Image Synthesis with Class-Aware Semantic Diffusion Models for Surgical Scene Segmentation

Surgical scene segmentation is essential for enhancing surgical precision, yet it is frequently compromised by the scarcity and imbalance of available data. To address these challenges, semantic image synthesis methods based on generative adversarial networks and diffusion models have been developed. However, these models often yield non-diverse images and fail to capture small, critical tissue classes, limiting their effectiveness. In response, we propose the Class-Aware Semantic Diffusion Model (CASDM), a novel approach which utilizes segmentation maps as conditions for image synthesis to tackle data scarcity and imbalance. Novel class-aware mean squared error and class-aware self-perceptual loss functions have been defined to prioritize critical, less visible classes, thereby enhancing image quality and relevance. Furthermore, to our knowledge, we are the first to generate multi-class segmentation maps using text prompts in a novel fashion to specify their contents. These maps are then used by CASDM to generate surgical scene images, enhancing datasets for training and validating segmentation models. Our evaluation, which assesses both image quality and downstream segmentation performance, demonstrates the strong effectiveness and generalisability of CASDM in producing realistic image-map pairs, significantly advancing surgical scene segmentation across diverse and challenging datasets.

Towards Safe and Collaborative Robotic Ultrasound Tissue Scanning in Neurosurgery

Intraoperative ultrasound imaging is used to facilitate safe brain tumour resection. However, due to challenges with image interpretation and the physical scanning, this tool has yet to achieve widespread adoption in neurosurgery. In this paper, we introduce the components and workflow of a novel, versatile robotic platform for intraoperative ultrasound tissue scanning in neurosurgery. An RGB-D camera attached to the robotic arm allows for automatic object localisation with ArUco markers, and 3D surface reconstruction as a triangular mesh using the ImFusion Suite software solution. Impedance controlled guidance of the US probe along arbitrary surfaces, represented as a mesh, enables collaborative US scanning, i.e., autonomous, teleoperated and hands-on guided data acquisition. A preliminary experiment evaluates the suitability of the conceptual workflow and system components for probe landing on a custom-made soft-tissue phantom. Further assessment in future experiments will be necessary to prove the effectiveness of the presented platform.

Dietary Assessment with Multimodal ChatGPT: A Systematic Analysis

Conventional approaches to dietary assessment are primarily grounded in self-reporting methods or structured interviews conducted under the supervision of dietitians. These methods, however, are often subjective, potentially inaccurate, and time-intensive. Although artificial intelligence (AI)-based solutions have been devised to automate the dietary assessment process, these prior AI methodologies encounter challenges in their ability to generalize across a diverse range of food types, dietary behaviors, and cultural contexts. This results in AI applications in the dietary field that possess a narrow specialization and limited accuracy. Recently, the emergence of multimodal foundation models such as GPT-4V powering the latest ChatGPT has exhibited transformative potential across a wide range of tasks (e.g., Scene understanding and image captioning) in numerous research domains. These models have demonstrated remarkable generalist intelligence and accuracy, capable of processing various data modalities. In this study, we explore the application of multimodal ChatGPT within the realm of dietary assessment. Our findings reveal that GPT-4V excels in food detection under challenging conditions with accuracy up to 87.5% without any fine-tuning or adaptation using food-specific datasets. By guiding the model with specific language prompts (e.g., African cuisine), it shifts from recognizing common staples like rice and bread to accurately identifying regional dishes like banku and ugali. Another GPT-4V's standout feature is its contextual awareness. GPT-4V can leverage surrounding objects as scale references to deduce the portion sizes of food items, further enhancing its accuracy in translating food weight into nutritional content. This alignment with the USDA National Nutrient Database underscores GPT-4V's potential to advance nutritional science and dietary assessment techniques.

Detecting the Sensing Area of A Laparoscopic Probe in Minimally Invasive Cancer Surgery

In surgical oncology, it is challenging for surgeons to identify lymph nodes and completely resect cancer even with pre-operative imaging systems like PET and CT, because of the lack of reliable intraoperative visualization tools. Endoscopic radio-guided cancer detection and resection has recently been evaluated whereby a novel tethered laparoscopic gamma detector is used to localize a preoperatively injected radiotracer. This can both enhance the endoscopic imaging and complement preoperative nuclear imaging data. However, gamma activity visualization is challenging to present to the operator because the probe is non-imaging and it does not visibly indicate the activity origination on the tissue surface. Initial failed attempts used segmentation or geometric methods, but led to the discovery that it could be resolved by leveraging high-dimensional image features and probe position information. To demonstrate the effectiveness of this solution, we designed and implemented a simple regression network that successfully addressed the problem. To further validate the proposed solution, we acquired and publicly released two datasets captured using a custom-designed, portable stereo laparoscope system. Through intensive experimentation, we demonstrated that our method can successfully and effectively detect the sensing area, establishing a new performance benchmark. Code and data are available at https://github.com/br0202/Sensing_area_detection.git

Identifying Visible Tissue in Intraoperative Ultrasound Images during Brain Surgery: A Method and Application

Intraoperative ultrasound scanning is a demanding visuotactile task. It requires operators to simultaneously localise the ultrasound perspective and manually perform slight adjustments to the pose of the probe, making sure not to apply excessive force or breaking contact with the tissue, whilst also characterising the visible tissue. In this paper, we propose a method for the identification of the visible tissue, which enables the analysis of ultrasound probe and tissue contact via the detection of acoustic shadow and construction of confidence maps of the perceptual salience. Detailed validation with both in vivo and phantom data is performed. First, we show that our technique is capable of achieving state of the art acoustic shadow scan line classification - with an average binary classification accuracy on unseen data of 0.87. Second, we show that our framework for constructing confidence maps is able to produce an ideal response to a probe's pose that is being oriented in and out of optimality - achieving an average RMSE across five scans of 0.174. The performance evaluation justifies the potential clinical value of the method which can be used both to assist clinical training and optimise robot-assisted ultrasound tissue scanning.

