Dynamic Scene Graph Representation for Surgical Video

Surgical videos captured from microscopic or endoscopic imaging devices are rich but complex sources of information, depicting different tools and anatomical structures utilized during an extended amount of time. Despite containing crucial workflow information and being commonly recorded in many procedures, usage of surgical videos for automated surgical workflow understanding is still limited. In this work, we exploit scene graphs as a more holistic, semantically meaningful and human-readable way to represent surgical videos while encoding all anatomical structures, tools, and their interactions. To properly evaluate the impact of our solutions, we create a scene graph dataset from semantic segmentations from the CaDIS and CATARACTS datasets. We demonstrate that scene graphs can be leveraged through the use of graph convolutional networks (GCNs) to tackle surgical downstream tasks such as surgical workflow recognition with competitive performance. Moreover, we demonstrate the benefits of surgical scene graphs regarding the explainability and robustness of model decisions, which are crucial in the clinical setting.

DisguisOR: Holistic Face Anonymization for the Operating Room

Purpose: Recent advances in Surgical Data Science (SDS) have contributed to an increase in video recordings from hospital environments. While methods such as surgical workflow recognition show potential in increasing the quality of patient care, the quantity of video data has surpassed the scale at which images can be manually anonymized. Existing automated 2D anonymization methods under-perform in Operating Rooms (OR), due to occlusions and obstructions. We propose to anonymize multi-view OR recordings using 3D data from multiple camera streams. Methods: RGB and depth images from multiple cameras are fused into a 3D point cloud representation of the scene. We then detect each individual's face in 3D by regressing a parametric human mesh model onto detected 3D human keypoints and aligning the face mesh with the fused 3D point cloud. The mesh model is rendered into every acquired camera view, replacing each individual's face. Results: Our method shows promise in locating faces at a higher rate than existing approaches. DisguisOR produces geometrically consistent anonymizations for each camera view, enabling more realistic anonymization that is less detrimental to downstream tasks. Conclusion: Frequent obstructions and crowding in operating rooms leaves significant room for improvement for off-the-shelf anonymization methods. DisguisOR addresses privacy on a scene level and has the potential to facilitate further research in SDS.

Whether and When does Endoscopy Domain Pretraining Make Sense?

Automated endoscopy video analysis is a challenging task in medical computer vision, with the primary objective of assisting surgeons during procedures. The difficulty arises from the complexity of surgical scenes and the lack of a sufficient amount of annotated data. In recent years, large-scale pretraining has shown great success in natural language processing and computer vision communities. These approaches reduce the need for annotated data, which is always a concern in the medical domain. However, most works on endoscopic video understanding use models pretrained on natural images, creating a domain gap between pretraining and finetuning. In this work, we investigate the need for endoscopy domain-specific pretraining based on downstream objectives. To this end, we first collect Endo700k, the largest publicly available corpus of endoscopic images, extracted from nine public Minimally Invasive Surgery (MIS) datasets. Endo700k comprises more than 700,000 unannotated raw images. Next, we introduce EndoViT, an endoscopy pretrained Vision Transformer (ViT). Through ablations, we demonstrate that domain-specific pretraining is particularly beneficial for more complex downstream tasks, such as Action Triplet Detection, and less effective and even unnecessary for simpler tasks, such as Surgical Phase Recognition. We will release both our code and pretrained models upon acceptance to facilitate further research in this direction.

LABRAD-OR: Lightweight Memory Scene Graphs for Accurate Bimodal Reasoning in Dynamic Operating Rooms

Modern surgeries are performed in complex and dynamic settings, including ever-changing interactions between medical staff, patients, and equipment. The holistic modeling of the operating room (OR) is, therefore, a challenging but essential task, with the potential to optimize the performance of surgical teams and aid in developing new surgical technologies to improve patient outcomes. The holistic representation of surgical scenes as semantic scene graphs (SGG), where entities are represented as nodes and relations between them as edges, is a promising direction for fine-grained semantic OR understanding. We propose, for the first time, the use of temporal information for more accurate and consistent holistic OR modeling. Specifically, we introduce memory scene graphs, where the scene graphs of previous time steps act as the temporal representation guiding the current prediction. We design an end-to-end architecture that intelligently fuses the temporal information of our lightweight memory scene graphs with the visual information from point clouds and images. We evaluate our method on the 4D-OR dataset and demonstrate that integrating temporality leads to more accurate and consistent results achieving an +5% increase and a new SOTA of 0.88 in macro F1. This work opens the path for representing the entire surgery history with memory scene graphs and improves the holistic understanding in the OR. Introducing scene graphs as memory representations can offer a valuable tool for many temporal understanding tasks.

Location-Free Scene Graph Generation

Scene Graph Generation (SGG) is a challenging visual understanding task. It combines the detection of entities and relationships between them in a scene. Both previous works and existing evaluation metrics rely on bounding box labels, even though many downstream scene graph applications do not need location information. The need for localization labels significantly increases the annotation cost and hampers the creation of more and larger scene graph datasets. We suggest breaking the dependency of scene graphs on bounding box labels by proposing location-free scene graph generation (LF-SGG). This new task aims at predicting instances of entities, as well as their relationships, without spatial localization. To objectively evaluate the task, the predicted and ground truth scene graphs need to be compared. We solve this NP-hard problem through an efficient algorithm using branching. Additionally, we design the first LF-SGG method, Pix2SG, using autoregressive sequence modeling. Our proposed method is evaluated on Visual Genome and 4D-OR. Although using significantly fewer labels during training, we achieve 74.12\% of the location-supervised SOTA performance on Visual Genome and even outperform the best method on 4D-OR.

