Surgery-R1: Advancing Surgical-VQLA with Reasoning Multimodal Large Language Model via Reinforcement Learning

In recent years, significant progress has been made in the field of surgical scene understanding, particularly in the task of Visual Question Localized-Answering in robotic surgery (Surgical-VQLA). However, existing Surgical-VQLA models lack deep reasoning capabilities and interpretability in surgical scenes, which limits their reliability and potential for development in clinical applications. To address this issue, inspired by the development of Reasoning Multimodal Large Language Models (MLLMs), we first build the Surgery-R1-54k dataset, including paired data for Visual-QA, Grounding-QA, and Chain-of-Thought (CoT). Then, we propose the first Reasoning MLLM for Surgical-VQLA (Surgery-R1). In our Surgery-R1, we design a two-stage fine-tuning mechanism to enable the basic MLLM with complex reasoning abilities by utilizing supervised fine-tuning (SFT) and reinforcement fine-tuning (RFT). Furthermore, for an efficient and high-quality rule-based reward system in our RFT, we design a Multimodal Coherence reward mechanism to mitigate positional illusions that may arise in surgical scenarios. Experiment results demonstrate that Surgery-R1 outperforms other existing state-of-the-art (SOTA) models in the Surgical-VQLA task and widely-used MLLMs, while also validating its reasoning capabilities and the effectiveness of our approach. The code and dataset will be organized in https://github.com/FiFi-HAO467/Surgery-R1.

Rethinking Diffusion-Based Image Generators for Fundus Fluorescein Angiography Synthesis on Limited Data

Fundus imaging is a critical tool in ophthalmology, with different imaging modalities offering unique advantages. For instance, fundus fluorescein angiography (FFA) can accurately identify eye diseases. However, traditional invasive FFA involves the injection of sodium fluorescein, which can cause discomfort and risks. Generating corresponding FFA images from non-invasive fundus images holds significant practical value but also presents challenges. First, limited datasets constrain the performance and effectiveness of models. Second, previous studies have primarily focused on generating FFA for single diseases or single modalities, often resulting in poor performance for patients with various ophthalmic conditions. To address these issues, we propose a novel latent diffusion model-based framework, Diffusion, which introduces a fine-tuning protocol to overcome the challenge of limited medical data and unleash the generative capabilities of diffusion models. Furthermore, we designed a new approach to tackle the challenges of generating across different modalities and disease types. On limited datasets, our framework achieves state-of-the-art results compared to existing methods, offering significant potential to enhance ophthalmic diagnostics and patient care. Our code will be released soon to support further research in this field.

Automated 3D Physical Simulation of Open-world Scene with Gaussian Splatting

Recent advancements in 3D generation models have opened new possibilities for simulating dynamic 3D object movements and customizing behaviors, yet creating this content remains challenging. Current methods often require manual assignment of precise physical properties for simulations or rely on video generation models to predict them, which is computationally intensive. In this paper, we rethink the usage of multi-modal large language model (MLLM) in physics-based simulation, and present Sim Anything, a physics-based approach that endows static 3D objects with interactive dynamics. We begin with detailed scene reconstruction and object-level 3D open-vocabulary segmentation, progressing to multi-view image in-painting. Inspired by human visual reasoning, we propose MLLM-based Physical Property Perception (MLLM-P3) to predict mean physical properties of objects in a zero-shot manner. Based on the mean values and the object's geometry, the Material Property Distribution Prediction model (MPDP) model then estimates the full distribution, reformulating the problem as probability distribution estimation to reduce computational costs. Finally, we simulate objects in an open-world scene with particles sampled via the Physical-Geometric Adaptive Sampling (PGAS) strategy, efficiently capturing complex deformations and significantly reducing computational costs. Extensive experiments and user studies demonstrate our Sim Anything achieves more realistic motion than state-of-the-art methods within 2 minutes on a single GPU.

Non-Invasive to Invasive: Enhancing FFA Synthesis from CFP with a Benchmark Dataset and a Novel Network

