Transferring Knowledge from High-Quality to Low-Quality MRI for Adult Glioma Diagnosis

Glioma, a common and deadly brain tumor, requires early diagnosis for improved prognosis. However, low-quality Magnetic Resonance Imaging (MRI) technology in Sub-Saharan Africa (SSA) hinders accurate diagnosis. This paper presents our work in the BraTS Challenge on SSA Adult Glioma. We adopt the model from the BraTS-GLI 2021 winning solution and utilize it with three training strategies: (1) initially training on the BraTS-GLI 2021 dataset with fine-tuning on the BraTS-Africa dataset, (2) training solely on the BraTS-Africa dataset, and (3) training solely on the BraTS-Africa dataset with 2x super-resolution enhancement. Results show that initial training on the BraTS-GLI 2021 dataset followed by fine-tuning on the BraTS-Africa dataset has yielded the best results. This suggests the importance of high-quality datasets in providing prior knowledge during training. Our top-performing model achieves Dice scores of 0.882, 0.840, and 0.926, and Hausdorff Distance (95%) scores of 15.324, 37.518, and 13.971 for enhancing tumor, tumor core, and whole tumor, respectively, in the validation phase. In the final phase of the competition, our approach successfully secured second place overall, reflecting the strength and effectiveness of our model and training strategies. Our approach provides insights into improving glioma diagnosis in SSA, showing the potential of deep learning in resource-limited settings and the importance of transfer learning from high-quality datasets.

SurgicalGS: Dynamic 3D Gaussian Splatting for Accurate Robotic-Assisted Surgical Scene Reconstruction

Accurate 3D reconstruction of dynamic surgical scenes from endoscopic video is essential for robotic-assisted surgery. While recent 3D Gaussian Splatting methods have shown promise in achieving high-quality reconstructions with fast rendering speeds, their use of inverse depth loss functions compresses depth variations. This can lead to a loss of fine geometric details, limiting their ability to capture precise 3D geometry and effectiveness in intraoperative application. To address these challenges, we present SurgicalGS, a dynamic 3D Gaussian Splatting framework specifically designed for surgical scene reconstruction with improved geometric accuracy. Our approach first initialises a Gaussian point cloud using depth priors, employing binary motion masks to identify pixels with significant depth variations and fusing point clouds from depth maps across frames for initialisation. We use the Flexible Deformation Model to represent dynamic scene and introduce a normalised depth regularisation loss along with an unsupervised depth smoothness constraint to ensure more accurate geometric reconstruction. Extensive experiments on two real surgical datasets demonstrate that SurgicalGS achieves state-of-the-art reconstruction quality, especially in terms of accurate geometry, advancing the usability of 3D Gaussian Splatting in robotic-assisted surgery.

DARES: Depth Anything in Robotic Endoscopic Surgery with Self-supervised Vector-LoRA of the Foundation Model

Robotic-assisted surgery (RAS) relies on accurate depth estimation for 3D reconstruction and visualization. While foundation models like Depth Anything Models (DAM) show promise, directly applying them to surgery often yields suboptimal results. Fully fine-tuning on limited surgical data can cause overfitting and catastrophic forgetting, compromising model robustness and generalization. Although Low-Rank Adaptation (LoRA) addresses some adaptation issues, its uniform parameter distribution neglects the inherent feature hierarchy, where earlier layers, learning more general features, require more parameters than later ones. To tackle this issue, we introduce Depth Anything in Robotic Endoscopic Surgery (DARES), a novel approach that employs a new adaptation technique, Vector Low-Rank Adaptation (Vector-LoRA) on the DAM V2 to perform self-supervised monocular depth estimation in RAS scenes. To enhance learning efficiency, we introduce Vector-LoRA by integrating more parameters in earlier layers and gradually decreasing parameters in later layers. We also design a reprojection loss based on the multi-scale SSIM error to enhance depth perception by better tailoring the foundation model to the specific requirements of the surgical environment. The proposed method is validated on the SCARED dataset and demonstrates superior performance over recent state-of-the-art self-supervised monocular depth estimation techniques, achieving an improvement of 13.3% in the absolute relative error metric. The code and pre-trained weights are available at https://github.com/mobarakol/DARES.

