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Purpose
Supporting the surgeon during surgery is one of the main goals of intelligent ORs. The OR-Pad project aims to optimize the information flow within the perioperative area. A shared information space should enable appropriate preparation and provision of relevant information at any time before, during, and after surgery.
Methods
Based on previous work on an interaction concept and system architecture for the sterile OR-Pad system, we designed a user interface for mobile and intraoperative (stationary) use, focusing on the most important functionalities like clear information provision to reduce information overload. The concepts were transferred into a high-fidelity prototype for demonstration purposes. The prototype was evaluated from different perspectives, including a usability study.
Results
The prototype’s central element is a timeline displaying all available case information chronologically, like radiological images, labor findings, or notes. This information space can be adapted for individual purposes (e.g., highlighting a tumor, filtering for own material). With the mobile and intraoperative mode of the system, relevant information can be added, preselected, viewed, and extended during the perioperative process. Overall, the evaluation showed good results and confirmed the vision of the information system.
Conclusion
The high-fidelity prototype of the information system OR-Pad focuses on supporting the surgeon via a timeline making all available case information accessible before, during, and after surgery. The information space can be personalized to enable targeted support. Further development is reasonable to optimize the approach and address missing or insufficient aspects, like the holding arm and sterility concept or new desired features.
Physicians in interventional radiology are exposed to high physical stress. To avoid negative long-term effects resulting from unergonomic working conditions, we demonstrated the feasibility of a system that gives feedback about unergonomic
situations arising during the intervention based on the Azure Kinect camera. The overall feasibility of the approach could be shown.
Intraoperative imaging can assist neurosurgeons to define brain tumours and other surrounding brain structures. Interventional ultrasound (iUS) is a convenient modality with fast scan times. However, iUS data may suffer from noise and artefacts which limit their interpretation during brain surgery. In this work, we use two deep learning networks, namely UNet and TransUNet, to make automatic and accurate segmentation of the brain tumour in iUS data. Experiments were conducted on a dataset of 27 iUS volumes. The outcomes show that using a transformer with UNet is advantageous providing an efficient segmentation modelling long-range dependencies between each iUS image. In particular, the enhanced TransUNet was able to predict cavity segmentation in iUS data with an inference rate of more than 125 FPS. These promising results suggest that deep learning networks can be successfully deployed to assist neurosurgeons in the operating room.
Glioblastomas are the most aggressive fast-growing primary brain cancer which originate in the glial cells of the brain. Accurate identification of the malignant brain tumor and its sub-regions is still one of the most challenging problems in medical image segmentation. The Brain Tumor Segmentation Challenge (BraTS) has been a popular benchmark for automatic brain glioblastomas segmentation algorithms since its initiation. In this year, BraTS 2021 challenge provides the largest multi-parametric (mpMRI) dataset of 2,000 pre-operative patients. In this paper, we propose a new aggregation of two deep learning frameworksnamely, DeepSeg and nnU-Net for automatic glioblastoma recognition in pre-operative mpMRI. Our ensemble method obtains Dice similarity scores of 92.00, 87.33, and 84.10 and Hausdorff Distances of 3.81, 8.91, and 16.02 for the enhancing tumor, tumor core, and whole tumor regions, respectively, on the BraTS 2021 validation set, ranking us among the top ten teams. These experimental findings provide evidence that it can be readily applied clinically and thereby aiding in the brain cancer prognosis, therapy planning, and therapy response monitoring. A docker image for reproducing our segmentation results is available online at (https://hub.docker.com/r/razeineldin/deepseg21).
Hintergrund: Endoskopische Operationsverfahren haben sich als Goldstandard in der Nasennebenhöhlen-(NNH-)Chirurgie etabliert. Den sich daraus ergebenden Herausforderungen für die chirurgische Ausbildung kann durch den Einsatz von Virtuelle-Realität-(VR-)Trainingssimulatoren begegnet werden. Bislang wurde eine Reihe von Simulatoren für NNH-Operationen entwickelt. Frühere Studien im Hinblick auf den Trainingseffekt wurden jedoch nur mit medizinisch vorgebildeten Probanden durchgeführt oder es wurde nicht über dessen zeitlichen Verlauf berichtet.
