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Mathias Unberath

Publications and source records attributed to Mathias Unberath.

At least 55 records · Page 3Linked to original sources

Detecting Dataset Bias in Medical AI: A Generalized and Modality-Agnostic Auditing Framework

Artificial Intelligence (AI) is now firmly at the center of evidence-based medicine. Despite many success stories that edge the path of AI's rise in healthcare, there are comparably many reports of significant shortcomings and unexpected behavior of AI in deployment. A major reason for these limitations is AI's reliance on association-based learning, where non-representative machine learning datasets can amplify latent bias during training and/or hide it during testing. To unlock new tools capable of foreseeing and preventing such AI bias issues, we present G-AUDIT. Generalized Attribute Utility and Detectability-Induced bias Testing (G-AUDIT) for datasets is a modality-agnostic dataset auditing framework that allows for generating targeted hypotheses about sources of bias in training or testing data. Our method examines the relationship between task-level annotations (commonly referred to as ``labels'') and data properties including patient attributes (e.g., age, sex) and environment/acquisition characteristics (e.g., clinical site, imaging protocols). G-AUDIT quantifies the extent to which the observed data attributes pose a risk for shortcut learning, or in the case of testing data, might hide predictions made based on spurious associations. We demonstrate the broad applicability of our method by analyzing large-scale medical datasets for three distinct modalities and machine learning tasks: skin lesion classification in images, stigmatizing language classification in Electronic Health Records (EHR), and mortality prediction for ICU tabular data. In each setting, G-AUDIT successfully identifies subtle biases commonly overlooked by traditional qualitative methods, underscoring its practical value in exposing dataset-level risks and supporting the downstream development of reliable AI systems.

cs.LG↗

Reasoning Segmentation for Images and Videos: A Survey

Reasoning Segmentation (RS) aims to delineate objects based on implicit text queries, the interpretation of which requires reasoning and knowledge integration. Unlike the traditional formulation of segmentation problems that relies on fixed semantic categories or explicit prompting, RS bridges the gap between visual perception and human-like reasoning capabilities, facilitating more intuitive human-AI interaction through natural language. Our work presents the first comprehensive survey of RS for image and video processing, examining 26 state-of-the-art methods together with a review of the corresponding evaluation metrics, as well as 29 datasets and benchmarks. We also explore existing applications of RS across diverse domains and identify their potential extensions. Finally, we identify current research gaps and highlight promising future directions.

cs.CV↗

RVTBench: A Benchmark for Visual Reasoning Tasks

Visual reasoning, the capability to interpret visual input in response to implicit text query through multi-step reasoning, remains a challenge for deep learning models due to the lack of relevant benchmarks. Previous work in visual reasoning has primarily focused on reasoning segmentation, where models aim to segment objects based on implicit text queries. This paper introduces reasoning visual tasks (RVTs), a unified formulation that extends beyond traditional video reasoning segmentation to a diverse family of visual language reasoning problems, which can therefore accommodate multiple output formats including bounding boxes, natural language descriptions, and question-answer pairs. Correspondingly, we identify the limitations in current benchmark construction methods that rely solely on large language models (LLMs), which inadequately capture complex spatial-temporal relationships and multi-step reasoning chains in video due to their reliance on token representation, resulting in benchmarks with artificially limited reasoning complexity. To address this limitation, we propose a novel automated RVT benchmark construction pipeline that leverages digital twin (DT) representations as structured intermediaries between perception and the generation of implicit text queries. Based on this method, we construct RVTBench, a RVT benchmark containing 3,896 queries of over 1.2 million tokens across four types of RVT (segmentation, grounding, VQA and summary), three reasoning categories (semantic, spatial, and temporal), and four increasing difficulty levels, derived from 200 video sequences. Finally, we propose RVTagent, an agent framework for RVT that allows for zero-shot generalization across various types of RVT without task-specific fine-tuning.

