arXiv subjects

Mathias Unberath

Publications and source records attributed to Mathias Unberath.

At least 73 records · Page 4Linked to original sources

arXiv2024

Promptable Counterfactual Diffusion Model for Unified Brain Tumor Segmentation and Generation with MRIs

Brain tumor analysis in Magnetic Resonance Imaging (MRI) is crucial for accurate diagnosis and treatment planning. However, the task remains challenging due to the complexity and variability of tumor appearances, as well as the scarcity of labeled data. Traditional approaches often address tumor segmentation and image generation separately, limiting their effectiveness in capturing the intricate relationships between healthy and pathological tissue structures. We introduce a novel promptable counterfactual diffusion model as a unified solution for brain tumor segmentation and generation in MRI. The key innovation lies in our mask-level prompting mechanism at the sampling stage, which enables guided generation and manipulation of specific healthy or unhealthy regions in MRI images. Specifically, the model's architecture allows for bidirectional inference, which can segment tumors in existing images and generate realistic tumor structures in healthy brain scans. Furthermore, we present a two-step approach for tumor generation and position transfer, showcasing the model's versatility in synthesizing realistic tumor structures. Experiments on the BRATS2021 dataset demonstrate that our method outperforms traditional counterfactual diffusion approaches, achieving a mean IoU of 0.653 and mean Dice score of 0.785 for tumor segmentation, outperforming the 0.344 and 0.475 of conventional counterfactual diffusion model. Our work contributes to improving brain tumor detection and segmentation accuracy, with potential implications for data augmentation and clinical decision support in neuro-oncology. The code is available at https://github.com/arcadelab/counterfactual_diffusion.

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arXiv2024

Explainable AI Enhances Glaucoma Referrals, Yet the Human-AI Team Still Falls Short of the AI Alone

Primary care providers are vital for initial triage and referrals to specialty care. In glaucoma, asymptomatic and fast progression can lead to vision loss, necessitating timely referrals to specialists. However, primary eye care providers may not identify urgent cases, potentially delaying care. Artificial Intelligence (AI) offering explanations could enhance their referral decisions. We investigate how various AI explanations help providers distinguish between patients needing immediate or non-urgent specialist referrals. We built explainable AI algorithms to predict glaucoma surgery needs from routine eyecare data as a proxy for identifying high-risk patients. We incorporated intrinsic and post-hoc explainability and conducted an online study with optometrists to assess human-AI team performance, measuring referral accuracy and analyzing interactions with AI, including agreement rates, task time, and user experience perceptions. AI support enhanced referral accuracy among 87 participants (59.9%/50.8% with/without AI), though Human-AI teams underperformed compared to AI alone. Participants believed they included AI advice more when using the intrinsic model, and perceived it more useful and promising. Without explanations, deviations from AI recommendations increased. AI support did not increase workload, confidence, and trust, but reduced challenges. On a separate test set, our black-box and intrinsic models achieved an accuracy of 77% and 71%, respectively, in predicting surgical outcomes. We identify opportunities of human-AI teaming for glaucoma management in primary eye care, noting that while AI enhances referral accuracy, it also shows a performance gap compared to AI alone, even with explanations. Human involvement remains essential in medical decision making, underscoring the need for future research to optimize collaboration, ensuring positive experiences and safe AI use.

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arXiv2024

Human-AI collaboration is not very collaborative yet: A taxonomy of interaction patterns in AI-assisted decision making from a systematic review

Leveraging Artificial Intelligence (AI) in decision support systems has disproportionately focused on technological advancements, often overlooking the alignment between algorithmic outputs and human expectations. A human-centered perspective attempts to alleviate this concern by designing AI solutions for seamless integration with existing processes. Determining what information AI should provide to aid humans is vital, a concept underscored by explainable AI's efforts to justify AI predictions. However, how the information is presented, e.g., the sequence of recommendations and solicitation of interpretations, is equally crucial as complex interactions may emerge between humans and AI. While empirical studies have evaluated human-AI dynamics across domains, a common vocabulary for human-AI interaction protocols is lacking. To promote more deliberate consideration of interaction designs, we introduce a taxonomy of interaction patterns that delineate various modes of human-AI interactivity. We summarize the results of a systematic review of AI-assisted decision making literature and identify trends and opportunities in existing interactions across application domains from 105 articles. We find that current interactions are dominated by simplistic collaboration paradigms, leading to little support for truly interactive functionality. Our taxonomy offers a tool to understand interactivity with AI in decision-making and foster interaction designs for achieving clear communication, trustworthiness, and collaboration.

