On the Fly Robotic-Assisted Medical Instrument Planning and Execution Using Mixed Reality

Robotic-assisted medical systems (RAMS) have gained significant attention for their advantages in alleviating surgeons' fatigue and improving patients' outcomes. These systems comprise a range of human-computer interactions, including medical scene monitoring, anatomical target planning, and robot manipulation. However, despite its versatility and effectiveness, RAMS demands expertise in robotics, leading to a high learning cost for the operator. In this work, we introduce a novel framework using mixed reality technologies to ease the use of RAMS. The proposed framework achieves real-time planning and execution of medical instruments by providing 3D anatomical image overlay, human-robot collision detection, and robot programming interface. These features, integrated with an easy-to-use calibration method for head-mounted display, improve the effectiveness of human-robot interactions. To assess the feasibility of the framework, two medical applications are presented in this work: 1) coil placement during transcranial magnetic stimulation and 2) drill and injector device positioning during femoroplasty. Results from these use cases demonstrate its potential to extend to a wider range of medical scenarios.

GBEC: Geometry-Based Hand-Eye Calibration

Hand-eye calibration is the problem of solving the transformation from the end-effector of a robot to the sensor attached to it. Commonly employed techniques, such as AXXB or AXZB formulations, rely on regression methods that require collecting pose data from different robot configurations, which can produce low accuracy and repeatability. However, the derived transformation should solely depend on the geometry of the end-effector and the sensor attachment. We propose Geometry-Based End-Effector Calibration (GBEC) that enhances the repeatability and accuracy of the derived transformation compared to traditional hand-eye calibrations. To demonstrate improvements, we apply the approach to two different robot-assisted procedures: Transcranial Magnetic Stimulation (TMS) and femoroplasty. We also discuss the generalizability of GBEC for camera-in-hand and marker-in-hand sensor mounting methods. In the experiments, we perform GBEC between the robot end-effector and an optical tracker's rigid body marker attached to the TMS coil or femoroplasty drill guide. Previous research documents low repeatability and accuracy of the conventional methods for robot-assisted TMS hand-eye calibration. When compared to some existing methods, the proposed method relies solely on the geometry of the flange and the pose of the rigid-body marker, making it independent of workspace constraints or robot accuracy, without sacrificing the orthogonality of the rotation matrix. Our results validate the accuracy and applicability of the approach, providing a new and generalizable methodology for obtaining the transformation from the end-effector to a sensor.

Segment Any Medical Model Extended

The Segment Anything Model (SAM) has drawn significant attention from researchers who work on medical image segmentation because of its generalizability. However, researchers have found that SAM may have limited performance on medical images compared to state-of-the-art non-foundation models. Regardless, the community sees potential in extending, fine-tuning, modifying, and evaluating SAM for analysis of medical imaging. An increasing number of works have been published focusing on the mentioned four directions, where variants of SAM are proposed. To this end, a unified platform helps push the boundary of the foundation model for medical images, facilitating the use, modification, and validation of SAM and its variants in medical image segmentation. In this work, we introduce SAMM Extended (SAMME), a platform that integrates new SAM variant models, adopts faster communication protocols, accommodates new interactive modes, and allows for fine-tuning of subcomponents of the models. These features can expand the potential of foundation models like SAM, and the results can be translated to applications such as image-guided therapy, mixed reality interaction, robotic navigation, and data augmentation.

Realtime Robust Shape Estimation of Deformable Linear Object

Realtime shape estimation of continuum objects and manipulators is essential for developing accurate planning and control paradigms. The existing methods that create dense point clouds from camera images, and/or use distinguishable markers on a deformable body have limitations in realtime tracking of large continuum objects/manipulators. The physical occlusion of markers can often compromise accurate shape estimation. We propose a robust method to estimate the shape of linear deformable objects in realtime using scattered and unordered key points. By utilizing a robust probability-based labeling algorithm, our approach identifies the true order of the detected key points and then reconstructs the shape using piecewise spline interpolation. The approach only relies on knowing the number of the key points and the interval between two neighboring points. We demonstrate the robustness of the method when key points are partially occluded. The proposed method is also integrated into a simulation in Unity for tracking the shape of a cable with a length of 1m and a radius of 5mm. The simulation results show that our proposed approach achieves an average length error of 1.07% over the continuum's centerline and an average cross-section error of 2.11mm. The real-world experiments of tracking and estimating a heavy-load cable prove that the proposed approach is robust under occlusion and complex entanglement scenarios.