Methoden: Ein NNH-CT-Datensatz wurde nach der Segmentierung in ein 3-dimensionales, polygonales Oberflächenmodell überführt und mithilfe von originalem Fotomaterial texturiert. Die Interaktion mit der virtuellen Umgebung erfolgte über ein haptisches Eingabegerät. Während der Simulation wurden die Parameter Eingriffsdauer und Fehleranzahl erfasst. Zehn Probanden absolvierten jeweils eine Trainingseinheit bestehend aus je 5 Übungsdurchläufen an 10 aufeinanderfolgenden Tagen.
Ergebnisse: Vier Probanden verringerten die benötigte Zeit um mehr als 60% im Verlauf des Übungszeitraums. Vier der Probanden verringerten ihre Fehleranzahl um mehr als 60%. Acht von 10 Probanden zeigten eine Verbesserung bezüglich beider Parameter. Im Median wurde im gesamten gemessenen Zeitraum die Dauer des Eingriffs um 46 Sekunden und die Fehleranzahl um 191 reduziert. Die Überprüfung eines Zusammenhangs zwischen den 2 Parametern ergab eine positive Korrelation.
Schlussfolgerung: Zusammenfassend lässt sich feststellen, dass das Training am NNH-Simulator auch bei unerfahrenen Personen die Performance beträchtlich verbessert, sowohl in Bezug auf die Dauer als auch auf die Genauigkeit des Eingriffs.
Purpose
Artificial intelligence (AI), in particular deep neural networks, has achieved remarkable results for medical image analysis in several applications. Yet the lack of explainability of deep neural models is considered the principal restriction before applying these methods in clinical practice.
Methods
In this study, we propose a NeuroXAI framework for explainable AI of deep learning networks to increase the trust of medical experts. NeuroXAI implements seven state-of-the-art explanation methods providing visualization maps to help make deep learning models transparent.
Results
NeuroXAI has been applied to two applications of the most widely investigated problems in brain imaging analysis, i.e., image classification and segmentation using magnetic resonance (MR) modality. Visual attention maps of multiple XAI methods have been generated and compared for both applications. Another experiment demonstrated that NeuroXAI can provide information flow visualization on internal layers of a segmentation CNN.
Conclusion
Due to its open architecture, ease of implementation, and scalability to new XAI methods, NeuroXAI could be utilized to assist radiologists and medical professionals in the detection and diagnosis of brain tumors in the clinical routine of cancer patients. The code of NeuroXAI is publicly accessible at https://github.com/razeineldin/NeuroXAI.
Purpose
Artificial intelligence (AI), in particular deep learning (DL), has achieved remarkable results for medical image analysis in several applications. Yet the lack of human-like explanations of such systems is considered the principal restriction before utilizing these methods in clinical practice (Yang, Ye, & Xia, 2022).
Methods
Explainable Artificial Intelligence (XAI) provides a human-explainable and interpretable description of the “black-box” nature of DL (Gulum, Trombley, & Kantardzic, 2021). An effective XAI diagnosis generator, namely NeuroXAI (refer to Fig. 1), has been developed to extract 3D explanations from convolutional neural networks (CNN) models of brain gliomas (Zeineldin et al., 2022). By providing visual justification maps, NeuroXAI can help make DL models transparent and thus increase the trust of medical experts.
Results
NeuroXAI has been applied to two applications of the most widely investigated problems in brain imaging analysis, i.e. image classification and segmentation using magnetic resonance imaging (MRI). Visual attention maps of multiple XAI methods have been generated and compared for both applications, which could help to provide transparency about the performance of DL systems.
Conclusion
NeuroXAI helps to understand the prediction process of 3D CNN networks for brain glioma using human-understandable explanations. Results revealed that the investigated DL models behave in a logical human-like manner and can improve the analytical process of the MRI images systematically. Due to its open architecture, ease of implementation, and scalability to new XAI methods, NeuroXAI could be utilized to assist medical professionals in the detection and diagnosis of brain tumors. NeuroXAI code is publicly accessible at https://github.com/razeineldin/NeuroXAI
The paper describes how eye-tracking can be used to explore electronic patient records (EPR) in a sterile environment. As an information display, we used a system that we developed for the presentation of patient data and for supporting surgical hand disinfection. The eye-tracking was performed using the Tobii Eye Tracker 4C, and the connection between the eye-tracker and the HTML website was realized using the Tobii EyeX Chrome Extension. Interactions with the EPR are triggered by fixations of icons. The interaction was working as intended, but test persons reported a high mental load while using the system.