cs.CV↗

Position: Foundation Models Need Digital Twin Representations

Current foundation models (FMs) rely on token representations that directly fragment continuous real-world multimodal data into discrete tokens. They limit FMs to learning real-world knowledge and relationships purely through statistical correlation rather than leveraging explicit domain knowledge. Consequently, current FMs struggle with maintaining semantic coherence across modalities, capturing fine-grained spatial-temporal dynamics, and performing causal reasoning. These limitations cannot be overcome by simply scaling up model size or expanding datasets. This position paper argues that the machine learning community should consider digital twin (DT) representations, which are outcome-driven digital representations that serve as building blocks for creating virtual replicas of physical processes, as an alternative to the token representation for building FMs. Finally, we discuss how DT representations can address these challenges by providing physically grounded representations that explicitly encode domain knowledge and preserve the continuous nature of real-world processes.

cs.LG↗

Online Reasoning Video Segmentation with Just-in-Time Digital Twins

Reasoning segmentation (RS) aims to identify and segment objects of interest based on implicit text queries. As such, RS is a catalyst for embodied AI agents, enabling them to interpret high-level commands without requiring explicit step-by-step guidance. However, current RS approaches rely heavily on the visual perception capabilities of multimodal large language models (LLMs), leading to several major limitations. First, they struggle with queries that require multiple steps of reasoning or those that involve complex spatial/temporal relationships. Second, they necessitate LLM fine-tuning, which may require frequent updates to maintain compatibility with contemporary LLMs and may increase risks of catastrophic forgetting during fine-tuning. Finally, being primarily designed for static images or offline video processing, they scale poorly to online video data. To address these limitations, we propose an agent framework that disentangles perception and reasoning for online video RS without LLM fine-tuning. Our innovation is the introduction of a just-in-time digital twin concept, where -- given an implicit query -- a LLM plans the construction of a low-level scene representation from high-level video using specialist vision models. We refer to this approach to creating a digital twin as "just-in-time" because the LLM planner will anticipate the need for specific information and only request this limited subset instead of always evaluating every specialist model. The LLM then performs reasoning on this digital twin representation to identify target objects. To evaluate our approach, we introduce a new comprehensive video reasoning segmentation benchmark comprising 200 videos with 895 implicit text queries. The benchmark spans three reasoning categories (semantic, spatial, and temporal) with three different reasoning chain complexity.

cs.CV↗

Operating Room Workflow Analysis via Reasoning Segmentation over Digital Twins

Analyzing operating room (OR) workflows to derive quantitative insights into OR efficiency is important for hospitals to maximize patient care and financial sustainability. Prior work on OR-level workflow analysis has relied on end-to-end deep neural networks. While these approaches work well in constrained settings, they are limited to the conditions specified at development time and do not offer the flexibility necessary to accommodate the OR workflow analysis needs of various OR scenarios (e.g., large academic center vs. rural provider) without data collection, annotation, and retraining. Reasoning segmentation (RS) based on foundation models offers this flexibility by enabling automated analysis of OR workflows from OR video feeds given only an implicit text query related to the objects of interest. Due to the reliance on large language model (LLM) fine-tuning, current RS approaches struggle with reasoning about semantic/spatial relationships and show limited generalization to OR video due to variations in visual characteristics and domain-specific terminology. To address these limitations, we first propose a novel digital twin (DT) representation that preserves both semantic and spatial relationships between the various OR components. Then, building on this foundation, we propose ORDiRS (Operating Room Digital twin representation for Reasoning Segmentation), an LLM-tuning-free RS framework that reformulates RS into a "reason-retrieval-synthesize" paradigm. Finally, we present ORDiRS-Agent, an LLM-based agent that decomposes OR workflow analysis queries into manageable RS sub-queries and generates responses by combining detailed textual explanations with supporting visual evidence from RS. Experimental results on both an in-house and a public OR dataset demonstrate that our ORDiRS achieves a cIoU improvement of 6.12%-9.74% compared to the existing state-of-the-arts.

eess.IV↗

Towards Robust Algorithms for Surgical Phase Recognition via Digital Twin Representation

