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3D reconstruction in endoscopic sinus surgery (ESS) demands exceptional accuracy, with the mean error and standard deviation necessitating within the range of a single CT slice (0.625 mm), as the critical structures in the nasal cavity are situated within submillimeter distances from surgical instruments. This poses a formidable challenge when using conventional monocular endoscopes. Depth estimation is crucial for 3D reconstruction, yet existing depth estimation methodologies either suffer from inherent accuracy limitations or, in the case of learning-based approaches, perform poorly when applied to ESS despite succeeding on their original datasets. In this study, we present a novel, highly generalizable method that combines Neural Radiance Fields (NeRF) and stereo depth estimation for 3D reconstruction that can derive metric monocular depth. Our approach begins with an initial NeRF reconstruction yielding a coarse 3D scene, the subsequent creation of binocular pairs within coarse 3D scene, and generation of depth maps through stereo vision, These depth maps are used to supervise subsequent NeRF iteration, progressively refining NeRF and binocular depth, the refinement process continues until the depth maps converged. This recursive process generates high-accuracy depth maps from monocular endoscopic video. Evaluation in synthetic endoscopy shows a depth accuracy of 0.125 $\pm$ 0.443 mm, well within the 0.625 mm threshold. Further clinical experiments with real endoscopic data demonstrate a mean distance to CT mesh of 0.269 mm, representing the highest accuracy among monocular 3D reconstruction methods in ESS.

We present the first wireless earbud hardware that can perform hearing screening by detecting otoacoustic emissions. The conventional wisdom has been that detecting otoacoustic emissions, which are the faint sounds generated by the cochlea, requires sensitive and expensive acoustic hardware. Thus, medical devices for hearing screening cost thousands of dollars and are inaccessible in low and middle income countries. We show that by designing wireless earbuds using low-cost acoustic hardware and combining them with wireless sensing algorithms, we can reliably identify otoacoustic emissions and perform hearing screening. Our algorithms combine frequency modulated chirps with wideband pulses emitted from a low-cost speaker to reliably separate otoacoustic emissions from in-ear reflections and echoes. We conducted a clinical study with 50 ears across two healthcare sites. Our study shows that the low-cost earbuds detect hearing loss with 100% sensitivity and 89.7% specificity, which is comparable to the performance of a $8000 medical device. By developing low-cost and open-source wearable technology, our work may help address global health inequities in hearing screening by democratizing these medical devices.

Abstract. Purpose: This paper presents a scheme for generating virtual intraoperative CT scans in order to improve surgical completeness in Endoscopic Sinus Surgeries (ESS). Approach: The work presents three methods, the tip motion-based, the tip trajectory-based, and the instrument based, along with non-parametric smoothing and Gaussian Process Regression, for virtual intraoperative CT generation. Results: The proposed methods studied and compared on ESS performed on cadavers. Surgical results show all three methods improve the Dice Similarity Coefficients > 86%, with F-score > 92% and precision > 89.91%. The tip trajectory-based method was found to have best performance and reached 96.87% precision in surgical completeness evaluation. Conclusions: This work demonstrated that virtual intraoperative CT scans improves the consistency between the actual surgical scene and the reference model, and improves surgical completeness in ESS. Comparing with actual intraoperative CT scans, the proposed scheme has no impact on existing surgical protocols, does not require extra hardware other than the one is already available in most ESS overcome the high costs, the repeated radiation, and the elongated anesthesia caused by actual intraoperative CTs, and is practical in ESS.

Endoscopic Sinus and Skull Base Surgeries (ESSBSs) is a challenging and potentially dangerous surgical procedure, and objective skill assessment is the key components to improve the effectiveness of surgical training, to re-validate surgeons' skills, and to decrease surgical trauma and the complication rate in operating rooms. Because of the complexity of surgical procedures, the variation of operation styles, and the fast development of new surgical skills, the surgical skill assessment remains a challenging problem. This work presents a novel Gaussian Process Learning-based heuristic automatic objective surgical skill assessment method for ESSBSs. Different with classical surgical skill assessment algorithms, the proposed method 1) utilizes the kinematic features in surgical instrument relative movements, instead of using specific surgical tasks or the statistics to assess skills in real-time; 2) provide informative feedback, instead of a summative scores; 3) has the ability to incrementally learn from new data, instead of depending on a fixed dataset. The proposed method projects the instrument movements into the endoscope coordinate to reduce the data dimensionality. It then extracts the kinematic features of the projected data and learns the relationship between surgical skill levels and the features with the Gaussian Process learning technique. The proposed method was verified in full endoscopic skull base and sinus surgeries on cadavers. These surgeries have different pathology, requires different treatment and has different complexities. The experimental results show that the proposed method reaches 100\% prediction precision for complete surgical procedures and 90\% precision for real-time prediction assessment.