Fundus imaging is a pivotal tool in ophthalmology, and different imaging modalities are characterized by their specific advantages. For example, Fundus Fluorescein Angiography (FFA) uniquely provides detailed insights into retinal vascular dynamics and pathology, surpassing Color Fundus Photographs (CFP) in detecting microvascular abnormalities and perfusion status. However, the conventional invasive FFA involves discomfort and risks due to fluorescein dye injection, and it is meaningful but challenging to synthesize FFA images from non-invasive CFP. Previous studies primarily focused on FFA synthesis in a single disease category. In this work, we explore FFA synthesis in multiple diseases by devising a Diffusion-guided generative adversarial network, which introduces an adaptive and dynamic diffusion forward process into the discriminator and adds a category-aware representation enhancer. Moreover, to facilitate this research, we collect the first multi-disease CFP and FFA paired dataset, named the Multi-disease Paired Ocular Synthesis (MPOS) dataset, with four different fundus diseases. Experimental results show that our FFA synthesis network can generate better FFA images compared to state-of-the-art methods. Furthermore, we introduce a paired-modal diagnostic network to validate the effectiveness of synthetic FFA images in the diagnosis of multiple fundus diseases, and the results show that our synthesized FFA images with the real CFP images have higher diagnosis accuracy than that of the compared FFA synthesizing methods. Our research bridges the gap between non-invasive imaging and FFA, thereby offering promising prospects to enhance ophthalmic diagnosis and patient care, with a focus on reducing harm to patients through non-invasive procedures. Our dataset and code will be released to support further research in this field (https://github.com/whq-xxh/FFA-Synthesis).

Serp-Mamba: Advancing High-Resolution Retinal Vessel Segmentation with Selective State-Space Model

Ultra-Wide-Field Scanning Laser Ophthalmoscopy (UWF-SLO) images capture high-resolution views of the retina with typically 200 spanning degrees. Accurate segmentation of vessels in UWF-SLO images is essential for detecting and diagnosing fundus disease. Recent studies have revealed that the selective State Space Model (SSM) in Mamba performs well in modeling long-range dependencies, which is crucial for capturing the continuity of elongated vessel structures. Inspired by this, we propose the first Serpentine Mamba (Serp-Mamba) network to address this challenging task. Specifically, we recognize the intricate, varied, and delicate nature of the tubular structure of vessels. Furthermore, the high-resolution of UWF-SLO images exacerbates the imbalance between the vessel and background categories. Based on the above observations, we first devise a Serpentine Interwoven Adaptive (SIA) scan mechanism, which scans UWF-SLO images along curved vessel structures in a snake-like crawling manner. This approach, consistent with vascular texture transformations, ensures the effective and continuous capture of curved vascular structure features. Second, we propose an Ambiguity-Driven Dual Recalibration (ADDR) module to address the category imbalance problem intensified by high-resolution images. Our ADDR module delineates pixels by two learnable thresholds and refines ambiguous pixels through a dual-driven strategy, thereby accurately distinguishing vessels and background regions. Experiment results on three datasets demonstrate the superior performance of our Serp-Mamba on high-resolution vessel segmentation. We also conduct a series of ablation studies to verify the impact of our designs. Our code shall be released upon publication of this work.

Language-Driven Interactive Shadow Detection

Traditional shadow detectors often identify all shadow regions of static images or video sequences. This work presents the Referring Video Shadow Detection (RVSD), which is an innovative task that rejuvenates the classic paradigm by facilitating the segmentation of particular shadows in videos based on descriptive natural language prompts. This novel RVSD not only achieves segmentation of arbitrary shadow areas of interest based on descriptions (flexibility) but also allows users to interact with visual content more directly and naturally by using natural language prompts (interactivity), paving the way for abundant applications ranging from advanced video editing to virtual reality experiences. To pioneer the RVSD research, we curated a well-annotated RVSD dataset, which encompasses 86 videos and a rich set of 15,011 paired textual descriptions with corresponding shadows. To the best of our knowledge, this dataset is the first one for addressing RVSD. Based on this dataset, we propose a Referring Shadow-Track Memory Network (RSM-Net) for addressing the RVSD task. In our RSM-Net, we devise a Twin-Track Synergistic Memory (TSM) to store intra-clip memory features and hierarchical inter-clip memory features, and then pass these memory features into a memory read module to refine features of the current video frame for referring shadow detection. We also develop a Mixed-Prior Shadow Attention (MSA) to utilize physical priors to obtain a coarse shadow map for learning more visual features by weighting it with the input video frame. Experimental results show that our RSM-Net achieves state-of-the-art performance for RVSD with a notable Overall IOU increase of 4.4\%. Our code and dataset are available at https://github.com/whq-xxh/RVSD.

Advancing UWF-SLO Vessel Segmentation with Source-Free Active Domain Adaptation and a Novel Multi-Center Dataset

Accurate vessel segmentation in Ultra-Wide-Field Scanning Laser Ophthalmoscopy (UWF-SLO) images is crucial for diagnosing retinal diseases. Although recent techniques have shown encouraging outcomes in vessel segmentation, models trained on one medical dataset often underperform on others due to domain shifts. Meanwhile, manually labeling high-resolution UWF-SLO images is an extremely challenging, time-consuming and expensive task. In response, this study introduces a pioneering framework that leverages a patch-based active domain adaptation approach. By actively recommending a few valuable image patches by the devised Cascade Uncertainty-Predominance (CUP) selection strategy for labeling and model-finetuning, our method significantly improves the accuracy of UWF-SLO vessel segmentation across diverse medical centers. In addition, we annotate and construct the first Multi-center UWF-SLO Vessel Segmentation (MU-VS) dataset to promote this topic research, comprising data from multiple institutions. This dataset serves as a valuable resource for cross-center evaluation, verifying the effectiveness and robustness of our approach. Experimental results demonstrate that our approach surpasses existing domain adaptation and active learning methods, considerably reducing the gap between the Upper and Lower bounds with minimal annotations, highlighting our method's practical clinical value. We will release our dataset and code to facilitate relevant research: https://github.com/whq-xxh/SFADA-UWF-SLO.

