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Background: Cone-beam computed tomography (CBCT) plays a crucial role in image-guided radiotherapy, but artifacts and noise make them unsuitable for accurate dose calculation. Artificial intelligence methods have shown promise in enhancing CBCT quality to produce synthetic CT (sCT) images. However, existing methods either produce images of suboptimal quality or incur excessive time costs, failing to satisfy clinical practice standards. Methods and materials: We propose a novel hybrid conditional latent diffusion model for efficient and accurate CBCT-to-CT synthesis, named HC$^3$L-Diff. We employ the Unified Feature Encoder (UFE) to compress images into a low-dimensional latent space, thereby optimizing computational efficiency. Beyond the use of CBCT images, we propose integrating its high-frequency knowledge as a hybrid condition to guide the diffusion model in generating sCT images with preserved structural details. This high-frequency information is captured using our designed High-Frequency Extractor (HFE). During inference, we utilize denoising diffusion implicit model to facilitate rapid sampling. We construct a new in-house prostate dataset with paired CBCT and CT to validate the effectiveness of our method. Result: Extensive experimental results demonstrate that our approach outperforms state-of-the-art methods in terms of sCT quality and generation efficiency. Moreover, our medical physicist conducts the dosimetric evaluations to validate the benefit of our method in practical dose calculation, achieving a remarkable 93.8% gamma passing rate with a 2%/2mm criterion, superior to other methods. Conclusion: The proposed HC$^3$L-Diff can efficiently achieve high-quality CBCT-to-CT synthesis in only over 2 mins per patient. Its promising performance in dose calculation shows great potential for enhancing real-world adaptive radiotherapy., Comment: 13 pages, 5 figures

Reconstructing endoscopic videos is crucial for high-fidelity visualization and the efficiency of surgical operations. Despite the importance, existing 3D reconstruction methods encounter several challenges, including stringent demands for accuracy, imprecise camera positioning, intricate dynamic scenes, and the necessity for rapid reconstruction. Addressing these issues, this paper presents the first camera-pose-free scene reconstruction framework, Free-DyGS, tailored for dynamic surgical videos, leveraging 3D Gaussian splatting technology. Our approach employs a frame-by-frame reconstruction strategy and is delineated into four distinct phases: Scene Initialization, Joint Learning, Scene Expansion, and Retrospective Learning. We introduce a Generalizable Gaussians Parameterization module within the Scene Initialization and Expansion phases to proficiently generate Gaussian attributes for each pixel from the RGBD frames. The Joint Learning phase is crafted to concurrently deduce scene deformation and camera pose, facilitated by an innovative flexible deformation module. In the scene expansion stage, the Gaussian points gradually grow as the camera moves. The Retrospective Learning phase is dedicated to enhancing the precision of scene deformation through the reassessment of prior frames. The efficacy of the proposed Free-DyGS is substantiated through experiments on two datasets: the StereoMIS and Hamlyn datasets. The experimental outcomes underscore that Free-DyGS surpasses conventional baseline models in both rendering fidelity and computational efficiency.

We introduce Scaffold Prompt Tuning (ScaPT), a novel prompt-based framework for adapting large-scale functional magnetic resonance imaging (fMRI) pre-trained models to downstream tasks, with high parameter efficiency and improved performance compared to fine-tuning and baselines for prompt tuning. The full fine-tuning updates all pre-trained parameters, which may distort the learned feature space and lead to overfitting with limited training data which is common in fMRI fields. In contrast, we design a hierarchical prompt structure that transfers the knowledge learned from high-resource tasks to low-resource ones. This structure, equipped with a Deeply-conditioned Input-Prompt (DIP) mapping module, allows for efficient adaptation by updating only 2% of the trainable parameters. The framework enhances semantic interpretability through attention mechanisms between inputs and prompts, and it clusters prompts in the latent space in alignment with prior knowledge. Experiments on public resting state fMRI datasets reveal ScaPT outperforms fine-tuning and multitask-based prompt tuning in neurodegenerative diseases diagnosis/prognosis and personality trait prediction, even with fewer than 20 participants. It highlights ScaPT's efficiency in adapting pre-trained fMRI models to low-resource tasks., Comment: MICCAI 2024

Surgical video segmentation is a critical task in computer-assisted surgery and is vital for enhancing surgical quality and patient outcomes. Recently, the Segment Anything Model 2 (SAM2) framework has shown superior advancements in image and video segmentation. However, SAM2 struggles with efficiency due to the high computational demands of processing high-resolution images and complex and long-range temporal dynamics in surgical videos. To address these challenges, we introduce Surgical SAM 2 (SurgSAM-2), an advanced model to utilize SAM2 with an Efficient Frame Pruning (EFP) mechanism, to facilitate real-time surgical video segmentation. The EFP mechanism dynamically manages the memory bank by selectively retaining only the most informative frames, reducing memory usage and computational cost while maintaining high segmentation accuracy. Our extensive experiments demonstrate that SurgSAM-2 significantly improves both efficiency and segmentation accuracy compared to the vanilla SAM2. Remarkably, SurgSAM-2 achieves a 3$\times$ FPS compared with SAM2, while also delivering state-of-the-art performance after fine-tuning with lower-resolution data. These advancements establish SurgSAM-2 as a leading model for surgical video analysis, making real-time surgical video segmentation in resource-constrained environments a feasible reality., Comment: 16 pages, 2 figures

