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Didier Mutter

Publications and source records attributed to Didier Mutter.

At least 37 records · Page 2Linked to original sources
arXiv2023

Encoding Surgical Videos as Latent Spatiotemporal Graphs for Object and Anatomy-Driven Reasoning

Recently, spatiotemporal graphs have emerged as a concise and elegant manner of representing video clips in an object-centric fashion, and have shown to be useful for downstream tasks such as action recognition. In this work, we investigate the use of latent spatiotemporal graphs to represent a surgical video in terms of the constituent anatomical structures and tools and their evolving properties over time. To build the graphs, we first predict frame-wise graphs using a pre-trained model, then add temporal edges between nodes based on spatial coherence and visual and semantic similarity. Unlike previous approaches, we incorporate long-term temporal edges in our graphs to better model the evolution of the surgical scene and increase robustness to temporary occlusions. We also introduce a novel graph-editing module that incorporates prior knowledge and temporal coherence to correct errors in the graph, enabling improved downstream task performance. Using our graph representations, we evaluate two downstream tasks, critical view of safety prediction and surgical phase recognition, obtaining strong results that demonstrate the quality and flexibility of the learned representations. Code is available at github.com/CAMMA-public/SurgLatentGraph.

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arXiv2023

TRUSTED: The Paired 3D Transabdominal Ultrasound and CT Human Data for Kidney Segmentation and Registration Research

Inter-modal image registration (IMIR) and image segmentation with abdominal Ultrasound (US) data has many important clinical applications, including image-guided surgery, automatic organ measurement and robotic navigation. However, research is severely limited by the lack of public datasets. We propose TRUSTED (the Tridimensional Renal Ultra Sound TomodEnsitometrie Dataset), comprising paired transabdominal 3DUS and CT kidney images from 48 human patients (96 kidneys), including segmentation, and anatomical landmark annotations by two experienced radiographers. Inter-rater segmentation agreement was over 94 (Dice score), and gold-standard segmentations were generated using the STAPLE algorithm. Seven anatomical landmarks were annotated, important for IMIR systems development and evaluation. To validate the dataset's utility, 5 competitive Deep Learning models for automatic kidney segmentation were benchmarked, yielding average DICE scores from 83.2% to 89.1% for CT, and 61.9% to 79.4% for US images. Three IMIR methods were benchmarked, and Coherent Point Drift performed best with an average Target Registration Error of 4.53mm. The TRUSTED dataset may be used freely researchers to develop and validate new segmentation and IMIR methods.

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arXiv2023

Surgical Action Triplet Detection by Mixed Supervised Learning of Instrument-Tissue Interactions

Surgical action triplets describe instrument-tissue interactions as (instrument, verb, target) combinations, thereby supporting a detailed analysis of surgical scene activities and workflow. This work focuses on surgical action triplet detection, which is challenging but more precise than the traditional triplet recognition task as it consists of joint (1) localization of surgical instruments and (2) recognition of the surgical action triplet associated with every localized instrument. Triplet detection is highly complex due to the lack of spatial triplet annotation. We analyze how the amount of instrument spatial annotations affects triplet detection and observe that accurate instrument localization does not guarantee better triplet detection due to the risk of erroneous associations with the verbs and targets. To solve the two tasks, we propose MCIT-IG, a two-stage network, that stands for Multi-Class Instrument-aware Transformer-Interaction Graph. The MCIT stage of our network models per class embedding of the targets as additional features to reduce the risk of misassociating triplets. Furthermore, the IG stage constructs a bipartite dynamic graph to model the interaction between the instruments and targets, cast as the verbs. We utilize a mixed-supervised learning strategy that combines weak target presence labels for MCIT and pseudo triplet labels for IG to train our network. We observed that complementing minimal instrument spatial annotations with target embeddings results in better triplet detection. We evaluate our model on the CholecT50 dataset and show improved performance on both instrument localization and triplet detection, topping the leaderboard of the CholecTriplet challenge in MICCAI 2022.