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arXiv2024

FastSAM3D: An Efficient Segment Anything Model for 3D Volumetric Medical Images

Segment anything models (SAMs) are gaining attention for their zero-shot generalization capability in segmenting objects of unseen classes and in unseen domains when properly prompted. Interactivity is a key strength of SAMs, allowing users to iteratively provide prompts that specify objects of interest to refine outputs. However, to realize the interactive use of SAMs for 3D medical imaging tasks, rapid inference times are necessary. High memory requirements and long processing delays remain constraints that hinder the adoption of SAMs for this purpose. Specifically, while 2D SAMs applied to 3D volumes contend with repetitive computation to process all slices independently, 3D SAMs suffer from an exponential increase in model parameters and FLOPS. To address these challenges, we present FastSAM3D which accelerates SAM inference to 8 milliseconds per 128*128*128 3D volumetric image on an NVIDIA A100 GPU. This speedup is accomplished through 1) a novel layer-wise progressive distillation scheme that enables knowledge transfer from a complex 12-layer ViT-B to a lightweight 6-layer ViT-Tiny variant encoder without training from scratch; and 2) a novel 3D sparse flash attention to replace vanilla attention operators, substantially reducing memory needs and improving parallelization. Experiments on three diverse datasets reveal that FastSAM3D achieves a remarkable speedup of 527.38x compared to 2D SAMs and 8.75x compared to 3D SAMs on the same volumes without significant performance decline. Thus, FastSAM3D opens the door for low-cost truly interactive SAM-based 3D medical imaging segmentation with commonly used GPU hardware. Code is available at https://github.com/arcadelab/FastSAM3D.

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arXiv2024

From Generalization to Precision: Exploring SAM for Tool Segmentation in Surgical Environments

Purpose: Accurate tool segmentation is essential in computer-aided procedures. However, this task conveys challenges due to artifacts' presence and the limited training data in medical scenarios. Methods that generalize to unseen data represent an interesting venue, where zero-shot segmentation presents an option to account for data limitation. Initial exploratory works with the Segment Anything Model (SAM) show that bounding-box-based prompting presents notable zero-short generalization. However, point-based prompting leads to a degraded performance that further deteriorates under image corruption. We argue that SAM drastically over-segment images with high corruption levels, resulting in degraded performance when only a single segmentation mask is considered, while the combination of the masks overlapping the object of interest generates an accurate prediction. Method: We use SAM to generate the over-segmented prediction of endoscopic frames. Then, we employ the ground-truth tool mask to analyze the results of SAM when the best single mask is selected as prediction and when all the individual masks overlapping the object of interest are combined to obtain the final predicted mask. We analyze the Endovis18 and Endovis17 instrument segmentation datasets using synthetic corruptions of various strengths and an In-House dataset featuring counterfactually created real-world corruptions. Results: Combining the over-segmented masks contributes to improvements in the IoU. Furthermore, selecting the best single segmentation presents a competitive IoU score for clean images. Conclusions: Combined SAM predictions present improved results and robustness up to a certain corruption level. However, appropriate prompting strategies are fundamental for implementing these models in the medical domain.

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arXiv2024

An Endoscopic Chisel: Intraoperative Imaging Carves 3D Anatomical Models

Purpose: Preoperative imaging plays a pivotal role in sinus surgery where CTs offer patient-specific insights of complex anatomy, enabling real-time intraoperative navigation to complement endoscopy imaging. However, surgery elicits anatomical changes not represented in the preoperative model, generating an inaccurate basis for navigation during surgery progression. Methods: We propose a first vision-based approach to update the preoperative 3D anatomical model leveraging intraoperative endoscopic video for navigated sinus surgery where relative camera poses are known. We rely on comparisons of intraoperative monocular depth estimates and preoperative depth renders to identify modified regions. The new depths are integrated in these regions through volumetric fusion in a truncated signed distance function representation to generate an intraoperative 3D model that reflects tissue manipulation. Results: We quantitatively evaluate our approach by sequentially updating models for a five-step surgical progression in an ex vivo specimen. We compute the error between correspondences from the updated model and ground-truth intraoperative CT in the region of anatomical modification. The resulting models show a decrease in error during surgical progression as opposed to increasing when no update is employed. Conclusion: Our findings suggest that preoperative 3D anatomical models can be updated using intraoperative endoscopy video in navigated sinus surgery. Future work will investigate improvements to monocular depth estimation as well as removing the need for external navigation systems. The resulting ability to continuously update the patient model may provide surgeons with a more precise understanding of the current anatomical state and paves the way toward a digital twin paradigm for sinus surgery.