Surgical phase recognition (SPR) is an integral component of surgical data science, enabling high-level surgical analysis. End-to-end trained neural networks that predict surgical phase directly from videos have shown excellent performance on benchmarks. However, these models struggle with robustness due to non-causal associations in the training set. Our goal is to improve model robustness to variations in the surgical videos by leveraging the digital twin (DT) paradigm -- an intermediary layer to separate high-level analysis (SPR) from low-level processing. As a proof of concept, we present a DT representation-based framework for SPR from videos. The framework employs vision foundation models with reliable low-level scene understanding to craft DT representation. We embed the DT representation in place of raw video inputs in the state-of-the-art SPR model. The framework is trained on the Cholec80 dataset and evaluated on out-of-distribution (OOD) and corrupted test samples. Contrary to the vulnerability of the baseline model, our framework demonstrates strong robustness on both OOD and corrupted samples, with a video-level accuracy of 80.3 on a highly corrupted Cholec80 test set, 67.9 on the challenging CRCD dataset, and 99.8 on an internal robotic surgery dataset, outperforming the baseline by 3.9, 16.8, and 90.9 respectively. We also find that using DT representation as an augmentation to the raw input can significantly improve model robustness. Our findings lend support to the thesis that DT representations are effective in enhancing model robustness. Future work will seek to improve the feature informativeness and incorporate interpretability for a more comprehensive framework.

cs.CV↗

Neural Finite-State Machines for Surgical Phase Recognition

Surgical phase recognition (SPR) is crucial for applications in workflow optimization, performance evaluation, and real-time intervention guidance. However, current deep learning models often struggle with fragmented predictions, failing to capture the sequential nature of surgical workflows. We propose the Neural Finite-State Machine (NFSM), a novel approach that enforces temporal coherence by integrating classical state-transition priors with modern neural networks. NFSM leverages learnable global state embeddings as unique phase identifiers and dynamic transition tables to model phase-to-phase progressions. Additionally, a future phase forecasting mechanism employs repeated frame padding to anticipate upcoming transitions. Implemented as a plug-and-play module, NFSM can be integrated into existing SPR pipelines without changing their core architectures. We demonstrate state-of-the-art performance across multiple benchmarks, including a significant improvement on the BernBypass70 dataset - raising video-level accuracy by 0.9 points and phase-level precision, recall, F1-score, and mAP by 3.8, 3.1, 3.3, and 4.1, respectively. Ablation studies confirm each component's effectiveness and the module's adaptability to various architectures. By unifying finite-state principles with deep learning, NFSM offers a robust path toward consistent, long-term surgical video analysis.

eess.IV↗

MoSFormer: Augmenting Temporal Context with Memory of Surgery for Surgical Phase Recognition

Surgical phase recognition from video enables various downstream applications. Transformer-based sliding window approaches have set the state-of-the-art by capturing rich spatial-temporal features. However, while transformers can theoretically handle arbitrary-length sequences, in practice they are limited by memory and compute constraints, resulting in fixed context windows that struggle with maintaining temporal consistency across lengthy surgical procedures. This often leads to fragmented predictions and limited procedure-level understanding. To address these challenges, we propose Memory of Surgery (MoS), a framework that enriches temporal modeling by incorporating both semantic interpretable long-term surgical history and short-term impressions. MoSFormer, our enhanced transformer architecture, integrates MoS using a carefully designed encoding and fusion mechanism. We further introduce step filtering to refine history representation and develop a memory caching pipeline to improve training and inference stability, mitigating shortcut learning and overfitting. MoSFormer demonstrates state-of-the-art performance on multiple benchmarks. On the Challenging BernBypass70 benchmark, it attains 88.0 video-level accuracy and phase-level metrics of 70.7 precision, 68.7 recall, and 66.3 F1 score, outperforming its baseline with 2.1 video-level accuracy and phase-level metrics of 4.6 precision, 3.6 recall, and 3.8 F1 score. Further studies confirms the individual and combined benefits of long-term and short-term memory components through ablation and counterfactual inference. Qualitative results shows improved temporal consistency. The augmented temporal context enables procedure-level understanding, paving the way for more comprehensive surgical video analysis.

cs.CV↗

Towards Virtual Clinical Trials of Radiology AI with Conditional Generative Modeling

