CAS-GAN for Contrast-free Angiography Synthesis

Iodinated contrast agents are widely utilized in numerous interventional procedures, yet posing substantial health risks to patients. This paper presents CAS-GAN, a novel GAN framework that serves as a ``virtual contrast agent" to synthesize X-ray angiographies via disentanglement representation learning and vessel semantic guidance, thereby reducing the reliance on iodinated agents during interventional procedures. Specifically, our approach disentangles X-ray angiographies into background and vessel components, leveraging medical prior knowledge. A specialized predictor then learns to map the interrelationships between these components. Additionally, a vessel semantic-guided generator and a corresponding loss function are introduced to enhance the visual fidelity of generated images. Experimental results on the XCAD dataset demonstrate the state-of-the-art performance of our CAS-GAN, achieving a FID of 5.94 and a MMD of 0.017. These promising results highlight CAS-GAN's potential for clinical applications.

SPIRONet: Spatial-Frequency Learning and Topological Channel Interaction Network for Vessel Segmentation

Automatic vessel segmentation is paramount for developing next-generation interventional navigation systems. However, current approaches suffer from suboptimal segmentation performances due to significant challenges in intraoperative images (i.e., low signal-to-noise ratio, small or slender vessels, and strong interference). In this paper, a novel spatial-frequency learning and topological channel interaction network (SPIRONet) is proposed to address the above issues. Specifically, dual encoders are utilized to comprehensively capture local spatial and global frequency vessel features. Then, a cross-attention fusion module is introduced to effectively fuse spatial and frequency features, thereby enhancing feature discriminability. Furthermore, a topological channel interaction module is designed to filter out task-irrelevant responses based on graph neural networks. Extensive experimental results on several challenging datasets (CADSA, CAXF, DCA1, and XCAD) demonstrate state-of-the-art performances of our method. Moreover, the inference speed of SPIRONet is 21 FPS with a 512x512 input size, surpassing clinical real-time requirements (6~12FPS). These promising outcomes indicate SPIRONet's potential for integration into vascular interventional navigation systems. Code is available at https://github.com/Dxhuang-CASIA/SPIRONet.

MOSformer: Momentum encoder-based inter-slice fusion transformer for medical image segmentation

Medical image segmentation takes an important position in various clinical applications. Deep learning has emerged as the predominant solution for automated segmentation of volumetric medical images. 2.5D-based segmentation models bridge computational efficiency of 2D-based models and spatial perception capabilities of 3D-based models. However, prevailing 2.5D-based models often treat each slice equally, failing to effectively learn and exploit inter-slice information, resulting in suboptimal segmentation performances. In this paper, a novel Momentum encoder-based inter-slice fusion transformer (MOSformer) is proposed to overcome this issue by leveraging inter-slice information at multi-scale feature maps extracted by different encoders. Specifically, dual encoders are employed to enhance feature distinguishability among different slices. One of the encoders is moving-averaged to maintain the consistency of slice representations. Moreover, an IF-Swin transformer module is developed to fuse inter-slice multi-scale features. The MOSformer is evaluated on three benchmark datasets (Synapse, ACDC, and AMOS), establishing a new state-of-the-art with 85.63%, 92.19%, and 85.43% of DSC, respectively. These promising results indicate its competitiveness in medical image segmentation. Codes and models of MOSformer will be made publicly available upon acceptance.

CROP: Conservative Reward for Model-based Offline Policy Optimization

Offline reinforcement learning (RL) aims to optimize policy using collected data without online interactions. Model-based approaches are particularly appealing for addressing offline RL challenges due to their capability to mitigate the limitations of offline data through data generation using models. Prior research has demonstrated that introducing conservatism into the model or Q-function during policy optimization can effectively alleviate the prevalent distribution drift problem in offline RL. However, the investigation into the impacts of conservatism in reward estimation is still lacking. This paper proposes a novel model-based offline RL algorithm, Conservative Reward for model-based Offline Policy optimization (CROP), which conservatively estimates the reward in model training. To achieve a conservative reward estimation, CROP simultaneously minimizes the estimation error and the reward of random actions. Theoretical analysis shows that this conservative reward mechanism leads to a conservative policy evaluation and helps mitigate distribution drift. Experiments on D4RL benchmarks showcase that the performance of CROP is comparable to the state-of-the-art baselines. Notably, CROP establishes an innovative connection between offline and online RL, highlighting that offline RL problems can be tackled by adopting online RL techniques to the empirical Markov decision process trained with a conservative reward. The source code is available with https://github.com/G0K0URURI/CROP.git.

DOMAIN: MilDly COnservative Model-BAsed OfflINe Reinforcement Learning

Model-based reinforcement learning (RL), which learns environment model from offline dataset and generates more out-of-distribution model data, has become an effective approach to the problem of distribution shift in offline RL. Due to the gap between the learned and actual environment, conservatism should be incorporated into the algorithm to balance accurate offline data and imprecise model data. The conservatism of current algorithms mostly relies on model uncertainty estimation. However, uncertainty estimation is unreliable and leads to poor performance in certain scenarios, and the previous methods ignore differences between the model data, which brings great conservatism. Therefore, this paper proposes a milDly cOnservative Model-bAsed offlINe RL algorithm (DOMAIN) without estimating model uncertainty to address the above issues. DOMAIN introduces adaptive sampling distribution of model samples, which can adaptively adjust the model data penalty. In this paper, we theoretically demonstrate that the Q value learned by the DOMAIN outside the region is a lower bound of the true Q value, the DOMAIN is less conservative than previous model-based offline RL algorithms and has the guarantee of security policy improvement. The results of extensive experiments show that DOMAIN outperforms prior RL algorithms on the D4RL dataset benchmark, and achieves better performance than other RL algorithms on tasks that require generalization.

