Think Step by Step: Chain-of-Gesture Prompting for Error Detection in Robotic Surgical Videos

Despite significant advancements in robotic systems and surgical data science, ensuring safe and optimal execution in robot-assisted minimally invasive surgery (RMIS) remains a complex challenge. Current surgical error detection methods involve two parts: identifying surgical gestures and then detecting errors within each gesture clip. These methods seldom consider the rich contextual and semantic information inherent in surgical videos, limiting their performance due to reliance on accurate gesture identification. Motivated by the chain-of-thought prompting in natural language processing, this letter presents a novel and real-time end-to-end error detection framework, Chain-of-Thought (COG) prompting, leveraging contextual information from surgical videos. This encompasses two reasoning modules designed to mimic the decision-making processes of expert surgeons. Concretely, we first design a Gestural-Visual Reasoning module, which utilizes transformer and attention architectures for gesture prompting, while the second, a Multi-Scale Temporal Reasoning module, employs a multi-stage temporal convolutional network with both slow and fast paths for temporal information extraction. We extensively validate our method on the public benchmark RMIS dataset JIGSAWS. Our method encapsulates the reasoning processes inherent to surgical activities enabling it to outperform the state-of-the-art by 4.6% in F1 score, 4.6% in Accuracy, and 5.9% in Jaccard index while processing each frame in 6.69 milliseconds on average, demonstrating the great potential of our approach in enhancing the safety and efficacy of RMIS procedures and surgical education. The code will be available.

Epicardium Prompt-guided Real-time Cardiac Ultrasound Frame-to-volume Registration

A comprehensive guidance view for cardiac interventional surgery can be provided by the real-time fusion of the intraoperative 2D images and preoperative 3D volume based on the ultrasound frame-to-volume registration. However, cardiac ultrasound images are characterized by a low signal-to-noise ratio and small differences between adjacent frames, coupled with significant dimension variations between 2D frames and 3D volumes to be registered, resulting in real-time and accurate cardiac ultrasound frame-to-volume registration being a very challenging task. This paper introduces a lightweight end-to-end Cardiac Ultrasound frame-to-volume Registration network, termed CU-Reg. Specifically, the proposed model leverages epicardium prompt-guided anatomical clues to reinforce the interaction of 2D sparse and 3D dense features, followed by a voxel-wise local-global aggregation of enhanced features, thereby boosting the cross-dimensional matching effectiveness of low-quality ultrasound modalities. We further embed an inter-frame discriminative regularization term within the hybrid supervised learning to increase the distinction between adjacent slices in the same ultrasound volume to ensure registration stability. Experimental results on the reprocessed CAMUS dataset demonstrate that our CU-Reg surpasses existing methods in terms of registration accuracy and efficiency, meeting the guidance requirements of clinical cardiac interventional surgery.

Dealing with All-stage Missing Modality: Towards A Universal Model with Robust Reconstruction and Personalization

Addressing missing modalities presents a critical challenge in multimodal learning. Current approaches focus on developing models that can handle modality-incomplete inputs during inference, assuming that the full set of modalities are available for all the data during training. This reliance on full-modality data for training limits the use of abundant modality-incomplete samples that are often encountered in practical settings. In this paper, we propose a robust universal model with modality reconstruction and model personalization, which can effectively tackle the missing modality at both training and testing stages. Our method leverages a multimodal masked autoencoder to reconstruct the missing modality and masked patches simultaneously, incorporating an innovative distribution approximation mechanism to fully utilize both modality-complete and modality-incomplete data. The reconstructed modalities then contributes to our designed data-model co-distillation scheme to guide the model learning in the presence of missing modalities. Moreover, we propose a CLIP-driven hyper-network to personalize partial model parameters, enabling the model to adapt to each distinct missing modality scenario. Our method has been extensively validated on two brain tumor segmentation benchmarks. Experimental results demonstrate the promising performance of our method, which consistently exceeds previous state-of-the-art approaches under the all-stage missing modality settings with different missing ratios. Code will be available.

