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Mathias Unberath

Publications and source records attributed to Mathias Unberath.

At least 91 records · Page 5Linked to original sources

Twin-S: A Digital Twin for Skull-base Surgery

Purpose: Digital twins are virtual interactive models of the real world, exhibiting identical behavior and properties. In surgical applications, computational analysis from digital twins can be used, for example, to enhance situational awareness. Methods: We present a digital twin framework for skull-base surgeries, named Twin-S, which can be integrated within various image-guided interventions seamlessly. Twin-S combines high-precision optical tracking and real-time simulation. We rely on rigorous calibration routines to ensure that the digital twin representation precisely mimics all real-world processes. Twin-S models and tracks the critical components of skull-base surgery, including the surgical tool, patient anatomy, and surgical camera. Significantly, Twin-S updates and reflects real-world drilling of the anatomical model in frame rate. Results: We extensively evaluate the accuracy of Twin-S, which achieves an average 1.39 mm error during the drilling process. We further illustrate how segmentation masks derived from the continuously updated digital twin can augment the surgical microscope view in a mixed reality setting, where bone requiring ablation is highlighted to provide surgeons additional situational awareness. Conclusion: We present Twin-S, a digital twin environment for skull-base surgery. Twin-S tracks and updates the virtual model in real-time given measurements from modern tracking technologies. Future research on complementing optical tracking with higher-precision vision-based approaches may further increase the accuracy of Twin-S.

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Pelphix: Surgical Phase Recognition from X-ray Images in Percutaneous Pelvic Fixation

Surgical phase recognition (SPR) is a crucial element in the digital transformation of the modern operating theater. While SPR based on video sources is well-established, incorporation of interventional X-ray sequences has not yet been explored. This paper presents Pelphix, a first approach to SPR for X-ray-guided percutaneous pelvic fracture fixation, which models the procedure at four levels of granularity -- corridor, activity, view, and frame value -- simulating the pelvic fracture fixation workflow as a Markov process to provide fully annotated training data. Using added supervision from detection of bony corridors, tools, and anatomy, we learn image representations that are fed into a transformer model to regress surgical phases at the four granularity levels. Our approach demonstrates the feasibility of X-ray-based SPR, achieving an average accuracy of 93.8% on simulated sequences and 67.57% in cadaver across all granularity levels, with up to 88% accuracy for the target corridor in real data. This work constitutes the first step toward SPR for the X-ray domain, establishing an approach to categorizing phases in X-ray-guided surgery, simulating realistic image sequences to enable machine learning model development, and demonstrating that this approach is feasible for the analysis of real procedures. As X-ray-based SPR continues to mature, it will benefit procedures in orthopedic surgery, angiography, and interventional radiology by equipping intelligent surgical systems with situational awareness in the operating room.

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Data AUDIT: Identifying Attribute Utility- and Detectability-Induced Bias in Task Models

To safely deploy deep learning-based computer vision models for computer-aided detection and diagnosis, we must ensure that they are robust and reliable. Towards that goal, algorithmic auditing has received substantial attention. To guide their audit procedures, existing methods rely on heuristic approaches or high-level objectives (e.g., non-discrimination in regards to protected attributes, such as sex, gender, or race). However, algorithms may show bias with respect to various attributes beyond the more obvious ones, and integrity issues related to these more subtle attributes can have serious consequences. To enable the generation of actionable, data-driven hypotheses which identify specific dataset attributes likely to induce model bias, we contribute a first technique for the rigorous, quantitative screening of medical image datasets. Drawing from literature in the causal inference and information theory domains, our procedure decomposes the risks associated with dataset attributes in terms of their detectability and utility (defined as the amount of information knowing the attribute gives about a task label). To demonstrate the effectiveness and sensitivity of our method, we develop a variety of datasets with synthetically inserted artifacts with different degrees of association to the target label that allow evaluation of inherited model biases via comparison of performance against true counterfactual examples. Using these datasets and results from hundreds of trained models, we show our screening method reliably identifies nearly imperceptible bias-inducing artifacts. Lastly, we apply our method to the natural attributes of a popular skin-lesion dataset and demonstrate its success. Our approach provides a means to perform more systematic algorithmic audits and guide future data collection efforts in pursuit of safer and more reliable models.