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arXiv2023

CholecTriplet2022: Show me a tool and tell me the triplet -- an endoscopic vision challenge for surgical action triplet detection

Formalizing surgical activities as triplets of the used instruments, actions performed, and target anatomies is becoming a gold standard approach for surgical activity modeling. The benefit is that this formalization helps to obtain a more detailed understanding of tool-tissue interaction which can be used to develop better Artificial Intelligence assistance for image-guided surgery. Earlier efforts and the CholecTriplet challenge introduced in 2021 have put together techniques aimed at recognizing these triplets from surgical footage. Estimating also the spatial locations of the triplets would offer a more precise intraoperative context-aware decision support for computer-assisted intervention. This paper presents the CholecTriplet2022 challenge, which extends surgical action triplet modeling from recognition to detection. It includes weakly-supervised bounding box localization of every visible surgical instrument (or tool), as the key actors, and the modeling of each tool-activity in the form of triplet. The paper describes a baseline method and 10 new deep learning algorithms presented at the challenge to solve the task. It also provides thorough methodological comparisons of the methods, an in-depth analysis of the obtained results across multiple metrics, visual and procedural challenges; their significance, and useful insights for future research directions and applications in surgery.

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arXiv2023

Rendezvous in Time: An Attention-based Temporal Fusion approach for Surgical Triplet Recognition

One of the recent advances in surgical AI is the recognition of surgical activities as triplets of (instrument, verb, target). Albeit providing detailed information for computer-assisted intervention, current triplet recognition approaches rely only on single frame features. Exploiting the temporal cues from earlier frames would improve the recognition of surgical action triplets from videos. In this paper, we propose Rendezvous in Time (RiT) - a deep learning model that extends the state-of-the-art model, Rendezvous, with temporal modeling. Focusing more on the verbs, our RiT explores the connectedness of current and past frames to learn temporal attention-based features for enhanced triplet recognition. We validate our proposal on the challenging surgical triplet dataset, CholecT45, demonstrating an improved recognition of the verb and triplet along with other interactions involving the verb such as (instrument, verb). Qualitative results show that the RiT produces smoother predictions for most triplet instances than the state-of-the-arts. We present a novel attention-based approach that leverages the temporal fusion of video frames to model the evolution of surgical actions and exploit their benefits for surgical triplet recognition.

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arXiv2023

Live Laparoscopic Video Retrieval with Compressed Uncertainty

Searching through large volumes of medical data to retrieve relevant information is a challenging yet crucial task for clinical care. However the primitive and most common approach to retrieval, involving text in the form of keywords, is severely limited when dealing with complex media formats. Content-based retrieval offers a way to overcome this limitation, by using rich media as the query itself. Surgical video-to-video retrieval in particular is a new and largely unexplored research problem with high clinical value, especially in the real-time case: using real-time video hashing, search can be achieved directly inside of the operating room. Indeed, the process of hashing converts large data entries into compact binary arrays or hashes, enabling large-scale search operations at a very fast rate. However, due to fluctuations over the course of a video, not all bits in a given hash are equally reliable. In this work, we propose a method capable of mitigating this uncertainty while maintaining a light computational footprint. We present superior retrieval results (3-4 % top 10 mean average precision) on a multi-task evaluation protocol for surgery, using cholecystectomy phases, bypass phases, and coming from an entirely new dataset introduced here, critical events across six different surgery types. Success on this multi-task benchmark shows the generalizability of our approach for surgical video retrieval.

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arXiv2023

Preserving Privacy in Surgical Video Analysis Using Artificial Intelligence: A Deep Learning Classifier to Identify Out-of-Body Scenes in Endoscopic Videos

Objective: To develop and validate a deep learning model for the identification of out-of-body images in endoscopic videos. Background: Surgical video analysis facilitates education and research. However, video recordings of endoscopic surgeries can contain privacy-sensitive information, especially if out-of-body scenes are recorded. Therefore, identification of out-of-body scenes in endoscopic videos is of major importance to preserve the privacy of patients and operating room staff. Methods: A deep learning model was trained and evaluated on an internal dataset of 12 different types of laparoscopic and robotic surgeries. External validation was performed on two independent multicentric test datasets of laparoscopic gastric bypass and cholecystectomy surgeries. All images extracted from the video datasets were annotated as inside or out-of-body. Model performance was evaluated compared to human ground truth annotations measuring the receiver operating characteristic area under the curve (ROC AUC). Results: The internal dataset consisting of 356,267 images from 48 videos and the two multicentric test datasets consisting of 54,385 and 58,349 images from 10 and 20 videos, respectively, were annotated. Compared to ground truth annotations, the model identified out-of-body images with 99.97% ROC AUC on the internal test dataset. Mean $\pm$ standard deviation ROC AUC on the multicentric gastric bypass dataset was 99.94$\pm$0.07% and 99.71$\pm$0.40% on the multicentric cholecystectomy dataset, respectively. Conclusion: The proposed deep learning model can reliably identify out-of-body images in endoscopic videos. The trained model is publicly shared. This facilitates privacy preservation in surgical video analysis.