Personalized federated learning (PFL) for surgical instrument segmentation (SIS) is a promising approach. It enables multiple clinical sites to collaboratively train a series of models in privacy, with each model tailored to the individual distribution of each site. Existing PFL methods rarely consider the personalization of multi-headed self-attention, and do not account for appearance diversity and instrument shape similarity, both inherent in surgical scenes. We thus propose PFedSIS, a novel PFL method with visual trait priors for SIS, incorporating global-personalized disentanglement (GPD), appearance-regulation personalized enhancement (APE), and shape-similarity global enhancement (SGE), to boost SIS performance in each site. GPD represents the first attempt at head-wise assignment for multi-headed self-attention personalization. To preserve the unique appearance representation of each site and gradually leverage the inter-site difference, APE introduces appearance regulation and provides customized layer-wise aggregation solutions via hypernetworks for each site's personalized parameters. The mutual shape information of instruments is maintained and shared via SGE, which enhances the cross-style shape consistency on the image level and computes the shape-similarity contribution of each site on the prediction level for updating the global parameters. PFedSIS outperforms state-of-the-art methods with +1.51% Dice, +2.11% IoU, -2.79 ASSD, -15.55 HD95 performance gains. The corresponding code and models will be released at https://github.com/wzjialang/PFedSIS., Comment: 9 pages, 3 figures, under review

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., Comment: 8 pages, 4 figures

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., Comment: This paper has been accepted by MICCAI 2024

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.

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.

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. Our code is available at https://github.com/jinlab-imvr/Deform3DGS., Comment: Early accepted at MICCAI 2024, 10 pages, 2 figures

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., Comment: 10 pages, 4 figures, 3 tables

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.

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., Comment: 20 pages including reference. arXiv admin note: text overlap with arXiv:2211.15672

Visual question answering (VQA) is crucial for promoting 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 various surgeries. However, patient data privacy often restricts the availability of old data when updating the model, necessitating an exemplar-free continual learning (CL) setup. Prior CL studies overlooked two vital problems in the surgical domain: 1) large domain shifts from diverse surgical operations collected from multiple sources, and 2) severe data imbalance arising from the uneven presence of surgical instruments or activities. This paper proposes addressing these 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. Finally, to comprehensively test the effectiveness of our proposed method, we have also constructed two new surgical VQA datasets that are largely different from existing ones and could be valuable resources for future research. Extensive experimental results on the tested datasets demonstrate the superiority of our method to other advanced CL schemes., Comment: This paper has been accapted by 2024 IEEE International Conference on Robotics and Automation (ICRA)

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 multi-stage learning, where the generated semantic scene graphs depend on intermediate processes with pose estimation and object detection. This pipeline may potentially compromise the flexibility of learning multimodal representations, consequently constraining the overall effectiveness. In this study, we introduce a novel single-stage bi-modal 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 percentage points 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., Comment: This work has been accepted by TMI2024

Augmented reality for laparoscopic liver resection is a visualisation mode that allows a surgeon to localise tumours and vessels embedded within the liver by projecting them on top of a laparoscopic image. Preoperative 3D models extracted from CT or MRI data are registered to the intraoperative laparoscopic images during this process. In terms of 3D-2D fusion, most of the algorithms make use of anatomical landmarks to guide registration. These landmarks include the liver's inferior ridge, the falciform ligament, and the occluding contours. They are usually marked by hand in both the laparoscopic image and the 3D model, which is time-consuming and may contain errors if done by a non-experienced user. Therefore, there is a need to automate this process so that augmented reality can be used effectively in the operating room. We present the Preoperative-to-Intraoperative Laparoscopic Fusion Challenge (P2ILF), held during the Medical Imaging and Computer Assisted Interventions (MICCAI 2022) conference, which investigates the possibilities of detecting these landmarks automatically and using them in registration. The challenge was divided into two tasks: 1) A 2D and 3D landmark detection task and 2) a 3D-2D registration task. The teams were provided with training data consisting of 167 laparoscopic images and 9 preoperative 3D models from 9 patients, with the corresponding 2D and 3D landmark annotations. A total of 6 teams from 4 countries participated, whose proposed methods were evaluated on 16 images and two preoperative 3D models from two patients. All the teams proposed deep learning-based methods for the 2D and 3D landmark segmentation tasks and differentiable rendering-based methods for the registration task. Based on the experimental outcomes, we propose three key hypotheses that determine current limitations and future directions for research in this domain., Comment: 24 pages

Robot-assisted surgery has made significant progress, with instrument segmentation being a critical factor in surgical intervention quality. It serves as the building block to facilitate surgical robot navigation and surgical education for the next generation of operating intelligence. Although existing methods have achieved accurate instrument segmentation results, they simultaneously generate segmentation masks for all instruments, without the capability to specify a target object and allow an interactive experience. This work explores a new task of Referring Surgical Video Instrument Segmentation (RSVIS), which aims to automatically identify and segment the corresponding surgical instruments based on the given language expression. To achieve this, we devise a novel Video-Instrument Synergistic Network (VIS-Net) to learn both video-level and instrument-level knowledge to boost performance, while previous work only used video-level information. Meanwhile, we design a Graph-based Relation-aware Module (GRM) to model the correlation between multi-modal information (i.e., textual description and video frame) to facilitate the extraction of instrument-level information. We are also the first to produce two RSVIS datasets to promote related research. Our method is verified on these datasets, and experimental results exhibit that the VIS-Net can significantly outperform existing state-of-the-art referring segmentation methods. Our code and our datasets will be released upon the publication of this work.