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arXiv2023

A Quantitative Evaluation of Dense 3D Reconstruction of Sinus Anatomy from Monocular Endoscopic Video

Generating accurate 3D reconstructions from endoscopic video is a promising avenue for longitudinal radiation-free analysis of sinus anatomy and surgical outcomes. Several methods for monocular reconstruction have been proposed, yielding visually pleasant 3D anatomical structures by retrieving relative camera poses with structure-from-motion-type algorithms and fusion of monocular depth estimates. However, due to the complex properties of the underlying algorithms and endoscopic scenes, the reconstruction pipeline may perform poorly or fail unexpectedly. Further, acquiring medical data conveys additional challenges, presenting difficulties in quantitatively benchmarking these models, understanding failure cases, and identifying critical components that contribute to their precision. In this work, we perform a quantitative analysis of a self-supervised approach for sinus reconstruction using endoscopic sequences paired with optical tracking and high-resolution computed tomography acquired from nine ex-vivo specimens. Our results show that the generated reconstructions are in high agreement with the anatomy, yielding an average point-to-mesh error of 0.91 mm between reconstructions and CT segmentations. However, in a point-to-point matching scenario, relevant for endoscope tracking and navigation, we found average target registration errors of 6.58 mm. We identified that pose and depth estimation inaccuracies contribute equally to this error and that locally consistent sequences with shorter trajectories generate more accurate reconstructions. These results suggest that achieving global consistency between relative camera poses and estimated depths with the anatomy is essential. In doing so, we can ensure proper synergy between all components of the pipeline for improved reconstructions that will facilitate clinical application of this innovative technology.

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arXiv2023

Eye Tracking for Tele-robotic Surgery: A Comparative Evaluation of Head-worn Solutions

Purpose: Metrics derived from eye-gaze-tracking and pupillometry show promise for cognitive load assessment, potentially enhancing training and patient safety through user-specific feedback in tele-robotic surgery. However, current eye-tracking solutions' effectiveness in tele-robotic surgery is uncertain compared to everyday situations due to close-range interactions causing extreme pupil angles and occlusions. To assess the effectiveness of modern eye-gaze-tracking solutions in tele-robotic surgery, we compare the Tobii Pro 3 Glasses and Pupil Labs Core, evaluating their pupil diameter and gaze stability when integrated with the da Vinci Research Kit (dVRK). Methods: The study protocol includes a nine-point gaze calibration followed by pick-and-place task using the dVRK and is repeated three times. After a final calibration, users view a 3x3 grid of AprilTags, focusing on each marker for 10 seconds, to evaluate gaze stability across dVRK-screen positions with the L2-norm. Different gaze calibrations assess calibration's temporal deterioration due to head movements. Pupil diameter stability is evaluated using the FFT from the pupil diameter during the pick-and-place tasks. Users perform this routine with both head-worn eye-tracking systems. Results: Data collected from ten users indicate comparable pupil diameter stability. FFTs of pupil diameters show similar amplitudes in high-frequency components. Tobii Glasses show more temporal gaze stability compared to Pupil Labs, though both eye trackers yield a similar 4cm error in gaze estimation without an outdated calibration. Conclusion: Both eye trackers demonstrate similar stability of the pupil diameter and gaze, when the calibration is not outdated, indicating comparable eye-tracking and pupillometry performance in tele-robotic surgery settings.