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Task-based Generation of Optimized Projection Sets using Differentiable Ranking

We present a method for selecting valuable projections in computed tomography (CT) scans to enhance image reconstruction and diagnosis. The approach integrates two important factors, projection-based detectability and data completeness, into a single feed-forward neural network. The network evaluates the value of projections, processes them through a differentiable ranking function and makes the final selection using a straight-through estimator. Data completeness is ensured through the label provided during training. The approach eliminates the need for heuristically enforcing data completeness, which may exclude valuable projections. The method is evaluated on simulated data in a non-destructive testing scenario, where the aim is to maximize the reconstruction quality within a specified region of interest. We achieve comparable results to previous methods, laying the foundation for using reconstruction-based loss functions to learn the selection of projections.

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Temporally Consistent Online Depth Estimation in Dynamic Scenes

Temporally consistent depth estimation is crucial for online applications such as augmented reality. While stereo depth estimation has received substantial attention as a promising way to generate 3D information, there is relatively little work focused on maintaining temporal stability. Indeed, based on our analysis, current techniques still suffer from poor temporal consistency. Stabilizing depth temporally in dynamic scenes is challenging due to concurrent object and camera motion. In an online setting, this process is further aggravated because only past frames are available. We present a framework named Consistent Online Dynamic Depth (CODD) to produce temporally consistent depth estimates in dynamic scenes in an online setting. CODD augments per-frame stereo networks with novel motion and fusion networks. The motion network accounts for dynamics by predicting a per-pixel SE3 transformation and aligning the observations. The fusion network improves temporal depth consistency by aggregating the current and past estimates. We conduct extensive experiments and demonstrate quantitatively and qualitatively that CODD outperforms competing methods in terms of temporal consistency and performs on par in terms of per-frame accuracy.

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Rethinking Causality-driven Robot Tool Segmentation with Temporal Constraints

Purpose: Vision-based robot tool segmentation plays a fundamental role in surgical robots and downstream tasks. CaRTS, based on a complementary causal model, has shown promising performance in unseen counterfactual surgical environments in the presence of smoke, blood, etc. However, CaRTS requires over 30 iterations of optimization to converge for a single image due to limited observability. Method: To address the above limitations, we take temporal relation into consideration and propose a temporal causal model for robot tool segmentation on video sequences. We design an architecture named Temporally Constrained CaRTS (TC-CaRTS). TC-CaRTS has three novel modules to complement CaRTS - temporal optimization pipeline, kinematics correction network, and spatial-temporal regularization. Results: Experiment results show that TC-CaRTS requires much fewer iterations to achieve the same or better performance as CaRTS. TC- CaRTS also has the same or better performance in different domains compared to CaRTS. All three modules are proven to be effective. Conclusion: We propose TC-CaRTS, which takes advantage of temporal constraints as additional observability. We show that TC-CaRTS outperforms prior work in the robot tool segmentation task with improved convergence speed on test datasets from different domains.

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A Systematic Review of Robustness in Deep Learning for Computer Vision: Mind the gap?

Deep neural networks for computer vision are deployed in increasingly safety-critical and socially-impactful applications, motivating the need to close the gap in model performance under varied, naturally occurring imaging conditions. Robustness, ambiguously used in multiple contexts including adversarial machine learning, refers here to preserving model performance under naturally-induced image corruptions or alterations. We perform a systematic review to identify, analyze, and summarize current definitions and progress towards non-adversarial robustness in deep learning for computer vision. We find this area of research has received disproportionately less attention relative to adversarial machine learning, yet a significant robustness gap exists that manifests in performance degradation similar in magnitude to adversarial conditions. Toward developing a more transparent definition of robustness, we provide a conceptual framework based on a structural causal model of the data generating process and interpret non-adversarial robustness as pertaining to a model's behavior on corrupted images corresponding to low-probability samples from the unaltered data distribution. We identify key architecture-, data augmentation-, and optimization tactics for improving neural network robustness. This robustness perspective reveals that common practices in the literature correspond to causal concepts. We offer perspectives on how future research may mind this evident and significant non-adversarial robustness gap.