Surgical-VQLA++: Adversarial Contrastive Learning for Calibrated Robust Visual Question-Localized Answering in Robotic Surgery

Medical visual question answering (VQA) bridges the gap between visual information and clinical decision-making, enabling doctors to extract understanding from clinical images and videos. In particular, surgical VQA can enhance the interpretation of surgical data, aiding in accurate diagnoses, effective education, and clinical interventions. However, the inability of VQA models to visually indicate the regions of interest corresponding to the given questions results in incomplete comprehension of the surgical scene. To tackle this, we propose the surgical visual question localized-answering (VQLA) for precise and context-aware responses to specific queries regarding surgical images. Furthermore, to address the strong demand for safety in surgical scenarios and potential corruptions in image acquisition and transmission, we propose a novel approach called Calibrated Co-Attention Gated Vision-Language (C$^2$G-ViL) embedding to integrate and align multimodal information effectively. Additionally, we leverage the adversarial sample-based contrastive learning strategy to boost our performance and robustness. We also extend our EndoVis-18-VQLA and EndoVis-17-VQLA datasets to broaden the scope and application of our data. Extensive experiments on the aforementioned datasets demonstrate the remarkable performance and robustness of our solution. Our solution can effectively combat real-world image corruption. Thus, our proposed approach can serve as an effective tool for assisting surgical education, patient care, and enhancing surgical outcomes.

SAM 2 in Robotic Surgery: An Empirical Evaluation for Robustness and Generalization in Surgical Video Segmentation

The recent Segment Anything Model (SAM) 2 has demonstrated remarkable foundational competence in semantic segmentation, with its memory mechanism and mask decoder further addressing challenges in video tracking and object occlusion, thereby achieving superior results in interactive segmentation for both images and videos. Building upon our previous empirical studies, we further explore the zero-shot segmentation performance of SAM 2 in robot-assisted surgery based on prompts, alongside its robustness against real-world corruption. For static images, we employ two forms of prompts: 1-point and bounding box, while for video sequences, the 1-point prompt is applied to the initial frame. Through extensive experimentation on the MICCAI EndoVis 2017 and EndoVis 2018 benchmarks, SAM 2, when utilizing bounding box prompts, outperforms state-of-the-art (SOTA) methods in comparative evaluations. The results with point prompts also exhibit a substantial enhancement over SAM's capabilities, nearing or even surpassing existing unprompted SOTA methodologies. Besides, SAM 2 demonstrates improved inference speed and less performance degradation against various image corruption. Although slightly unsatisfactory results remain in specific edges or regions, SAM 2's robust adaptability to 1-point prompts underscores its potential for downstream surgical tasks with limited prompt requirements.

EndoUIC: Promptable Diffusion Transformer for Unified Illumination Correction in Capsule Endoscopy

Wireless Capsule Endoscopy (WCE) is highly valued for its non-invasive and painless approach, though its effectiveness is compromised by uneven illumination from hardware constraints and complex internal dynamics, leading to overexposed or underexposed images. While researchers have discussed the challenges of low-light enhancement in WCE, the issue of correcting for different exposure levels remains underexplored. To tackle this, we introduce EndoUIC, a WCE unified illumination correction solution using an end-to-end promptable diffusion transformer (DFT) model. In our work, the illumination prompt module shall navigate the model to adapt to different exposure levels and perform targeted image enhancement, in which the Adaptive Prompt Integration (API) and Global Prompt Scanner (GPS) modules shall further boost the concurrent representation learning between the prompt parameters and features. Besides, the U-shaped restoration DFT model shall capture the long-range dependencies and contextual information for unified illumination restoration. Moreover, we present a novel Capsule-endoscopy Exposure Correction (CEC) dataset, including ground-truth and corrupted image pairs annotated by expert photographers. Extensive experiments against a variety of state-of-the-art (SOTA) methods on four datasets showcase the effectiveness of our proposed method and components in WCE illumination restoration, and the additional downstream experiments further demonstrate its utility for clinical diagnosis and surgical assistance.

PitVQA: Image-grounded Text Embedding LLM for Visual Question Answering in Pituitary Surgery

Visual Question Answering (VQA) within the surgical domain, utilizing Large Language Models (LLMs), offers a distinct opportunity to improve intra-operative decision-making and facilitate intuitive surgeon-AI interaction. However, the development of LLMs for surgical VQA is hindered by the scarcity of diverse and extensive datasets with complex reasoning tasks. Moreover, contextual fusion of the image and text modalities remains an open research challenge due to the inherent differences between these two types of information and the complexity involved in aligning them. This paper introduces PitVQA, a novel dataset specifically designed for VQA in endonasal pituitary surgery and PitVQA-Net, an adaptation of the GPT2 with a novel image-grounded text embedding for surgical VQA. PitVQA comprises 25 procedural videos and a rich collection of question-answer pairs spanning crucial surgical aspects such as phase and step recognition, context understanding, tool detection and localization, and tool-tissue interactions. PitVQA-Net consists of a novel image-grounded text embedding that projects image and text features into a shared embedding space and GPT2 Backbone with an excitation block classification head to generate contextually relevant answers within the complex domain of endonasal pituitary surgery. Our image-grounded text embedding leverages joint embedding, cross-attention and contextual representation to understand the contextual relationship between questions and surgical images. We demonstrate the effectiveness of PitVQA-Net on both the PitVQA and the publicly available EndoVis18-VQA dataset, achieving improvements in balanced accuracy of 8% and 9% over the most recent baselines, respectively. Our code and dataset is available at https://github.com/mobarakol/PitVQA.

