arXiv subjects

Nassir Navab

Publications and source records attributed to Nassir Navab.

At least 73 records · Page 4Linked to original sources

arXiv2026

Towards Comprehensive Real-Time Scene Understanding in Ophthalmic Surgery through Multimodal Image Fusion

Purpose: The integration of multimodal imaging into operating rooms paves the way for comprehensive surgical scene understanding. In ophthalmic surgery, by now, two complementary imaging modalities are available: operating microscope (OPMI) imaging and real-time intraoperative optical coherence tomography (iOCT). This first work toward temporal OPMI and iOCT feature fusion demonstrates the potential of multimodal image processing for multi-head prediction through the example of precise instrument tracking in vitreoretinal surgery. Methods: We propose a multimodal, temporal, real-time capable network architecture to perform joint instrument detection, keypoint localization, and tool-tissue distance estimation. Our network design integrates a cross-attention fusion module to merge OPMI and iOCT image features, which are efficiently extracted via a YoloNAS and a CNN encoder, respectively. Furthermore, a region-based recurrent module leverages temporal coherence. Results: Our experiments demonstrate reliable instrument localization and keypoint detection (95.79% mAP50) and show that the incorporation of iOCT significantly improves tool-tissue distance estimation, while achieving real-time processing rates of 22.5 ms per frame. Especially for close distances to the retina (below 1 mm), the distance estimation accuracy improved from 284 $μm$ (OPMI only) to 33 $μm$ (multimodal). Conclusion: Feature fusion of multimodal imaging can enhance multi-task prediction accuracy compared to single-modality processing and real-time processing performance can be achieved through tailored network design. While our results demonstrate the potential of multi-modal processing for image-guided vitreoretinal surgery, they also underline key challenges that motivate future research toward more reliable, consistent, and comprehensive surgical scene understanding.

cs.CV↗

arXiv2026

CliPPER: Contextual Video-Language Pretraining on Long-form Intraoperative Surgical Procedures for Event Recognition

Video-language foundation models have proven to be highly effective in zero-shot applications across a wide range of tasks. A particularly challenging area is the intraoperative surgical procedure domain, where labeled data is scarce, and precise temporal understanding is often required for complex downstream tasks. To address this challenge, we introduce CliPPER (Contextual Video-Language Pretraining on Long-form Intraoperative Surgical Procedures for Event Recognition), a novel video-language pretraining framework trained on surgical lecture videos. Our method is designed for fine-grained temporal video-text recognition and introduces several novel pretraining strategies to improve multimodal alignment in long-form surgical videos. Specifically, we propose Contextual Video-Text Contrastive Learning (VTC_CTX) and Clip Order Prediction (COP) pretraining objectives, both of which leverage temporal and contextual dependencies to enhance local video understanding. In addition, we incorporate a Cycle-Consistency Alignment over video-text matches within the same surgical video to enforce bidirectional consistency and improve overall representation coherence. Moreover, we introduce a more refined alignment loss, Frame-Text Matching (FTM), to improve the alignment between video frames and text. As a result, our model establishes a new state-of-the-art across multiple public surgical benchmarks, including zero-shot recognition of phases, steps, instruments, and triplets. The source code and pretraining captions can be found at https://github.com/CAMMA-public/CliPPER.

cs.CV↗

arXiv2026

From Panel to Pixel: Zoom-In Vision-Language Pretraining from Biomedical Scientific Literature

There is a growing interest in developing strong biomedical vision-language models. A popular approach to achieve robust representations is to use web-scale scientific data. However, current biomedical vision-language pretraining typically compresses rich scientific figures and text into coarse figure-level pairs, discarding the fine-grained correspondences that clinicians actually rely on when zooming into local structures. To tackle this issue, we introduce Panel2Patch, a novel data pipeline that mines hierarchical structure from existing biomedical scientific literature, i.e., multi-panel, marker-heavy figures and their surrounding text, and converts them into multi-granular supervision. Given scientific figures and captions, Panel2Patch parses layouts, panels, and visual markers, then constructs hierarchical aligned vision-language pairs at the figure, panel, and patch levels, preserving local semantics instead of treating each figure as a single data sample. Built on this hierarchical corpus, we develop a granularity-aware pretraining strategy that unifies heterogeneous objectives from coarse didactic descriptions to fine region-focused phrases. By applying Panel2Patch to only a small set of the literature figures, we extract far more effective supervision than prior pipelines, enabling substantially better performance with less pretraining data.

