A Modified da Vinci Surgical Instrument for OCE based Elasticity Estimation with Deep Learning

Robot-assisted surgery has advantages compared to conventional laparoscopic procedures, e.g., precise movement of the surgical instruments, improved dexterity, and high-resolution visualization of the surgical field. However, mechanical tissue properties may provide additional information, e.g., on the location of lesions or vessels. While elastographic imaging has been proposed, it is not readily available as an online modality during robot-assisted surgery. We propose modifying a da~Vinci surgical instrument to realize optical coherence elastography (OCE) for quantitative elasticity estimation. The modified da~Vinci instrument is equipped with piezoelectric elements for shear wave excitation and we employ fast optical coherence tomography (OCT) imaging to track propagating wave fields, which are directly related to biomechanical tissue properties. All high-voltage components are mounted at the proximal end outside the patient. We demonstrate that external excitation at the instrument shaft can effectively stimulate shear waves, even when considering damping. Comparing conventional and deep learning-based signal processing, resulting in mean absolute errors of 19.27 kPa and 6.29 kPa, respectively. These results illustrate that precise quantitative elasticity estimates can be obtained. We also demonstrate quantitative elasticity estimation on ex-vivo tissue samples of heart, liver and stomach, and show that the measurements can be used to distinguish soft and stiff tissue types.

Collaborative Robotic Biopsy with Trajectory Guidance and Needle Tip Force Feedback

The diagnostic value of biopsies is highly dependent on the placement of needles. Robotic trajectory guidance has been shown to improve needle positioning, but feedback for real-time navigation is limited. Haptic display of needle tip forces can provide rich feedback for needle navigation by enabling localization of tissue structures along the insertion path. We present a collaborative robotic biopsy system that combines trajectory guidance with kinesthetic feedback to assist the physician in needle placement. The robot aligns the needle while the insertion is performed in collaboration with a medical expert who controls the needle position on site. We present a needle design that senses forces at the needle tip based on optical coherence tomography and machine learning for real-time data processing. Our robotic setup allows operators to sense deep tissue interfaces independent of frictional forces to improve needle placement relative to a desired target structure. We first evaluate needle tip force sensing in ex-vivo tissue in a phantom study. We characterize the tip forces during insertions with constant velocity and demonstrate the ability to detect tissue interfaces in a collaborative user study. Participants are able to detect 91% of ex-vivo tissue interfaces based on needle tip force feedback alone. Finally, we demonstrate that even smaller, deep target structures can be accurately sampled by performing post-mortem in situ biopsies of the pancreas.

Tissue Classification During Needle Insertion Using Self-Supervised Contrastive Learning and Optical Coherence Tomography

Needle positioning is essential for various medical applications such as epidural anaesthesia. Physicians rely on their instincts while navigating the needle in epidural spaces. Thereby, identifying the tissue structures may be helpful to the physician as they can provide additional feedback in the needle insertion process. To this end, we propose a deep neural network that classifies the tissues from the phase and intensity data of complex OCT signals acquired at the needle tip. We investigate the performance of the deep neural network in a limited labelled dataset scenario and propose a novel contrastive pretraining strategy that learns invariant representation for phase and intensity data. We show that with 10% of the training set, our proposed pretraining strategy helps the model achieve an F1 score of 0.84 whereas the model achieves an F1 score of 0.60 without it. Further, we analyse the importance of phase and intensity individually towards tissue classification.

Ultrasound Shear Wave Elasticity Imaging with Spatio-Temporal Deep Learning

Ultrasound shear wave elasticity imaging is a valuable tool for quantifying the elastic properties of tissue. Typically, the shear wave velocity is derived and mapped to an elasticity value, which neglects information such as the shape of the propagating shear wave or push sequence characteristics. We present 3D spatio-temporal CNNs for fast local elasticity estimation from ultrasound data. This approach is based on retrieving elastic properties from shear wave propagation within small local regions. A large training data set is acquired with a robot from homogeneous gelatin phantoms ranging from 17.42 kPa to 126.05 kPa with various push locations. The results show that our approach can estimate elastic properties on a pixelwise basis with a mean absolute error of 5.01+-4.37 kPa. Furthermore, we estimate local elasticity independent of the push location and can even perform accurate estimates inside the push region. For phantoms with embedded inclusions, we report a 53.93% lower MAE (7.50 kPa) and on the background of 85.24% (1.64 kPa) compared to a conventional shear wave method. Overall, our method offers fast local estimations of elastic properties with small spatio-temporal window sizes.

A novel optical needle probe for deep learning-based tissue elasticity characterization

The distinction between malignant and benign tumors is essential to the treatment of cancer. The tissue's elasticity can be used as an indicator for the required tissue characterization. Optical coherence elastography (OCE) probes have been proposed for needle insertions but have so far lacked the necessary load sensing capabilities. We present a novel OCE needle probe that provides simultaneous optical coherence tomography (OCT) imaging and load sensing at the needle tip. We demonstrate the application of the needle probe in indentation experiments on gelatin phantoms with varying gelatin concentrations. We further implement two deep learning methods for the end-to-end sample characterization from the acquired OCT data. We report the estimation of gelatin sample concentrations in unseen samples with a mean error of $1.21 \pm 0.91$ wt\%. Both evaluated deep learning models successfully provide sample characterization with different advantages regarding the accuracy and inference time.

