Optical techniques for 3D surface reconstruction in computer-assisted laparoscopic surgery

One of the main challenges for computer-assisted surgery (CAS) is to determine the intra-opera- tive morphology and motion of soft-tissues. This information is prerequisite to the registration of multi-modal patient-specific data for enhancing the surgeon’s navigation capabilites by observ- ing beyond exposed tissue surfaces and for providing intelligent control of robotic-assisted in- struments. In minimally invasive surgery (MIS), optical techniques are an increasingly attractive approach for in vivo 3D reconstruction of the soft-tissue surface geometry. This paper reviews the state-of-the-art methods for optical intra-operative 3D reconstruction in laparoscopic surgery and discusses the technical challenges and future perspectives towards clinical translation. With the recent paradigm shift of surgical practice towards MIS and new developments in 3D opti- cal imaging, this is a timely discussion about technologies that could facilitate complex CAS procedures in dynamic and deformable anatomical regions

Specular reflection removal and bloodless vessel segmentation for 3-D heart model reconstruction from single view images

Three Dimensional (3D) human heart model is attracting attention for its role in medical images for education and clinical purposes. Analysing 2D images to obtain meaningful information requires a certain level of expertise. Moreover, it is time consuming and requires special devices to obtain aforementioned images. In contrary, a 3D model conveys much more information. 3D human heart model reconstruction from medical imaging devices requires several input images, while reconstruction from a single view image is challenging due to the colour property of the heart image, light reflections, and its featureless surface. Lights and illumination condition of the operating room cause specular reflections on the wet heart surface that result in noises forming of the reconstruction process. Image-based technique is used for the proposed human heart surface reconstruction. It is important the reflection is eliminated to allow for proper 3D reconstruction and avoid imperfect final output. Specular reflections detection and correction process examine the surface properties. This was implemented as a first step to detect reflections using the standard deviation of RGB colour channel and the maximum value of blue channel to establish colour, devoid of specularities. The result shows the accurate and efficient performance of the specularities removing process with 88.7% similarity with the ground truth. Realistic 3D heart model reconstruction was developed based on extraction of pixel information from digital images to allow novice surgeons to reduce the time for cardiac surgery training and enhancing their perception of the Operating Theatre (OT). Cardiac medical imaging devices such as Magnetic Resonance Imaging (MRI), Computed Tomography (CT) images, or Echocardiography provide cardiac information. However,these images from medical modalities are not adequate, to precisely simulate the real environment and to be used in the training simulator for cardiac surgery. The propose method exploits and develops techniques based on analysing real coloured images taken during cardiac surgery in order to obtain meaningful information of the heart anatomical structures. Another issue is the different human heart surface vessels. The most important vessel region is the bloodless, lack of blood, vessels. Surgeon faces some difficulties in locating the bloodless vessel region during surgery. The thesis suggests a technique of identifying the vessels’ Region of Interest (ROI) to avoid surgical injuries by examining an enhanced input image. The proposed method locates vessels’ ROI by using Decorrelation Stretch technique. This Decorrelation Stretch can clearly enhance the heart’s surface image. Through this enhancement, the surgeon become enables effectively identifying the vessels ROI to perform the surgery from textured and coloured surface images. In addition, after enhancement and segmentation of the vessels ROI, a 3D reconstruction of this ROI takes place and then visualize it over the 3D heart model. Experiments for each phase in the research framework were qualitatively and quantitatively evaluated. Two hundred and thirteen real human heart images are the dataset collected during cardiac surgery using a digital camera. The experimental results of the proposed methods were compared with manual hand-labelling ground truth data. The cost reduction of false positive and false negative of specular detection and correction processes of the proposed method was less than 24% compared to other methods. In addition, the efficient results of Root Mean Square Error (RMSE) to measure the correctness of the z-axis values to reconstruction of the 3D model accurately compared to other method. Finally, the 94.42% accuracy rate of the proposed vessels segmentation method using RGB colour space achieved is comparable to other colour spaces. Experimental results show that there is significant efficiency and robustness compared to existing state of the art methods

