Generalizable automated ischaemic stroke lesion segmentation with vision transformers

Ischaemic stroke, a leading cause of death and disability, critically relies on neuroimaging for characterising the anatomical pattern of injury. Diffusion-weighted imaging (DWI) provides the highest expressivity in ischemic stroke but poses substantial challenges for automated lesion segmentation: susceptibility artefacts, morphological heterogeneity, age-related comorbidities, time-dependent signal dynamics, instrumental variability, and limited labelled data. Current U-Net-based models therefore underperform, a problem accentuated by inadequate evaluation metrics that focus on mean performance, neglecting anatomical, subpopulation, and acquisition-dependent variability. Here, we present a high-performance DWI lesion segmentation tool addressing these challenges through optimized vision transformer-based architectures, integration of 3563 annotated lesions from multi-site data, and algorithmic enhancements, achieving state-of-the-art results. We further propose a novel evaluative framework assessing model fidelity, equity (across demographics and lesion subtypes), anatomical precision, and robustness to instrumental variability, promoting clinical and research utility. This work advances stroke imaging by reconciling model expressivity with domain-specific challenges and redefining performance benchmarks to prioritize equity and generalizability, critical for personalized medicine and mechanistic research.

Deep generative computed perfusion-deficit mapping of ischaemic stroke

Focal deficits in ischaemic stroke result from impaired perfusion downstream of a critical vascular occlusion. While parenchymal lesions are traditionally used to predict clinical deficits, the underlying pattern of disrupted perfusion provides information upstream of the lesion, potentially yielding earlier predictive and localizing signals. Such perfusion maps can be derived from routine CT angiography (CTA) widely deployed in clinical practice. Analysing computed perfusion maps from 1,393 CTA-imaged-patients with acute ischaemic stroke, we use deep generative inference to localise neural substrates of NIHSS sub-scores. We show that our approach replicates known lesion-deficit relations without knowledge of the lesion itself and reveals novel neural dependents. The high achieved anatomical fidelity suggests acute CTA-derived computed perfusion maps may be of substantial clinical-and-scientific value in rich phenotyping of acute stroke. Using only hyperacute imaging, deep generative inference could power highly expressive models of functional anatomical relations in ischaemic stroke within the pre-interventional window.

SWAG: Long-term Surgical Workflow Prediction with Generative-based Anticipation

While existing recognition approaches excel at identifying current surgical phases, they provide limited foresight into future procedural steps, restricting their intraoperative utility. Similarly, current anticipation methods are constrained to predicting short-term events or singular future occurrences, neglecting the dynamic and sequential nature of surgical workflows. To address these limitations, we propose SWAG (Surgical Workflow Anticipative Generation), a unified framework for phase recognition and long-term anticipation of surgical workflows. SWAG employs two generative decoding methods -- single-pass (SP) and auto-regressive (AR) -- to predict sequences of future surgical phases. A novel prior knowledge embedding mechanism enhances the accuracy of anticipatory predictions. The framework addresses future phase classification and remaining time regression tasks. Additionally, a regression-to-classification (R2C) method is introduced to map continuous predictions to discrete temporal segments. SWAG's performance was evaluated on the Cholec80 and AutoLaparo21 datasets. The single-pass classification model with prior knowledge embeddings (SWAG-SP\*) achieved 53.5\% accuracy in 15-minute anticipation on AutoLaparo21, while the R2C model reached 60.8\% accuracy on Cholec80. SWAG's single-pass regression approach outperformed existing methods for remaining time prediction, achieving weighted mean absolute errors of 0.32 and 0.48 minutes for 2- and 3-minute horizons, respectively. SWAG demonstrates versatility across classification and regression tasks, offering robust tools for real-time surgical workflow anticipation. By unifying recognition and anticipatory capabilities, SWAG provides actionable predictions to enhance intraoperative decision-making.