Automated robotic intraoperative ultrasound for brain surgery

During brain tumour resection, localising cancerous tissue and delineating healthy and pathological borders is challenging, even for experienced neurosurgeons and neuroradiologists. Intraoperative imaging is commonly employed for determining and updating surgical plans in the operating room. Ultrasound (US) has presented itself a suitable tool for this task, owing to its ease of integration into the operating room and surgical procedure. However, widespread establishment of this tool has been limited because of the difficulty of anatomy localisation and data interpretation. In this work, we present a robotic framework designed and tested on a soft-tissue-mimicking brain phantom, simulating intraoperative US (iUS) scanning during brain tumour surgery.

SurgT challenge: Benchmark of Soft-Tissue Trackers for Robotic Surgery

This paper introduces the "SurgT: Surgical Tracking" challenge which was organised in conjunction with the 25th International Conference on Medical Image Computing and Computer-Assisted Intervention (MICCAI 2022). There were two purposes for the creation of this challenge: (1) the establishment of the first standardised benchmark for the research community to assess soft-tissue trackers; and (2) to encourage the development of unsupervised deep learning methods, given the lack of annotated data in surgery. A dataset of 157 stereo endoscopic videos from 20 clinical cases, along with stereo camera calibration parameters, have been provided. The participants were tasked with the development of algorithms to track a bounding box on stereo endoscopic videos. At the end of the challenge, the developed methods were assessed on a previously hidden test subset. This assessment uses benchmarking metrics that were purposely developed for this challenge and are now available online. The teams were ranked according to their Expected Average Overlap (EAO) score, which is a weighted average of the Intersection over Union (IoU) scores. The performance evaluation study verifies the efficacy of unsupervised deep learning algorithms in tracking soft-tissue. The best-performing method achieved an EAO score of 0.583 in the test subset. The dataset and benchmarking tool created for this challenge have been made publicly available. This challenge is expected to contribute to the development of autonomous robotic surgery and other digital surgical technologies.

Regularizing disparity estimation via multi task learning with structured light reconstruction

3D reconstruction is a useful tool for surgical planning and guidance. However, the lack of available medical data stunts research and development in this field, as supervised deep learning methods for accurate disparity estimation rely heavily on large datasets containing ground truth information. Alternative approaches to supervision have been explored, such as self-supervision, which can reduce or remove entirely the need for ground truth. However, no proposed alternatives have demonstrated performance capabilities close to what would be expected from a supervised setup. This work aims to alleviate this issue. In this paper, we investigate the learning of structured light projections to enhance the development of direct disparity estimation networks. We show for the first time that it is possible to accurately learn the projection of structured light on a scene, implicitly learning disparity. Secondly, we \textcolor{black}{explore the use of a multi task learning (MTL) framework for the joint training of structured light and disparity. We present results which show that MTL with structured light improves disparity training; without increasing the number of model parameters. Our MTL setup outperformed the single task learning (STL) network in every validation test. Notably, in the medical generalisation test, the STL error was 1.4 times worse than that of the best MTL performance. The benefit of using MTL is emphasised when the training data is limited.} A dataset containing stereoscopic images, disparity maps and structured light projections on medical phantoms and ex vivo tissue was created for evaluation together with virtual scenes. This dataset will be made publicly available in the future.

Collaborative Robotic Ultrasound Tissue Scanning for Surgical Resection Guidance in Neurosurgery

The aim of this paper is to introduce a robotic platform for autonomous iUS tissue scanning to optimise intraoperative diagnosis and improve surgical resection during robot-assisted operations. To guide anatomy specific robotic scanning and generate a representation of the robot task space, fast and accurate techniques for the recovery of 3D morphological structures of the surgical cavity are developed. The prototypic DLR MIRO surgical robotic arm is used to control the applied force and the in-plane motion of the US transducer. A key application of the proposed platform is the scanning of brain tissue to guide tumour resection.

Caveats on the first-generation da Vinci Research Kit: latent technical constraints and essential calibrations

Telesurgical robotic systems provide a well established form of assistance in the operating theater, with evidence of growing uptake in recent years. Until now, the da Vinci surgical system (Intuitive Surgical Inc, Sunnyvale, California) has been the most widely adopted robot of this kind, with more than 6,700 systems in current clinical use worldwide. To accelerate research on robotic-assisted surgery, the retired first-generation da Vinci robots have been redeployed for research use as "da Vinci Research Kits" (dVRKs), which have been distributed to research institutions around the world to support both training and research in the sector. In the past ten years, a great amount of research on the dVRK has been carried out across a vast range of research topics. During this extensive and distributed process, common technical issues have been identified that are buried deep within the dVRK research and development architecture, and were found to be common among dVRK user feedback, regardless of the breadth and disparity of research directions identified. This paper gathers and analyzes the most significant of these, with a focus on the technical constraints of the first-generation dVRK, which both existing and prospective users should be aware of before embarking onto dVRK-related research. The hope is that this review will aid users in identifying and addressing common limitations of the systems promptly, thus helping to accelerate progress in the field.