Deep learning-based methods have achieved promising results on surgical instrument segmentation. However, the high computation cost may limit the application of deep models to time-sensitive tasks such as online surgical video analysis for robotic-assisted surgery. Moreover, current methods may still suffer from challenging conditions in surgical images such as various lighting conditions and the presence of blood. We propose a novel Multi-frame Feature Aggregation (MFFA) module to aggregate video frame features temporally and spatially in a recurrent mode. By distributing the computation load of deep feature extraction over sequential frames, we can use a lightweight encoder to reduce the computation costs at each time step. Moreover, public surgical videos usually are not labeled frame by frame, so we develop a method that can randomly synthesize a surgical frame sequence from a single labeled frame to assist network training. We demonstrate that our approach achieves superior performance to corresponding deeper segmentation models on two public surgery datasets., Comment: Published in IEEE Robotics and Automation Letters (Early Access)

Intelligent vision is appealing in computer-assisted and robotic surgeries. Vision-based analysis with deep learning usually requires large labeled datasets, but manual data labeling is expensive and time-consuming in medical problems. We investigate a novel cross-domain strategy to reduce the need for manual data labeling by proposing an image-to-image translation model live-cadaver GAN (LC-GAN) based on generative adversarial networks (GANs). We consider a situation when a labeled cadaveric surgery dataset is available while the task is instrument segmentation on an unlabeled live surgery dataset. We train LC-GAN to learn the mappings between the cadaveric and live images. For live image segmentation, we first translate the live images to fake-cadaveric images with LC-GAN and then perform segmentation on the fake-cadaveric images with models trained on the real cadaveric dataset. The proposed method fully makes use of the labeled cadaveric dataset for live image segmentation without the need to label the live dataset. LC-GAN has two generators with different architectures that leverage the deep feature representation learned from the cadaveric image based segmentation task. Moreover, we propose the structural similarity loss and segmentation consistency loss to improve the semantic consistency during translation. Our model achieves better image-to-image translation and leads to improved segmentation performance in the proposed cross-domain segmentation task., Comment: Accepted by 2020 IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS)

Accurate and real-time surgical instrument segmentation is important in the endoscopic vision of robot-assisted surgery, and significant challenges are posed by frequent instrument-tissue contacts and continuous change of observation perspective. For these challenging tasks more and more deep neural networks (DNN) models are designed in recent years. We are motivated to propose a general embeddable approach to improve these current DNN segmentation models without increasing the model parameter number. Firstly, observing the limited rotation-invariance performance of DNN, we proposed the Multi-Angle Feature Aggregation (MAFA) method, leveraging active image rotation to gain richer visual cues and make the prediction more robust to instrument orientation changes. Secondly, in the end-to-end training stage, the auxiliary contour supervision is utilized to guide the model to learn the boundary awareness, so that the contour shape of segmentation mask is more precise. The proposed method is validated with ablation experiments on the novel Sinus-Surgery datasets collected from surgeons' operations, and is compared to the existing methods on a public dataset collected with a da Vinci Xi Robot., Comment: Accepted by IEEE Robotics and Automation Letters

Vascular anomalies, more colloquially known as birthmarks, affect up to 1 in 10 infants. Though many of these lesions self-resolve, some types can result in medical complications or disfigurement without proper diagnosis or management. Accurately diagnosing vascular anomalies is challenging for pediatricians and primary care physicians due to subtle visual differences and similarity to other pediatric dermatologic conditions. This can result in delayed or incorrect referrals for treatment. To address this problem, we developed a convolutional neural network (CNN) to automatically classify images of vascular anomalies and other pediatric skin conditions to aid physicians with diagnosis. We constructed a dataset of 21,681 clinical images, including data collected between 2002-2018 at Seattle Children's hospital as well as five dermatologist-curated online repositories, and built a taxonomy over vascular anomalies and other common pediatric skin lesions. The CNN achieved an average AUC of 0.9731 when ten-fold cross-validation was performed across a taxonomy of 12 classes. The classifier's average AUC and weighted F1 score was 0.9889 and 0.9732 respectively when evaluated on a previously unseen test set of six of these classes. Further, when used as an aid by pediatricians (n = 7), the classifier increased their average visual diagnostic accuracy from 73.10% to 91.67%. The classifier runs in real-time on a smartphone and has the potential to improve diagnosis of these conditions, particularly in resource-limited areas.

Objective: Effective collaboration between machines and clinicians requires flexible data structures to represent medical processes and clinical practice guidelines. Such a data structure could enable effective turn-taking between human and automated components of a complex treatment, accurate on-line monitoring of clinical treatments (for example to detect medical errors), or automated treatment systems (such as future medical robots) whose overall treatment plan is understandable and auditable by human experts. Materials and Methods: Behavior trees (BTs) emerged from video game development as a graphical language for modeling intelligent agent behavior. BTs have several properties which are attractive for modeling medical procedures including human-readability, authoring tools, and composability. Results: This paper will illustrate construction of BTs for exemplary medical procedures and clinical protocols. Discussion and Conclusion: Behavior Trees thus form a useful, and human authorable/readable bridge between clinical practice guidelines and AI systems., Comment: We are pleased to acknowledge support from National Science Foundation grant #IIS-1637444. arXiv admin note: text overlap with arXiv:1801.07864