Towards retrieving force feedback in robotic-assisted surgery: a supervised neuro-recurrent-vision approach

Robotic-assisted minimally invasive surgeries have gained a lot of popularity over conventional procedures as they offer many benefits to both surgeons and patients. Nonetheless, they still suffer from some limitations that affect their outcome. One of them is the lack of force feedback which restricts the surgeon's sense of touch and might reduce precision during a procedure. To overcome this limitation, we propose a novel force estimation approach that combines a vision based solution with supervised learning to estimate the applied force and provide the surgeon with a suitable representation of it. The proposed solution starts with extracting the geometry of motion of the heart's surface by minimizing an energy functional to recover its 3D deformable structure. A deep network, based on a LSTM-RNN architecture, is then used to learn the relationship between the extracted visual-geometric information and the applied force, and to find accurate mapping between the two. Our proposed force estimation solution avoids the drawbacks usually associated with force sensing devices, such as biocompatibility and integration issues. We evaluate our approach on phantom and realistic tissues in which we report an average root-mean square error of 0.02 N.Peer ReviewedPostprint (author's final draft

Estimating and understanding motion : from diagnostic to robotic surgery

Estimating and understanding motion from an image sequence is a central topic in computer vision. The high interest in this topic is because we are living in a world where many events that occur in the environment are dynamic. This makes motion estimation and understanding a natural component and a key factor in a widespread of applications including object recognition , 3D shape reconstruction, autonomous navigation and medica! diagnosis. Particularly, we focus on the medical domain in which understanding the human body for clinical purposes requires retrieving the organs' complex motion patterns, which is in general a hard problem when using only image data. In this thesis, we cope with this problem by posing the question - How to achieve a realistic motion estimation to offer a better clinical understanding? We focus this thesis on answering this question by using a variational formulation as a basis to understand one of the most complex motions in the human's body, the heart motion, through three different applications: (i) cardiac motion estimation for diagnostic, (ii) force estimation and (iii) motion prediction, both for robotic surgery. Firstly, we focus on a central topic in cardiac imaging that is the estimation of the cardiac motion. The main aim is to offer objective and understandable measures to physicians for helping them in the diagnostic of cardiovascular diseases. We employ ultrafast ultrasound data and tools for imaging motion drawn from diverse areas such as low-rank analysis and variational deformation to perform a realistic cardiac motion estimation. The significance is that by taking low-rank data with carefully chosen penalization, synergies in this complex variational problem can be created. We demonstrate how our proposed solution deals with complex deformations through careful numerical experiments using realistic and simulated data. We then move from diagnostic to robotic surgeries where surgeons perform delicate procedures remotely through robotic manipulators without directly interacting with the patients. As a result, they lack force feedback, which is an important primary sense for increasing surgeon-patient transparency and avoiding injuries and high mental workload. To solve this problem, we follow the conservation principies of continuum mechanics in which it is clear that the change in shape of an elastic object is directly proportional to the force applied. Thus, we create a variational framework to acquire the deformation that the tissues undergo due to an applied force. Then, this information is used in a learning system to find the nonlinear relationship between the given data and the applied force. We carried out experiments with in-vivo and ex-vivo data and combined statistical, graphical and perceptual analyses to demonstrate the strength of our solution. Finally, we explore robotic cardiac surgery, which allows carrying out complex procedures including Off-Pump Coronary Artery Bypass Grafting (OPCABG). This procedure avoids the associated complications of using Cardiopulmonary Bypass (CPB) since the heart is not arrested while performing the surgery on a beating heart. Thus, surgeons have to deal with a dynamic target that compromisetheir dexterity and the surgery's precision. To compensate the