cs.CV↗

arXiv2026

Object Pose Transformer: Unifying Unseen Object Pose Estimation

Learning model-free object pose estimation for unseen instances remains a fundamental challenge in 3D vision. Existing methods typically fall into two disjoint paradigms: category-level approaches predict absolute poses in a canonical space but rely on predefined taxonomies, while relative pose methods estimate cross-view transformations but cannot recover single-view absolute pose. In this work, we propose Object Pose Transformer (\ours{}), a unified feed-forward framework that bridges these paradigms through task factorization within a single model. \ours{} jointly predicts depth, point maps, camera parameters, and normalized object coordinates (NOCS) from RGB inputs, enabling both category-level absolute SA(3) pose and unseen-object relative SE(3) pose. Our approach leverages contrastive object-centric latent embeddings for canonicalization without requiring semantic labels at inference time, and uses point maps as a camera-space representation to enable multi-view relative geometric reasoning. Through cross-frame feature interaction and shared object embeddings, our model leverages relative geometric consistency across views to improve absolute pose estimation, reducing ambiguity in single-view predictions. Furthermore, \ours{} is camera-agnostic, learning camera intrinsics on-the-fly and supporting optional depth input for metric-scale recovery, while remaining fully functional in RGB-only settings. Extensive experiments on diverse benchmarks (NOCS, HouseCat6D, Omni6DPose, Toyota-Light) demonstrate state-of-the-art performance in both absolute and relative pose estimation tasks within a single unified architecture.

cs.CV↗

arXiv2026

Feasibility of Augmented Reality-Guided Robotic Ultrasound with Cone-Beam CT Integration for Spine Procedures

Accurate needle placement in spine interventions is critical for effective pain management, yet it depends on reliable identification of anatomical landmarks and careful trajectory planning. Conventional imaging guidance often relies both on CT and X-ray fluoroscopy, exposing patients and staff to high dose of radiation while providing limited real-time 3D feedback. We present an optical see-through augmented reality (OST-AR)-guided robotic system for spine procedures that provides in situ visualization of spinal structures to support needle trajectory planning. We integrate a cone-beam CT (CBCT)-derived 3D spine model which is co-registered with live ultrasound, enabling users to combine global anatomical context with local, real-time imaging. We evaluated the system in a phantom user study involving two representative spine procedures: facet joint injection and lumbar puncture. Sixteen participants performed insertions under two visualization conditions: conventional screen vs. AR. Results show that AR significantly reduces execution time and across-task placement error, while also improving usability, trust, and spatial understanding and lowering cognitive workload. These findings demonstrate the feasibility of AR-guided robotic ultrasound for spine interventions, highlighting its potential to enhance accuracy, efficiency, and user experience in image-guided procedures.

cs.HC↗

arXiv2026

FlowScene: Style-Consistent Indoor Scene Generation with Multimodal Graph Rectified Flow

Scene generation has extensive industrial applications, demanding both high realism and precise control over geometry and appearance. Language-driven retrieval methods compose plausible scenes from a large object database, but overlook object-level control and often fail to enforce scene-level style coherence. Graph-based formulations offer higher controllability over objects and inform holistic consistency by explicitly modeling relations, yet existing methods struggle to produce high-fidelity textured results, thereby limiting their practical utility. We present FlowScene, a tri-branch scene generative model conditioned on multimodal graphs that collaboratively generates scene layouts, object shapes, and object textures. At its core lies a tight-coupled rectified flow model that exchanges object information during generation, enabling collaborative reasoning across the graph. This enables fine-grained control of objects' shapes, textures, and relations while enforcing scene-level style coherence across structure and appearance. Extensive experiments show that FlowScene outperforms both language-conditioned and graph-conditioned baselines in terms of generation realism, style consistency, and alignment with human preferences.