High-accuracy Dichotomous Image Segmentation (DIS) aims to pinpoint category-agnostic foreground objects from natural scenes. The main challenge for DIS involves identifying the highly accurate dominant area while rendering detailed object structure. However, directly using a general encoder-decoder architecture may result in an oversupply of high-level features and neglect the shallow spatial information necessary for partitioning meticulous structures. To fill this gap, we introduce a novel Unite-Divide-Unite Network (UDUN} that restructures and bipartitely arranges complementary features to simultaneously boost the effectiveness of trunk and structure identification. The proposed UDUN proceeds from several strengths. First, a dual-size input feeds into the shared backbone to produce more holistic and detailed features while keeping the model lightweight. Second, a simple Divide-and-Conquer Module (DCM) is proposed to decouple multiscale low- and high-level features into our structure decoder and trunk decoder to obtain structure and trunk information respectively. Moreover, we design a Trunk-Structure Aggregation module (TSA) in our union decoder that performs cascade integration for uniform high-accuracy segmentation. As a result, UDUN performs favorably against state-of-the-art competitors in all six evaluation metrics on overall DIS-TE, i.e., achieving 0.772 weighted F-measure and 977 HCE. Using 1024*1024 input, our model enables real-time inference at 65.3 fps with ResNet-18., Comment: This paper has been accepted by ACM MM2023

Colorectal cancer is one of the most common cancers in the world. While colonoscopy is an effective screening technique, navigating an endoscope through the colon to detect polyps is challenging. A 3D map of the observed surfaces could enhance the identification of unscreened colon tissue and serve as a training platform. However, reconstructing the colon from video footage remains difficult. Learning-based approaches hold promise as robust alternatives, but necessitate extensive datasets. Establishing a benchmark dataset, the 2022 EndoVis sub-challenge SimCol3D aimed to facilitate data-driven depth and pose prediction during colonoscopy. The challenge was hosted as part of MICCAI 2022 in Singapore. Six teams from around the world and representatives from academia and industry participated in the three sub-challenges: synthetic depth prediction, synthetic pose prediction, and real pose prediction. This paper describes the challenge, the submitted methods, and their results. We show that depth prediction from synthetic colonoscopy images is robustly solvable, while pose estimation remains an open research question.

We propose a novel approach for RGB-D salient instance segmentation using a dual-branch cross-modal feature calibration architecture called CalibNet. Our method simultaneously calibrates depth and RGB features in the kernel and mask branches to generate instance-aware kernels and mask features. CalibNet consists of three simple modules, a dynamic interactive kernel (DIK) and a weight-sharing fusion (WSF), which work together to generate effective instance-aware kernels and integrate cross-modal features. To improve the quality of depth features, we incorporate a depth similarity assessment (DSA) module prior to DIK and WSF. In addition, we further contribute a new DSIS dataset, which contains 1,940 images with elaborate instance-level annotations. Extensive experiments on three challenging benchmarks show that CalibNet yields a promising result, i.e., 58.0% AP with 320*480 input size on the COME15K-N test set, which significantly surpasses the alternative frameworks. Our code and dataset are available at: https://github.com/PJLallen/CalibNet., Comment: This work has been accepted by TIP 2024

Under the framework of network-based neurodegeneration, brain functional connectome (FC)-based Graph Neural Networks (GNN) have emerged as a valuable tool for the diagnosis and prognosis of neurodegenerative diseases such as Alzheimer's disease (AD). However, these models are tailored for brain FC at a single time point instead of characterizing FC trajectory. Discerning how FC evolves with disease progression, particularly at the predementia stages such as cognitively normal individuals with amyloid deposition or individuals with mild cognitive impairment (MCI), is crucial for delineating disease spreading patterns and developing effective strategies to slow down or even halt disease advancement. In this work, we proposed the first interpretable framework for brain FC trajectory embedding with application to neurodegenerative disease diagnosis and prognosis, namely Brain Tokenized Graph Transformer (Brain TokenGT). It consists of two modules: 1) Graph Invariant and Variant Embedding (GIVE) for generation of node and spatio-temporal edge embeddings, which were tokenized for downstream processing; 2) Brain Informed Graph Transformer Readout (BIGTR) which augments previous tokens with trainable type identifiers and non-trainable node identifiers and feeds them into a standard transformer encoder to readout. We conducted extensive experiments on two public longitudinal fMRI datasets of the AD continuum for three tasks, including differentiating MCI from controls, predicting dementia conversion in MCI, and classification of amyloid positive or negative cognitively normal individuals. Based on brain FC trajectory, the proposed Brain TokenGT approach outperformed all the other benchmark models and at the same time provided excellent interpretability. The code is available at https://github.com/ZijianD/Brain-TokenGT.git, Comment: MICCAI 2023

For robot-assisted surgery, an accurate surgical report reflects clinical operations during surgery and helps document entry tasks, post-operative analysis and follow-up treatment. It is a challenging task due to many complex and diverse interactions between instruments and tissues in the surgical scene. Although existing surgical report generation methods based on deep learning have achieved large success, they often ignore the interactive relation between tissues and instrumental tools, thereby degrading the report generation performance. This paper presents a neural network to boost surgical report generation by explicitly exploring the interactive relation between tissues and surgical instruments. We validate the effectiveness of our method on a widely-used robotic surgery benchmark dataset, and experimental results show that our network can significantly outperform existing state-of-the-art surgical report generation methods (e.g., 7.48% and 5.43% higher for BLEU-1 and ROUGE).