heart motion, we propase a solution composed of three elements: an energy function to estimate the 3D heart motion, a specular highlight detection strategy and a prediction approach for increasing the robustness of the solution. We conduct evaluation of our solution using phantom and realistic datasets. We conclude the thesis by reporting our findings on these three applications and highlight the dependency between motion estimation and motion understanding at any dynamic event, particularly in clinical scenarios.L’estimació i comprensió del moviment dins d’una seqüència d’imatges és un tema central en la visió per ordinador, el que genera un gran interès perquè vivim en un entorn ple d’esdeveniments dinàmics. Per aquest motiu és considerat com un component natural i factor clau dins d’un ampli ventall d’aplicacions, el qual inclou el reconeixement d’objectes, la reconstrucció de formes tridimensionals, la navegació autònoma i el diagnòstic de malalties. En particular, ens situem en l’àmbit mèdic en el qual la comprensió del cos humà, amb finalitats clíniques, requereix l’obtenció de patrons complexos de moviment dels òrgans. Aquesta és, en general, una tasca difícil quan s’utilitzen només dades de tipus visual. En aquesta tesi afrontem el problema plantejant-nos la pregunta - Com es pot aconseguir una estimació realista del moviment amb l’objectiu d’oferir una millor comprensió clínica? La tesi se centra en la resposta mitjançant l’ús d’una formulació variacional com a base per entendre un dels moviments més complexos del cos humà, el del cor, a través de tres aplicacions: (i) estimació del moviment cardíac per al diagnòstic, (ii) estimació de forces i (iii) predicció del moviment, orientant-se les dues últimes en cirurgia robòtica. En primer lloc, ens centrem en un tema principal en la imatge cardíaca, que és l’estimació del moviment cardíac. L’objectiu principal és oferir als metges mesures objectives i comprensibles per ajudar-los en el diagnòstic de les malalties cardiovasculars. Fem servir dades d’ultrasons ultraràpids i eines per al moviment d’imatges procedents de diverses àrees, com ara l’anàlisi de baix rang i la deformació variacional, per fer una estimació realista del moviment cardíac. La importància rau en que, en prendre les dades de baix rang amb una penalització acurada, es poden crear sinergies en aquest problema variacional complex. Mitjançant acurats experiments numèrics, amb dades realístiques i simulades, hem demostrat com les nostres propostes solucionen deformacions complexes. Després passem del diagnòstic a la cirurgia robòtica, on els cirurgians realitzen procediments delicats remotament, a través de manipuladors robòtics, sense interactuar directament amb els pacients. Com a conseqüència, no tenen la percepció de la força com a resposta, que és un sentit primari important per augmentar la transparència entre el cirurgià i el pacient, per evitar lesions i per reduir la càrrega de treball mental. Resolem aquest problema seguint els principis de conservació de la mecànica del medi continu, en els quals està clar que el canvi en la forma d’un objecte elàstic és directament proporcional a la força aplicada. Per això hem creat un marc variacional que adquireix la deformació que pateixen els teixits per l’aplicació d’una força. Aquesta informació s’utilitza en un sistema d’aprenentatge, per trobar la relació no lineal entre les dades donades i la força aplicada. Hem dut a terme experiments amb dades in-vivo i ex-vivo i hem combinat l’anàlisi estadístic, gràfic i de percepció que demostren la robustesa de la nostra solució. Finalment, explorem la cirurgia cardíaca robòtica, la qual cosa permet realitzar procediments complexos, incloent la cirurgia coronària sense bomba (off-pump coronary artery bypass grafting o OPCAB). Aquest procediment evita les complicacions associades a l’ús de circulació extracorpòria (Cardiopulmonary Bypass o CPB), ja que el cor no s’atura mentre es realitza la cirurgia. Això comporta que els cirurgians han de tractar amb un objectiu dinàmic que compromet la seva destresa i la precisió de la cirurgia. Per compensar el moviment del cor, proposem una solució composta de tres elements: un funcional d’energia per estimar el moviment tridimensional del cor, una estratègia de detecció de les reflexions especulars i una aproximació basada en mètodes de predicció, per tal d’augmentar la robustesa de la solució. L’avaluació de la nostra solució s’ha dut a terme mitjançant conjunts de dades sintètiques i realistes. La tesi conclou informant dels nostres resultats en aquestes tres aplicacions i posant de relleu la dependència entre l’estimació i la comprensió del moviment en qualsevol esdeveniment dinàmic, especialment en escenaris clínics.Postprint (published version