MGI: Multimodal Contrastive pre-training of Genomic and Medical Imaging

Medicine is inherently a multimodal discipline. Medical images can reflect the pathological changes of cancer and tumors, while the expression of specific genes can influence their morphological characteristics. However, most deep learning models employed for these medical tasks are unimodal, making predictions using either image data or genomic data exclusively. In this paper, we propose a multimodal pre-training framework that jointly incorporates genomics and medical images for downstream tasks. To address the issues of high computational complexity and difficulty in capturing long-range dependencies in genes sequence modeling with MLP or Transformer architectures, we utilize Mamba to model these long genomic sequences. We aligns medical images and genes using a self-supervised contrastive learning approach which combines the Mamba as a genetic encoder and the Vision Transformer (ViT) as a medical image encoder. We pre-trained on the TCGA dataset using paired gene expression data and imaging data, and fine-tuned it for downstream tumor segmentation tasks. The results show that our model outperformed a wide range of related methods.

Deform3DGS: Flexible Deformation for Fast Surgical Scene Reconstruction with Gaussian Splatting

Tissue deformation poses a key challenge for accurate surgical scene reconstruction. Despite yielding high reconstruction quality, existing methods suffer from slow rendering speeds and long training times, limiting their intraoperative applicability. Motivated by recent progress in 3D Gaussian Splatting, an emerging technology in real-time 3D rendering, this work presents a novel fast reconstruction framework, termed Deform3DGS, for deformable tissues during endoscopic surgery. Specifically, we introduce 3D GS into surgical scenes by integrating a point cloud initialization to improve reconstruction. Furthermore, we propose a novel flexible deformation modeling scheme (FDM) to learn tissue deformation dynamics at the level of individual Gaussians. Our FDM can model the surface deformation with efficient representations, allowing for real-time rendering performance. More importantly, FDM significantly accelerates surgical scene reconstruction, demonstrating considerable clinical values, particularly in intraoperative settings where time efficiency is crucial. Experiments on DaVinci robotic surgery videos indicate the efficacy of our approach, showcasing superior reconstruction fidelity PSNR: (37.90) and rendering speed (338.8 FPS) while substantially reducing training time to only 1 minute/scene.

Tri-modal Confluence with Temporal Dynamics for Scene Graph Generation in Operating Rooms

A comprehensive understanding of surgical scenes allows for monitoring of the surgical process, reducing the occurrence of accidents and enhancing efficiency for medical professionals. Semantic modeling within operating rooms, as a scene graph generation (SGG) task, is challenging since it involves consecutive recognition of subtle surgical actions over prolonged periods. To address this challenge, we propose a Tri-modal (i.e., images, point clouds, and language) confluence with Temporal dynamics framework, termed TriTemp-OR. Diverging from previous approaches that integrated temporal information via memory graphs, our method embraces two advantages: 1) we directly exploit bi-modal temporal information from the video streaming for hierarchical feature interaction, and 2) the prior knowledge from Large Language Models (LLMs) is embedded to alleviate the class-imbalance problem in the operating theatre. Specifically, our model performs temporal interactions across 2D frames and 3D point clouds, including a scale-adaptive multi-view temporal interaction (ViewTemp) and a geometric-temporal point aggregation (PointTemp). Furthermore, we transfer knowledge from the biomedical LLM, LLaVA-Med, to deepen the comprehension of intraoperative relations. The proposed TriTemp-OR enables the aggregation of tri-modal features through relation-aware unification to predict relations so as to generate scene graphs. Experimental results on the 4D-OR benchmark demonstrate the superior performance of our model for long-term OR streaming.

Uncertainty-Aware Adapter: Adapting Segment Anything Model (SAM) for Ambiguous Medical Image Segmentation

The Segment Anything Model (SAM) gained significant success in natural image segmentation, and many methods have tried to fine-tune it to medical image segmentation. An efficient way to do so is by using Adapters, specialized modules that learn just a few parameters to tailor SAM specifically for medical images. However, unlike natural images, many tissues and lesions in medical images have blurry boundaries and may be ambiguous. Previous efforts to adapt SAM ignore this challenge and can only predict distinct segmentation. It may mislead clinicians or cause misdiagnosis, especially when encountering rare variants or situations with low model confidence. In this work, we propose a novel module called the Uncertainty-aware Adapter, which efficiently fine-tuning SAM for uncertainty-aware medical image segmentation. Utilizing a conditional variational autoencoder, we encoded stochastic samples to effectively represent the inherent uncertainty in medical imaging. We designed a new module on a standard adapter that utilizes a condition-based strategy to interact with samples to help SAM integrate uncertainty. We evaluated our method on two multi-annotated datasets with different modalities: LIDC-IDRI (lung abnormalities segmentation) and REFUGE2 (optic-cup segmentation). The experimental results show that the proposed model outperforms all the previous methods and achieves the new state-of-the-art (SOTA) on both benchmarks. We also demonstrated that our method can generate diverse segmentation hypotheses that are more realistic as well as heterogeneous.

