
+        G = np.pad(G, (pad, pad), "constant", constant_values=(0, 0))
+        B = np.pad(A, (pad, pad), "constant", constant_values=(0, 0))
+
+        # Laplacian
+        D = self.confidence_laplacian(G, B, beta, gamma)
+
+        # Select marked columns from Laplacian to create L_M and B^T
+        B = D[:, seeds]
+
+        # Select marked nodes to create B^T
+        N = np.sum(G > 0).item()
+        i_U = np.setdiff1d(np.arange(N), seeds.astype(int))  # Index of unmarked nodes
+        B = B[i_U, :]
+
+        # Remove marked nodes from Laplacian by deleting rows and cols
+        keep_indices = np.setdiff1d(np.arange(D.shape[0]), seeds)
+        D = csc_matrix(D[keep_indices, :][:, keep_indices])
+
+        # Define M matrix
+        M = np.zeros((seeds.shape[0], 1), dtype="float64")
+        M[:, 0] = labels == 1
+
+        # Right-handside (-B^T*M)
+        rhs = -B @ M  # type: ignore
+
+        # Solve system exactly
+        x = self.oc.mldivide(D, rhs)[:, 0]
+
+        # Prepare output
+        probabilities = np.zeros((N,), dtype="float64")
+        # Probabilities for unmarked nodes
+        probabilities[i_U] = x
+        # Max probability for marked node
+        probabilities[seeds[labels == 1].astype(int)] = 1.0
+
+        # Final reshape with same size as input image (no padding)
+        probabilities = probabilities.reshape((A.shape[1], A.shape[0])).T
+
+        return probabilities
+
+    def __call__(self, data: np.ndarray, downsample=None) -> np.ndarray:
+        """Compute the confidence map
+
+        Args:
+            data (np.ndarray): RF ultrasound data (one scanline per column)
+
+        Returns:
+            map (np.ndarray): Confidence map
+        """
+
+        # Normalize data
+        data = data.astype("float64")
+        data = self.normalize(data)
+
+        if self.mode == "RF":
+            # MATLAB hilbert applies the Hilbert transform to columns
+            data = np.abs(hilbert(data, axis=0)).astype("float64")  # type: ignore
+
+        org_H, org_W = data.shape
+        if downsample is not None:
+            data = cv2.resize(data, (org_W // downsample, org_H // downsample), interpolation=cv2.INTER_CUBIC)
+
+        seeds, labels = self.get_seed_and_labels(data)
+
+        # Attenuation with Beer-Lambert
+        W = self.attenuation_weighting(data, self.alpha)
+
+        # Apply weighting directly to image
+        # Same as applying it individually during the formation of the
+        # Laplacian
+        data = data * W
+
+        # Find condidence values
+        map_ = self.confidence_estimation(data, seeds, labels, self.beta, self.gamma)
+
+        if downsample is not None:
+            map_ = cv2.resize(map_, (org_W, org_H), interpolation=cv2.INTER_CUBIC)
+
+        return map_