Activity profiling for minimally invasive surgery

Imperial Users onl

Translational Functional Imaging in Surgery Enabled by Deep Learning

Many clinical applications currently rely on several imaging modalities such as Positron Emission Tomography (PET), Magnetic Resonance Imaging (MRI), Computed Tomography (CT), etc. All such modalities provide valuable patient data to the clinical staff to aid clinical decision-making and patient care. Despite the undeniable success of such modalities, most of them are limited to preoperative scans and focus on morphology analysis, e.g. tumor segmentation, radiation treatment planning, anomaly detection, etc. Even though the assessment of different functional properties such as perfusion is crucial in many surgical procedures, it remains highly challenging via simple visual inspection. Functional imaging techniques such as Spectral Imaging (SI) link the unique optical properties of different tissue types with metabolism changes, blood flow, chemical composition, etc. As such, SI is capable of providing much richer information that can improve patient treatment and care. In particular, perfusion assessment with functional imaging has become more relevant due to its involvement in the treatment and development of several diseases such as cardiovascular diseases. Current clinical practice relies on Indocyanine Green (ICG) injection to assess perfusion. Unfortunately, this method can only be used once per surgery and has been shown to trigger deadly complications in some patients (e.g. anaphylactic shock). This thesis addressed common roadblocks in the path to translating optical functional imaging modalities to clinical practice. The main challenges that were tackled are related to a) the slow recording and processing speed that SI devices suffer from, b) the errors introduced in functional parameter estimations under changing illumination conditions, c) the lack of medical data, and d) the high tissue inter-patient heterogeneity that is commonly overlooked. This framework follows a natural path to translation that starts with hardware optimization. To overcome the limitation that the lack of labeled clinical data and current slow SI devices impose, a domain- and task-specific band selection component was introduced. The implementation of such component resulted in a reduction of the amount of data needed to monitor perfusion. Moreover, this method leverages large amounts of synthetic data, which paired with unlabeled in vivo data is capable of generating highly accurate simulations of a wide range of domains. This approach was validated in vivo in a head and neck rat model, and showed higher oxygenation contrast between normal and cancerous tissue, in comparison to a baseline using all available bands. The need for translation to open surgical procedures was met by the implementation of an automatic light source estimation component. This method extracts specular reflections from low exposure spectral images, and processes them to obtain an estimate of the light source spectrum that generated such reflections. The benefits of light source estimation were demonstrated in silico, in ex vivo pig liver, and in vivo human lips, where the oxygenation estimation error was reduced when utilizing the correct light source estimated with this method. These experiments also showed that the performance of the approach proposed in this thesis surpass the performance of other baseline approaches. Video-rate functional property estimation was achieved by two main components: a regression and an Out-of-Distribution (OoD) component. At the core of both components is a compact SI camera that is paired with state-of-the-art deep learning models to achieve real time functional estimations. The first of such components features a deep learning model based on a Convolutional Neural Network (CNN) architecture that was trained on highly accurate physics-based simulations of light-tissue interactions. By doing this, the challenge of lack of in vivo labeled data was overcome. This approach was validated in the task of perfusion monitoring in pig brain and in a clinical study involving human skin. It was shown that this approach is capable of monitoring subtle perfusion changes in human skin in an arm clamping experiment. Even more, this approach was capable of monitoring Spreading Depolarizations (SDs) (deoxygenation waves) in the surface of a pig brain. Even though this method is well suited for perfusion monitoring in domains that are well represented with the physics-based simulations on which it was trained, its performance cannot be guaranteed for outlier domains. To handle outlier domains, the task of ischemia monitoring was rephrased as an OoD detection task. This new functional estimation component comprises an ensemble of Invertible Neural Networks (INNs) that only requires perfused tissue data from individual patients to detect ischemic tissue as outliers. The first ever clinical study involving a video-rate capable SI camera in laparoscopic partial nephrectomy was designed to validate this approach. Such study revealed particularly high inter-patient tissue heterogeneity under the presence of pathologies (cancer). Moreover, it demonstrated that this personalized approach is now capable of monitoring ischemia at video-rate with SI during laparoscopic surgery. In conclusion, this thesis addressed challenges related to slow image recording and processing during surgery. It also proposed a method for light source estimation to facilitate translation to open surgical procedures. Moreover, the methodology proposed in this thesis was validated in a wide range of domains: in silico, rat head and neck, pig liver and brain, and human skin and kidney. In particular, the first clinical trial with spectral imaging in minimally invasive surgery demonstrated that video-rate ischemia monitoring is now possible with deep learning