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arXiv2023

MoViT: Memorizing Vision Transformers for Medical Image Analysis

The synergy of long-range dependencies from transformers and local representations of image content from convolutional neural networks (CNNs) has led to advanced architectures and increased performance for various medical image analysis tasks due to their complementary benefits. However, compared with CNNs, transformers require considerably more training data, due to a larger number of parameters and an absence of inductive bias. The need for increasingly large datasets continues to be problematic, particularly in the context of medical imaging, where both annotation efforts and data protection result in limited data availability. In this work, inspired by the human decision-making process of correlating new evidence with previously memorized experience, we propose a Memorizing Vision Transformer (MoViT) to alleviate the need for large-scale datasets to successfully train and deploy transformer-based architectures. MoViT leverages an external memory structure to cache history attention snapshots during the training stage. To prevent overfitting, we incorporate an innovative memory update scheme, attention temporal moving average, to update the stored external memories with the historical moving average. For inference speedup, we design a prototypical attention learning method to distill the external memory into smaller representative subsets. We evaluate our method on a public histology image dataset and an in-house MRI dataset, demonstrating that MoViT applied to varied medical image analysis tasks, can outperform vanilla transformer models across varied data regimes, especially in cases where only a small amount of annotated data is available. More importantly, MoViT can reach a competitive performance of ViT with only 3.0% of the training data.

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arXiv2023

RobustCLEVR: A Benchmark and Framework for Evaluating Robustness in Object-centric Learning

Object-centric representation learning offers the potential to overcome limitations of image-level representations by explicitly parsing image scenes into their constituent components. While image-level representations typically lack robustness to natural image corruptions, the robustness of object-centric methods remains largely untested. To address this gap, we present the RobustCLEVR benchmark dataset and evaluation framework. Our framework takes a novel approach to evaluating robustness by enabling the specification of causal dependencies in the image generation process grounded in expert knowledge and capable of producing a wide range of image corruptions unattainable in existing robustness evaluations. Using our framework, we define several causal models of the image corruption process which explicitly encode assumptions about the causal relationships and distributions of each corruption type. We generate dataset variants for each causal model on which we evaluate state-of-the-art object-centric methods. Overall, we find that object-centric methods are not inherently robust to image corruptions. Our causal evaluation approach exposes model sensitivities not observed using conventional evaluation processes, yielding greater insight into robustness differences across algorithms. Lastly, while conventional robustness evaluations view corruptions as out-of-distribution, we use our causal framework to show that even training on in-distribution image corruptions does not guarantee increased model robustness. This work provides a step towards more concrete and substantiated understanding of model performance and deterioration under complex corruption processes of the real-world.

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arXiv2023

TransNuSeg: A Lightweight Multi-Task Transformer for Nuclei Segmentation

Nuclei appear small in size, yet, in real clinical practice, the global spatial information and correlation of the color or brightness contrast between nuclei and background, have been considered a crucial component for accurate nuclei segmentation. However, the field of automatic nuclei segmentation is dominated by Convolutional Neural Networks (CNNs), meanwhile, the potential of the recently prevalent Transformers has not been fully explored, which is powerful in capturing local-global correlations. To this end, we make the first attempt at a pure Transformer framework for nuclei segmentation, called TransNuSeg. Different from prior work, we decouple the challenging nuclei segmentation task into an intrinsic multi-task learning task, where a tri-decoder structure is employed for nuclei instance, nuclei edge, and clustered edge segmentation respectively. To eliminate the divergent predictions from different branches in previous work, a novel self distillation loss is introduced to explicitly impose consistency regulation between branches. Moreover, to formulate the high correlation between branches and also reduce the number of parameters, an efficient attention sharing scheme is proposed by partially sharing the self-attention heads amongst the tri-decoders. Finally, a token MLP bottleneck replaces the over-parameterized Transformer bottleneck for a further reduction in model complexity. Experiments on two datasets of different modalities, including MoNuSeg have shown that our methods can outperform state-of-the-art counterparts such as CA2.5-Net by 2-3% Dice with 30% fewer parameters. In conclusion, TransNuSeg confirms the strength of Transformer in the context of nuclei segmentation, which thus can serve as an efficient solution for real clinical practice. Code is available at https://github.com/zhenqi-he/transnuseg.