A Roadmap Towards Automated and Regulated Robotic Systems

The rapid development of generative technology opens up possibility for higher level of automation, and artificial intelligence (AI) embodiment in robotic systems is imminent. However, due to the blackbox nature of the generative technology, the generation of the knowledge and workflow scheme is uncontrolled, especially in a dynamic environment and a complex scene. This poses challenges to regulations in safety-demanding applications such as medical scenes. We argue that the unregulated generative processes from AI is fitted for low level end tasks, but intervention in the form of manual or automated regulation should happen post-workflow-generation and pre-robotic-execution. To address this, we propose a roadmap that can lead to fully automated and regulated robotic systems. In this paradigm, the high level policies are generated as structured graph data, enabling regulatory oversight and reusability, while the code base for lower level tasks is generated by generative models. Our approach aims the transitioning from expert knowledge to regulated action, akin to the iterative processes of study, practice, scrutiny, and execution in human tasks. We identify the generative and deterministic processes in a design cycle, where generative processes serve as a text-based world simulator and the deterministic processes generate the executable system. We propose State Machine Seralization Language (SMSL) to be the conversion point between text simulator and executable workflow control. From there, we analyze the modules involved based on the current literature, and discuss human in the loop. As a roadmap, this work identifies the current possible implementation and future work. This work does not provide an implemented system but envisions to inspire the researchers working on the direction in the roadmap. We implement the SMSL and D-SFO paradigm that serve as the starting point of the roadmap.

FluoroSAM: A Language-aligned Foundation Model for X-ray Image Segmentation

Automated X-ray image segmentation would accelerate research and development in diagnostic and interventional precision medicine. Prior efforts have contributed task-specific models capable of solving specific image analysis problems, but the utility of these models is restricted to their particular task domain, and expanding to broader use requires additional data, labels, and retraining efforts. Recently, foundation models (FMs) -- machine learning models trained on large amounts of highly variable data thus enabling broad applicability -- have emerged as promising tools for automated image analysis. Existing FMs for medical image analysis focus on scenarios and modalities where objects are clearly defined by visually apparent boundaries, such as surgical tool segmentation in endoscopy. X-ray imaging, by contrast, does not generally offer such clearly delineated boundaries or structure priors. During X-ray image formation, complex 3D structures are projected in transmission onto the imaging plane, resulting in overlapping features of varying opacity and shape. To pave the way toward an FM for comprehensive and automated analysis of arbitrary medical X-ray images, we develop FluoroSAM, a language-aligned variant of the Segment-Anything Model, trained from scratch on 1.6M synthetic X-ray images. FluoroSAM is trained on data including masks for 128 organ types and 464 non-anatomical objects, such as tools and implants. In real X-ray images of cadaveric specimens, FluoroSAM is able to segment bony anatomical structures based on text-only prompting with 0.51 and 0.79 DICE with point-based refinement, outperforming competing SAM variants for all structures. FluoroSAM is also capable of zero-shot generalization to segmenting classes beyond the training set thanks to its language alignment, which we demonstrate for full lung segmentation on real chest X-rays.

Data-Driven Shape Sensing in Continuum Manipulators via Sliding Resistive Flex Sensors

We introduce a novel shape-sensing method using Resistive Flex Sensors (RFS) embedded in cable-driven Continuum Dexterous Manipulators (CDMs). The RFS is predominantly sensitive to deformation rather than direct forces, making it a distinctive tool for shape sensing. The RFS unit we designed is a considerably less expensive and robust alternative, offering comparable accuracy and real-time performance to existing shape sensing methods used for the CDMs proposed for minimally-invasive surgery. Our design allows the RFS to move along and inside the CDM conforming to its curvature, offering the ability to capture resistance metrics from various bending positions without the need for elaborate sensor setups. The RFS unit is calibrated using an overhead camera and a ResNet machine learning framework. Experiments using a 3D printed prototype of the CDM achieved an average shape estimation error of 0.968 mm with a standard error of 0.275 mm. The response time of the model was approximately 1.16 ms, making real-time shape sensing feasible. While this preliminary study successfully showed the feasibility of our approach for C-shape CDM deformations with non-constant curvatures, we are currently extending the results to show the feasibility for adapting to more complex CDM configurations such as S-shape created in obstructed environments or in presence of the external forces.