Artificial intelligence (AI) is poised to transform healthcare by enabling personalized and efficient care through data-driven insights. Although radiology is at the forefront of AI adoption, in practice, the potential of AI models is often overshadowed by severe failures to generalize: AI models can have performance degradation of up to 20% when transitioning from controlled test environments to clinical use by radiologists. This mismatch raises concerns that radiologists will be misled by incorrect AI predictions in practice and/or grow to distrust AI, rendering these promising technologies practically ineffectual. Exhaustive clinical trials of AI models on abundant and diverse data is thus critical to anticipate AI model degradation when encountering varied data samples. Achieving these goals, however, is challenging due to the high costs of collecting diverse data samples and corresponding annotations. To overcome these limitations, we introduce a novel conditional generative AI model designed for virtual clinical trials (VCTs) of radiology AI, capable of realistically synthesizing full-body CT images of patients with specified attributes. By learning the joint distribution of images and anatomical structures, our model enables precise replication of real-world patient populations with unprecedented detail at this scale. We demonstrate meaningful evaluation of radiology AI models through VCTs powered by our synthetic CT study populations, revealing model degradation and facilitating algorithmic auditing for bias-inducing data attributes. Our generative AI approach to VCTs is a promising avenue towards a scalable solution to assess model robustness, mitigate biases, and safeguard patient care by enabling simpler testing and evaluation of AI models in any desired range of diverse patient populations.

cs.CV↗

An Intrinsically Explainable Approach to Detecting Vertebral Compression Fractures in CT Scans via Neurosymbolic Modeling

Vertebral compression fractures (VCFs) are a common and potentially serious consequence of osteoporosis. Yet, they often remain undiagnosed. Opportunistic screening, which involves automated analysis of medical imaging data acquired primarily for other purposes, is a cost-effective method to identify undiagnosed VCFs. In high-stakes scenarios like opportunistic medical diagnosis, model interpretability is a key factor for the adoption of AI recommendations. Rule-based methods are inherently explainable and closely align with clinical guidelines, but they are not immediately applicable to high-dimensional data such as CT scans. To address this gap, we introduce a neurosymbolic approach for VCF detection in CT volumes. The proposed model combines deep learning (DL) for vertebral segmentation with a shape-based algorithm (SBA) that analyzes vertebral height distributions in salient anatomical regions. This allows for the definition of a rule set over the height distributions to detect VCFs. Evaluation of VerSe19 dataset shows that our method achieves an accuracy of 96% and a sensitivity of 91% in VCF detection. In comparison, a black box model, DenseNet, achieved an accuracy of 95% and sensitivity of 91% in the same dataset. Our results demonstrate that our intrinsically explainable approach can match or surpass the performance of black box deep neural networks while providing additional insights into why a prediction was made. This transparency can enhance clinician's trust thus, supporting more informed decision-making in VCF diagnosis and treatment planning.

cs.LG↗

Memorizing SAM: 3D Medical Segment Anything Model with Memorizing Transformer

Segment Anything Models (SAMs) have gained increasing attention in medical image analysis due to their zero-shot generalization capability in segmenting objects of unseen classes and domains when provided with appropriate user prompts. Addressing this performance gap is important to fully leverage the pre-trained weights of SAMs, particularly in the domain of volumetric medical image segmentation, where accuracy is important but well-annotated 3D medical data for fine-tuning is limited. In this work, we investigate whether introducing the memory mechanism as a plug-in, specifically the ability to memorize and recall internal representations of past inputs, can improve the performance of SAM with limited computation cost. To this end, we propose Memorizing SAM, a novel 3D SAM architecture incorporating a memory Transformer as a plug-in. Unlike conventional memorizing Transformers that save the internal representation during training or inference, our Memorizing SAM utilizes existing highly accurate internal representation as the memory source to ensure the quality of memory. We evaluate the performance of Memorizing SAM in 33 categories from the TotalSegmentator dataset, which indicates that Memorizing SAM can outperform state-of-the-art 3D SAM variant i.e., FastSAM3D with an average Dice increase of 11.36% at the cost of only 4.38 millisecond increase in inference time. The source code is publicly available at https://github.com/swedfr/memorizingSAM

cs.CV↗

Intelligent Control of Robotic X-ray Devices using a Language-promptable Digital Twin

Natural language offers a convenient, flexible interface for controlling robotic C-arm X-ray systems, making advanced functionality and controls accessible. However, enabling language interfaces requires specialized AI models that interpret X-ray images to create a semantic representation for reasoning. The fixed outputs of such AI models limit the functionality of language controls. Incorporating flexible, language-aligned AI models prompted through language enables more versatile interfaces for diverse tasks and procedures. Using a language-aligned foundation model for X-ray image segmentation, our system continually updates a patient digital twin based on sparse reconstructions of desired anatomical structures. This supports autonomous capabilities such as visualization, patient-specific viewfinding, and automatic collimation from novel viewpoints, enabling commands 'Focus in on the lower lumbar vertebrae.' In a cadaver study, users visualized, localized, and collimated structures across the torso using verbal commands, achieving 84% end-to-end success. Post hoc analysis of randomly oriented images showed our patient digital twin could localize 35 commonly requested structures to within 51.68 mm, enabling localization and isolation from arbitrary orientations. Our results demonstrate how intelligent robotic X-ray systems can incorporate physicians' expressed intent directly. While existing foundation models for intra-operative X-ray analysis exhibit failure modes, as they improve, they can facilitate highly flexible, intelligent robotic C-arms.

