From Generalization to Precision: Exploring SAM for Tool Segmentation in Surgical Environments

Purpose: Accurate tool segmentation is essential in computer-aided procedures. However, this task conveys challenges due to artifacts' presence and the limited training data in medical scenarios. Methods that generalize to unseen data represent an interesting venue, where zero-shot segmentation presents an option to account for data limitation. Initial exploratory works with the Segment Anything Model (SAM) show that bounding-box-based prompting presents notable zero-short generalization. However, point-based prompting leads to a degraded performance that further deteriorates under image corruption. We argue that SAM drastically over-segment images with high corruption levels, resulting in degraded performance when only a single segmentation mask is considered, while the combination of the masks overlapping the object of interest generates an accurate prediction. Method: We use SAM to generate the over-segmented prediction of endoscopic frames. Then, we employ the ground-truth tool mask to analyze the results of SAM when the best single mask is selected as prediction and when all the individual masks overlapping the object of interest are combined to obtain the final predicted mask. We analyze the Endovis18 and Endovis17 instrument segmentation datasets using synthetic corruptions of various strengths and an In-House dataset featuring counterfactually created real-world corruptions. Results: Combining the over-segmented masks contributes to improvements in the IoU. Furthermore, selecting the best single segmentation presents a competitive IoU score for clean images. Conclusions: Combined SAM predictions present improved results and robustness up to a certain corruption level. However, appropriate prompting strategies are fundamental for implementing these models in the medical domain.

An Endoscopic Chisel: Intraoperative Imaging Carves 3D Anatomical Models

Purpose: Preoperative imaging plays a pivotal role in sinus surgery where CTs offer patient-specific insights of complex anatomy, enabling real-time intraoperative navigation to complement endoscopy imaging. However, surgery elicits anatomical changes not represented in the preoperative model, generating an inaccurate basis for navigation during surgery progression. Methods: We propose a first vision-based approach to update the preoperative 3D anatomical model leveraging intraoperative endoscopic video for navigated sinus surgery where relative camera poses are known. We rely on comparisons of intraoperative monocular depth estimates and preoperative depth renders to identify modified regions. The new depths are integrated in these regions through volumetric fusion in a truncated signed distance function representation to generate an intraoperative 3D model that reflects tissue manipulation. Results: We quantitatively evaluate our approach by sequentially updating models for a five-step surgical progression in an ex vivo specimen. We compute the error between correspondences from the updated model and ground-truth intraoperative CT in the region of anatomical modification. The resulting models show a decrease in error during surgical progression as opposed to increasing when no update is employed. Conclusion: Our findings suggest that preoperative 3D anatomical models can be updated using intraoperative endoscopy video in navigated sinus surgery. Future work will investigate improvements to monocular depth estimation as well as removing the need for external navigation systems. The resulting ability to continuously update the patient model may provide surgeons with a more precise understanding of the current anatomical state and paves the way toward a digital twin paradigm for sinus surgery.

A Quantitative Evaluation of Dense 3D Reconstruction of Sinus Anatomy from Monocular Endoscopic Video

Generating accurate 3D reconstructions from endoscopic video is a promising avenue for longitudinal radiation-free analysis of sinus anatomy and surgical outcomes. Several methods for monocular reconstruction have been proposed, yielding visually pleasant 3D anatomical structures by retrieving relative camera poses with structure-from-motion-type algorithms and fusion of monocular depth estimates. However, due to the complex properties of the underlying algorithms and endoscopic scenes, the reconstruction pipeline may perform poorly or fail unexpectedly. Further, acquiring medical data conveys additional challenges, presenting difficulties in quantitatively benchmarking these models, understanding failure cases, and identifying critical components that contribute to their precision. In this work, we perform a quantitative analysis of a self-supervised approach for sinus reconstruction using endoscopic sequences paired with optical tracking and high-resolution computed tomography acquired from nine ex-vivo specimens. Our results show that the generated reconstructions are in high agreement with the anatomy, yielding an average point-to-mesh error of 0.91 mm between reconstructions and CT segmentations. However, in a point-to-point matching scenario, relevant for endoscope tracking and navigation, we found average target registration errors of 6.58 mm. We identified that pose and depth estimation inaccuracies contribute equally to this error and that locally consistent sequences with shorter trajectories generate more accurate reconstructions. These results suggest that achieving global consistency between relative camera poses and estimated depths with the anatomy is essential. In doing so, we can ensure proper synergy between all components of the pipeline for improved reconstructions that will facilitate clinical application of this innovative technology.