What might the attendee be able to do after being in your session?
Our work shows how to connect intra-operative devices via IEEE 11073 Service-oriented Device Connectivity (SDC).
Description of the Problem or Gap
Standardized device communication is essential for interoperability, availability of device data, and therefore for the intelligent operating room (OR) and arising solutions. The SDC standard was developed to make information from medical devices available in a uniform manner and enable interoperability. Existing devices are rarely SDC-capable and need interfaces to be interoperable via SDC.
Methods: What did you do to address the problem or gap?
We conceived an SDC-based architecture consisting of a service provider and service consumer. In our concept, the service provider is connected to the medical device and capable to translate the proprietary protocol of the device into SDC and vice versa. The service consumer is used to request or send information via the SDC protocol to the service provider and can function as a uniform bidirectional interface (e.g. for displaying or controlling). This concept was exemplarily demonstrated with the patient monitor MX800 of Philips to retrieve the device data (e.g. vital parameters) via SDC and partly for the operating light marLED X of KLS Martin Group.
Results: What was the outcome(s) of what you did to address the problem or gap?
The patient monitor MX800 was connected to a Raspberry Pi (RPi) via LAN, on which the service provider is running. The python script on the RPi establishes a connection to the monitor and translates incoming and outgoing messages from the proprietary protocol to SDC and vice versa to/from the service consumer. The service consumer is running on a laptop and acts as a simulation for different kinds of systems that want to get vital parameters or other information from the patient monitor. The operating light marLED X was connected to an RPi via USB-to-RS232. A python script on the RPi establishes a connection to the light and makes it possible via proprietary commands to get information of the light (e.g. status) and to control it (e.g. toggle the light, increment the intensity). A translation to SDC is not integrated yet.
Discussion of Results
Our practical implementation shows that medical devices can be accessed via external connections to get device data and control the device via commands. The example SDC implementation of the patient monitor MX800 makes it possible to request its data via the standardized communication protocol SDC. This is also possible for the operating light marLED X if its proprietary protocol is analyzed to be translatable to/from SDC. This would allow to control the device from an external system, or automatically depending on the status of the ongoing procedure. The advantage is, that existing intra-operative devices can be extended by a service provider which is capable of translating the proprietary protocol of the device in SDC and vice versa. This enables interoperability and an intelligent OR that, for example, is aware of all devices, their status, and data and can use this information to optimally support the surgeons and their team (e.g. provision of information, automated documentation). This interoperability allows that future innovations merely need to understand the SDC protocol instead of all vendor-dependent communication protocols.
Conclusion
Standardized device communication is essential to reach interoperability, and therefore intelligent ORs. Our contribution addresses the possibility of subsequently making medical devices SDC-capable. This may eliminate the need of understanding all the different proprietary protocols when developing new innovative solutions for the OR.
Motivation: Aim of this project is the automatic classification of total hip endoprosthesis (THEP) components in 2D Xray images. Revision surgeries of total hip arthroplasty (THA) are common procedures in orthopedics and trauma surgery. Currently, around 400.000 procedures per year are performed in the United States (US) alone. To achieve the best possible result, preoperative planning is crucial. Especially if parts of the current THEP system are to be retained.
Methods: First, a ground truth based on 76 X-ray images was created: We used an image processing pipeline consisting of a segmentation step performed by a convolutional neural network and a classification step performed by a support vector machine (SVM). In total, 11 classes (5 pans and 6 shafts) shall be classified.
Results: The ground truth generated was of good quality even though the initial segmentation was performed by technicians. The best segmentation results were achieved using a U-net architecture. For classification, SVM architectures performed much better than additional neural networks.
Conclusions: The overall image processing pipeline performed well, but the ground truth needs to be extended to include a broader variability of implant types and more examples per training class.