Large foundation models, known for their strong zero-shot generalization, have excelled in visual and language applications. However, applying them to medical image segmentation, a domain with diverse imaging types and target labels, remains an open challenge. Current approaches, such as adapting interactive segmentation models like Segment Anything Model (SAM), require user prompts for each sample during inference. Alternatively, transfer learning methods like few/one-shot models demand labeled samples, leading to high costs. This paper introduces a new paradigm toward the universal medical image segmentation, termed 'One-Prompt Segmentation.' One-Prompt Segmentation combines the strengths of one-shot and interactive methods. In the inference stage, with just \textbf{one prompted sample}, it can adeptly handle the unseen task in a single forward pass. We train One-Prompt Model on 64 open-source medical datasets, accompanied by the collection of over 3,000 clinician-labeled prompts. Tested on 14 previously unseen datasets, the One-Prompt Model showcases superior zero-shot segmentation capabilities, outperforming a wide range of related methods. The code and data is released as https://github.com/KidsWithTokens/one-prompt., Comment: arXiv admin note: text overlap with arXiv:2304.12620

The Segment Anything Model (SAM) has recently gained popularity in the field of image segmentation due to its impressive capabilities in various segmentation tasks and its prompt-based interface. However, recent studies and individual experiments have shown that SAM underperforms in medical image segmentation, since the lack of the medical specific knowledge. This raises the question of how to enhance SAM's segmentation capability for medical images. In this paper, instead of fine-tuning the SAM model, we propose the Medical SAM Adapter (Med-SA), which incorporates domain-specific medical knowledge into the segmentation model using a light yet effective adaptation technique. In Med-SA, we propose Space-Depth Transpose (SD-Trans) to adapt 2D SAM to 3D medical images and Hyper-Prompting Adapter (HyP-Adpt) to achieve prompt-conditioned adaptation. We conduct comprehensive evaluation experiments on 17 medical image segmentation tasks across various image modalities. Med-SA outperforms several state-of-the-art (SOTA) medical image segmentation methods, while updating only 2\% of the parameters. Our code is released at https://github.com/KidsWithTokens/Medical-SAM-Adapter., Comment: Code released at: https://github.com/KidsWithTokens/Medical-SAM-Adapter

Semi-supervised learning (SSL) methods assume that labeled data, unlabeled data and test data are from the same distribution. Open-set semi-supervised learning (Open-set SSL) considers a more practical scenario, where unlabeled data and test data contain new categories (outliers) not observed in labeled data (inliers). Most previous works focused on outlier detection via binary classifiers, which suffer from insufficient scalability and inability to distinguish different types of uncertainty. In this paper, we propose a novel framework, Adaptive Negative Evidential Deep Learning (ANEDL) to tackle these limitations. Concretely, we first introduce evidential deep learning (EDL) as an outlier detector to quantify different types of uncertainty, and design different uncertainty metrics for self-training and inference. Furthermore, we propose a novel adaptive negative optimization strategy, making EDL more tailored to the unlabeled dataset containing both inliers and outliers. As demonstrated empirically, our proposed method outperforms existing state-of-the-art methods across four datasets., Comment: Accepted by AAAI2024

This paper introduces the ``SurgT: Surgical Tracking" challenge which was organised in conjunction with MICCAI 2022. There were two purposes for the creation of this challenge: (1) the establishment of the first standardised benchmark for the research community to assess soft-tissue trackers; and (2) to encourage the development of unsupervised deep learning methods, given the lack of annotated data in surgery. A dataset of 157 stereo endoscopic videos from 20 clinical cases, along with stereo camera calibration parameters, have been provided. Participants were assigned the task of developing algorithms to track the movement of soft tissues, represented by bounding boxes, in stereo endoscopic videos. At the end of the challenge, the developed methods were assessed on a previously hidden test subset. This assessment uses benchmarking metrics that were purposely developed for this challenge, to verify the efficacy of unsupervised deep learning algorithms in tracking soft-tissue. The metric used for ranking the methods was the Expected Average Overlap (EAO) score, which measures the average overlap between a tracker's and the ground truth bounding boxes. Coming first in the challenge was the deep learning submission by ICVS-2Ai with a superior EAO score of 0.617. This method employs ARFlow to estimate unsupervised dense optical flow from cropped images, using photometric and regularization losses. Second, Jmees with an EAO of 0.583, uses deep learning for surgical tool segmentation on top of a non-deep learning baseline method: CSRT. CSRT by itself scores a similar EAO of 0.563. The results from this challenge show that currently, non-deep learning methods are still competitive. The dataset and benchmarking tool created for this challenge have been made publicly available at https://surgt.grand-challenge.org/.