cs.RO↗

ConceptAgent: LLM-Driven Precondition Grounding and Tree Search for Robust Task Planning and Execution

Robotic planning and execution in open-world environments is a complex problem due to the vast state spaces and high variability of task embodiment. Recent advances in perception algorithms, combined with Large Language Models (LLMs) for planning, offer promising solutions to these challenges, as the common sense reasoning capabilities of LLMs provide a strong heuristic for efficiently searching the action space. However, prior work fails to address the possibility of hallucinations from LLMs, which results in failures to execute the planned actions largely due to logical fallacies at high- or low-levels. To contend with automation failure due to such hallucinations, we introduce ConceptAgent, a natural language-driven robotic platform designed for task execution in unstructured environments. With a focus on scalability and reliability of LLM-based planning in complex state and action spaces, we present innovations designed to limit these shortcomings, including 1) Predicate Grounding to prevent and recover from infeasible actions, and 2) an embodied version of LLM-guided Monte Carlo Tree Search with self reflection. In simulation experiments, ConceptAgent achieved a 19% task completion rate across three room layouts and 30 easy level embodied tasks outperforming other state-of-the-art LLM-driven reasoning baselines that scored 10.26% and 8.11% on the same benchmark. Additionally, ablation studies on moderate to hard embodied tasks revealed a 20% increase in task completion from the baseline agent to the fully enhanced ConceptAgent, highlighting the individual and combined contributions of Predicate Grounding and LLM-guided Tree Search to enable more robust automation in complex state and action spaces.

cs.AI↗

StraightTrack: Towards Mixed Reality Navigation System for Percutaneous K-wire Insertion

In percutaneous pelvic trauma surgery, accurate placement of Kirschner wires (K-wires) is crucial to ensure effective fracture fixation and avoid complications due to breaching the cortical bone along an unsuitable trajectory. Surgical navigation via mixed reality (MR) can help achieve precise wire placement in a low-profile form factor. Current approaches in this domain are as yet unsuitable for real-world deployment because they fall short of guaranteeing accurate visual feedback due to uncontrolled bending of the wire. To ensure accurate feedback, we introduce StraightTrack, an MR navigation system designed for percutaneous wire placement in complex anatomy. StraightTrack features a marker body equipped with a rigid access cannula that mitigates wire bending due to interactions with soft tissue and a covered bony surface. Integrated with an Optical See-Through Head-Mounted Display (OST HMD) capable of tracking the cannula body, StraightTrack offers real-time 3D visualization and guidance without external trackers, which are prone to losing line-of-sight. In phantom experiments with two experienced orthopedic surgeons, StraightTrack improves wire placement accuracy, achieving the ideal trajectory within $5.26 \pm 2.29$ mm and $2.88 \pm 1.49$ degree, compared to over 12.08 mm and 4.07 degree for comparable methods. As MR navigation systems continue to mature, StraightTrack realizes their potential for internal fracture fixation and other percutaneous orthopedic procedures.

cs.RO↗

Seamless Augmented Reality Integration in Arthroscopy: A Pipeline for Articular Reconstruction and Guidance

