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Novel optical imaging techniques, such as hyperspectral imaging (HSI) combined with machine learning-based (ML) analysis, have the potential to revolutionize clinical surgical imaging. However, these novel modalities face a shortage of large-scale, representative clinical data for training ML algorithms, while preclinical animal data is abundantly available through standardized experiments and allows for controlled induction of pathological tissue states, which is not ethically possible in patients. To leverage this situation, we propose a novel concept called "xeno-learning", a cross-species knowledge transfer paradigm inspired by xeno-transplantation, where organs from a donor species are transplanted into a recipient species. Using a total of 11,268 HSI images from humans as well as porcine and rat models, we show that although spectral signatures of organs differ across species, shared pathophysiological mechanisms manifest as comparable relative spectral changes across species. Such changes learnt in one species can thus be transferred to a new species via a novel "physiology-based data augmentation" method, enabling the large-scale secondary use of preclinical animal data for humans. The resulting ethical, monetary, and performance benefits of the proposed knowledge transfer paradigm promise a high impact of the methodology on future developments in the field., Comment: Jan Sellner and Alexander Studier-Fischer contributed equally to this work

Hyperspectral imaging (HSI) is emerging as a promising novel imaging modality with various potential surgical applications. Currently available cameras, however, suffer from poor integration into the clinical workflow because they require the lights to be switched off, or the camera to be manually recalibrated as soon as lighting conditions change. Given this critical bottleneck, the contribution of this paper is threefold: (1) We demonstrate that dynamically changing lighting conditions in the operating room dramatically affect the performance of HSI applications, namely physiological parameter estimation, and surgical scene segmentation. (2) We propose a novel learning-based approach to automatically recalibrating hyperspectral images during surgery and show that it is sufficiently accurate to replace the tedious process of white reference-based recalibration. (3) Based on a total of 742 HSI cubes from a phantom, porcine models, and rats we show that our recalibration method not only outperforms previously proposed methods, but also generalizes across species, lighting conditions, and image processing tasks. Due to its simple workflow integration as well as high accuracy, speed, and generalization capabilities, our method could evolve as a central component in clinical surgical HSI., Comment: Oral at MICCAI 2024

Robust semantic segmentation of intraoperative image data holds promise for enabling automatic surgical scene understanding and autonomous robotic surgery. While model development and validation are primarily conducted on idealistic scenes, geometric domain shifts, such as occlusions of the situs, are common in real-world open surgeries. To close this gap, we (1) present the first analysis of state-of-the-art (SOA) semantic segmentation models when faced with geometric out-of-distribution (OOD) data, and (2) propose an augmentation technique called "Organ Transplantation", to enhance generalizability. Our comprehensive validation on six different OOD datasets, comprising 600 RGB and hyperspectral imaging (HSI) cubes from 33 pigs, each annotated with 19 classes, reveals a large performance drop in SOA organ segmentation models on geometric OOD data. This performance decline is observed not only in conventional RGB data (with a dice similarity coefficient (DSC) drop of 46 %) but also in HSI data (with a DSC drop of 45 %), despite the richer spectral information content. The performance decline increases with the spatial granularity of the input data. Our augmentation technique improves SOA model performance by up to 67 % for RGB data and 90 % for HSI data, achieving performance at the level of in-distribution performance on real OOD test data. Given the simplicity and effectiveness of our augmentation method, it is a valuable tool for addressing geometric domain shifts in surgical scene segmentation, regardless of the underlying model. Our code and pre-trained models are publicly available at https://github.com/IMSY-DKFZ/htc., Comment: Silvia Seidlitz and Jan Sellner contributed equally

Robust semantic segmentation of intraoperative image data could pave the way for automatic surgical scene understanding and autonomous robotic surgery. Geometric domain shifts, however, although common in real-world open surgeries due to variations in surgical procedures or situs occlusions, remain a topic largely unaddressed in the field. To address this gap in the literature, we (1) present the first analysis of state-of-the-art (SOA) semantic segmentation networks in the presence of geometric out-of-distribution (OOD) data, and (2) address generalizability with a dedicated augmentation technique termed "Organ Transplantation" that we adapted from the general computer vision community. According to a comprehensive validation on six different OOD data sets comprising 600 RGB and hyperspectral imaging (HSI) cubes from 33 pigs semantically annotated with 19 classes, we demonstrate a large performance drop of SOA organ segmentation networks applied to geometric OOD data. Surprisingly, this holds true not only for conventional RGB data (drop of Dice similarity coefficient (DSC) by 46 %) but also for HSI data (drop by 45 %), despite the latter's rich information content per pixel. Using our augmentation scheme improves on the SOA DSC by up to 67 % (RGB) and 90 % (HSI) and renders performance on par with in-distribution performance on real OOD test data. The simplicity and effectiveness of our augmentation scheme makes it a valuable network-independent tool for addressing geometric domain shifts in semantic scene segmentation of intraoperative data. Our code and pre-trained models are available at https://github.com/IMSY-DKFZ/htc., Comment: The first two authors (Jan Sellner and Silvia Seidlitz) contributed equally to this paper