Endoscopic vs. volumetric OCT imaging of mastoid bone structure for pose estimation in minimally invasive cochlear implant surgery

Purpose: The facial recess is a delicate structure that must be protected in minimally invasive cochlear implant surgery. Current research estimates the drill trajectory by using endoscopy of the unique mastoid patterns. However, missing depth information limits available features for a registration to preoperative CT data. Therefore, this paper evaluates OCT for enhanced imaging of drill holes in mastoid bone and compares OCT data to original endoscopic images. Methods: A catheter-based OCT probe is inserted into a drill trajectory of a mastoid phantom in a translation-rotation manner to acquire the inner surface state. The images are undistorted and stitched to create volumentric data of the drill hole. The mastoid cell pattern is segmented automatically and compared to ground truth. Results: The mastoid pattern segmented on images acquired with OCT show a similarity of J = 73.6 % to ground truth based on endoscopic images and measured with the Jaccard metric. Leveraged by additional depth information, automated segmentation tends to be more robust and fail-safe compared to endoscopic images. Conclusion: The feasibility of using a clinically approved OCT probe for imaging the drill hole in cochlear implantation is shown. The resulting volumentric images provide additional information on the shape of caveties in the bone structure, which will be useful for image-to-patient registration and to estimate the drill trajectory. This will be another step towards safe minimally invasive cochlear implantation.

Towards Automatic Lesion Classification in the Upper Aerodigestive Tract Using OCT and Deep Transfer Learning Methods

Early detection of cancer is crucial for treatment and overall patient survival. In the upper aerodigestive tract (UADT) the gold standard for identification of malignant tissue is an invasive biopsy. Recently, non-invasive imaging techniques such as confocal laser microscopy and optical coherence tomography (OCT) have been used for tissue assessment. In particular, in a recent study experts classified lesions in the UADT with respect to their invasiveness using OCT images only. As the results were promising, automatic classification of lesions might be feasible which could assist experts in their decision making. Therefore, we address the problem of automatic lesion classification from OCT images. This task is very challenging as the available dataset is extremely small and the data quality is limited. However, as similar issues are typical in many clinical scenarios we study to what extent deep learning approaches can still be trained and used for decision support.

Bioresorbable Scaffold Visualization in IVOCT Images Using CNNs and Weakly Supervised Localization

Bioresorbable scaffolds have become a popular choice for treatment of coronary heart disease, replacing traditional metal stents. Often, intravascular optical coherence tomography is used to assess potential malapposition after implantation and for follow-up examinations later on. Typically, the scaffold is manually reviewed by an expert, analyzing each of the hundreds of image slices. As this is time consuming, automatic stent detection and visualization approaches have been proposed, mostly for metal stent detection based on classic image processing. As bioresorbable scaffolds are harder to detect, recent approaches have used feature extraction and machine learning methods for automatic detection. However, these methods require detailed, pixel-level labels in each image slice and extensive feature engineering for the particular stent type which might limit the approaches' generalization capabilities. Therefore, we propose a deep learning-based method for bioresorbable scaffold visualization using only image-level labels. A convolutional neural network is trained to predict whether an image slice contains a metal stent, a bioresorbable scaffold, or no device. Then, we derive local stent strut information by employing weakly supervised localization using saliency maps with guided backpropagation. As saliency maps are generally diffuse and noisy, we propose a novel patch-based method with image shifting which allows for high resolution stent visualization. Our convolutional neural network model achieves a classification accuracy of 99.0 % for image-level stent classification which can be used for both high quality in-slice stent visualization and 3D rendering of the stent structure.

Automatic Plaque Detection in IVOCT Pullbacks Using Convolutional Neural Networks

Coronary heart disease is a common cause of death despite being preventable. To treat the underlying plaque deposits in the arterial walls, intravascular optical coherence tomography can be used by experts to detect and characterize the lesions. In clinical routine, hundreds of images are acquired for each patient which requires automatic plaque detection for fast and accurate decision support. So far, automatic approaches rely on classic machine learning methods and deep learning solutions have rarely been studied. Given the success of deep learning methods with other imaging modalities, a thorough understanding of deep learning-based plaque detection for future clinical decision support systems is required. We address this issue with a new dataset consisting of in-vivo patient images labeled by three trained experts. Using this dataset, we employ state-of-the-art deep learning models that directly learn plaque classification from the images. For improved performance, we study different transfer learning approaches. Furthermore, we investigate the use of cartesian and polar image representations and employ data augmentation techniques tailored to each representation. We fuse both representations in a multi-path architecture for more effective feature exploitation. Last, we address the challenge of plaque differentiation in addition to detection. Overall, we find that our combined model performs best with an accuracy of 91.7%, a sensitivity of 90.9% and a specificity of 92.4%. Our results indicate that building a deep learning-based clinical decision support system for plaque detection is feasible.

Adversarial Training for Patient-Independent Feature Learning with IVOCT Data for Plaque Classification

Deep learning methods have shown impressive results for a variety of medical problems over the last few years. However, datasets tend to be small due to time-consuming annotation. As datasets with different patients are often very heterogeneous generalization to new patients can be difficult. This is complicated further if large differences in image acquisition can occur, which is common during intravascular optical coherence tomography for coronary plaque imaging. We address this problem with an adversarial training strategy where we force a part of a deep neural network to learn features that are independent of patient- or acquisitionspecific characteristics. We compare our regularization method to typical data augmentation strategies and show that our approach improves performance for a small medical dataset.