A Temporal Learning Approach to Inpainting Endoscopic Specularities and Its effect on Image Correspondence

Video streams are utilised to guide minimally-invasive surgery and diagnostic procedures in a wide range of procedures, and many computer assisted techniques have been developed to automatically analyse them. These approaches can provide additional information to the surgeon such as lesion detection, instrument navigation, or anatomy 3D shape modeling. However, the necessary image features to recognise these patterns are not always reliably detected due to the presence of irregular light patterns such as specular highlight reflections. In this paper, we aim at removing specular highlights from endoscopic videos using machine learning. We propose using a temporal generative adversarial network (GAN) to inpaint the hidden anatomy under specularities, inferring its appearance spatially and from neighbouring frames where they are not present in the same location. This is achieved using in-vivo data of gastric endoscopy (Hyper-Kvasir) in a fully unsupervised manner that relies on automatic detection of specular highlights. System evaluations show significant improvements to traditional methods through direct comparison as well as other machine learning techniques through an ablation study that depicts the importance of the network's temporal and transfer learning components. The generalizability of our system to different surgical setups and procedures was also evaluated qualitatively on in-vivo data of gastric endoscopy and ex-vivo porcine data (SERV-CT, SCARED). We also assess the effect of our method in computer vision tasks that underpin 3D reconstruction and camera motion estimation, namely stereo disparity, optical flow, and sparse point feature matching. These are evaluated quantitatively and qualitatively and results show a positive effect of specular highlight inpainting on these tasks in a novel comprehensive analysis

Computer integrated system: medical imaging & visualization

The intent of this book’s conception is to present research work using a user centered design approach. Due to space constraints, the story of the journey, included in this book is relatively brief. However we believe that it manages to adequately represent the story of the journey, from its humble beginnings in 2008 to the point where it visualizes future trends amongst both researchers and practitioners across the Computer Science and Medical disciplines. This book aims not only to present a representative sampling of real-world collaboration between said disciplines but also to provide insights into the different aspects related to the use of real-world Computer Assisted Medical applications. Readers and potential clients should find the information particularly useful in analyzing the benefits of collaboration between these two fields, the products in and of their institutions. The work discussed here is a compilation of the work of several PhD students under my supervision, who have since graduated and produced several publications either in journals or proceedings of conferences. As their work has been published, this book will be more focused on the research methodology based on medical technology used in their research. The research work presented in this book partially encompasses the work under the MOA for collaborative Research and Development in the field of Computer Assisted Surgery and Diagnostics pertaining to Thoracic and Cardiovascular Diseases between UPM, UKM and IJN, spanning five years beginning from 15 Feb 2013