The Diffusion Probabilistic Model (DPM) has recently gained popularity in the field of computer vision, thanks to its image generation applications, such as Imagen, Latent Diffusion Models, and Stable Diffusion, which have demonstrated impressive capabilities and sparked much discussion within the community. Recent investigations have further unveiled the utility of DPM in the domain of medical image analysis, as underscored by the commendable performance exhibited by the medical image segmentation model across various tasks. Although these models were originally underpinned by a UNet architecture, there exists a potential avenue for enhancing their performance through the integration of vision transformer mechanisms. However, we discovered that simply combining these two models resulted in subpar performance. To effectively integrate these two cutting-edge techniques for the Medical image segmentation, we propose a novel Transformer-based Diffusion framework, called MedSegDiff-V2. We verify its effectiveness on 20 medical image segmentation tasks with different image modalities. Through comprehensive evaluation, our approach demonstrates superiority over prior state-of-the-art (SOTA) methodologies. Code is released at https://github.com/KidsWithTokens/MedSegDiff, Comment: Code will be released at https://github.com/KidsWithTokens/MedSegDiff

The number of international benchmarking competitions is steadily increasing in various fields of machine learning (ML) research and practice. So far, however, little is known about the common practice as well as bottlenecks faced by the community in tackling the research questions posed. To shed light on the status quo of algorithm development in the specific field of biomedical imaging analysis, we designed an international survey that was issued to all participants of challenges conducted in conjunction with the IEEE ISBI 2021 and MICCAI 2021 conferences (80 competitions in total). The survey covered participants' expertise and working environments, their chosen strategies, as well as algorithm characteristics. A median of 72% challenge participants took part in the survey. According to our results, knowledge exchange was the primary incentive (70%) for participation, while the reception of prize money played only a minor role (16%). While a median of 80 working hours was spent on method development, a large portion of participants stated that they did not have enough time for method development (32%). 25% perceived the infrastructure to be a bottleneck. Overall, 94% of all solutions were deep learning-based. Of these, 84% were based on standard architectures. 43% of the respondents reported that the data samples (e.g., images) were too large to be processed at once. This was most commonly addressed by patch-based training (69%), downsampling (37%), and solving 3D analysis tasks as a series of 2D tasks. K-fold cross-validation on the training set was performed by only 37% of the participants and only 50% of the participants performed ensembling based on multiple identical models (61%) or heterogeneous models (39%). 48% of the respondents applied postprocessing steps.

Timely and effective feedback within surgical training plays a critical role in developing the skills required to perform safe and efficient surgery. Feedback from expert surgeons, while especially valuable in this regard, is challenging to acquire due to their typically busy schedules, and may be subject to biases. Formal assessment procedures like OSATS and GEARS attempt to provide objective measures of skill, but remain time-consuming. With advances in machine learning there is an opportunity for fast and objective automated feedback on technical skills. The SimSurgSkill 2021 challenge (hosted as a sub-challenge of EndoVis at MICCAI 2021) aimed to promote and foster work in this endeavor. Using virtual reality (VR) surgical tasks, competitors were tasked with localizing instruments and predicting surgical skill. Here we summarize the winning approaches and how they performed. Using this publicly available dataset and results as a springboard, future work may enable more efficient training of surgeons with advances in surgical data science. The dataset can be accessed from https://console.cloud.google.com/storage/browser/isi-simsurgskill-2021., Comment: arXiv admin note: substantial text overlap with arXiv:1910.04071

Surgical action triplet recognition provides a better understanding of the surgical scene. This task is of high relevance as it provides the surgeon with context-aware support and safety. The current go-to strategy for improving performance is the development of new network mechanisms. However, the performance of current state-of-the-art techniques is substantially lower than other surgical tasks. Why is this happening? This is the question that we address in this work. We present the first study to understand the failure of existing deep learning models through the lens of robustness and explainability. Firstly, we study current existing models under weak and strong $\delta-$perturbations via an adversarial optimisation scheme. We then analyse the failure modes via feature based explanations. Our study reveals that the key to improving performance and increasing reliability is in the core and spurious attributes. Our work opens the door to more trustworthy and reliable deep learning models in surgical data science.

Surgical scene segmentation is fundamentally crucial for prompting cognitive assistance in robotic surgery. However, pixel-wise annotating surgical video in a frame-by-frame manner is expensive and time consuming. To greatly reduce the labeling burden, in this work, we study semi-supervised scene segmentation from robotic surgical video, which is practically essential yet rarely explored before. We consider a clinically suitable annotation situation under the equidistant sampling. We then propose PGV-CL, a novel pseudo-label guided cross-video contrast learning method to boost scene segmentation. It effectively leverages unlabeled data for a trusty and global model regularization that produces more discriminative feature representation. Concretely, for trusty representation learning, we propose to incorporate pseudo labels to instruct the pair selection, obtaining more reliable representation pairs for pixel contrast. Moreover, we expand the representation learning space from previous image-level to cross-video, which can capture the global semantics to benefit the learning process. We extensively evaluate our method on a public robotic surgery dataset EndoVis18 and a public cataract dataset CaDIS. Experimental results demonstrate the effectiveness of our method, consistently outperforming the state-of-the-art semi-supervised methods under different labeling ratios, and even surpassing fully supervised training on EndoVis18 with 10.1% labeling., Comment: Accepted by IROS 2022

