Multispectral image analysis in laparoscopy – A machine learning approach to live perfusion monitoring

Modern visceral surgery is often performed through small incisions. Compared to open surgery, these minimally invasive interventions result in smaller scars, fewer complications and a quicker recovery. While to the patients benefit, it has the drawback of limiting the physician’s perception largely to that of visual feedback through a camera mounted on a rod lens: the laparoscope. Conventional laparoscopes are limited by “imitating” the human eye. Multispectral cameras remove this arbitrary restriction of recording only red, green and blue colors. Instead, they capture many specific bands of light. Although these could help characterize important indications such as ischemia and early stage adenoma, the lack of powerful digital image processing prevents realizing the technique’s full potential. The primary objective of this thesis was to pioneer fluent functional multispectral imaging (MSI) in laparoscopy. The main technical obstacles were: (1) The lack of image analysis concepts that provide both high accuracy and speed. (2) Multispectral image recording is slow, typically ranging from seconds to minutes. (3) Obtaining a quantitative ground truth for the measurements is hard or even impossible. To overcome these hurdles and enable functional laparoscopy, for the first time in this field physical models are combined with powerful machine learning techniques. The physical model is employed to create highly accurate simulations, which in turn teach the algorithm to rapidly relate multispectral pixels to underlying functional changes. To reduce the domain shift introduced by learning from simulations, a novel transfer learning approach automatically adapts generic simulations to match almost arbitrary recordings of visceral tissue. In combination with the only available video-rate capable multispectral sensor, the method pioneers fluent perfusion monitoring with MSI. This system was carefully tested in a multistage process, involving in silico quantitative evaluations, tissue phantoms and a porcine study. Clinical applicability was ensured through in-patient recordings in the context of partial nephrectomy; in these, the novel system characterized ischemia live during the intervention. Verified against a fluorescence reference, the results indicate that fluent, non-invasive ischemia detection and monitoring is now possible. In conclusion, this thesis presents the first multispectral laparoscope capable of videorate functional analysis. The system was successfully evaluated in in-patient trials, and future work should be directed towards evaluation of the system in a larger study. Due to the broad applicability and the large potential clinical benefit of the presented functional estimation approach, I am confident the descendants of this system are an integral part of the next generation OR

STRUCTURED LIGHT FOR DATA-DRIVEN QUANTITATIVE TISSUE IMAGING

Compared to the other major medical imaging modalities (CT, MRI, PET, ultrasound, and microscopy), conventional wide-field optical imaging is particularly qualitative. For endoscopic and laparoscopic optical imaging, the spatial scale of the image is typically unknown, heterogeneous, and rapidly changing frame-to-frame. Moreover, the fundamental optical properties of the imaged tissue are conflated in the acquired images. This leads to several clinical limitations. The absorption coefficient, which can indicate important biomarkers such as tissue oxygenation, cannot be unambiguously determined. Moreover, for machine learning analysis of endoscopic images, qualitative image inputs lead to large training datasets requirements and limit generalizability compared to algorithms trained with quantitative images. Quantitative optical imaging may be key to enabling reliable artificial intelligence algorithms for tasks such as tissue classification or tumor margin assessment. Spatial Frequency Domain Imaging (SFDI) is a relatively new optical imaging technique that is capable of wide-field quantification and mapping of tissue optical properties. Using structured illumination at different phases and spatial frequencies, it is capable of unambiguously decoupling optical absorption and scattering. In recent years, SFDI has seen growing use in many applications, such as wound monitoring and diabetic ulcer staging. Unfortunately, conventional SFDI approaches suffer from the trade-off between imaging speed and accuracy. SFDI also requires a projection system, which limits the potential for clinical adoption in space-constrained applications, such as endoscopic imaging. In this work, we present a technique that leverages the power of data-driven methods, such as convolutional neural networks, to achieve real-time and accurate optical property and tissue oxygenation mapping from single-shot SFDI images. We also develop a signal processing model for projector-free SFDI using random laser speckle patterns as structured illumination. This approach is promising for rapid, low-cost, and compact endoscopic imaging of optical biomarkers. Overall, our work has the potential to facilitate clinical translation and adoption of quantitative tissue imaging techniques

Past, Present, and Future of Simultaneous Localization And Mapping: Towards the Robust-Perception Age

