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Autonomous Ultrasound Image Quality Assessment (US-IQA) is a promising tool to aid the interpretation by practicing sonographers and to enable the future robotization of ultrasound procedures. However, autonomous US-IQA has several challenges. Ultrasound images contain many spurious artifacts, such as noise due to handheld probe positioning, errors in the selection of probe parameters and patient respiration during the procedure. Further, these images are highly variable in appearance with respect to the individual patient's physiology. We propose to use a deep Convolutional Neural Network (CNN), USQNet, which utilizes a Multi-scale and Local-to-Global Second-order Pooling (MS-L2GSoP) classifier to conduct the sonographer-like assessment of image quality. This classifier first extracts features at multiple scales to encode the inter-patient anatomical variations, similar to a sonographer's understanding of anatomy. Then, it uses second-order pooling in the intermediate layers (local) and at the end of the network (global) to exploit the second-order statistical dependency of multi-scale structural and multi-region textural features. The L2GSoP will capture the higher-order relationships between different spatial locations and provide the seed for correlating local patches, much like a sonographer prioritizes regions across the image. We experimentally validated the USQNet for a new dataset of the human urinary bladder ultrasound images. The validation involved first with the subjective assessment by experienced radiologists' annotation, and then with state-of-the-art CNN networks for US-IQA and its ablated counterparts. The results demonstrate that USQNet achieves a remarkable accuracy of 92.4% and outperforms the SOTA models by 3 - 14% while requiring comparable computation time.

Introduction: Short response time is critical for future military medical operations in austere settings or remote areas. Such effective patient care at the point of injury can greatly benefit from the integration of semi-autonomous robotic systems. To achieve autonomy, robots would require massive libraries of maneuvers collected with the goal of training machine learning algorithms. Although this is attainable in controlled settings, obtaining surgical data in austere settings can be difficult. Hence, in this article, we present the Dexterous Surgical Skill (DESK) database for knowledge transfer between robots. The peg transfer task was selected as it is one of the six main tasks of laparoscopic training. In addition, we provide a machine learning framework to evaluate novel transfer learning methodologies on this database., Methods: A set of surgical gestures was collected for a peg transfer task, composed of seven atomic maneuvers referred to as surgemes. The collected Dexterous Surgical Skill dataset comprises a set of surgical robotic skills using the four robotic platforms: Taurus II, simulated Taurus II, YuMi, and the da Vinci Research Kit. Then, we explored two different learning scenarios: no-transfer and domain-transfer. In the no-transfer scenario, the training and testing data were obtained from the same domain; whereas in the domain-transfer scenario, the training data are a blend of simulated and real robot data, which are tested on a real robot., Results: Using simulation data to train the learning algorithms enhances the performance on the real robot where limited or no real data are available. The transfer model showed an accuracy of 81% for the YuMi robot when the ratio of real-tosimulated data were 22% to 78%. For the Taurus II and the da Vinci, the model showed an accuracy of 97.5% and 93%, respectively, training only with simulation data., Conclusions: The results indicate that simulation can be used to augment training data to enhance the performance of learned models in real scenarios. This shows potential for the future use of surgical data from the operating room in deployable surgical robots in remote areas., (© The Association of Military Surgeons of the United States 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Electroencephalography (EEG) activity in the mu frequency band (8-13 Hz) is suppressed during both gesture performance and observation. However, it is not clear if or how particular characteristics within the kinematic execution of gestures map onto dynamic changes in mu activity. Mapping the time course of gesture kinematics onto that of mu activity could help understand which aspects of gestures capture attention and aid in the classification of communicative intent. In this work, we test whether the timing of inflection points within gesture kinematics predicts the occurrence of oscillatory mu activity during passive gesture observation. The timing for salient features of performed gestures in video stimuli was determined by isolating inflection points in the hands' motion trajectories. Participants passively viewed the gesture videos while continuous EEG data was collected. We used wavelet analysis to extract mu oscillations at 11 Hz and at central electrodes and occipital electrodes. We used linear regression to test for associations between the timing of inflection points in motion trajectories and mu oscillations that generalized across gesture stimuli. Separately, we also tested whether inflection point occurrences evoked mu/alpha responses that generalized across participants. Across all gestures and inflection points, and pooled across participants, peaks in 11 Hz EEG waveforms were detected 465 and 535 ms after inflection points at occipital and central electrodes, respectively. A regression model showed that inflection points in the motion trajectories strongly predicted subsequent mu oscillations ([Formula: see text]<0.01); effects were weaker and non-significant for low (17 Hz) and high (21 Hz) beta activity. When segmented by inflection point occurrence rather than stimulus onset and testing participants as a random effect, inflection points evoked mu and beta activity from 308 to 364 ms at central electrodes, and broad activity from 226 to 800 ms at occipital electrodes. The results suggest that inflection points in gesture trajectories elicit coordinated activity in the visual and motor cortices, with prominent activity in the mu/alpha frequency band and extending into the beta frequency band. The time course of activity indicates that visual processing drives subsequent activity in the motor cortex during gesture processing, with a lag of approximately 80 ms.

The present management of retained biliary calculi utilizing irrigation with heparin and other agents through the T tube has proved disappointing. The use of basket catheters under fluoroscopy is more successful but has limited usefulness in extraction of impacted and certain other stones. The preliminary use of postoperative choledochoscopy utilizing a choledochofiberscope passed through the T-tube tract has been consistently effective in 17 patients for evaluation of filling defects on the postoperative cholangiogram and for the removal of difficult or multiple retained stones. Introduction of the endoscope may require dilation of the T-tube tract. This is accomplished with ease. Use of the recently available T tube with a larger external limb will improve postoperative access to the common bile duct for direct visual examination and removal of stones.