Medical image segmentation under federated learning (FL) is a promising direction by allowing multiple clinical sites to collaboratively learn a global model without centralizing datasets. However, using a single model to adapt to various data distributions from different sites is extremely challenging. Personalized FL tackles this issue by only utilizing partial model parameters shared from global server, while keeping the rest to adapt to its own data distribution in the local training of each site. However, most existing methods concentrate on the partial parameter splitting, while do not consider the \textit{inter-site in-consistencies} during the local training, which in fact can facilitate the knowledge communication over sites to benefit the model learning for improving the local accuracy. In this paper, we propose a personalized federated framework with \textbf{L}ocal \textbf{C}alibration (LC-Fed), to leverage the inter-site in-consistencies in both \textit{feature- and prediction- levels} to boost the segmentation. Concretely, as each local site has its alternative attention on the various features, we first design the contrastive site embedding coupled with channel selection operation to calibrate the encoded features. Moreover, we propose to exploit the knowledge of prediction-level in-consistency to guide the personalized modeling on the ambiguous regions, e.g., anatomical boundaries. It is achieved by computing a disagreement-aware map to calibrate the prediction. Effectiveness of our method has been verified on three medical image segmentation tasks with different modalities, where our method consistently shows superior performance to the state-of-the-art personalized FL methods. Code is available at https://github.com/jcwang123/FedLC., Comment: Accepted at ECCV 2022

Automatic surgical scene segmentation is fundamental for facilitating cognitive intelligence in the modern operating theatre. Previous works rely on conventional aggregation modules (e.g., dilated convolution, convolutional LSTM), which only make use of the local context. In this paper, we propose a novel framework STswinCL that explores the complementary intra- and inter-video relations to boost segmentation performance, by progressively capturing the global context. We firstly develop a hierarchy Transformer to capture intra-video relation that includes richer spatial and temporal cues from neighbor pixels and previous frames. A joint space-time window shift scheme is proposed to efficiently aggregate these two cues into each pixel embedding. Then, we explore inter-video relation via pixel-to-pixel contrastive learning, which well structures the global embedding space. A multi-source contrast training objective is developed to group the pixel embeddings across videos with the ground-truth guidance, which is crucial for learning the global property of the whole data. We extensively validate our approach on two public surgical video benchmarks, including EndoVis18 Challenge and CaDIS dataset. Experimental results demonstrate the promising performance of our method, which consistently exceeds previous state-of-the-art approaches. Code is available at https://github.com/YuemingJin/STswinCL., Comment: Accepted at IEEE TMI

Surgical instrument segmentation -- in general a pixel classification task -- is fundamentally crucial for promoting cognitive intelligence in robot-assisted surgery (RAS). However, previous methods are struggling with discriminating instrument types and instances. To address the above issues, we explore a mask classification paradigm that produces per-segment predictions. We propose TraSeTR, a novel Track-to-Segment Transformer that wisely exploits tracking cues to assist surgical instrument segmentation. TraSeTR jointly reasons about the instrument type, location, and identity with instance-level predictions i.e., a set of class-bbox-mask pairs, by decoding query embeddings. Specifically, we introduce the prior query that encoded with previous temporal knowledge, to transfer tracking signals to current instances via identity matching. A contrastive query learning strategy is further applied to reshape the query feature space, which greatly alleviates the tracking difficulty caused by large temporal variations. The effectiveness of our method is demonstrated with state-of-the-art instrument type segmentation results on three public datasets, including two RAS benchmarks from EndoVis Challenges and one cataract surgery dataset CaDIS., Comment: Accepted by ICRA 2022

We propose a novel shape-aware relation network for accurate and real-time landmark detection in endoscopic submucosal dissection (ESD) surgery. This task is of great clinical significance but extremely challenging due to bleeding, lighting reflection, and motion blur in the complicated surgical environment. Compared with existing solutions, which either neglect geometric relationships among targeting objects or capture the relationships by using complicated aggregation schemes, the proposed network is capable of achieving satisfactory accuracy while maintaining real-time performance by taking full advantage of the spatial relations among landmarks. We first devise an algorithm to automatically generate relation keypoint heatmaps, which are able to intuitively represent the prior knowledge of spatial relations among landmarks without using any extra manual annotation efforts. We then develop two complementary regularization schemes to progressively incorporate the prior knowledge into the training process. While one scheme introduces pixel-level regularization by multi-task learning, the other integrates global-level regularization by harnessing a newly designed grouped consistency evaluator, which adds relation constraints to the proposed network in an adversarial manner. Both schemes are beneficial to the model in training, and can be readily unloaded in inference to achieve real-time detection. We establish a large in-house dataset of ESD surgery for esophageal cancer to validate the effectiveness of our proposed method. Extensive experimental results demonstrate that our approach outperforms state-of-the-art methods in terms of accuracy and efficiency, achieving better detection results faster. Promising results on two downstream applications further corroborate the great potential of our method in ESD clinical practice.