Arthroscopy is a minimally invasive surgical procedure used to diagnose and treat joint problems. The clinical workflow of arthroscopy typically involves inserting an arthroscope into the joint through a small incision, during which surgeons navigate and operate largely by relying on their visual assessment through the arthroscope. However, the arthroscope's restricted field of view and lack of depth perception pose challenges in navigating complex articular structures and achieving surgical precision during procedures. Aiming at enhancing intraoperative awareness, we present a robust pipeline that incorporates simultaneous localization and mapping, depth estimation, and 3D Gaussian splatting to realistically reconstruct intra-articular structures solely based on monocular arthroscope video. Extending 3D reconstruction to Augmented Reality (AR) applications, our solution offers AR assistance for articular notch measurement and annotation anchoring in a human-in-the-loop manner. Compared to traditional Structure-from-Motion and Neural Radiance Field-based methods, our pipeline achieves dense 3D reconstruction and competitive rendering fidelity with explicit 3D representation in 7 minutes on average. When evaluated on four phantom datasets, our method achieves RMSE = 2.21mm reconstruction error, PSNR = 32.86 and SSIM = 0.89 on average. Because our pipeline enables AR reconstruction and guidance directly from monocular arthroscopy without any additional data and/or hardware, our solution may hold the potential for enhancing intraoperative awareness and facilitating surgical precision in arthroscopy. Our AR measurement tool achieves accuracy within 1.59 +/- 1.81mm and the AR annotation tool achieves a mIoU of 0.721.

cs.CV↗

Performance and Non-adversarial Robustness of the Segment Anything Model 2 in Surgical Video Segmentation

Fully supervised deep learning (DL) models for surgical video segmentation have been shown to struggle with non-adversarial, real-world corruptions of image quality including smoke, bleeding, and low illumination. Foundation models for image segmentation, such as the segment anything model (SAM) that focuses on interactive prompt-based segmentation, move away from semantic classes and thus can be trained on larger and more diverse data, which offers outstanding zero-shot generalization with appropriate user prompts. Recently, building upon this success, SAM-2 has been proposed to further extend the zero-shot interactive segmentation capabilities from independent frame-by-frame to video segmentation. In this paper, we present a first experimental study evaluating SAM-2's performance on surgical video data. Leveraging the SegSTRONG-C MICCAI EndoVIS 2024 sub-challenge dataset, we assess SAM-2's effectiveness on uncorrupted endoscopic sequences and evaluate its non-adversarial robustness on videos with corrupted image quality simulating smoke, bleeding, and low brightness conditions under various prompt strategies. Our experiments demonstrate that SAM-2, in zero-shot manner, can achieve competitive or even superior performance compared to fully-supervised deep learning models on surgical video data, including under non-adversarial corruptions of image quality. Additionally, SAM-2 consistently outperforms the original SAM and its medical variants across all conditions. Finally, frame-sparse prompting can consistently outperform frame-wise prompting for SAM-2, suggesting that allowing SAM-2 to leverage its temporal modeling capabilities leads to more coherent and accurate segmentation compared to frequent prompting.

eess.IV↗

FastSAM-3DSlicer: A 3D-Slicer Extension for 3D Volumetric Segment Anything Model with Uncertainty Quantification

Accurate segmentation of anatomical structures and pathological regions in medical images is crucial for diagnosis, treatment planning, and disease monitoring. While the Segment Anything Model (SAM) and its variants have demonstrated impressive interactive segmentation capabilities on image types not seen during training without the need for domain adaptation or retraining, their practical application in volumetric 3D medical imaging workflows has been hindered by the lack of a user-friendly interface. To address this challenge, we introduce FastSAM-3DSlicer, a 3D Slicer extension that integrates both 2D and 3D SAM models, including SAM-Med2D, MedSAM, SAM-Med3D, and FastSAM-3D. Building on the well-established open-source 3D Slicer platform, our extension enables efficient, real-time segmentation of 3D volumetric medical images, with seamless interaction and visualization. By automating the handling of raw image data, user prompts, and segmented masks, FastSAM-3DSlicer provides a streamlined, user-friendly interface that can be easily incorporated into medical image analysis workflows. Performance evaluations reveal that the FastSAM-3DSlicer extension running FastSAM-3D achieves low inference times of only 1.09 seconds per volume on CPU and 0.73 seconds per volume on GPU, making it well-suited for real-time interactive segmentation. Moreover, we introduce an uncertainty quantification scheme that leverages the rapid inference capabilities of FastSAM-3D for practical implementation, further enhancing its reliability and applicability in medical settings. FastSAM-3DSlicer offers an interactive platform and user interface for 2D and 3D interactive volumetric medical image segmentation, offering a powerful combination of efficiency, precision, and ease of use with SAMs. The source code and a video demonstration are publicly available at https://github.com/arcadelab/FastSAM3D_slicer.

eess.IV↗