A cautionary tale on the cost-effectiveness of collaborative AI in real-world medical applications

Background. Federated learning (FL) has gained wide popularity as a collaborative learning paradigm enabling collaborative AI in sensitive healthcare applications. Nevertheless, the practical implementation of FL presents technical and organizational challenges, as it generally requires complex communication infrastructures. In this context, consensus-based learning (CBL) may represent a promising collaborative learning alternative, thanks to the ability of combining local knowledge into a federated decision system, while potentially reducing deployment overhead. Methods. In this work we propose an extensive benchmark of the accuracy and cost-effectiveness of a panel of FL and CBL methods in a wide range of collaborative medical data analysis scenarios. The benchmark includes 7 different medical datasets, encompassing 3 machine learning tasks, 8 different data modalities, and multi-centric settings involving 3 to 23 clients. Findings. Our results reveal that CBL is a cost-effective alternative to FL. When compared across the panel of medical dataset in the considered benchmark, CBL methods provide equivalent accuracy to the one achieved by FL.Nonetheless, CBL significantly reduces training time and communication cost (resp. 15 fold and 60 fold decrease) (p < 0.05). Interpretation. This study opens a novel perspective on the deployment of collaborative AI in real-world applications, whereas the adoption of cost-effective methods is instrumental to achieve sustainability and democratisation of AI by alleviating the need for extensive computational resources.

SAM-I2I: Unleash the Power of Segment Anything Model for Medical Image Translation

Medical image translation is crucial for reducing the need for redundant and expensive multi-modal imaging in clinical field. However, current approaches based on Convolutional Neural Networks (CNNs) and Transformers often fail to capture fine-grain semantic features, resulting in suboptimal image quality. To address this challenge, we propose SAM-I2I, a novel image-to-image translation framework based on the Segment Anything Model 2 (SAM2). SAM-I2I utilizes a pre-trained image encoder to extract multiscale semantic features from the source image and a decoder, based on the mask unit attention module, to synthesize target modality images. Our experiments on multi-contrast MRI datasets demonstrate that SAM-I2I outperforms state-of-the-art methods, offering more efficient and accurate medical image translation.

EndoOmni: Zero-Shot Cross-Dataset Depth Estimation in Endoscopy by Robust Self-Learning from Noisy Labels

Single-image depth estimation is essential for endoscopy tasks such as localization, reconstruction, and augmented reality. Most existing methods in surgical scenes focus on in-domain depth estimation, limiting their real-world applicability. This constraint stems from the scarcity and inferior labeling quality of medical data for training. In this work, we present EndoOmni, the first foundation model for zero-shot cross-domain depth estimation for endoscopy. To harness the potential of diverse training data, we refine the advanced self-learning paradigm that employs a teacher model to generate pseudo-labels, guiding a student model trained on large-scale labeled and unlabeled data. To address training disturbance caused by inherent noise in depth labels, we propose a robust training framework that leverages both depth labels and estimated confidence from the teacher model to jointly guide the student model training. Moreover, we propose a weighted scale-and-shift invariant loss to adaptively adjust learning weights based on label confidence, thus imposing learning bias towards cleaner label pixels while reducing the influence of highly noisy pixels. Experiments on zero-shot relative depth estimation show that our EndoOmni improves state-of-the-art methods in medical imaging for 41\% and existing foundation models for 25\% in terms of absolute relative error on specific dataset. Furthermore, our model provides strong initialization for fine-tuning to metric depth estimation, maintaining superior performance in both in-domain and out-of-domain scenarios. The source code will be publicly available.

SurgeMOD: Translating image-space tissue motions into vision-based surgical forces

We present a new approach for vision-based force estimation in Minimally Invasive Robotic Surgery based on frequency domain basis of motion of organs derived directly from video. Using internal movements generated by natural processes like breathing or the cardiac cycle, we infer the image-space basis of the motion on the frequency domain. As we are working with this representation, we discretize the problem to a limited amount of low-frequencies to build an image-space mechanical model of the environment. We use this pre-built model to define our force estimation problem as a dynamic constraint problem. We demonstrate that this method can estimate point contact forces reliably for silicone phantom and ex-vivo experiments, matching real readings from a force sensor. In addition, we perform qualitative experiments in which we synthesize coherent force textures from surgical videos over a certain region of interest selected by the user. Our method demonstrates good results for both quantitative and qualitative analysis, providing a good starting point for a purely vision-based method for surgical force estimation.