PURPOSE: Surgical workflow and skill analysis are key technologies for the next generation of cognitive surgical assistance systems. These systems could increase the safety of the operation through context-sensitive warnings and semi-autonomous robotic assistance or improve training of surgeons via data-driven feedback. In surgical workflow analysis up to 91% average precision has been reported for phase recognition on an open data single-center dataset. In this work we investigated the generalizability of phase recognition algorithms in a multi-center setting including more difficult recognition tasks such as surgical action and surgical skill. METHODS: To achieve this goal, a dataset with 33 laparoscopic cholecystectomy videos from three surgical centers with a total operation time of 22 hours was created. Labels included annotation of seven surgical phases with 250 phase transitions, 5514 occurences of four surgical actions, 6980 occurences of 21 surgical instruments from seven instrument categories and 495 skill classifications in five skill dimensions. The dataset was used in the 2019 Endoscopic Vision challenge, sub-challenge for surgical workflow and skill analysis. Here, 12 teams submitted their machine learning algorithms for recognition of phase, action, instrument and/or skill assessment. RESULTS: F1-scores were achieved for phase recognition between 23.9% and 67.7% (n=9 teams), for instrument presence detection between 38.5% and 63.8% (n=8 teams), but for action recognition only between 21.8% and 23.3% (n=5 teams). The average absolute error for skill assessment was 0.78 (n=1 team). CONCLUSION: Surgical workflow and skill analysis are promising technologies to support the surgical team, but are not solved yet, as shown by our comparison of algorithms. This novel benchmark can be used for comparable evaluation and validation of future work.

Performing a real-time and accurate instrument segmentation from videos is of great significance for improving the performance of robotic-assisted surgery. We identify two important clues for surgical instrument perception, including local temporal dependency from adjacent frames and global semantic correlation in long-range duration. However, most existing works perform segmentation purely using visual cues in a single frame. Optical flow is just used to model the motion between only two frames and brings heavy computational cost. We propose a novel dual-memory network (DMNet) to wisely relate both global and local spatio-temporal knowledge to augment the current features, boosting the segmentation performance and retaining the real-time prediction capability. We propose, on the one hand, an efficient local memory by taking the complementary advantages of convolutional LSTM and non-local mechanisms towards the relating reception field. On the other hand, we develop an active global memory to gather the global semantic correlation in long temporal range to current one, in which we gather the most informative frames derived from model uncertainty and frame similarity. We have extensively validated our method on two public benchmark surgical video datasets. Experimental results demonstrate that our method largely outperforms the state-of-the-art works on segmentation accuracy while maintaining a real-time speed.

This paper presents a self-supervised method for learning reliable visual correspondence from unlabeled videos. We formulate the correspondence as finding paths in a joint space-time graph, where nodes are grid patches sampled from frames, and are linked by two types of edges: (i) neighbor relations that determine the aggregation strength from intra-frame neighbors in space, and (ii) similarity relations that indicate the transition probability of inter-frame paths across time. Leveraging the cycle-consistency in videos, our contrastive learning objective discriminates dynamic objects from both their neighboring views and temporal views. Compared with prior works, our approach actively explores the neighbor relations of central instances to learn a latent association between center-neighbor pairs (e.g., "hand -- arm") across time, thus improving the instance discrimination. Without fine-tuning, our learned representation outperforms the state-of-the-art self-supervised methods on a variety of visual tasks including video object propagation, part propagation, and pose keypoint tracking. Our self-supervised method also surpasses some fully supervised algorithms designed for the specific tasks., Comment: Accepted by ICCV 2021

Domain adaptation typically requires to access source domain data to utilize their distribution information for domain alignment with the target data. However, in many real-world scenarios, the source data may not be accessible during the model adaptation in the target domain due to privacy issue. This paper studies the practical yet challenging source-free unsupervised domain adaptation problem, in which only an existing source model and the unlabeled target data are available for model adaptation. We present a novel denoised pseudo-labeling method for this problem, which effectively makes use of the source model and unlabeled target data to promote model self-adaptation from pseudo labels. Importantly, considering that the pseudo labels generated from source model are inevitably noisy due to domain shift, we further introduce two complementary pixel-level and class-level denoising schemes with uncertainty estimation and prototype estimation to reduce noisy pseudo labels and select reliable ones to enhance the pseudo-labeling efficacy. Experimental results on cross-domain fundus image segmentation show that without using any source images or altering source training, our approach achieves comparable or even higher performance than state-of-the-art source-dependent unsupervised domain adaptation methods., Comment: Accepted to MICCAI 2021

Video prediction methods generally consume substantial computing resources in training and deployment, among which keypoint-based approaches show promising improvement in efficiency by simplifying dense image prediction to light keypoint prediction. However, keypoint locations are often modeled only as continuous coordinates, so noise from semantically insignificant deviations in videos easily disrupt learning stability, leading to inaccurate keypoint modeling. In this paper, we design a new grid keypoint learning framework, aiming at a robust and explainable intermediate keypoint representation for long-term efficient video prediction. We have two major technical contributions. First, we detect keypoints by jumping among candidate locations in our raised grid space and formulate a condensation loss to encourage meaningful keypoints with strong representative capability. Second, we introduce a 2D binary map to represent the detected grid keypoints and then suggest propagating keypoint locations with stochasticity by selecting entries in the discrete grid space, thus preserving the spatial structure of keypoints in the longterm horizon for better future frame generation. Extensive experiments verify that our method outperforms the state-ofthe-art stochastic video prediction methods while saves more than 98% of computing resources. We also demonstrate our method on a robotic-assisted surgery dataset with promising results. Our code is available at https://github.com/xjgaocs/Grid-Keypoint-Learning., Comment: IROS2021

