Text-driven Adaptation of Foundation Models for Few-shot Surgical Workflow Analysis

Purpose: Surgical workflow analysis is crucial for improving surgical efficiency and safety. However, previous studies rely heavily on large-scale annotated datasets, posing challenges in cost, scalability, and reliance on expert annotations. To address this, we propose Surg-FTDA (Few-shot Text-driven Adaptation), designed to handle various surgical workflow analysis tasks with minimal paired image-label data. Methods: Our approach has two key components. First, Few-shot selection-based modality alignment selects a small subset of images and aligns their embeddings with text embeddings from the downstream task, bridging the modality gap. Second, Text-driven adaptation leverages only text data to train a decoder, eliminating the need for paired image-text data. This decoder is then applied to aligned image embeddings, enabling image-related tasks without explicit image-text pairs. Results: We evaluate our approach to generative tasks (image captioning) and discriminative tasks (triplet recognition and phase recognition). Results show that Surg-FTDA outperforms baselines and generalizes well across downstream tasks. Conclusion: We propose a text-driven adaptation approach that mitigates the modality gap and handles multiple downstream tasks in surgical workflow analysis, with minimal reliance on large annotated datasets. The code and dataset will be released in https://github.com/TingxuanSix/Surg-FTDA.

UltraRay: Full-Path Ray Tracing for Enhancing Realism in Ultrasound Simulation

Traditional ultrasound simulators solve the wave equation to model pressure distribution fields, achieving high accuracy but requiring significant computational time and resources. To address this, ray tracing approaches have been introduced, modeling wave propagation as rays interacting with boundaries and scatterers. However, existing models simplify ray propagation, generating echoes at interaction points without considering return paths to the sensor. This can result in unrealistic artifacts and necessitates careful scene tuning for plausible results. We propose a novel ultrasound simulation pipeline that utilizes a ray tracing algorithm to generate echo data, tracing each ray from the transducer through the scene and back to the sensor. To replicate advanced ultrasound imaging, we introduce a ray emission scheme optimized for plane wave imaging, incorporating delay and steering capabilities. Furthermore, we integrate a standard signal processing pipeline to simulate end-to-end ultrasound image formation. We showcase the efficacy of the proposed pipeline by modeling synthetic scenes featuring highly reflective objects, such as bones. In doing so, our proposed approach, UltraRay, not only enhances the overall visual quality but also improves the realism of the simulated images by accurately capturing secondary reflections and reducing unnatural artifacts. By building on top of a differentiable framework, the proposed pipeline lays the groundwork for a fast and differentiable ultrasound simulation tool necessary for gradient-based optimization, enabling advanced ultrasound beamforming strategies, neural network integration, and accurate inverse scene reconstruction.

Latent Drifting in Diffusion Models for Counterfactual Medical Image Synthesis

Scaling by training on large datasets has been shown to enhance the quality and fidelity of image generation and manipulation with diffusion models; however, such large datasets are not always accessible in medical imaging due to cost and privacy issues, which contradicts one of the main applications of such models to produce synthetic samples where real data is scarce. Also, finetuning on pre-trained general models has been a challenge due to the distribution shift between the medical domain and the pre-trained models. Here, we propose Latent Drift (LD) for diffusion models that can be adopted for any fine-tuning method to mitigate the issues faced by the distribution shift or employed in inference time as a condition. Latent Drifting enables diffusion models to be conditioned for medical images fitted for the complex task of counterfactual image generation, which is crucial to investigate how parameters such as gender, age, and adding or removing diseases in a patient would alter the medical images. We evaluate our method on three public longitudinal benchmark datasets of brain MRI and chest X-rays for counterfactual image generation. Our results demonstrate significant performance gains in various scenarios when combined with different fine-tuning schemes. The source code of this work will be publicly released upon its acceptance.