Self-supervised Brain Lesion Generation for Effective Data Augmentation of Medical Images

Accurate brain lesion delineation is important for planning neurosurgical treatment. Automatic brain lesion segmentation methods based on convolutional neural networks have demonstrated remarkable performance. However, neural network performance is constrained by the lack of large-scale well-annotated training datasets. In this manuscript, we propose a comprehensive framework to efficiently generate new, realistic samples for training a brain lesion segmentation model. We first train a lesion generator, based on an adversarial autoencoder, in a self-supervised manner. Next, we utilize a novel image composition algorithm, Soft Poisson Blending, to seamlessly combine synthetic lesions and brain images to obtain training samples. Finally, to effectively train the brain lesion segmentation model with augmented images we introduce a new prototype consistence regularization to align real and synthetic features. Our framework is validated by extensive experiments on two public brain lesion segmentation datasets: ATLAS v2.0 and Shift MS. Our method outperforms existing brain image data augmentation schemes. For instance, our method improves the Dice from 50.36% to 60.23% compared to the U-Net with conventional data augmentation techniques for the ATLAS v2.0 dataset.

VS-Assistant: Versatile Surgery Assistant on the Demand of Surgeons

The surgical intervention is crucial to patient healthcare, and many studies have developed advanced algorithms to provide understanding and decision-making assistance for surgeons. Despite great progress, these algorithms are developed for a single specific task and scenario, and in practice require the manual combination of different functions, thus limiting the applicability. Thus, an intelligent and versatile surgical assistant is expected to accurately understand the surgeon's intentions and accordingly conduct the specific tasks to support the surgical process. In this work, by leveraging advanced multimodal large language models (MLLMs), we propose a Versatile Surgery Assistant (VS-Assistant) that can accurately understand the surgeon's intention and complete a series of surgical understanding tasks, e.g., surgical scene analysis, surgical instrument detection, and segmentation on demand. Specifically, to achieve superior surgical multimodal understanding, we devise a mixture of projectors (MOP) module to align the surgical MLLM in VS-Assistant to balance the natural and surgical knowledge. Moreover, we devise a surgical Function-Calling Tuning strategy to enable the VS-Assistant to understand surgical intentions, and thus make a series of surgical function calls on demand to meet the needs of the surgeons. Extensive experiments on neurosurgery data confirm that our VS-Assistant can understand the surgeon's intention more accurately than the existing MLLM, resulting in overwhelming performance in textual analysis and visual tasks. Source code and models will be made public.

Artificial Intelligence in the Autonomous Navigation of Endovascular Interventions: A Systematic Review

Purpose: Autonomous navigation of devices in endovascular interventions can decrease operation times, improve decision-making during surgery, and reduce operator radiation exposure while increasing access to treatment. This systematic review explores recent literature to assess the impact, challenges, and opportunities artificial intelligence (AI) has for the autonomous endovascular intervention navigation. Methods: PubMed and IEEEXplore databases were queried. Eligibility criteria included studies investigating the use of AI in enabling the autonomous navigation of catheters/guidewires in endovascular interventions. Following PRISMA, articles were assessed using QUADAS-2. PROSPERO: CRD42023392259. Results: Among 462 studies, fourteen met inclusion criteria. Reinforcement learning (9/14, 64%) and learning from demonstration (7/14, 50%) were used as data-driven models for autonomous navigation. Studies predominantly utilised physical phantoms (10/14, 71%) and in silico (4/14, 29%) models. Experiments within or around the blood vessels of the heart were reported by the majority of studies (10/14, 71%), while simple non-anatomical vessel platforms were used in three studies (3/14, 21%), and the porcine liver venous system in one study. We observed that risk of bias and poor generalisability were present across studies. No procedures were performed on patients in any of the studies reviewed. Studies lacked patient selection criteria, reference standards, and reproducibility, resulting in low clinical evidence levels. Conclusions: AI's potential in autonomous endovascular navigation is promising, but in an experimental proof-of-concept stage, with a technology readiness level of 3. We highlight that reference standards with well-identified performance metrics are crucial to allow for comparisons of data-driven algorithms proposed in the years to come.