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arXiv2023

Weakly Supervised Temporal Convolutional Networks for Fine-grained Surgical Activity Recognition

Automatic recognition of fine-grained surgical activities, called steps, is a challenging but crucial task for intelligent intra-operative computer assistance. The development of current vision-based activity recognition methods relies heavily on a high volume of manually annotated data. This data is difficult and time-consuming to generate and requires domain-specific knowledge. In this work, we propose to use coarser and easier-to-annotate activity labels, namely phases, as weak supervision to learn step recognition with fewer step annotated videos. We introduce a step-phase dependency loss to exploit the weak supervision signal. We then employ a Single-Stage Temporal Convolutional Network (SS-TCN) with a ResNet-50 backbone, trained in an end-to-end fashion from weakly annotated videos, for temporal activity segmentation and recognition. We extensively evaluate and show the effectiveness of the proposed method on a large video dataset consisting of 40 laparoscopic gastric bypass procedures and the public benchmark CATARACTS containing 50 cataract surgeries.

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arXiv2022

CholecTriplet2021: A benchmark challenge for surgical action triplet recognition

Context-aware decision support in the operating room can foster surgical safety and efficiency by leveraging real-time feedback from surgical workflow analysis. Most existing works recognize surgical activities at a coarse-grained level, such as phases, steps or events, leaving out fine-grained interaction details about the surgical activity; yet those are needed for more helpful AI assistance in the operating room. Recognizing surgical actions as triplets of combination delivers comprehensive details about the activities taking place in surgical videos. This paper presents CholecTriplet2021: an endoscopic vision challenge organized at MICCAI 2021 for the recognition of surgical action triplets in laparoscopic videos. The challenge granted private access to the large-scale CholecT50 dataset, which is annotated with action triplet information. In this paper, we present the challenge setup and assessment of the state-of-the-art deep learning methods proposed by the participants during the challenge. A total of 4 baseline methods from the challenge organizers and 19 new deep learning algorithms by competing teams are presented to recognize surgical action triplets directly from surgical videos, achieving mean average precision (mAP) ranging from 4.2% to 38.1%. This study also analyzes the significance of the results obtained by the presented approaches, performs a thorough methodological comparison between them, in-depth result analysis, and proposes a novel ensemble method for enhanced recognition. Our analysis shows that surgical workflow analysis is not yet solved, and also highlights interesting directions for future research on fine-grained surgical activity recognition which is of utmost importance for the development of AI in surgery.

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arXiv2022

Rendezvous: Attention Mechanisms for the Recognition of Surgical Action Triplets in Endoscopic Videos

Out of all existing frameworks for surgical workflow analysis in endoscopic videos, action triplet recognition stands out as the only one aiming to provide truly fine-grained and comprehensive information on surgical activities. This information, presented as combinations, is highly challenging to be accurately identified. Triplet components can be difficult to recognize individually; in this task, it requires not only performing recognition simultaneously for all three triplet components, but also correctly establishing the data association between them. To achieve this task, we introduce our new model, the Rendezvous (RDV), which recognizes triplets directly from surgical videos by leveraging attention at two different levels. We first introduce a new form of spatial attention to capture individual action triplet components in a scene; called Class Activation Guided Attention Mechanism (CAGAM). This technique focuses on the recognition of verbs and targets using activations resulting from instruments. To solve the association problem, our RDV model adds a new form of semantic attention inspired by Transformer networks; called Multi-Head of Mixed Attention (MHMA). This technique uses several cross and self attentions to effectively capture relationships between instruments, verbs, and targets. We also introduce CholecT50 - a dataset of 50 endoscopic videos in which every frame has been annotated with labels from 100 triplet classes. Our proposed RDV model significantly improves the triplet prediction mean AP by over 9% compared to the state-of-the-art methods on this dataset.

cs.CV↗
arXiv2021

Temporally Constrained Neural Networks (TCNN): A framework for semi-supervised video semantic segmentation