Conformable Convolution for Topologically Aware Learning of Complex Anatomical Structures

While conventional computer vision emphasizes pixel-level and feature-based objectives, medical image analysis of intricate biological structures necessitates explicit representation of their complex topological properties. Despite their successes, deep learning models often struggle to accurately capture the connectivity and continuity of fine, sometimes pixel-thin, yet critical structures due to their reliance on implicit learning from data. Such shortcomings can significantly impact the reliability of analysis results and hinder clinical decision-making. To address this challenge, we introduce Conformable Convolution, a novel convolutional layer designed to explicitly enforce topological consistency. Conformable Convolution learns adaptive kernel offsets that preferentially focus on regions of high topological significance within an image. This prioritization is guided by our proposed Topological Posterior Generator (TPG) module, which leverages persistent homology. The TPG module identifies key topological features and guides the convolutional layers by applying persistent homology to feature maps transformed into cubical complexes. Our proposed modules are architecture-agnostic, enabling them to be integrated seamlessly into various architectures. We showcase the effectiveness of our framework in the segmentation task, where preserving the interconnectedness of structures is critical. Experimental results on three diverse datasets demonstrate that our framework effectively preserves the topology in the segmentation downstream task, both quantitatively and qualitatively.

SuperGSeg: Open-Vocabulary 3D Segmentation with Structured Super-Gaussians

3D Gaussian Splatting has recently gained traction for its efficient training and real-time rendering. While the vanilla Gaussian Splatting representation is mainly designed for view synthesis, more recent works investigated how to extend it with scene understanding and language features. However, existing methods lack a detailed comprehension of scenes, limiting their ability to segment and interpret complex structures. To this end, We introduce SuperGSeg, a novel approach that fosters cohesive, context-aware scene representation by disentangling segmentation and language field distillation. SuperGSeg first employs neural Gaussians to learn instance and hierarchical segmentation features from multi-view images with the aid of off-the-shelf 2D masks. These features are then leveraged to create a sparse set of what we call Super-Gaussians. Super-Gaussians facilitate the distillation of 2D language features into 3D space. Through Super-Gaussians, our method enables high-dimensional language feature rendering without extreme increases in GPU memory. Extensive experiments demonstrate that SuperGSeg outperforms prior works on both open-vocabulary object localization and semantic segmentation tasks.

ESCAPE: Equivariant Shape Completion via Anchor Point Encoding

Shape completion, a crucial task in 3D computer vision, involves predicting and filling the missing regions of scanned or partially observed objects. Current methods expect known pose or canonical coordinates and do not perform well under varying rotations, limiting their real-world applicability. We introduce ESCAPE (Equivariant Shape Completion via Anchor Point Encoding), a novel framework designed to achieve rotation-equivariant shape completion. Our approach employs a distinctive encoding strategy by selecting anchor points from a shape and representing all points as a distance to all anchor points. This enables the model to capture a consistent, rotation-equivariant understanding of the object's geometry. ESCAPE leverages a transformer architecture to encode and decode the distance transformations, ensuring that generated shape completions remain accurate and equivariant under rotational transformations. Subsequently, we perform optimization to calculate the predicted shapes from the encodings. Experimental evaluations demonstrate that ESCAPE achieves robust, high-quality reconstructions across arbitrary rotations and translations, showcasing its effectiveness in real-world applications without additional pose estimation modules.

Towards Motion Compensation in Autonomous Robotic Subretinal Injections

Exudative (wet) age-related macular degeneration (AMD) is a leading cause of vision loss in older adults, typically treated with intravitreal injections. Emerging therapies, such as subretinal injections of stem cells, gene therapy, small molecules or RPE cells require precise delivery to avoid damaging delicate retinal structures. Autonomous robotic systems can potentially offer the necessary precision for these procedures. This paper presents a novel approach for motion compensation in robotic subretinal injections, utilizing real-time Optical Coherence Tomography (OCT). The proposed method leverages B$^{5}$-scans, a rapid acquisition of small-volume OCT data, for dynamic tracking of retinal motion along the Z-axis, compensating for physiological movements such as breathing and heartbeat. Validation experiments on \textit{ex vivo} porcine eyes revealed challenges in maintaining a consistent tool-to-retina distance, with deviations of up to 200 $\mu m$ for 100 $\mu m$ amplitude motions and over 80 $\mu m$ for 25 $\mu m$ amplitude motions over one minute. Subretinal injections faced additional difficulties, with horizontal shifts causing the needle to move off-target and inject into the vitreous. These results highlight the need for improved motion prediction and horizontal stability to enhance the accuracy and safety of robotic subretinal procedures.

