搜索结果：Clinics in colon and rectal surgery

Clinical trial studies indicate benefit of watch-and-wait (WW) surveillance for patients with rectal cancer showing a complete or near clinical response (CR) directly after treatment (restaging). However, there are no objectively accurate methods to early detect local tumor regrowth (LR) in patients undergoing WW from follow-up exams. Hence, we developed Temporal Rectal Endoscopy Cross-attention (TREX), a longitudinal deep learning approach that combines pairs of images acquired at restaging and follow-up to distinguish CR from LR. TREX uses pretrained Swin Transformers in a siamese setting to extract features from longitudinal images and dual cross-attention to combine the features without spatial co-registration between image pairs. TREX and Swin-based baselines were trained under two settings: (a) detecting LR or CR at the last available follow-up and (b) early detection of LR at 3--6, 6--12, and 12--24 months before clinical confirmation. TREX achieved the highest accuracy in detecting LR with a high sensitivity of 97% $\pm$ 6% and a balanced accuracy of 90% $\pm$ 3%, and outperformed all baselines in early detection at both 3--6 (74% $\pm$ 1%) and 6--12 months (62% $\pm$ 4%) p

High-resolution colon segmentation is crucial for clinical and research applications, such as digital twins and personalized medicine. However, the leading open-source abdominal segmentation tool, TotalSegmentator, struggles with accuracy for the colon, which has a complex and variable shape, requiring time-intensive labeling. Here, we present the first fully automatic high-resolution colon segmentation method. To develop it, we first created a high resolution colon dataset using a pipeline that combines region growing with interactive machine learning to efficiently and accurately label the colon on CT colonography (CTC) images. Based on the generated dataset consisting of 435 labeled CTC images we trained an nnU-Net model for fully automatic colon segmentation. Our fully automatic model achieved an average symmetric surface distance of 0.2 mm (vs. 4.0 mm from TotalSegmentator) and a 95th percentile Hausdorff distance of 1.0 mm (vs. 18 mm from TotalSegmentator). Our segmentation accuracy substantially surpasses TotalSegmentator. We share our trained model and pipeline code, providing the first and only open-source tool for high-resolution colon segmentation. Additionally, we creat

Endoscopic images are used at various stages of rectal cancer treatment starting from cancer screening, diagnosis, during treatment to assess response and toxicity from treatments such as colitis, and at follow up to detect new tumor or local regrowth (LR). However, subjective assessment is highly variable and can underestimate the degree of response in some patients, subjecting them to unnecessary surgery, or overestimate response that places patients at risk of disease spread. Advances in deep learning has shown the ability to produce consistent and objective response assessment for endoscopic images. However, methods for detecting cancers, regrowth, and monitoring response during the entire course of patient treatment and follow-up are lacking. This is because, automated diagnosis and rectal cancer response assessment requires methods that are robust to inherent imaging illumination variations and confounding conditions (blood, scope, blurring) present in endoscopy images as well as changes to the normal lumen and tumor during treatment. Hence, a hierarchical shifted window (Swin) transformer was trained to distinguish rectal cancer from normal lumen using endoscopy images. Swin

Surgery duration is usually used as an input to the operation room (OR) allocation and surgery scheduling problems. A good estimation of surgery duration benefits the operation planning in ORs. In contrast, we would like to investigate whether the allocation decisions in turn influence surgery duration. Using almost two years of data from a large hospital in China, we find evidence in support of our conjecture. Surgery duration decreases with the number of surgeries a surgeon performs in a day. Numerically, surgery duration will decrease by 10 minutes on average if a surgeon performs one more surgery. Furthermore, we find a non-linear relationship between surgery duration and the number of surgeries allocated to an OR. Also, a surgery's duration is affected by its position in a sequence of surgeries performed by one surgeon. In addition, surgeons exhibit different patterns on the effects of surgery type and position. Since the findings are obtained from a particular data set, We do not claim the generalizability. Instead, the analysis in this paper provides insights into surgery duration study in ORs.

Cancer is a fatal disease caused by a combination of genetic diseases and a variety of biochemical abnormalities. Lung and colon cancer have emerged as two of the leading causes of death and disability in humans. The histopathological detection of such malignancies is usually the most important component in determining the best course of action. Early detection of the ailment on either front considerably decreases the likelihood of mortality. Machine learning and deep learning techniques can be utilized to speed up such cancer detection, allowing researchers to study a large number of patients in a much shorter amount of time and at a lower cost. In this research work, we introduced a hybrid ensemble feature extraction model to efficiently identify lung and colon cancer. It integrates deep feature extraction and ensemble learning with high-performance filtering for cancer image datasets. The model is evaluated on histopathological (LC25000) lung and colon datasets. According to the study findings, our hybrid model can detect lung, colon, and (lung and colon) cancer with accuracy rates of 99.05%, 100%, and 99.30%, respectively. The study's findings show that our proposed strategy ou