cs.CV↗

arXiv2026

PanORama: Multiview Consistent Panoptic Segmentation in Operating Rooms

Operating rooms (ORs) are cluttered, dynamic, highly occluded environments, where reliable spatial understanding is essential for situational awareness during complex surgical workflows. Achieving spatial understanding for panoptic segmentation from sparse multiview images poses a fundamental challenge, as limited visibility in a subset of views often leads to mispredictions across cameras. To this end, we introduce PanORama, the first panoptic segmentation for the operating room that is multiview-consistent by design. By modeling cross-view interactions at the feature level inside the backbone in a single forward pass, view consistency emerges directly rather than through post-hoc refinement. We evaluate on the MM-OR and 4D-OR datasets, achieving >70% Panoptic Quality (PQ) performance, and outperforming the previous state of the art. Importantly, PanORama is calibration-free, requiring no camera parameters, and generalizes to unseen camera viewpoints within any multiview configuration at inference time. By substantially enhancing multiview segmentation and, consequently, spatial understanding in the OR, we believe our approach opens new opportunities for surgical perception and assistance. Code will be released upon acceptance.

cs.CV↗

arXiv2026

From Scanning Guidelines to Action: A Robotic Ultrasound Agent with LLM-Based Reasoning

Robotic ultrasound offers advantages over free-hand scanning, including improved reproducibility and reduced operator dependency. In clinical practice, US acquisition relies heavily on the sonographer's experience and situational judgment. When transferring this process to robotic systems, such expertise is often encoded explicitly through fixed procedures and task-specific models, yielding pipelines that can be difficult to adapt to new scanning tasks. In this work, we propose a unified framework for autonomous robotic US scanning that leverages a LLM-based agent to interpret US scanning guidelines and execute scans by dynamically invoking a set of provided software tools. Instead of encoding fixed scanning procedures, the LLM agent retrieves and reasons over guideline steps from scanning handbooks and adapts its planning decisions based on observations and the current scanning state. This enables the system to handle variable and decision-dependent workflows, such as adjusting scanning strategies, repeating steps, or selecting the appropriate next tool call in response to image quality or anatomical findings. Because the reasoning underlying tool selection is also critical for transparent and trustworthy planning, we further fine tune the LLM agent using a RL based strategy to improve both its reasoning quality and the correctness of tool selection and parameterization, while maintaining robust generalization to unseen guidelines and related tasks. We first validate the approach via verbal execution on 10 US scanning guidelines, assessing reasoning as well as tool selection and parameterization, and showing the benefit of RL fine tuning. We then demonstrate real world feasibility on robotic scanning of the gallbladder, spine, and kidney. Overall, the framework follows diverse guidelines and enables reliable autonomous scanning across multiple anatomical targets within a unified system.

cs.RO↗

arXiv2026

TopoOR: A Unified Topological Scene Representation for the Operating Room

Surgical Scene Graphs abstract the complexity of surgical operating rooms (OR) into a structure of entities and their relations, but existing paradigms suffer from strictly dyadic structural limitations. Frameworks that predominantly rely on pairwise message passing or tokenized sequences flatten the manifold geometry inherent to relational structures and lose structure in the process. We introduce TopoOR, a new paradigm that models multimodal operating rooms as a higher-order structure, innately preserving pairwise and group relationships. By lifting interactions between entities into higher-order topological cells, TopoOR natively models complex dynamics and multimodality present in the OR. This topological representation subsumes traditional scene graphs, thereby offering strictly greater expressivity. We also propose a higher-order attention mechanism that explicitly preserves manifold structure and modality-specific features throughout hierarchical relational attention. In this way, we circumvent combining 3D geometry, audio, and robot kinematics into a single joint latent representation, preserving the precise multimodal structure required for safety-critical reasoning, unlike existing methods. Extensive experiments demonstrate that our approach outperforms traditional graph and LLM-based baselines across sterility breach detection, robot phase prediction, and next-action anticipation