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arXiv2023

Automated Artifact Detection in Ultra-widefield Fundus Photography of Patients with Sickle Cell Disease

Importance: Ultra-widefield fundus photography (UWF-FP) has shown utility in sickle cell retinopathy screening; however, image artifact may diminish quality and gradeability of images. Objective: To create an automated algorithm for UWF-FP artifact classification. Design: A neural network based automated artifact detection algorithm was designed to identify commonly encountered UWF-FP artifacts in a cross section of patient UWF-FP. A pre-trained ResNet-50 neural network was trained on a subset of the images and the classification accuracy, sensitivity, and specificity were quantified on the hold out test set. Setting: The study is based on patients from a tertiary care hospital site. Participants: There were 243 UWF-FP acquired from patients with sickle cell disease (SCD), and artifact labelling in the following categories was performed: Eyelash Present, Lower Eyelid Obstructing, Upper Eyelid Obstructing, Image Too Dark, Dark Artifact, and Image Not Centered. Results: Overall, the accuracy for each class was Eyelash Present at 83.7%, Lower Eyelid Obstructing at 83.7%, Upper Eyelid Obstructing at 98.0%, Image Too Dark at 77.6%, Dark Artifact at 93.9%, and Image Not Centered at 91.8%. Conclusions and Relevance: This automated algorithm shows promise in identifying common imaging artifacts on a subset of Optos UWF-FP in SCD patients. Further refinement is ongoing with the goal of improving efficiency of tele-retinal screening in sickle cell retinopathy (SCR) by providing a photographer real-time feedback as to the types of artifacts present, and the need for image re-acquisition. This algorithm also may have potential future applicability in other retinal diseases by improving quality and efficiency of image acquisition of UWF-FP.

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arXiv2023

Neuralangelo: High-Fidelity Neural Surface Reconstruction

Neural surface reconstruction has been shown to be powerful for recovering dense 3D surfaces via image-based neural rendering. However, current methods struggle to recover detailed structures of real-world scenes. To address the issue, we present Neuralangelo, which combines the representation power of multi-resolution 3D hash grids with neural surface rendering. Two key ingredients enable our approach: (1) numerical gradients for computing higher-order derivatives as a smoothing operation and (2) coarse-to-fine optimization on the hash grids controlling different levels of details. Even without auxiliary inputs such as depth, Neuralangelo can effectively recover dense 3D surface structures from multi-view images with fidelity significantly surpassing previous methods, enabling detailed large-scale scene reconstruction from RGB video captures.

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arXiv2023

TAToo: Vision-based Joint Tracking of Anatomy and Tool for Skull-base Surgery

Purpose: Tracking the 3D motion of the surgical tool and the patient anatomy is a fundamental requirement for computer-assisted skull-base surgery. The estimated motion can be used both for intra-operative guidance and for downstream skill analysis. Recovering such motion solely from surgical videos is desirable, as it is compliant with current clinical workflows and instrumentation. Methods: We present Tracker of Anatomy and Tool (TAToo). TAToo jointly tracks the rigid 3D motion of patient skull and surgical drill from stereo microscopic videos. TAToo estimates motion via an iterative optimization process in an end-to-end differentiable form. For robust tracking performance, TAToo adopts a probabilistic formulation and enforces geometric constraints on the object level. Results: We validate TAToo on both simulation data, where ground truth motion is available, as well as on anthropomorphic phantom data, where optical tracking provides a strong baseline. We report sub-millimeter and millimeter inter-frame tracking accuracy for skull and drill, respectively, with rotation errors below 1°. We further illustrate how TAToo may be used in a surgical navigation setting. Conclusion: We present TAToo, which simultaneously tracks the surgical tool and the patient anatomy in skull-base surgery. TAToo directly predicts the motion from surgical videos, without the need of any markers. Our results show that the performance of TAToo compares favorably to competing approaches. Future work will include fine-tuning of our depth network to reach a 1 mm clinical accuracy goal desired for surgical applications in the skull base.