Automatic surgical workflow recognition is a key component for developing context-aware computer-assisted systems in the operating theatre. Previous works either jointly modeled the spatial features with short fixed-range temporal information, or separately learned visual and long temporal cues. In this paper, we propose a novel end-to-end temporal memory relation network (TMRNet) for relating long-range and multi-scale temporal patterns to augment the present features. We establish a long-range memory bank to serve as a memory cell storing the rich supportive information. Through our designed temporal variation layer, the supportive cues are further enhanced by multi-scale temporal-only convolutions. To effectively incorporate the two types of cues without disturbing the joint learning of spatio-temporal features, we introduce a non-local bank operator to attentively relate the past to the present. In this regard, our TMRNet enables the current feature to view the long-range temporal dependency, as well as tolerate complex temporal extents. We have extensively validated our approach on two benchmark surgical video datasets, M2CAI challenge dataset and Cholec80 dataset. Experimental results demonstrate the outstanding performance of our method, consistently exceeding the state-of-the-art methods by a large margin (e.g., 67.0% v.s. 78.9% Jaccard on Cholec80 dataset)., Comment: Accepted at IEEE Transactions on Medical Imaging (IEEE TMI); Code is available at https://github.com/YuemingJin/TMRNet

Surgical instrument segmentation in robot-assisted surgery (RAS) - especially that using learning-based models - relies on the assumption that training and testing videos are sampled from the same domain. However, it is impractical and expensive to collect and annotate sufficient data from every new domain. To greatly increase the label efficiency, we explore a new problem, i.e., adaptive instrument segmentation, which is to effectively adapt one source model to new robotic surgical videos from multiple target domains, only given the annotated instruments in the first frame. We propose MDAL, a meta-learning based dynamic online adaptive learning scheme with a two-stage framework to fast adapt the model parameters on the first frame and partial subsequent frames while predicting the results. MDAL learns the general knowledge of instruments and the fast adaptation ability through the video-specific meta-learning paradigm. The added gradient gate excludes the noisy supervision from pseudo masks for dynamic online adaptation on target videos. We demonstrate empirically that MDAL outperforms other state-of-the-art methods on two datasets (including a real-world RAS dataset). The promising performance on ex-vivo scenes also benefits the downstream tasks such as robot-assisted suturing and camera control., Comment: Accepted by ICRA 2021

Predicting future frames for robotic surgical video is an interesting, important yet extremely challenging problem, given that the operative tasks may have complex dynamics. Existing approaches on future prediction of natural videos were based on either deterministic models or stochastic models, including deep recurrent neural networks, optical flow, and latent space modeling. However, the potential in predicting meaningful movements of robots with dual arms in surgical scenarios has not been tapped so far, which is typically more challenging than forecasting independent motions of one arm robots in natural scenarios. In this paper, we propose a ternary prior guided variational autoencoder (TPG-VAE) model for future frame prediction in robotic surgical video sequences. Besides content distribution, our model learns motion distribution, which is novel to handle the small movements of surgical tools. Furthermore, we add the invariant prior information from the gesture class into the generation process to constrain the latent space of our model. To our best knowledge, this is the first time that the future frames of dual arm robots are predicted considering their unique characteristics relative to general robotic videos. Experiments demonstrate that our model gains more stable and realistic future frame prediction scenes with the suturing task on the public JIGSAWS dataset., Comment: IPMI2021

Real-time surgical phase recognition is a fundamental task in modern operating rooms. Previous works tackle this task relying on architectures arranged in spatio-temporal order, however, the supportive benefits of intermediate spatial features are not considered. In this paper, we introduce, for the first time in surgical workflow analysis, Transformer to reconsider the ignored complementary effects of spatial and temporal features for accurate surgical phase recognition. Our hybrid embedding aggregation Transformer fuses cleverly designed spatial and temporal embeddings by allowing for active queries based on spatial information from temporal embedding sequences. More importantly, our framework processes the hybrid embeddings in parallel to achieve a high inference speed. Our method is thoroughly validated on two large surgical video datasets, i.e., Cholec80 and M2CAI16 Challenge datasets, and outperforms the state-of-the-art approaches at a processing speed of 91 fps., Comment: MICCAI2021

Automated surgical gesture recognition is of great importance in robot-assisted minimally invasive surgery. However, existing methods assume that training and testing data are from the same domain, which suffers from severe performance degradation when a domain gap exists, such as the simulator and real robot. In this paper, we propose a novel unsupervised domain adaptation framework which can simultaneously transfer multi-modality knowledge, i.e., both kinematic and visual data, from simulator to real robot. It remedies the domain gap with enhanced transferable features by using temporal cues in videos, and inherent correlations in multi-modal towards recognizing gesture. Specifically, we first propose an MDO-K to align kinematics, which exploits temporal continuity to transfer motion directions with smaller gap rather than position values, relieving the adaptation burden. Moreover, we propose a KV-Relation-ATT to transfer the co-occurrence signals of kinematics and vision. Such features attended by correlation similarity are more informative for enhancing domain-invariance of the model. Two feature alignment strategies benefit the model mutually during the end-to-end learning process. We extensively evaluate our method for gesture recognition using DESK dataset with peg transfer procedure. Results show that our approach recovers the performance with great improvement gains, up to 12.91% in ACC and 20.16% in F1score without using any annotations in real robot., Comment: Accepted as a conference paper in IROS 2021