cs.CV↗

arXiv2026

Robotic Ultrasound Makes CBCT Alive

Intraoperative Cone Beam Computed Tomography (CBCT) provides a reliable 3D anatomical context essential for interventional planning. However, its static nature fails to provide continuous monitoring of soft-tissue deformations induced by respiration, probe pressure, and surgical manipulation, leading to navigation discrepancies. We propose a deformation-aware CBCT updating framework that leverages robotic ultrasound as a dynamic proxy to infer tissue motion and update static CBCT slices in real time. Starting from calibration-initialized alignment with linear correlation of linear combination (LC2)-based rigid refinement, our method establishes accurate multimodal correspondence. To capture intraoperative dynamics, we introduce the ultrasound correlation UNet (USCorUNet), a lightweight network trained with optical flow-guided supervision to learn deformation-aware correlation representations, enabling accurate, real-time dense deformation field estimation from ultrasound streams. The inferred deformation is spatially regularized and transferred to the CBCT reference to produce deformation-consistent visualizations without repeated radiation exposure. We validate the proposed approach through deformation estimation and ultrasound-guided CBCT updating experiments. Results demonstrate real-time end-to-end CBCT slice updating and physically plausible deformation estimation, enabling dynamic refinement of static CBCT guidance during robotic ultrasound-assisted interventions. The source code is publicly available at https://github.com/anonymous-codebase/us-cbct-demo.

cs.CV↗

arXiv2026

DAISS: Phase-Aware Imitation Learning for Dual-Arm Robotic Ultrasound-Guided Interventions

Imitation learning has shown strong potential for automating complex robotic manipulation. In medical robotics, ultrasound-guided needle insertion demands precise bimanual coordination, as clinicians must simultaneously manipulate an ultrasound probe to maintain an optimal acoustic view while steering an interventional needle. Automating this asymmetric workflow -- and reliably transferring expert strategies to robots -- remains highly challenging. In this paper, we present the Dual-Arm Interventional Surgical System (DAISS), a teleoperated platform that collects high-fidelity dual-arm demonstrations and learns a phase-aware imitation policy for ultrasound-guided interventions. To avoid constraining the operator's natural behavior, DAISS uses a flexible NDI-based leader interface for teleoperating two coordinated follower arms. To support robust execution under real-time ultrasound feedback, we develop a lightweight, data-efficient imitation policy. Specifically, the policy incorporates a phase-aware architecture and a dynamic mask loss tailored to asymmetric bimanual control. Conditioned on a planned trajectory, the network fuses real-time ultrasound with external visual observations to generate smooth, coordinated dual-arm motions. Experimental results show that DAISS can learn personalized expert strategies from limited demonstrations. Overall, these findings highlight the promise of phase-aware imitation-learning-driven dual-arm robots for improving precision and reducing cognitive workload in image-guided interventions.

cs.RO↗

arXiv2026

Comparative Study of Ultrasound Shape Completion and CBCT-Based AR Workflows for Spinal Needle Interventions

Purpose: This study compares two augmented reality (AR)-guided imaging workflows, one based on ultrasound shape completion and the other on cone-beam computed tomography (CBCT), for planning and executing lumbar needle interventions. The aim is to assess how imaging modality influences user performance, usability, and trust during AR-assisted spinal procedures. Methods: Both imaging systems were integrated into an AR framework, enabling in situ visualization and trajectory guidance. The ultrasound-based workflow combined AR-guided robotic scanning, probabilistic shape completion, and AR visualization. The CBCT-based workflow used AR-assisted scan volume planning, CBCT acquisition, and AR visualization. A between-subject user study was conducted and evaluated in two phases: (1) planning and image acquisition, and (2) needle insertion. Results: Planning time was significantly shorter with the CBCT-based workflow, while SUS, SEQ, and NASA-TLX were comparable between modalities. In the needle insertion phase, the CBCT-based workflow yielded marginally faster insertion times, lower placement error, and better subjective ratings with higher Trust. The ultrasound-based workflow achieved adequate accuracy for facet joint insertion, but showed larger errors for lumbar puncture, where reconstructions depended more heavily on shape completion. Conclusion: The findings indicate that both AR-guided imaging pipelines are viable for spinal intervention support. CBCT-based AR offers advantages in efficiency, precision, usability, and user confidence during insertion, whereas ultrasound-based AR provides adaptive, radiation-free imaging but is limited by shape completion in deeper spinal regions. These complementary characteristics motivate hybrid AR guidance that uses CBCT for global anatomical context and planning, augmented by ultrasound for adaptive intraoperative updates.