Simultaneous Localization and Mapping (SLAM)consists in the concurrent construction of a model of the environment (the map), and the estimation of the state of the robot moving within it. The SLAM community has made astonishing progress over the last 30 years, enabling large-scale real-world applications, and witnessing a steady transition of this technology to industry. We survey the current state of SLAM. We start by presenting what is now the de-facto standard formulation for SLAM. We then review related work, covering a broad set of topics including robustness and scalability in long-term mapping, metric and semantic representations for mapping, theoretical performance guarantees, active SLAM and exploration, and other new frontiers. This paper simultaneously serves as a position paper and tutorial to those who are users of SLAM. By looking at the published research with a critical eye, we delineate open challenges and new research issues, that still deserve careful scientific investigation. The paper also contains the authors' take on two questions that often animate discussions during robotics conferences: Do robots need SLAM? and Is SLAM solved

Deep Learning Meets Hyperspectral Image Analysis: A Multidisciplinary Review

Modern hyperspectral imaging systems produce huge datasets potentially conveying a great abundance of information; such a resource, however, poses many challenges in the analysis and interpretation of these data. Deep learning approaches certainly offer a great variety of opportunities for solving classical imaging tasks and also for approaching new stimulating problems in the spatial–spectral domain. This is fundamental in the driving sector of Remote Sensing where hyperspectral technology was born and has mostly developed, but it is perhaps even more true in the multitude of current and evolving application sectors that involve these imaging technologies. The present review develops on two fronts: on the one hand, it is aimed at domain professionals who want to have an updated overview on how hyperspectral acquisition techniques can combine with deep learning architectures to solve specific tasks in different application fields. On the other hand, we want to target the machine learning and computer vision experts by giving them a picture of how deep learning technologies are applied to hyperspectral data from a multidisciplinary perspective. The presence of these two viewpoints and the inclusion of application fields other than Remote Sensing are the original contributions of this review, which also highlights some potentialities and critical issues related to the observed development trends

Cable-driven parallel mechanisms for minimally invasive robotic surgery

Minimally invasive surgery (MIS) has revolutionised surgery by providing faster recovery times, less post-operative complications, improved cosmesis and reduced pain for the patient. Surgical robotics are used to further decrease the invasiveness of procedures, by using yet smaller and fewer incisions or using natural orifices as entry point. However, many robotic systems still suffer from technical challenges such as sufficient instrument dexterity and payloads, leading to limited adoption in clinical practice. Cable-driven parallel mechanisms (CDPMs) have unique properties, which can be used to overcome existing challenges in surgical robotics. These beneficial properties include high end-effector payloads, efficient force transmission and a large configurable instrument workspace. However, the use of CDPMs in MIS is largely unexplored. This research presents the first structured exploration of CDPMs for MIS and demonstrates the potential of this type of mechanism through the development of multiple prototypes: the ESD CYCLOPS, CDAQS, SIMPLE, neuroCYCLOPS and microCYCLOPS. One key challenge for MIS is the access method used to introduce CDPMs into the body. Three different access methods are presented by the prototypes. By focusing on the minimally invasive access method in which CDPMs are introduced into the body, the thesis provides a framework, which can be used by researchers, engineers and clinicians to identify future opportunities of CDPMs in MIS. Additionally, through user studies and pre-clinical studies, these prototypes demonstrate that this type of mechanism has several key advantages for surgical applications in which haptic feedback, safe automation or a high payload are required. These advantages, combined with the different access methods, demonstrate that CDPMs can have a key role in the advancement of MIS technology.Open Acces

Medical Robotics

The first generation of surgical robots are already being installed in a number of operating rooms around the world. Robotics is being introduced to medicine because it allows for unprecedented control and precision of surgical instruments in minimally invasive procedures. So far, robots have been used to position an endoscope, perform gallbladder surgery and correct gastroesophogeal reflux and heartburn. The ultimate goal of the robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery. The use of robotics in surgery will expand over the next decades without any doubt. Minimally Invasive Surgery (MIS) is a revolutionary approach in surgery. In MIS, the operation is performed with instruments and viewing equipment inserted into the body through small incisions created by the surgeon, in contrast to open surgery with large incisions. This minimizes surgical trauma and damage to healthy tissue, resulting in shorter patient recovery time. The aim of this book is to provide an overview of the state-of-art, to present new ideas, original results and practical experiences in this expanding area. Nevertheless, many chapters in the book concern advanced research on this growing area. The book provides critical analysis of clinical trials, assessment of the benefits and risks of the application of these technologies. This book is certainly a small sample of the research activity on Medical Robotics going on around the globe as you read it, but it surely covers a good deal of what has been done in the field recently, and as such it works as a valuable source for researchers interested in the involved subjects, whether they are currently “medical roboticists” or not

Brain Tumour Classification Using Deep Features from Structural MRI

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