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Context-Enhanced Stereo Transformer

Stereo depth estimation is of great interest for computer vision research. However, existing methods struggles to generalize and predict reliably in hazardous regions, such as large uniform regions. To overcome these limitations, we propose Context Enhanced Path (CEP). CEP improves the generalization and robustness against common failure cases in existing solutions by capturing the long-range global information. We construct our stereo depth estimation model, Context Enhanced Stereo Transformer (CSTR), by plugging CEP into the state-of-the-art stereo depth estimation method Stereo Transformer. CSTR is examined on distinct public datasets, such as Scene Flow, Middlebury-2014, KITTI-2015, and MPI-Sintel. We find CSTR outperforms prior approaches by a large margin. For example, in the zero-shot synthetic-to-real setting, CSTR outperforms the best competing approaches on Middlebury-2014 dataset by 11%. Our extensive experiments demonstrate that the long-range information is critical for stereo matching task and CEP successfully captures such information.

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Explainable Medical Imaging AI Needs Human-Centered Design: Guidelines and Evidence from a Systematic Review

Transparency in Machine Learning (ML), attempts to reveal the working mechanisms of complex models. Transparent ML promises to advance human factors engineering goals of human-centered AI in the target users. From a human-centered design perspective, transparency is not a property of the ML model but an affordance, i.e. a relationship between algorithm and user; as a result, iterative prototyping and evaluation with users is critical to attaining adequate solutions that afford transparency. However, following human-centered design principles in healthcare and medical image analysis is challenging due to the limited availability of and access to end users. To investigate the state of transparent ML in medical image analysis, we conducted a systematic review of the literature. Our review reveals multiple severe shortcomings in the design and validation of transparent ML for medical image analysis applications. We find that most studies to date approach transparency as a property of the model itself, similar to task performance, without considering end users during neither development nor evaluation. Additionally, the lack of user research, and the sporadic validation of transparency claims put contemporary research on transparent ML for medical image analysis at risk of being incomprehensible to users, and thus, clinically irrelevant. To alleviate these shortcomings in forthcoming research while acknowledging the challenges of human-centered design in healthcare, we introduce the INTRPRT guideline, a systematic design directive for transparent ML systems in medical image analysis. The INTRPRT guideline suggests formative user research as the first step of transparent model design to understand user needs and domain requirements. Following this process produces evidence to support design choices, and ultimately, increases the likelihood that the algorithms afford transparency.

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CaRTS: Causality-driven Robot Tool Segmentation from Vision and Kinematics Data

Vision-based segmentation of the robotic tool during robot-assisted surgery enables downstream applications, such as augmented reality feedback, while allowing for inaccuracies in robot kinematics. With the introduction of deep learning, many methods were presented to solve instrument segmentation directly and solely from images. While these approaches made remarkable progress on benchmark datasets, fundamental challenges pertaining to their robustness remain. We present CaRTS, a causality-driven robot tool segmentation algorithm, that is designed based on a complementary causal model of the robot tool segmentation task. Rather than directly inferring segmentation masks from observed images, CaRTS iteratively aligns tool models with image observations by updating the initially incorrect robot kinematic parameters through forward kinematics and differentiable rendering to optimize image feature similarity end-to-end. We benchmark CaRTS with competing techniques on both synthetic as well as real data from the dVRK, generated in precisely controlled scenarios to allow for counterfactual synthesis. On training-domain test data, CaRTS achieves a Dice score of 93.4 that is preserved well (Dice score of 91.8) when tested on counterfactually altered test data, exhibiting low brightness, smoke, blood, and altered background patterns. This compares favorably to Dice scores of 95.0 and 86.7, respectively, of the SOTA image-based method. Future work will involve accelerating CaRTS to achieve video framerate and estimating the impact occlusion has in practice. Despite these limitations, our results are promising: In addition to achieving high segmentation accuracy, CaRTS provides estimates of the true robot kinematics, which may benefit applications such as force estimation. Code is available at: https://github.com/hding2455/CaRTS

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SyntheX: Scaling Up Learning-based X-ray Image Analysis Through In Silico Experiments