Toward Process Controlled Medical Robotic System

Medical errors, defined as unintended acts either of omission or commission that cause the failure of medical actions, are the third leading cause of death in the United States. The application of autonomy and robotics can alleviate some causes of medical errors by improving accuracy and providing means to preciously follow planned procedures. However, for the robotic applications to improve safety, they must maintain constant operating conditions in the presence of disturbances, and provide reliable measurements, evaluation, and control for each state of the procedure. This article addresses the need for process control in medical robotic systems, and proposes a standardized design cycle toward its automation. Monitoring and controlling the changing conditions in a medical or surgical environment necessitates a clear definition of workflows and their procedural dependencies. We propose integrating process control into medical robotic workflows to identify change in states of the system and environment, possible operations, and transitions to new states. Therefore, the system translates clinician experiences and procedure workflows into machine-interpretable languages. The design cycle using hFSM formulation can be a deterministic process, which opens up possibilities for higher-level automation in medical robotics. Shown in our work, with a standardized design cycle and software paradigm, we pave the way toward controlled workflows that can be automatically generated. Additionally, a modular design for a robotic system architecture that integrates hFSM can provide easy software and hardware integration. This article discusses the system design, software implementation, and example application to Robot-Assisted Transcranial Magnetic Stimulation and robot-assisted femoroplasty. We also provide assessments of these two system examples by testing their robotic tool placement.

Skin Lesion Correspondence Localization in Total Body Photography

Longitudinal tracking of skin lesions - finding correspondence, changes in morphology, and texture - is beneficial to the early detection of melanoma. However, it has not been well investigated in the context of full-body imaging. We propose a novel framework combining geometric and texture information to localize skin lesion correspondence from a source scan to a target scan in total body photography (TBP). Body landmarks or sparse correspondence are first created on the source and target 3D textured meshes. Every vertex on each of the meshes is then mapped to a feature vector characterizing the geodesic distances to the landmarks on that mesh. Then, for each lesion of interest (LOI) on the source, its corresponding location on the target is first coarsely estimated using the geometric information encoded in the feature vectors and then refined using the texture information. We evaluated the framework quantitatively on both a public and a private dataset, for which our success rates (at 10 mm criterion) are comparable to the only reported longitudinal study. As full-body 3D capture becomes more prevalent and has higher quality, we expect the proposed method to constitute a valuable step in the longitudinal tracking of skin lesions.

Pelphix: Surgical Phase Recognition from X-ray Images in Percutaneous Pelvic Fixation

Surgical phase recognition (SPR) is a crucial element in the digital transformation of the modern operating theater. While SPR based on video sources is well-established, incorporation of interventional X-ray sequences has not yet been explored. This paper presents Pelphix, a first approach to SPR for X-ray-guided percutaneous pelvic fracture fixation, which models the procedure at four levels of granularity -- corridor, activity, view, and frame value -- simulating the pelvic fracture fixation workflow as a Markov process to provide fully annotated training data. Using added supervision from detection of bony corridors, tools, and anatomy, we learn image representations that are fed into a transformer model to regress surgical phases at the four granularity levels. Our approach demonstrates the feasibility of X-ray-based SPR, achieving an average accuracy of 93.8% on simulated sequences and 67.57% in cadaver across all granularity levels, with up to 88% accuracy for the target corridor in real data. This work constitutes the first step toward SPR for the X-ray domain, establishing an approach to categorizing phases in X-ray-guided surgery, simulating realistic image sequences to enable machine learning model development, and demonstrating that this approach is feasible for the analysis of real procedures. As X-ray-based SPR continues to mature, it will benefit procedures in orthopedic surgery, angiography, and interventional radiology by equipping intelligent surgical systems with situational awareness in the operating room.