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Ultrasound is a hand-held, low-cost, non-invasive medical imaging modality which plays a vital role in diagnosing various diseases. Despite this, many rural and remote communities do not have access to ultrasound scans due to the lack of local experts trained to perform them. To address this challenge, we built a mixed reality and haptics-based tele-ultrasound system to enable an expert to precisely guide a novice remotely in carrying out an ultrasound exam. The precision and flexibility of our solution makes it more practical than existing tele-ultrasound solutions. We tested the system in Skidegate on the islands of Haida Gwaii, BC, Canada, with the experts positioned 754 km away at the University of British Columbia, Vancouver, Canada. We performed 11 scans with 10 novices and 2 experts. The experts were tasked with acquiring 5 target images and measurements in the epigastric region. The novices of various backgrounds and ages were all inexperienced in mixed reality and were not required to have prior ultrasound experience. The captured images were evaluated by two radiologists who were not present for the tests. These results are discussed along with new insights into the human computer interaction in such a system. We show that human teleoperation is feasible and can achieve high performance for completing remote ultrasound procedures, even at a large distance and with completely novice followers., Comment: 8 pages, 10 figures, submitted to IEEE VR 2025

The Segment Anything Model (SAM) is a powerful vision foundation model that is revolutionizing the traditional paradigm of segmentation. Despite this, a reliance on prompting each frame and large computational cost limit its usage in robotically assisted surgery. Applications, such as augmented reality guidance, require little user intervention along with efficient inference to be usable clinically. In this study, we address these limitations by adopting lightweight SAM variants to meet the efficiency requirement and employing fine-tuning techniques to enhance their generalization in surgical scenes. Recent advancements in Tracking Any Point (TAP) have shown promising results in both accuracy and efficiency, particularly when points are occluded or leave the field of view. Inspired by this progress, we present a novel framework that combines an online point tracker with a lightweight SAM model that is fine-tuned for surgical instrument segmentation. Sparse points within the region of interest are tracked and used to prompt SAM throughout the video sequence, providing temporal consistency. The quantitative results surpass the state-of-the-art semi-supervised video object segmentation method XMem on the EndoVis 2015 dataset with 84.8 IoU and 91.0 Dice. Our method achieves promising performance that is comparable to XMem and transformer-based fully supervised segmentation methods on ex vivo UCL dVRK and in vivo CholecSeg8k datasets. In addition, the proposed method shows promising zero-shot generalization ability on the label-free STIR dataset. In terms of efficiency, we tested our method on a single GeForce RTX 4060/4090 GPU respectively, achieving an over 25/90 FPS inference speed. Code is available at: https://github.com/wuzijian1997/SIS-PT-SAM, Comment: 6 pages, 9 figures

Finding point-level correspondences is a fundamental problem in ultrasound (US), since it can enable US landmark tracking for intraoperative image guidance in different surgeries, including head and neck. Most existing US tracking methods, e.g., those based on optical flow or feature matching, were initially designed for RGB images before being applied to US. Therefore domain shift can impact their performance. Training could be supervised by ground-truth correspondences, but these are expensive to acquire in US. To solve these problems, we propose a self-supervised pixel-level tracking model called PIPsUS. Our model can track an arbitrary number of points in one forward pass and exploits temporal information by considering multiple, instead of just consecutive, frames. We developed a new self-supervised training strategy that utilizes a long-term point-tracking model trained for RGB images as a teacher to guide the model to learn realistic motions and use data augmentation to enforce tracking from US appearance. We evaluate our method on neck and oral US and echocardiography, showing higher point tracking accuracy when compared with fast normalized cross-correlation and tuned optical flow. Code will be available once the paper is accepted., Comment: 10 pages, 3 figures, submitted to MICCAI 2024

As computer vision algorithms increase in capability, their applications in clinical systems will become more pervasive. These applications include: diagnostics, such as colonoscopy and bronchoscopy; guiding biopsies, minimally invasive interventions, and surgery; automating instrument motion; and providing image guidance using pre-operative scans. Many of these applications depend on the specific visual nature of medical scenes and require designing algorithms to perform in this environment. In this review, we provide an update to the field of camera-based tracking and scene mapping in surgery and diagnostics in medical computer vision. We begin with describing our review process, which results in a final list of 515 papers that we cover. We then give a high-level summary of the state of the art and provide relevant background for those who need tracking and mapping for their clinical applications. After which, we review datasets provided in the field and the clinical needs that motivate their design. Then, we delve into the algorithmic side, and summarize recent developments. This summary should be especially useful for algorithm designers and to those looking to understand the capability of off-the-shelf methods. We maintain focus on algorithms for deformable environments while also reviewing the essential building blocks in rigid tracking and mapping since there is a large amount of crossover in methods. With the field summarized, we discuss the current state of the tracking and mapping methods along with needs for future algorithms, needs for quantification, and the viability of clinical applications. We then provide some research directions and questions. We conclude that new methods need to be designed or combined to support clinical applications in deformable environments, and more focus needs to be put into collecting datasets for training and evaluation., Comment: 36 pages, 17 figures. To appear in Medical Image Analysis