Synthetic medical image generation has evolved as a key technique for neural network training and validation. A core challenge, however, remains in the domain gap between simulations and real data. While deep learning-based domain transfer using Cycle Generative Adversarial Networks and similar architectures has led to substantial progress in the field, there are use cases in which state-of-the-art approaches still fail to generate training images that produce convincing results on relevant downstream tasks. Here, we address this issue with a domain transfer approach based on conditional invertible neural networks (cINNs). As a particular advantage, our method inherently guarantees cycle consistency through its invertible architecture, and network training can efficiently be conducted with maximum likelihood training. To showcase our method's generic applicability, we apply it to two spectral imaging modalities at different scales, namely hyperspectral imaging (pixel-level) and photoacoustic tomography (image-level). According to comprehensive experiments, our method enables the generation of realistic spectral data and outperforms the state of the art on two downstream classification tasks (binary and multi-class). cINN-based domain transfer could thus evolve as an important method for realistic synthetic data generation in the field of spectral imaging and beyond.

Semantic image segmentation is an important prerequisite for context-awareness and autonomous robotics in surgery. The state of the art has focused on conventional RGB video data acquired during minimally invasive surgery, but full-scene semantic segmentation based on spectral imaging data and obtained during open surgery has received almost no attention to date. To address this gap in the literature, we are investigating the following research questions based on hyperspectral imaging (HSI) data of pigs acquired in an open surgery setting: (1) What is an adequate representation of HSI data for neural network-based fully automated organ segmentation, especially with respect to the spatial granularity of the data (pixels vs. superpixels vs. patches vs. full images)? (2) Is there a benefit of using HSI data compared to other modalities, namely RGB data and processed HSI data (e.g. tissue parameters like oxygenation), when performing semantic organ segmentation? According to a comprehensive validation study based on 506 HSI images from 20 pigs, annotated with a total of 19 classes, deep learning-based segmentation performance increases, consistently across modalities, with the spatial context of the input data. Unprocessed HSI data offers an advantage over RGB data or processed data from the camera provider, with the advantage increasing with decreasing size of the input to the neural network. Maximum performance (HSI applied to whole images) yielded a mean DSC of 0.90 ((standard deviation (SD)) 0.04), which is in the range of the inter-rater variability (DSC of 0.89 ((standard deviation (SD)) 0.07)). We conclude that HSI could become a powerful image modality for fully-automatic surgical scene understanding with many advantages over traditional imaging, including the ability to recover additional functional tissue information. Code and pre-trained models: https://github.com/IMSY-DKFZ/htc., Comment: The first two authors (Silvia Seidlitz and Jan Sellner) contributed equally to this paper

Sepsis is a leading cause of mortality and critical illness worldwide. While robust biomarkers for early diagnosis are still missing, recent work indicates that hyperspectral imaging (HSI) has the potential to overcome this bottleneck by monitoring microcirculatory alterations. Automated machine learning-based diagnosis of sepsis based on HSI data, however, has not been explored to date. Given this gap in the literature, we leveraged an existing data set to (1) investigate whether HSI-based automated diagnosis of sepsis is possible and (2) put forth a list of possible confounders relevant for HSI-based tissue classification. While we were able to classify sepsis with an accuracy of over $98\,\%$ using the existing data, our research also revealed several subject-, therapy- and imaging-related confounders that may lead to an overestimation of algorithm performance when not balanced across the patient groups. We conclude that further prospective studies, carefully designed with respect to these confounders, are necessary to confirm the preliminary results obtained in this study., Comment: Maximilian Dietrich and Silvia Seidlitz contributed equally. Markus A. Weigand and Lena Maier-Hein contributed equally