SegRap2023: A Benchmark of Organs-at-Risk and Gross Tumor Volume Segmentation for Radiotherapy Planning of Nasopharyngeal Carcinoma

Radiation therapy is a primary and effective NasoPharyngeal Carcinoma (NPC) treatment strategy. The precise delineation of Gross Tumor Volumes (GTVs) and Organs-At-Risk (OARs) is crucial in radiation treatment, directly impacting patient prognosis. Previously, the delineation of GTVs and OARs was performed by experienced radiation oncologists. Recently, deep learning has achieved promising results in many medical image segmentation tasks. However, for NPC OARs and GTVs segmentation, few public datasets are available for model development and evaluation. To alleviate this problem, the SegRap2023 challenge was organized in conjunction with MICCAI2023 and presented a large-scale benchmark for OAR and GTV segmentation with 400 Computed Tomography (CT) scans from 200 NPC patients, each with a pair of pre-aligned non-contrast and contrast-enhanced CT scans. The challenge's goal was to segment 45 OARs and 2 GTVs from the paired CT scans. In this paper, we detail the challenge and analyze the solutions of all participants. The average Dice similarity coefficient scores for all submissions ranged from 76.68\% to 86.70\%, and 70.42\% to 73.44\% for OARs and GTVs, respectively. We conclude that the segmentation of large-size OARs is well-addressed, and more efforts are needed for GTVs and small-size or thin-structure OARs. The benchmark will remain publicly available here: https://segrap2023.grand-challenge.org

Dual-Reference Source-Free Active Domain Adaptation for Nasopharyngeal Carcinoma Tumor Segmentation across Multiple Hospitals

Nasopharyngeal carcinoma (NPC) is a prevalent and clinically significant malignancy that predominantly impacts the head and neck area. Precise delineation of the Gross Tumor Volume (GTV) plays a pivotal role in ensuring effective radiotherapy for NPC. Despite recent methods that have achieved promising results on GTV segmentation, they are still limited by lacking carefully-annotated data and hard-to-access data from multiple hospitals in clinical practice. Although some unsupervised domain adaptation (UDA) has been proposed to alleviate this problem, unconditionally mapping the distribution distorts the underlying structural information, leading to inferior performance. To address this challenge, we devise a novel Sourece-Free Active Domain Adaptation (SFADA) framework to facilitate domain adaptation for the GTV segmentation task. Specifically, we design a dual reference strategy to select domain-invariant and domain-specific representative samples from a specific target domain for annotation and model fine-tuning without relying on source-domain data. Our approach not only ensures data privacy but also reduces the workload for oncologists as it just requires annotating a few representative samples from the target domain and does not need to access the source data. We collect a large-scale clinical dataset comprising 1057 NPC patients from five hospitals to validate our approach. Experimental results show that our method outperforms the UDA methods and achieves comparable results to the fully supervised upper bound, even with few annotations, highlighting the significant medical utility of our approach. In addition, there is no public dataset about multi-center NPC segmentation, we will release code and dataset for future research.

Video-Instrument Synergistic Network for Referring Video Instrument Segmentation in Robotic Surgery

Robot-assisted surgery has made significant progress, with instrument segmentation being a critical factor in surgical intervention quality. It serves as the building block to facilitate surgical robot navigation and surgical education for the next generation of operating intelligence. Although existing methods have achieved accurate instrument segmentation results, they simultaneously generate segmentation masks for all instruments, without the capability to specify a target object and allow an interactive experience. This work explores a new task of Referring Surgical Video Instrument Segmentation (RSVIS), which aims to automatically identify and segment the corresponding surgical instruments based on the given language expression. To achieve this, we devise a novel Video-Instrument Synergistic Network (VIS-Net) to learn both video-level and instrument-level knowledge to boost performance, while previous work only used video-level information. Meanwhile, we design a Graph-based Relation-aware Module (GRM) to model the correlation between multi-modal information (i.e., textual description and video frame) to facilitate the extraction of instrument-level information. We are also the first to produce two RSVIS datasets to promote related research. Our method is verified on these datasets, and experimental results exhibit that the VIS-Net can significantly outperform existing state-of-the-art referring segmentation methods. Our code and our datasets will be released upon the publication of this work.