Quantifying performance of methods for tracking and mapping tissue in endoscopic environments is essential for enabling image guidance and automation of medical interventions and surgery. Datasets developed so far either use rigid environments, visible markers, or require annotators to label salient points in videos after collection. These are respectively: not general, visible to algorithms, or costly and error-prone. We introduce a novel labeling methodology along with a dataset that uses said methodology, Surgical Tattoos in Infrared (STIR). STIR has labels that are persistent but invisible to visible spectrum algorithms. This is done by labelling tissue points with IR-fluorescent dye, indocyanine green (ICG), and then collecting visible light video clips. STIR comprises hundreds of stereo video clips in both in-vivo and ex-vivo scenes with start and end points labelled in the IR spectrum. With over 3,000 labelled points, STIR will help to quantify and enable better analysis of tracking and mapping methods. After introducing STIR, we analyze multiple different frame-based tracking methods on STIR using both 3D and 2D endpoint error and accuracy metrics. STIR is available at https://dx.doi.org/10.21227/w8g4-g548, Comment: \c{opyright} 2024 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works

In this paper, we report our discovery of a gaze behavior called Quiet Eye (QE) in minimally invasive surgery. The QE behavior has been extensively studied in sports training and has been associated with higher level of expertise in multiple sports. We investigated the QE behavior in two independently collected data sets of surgeons performing tasks in a sinus surgery setting and a robotic surgery setting, respectively. Our results show that the QE behavior is more likely to occur in successful task executions and in performances of surgeons of high level of expertise. These results open the door to use the QE behavior in both training and skill assessment in minimally invasive surgery.

Real-time transrectal ultrasound (TRUS) image guidance during robot-assisted laparoscopic radical prostatectomy has the potential to enhance surgery outcomes. Whether conventional or photoacoustic TRUS is used, the robotic system and the TRUS must be registered to each other. Accurate registration can be performed using photoacoustic (PA markers). However, this requires a manual search by an assistant [19]. This paper introduces the first automatic search for PA markers using a transrectal ultrasound robot. This effectively reduces the challenges associated with the da Vinci-TRUS registration. This paper investigated the performance of three search algorithms in simulation and experiment: Weighted Average (WA), Golden Section Search (GSS), and Ternary Search (TS). For validation, a surgical prostate scenario was mimicked and various ex vivo tissues were tested. As a result, the WA algorithm can achieve 0.53 degree average error after 9 data acquisitions, while the TS and GSS algorithm can achieve 0.29 degree and 0.48 degree average errors after 28 data acquisitions., Comment: 13 pages, 9 figures

Ultrasound (US) is one of the most widely used modalities for clinical intervention and diagnosis due to the merits of providing non-invasive, radiation-free, and real-time images. However, free-hand US examinations are highly operator-dependent. Robotic US System (RUSS) aims at overcoming this shortcoming by offering reproducibility, while also aiming at improving dexterity, and intelligent anatomy and disease-aware imaging. In addition to enhancing diagnostic outcomes, RUSS also holds the potential to provide medical interventions for populations suffering from the shortage of experienced sonographers. In this paper, we categorize RUSS as teleoperated or autonomous. Regarding teleoperated RUSS, we summarize their technical developments, and clinical evaluations, respectively. This survey then focuses on the review of recent work on autonomous robotic US imaging. We demonstrate that machine learning and artificial intelligence present the key techniques, which enable intelligent patient and process-specific, motion and deformation-aware robotic image acquisition. We also show that the research on artificial intelligence for autonomous RUSS has directed the research community toward understanding and modeling expert sonographers' semantic reasoning and action. Here, we call this process, the recovery of the "language of sonography". This side result of research on autonomous robotic US acquisitions could be considered as valuable and essential as the progress made in the robotic US examination itself. This article will provide both engineers and clinicians with a comprehensive understanding of RUSS by surveying underlying techniques., Comment: Accepted by Medical Image Analysis