CholecTriplet2022: Show me a tool and tell me the triplet -- an endoscopic vision challenge for surgical action triplet detection

Formalizing surgical activities as triplets of the used instruments, actions performed, and target anatomies is becoming a gold standard approach for surgical activity modeling. The benefit is that this formalization helps to obtain a more detailed understanding of tool-tissue interaction which can be used to develop better Artificial Intelligence assistance for image-guided surgery. Earlier efforts and the CholecTriplet challenge introduced in 2021 have put together techniques aimed at recognizing these triplets from surgical footage. Estimating also the spatial locations of the triplets would offer a more precise intraoperative context-aware decision support for computer-assisted intervention. This paper presents the CholecTriplet2022 challenge, which extends surgical action triplet modeling from recognition to detection. It includes weakly-supervised bounding box localization of every visible surgical instrument (or tool), as the key actors, and the modeling of each tool-activity in the form of <instrument, verb, target> triplet. The paper describes a baseline method and 10 new deep learning algorithms presented at the challenge to solve the task. It also provides thorough methodological comparisons of the methods, an in-depth analysis of the obtained results, their significance, and useful insights for future research directions and applications in surgery.

CholecTriplet2021: A benchmark challenge for surgical action triplet recognition

Context-aware decision support in the operating room can foster surgical safety and efficiency by leveraging real-time feedback from surgical workflow analysis. Most existing works recognize surgical activities at a coarse-grained level, such as phases, steps or events, leaving out fine-grained interaction details about the surgical activity; yet those are needed for more helpful AI assistance in the operating room. Recognizing surgical actions as triplets of <instrument, verb, target> combination delivers comprehensive details about the activities taking place in surgical videos. This paper presents CholecTriplet2021: an endoscopic vision challenge organized at MICCAI 2021 for the recognition of surgical action triplets in laparoscopic videos. The challenge granted private access to the large-scale CholecT50 dataset, which is annotated with action triplet information. In this paper, we present the challenge setup and assessment of the state-of-the-art deep learning methods proposed by the participants during the challenge. A total of 4 baseline methods from the challenge organizers and 19 new deep learning algorithms by competing teams are presented to recognize surgical action triplets directly from surgical videos, achieving mean average precision (mAP) ranging from 4.2% to 38.1%. This study also analyzes the significance of the results obtained by the presented approaches, performs a thorough methodological comparison between them, in-depth result analysis, and proposes a novel ensemble method for enhanced recognition. Our analysis shows that surgical workflow analysis is not yet solved, and also highlights interesting directions for future research on fine-grained surgical activity recognition which is of utmost importance for the development of AI in surgery.

Few-shot Structured Radiology Report Generation Using Natural Language Prompts

Chest radiograph reporting is time-consuming, and numerous solutions to automate this process have been proposed. Due to the complexity of medical information, the variety of writing styles, and free text being prone to typos and inconsistencies, the efficacy of quantifying the clinical accuracy of free-text reports using natural language processing measures is challenging. On the other hand, structured reports ensure consistency and can more easily be used as a quality assurance tool. To accomplish this, we present a strategy for predicting clinical observations and their anatomical location that is easily extensible to other structured findings. First, we train a contrastive language-image model using related chest radiographs and free-text radiological reports. Then, we create textual prompts for each structured finding and optimize a classifier for predicting clinical findings and their associations within the medical image. The results indicate that even when only a few image-level annotations are used for training, the method can localize pathologies in chest radiographs and generate structured reports.

4D-OR: Semantic Scene Graphs for OR Domain Modeling

Surgical procedures are conducted in highly complex operating rooms (OR), comprising different actors, devices, and interactions. To date, only medically trained human experts are capable of understanding all the links and interactions in such a demanding environment. This paper aims to bring the community one step closer to automated, holistic and semantic understanding and modeling of OR domain. Towards this goal, for the first time, we propose using semantic scene graphs (SSG) to describe and summarize the surgical scene. The nodes of the scene graphs represent different actors and objects in the room, such as medical staff, patients, and medical equipment, whereas edges are the relationships between them. To validate the possibilities of the proposed representation, we create the first publicly available 4D surgical SSG dataset, 4D-OR, containing ten simulated total knee replacement surgeries recorded with six RGB-D sensors in a realistic OR simulation center. 4D-OR includes 6734 frames and is richly annotated with SSGs, human and object poses, and clinical roles. We propose an end-to-end neural network-based SSG generation pipeline, with a rate of success of 0.75 macro F1, indeed being able to infer semantic reasoning in the OR. We further demonstrate the representation power of our scene graphs by using it for the problem of clinical role prediction, where we achieve 0.85 macro F1. The code and dataset will be made available upon acceptance.

Know your sensORs -- A Modality Study For Surgical Action Classification

The surgical operating room (OR) presents many opportunities for automation and optimization. Videos from various sources in the OR are becoming increasingly available. The medical community seeks to leverage this wealth of data to develop automated methods to advance interventional care, lower costs, and improve overall patient outcomes. Existing datasets from OR room cameras are thus far limited in size or modalities acquired, leaving it unclear which sensor modalities are best suited for tasks such as recognizing surgical action from videos. This study demonstrates that surgical action recognition performance can vary depending on the image modalities used. We perform a methodical analysis on several commonly available sensor modalities, presenting two fusion approaches that improve classification performance. The analyses are carried out on a set of multi-view RGB-D video recordings of 18 laparoscopic procedures.