Conditional Generative Data Augmentation for Clinical Audio Datasets

In this work, we propose a novel data augmentation method for clinical audio datasets based on a conditional Wasserstein Generative Adversarial Network with Gradient Penalty (cWGAN-GP), operating on log-mel spectrograms. To validate our method, we created a clinical audio dataset which was recorded in a real-world operating room during Total Hip Arthroplasty (THA) procedures and contains typical sounds which resemble the different phases of the intervention. We demonstrate the capability of the proposed method to generate realistic class-conditioned samples from the dataset distribution and show that training with the generated augmented samples outperforms classical audio augmentation methods in terms of classification performance. The performance was evaluated using a ResNet-18 classifier which shows a mean Macro F1-score improvement of 1.70% in a 5-fold cross validation experiment using the proposed augmentation method. Because clinical data is often expensive to acquire, the development of realistic and high-quality data augmentation methods is crucial to improve the robustness and generalization capabilities of learning-based algorithms which is especially important for safety-critical medical applications. Therefore, the proposed data augmentation method is an important step towards improving the data bottleneck for clinical audio-based machine learning systems

Improved Techniques for the Conditional Generative Augmentation of Clinical Audio Data

Data augmentation is a valuable tool for the design of deep learning systems to overcome data limitations and stabilize the training process. Especially in the medical domain, where the collection of large-scale data sets is challenging and expensive due to limited access to patient data, relevant environments, as well as strict regulations, community-curated large-scale public datasets, pretrained models, and advanced data augmentation methods are the main factors for developing reliable systems to improve patient care. However, for the development of medical acoustic sensing systems, an emerging field of research, the community lacks large-scale publicly available data sets and pretrained models. To address the problem of limited data, we propose a conditional generative adversarial neural network-based augmentation method which is able to synthesize mel spectrograms from a learned data distribution of a source data set. In contrast to previously proposed fully convolutional models, the proposed model implements residual Squeeze and Excitation modules in the generator architecture. We show that our method outperforms all classical audio augmentation techniques and previously published generative methods in terms of generated sample quality and a performance improvement of 2.84% of Macro F1-Score for a classifier trained on the augmented data set, an enhancement of 1.14% in relation to previous work. By analyzing the correlation of intermediate feature spaces, we show that the residual Squeeze and Excitation modules help the model to reduce redundancy in the latent features. Therefore, the proposed model advances the state-of-the-art in the augmentation of clinical audio data and improves the data bottleneck for the design of clinical acoustic sensing systems

Sonification as a Reliable Alternative to Conventional Visual Surgical Navigation

Despite the undeniable advantages of image-guided surgical assistance systems in terms of accuracy, such systems have not yet fully met surgeons' needs or expectations regarding usability, time efficiency, and their integration into the surgical workflow. On the other hand, perceptual studies have shown that presenting independent but causally correlated information via multimodal feedback involving different sensory modalities can improve task performance. This article investigates an alternative method for computer-assisted surgical navigation, introduces a novel sonification methodology for navigated pedicle screw placement, and discusses advanced solutions based on multisensory feedback. The proposed method comprises a novel sonification solution for alignment tasks in four degrees of freedom based on frequency modulation (FM) synthesis. We compared the resulting accuracy and execution time of the proposed sonification method with visual navigation, which is currently considered the state of the art. We conducted a phantom study in which 17 surgeons executed the pedicle screw placement task in the lumbar spine, guided by either the proposed sonification-based or the traditional visual navigation method. The results demonstrated that the proposed method is as accurate as the state of the art while decreasing the surgeon's need to focus on visual navigation displays instead of the natural focus on surgical tools and targeted anatomy during task execution

3D planning and surgical navigation of clavicle osteosynthesis using adaptable patient-specific instruments

BACKGROUND Preoperative three-dimensional planning and intraoperative navigation by patient-specific instruments is a promising method for the exact correction of bone deformities. Nevertheless, disadvantages of current concepts are the missing options of adapting the surgical plan intraoperatively. By providing the surgeons with a controlled length adjustment through the patient-specific instruments, the application area can usefully be expanded in the treatment of clavicle osteosyntheses. METHODS In three cases, preoperative three-dimensional surgical planning with the intraoperative use of patient-specific instruments was applied. The computer-assisted assessments of clavicle deformities, the preoperative plan, and the design of patient-specific instruments were created on the basis of computed tomography data. Reduction guides for restoring length and rotation according to the mirrored healthy contralateral side were enhanced with adaptable length adjustment functions. The screw thread of the reduction guides enabled temporary distraction of the clavicle fracture fragments and a controlled compression of the optionally used interposed bone block between clavicle fragments. RESULTS Navigated clavicle osteosyntheses by enhanced patient-specific instruments was executed uneventful in all three cases. The surgeon was able to adapt clavicle length in a planned axis intraoperatively as clinically desired. CONCLUSION Computer-assisted planning of clavicle osteosynthesis and surgical navigation with additional adaptable patient-specific instruments can usefully expand the previous application areas. By using guided length adjustments, the fragments and optionally the graft can be compressed along a planned axis as desired to ensure optimal bone healing. LEVEL OF EVIDENCE Basic science study, Surgical technique