Purpose: To achieve effective robot-assisted laparoscopic prostatectomy, the integration of transrectal ultrasound (TRUS) imaging system which is the most widely used imaging modelity in prostate imaging is essential. However, manual manipulation of the ultrasound transducer during the procedure will significantly interfere with the surgery. Therefore, we propose an image co-registration algorithm based on a photoacoustic marker method, where the ultrasound / photoacoustic (US/PA) images can be registered to the endoscopic camera images to ultimately enable the TRUS transducer to automatically track the surgical instrument Methods: An optimization-based algorithm is proposed to co-register the images from the two different imaging modalities. The principles of light propagation and an uncertainty in PM detection were assumed in this algorithm to improve the stability and accuracy of the algorithm. The algorithm is validated using the previously developed US/PA image-guided system with a da Vinci surgical robot. Results: The target-registration-error (TRE) is measured to evaluate the proposed algorithm. In both simulation and experimental demonstration, the proposed algorithm achieved a sub-centimeter accuracy which is acceptable in practical clinics. The result is also comparable with our previous approach, and the proposed method can be implemented with a normal white light stereo camera and doesn't require highly accurate localization of the PM. Conclusion: The proposed frame registration algorithm enabled a simple yet efficient integration of commercial US/PA imaging system into laparoscopic surgical setting by leveraging the characteristic properties of acoustic wave propagation and laser excitation, contributing to automated US/PA image-guided surgical intervention applications., Comment: 12 pages, 9 figures

3D ultrasound imaging provides more spatial information compared to conventional 2D frames by considering the volumes of data. One of the main bottlenecks of 3D imaging is the long data acquisition time which reduces practicality and can introduce artifacts from unwanted patient or sonographer motion. This paper introduces the first shear wave absolute vibro-elastography (S-WAVE) method with real-time volumetric acquisition using a matrix array transducer. In SWAVE, an external vibration source generates mechanical vibrations inside the tissue. The tissue motion is then estimated and used in solving a wave equation inverse problem to provide the tissue elasticity. A matrix array transducer is used with a Verasonics ultrasound machine and frame rate of 2000 volumes/s to acquire 100 radio frequency (RF) volumes in 0.05 s. Using plane wave (PW) and compounded diverging wave (CDW) imaging methods, we estimate axial, lateral and elevational displacements over 3D volumes. The curl of the displacements is used with local frequency estimation to estimate elasticity in the acquired volumes. Ultrafast acquisition extends substantially the possible S-WAVE excitation frequency range, now up to 800 Hz, enabling new tissue modeling and characterization. The method was validated on three homogeneous liver fibrosis phantoms and on four different inclusions within a heterogeneous phantom. The homogeneous phantom results show less than 8% (PW) and 5% (CDW) difference between the manufacturer values and the corresponding estimated values over a frequency range of 80 Hz to 800 Hz. The estimated elasticity values for the heterogeneous phantom at 400 Hz excitation frequency show average errors of 9% (PW) and 6% (CDW) compared to the provided average values by MRE. Furthermore, both imaging methods were able to detect the inclusions within the elasticity volumes.

Deformable tracking and real-time estimation of 3D tissue motion is essential to enable automation and image guidance applications in robotically assisted surgery. Our model, Sparse Efficient Neural Depth and Deformation (SENDD), extends prior 2D tracking work to estimate flow in 3D space. SENDD introduces novel contributions of learned detection, and sparse per-point depth and 3D flow estimation, all with less than half a million parameters. SENDD does this by using graph neural networks of sparse keypoint matches to estimate both depth and 3D flow anywhere. We quantify and benchmark SENDD on a comprehensively labelled tissue dataset, and compare it to an equivalent 2D flow model. SENDD performs comparably while enabling applications that 2D flow cannot. SENDD can track points and estimate depth at 10fps on an NVIDIA RTX 4000 for 1280 tracked (query) points and its cost scales linearly with an increasing/decreasing number of points. SENDD enables multiple downstream applications that require estimation of 3D motion in stereo endoscopy., Comment: 12 pages, 4 figures. Accepted by MICCAI 2023

A new development in photoacoustic (PA) imaging has been the use of compact, portable and low-cost laser diodes (LDs), but LD-based PA imaging suffers from low signal intensity recorded by the conventional transducers. A common method to improve signal strength is temporal averaging, which reduces frame rate and increases laser exposure to patients. To tackle this problem, we propose a deep learning method that will denoise the PA images before beamforming with a very few frames, even one. We also present a deep learning method to automatically reconstruct point sources from noisy pre-beamformed data. Finally, we employ a strategy of combined denoising and reconstruction, which can supplement the reconstruction algorithm for very low signal-to-noise ratio inputs.