Not just Birds and Cars: Generic, Scalable and Explainable Models for Professional Visual Recognition

Some visual recognition tasks are more challenging then the general ones as they require professional categories of images. The previous efforts, like fine-grained vision classification, primarily introduced models tailored to specific tasks, like identifying bird species or car brands with limited scalability and generalizability. This paper aims to design a scalable and explainable model to solve Professional Visual Recognition tasks from a generic standpoint. We introduce a biologically-inspired structure named Pro-NeXt and reveal that Pro-NeXt exhibits substantial generalizability across diverse professional fields such as fashion, medicine, and art-areas previously considered disparate. Our basic-sized Pro-NeXt-B surpasses all preceding task-specific models across 12 distinct datasets within 5 diverse domains. Furthermore, we find its good scaling property that scaling up Pro-NeXt in depth and width with increasing GFlops can consistently enhances its accuracy. Beyond scalability and adaptability, the intermediate features of Pro-NeXt achieve reliable object detection and segmentation performance without extra training, highlighting its solid explainability. We will release the code to foster further research in this area.

LLM-Assisted Multi-Teacher Continual Learning for Visual Question Answering in Robotic Surgery

Visual question answering (VQA) can be fundamentally crucial for promoting robotic-assisted surgical education. In practice, the needs of trainees are constantly evolving, such as learning more surgical types, adapting to different robots, and learning new surgical instruments and techniques for one surgery. Therefore, continually updating the VQA system by a sequential data stream from multiple resources is demanded in robotic surgery to address new tasks. In surgical scenarios, the storage cost and patient data privacy often restrict the availability of old data when updating the model, necessitating an exemplar-free continual learning (CL) setup. However, prior studies overlooked two vital problems of the surgical domain: i) large domain shifts from diverse surgical operations collected from multiple departments or clinical centers, and ii) severe data imbalance arising from the uneven presence of surgical instruments or activities during surgical procedures. This paper proposes to address these two problems with a multimodal large language model (LLM) and an adaptive weight assignment methodology. We first develop a new multi-teacher CL framework that leverages a multimodal LLM as the additional teacher. The strong generalization ability of the LLM can bridge the knowledge gap when domain shifts and data imbalances occur. We then put forth a novel data processing method that transforms complex LLM embeddings into logits compatible with our CL framework. We further design an adaptive weight assignment approach that balances the generalization ability of the LLM and the domain expertise of the old CL model. We construct a new dataset for surgical VQA tasks, providing valuable data resources for future research. Extensive experimental results on three datasets demonstrate the superiority of our method to other advanced CL models.

S^2Former-OR: Single-Stage Bimodal Transformer for Scene Graph Generation in OR

Scene graph generation (SGG) of surgical procedures is crucial in enhancing holistically cognitive intelligence in the operating room (OR). However, previous works have primarily relied on the multi-stage learning that generates semantic scene graphs dependent on intermediate processes with pose estimation and object detection, which may compromise model efficiency and efficacy, also impose extra annotation burden. In this study, we introduce a novel single-stage bimodal transformer framework for SGG in the OR, termed S^2Former-OR, aimed to complementally leverage multi-view 2D scenes and 3D point clouds for SGG in an end-to-end manner. Concretely, our model embraces a View-Sync Transfusion scheme to encourage multi-view visual information interaction. Concurrently, a Geometry-Visual Cohesion operation is designed to integrate the synergic 2D semantic features into 3D point cloud features. Moreover, based on the augmented feature, we propose a novel relation-sensitive transformer decoder that embeds dynamic entity-pair queries and relational trait priors, which enables the direct prediction of entity-pair relations for graph generation without intermediate steps. Extensive experiments have validated the superior SGG performance and lower computational cost of S^2Former-OR on 4D-OR benchmark, compared with current OR-SGG methods, e.g., 3% Precision increase and 24.2M reduction in model parameters. We further compared our method with generic single-stage SGG methods with broader metrics for a comprehensive evaluation, with consistently better performance achieved. The code will be made available.