cs.HC↗

arXiv2026

MMNavAgent: Multi-Magnification WSI Navigation Agent for Clinically Consistent Whole-Slide Analysis

Recent AI navigation approaches aim to improve Whole-Slide Image (WSI) diagnosis by modeling spatial exploration and selecting diagnostically relevant regions, yet most operate at a single fixed magnification or rely on predefined magnification traversal. In clinical practice, pathologists examine slides across multiple magnifications and selectively inspect only necessary scales, dynamically integrating global and cellular evidence in a sequential manner. This mismatch prevents existing methods from modeling cross-magnification interactions and adaptive magnification selection inherent to real diagnostic workflows. To these, we propose a clinically consistent Multi-Magnification WSI Navigation Agent (MMNavAgent) that explicitly models multi magnification interaction and adaptive magnification selection. Specifically, we introduce a Cross-Magnification navigation Tool (CMT) that aggregates contextual information from adjacent magnifications to enhance discriminative representations along the navigation path. We further introduce a Magnification Selection Tool (MST) that leverages memory-driven reasoning within the agent framework to enable interactive and adaptive magnification selection, mimicking the sequential decision process of pathologists. Extensive experiments on a public dataset demonstrate improved diagnostic performance, with 1.45% gain of AUC and 2.93% gain of BACC over a non-agent baseline. Code will be public upon acceptance.

cs.CV↗

arXiv2026

RAG-RUSS: A Retrieval-Augmented Robotic Ultrasound for Autonomous Carotid Examination

Robotic ultrasound (US) has recently attracted increasing attention as a means to overcome the limitations of conventional US examinations, such as the strong operator dependence. However, the decision-making process of existing methods is often either rule-based or relies on end-to-end learning models that operate as black boxes. This has been seen as a main limit for clinical acceptance and raises safety concerns for widespread adoption in routine practice. To tackle this challenge, we introduce the RAG-RUSS, an interpretable framework capable of performing a full carotid examination in accordance with the clinical workflow while explicitly explaining both the current stage and the next planned action. Furthermore, given the scarcity of medical data, we incorporate retrieval-augmented generation to enhance generalization and reduce dependence on large-scale training datasets. The method was trained on data acquired from 28 volunteers, while an additional four volumetric scans recorded from previously unseen volunteers were reserved for testing. The results demonstrate that the method can explain the current scanning stage and autonomously plan probe motions to complete the carotid examination, encompassing both transverse and longitudinal planes.

cs.RO↗

arXiv2026

ConVibNet: Needle Detection during Continuous Insertion via Frequency-Inspired Features

Purpose: Ultrasound-guided needle interventions are widely used in clinical practice, but their success critically depends on accurate needle placement, which is frequently hindered by the poor and intermittent visibility of needles in ultrasound images. Existing approaches remain limited by artifacts, occlusions, and low contrast, and often fail to support real-time continuous insertion. To overcome these challenges, this study introduces a robust real-time framework for continuous needle detection. Methods: We present ConVibNet, an extension of VibNet for detecting needles with significantly reduced visibility, addressing real-time, continuous needle tracking during insertion. ConVibNet leverages temporal dependencies across successive ultrasound frames to enable continuous estimation of both needle tip position and shaft angle in dynamic scenarios. To strengthen temporal awareness of needle-tip motion, we introduce a novel intersection-and-difference loss that explicitly leverages motion correlations across consecutive frames. In addition, we curated a dedicated dataset for model development and evaluation. Results: The performance of the proposed ConVibNet model was evaluated on our dataset, demonstrating superior accuracy compared to the baseline VibNet and UNet-LSTM models. Specifically, ConVibNet achieved a tip error of 2.80+-2.42 mm and an angle error of 1.69+-2.00 deg. These results represent a 0.75 mm improvement in tip localization accuracy over the best-performing baseline, while preserving real-time inference capability. Conclusion: ConVibNet advances real-time needle detection in ultrasound-guided interventions by integrating temporal correlation modeling with a novel intersection-and-difference loss, thereby improving accuracy and robustness and demonstrating high potential for integration into autonomous insertion systems.