Eye Tracking for Tele-robotic Surgery: A Comparative Evaluation of Head-worn Solutions

Purpose: Metrics derived from eye-gaze-tracking and pupillometry show promise for cognitive load assessment, potentially enhancing training and patient safety through user-specific feedback in tele-robotic surgery. However, current eye-tracking solutions' effectiveness in tele-robotic surgery is uncertain compared to everyday situations due to close-range interactions causing extreme pupil angles and occlusions. To assess the effectiveness of modern eye-gaze-tracking solutions in tele-robotic surgery, we compare the Tobii Pro 3 Glasses and Pupil Labs Core, evaluating their pupil diameter and gaze stability when integrated with the da Vinci Research Kit (dVRK). Methods: The study protocol includes a nine-point gaze calibration followed by pick-and-place task using the dVRK and is repeated three times. After a final calibration, users view a 3x3 grid of AprilTags, focusing on each marker for 10 seconds, to evaluate gaze stability across dVRK-screen positions with the L2-norm. Different gaze calibrations assess calibration's temporal deterioration due to head movements. Pupil diameter stability is evaluated using the FFT from the pupil diameter during the pick-and-place tasks. Users perform this routine with both head-worn eye-tracking systems. Results: Data collected from ten users indicate comparable pupil diameter stability. FFTs of pupil diameters show similar amplitudes in high-frequency components. Tobii Glasses show more temporal gaze stability compared to Pupil Labs, though both eye trackers yield a similar 4cm error in gaze estimation without an outdated calibration. Conclusion: Both eye trackers demonstrate similar stability of the pupil diameter and gaze, when the calibration is not outdated, indicating comparable eye-tracking and pupillometry performance in tele-robotic surgery settings.

An Uncertainty-Driven GCN Refinement Strategy for Organ Segmentation

Organ segmentation in CT volumes is an important pre-processing step in many computer assisted intervention and diagnosis methods. In recent years, convolutional neural networks have dominated the state of the art in this task. However, since this problem presents a challenging environment due to high variability in the organ's shape and similarity between tissues, the generation of false negative and false positive regions in the output segmentation is a common issue. Recent works have shown that the uncertainty analysis of the model can provide us with useful information about potential errors in the segmentation. In this context, we proposed a segmentation refinement method based on uncertainty analysis and graph convolutional networks. We employ the uncertainty levels of the convolutional network in a particular input volume to formulate a semi-supervised graph learning problem that is solved by training a graph convolutional network. To test our method we refine the initial output of a 2D U-Net. We validate our framework with the NIH pancreas dataset and the spleen dataset of the medical segmentation decathlon. We show that our method outperforms the state-of-the-art CRF refinement method by improving the dice score by 1% for the pancreas and 2% for spleen, with respect to the original U-Net's prediction. Finally, we perform a sensitivity analysis on the parameters of our proposal and discuss the applicability to other CNN architectures, the results, and current limitations of the model for future work in this research direction. For reproducibility purposes, we make our code publicly available at https://github.com/rodsom22/gcn_refinement.

Polyp-artifact relationship analysis using graph inductive learned representations

The diagnosis process of colorectal cancer mainly focuses on the localization and characterization of abnormal growths in the colon tissue known as polyps. Despite recent advances in deep object localization, the localization of polyps remains challenging due to the similarities between tissues, and the high level of artifacts. Recent studies have shown the negative impact of the presence of artifacts in the polyp detection task, and have started to take them into account within the training process. However, the use of prior knowledge related to the spatial interaction of polyps and artifacts has not yet been considered. In this work, we incorporate artifact knowledge in a post-processing step. Our method models this task as an inductive graph representation learning problem, and is composed of training and inference steps. Detected bounding boxes around polyps and artifacts are considered as nodes connected by a defined criterion. The training step generates a node classifier with ground truth bounding boxes. In inference, we use this classifier to analyze a second graph, generated from artifact and polyp predictions given by region proposal networks. We evaluate how the choices in the connectivity and artifacts affect the performance of our method and show that it has the potential to reduce the false positives in the results of a region proposal network.

A learning without forgetting approach to incorporate artifact knowledge in polyp localization tasks

Colorectal polyps are abnormalities in the colon tissue that can develop into colorectal cancer. The survival rate for patients is higher when the disease is detected at an early stage and polyps can be removed before they develop into malignant tumors. Deep learning methods have become the state of art in automatic polyp detection. However, the performance of current models heavily relies on the size and quality of the training datasets. Endoscopic video sequences tend to be corrupted by different artifacts affecting visibility and hence, the detection rates. In this work, we analyze the effects that artifacts have in the polyp localization problem. For this, we evaluate the RetinaNet architecture, originally defined for object localization. We also define a model inspired by the learning without forgetting framework, which allows us to employ artifact detection knowledge in the polyp localization problem. Finally, we perform several experiments to analyze the influence of the artifacts in the performance of these models. To our best knowledge, this is the first extensive analysis of the influence of artifact in polyp localization and the first work incorporating learning without forgetting ideas for simultaneous artifact and polyp localization tasks.