Automatic and robust forearm segmentation using graph cuts

The segmentation of bones in computed tomography (CT) images is an important step for the simulation of forearm bone motion, since it allows to include patient specific anatomy in a kinematic model. While the identification of the bone diaphysis is straightforward, the segmentation of bone joints with weak, thin, and diffusive boundaries is still a challenge. We propose a graph cut segmentation approach that is particularly suited to robustly segment joints in 3-d CT images. We incorporate knowledge about intensity, bone shape and local structures into a novel energy function. Our presented framework performs a simultaneous segmentation of both forearm bones without any user interaction

Accuracy of 3D-planned patient specific instrumentation in high tibial open wedge valgisation osteotomy

PURPOSE: High tibial osteotomy (HTO) is an effective treatment option in early osteoarthritis. However, preoperative planning and surgical execution can be challenging. Computer assisted three-dimensional (3D) planning and patient-specific instruments (PSI) might be helpful tools in achieving successful outcomes. Goal of this study was to assess the accuracy of HTO using PSI. METHODS: All medial open wedge PSI-HTO between 2014 and 2016 were reviewed. Using pre- and postoperative radiographs, hip-knee-ankle angle (HKA) and posterior tibial slope (PTS) were determined two-dimensionally (2D) to calculate 2D accuracy. Using postoperative CT-data, 3D surface models of the tibias were reconstructed and superimposed with the planning to calculate 3D accuracy. RESULTS: Twenty-three patients could be included. A mean correction of HKA of 9.7° ± 2.6° was planned. Postoperative assessment of HKA correction showed a mean correction of 8.9° ± 3.2°, resulting in a 2D accuracy for HKA correction of 0.8° ± 1.5°. The postoperative PTS changed by 1.7° ± 2.2°. 3D accuracy showed average 3D rotational differences of - 0.1° ± 2.3° in coronal plane, - 0.2° ± 2.3° in transversal plane, and 1.3° ± 2.1° in sagittal plane, whereby 3D translational differences were calculated as 0.1 mm ± 1.3 mm in coronal plane, - 0.1 ± 0.6 mm in transversal plane, and - 0.1 ± 0.6 mm in sagittal plane. CONCLUSION: The use of PSI in HTO results in accurate correction of mechanical leg axis. In contrast to the known problem of unintended PTS changes in conventional HTO, just slight changes of PTS could be observed using PSI. The use of PSI in HTO might be preferable to obtain desired correction of HKA and to maintain PTS

Continuing to work with a sterile thumb splint: A case report

Nonoperative treatment of an injured ulnar collateral ligament of the thumb metacarpophalangeal (MCP) joint (skier's thumb without a Stener lesion) is managed by immobilization. A splint is applied on the radial side with the thumb in slight flexion to immobilize the MCP joint and allow motion in the interphalangeal joint. Thermoplastic splints are mainly used for daily activities with the advantage of custom fabrication for optimal comfort. To immobilize the thumb during surgical procedures performed by an orthopedic surgeon, splints made of sterilizable materials are needed but not yet available to our knowledge. We present the case of a 36-year-old orthopedic surgeon diagnosed with skier's thumb, and the development and application of a reusable, patient-specific (i.e., the orthopedic surgeon) splint to immobilize the thumb MCP joint in a sterile environment so the surgeon could continue working

Complex Radius Shaft Malunion: Osteotomy with Computer-Assisted Planning

We report about two cases with a combined axial and angular malunion of the radius shaft with functional loss of pro-supination. For the preoperative planning, a computer simulation was developed that allows the quantification of the malunion by comparing the 3-d surface model of the impaired bone with the contralateral anatomy. The proximal parts of the left and right radii are superimposed, while the different positions of the distal parts are used to quantify the malunion. This task is performed fully automatically which reduces the overall planning time. The osteotomies were performed according to the results of the computer-aided planning. The first case showed 1 year postoperatively an increase of pronation from 40° to 70° at expense of supination from 95° to 90°. The patient was practically pain-free and reported functional improvement. The second case showed 6 months postoperatively an improvement of supination from 15° to 40° and of pronation from 50° to 60°. The computer-assisted operation planning facilitated the quantification of combined axial and angular malunions which were difficult to detect on plain radiographs