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arXiv2023

Twin-S: A Digital Twin for Skull-base Surgery

Purpose: Digital twins are virtual interactive models of the real world, exhibiting identical behavior and properties. In surgical applications, computational analysis from digital twins can be used, for example, to enhance situational awareness. Methods: We present a digital twin framework for skull-base surgeries, named Twin-S, which can be integrated within various image-guided interventions seamlessly. Twin-S combines high-precision optical tracking and real-time simulation. We rely on rigorous calibration routines to ensure that the digital twin representation precisely mimics all real-world processes. Twin-S models and tracks the critical components of skull-base surgery, including the surgical tool, patient anatomy, and surgical camera. Significantly, Twin-S updates and reflects real-world drilling of the anatomical model in frame rate. Results: We extensively evaluate the accuracy of Twin-S, which achieves an average 1.39 mm error during the drilling process. We further illustrate how segmentation masks derived from the continuously updated digital twin can augment the surgical microscope view in a mixed reality setting, where bone requiring ablation is highlighted to provide surgeons additional situational awareness. Conclusion: We present Twin-S, a digital twin environment for skull-base surgery. Twin-S tracks and updates the virtual model in real-time given measurements from modern tracking technologies. Future research on complementing optical tracking with higher-precision vision-based approaches may further increase the accuracy of Twin-S.

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arXiv2023

Pelphix: Surgical Phase Recognition from X-ray Images in Percutaneous Pelvic Fixation

Surgical phase recognition (SPR) is a crucial element in the digital transformation of the modern operating theater. While SPR based on video sources is well-established, incorporation of interventional X-ray sequences has not yet been explored. This paper presents Pelphix, a first approach to SPR for X-ray-guided percutaneous pelvic fracture fixation, which models the procedure at four levels of granularity -- corridor, activity, view, and frame value -- simulating the pelvic fracture fixation workflow as a Markov process to provide fully annotated training data. Using added supervision from detection of bony corridors, tools, and anatomy, we learn image representations that are fed into a transformer model to regress surgical phases at the four granularity levels. Our approach demonstrates the feasibility of X-ray-based SPR, achieving an average accuracy of 93.8% on simulated sequences and 67.57% in cadaver across all granularity levels, with up to 88% accuracy for the target corridor in real data. This work constitutes the first step toward SPR for the X-ray domain, establishing an approach to categorizing phases in X-ray-guided surgery, simulating realistic image sequences to enable machine learning model development, and demonstrating that this approach is feasible for the analysis of real procedures. As X-ray-based SPR continues to mature, it will benefit procedures in orthopedic surgery, angiography, and interventional radiology by equipping intelligent surgical systems with situational awareness in the operating room.

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arXiv2023

Data AUDIT: Identifying Attribute Utility- and Detectability-Induced Bias in Task Models

To safely deploy deep learning-based computer vision models for computer-aided detection and diagnosis, we must ensure that they are robust and reliable. Towards that goal, algorithmic auditing has received substantial attention. To guide their audit procedures, existing methods rely on heuristic approaches or high-level objectives (e.g., non-discrimination in regards to protected attributes, such as sex, gender, or race). However, algorithms may show bias with respect to various attributes beyond the more obvious ones, and integrity issues related to these more subtle attributes can have serious consequences. To enable the generation of actionable, data-driven hypotheses which identify specific dataset attributes likely to induce model bias, we contribute a first technique for the rigorous, quantitative screening of medical image datasets. Drawing from literature in the causal inference and information theory domains, our procedure decomposes the risks associated with dataset attributes in terms of their detectability and utility (defined as the amount of information knowing the attribute gives about a task label). To demonstrate the effectiveness and sensitivity of our method, we develop a variety of datasets with synthetically inserted artifacts with different degrees of association to the target label that allow evaluation of inherited model biases via comparison of performance against true counterfactual examples. Using these datasets and results from hundreds of trained models, we show our screening method reliably identifies nearly imperceptible bias-inducing artifacts. Lastly, we apply our method to the natural attributes of a popular skin-lesion dataset and demonstrate its success. Our approach provides a means to perform more systematic algorithmic audits and guide future data collection efforts in pursuit of safer and more reliable models.

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arXiv2023

Task-based Generation of Optimized Projection Sets using Differentiable Ranking

We present a method for selecting valuable projections in computed tomography (CT) scans to enhance image reconstruction and diagnosis. The approach integrates two important factors, projection-based detectability and data completeness, into a single feed-forward neural network. The network evaluates the value of projections, processes them through a differentiable ranking function and makes the final selection using a straight-through estimator. Data completeness is ensured through the label provided during training. The approach eliminates the need for heuristically enforcing data completeness, which may exclude valuable projections. The method is evaluated on simulated data in a non-destructive testing scenario, where the aim is to maximize the reconstruction quality within a specified region of interest. We achieve comparable results to previous methods, laying the foundation for using reconstruction-based loss functions to learn the selection of projections.

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