CASOG: Conservative Actor-critic with SmOoth Gradient for Skill Learning in Robot-Assisted Intervention

Robot-assisted intervention has shown reduced radiation exposure to physicians and improved precision in clinical trials. However, existing vascular robotic systems follow master-slave control mode and entirely rely on manual commands. This paper proposes a novel offline reinforcement learning algorithm, Conservative Actor-critic with SmOoth Gradient (CASOG), to learn manipulation skills from human demonstrations on vascular robotic systems. The proposed algorithm conservatively estimates Q-function and smooths gradients of convolution layers to deal with distribution shift and overfitting issues. Furthermore, to focus on complex manipulations, transitions with larger temporal-difference error are sampled with higher probability. Comparative experiments in a pre-clinical environment demonstrate that CASOG can deliver guidewire to the target at a success rate of 94.00\% and mean backward steps of 14.07, performing closer to humans and better than prior offline reinforcement learning methods. These results indicate that the proposed algorithm is promising to improve the autonomy of vascular robotic systems.

BARNet: Bilinear Attention Network with Adaptive Receptive Field for Surgical Instrument Segmentation

Surgical instrument segmentation is extremely important for computer-assisted surgery. Different from common object segmentation, it is more challenging due to the large illumination and scale variation caused by the special surgical scenes. In this paper, we propose a novel bilinear attention network with adaptive receptive field to solve these two challenges. For the illumination variation, the bilinear attention module can capture second-order statistics to encode global contexts and semantic dependencies between local pixels. With them, semantic features in challenging areas can be inferred from their neighbors and the distinction of various semantics can be boosted. For the scale variation, our adaptive receptive field module aggregates multi-scale features and automatically fuses them with different weights. Specifically, it encodes the semantic relationship between channels to emphasize feature maps with appropriate scales, changing the receptive field of subsequent convolutions. The proposed network achieves the best performance 97.47% mean IOU on Cata7 and comes first place on EndoVis 2017 by 10.10% IOU overtaking second-ranking method.

Attention-Guided Lightweight Network for Real-Time Segmentation of Robotic Surgical Instruments

Real-time segmentation of surgical instruments plays a crucial role in robot-assisted surgery. However, real-time segmentation of surgical instruments using current deep learning models is still a challenging task due to the high computational costs and slow inference speed. In this paper, an attention-guided lightweight network (LWANet), is proposed to segment surgical instruments in real-time. LWANet adopts the encoder-decoder architecture, where the encoder is the lightweight network MobileNetV2 and the decoder consists of depth-wise separable convolution, attention fusion block, and transposed convolution. Depth-wise separable convolution is used as the basic unit to construct the decoder, which can reduce the model size and computational costs. Attention fusion block captures global context and encodes semantic dependencies between channels to emphasize target regions, contributing to locating the surgical instrument. Transposed convolution is performed to upsample the feature map for acquiring refined edges. LWANet can segment surgical instruments in real-time, taking few computational costs. Based on 960*544 inputs, its inference speed can reach 39 fps with only 3.39 GFLOPs. Also, it has a small model size and the number of parameters is only 2.06 M. The proposed network is evaluated on two datasets. It achieves state-of-the-art performance 94.10% mean IOU on Cata7 and obtains a new record on EndoVis 2017 with 4.10% increase on mean mIOU.

RAUNet: Residual Attention U-Net for Semantic Segmentation of Cataract Surgical Instruments

Semantic segmentation of surgical instruments plays a crucial role in robot-assisted surgery. However, accurate segmentation of cataract surgical instruments is still a challenge due to specular reflection and class imbalance issues. In this paper, an attention-guided network is proposed to segment the cataract surgical instrument. A new attention module is designed to learn discriminative features and address the specular reflection issue. It captures global context and encodes semantic dependencies to emphasize key semantic features, boosting the feature representation. This attention module has very few parameters, which helps to save memory. Thus, it can be flexibly plugged into other networks. Besides, a hybrid loss is introduced to train our network for addressing the class imbalance issue, which merges cross entropy and logarithms of Dice loss. A new dataset named Cata7 is constructed to evaluate our network. To the best of our knowledge, this is the first cataract surgical instrument dataset for semantic segmentation. Based on this dataset, RAUNet achieves state-of-the-art performance 97.71% mean Dice and 95.62% mean IOU.

RASNet: Segmentation for Tracking Surgical Instruments in Surgical Videos Using Refined Attention Segmentation Network

Segmentation for tracking surgical instruments plays an important role in robot-assisted surgery. Segmentation of surgical instruments contributes to capturing accurate spatial information for tracking. In this paper, a novel network, Refined Attention Segmentation Network, is proposed to simultaneously segment surgical instruments and identify their categories. The U-shape network which is popular in segmentation is used. Different from previous work, an attention module is adopted to help the network focus on key regions, which can improve the segmentation accuracy. To solve the class imbalance problem, the weighted sum of the cross entropy loss and the logarithm of the Jaccard index is used as loss function. Furthermore, transfer learning is adopted in our network. The encoder is pre-trained on ImageNet. The dataset from the MICCAI EndoVis Challenge 2017 is used to evaluate our network. Based on this dataset, our network achieves state-of-the-art performance 94.65% mean Dice and 90.33% mean IOU.