Illumination Histogram Consistency Metric for Quantitative Assessment of Video Sequences

The advances in deep generative models have greatly accelerate the process of video procession such as video enhancement and synthesis. Learning spatio-temporal video models requires to capture the temporal dynamics of a scene, in addition to the visual appearance of individual frames. Illumination consistency, which reflects the variations of illumination in the dynamic video sequences, play a vital role in video processing. Unfortunately, to date, no well-accepted quantitative metric has been proposed for video illumination consistency evaluation. In this paper, we propose a illumination histogram consistency (IHC) metric to quantitatively and automatically evaluate the illumination consistency of the video sequences. IHC measures the illumination variation of any video sequence based on the illumination histogram discrepancies across all the frames in the video sequence. Specifically, given a video sequence, we first estimate the illumination map of each individual frame using the Retinex model; Then, using the illumination maps, the mean illumination histogram of the video sequence is computed by the mean operation across all the frames; Next, we compute the illumination histogram discrepancy between each individual frame and the mean illumination histogram and sum up all the illumination histogram discrepancies to represent the illumination variations of the video sequence. Finally, we obtain the IHC score from the illumination histogram discrepancies via normalization and subtraction operations. Experiments are conducted to illustrate the performance of the proposed IHC metric and its capability to measure the illumination variations in video sequences. The source code is available on \url{https://github.com/LongChenCV/IHC-Metric}.

EndoDAC: Efficient Adapting Foundation Model for Self-Supervised Depth Estimation from Any Endoscopic Camera

Depth estimation plays a crucial role in various tasks within endoscopic surgery, including navigation, surface reconstruction, and augmented reality visualization. Despite the significant achievements of foundation models in vision tasks, including depth estimation, their direct application to the medical domain often results in suboptimal performance. This highlights the need for efficient adaptation methods to adapt these models to endoscopic depth estimation. We propose Endoscopic Depth Any Camera (EndoDAC) which is an efficient self-supervised depth estimation framework that adapts foundation models to endoscopic scenes. Specifically, we develop the Dynamic Vector-Based Low-Rank Adaptation (DV-LoRA) and employ Convolutional Neck blocks to tailor the foundational model to the surgical domain, utilizing remarkably few trainable parameters. Given that camera information is not always accessible, we also introduce a self-supervised adaptation strategy that estimates camera intrinsics using the pose encoder. Our framework is capable of being trained solely on monocular surgical videos from any camera, ensuring minimal training costs. Experiments demonstrate that our approach obtains superior performance even with fewer training epochs and unaware of the ground truth camera intrinsics. Code is available at https://github.com/BeileiCui/EndoDAC.

Surgical-DeSAM: Decoupling SAM for Instrument Segmentation in Robotic Surgery

Purpose: The recent Segment Anything Model (SAM) has demonstrated impressive performance with point, text or bounding box prompts, in various applications. However, in safety-critical surgical tasks, prompting is not possible due to (i) the lack of per-frame prompts for supervised learning, (ii) it is unrealistic to prompt frame-by-frame in a real-time tracking application, and (iii) it is expensive to annotate prompts for offline applications. Methods: We develop Surgical-DeSAM to generate automatic bounding box prompts for decoupling SAM to obtain instrument segmentation in real-time robotic surgery. We utilise a commonly used detection architecture, DETR, and fine-tuned it to obtain bounding box prompt for the instruments. We then empolyed decoupling SAM (DeSAM) by replacing the image encoder with DETR encoder and fine-tune prompt encoder and mask decoder to obtain instance segmentation for the surgical instruments. To improve detection performance, we adopted the Swin-transformer to better feature representation. Results: The proposed method has been validated on two publicly available datasets from the MICCAI surgical instruments segmentation challenge EndoVis 2017 and 2018. The performance of our method is also compared with SOTA instrument segmentation methods and demonstrated significant improvements with dice metrics of 89.62 and 90.70 for the EndoVis 2017 and 2018. Conclusion: Our extensive experiments and validations demonstrate that Surgical-DeSAM enables real-time instrument segmentation without any additional prompting and outperforms other SOTA segmentation methods.