G2SDF: Surface Reconstruction from Explicit Gaussians with Implicit SDFs

State-of-the-art novel view synthesis methods such as 3D Gaussian Splatting (3DGS) achieve remarkable visual quality. While 3DGS and its variants can be rendered efficiently using rasterization, many tasks require access to the underlying 3D surface, which remains challenging to extract due to the sparse and explicit nature of this representation. In this paper, we introduce G2SDF, a novel approach that addresses this limitation by integrating a neural implicit Signed Distance Field (SDF) into the Gaussian Splatting framework. Our method links the opacity values of Gaussians with their distances to the surface, ensuring a closer alignment of Gaussians with the scene surface. To extend this approach to unbounded scenes at varying scales, we propose a normalization function that maps any range to a fixed interval. To further enhance reconstruction quality, we leverage an off-the-shelf depth estimator as pseudo ground truth during Gaussian Splatting optimization. By establishing a differentiable connection between the explicit Gaussians and the implicit SDF, our approach enables high-quality surface reconstruction and rendering. Experimental results on several real-world datasets demonstrate that G2SDF achieves superior reconstruction quality than prior works while maintaining the efficiency of 3DGS.

OphCLIP: Hierarchical Retrieval-Augmented Learning for Ophthalmic Surgical Video-Language Pretraining

Surgical practice involves complex visual interpretation, procedural skills, and advanced medical knowledge, making surgical vision-language pretraining (VLP) particularly challenging due to this complexity and the limited availability of annotated data. To address the gap, we propose OphCLIP, a hierarchical retrieval-augmented vision-language pretraining framework specifically designed for ophthalmic surgical workflow understanding. OphCLIP leverages the OphVL dataset we constructed, a large-scale and comprehensive collection of over 375K hierarchically structured video-text pairs with tens of thousands of different combinations of attributes (surgeries, phases/operations/actions, instruments, medications, as well as more advanced aspects like the causes of eye diseases, surgical objectives, and postoperative recovery recommendations, etc). These hierarchical video-text correspondences enable OphCLIP to learn both fine-grained and long-term visual representations by aligning short video clips with detailed narrative descriptions and full videos with structured titles, capturing intricate surgical details and high-level procedural insights, respectively. Our OphCLIP also designs a retrieval-augmented pretraining framework to leverage the underexplored large-scale silent surgical procedure videos, automatically retrieving semantically relevant content to enhance the representation learning of narrative videos. Evaluation across 11 datasets for phase recognition and multi-instrument identification shows OphCLIP's robust generalization and superior performance.

Real-time Deformation-aware Control for Autonomous Robotic Subretinal Injection under iOCT Guidance

Robotic platforms provide repeatable and precise tool positioning that significantly enhances retinal microsurgery. Integration of such systems with intraoperative optical coherence tomography (iOCT) enables image-guided robotic interventions, allowing to autonomously perform advanced treatment possibilities, such as injecting therapeutic agents into the subretinal space. Yet, tissue deformations due to tool-tissue interactions are a major challenge in autonomous iOCT-guided robotic subretinal injection, impacting correct needle positioning and, thus, the outcome of the procedure. This paper presents a novel method for autonomous subretinal injection under iOCT guidance that considers tissue deformations during the insertion procedure. This is achieved through real-time segmentation and 3D reconstruction of the surgical scene from densely sampled iOCT B-scans, which we refer to as B5-scans, to monitor the positioning of the instrument regarding a virtual target layer defined at a relative position between the ILM and RPE. Our experiments on ex-vivo porcine eyes demonstrate dynamic adjustment of the insertion depth and overall improved accuracy in needle positioning compared to previous autonomous insertion approaches. Compared to a 35% success rate in subretinal bleb generation with previous approaches, our proposed method reliably and robustly created subretinal blebs in all our experiments.