Artificial intelligence (AI) now enables automated interpretation of medical images for clinical use. However, AI's potential use for interventional images (versus those involved in triage or diagnosis), such as for guidance during surgery, remains largely untapped. This is because surgical AI systems are currently trained using post hoc analysis of data collected during live surgeries, which has fundamental and practical limitations, including ethical considerations, expense, scalability, data integrity, and a lack of ground truth. Here, we demonstrate that creating realistic simulated images from human models is a viable alternative and complement to large-scale in situ data collection. We show that training AI image analysis models on realistically synthesized data, combined with contemporary domain generalization or adaptation techniques, results in models that on real data perform comparably to models trained on a precisely matched real data training set. Because synthetic generation of training data from human-based models scales easily, we find that our model transfer paradigm for X-ray image analysis, which we refer to as SyntheX, can even outperform real data-trained models due to the effectiveness of training on a larger dataset. We demonstrate the potential of SyntheX on three clinical tasks: Hip image analysis, surgical robotic tool detection, and COVID-19 lung lesion segmentation. SyntheX provides an opportunity to drastically accelerate the conception, design, and evaluation of intelligent systems for X-ray-based medicine. In addition, simulated image environments provide the opportunity to test novel instrumentation, design complementary surgical approaches, and envision novel techniques that improve outcomes, save time, or mitigate human error, freed from the ethical and practical considerations of live human data collection.

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SAGE: SLAM with Appearance and Geometry Prior for Endoscopy

In endoscopy, many applications (e.g., surgical navigation) would benefit from a real-time method that can simultaneously track the endoscope and reconstruct the dense 3D geometry of the observed anatomy from a monocular endoscopic video. To this end, we develop a Simultaneous Localization and Mapping system by combining the learning-based appearance and optimizable geometry priors and factor graph optimization. The appearance and geometry priors are explicitly learned in an end-to-end differentiable training pipeline to master the task of pair-wise image alignment, one of the core components of the SLAM system. In our experiments, the proposed SLAM system is shown to robustly handle the challenges of texture scarceness and illumination variation that are commonly seen in endoscopy. The system generalizes well to unseen endoscopes and subjects and performs favorably compared with a state-of-the-art feature-based SLAM system. The code repository is available at https://github.com/lppllppl920/SAGE-SLAM.git.

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Mapping DNN Embedding Manifolds for Network Generalization Prediction

Understanding Deep Neural Network (DNN) performance in changing conditions is essential for deploying DNNs in safety critical applications with unconstrained environments, e.g., perception for self-driving vehicles or medical image analysis. Recently, the task of Network Generalization Prediction (NGP) has been proposed to predict how a DNN will generalize in a new operating domain. Previous NGP approaches have relied on labeled metadata and known distributions for the new operating domains. In this study, we propose the first NGP approach that predicts DNN performance based solely on how unlabeled images from an external operating domain map in the DNN embedding space. We demonstrate this technique for pedestrian, melanoma, and animal classification tasks and show state of the art NGP in 13 of 15 NGP tasks without requiring domain knowledge. Additionally, we show that our NGP embedding maps can be used to identify misclassified images when the DNN performance is poor.

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Virtual Reality for Synergistic Surgical Training and Data Generation

Surgical simulators not only allow planning and training of complex procedures, but also offer the ability to generate structured data for algorithm development, which may be applied in image-guided computer assisted interventions. While there have been efforts on either developing training platforms for surgeons or data generation engines, these two features, to our knowledge, have not been offered together. We present our developments of a cost-effective and synergistic framework, named Asynchronous Multibody Framework Plus (AMBF+), which generates data for downstream algorithm development simultaneously with users practicing their surgical skills. AMBF+ offers stereoscopic display on a virtual reality (VR) device and haptic feedback for immersive surgical simulation. It can also generate diverse data such as object poses and segmentation maps. AMBF+ is designed with a flexible plugin setup which allows for unobtrusive extension for simulation of different surgical procedures. We show one use case of AMBF+ as a virtual drilling simulator for lateral skull-base surgery, where users can actively modify the patient anatomy using a virtual surgical drill. We further demonstrate how the data generated can be used for validating and training downstream computer vision algorithms

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Pediatric Otoscopy Video Screening with Shift Contrastive Anomaly Detection