Purpose: Trans-oral robotic surgery (TORS) using the da Vinci surgical robot is a new minimally-invasive surgery method to treat oropharyngeal tumors, but it is a challenging operation. Augmented reality (AR) based on intra-operative ultrasound (US) has the potential to enhance the visualization of the anatomy and cancerous tumors to provide additional tools for decision-making in surgery. Methods: We propose and carry out preliminary evaluations of a US-guided AR system for TORS, with the transducer placed on the neck for a transcervical view. Firstly, we perform a novel MRI-transcervical 3D US registration study. Secondly, we develop a US-robot calibration method with an optical tracker and an AR system to display the anatomy mesh model in the real-time endoscope images inside the surgeon console. Results: Our AR system reaches a mean projection error of 26.81 and 27.85 pixels for the projection from the US to stereo cameras in a water bath experiment. The average target registration error for MRI to 3D US is 8.90 mm for the 3D US transducer and 5.85 mm for freehand 3D US, and the average distance between the vessel centerlines is 2.32 mm. Conclusion: We demonstrate the first proof-of-concept transcervical US-guided AR system for TORS and the feasibility of trans-cervical 3D US-MRI registration. Our results show that trans-cervical 3D US is a promising technique for TORS image guidance., Comment: 12 pages, 8 figures. Accepted by Information Processing for Computer Assisted Interventions (IPCAI 2023)

This article describes a novel quasi-real time system for quantitative and volumetric measurement of tissue elasticity in the prostate. Tissue elasticity is computed by using a local frequency estimator to measure the three dimensional local wavelengths of a steady-state shear wave within the prostate gland. The shear wave is created using a mechanical voice coil shaker which transmits multi-frequency vibrations transperineally. Radio frequency data is streamed directly from a BK Medical 8848 trans-rectal ultrasound transducer to an external computer where tissue displacement due to the excitation is measured using a speckle tracking algorithm. Bandpass sampling is used that eliminates the need for an ultra fast frame rate to track the tissue motion and allows for accurate reconstruction at a sampling frequency that is below the Nyquist rate. A roll motor with computer control is used to rotate the sagittal array of the transducer and obtain the 3D data. Two CIRS phantoms were used to validate both the accuracy of the elasticity measurement as well as the functional feasibility of using the system for in vivo prostate imaging. The system has been used in two separate clinical studies as a method for cancer identification. The results, presented here, show numerical and visual correlations between our stiffness measurements and cancer likelihood as determined from pathology results. Initial published results using this system include an area under the receiver operating characteristic curve of 0.82+/-0.01 with regards to prostate cancer identification in the peripheral zone., Comment: 10 pages, 8 figures. IEEE Transactions on Medical Imaging (2023)

Shear wave absolute vibro-elastography (S-WAVE) is an imaging technique that generates steady-state shear waves inside the tissue using multi-frequency excitation from an external vibration source. In this work, plane wave imaging is introduced to reduce total acquisition time while retaining the benefit of 3D formulation. Plane wave imaging with a frame rate of 3000 frames/s is followed by 3D absolute elasticity estimation. We design two imaging sequences of ultrafast S-WAVE for two sets of excitation frequencies using a Verasonics system and a motorized swept ultrasound transducer to synchronize ultrasound acquisition with the external mechanical excitation. The overall data collection time is improved by 83-88% compared to the original 3D S-WAVE because of the per-channel acquisition offered by the Verasonics system. Tests are performed on liver fibrosis tissue-mimicking phantoms and on ex vivo bovine liver. The curl operator was previously used in magnetic resonance elastography (MRE) to cancel out the effect of the compressional waves. In this work, we apply the curl operator to the full 3D displacement field followed by 3D elasticity reconstruction. The results of phantom experiment show more accurate elasticity estimation as well as 18% less standard deviation (STD) compared to reconstruction using the curl of a 2D displacement field and 45% less STD than without the curl. We also compare our experimental results with a previous method based on acoustic radiation force impulse (ARFI) and achieve closer results to phantom manufacturer provided values with ultrafast S-WAVE. Furthermore, the dependency of the bovine liver elasticity on the frequency of excitation was also shown with our system.