A major obstacle to building models for effective semantic segmentation, and particularly video semantic segmentation, is a lack of large and well annotated datasets. This bottleneck is particularly prohibitive in highly specialized and regulated fields such as medicine and surgery, where video semantic segmentation could have important applications but data and expert annotations are scarce. In these settings, temporal clues and anatomical constraints could be leveraged during training to improve performance. Here, we present Temporally Constrained Neural Networks (TCNN), a semi-supervised framework used for video semantic segmentation of surgical videos. In this work, we show that autoencoder networks can be used to efficiently provide both spatial and temporal supervisory signals to train deep learning models. We test our method on a newly introduced video dataset of laparoscopic cholecystectomy procedures, Endoscapes, and an adaptation of a public dataset of cataract surgeries, CaDIS. We demonstrate that lower-dimensional representations of predicted masks can be leveraged to provide a consistent improvement on both sparsely labeled datasets with no additional computational cost at inference time. Further, the TCNN framework is model-agnostic and can be used in conjunction with other model design choices with minimal additional complexity.

cs.CV↗
arXiv2021

Intraoperative time out to promote the implementation of the critical view of safety in laparoscopic cholecystectomy: a video-based assessment of 343 procedures

Background: The critical view of safety (CVS) is poorly adopted in surgical practices although it is ubiquitously recommended to prevent major bile duct injuries during laparoscopic cholecystectomy (LC). This study aims to determine whether performing a short intraoperative time out can improve CVS implementation. Methods: Surgeons performing LCs at an academic centre were invited to perform a 5-second long time out to verify CVS before dividing the cystic duct (5-second rule). The primary endpoint was to compare the rate of CVS achievement between LCs performed in the year before and the year after the 5-second rule. The CVS achievement rate was computed using the mediated video-based assessment of two independent reviewers. Clinical outcomes, LC workflows, and postoperative reports were also compared. Results: Three hundred and forty-three (171 before and 172 after the 5-second rule) of the 381 LCs performed over the 2-year study were analysed. After the implementation of the 5-second rule, the rate of CVS achievement increased significantly (15.9 vs 44.1 %; P<0.001) as well as the rate of bailout procedures (8.2 vs 15.7 %; P=0.045), the median time to clip the cystic duct or artery (17:26 [interquartile range: 16:46] vs 23:12 [17:16] minutes; P=0.007), and the rate of postoperative CVS reporting (1.3 vs 28.8 %; P<0.001). Morbidity was comparable (1.75 vs 2.33 % before and after the 5-second rule respectively; P=0.685). Conclusion: Performing a short intraoperative time out improves CVS implementation during LC. Systematic intraoperative cognitive aids should be studied to sustain the uptake of guidelines.

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arXiv2021

Multi-Task Temporal Convolutional Networks for Joint Recognition of Surgical Phases and Steps in Gastric Bypass Procedures

Purpose: Automatic segmentation and classification of surgical activity is crucial for providing advanced support in computer-assisted interventions and autonomous functionalities in robot-assisted surgeries. Prior works have focused on recognizing either coarse activities, such as phases, or fine-grained activities, such as gestures. This work aims at jointly recognizing two complementary levels of granularity directly from videos, namely phases and steps. Method: We introduce two correlated surgical activities, phases and steps, for the laparoscopic gastric bypass procedure. We propose a Multi-task Multi-Stage Temporal Convolutional Network (MTMS-TCN) along with a multi-task Convolutional Neural Network (CNN) training setup to jointly predict the phases and steps and benefit from their complementarity to better evaluate the execution of the procedure. We evaluate the proposed method on a large video dataset consisting of 40 surgical procedures (Bypass40). Results: We present experimental results from several baseline models for both phase and step recognition on the Bypass40 dataset. The proposed MTMS-TCN method outperforms in both phase and step recognition by 1-2% in accuracy, precision and recall, compared to single-task methods. Furthermore, for step recognition, MTMS-TCN achieves a superior performance of 3-6% compared to LSTM based models in accuracy, precision, and recall. Conclusion: In this work, we present a multi-task multi-stage temporal convolutional network for surgical activity recognition, which shows improved results compared to single-task models on the Bypass40 gastric bypass dataset with multi-level annotations. The proposed method shows that the joint modeling of phases and steps is beneficial to improve the overall recognition of each type of activity.