cs.CV↗

arXiv2026

Rewarding Doubt: A Reinforcement Learning Approach to Calibrated Confidence Expression of Large Language Models

A safe and trustworthy use of Large Language Models (LLMs) requires an accurate expression of confidence in their answers. We propose a novel Reinforcement Learning approach that allows to directly fine-tune LLMs to express calibrated confidence estimates alongside their answers to factual questions. Our method optimizes a reward based on the logarithmic scoring rule, explicitly penalizing both over- and under-confidence. This encourages the model to align its confidence estimates with the actual predictive accuracy. The optimal policy under our reward design would result in perfectly calibrated confidence expressions. Unlike prior approaches that decouple confidence estimation from response generation, our method integrates confidence calibration seamlessly into the generative process of the LLM. Empirically, we demonstrate that models trained with our approach exhibit substantially improved calibration and generalize to unseen tasks without further fine-tuning, suggesting the emergence of general confidence awareness.

cs.CL↗

arXiv2026

Language Agents for Hypothesis-driven Clinical Decision Making with Reinforcement Learning

Clinical decision-making is a dynamic, interactive, and cyclic process where doctors have to repeatedly decide on which clinical action to perform and consider newly uncovered information for diagnosis and treatment. Large Language Models (LLMs) have the potential to support clinicians in this process, however, most applications of LLMs in clinical decision support suffer from one of two limitations: Either they assume the unrealistic scenario of immediate availability of all patient information and do not model the interactive and iterative investigation process, or they restrict themselves to the limited "out-of-the-box" capabilities of large pre-trained models without performing task-specific training. In contrast to this, we propose to model clinical decision-making for diagnosis with a hypothesis-driven uncertainty-aware language agent, LA-CDM, that converges towards a diagnosis via repeatedly requesting and interpreting relevant tests. Using a hybrid training paradigm combining supervised and reinforcement learning, we train LA-CDM with three objectives targeting critical aspects of clinical decision-making: accurate hypothesis generation, hypothesis uncertainty estimation, and efficient decision-making. We evaluate our methodology on MIMIC-CDM, a real-world dataset covering four abdominal diseases containing various clinical tests and show the benefit of explicitly training clinical decision-making for increasing diagnostic performance and efficiency.

cs.CL↗

arXiv2026

Geometry OR Tracker: Universal Geometric Operating Room Tracking

In operating rooms (OR), world-scale multi-view 3D tracking supports downstream applications such as surgeon behavior recognition, where physically meaningful quantities such as distances and motion statistics must be measured in meters. However, real clinical deployments rarely satisfy the geometric prerequisites for stable multi-view fusion and tracking: camera calibration and RGB-D registration are always unreliable, leading to cross-view geometric inconsistency that produces "ghosting" during fusion and degrades 3D trajectories in a shared OR coordinate frame. To address this, we introduce Geometry OR Tracker, a two-stage pipeline that first rectifies imprecise calibration into a scaleconsistent and geometrically consistent camera setup with a single global scale via a Multi-view Metric Geometry Rectification module, and then performs Occlusion-Robust 3D Point Tracking directly in the unified OR world frame. On the MM-OR benchmark, improved geometric consistency translates into tracking gains: our rectification front-end reduces cross-view depth disagreement by more than 30$\times$ compared to raw calibration. Ablation studies further demonstrate the relationship between calibration quality and tracking accuracy, showing that improved geometric consistency yields stronger world-frame tracking.

cs.CV↗