Development of workflow task analysis during cerebral diagnostic angiographies: Time-based comparison of junior and senior tasks

International audienceOBJECTIVE: Assessing neuroradiologists' skills in the operating room (OR) is difficult and often subjective. This study used a workflow time-based task analysis approach while performing cerebral angiography. METHODS: Eight angiographies performed by a senior neuroradiologist and eight performed by a junior neuroradiologist were compared. Dedicated software with specific terminology was used to record the tasks. Procedures were subdivided into phases, each comprising multiple tasks. Each task was defined as a triplet, associating an action, an instrument and an anatomical structure. The duration of each task was the metric. Total duration of the procedure, task duration and the number of times a task was repeated were identified. The focus was on tasks using fluoroscopy and for moving the X-ray table/tube. RESULTS: The total duration of tasks to complete the entire procedure was longer for the junior operators than for the seniors (P=0.012). The mean duration per task during the navigation phase was 86s for the juniors and 43s for the seniors (P=0.002). The total and mean durations of tasks involving the use of fluoroscopy were also longer for the juniors (P=0.002 and P=0.033, respectively). For tasks involving the table/tube, the total and mean durations were again longer for the juniors (P=0.019 and P=0.082, respectively). CONCLUSION: This approach allows reliable skill assessment in the radiology OR and comparison of junior and senior competencies during cerebral diagnostic angiography. This new tool can improve the quality and safety of procedures, and facilitate the learning process for neuroradiologists

Inductive learning of the surgical workflow model through video annotations

partially_open5siSurgical workflow modeling is becoming increasingly useful to train surgical residents for complex surgical procedures. Rule-based surgical workflows have shown to be useful to create context-aware systems. However, manually constructing production rules is a time-intensive and laborious task. With the expansion of new technologies, large video archive can be created and annotated exploiting and storing the expert’s knowledge. This paper presents a prototypical study of automatic generation of production rules, in the Horn-clause, using the First Order Inductive Learner (FOIL) algorithm applied to annotated surgical videos of Thoracentesis procedure and of its feasibility to use in context-aware system framework. The algorithm was able to learn 18 rules for surgical workflow model with 0.88 precision, and 0.94 F1 score on the standard video annotation data, representing entities of the surgical workflow, which was used to retrieve contextual information on Thoracentesis workflow for its application to surgical training.openNakawala, HIRENKUMAR CHANDRAKANT; DE MOMI, Elena; Pescatori, Erica Laura; Morelli, Anna; Ferrigno, GiancarloNakawala, HIRENKUMAR CHANDRAKANT; DE MOMI, Elena; Pescatori, Erica Laura; Morelli, Anna; Ferrigno, Giancarl

Why Deep Surgical Models Fail?: Revisiting Surgical Action Triplet Recognition through the Lens of Robustness

Surgical action triplet recognition provides a better understanding of the surgical scene. This task is of high relevance as it provides to the surgeon with context-aware support and safety. The current go-to strategy for improving performance is the development of new network mechanisms. However, the performance of current state-of-the-art techniques is substantially lower than other surgical tasks. Why is this happening? This is the question that we address in this work. We present the first study to understand the failure of existing deep learning models through the lens of robustness and explainabilty. Firstly, we study current existing models under weak and strong $\delta-$perturbations via adversarial optimisation scheme. We then provide the failure modes via feature based explanations. Our study revels that the key for improving performance and increasing reliability is in the core and spurious attributes. Our work opens the door to more trustworthiness and reliability deep learning models in surgical science

Multi-site study of surgical practice in neurosurgery based on surgical process models.

Surgical Process Modelling (SPM) was introduced to improve understanding the different parameters that influence the performance of a Surgical Process (SP). Data acquired from SPM methodology is enormous and complex. Several analysis methods based on comparison or classification of Surgical Process Models (SPMs) have previously been proposed. Such methods compare a set of SPMs to highlight specific parameters explaining differences between populations of patients, surgeons or systems. In this study, procedures performed at three different international University hospitals were compared using SPM methodology based on a similarity metric focusing on the sequence of activities occurring during surgery. The proposed approach is based on Dynamic Time Warping (DTW) algorithm combined with a clustering algorithm. SPMs of 41 Anterior Cervical Discectomy (ACD) surgeries were acquired at three Neurosurgical departments; in France, Germany, and Canada. The proposed approach distinguished the different surgical behaviors according to the location where surgery was performed as well as between the categorized surgical experience of individual surgeons. We also propose the use of Multidimensional Scaling to induce a new space of representation of the sequences of activities. The approach was compared to a time-based approach (e.g. duration of surgeries) and has been shown to be more precise. We also discuss the integration of other criteria in order to better understand what influences the way the surgeries are performed. This first multi-site study represents an important step towards the creation of robust analysis tools for processing SPMs. It opens new perspectives for the assessment of surgical approaches, tools or systems as well as objective assessment and comparison of surgeon’s expertise

Development of an intelligent surgical training system for Thoracentesis

Surgical training improves patient care, helps to reduce surgical risks, increases surgeon’s confidence, and thus enhances overall patient safety. Current surgical training systems are more focused on developing technical skills, e.g. dexterity, of the surgeons while lacking the aspects of context-awareness and intra-operative real-time guidance. Context-aware intelligent training systems interpret the current surgical situation and help surgeons to train on surgical tasks. As a prototypical scenario, we chose Thoracentesis procedure in this work. We designed the context-aware software framework using the surgical process model encompassing ontology and production rules, based on the procedure descriptions obtained through textbooks and interviews, and ontology-based and marker-based object recognition, where the system tracked and recognised surgical instruments and materials in surgeon’s hands and recognised surgical instruments on the surgical stand. The ontology was validated using annotated surgical videos, where the system identified “Anaesthesia” and “Aspiration” phase with 100% relative frequency and “Penetration” phase with 65% relative frequency. The system tracked surgical swab and 50 mL syringe with approximately 88.23% and 100% accuracy in surgeon’s hands and recognised surgical instruments with approximately 90% accuracy on the surgical stand. Surgical workflow training with the proposed system showed equivalent results as the traditional mentor-based training regime, thus this work is a step forward a new tool for context awareness and decision-making during surgical training

Inductive learning of answer set programs for autonomous surgical task planning

The quality of robot-assisted surgery can be improved and the use of hospital resources can be optimized by enhancing autonomy and reliability in the robot’s operation. Logic programming is a good choice for task planning in robot-assisted surgery because it supports reliable reasoning with domain knowledge and increases transparency in the decision making. However, prior knowledge of the task and the domain is typically incomplete, and it often needs to be refined from executions of the surgical task(s) under consideration to avoid sub-optimal performance. In this paper, we investigate the applicability of inductive logic programming for learning previously unknown axioms governing domain dynamics. We do so under answer set semantics for a benchmark surgical training task, the ring transfer. We extend our previous work on learning the immediate preconditions of actions and constraints, to also learn axioms encoding arbitrary temporal delays between atoms that are effects of actions under the event calculus formalism. We propose a systematic approach for learning the specifications of a generic robotic task under the answer set semantics, allowing easy knowledge refinement with iterative learning. In the context of 1000 simulated scenarios, we demonstrate the significant improvement in performance obtained with the learned axioms compared with the hand-written ones; specifically, the learned axioms address some critical issues related to the plan computation time, which is promising for reliable real-time performance during surgery