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arXiv2020

Learning from a tiny dataset of manual annotations: a teacher/student approach for surgical phase recognition

Vision algorithms capable of interpreting scenes from a real-time video stream are necessary for computer-assisted surgery systems to achieve context-aware behavior. In laparoscopic procedures one particular algorithm needed for such systems is the identification of surgical phases, for which the current state of the art is a model based on a CNN-LSTM. A number of previous works using models of this kind have trained them in a fully supervised manner, requiring a fully annotated dataset. Instead, our work confronts the problem of learning surgical phase recognition in scenarios presenting scarce amounts of annotated data (under 25% of all available video recordings). We propose a teacher/student type of approach, where a strong predictor called the teacher, trained beforehand on a small dataset of ground truth-annotated videos, generates synthetic annotations for a larger dataset, which another model - the student - learns from. In our case, the teacher features a novel CNN-biLSTM-CRF architecture, designed for offline inference only. The student, on the other hand, is a CNN-LSTM capable of making real-time predictions. Results for various amounts of manually annotated videos demonstrate the superiority of the new CNN-biLSTM-CRF predictor as well as improved performance from the CNN-LSTM trained using synthetic labels generated for unannotated videos. For both offline and online surgical phase recognition with very few annotated recordings available, this new teacher/student strategy provides a valuable performance improvement by efficiently leveraging the unannotated data.

cs.LG↗
arXiv2020

Recognition of Instrument-Tissue Interactions in Endoscopic Videos via Action Triplets

Recognition of surgical activity is an essential component to develop context-aware decision support for the operating room. In this work, we tackle the recognition of fine-grained activities, modeled as action triplets representing the tool activity. To this end, we introduce a new laparoscopic dataset, CholecT40, consisting of 40 videos from the public dataset Cholec80 in which all frames have been annotated using 128 triplet classes. Furthermore, we present an approach to recognize these triplets directly from the video data. It relies on a module called Class Activation Guide (CAG), which uses the instrument activation maps to guide the verb and target recognition. To model the recognition of multiple triplets in the same frame, we also propose a trainable 3D Interaction Space, which captures the associations between the triplet components. Finally, we demonstrate the significance of these contributions via several ablation studies and comparisons to baselines on CholecT40.

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arXiv2019

Future-State Predicting LSTM for Early Surgery Type Recognition

This work presents a novel approach for the early recognition of the type of a laparoscopic surgery from its video. Early recognition algorithms can be beneficial to the development of 'smart' OR systems that can provide automatic context-aware assistance, and also enable quick database indexing. The task is however ridden with challenges specific to videos belonging to the domain of laparoscopy, such as high visual similarity across surgeries and large variations in video durations. To capture the spatio-temporal dependencies in these videos, we choose as our model a combination of a Convolutional Neural Network (CNN) and Long Short-Term Memory (LSTM) network. We then propose two complementary approaches for improving early recognition performance. The first approach is a CNN fine-tuning method that encourages surgeries to be distinguished based on the initial frames of laparoscopic videos. The second approach, referred to as 'Future-State Predicting LSTM', trains an LSTM to predict information related to future frames, which helps in distinguishing between the different types of surgeries. We evaluate our approaches on a large dataset of 425 laparoscopic videos containing 9 types of surgeries (Laparo425), and achieve on average an accuracy of 75% having observed only the first 10 minutes of a surgery. These results are quite promising from a practical standpoint and also encouraging for other types of image-guided surgeries.

cs.CV↗
arXiv2019

Weakly Supervised Convolutional LSTM Approach for Tool Tracking in Laparoscopic Videos

Purpose: Real-time surgical tool tracking is a core component of the future intelligent operating room (OR), because it is highly instrumental to analyze and understand the surgical activities. Current methods for surgical tool tracking in videos need to be trained on data in which the spatial positions of the tools are manually annotated. Generating such training data is difficult and time-consuming. Instead, we propose to use solely binary presence annotations to train a tool tracker for laparoscopic videos. Methods: The proposed approach is composed of a CNN + Convolutional LSTM (ConvLSTM) neural network trained end-to-end, but weakly supervised on tool binary presence labels only. We use the ConvLSTM to model the temporal dependencies in the motion of the surgical tools and leverage its spatio-temporal ability to smooth the class peak activations in the localization heat maps (Lh-maps). Results: We build a baseline tracker on top of the CNN model and demonstrate that our approach based on the ConvLSTM outperforms the baseline in tool presence detection, spatial localization, and motion tracking by over 5.0%, 13.9%, and 12.6%, respectively. Conclusions: In this paper, we demonstrate that binary presence labels are sufficient for training a deep learning tracking model using our proposed method. We also show that the ConvLSTM can leverage the spatio-temporal coherence of consecutive image frames across a surgical video to improve tool presence detection, spatial localization, and motion tracking. keywords: Surgical workflow analysis, tool tracking, weak supervision, spatio-temporal coherence, ConvLSTM, endoscopic videos

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