Ear related concerns and symptoms represents the leading indication for seeking pediatric healthcare attention. Despite the high incidence of such encounters, the diagnostic process of commonly encountered disease of the middle and external presents significant challenge. Much of this challenge stems from the lack of cost effective diagnostic testing, which necessitating the presence or absence of ear pathology to be determined clinically. Research has however demonstrated considerable variation among clinicians in their ability to accurately diagnose and consequently manage ear pathology. With recent advances in computer vision and machine learning, there is an increasing interest in helping clinicians to accurately diagnose middle and external ear pathology with computer-aided systems. It has been shown that AI has the capacity to analyse a single clinical image captured during examination of the ear canal and eardrum from which it can determine the likelihood of a pathognomonic pattern for a specific diagnosis being present. The capture of such an image can however be challenging especially to inexperienced clinicians. To help mitigate this technical challenge we have developed and tested a method using video sequences. We present a two stage method that first, identifies valid frames by detecting and extracting ear drum patches from the video sequence, and second, performs the proposed shift contrastive anomaly detection to flag the otoscopy video sequences as normal or abnormal. Our method achieves an AUROC of 88.0% on the patient-level and also outperforms the average of a group of 25 clinicians in a comparative study, which is the largest of such published to date. We conclude that the presented method achieves a promising first step towards automated analysis of otoscopy video.

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On the Sins of Image Synthesis Loss for Self-supervised Depth Estimation

Scene depth estimation from stereo and monocular imagery is critical for extracting 3D information for downstream tasks such as scene understanding. Recently, learning-based methods for depth estimation have received much attention due to their high performance and flexibility in hardware choice. However, collecting ground truth data for supervised training of these algorithms is costly or outright impossible. This circumstance suggests a need for alternative learning approaches that do not require corresponding depth measurements. Indeed, self-supervised learning of depth estimation provides an increasingly popular alternative. It is based on the idea that observed frames can be synthesized from neighboring frames if accurate depth of the scene is known - or in this case, estimated. We show empirically that - contrary to common belief - improvements in image synthesis do not necessitate improvement in depth estimation. Rather, optimizing for image synthesis can result in diverging performance with respect to the main prediction objective - depth. We attribute this diverging phenomenon to aleatoric uncertainties, which originate from data. Based on our experiments on four datasets (spanning street, indoor, and medical) and five architectures (monocular and stereo), we conclude that this diverging phenomenon is independent of the dataset domain and not mitigated by commonly used regularization techniques. To underscore the importance of this finding, we include a survey of methods which use image synthesis, totaling 127 papers over the last six years. This observed divergence has not been previously reported or studied in depth, suggesting room for future improvement of self-supervised approaches which might be impacted the finding.

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Revisiting Stereo Depth Estimation From a Sequence-to-Sequence Perspective with Transformers

Stereo depth estimation relies on optimal correspondence matching between pixels on epipolar lines in the left and right images to infer depth. In this work, we revisit the problem from a sequence-to-sequence correspondence perspective to replace cost volume construction with dense pixel matching using position information and attention. This approach, named STereo TRansformer (STTR), has several advantages: It 1) relaxes the limitation of a fixed disparity range, 2) identifies occluded regions and provides confidence estimates, and 3) imposes uniqueness constraints during the matching process. We report promising results on both synthetic and real-world datasets and demonstrate that STTR generalizes across different domains, even without fine-tuning.

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An Interpretable Algorithm for Uveal Melanoma Subtyping from Whole Slide Cytology Images

Algorithmic decision support is rapidly becoming a staple of personalized medicine, especially for high-stakes recommendations in which access to certain information can drastically alter the course of treatment, and thus, patient outcome; a prominent example is radiomics for cancer subtyping. Because in these scenarios the stakes are high, it is desirable for decision systems to not only provide recommendations but supply transparent reasoning in support thereof. For learning-based systems, this can be achieved through an interpretable design of the inference pipeline. Herein we describe an automated yet interpretable system for uveal melanoma subtyping with digital cytology images from fine needle aspiration biopsies. Our method embeds every automatically segmented cell of a candidate cytology image as a point in a 2D manifold defined by many representative slides, which enables reasoning about the cell-level composition of the tissue sample, paving the way for interpretable subtyping of the biopsy. Finally, a rule-based slide-level classification algorithm is trained on the partitions of the circularly distorted 2D manifold. This process results in a simple rule set that is evaluated automatically but highly transparent for human verification. On our in house cytology dataset of 88 uveal melanoma patients, the proposed method achieves an accuracy of 87.5% that compares favorably to all competing approaches, including deep "black box" models. The method comes with a user interface to facilitate interaction with cell-level content, which may offer additional insights for pathological assessment.

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