Treatment planning in low-dose-rate prostate brachytherapy (LDR-PB) aims to produce arrangement of implantable radioactive seeds that deliver a minimum prescribed dose to the prostate whilst minimizing toxicity to healthy tissues. There can be multiple seed arrangements that satisfy this dosimetric criterion, not all deemed 'acceptable' for implant from a physician's perspective. This leads to plans that are subjective to the physician's/centre's preference, planning style, and expertise. We propose a method that aims to reduce this variability by training a model to learn from a large pool of successful retrospective LDR-PB data (961 patients) and create consistent plans that mimic the high-quality manual plans. Our model is based on conditional generative adversarial networks that use a novel loss function for penalizing the model on spatial constraints of the seeds. An optional optimizer based on a simulated annealing (SA) algorithm can be used to further fine-tune the plans if necessary (determined by the treating physician). Performance analysis was conducted on 150 test cases demonstrating comparable results to that of the manual prehistorical plans. On average, the clinical target volume covering 100% of the prescribed dose was 98.9% for our method compared to 99.4% for manual plans. Moreover, using our model, the planning time was significantly reduced to an average of 2.5 mins/plan with SA, and less than 3 seconds without SA. Compared to this, manual planning at our centre takes around 20 mins/plan., Comment: 10 pages, 2 figures, 2 tables

Surgical instrument segmentation for robot-assisted surgery is needed for accurate instrument tracking and augmented reality overlays. Therefore, the topic has been the subject of a number of recent papers in the CAI community. Deep learning-based methods have shown state-of-the-art performance for surgical instrument segmentation, but their results depend on labelled data. However, labelled surgical data is of limited availability and is a bottleneck in surgical translation of these methods. In this paper, we demonstrate the limited generalizability of these methods on different datasets, including human robot-assisted surgeries. We then propose a novel joint generation and segmentation strategy to learn a segmentation model with better generalization capability to domains that have no labelled data. The method leverages the availability of labelled data in a different domain. The generator does the domain translation from the labelled domain to the unlabelled domain and simultaneously, the segmentation model learns using the generated data while regularizing the generative model. We compared our method with state-of-the-art methods and showed its generalizability on publicly available datasets and on our own recorded video frames from robot-assisted prostatectomies. Our method shows consistently high mean Dice scores on both labelled and unlabelled domains when data is available only for one of the domains. *M. Kalia and T. Aleef contributed equally to the manuscript, Comment: 11 pages, 3 figures

We propose a new method for six-degree-of-freedom (6-DoF) autonomous camera movement for minimally invasive surgery, which, unlike previous methods, takes into account both the position and orientation information from structures in the surgical scene. In addition to locating the camera for a good view of the manipulated object, our autonomous camera takes into account workspace constraints, including the horizon and safety constraints. We developed a simulation environment to test our method on the "wire chaser" surgical training task from validated training curricula in conventional laparoscopy and robot-assisted surgery. Furthermore, we propose, for the first time, the application of the proposed autonomous camera method in video-based surgical skill assessment, an area where videos are typically recorded using fixed cameras. In a study with N=30 human subjects, we show that video examination of the autonomous camera view as it tracks the ring motion over the wire leads to more accurate user error (ring touching the wire) detection than when using a fixed camera view, or camera movement with a fixed orientation. Our preliminary work suggests that there are potential benefits to autonomous camera positioning informed by scene orientation, and this can direct designers of automated endoscopes and surgical robotic systems, especially when using chip-on-tip cameras that can be wristed for 6-DoF motion.

The Hausdorff Distance (HD) is widely used in evaluating medical image segmentation methods. However, existing segmentation methods do not attempt to reduce HD directly. In this paper, we present novel loss functions for training convolutional neural network (CNN)-based segmentation methods with the goal of reducing HD directly. We propose three methods to estimate HD from the segmentation probability map produced by a CNN. One method makes use of the distance transform of the segmentation boundary. Another method is based on applying morphological erosion on the difference between the true and estimated segmentation maps. The third method works by applying circular/spherical convolution kernels of different radii on the segmentation probability maps. Based on these three methods for estimating HD, we suggest three loss functions that can be used for training to reduce HD. We use these loss functions to train CNNs for segmentation of the prostate, liver, and pancreas in ultrasound, magnetic resonance, and computed tomography images and compare the results with commonly-used loss functions. Our results show that the proposed loss functions can lead to approximately 18-45 % reduction in HD without degrading other segmentation performance criteria such as the Dice similarity coefficient. The proposed loss functions can be used for training medical image segmentation methods in order to reduce the large segmentation errors.