A reliable evaluation of surgical difficulty can improve the success of the treatment for rectal cancer and the current evaluation method is based on clinical data. However, more data about rectal cancer can be collected with the development of technology. Meanwhile, with the development of artificial intelligence, its application in rectal cancer treatment is becoming possible. In this paper, a multi-view rectal cancer dataset is first constructed to give a more comprehensive view of patients, including the high-resolution MRI image view, pressed-fat MRI image view, and clinical data view. Then, an interpretable incomplete multi-view surgical evaluation model is proposed, considering that it is hard to obtain extensive and complete patient data in real application scenarios. Specifically, a dual representation incomplete multi-view learning model is first proposed to extract the common information between views and specific information in each view. In this model, the missing view imputation is integrated into representation learning, and second-order similarity constraint is also introduced to improve the cooperative learning between these two parts. Then, based on the imputed mu

The integration of medical imaging, computational analysis, and robotic technology has brought about a significant transformation in minimally invasive surgical procedures, particularly in the realm of laparoscopic rectal surgery (LRS). This specialized surgical technique, aimed at addressing rectal cancer, requires an in-depth comprehension of the spatial dynamics within the narrow space of the pelvis. Leveraging Magnetic Resonance Imaging (MRI) scans as a foundational dataset, this study incorporates them into Computer-Aided Design (CAD) software to generate precise three-dimensional (3D) reconstructions of the patient's anatomy. At the core of this research is the analysis of the surgical workspace, a critical aspect in the optimization of robotic interventions. Sophisticated computational algorithms process MRI data within the CAD environment, meticulously calculating the dimensions and contours of the pelvic internal regions. The outcome is a nuanced understanding of both viable and restricted zones during LRS, taking into account factors such as curvature, diameter variations, and potential obstacles. This paper delves deeply into the complexities of workspace analysis for ro

The dielectric characterization of human tissues can play a crucial role in the development of new medical diagnostic tools. In particular, the characterization of healthy and pathological tissues can provide vital information for diagnosis. In this paper, preliminary results from a small-scale measurement campaign conducted in 0.5-26.5GHz during real surgeries on healthy and malignant human colon tissues are presented. Those measurements were carried out externally to the colon, without direct contact to the tumor growing inside the colon. Furthermore, different tumor stages are taken into account. Initial findings reveal that advanced tumor stages are related with increased higher values of dielectric properties in malignant tumor tissues compared to the healthy ones.

The recent Segment Anything Model (SAM) 2 has demonstrated remarkable foundational competence in semantic segmentation, with its memory mechanism and mask decoder further addressing challenges in video tracking and object occlusion, thereby achieving superior results in interactive segmentation for both images and videos. Building upon our previous empirical studies, we further explore the zero-shot segmentation performance of SAM 2 in robot-assisted surgery based on prompts, alongside its robustness against real-world corruption. For static images, we employ two forms of prompts: 1-point and bounding box, while for video sequences, the 1-point prompt is applied to the initial frame. Through extensive experimentation on the MICCAI EndoVis 2017 and EndoVis 2018 benchmarks, SAM 2, when utilizing bounding box prompts, outperforms state-of-the-art (SOTA) methods in comparative evaluations. The results with point prompts also exhibit a substantial enhancement over SAM's capabilities, nearing or even surpassing existing unprompted SOTA methodologies. Besides, SAM 2 demonstrates improved inference speed and less performance degradation against various image corruption. Although slightly u

Fecal incontinence, arising from a myriad of pathogenic mechanisms, has attracted considerable global attention. Despite its significance, the replication of the defecatory system for studying fecal incontinence mechanisms remains limited largely due to social stigma and taboos. Inspired by the rectum's functionalities, we have developed a soft robotic system, encompassing a power supply, pressure sensing, data acquisition systems, a flushing mechanism, a stage, and a rectal module. The innovative soft rectal module includes actuators inspired by sphincter muscles, both soft and rigid covers, and soft rectum mold. The rectal mold, fabricated from materials that closely mimic human rectal tissue, is produced using the mold replication fabrication method. Both the soft and rigid components of the mold are realized through the application of 3D-printing technology. The sphincter muscles-inspired actuators featuring double-layer pouch structures are modeled and optimized based on multilayer perceptron methods aiming to obtain high contractions ratios (100%), high generated pressure (9.8 kPa), and small recovery time (3 s). Upon assembly, this defecation robot is capable of smoothly exp

Rectal cancer segmentation of CT image plays a crucial role in timely clinical diagnosis, radiotherapy treatment, and follow-up. Although current segmentation methods have shown promise in delineating cancerous tissues, they still encounter challenges in achieving high segmentation precision. These obstacles arise from the intricate anatomical structures of the rectum and the difficulties in performing differential diagnosis of rectal cancer. Additionally, a major obstacle is the lack of a large-scale, finely annotated CT image dataset for rectal cancer segmentation. To address these issues, this work introduces a novel large scale rectal cancer CT image dataset CARE with pixel-level annotations for both normal and cancerous rectum, which serves as a valuable resource for algorithm research and clinical application development. Moreover, we propose a novel medical cancer lesion segmentation benchmark model named U-SAM. The model is specifically designed to tackle the challenges posed by the intricate anatomical structures of abdominal organs by incorporating prompt information. U-SAM contains three key components: promptable information (e.g., points) to aid in target area localiza

Background Analyzing kinematic and video data can help identify potentially erroneous motions that lead to sub-optimal surgeon performance and safety-critical events in robot-assisted surgery. Methods We develop a rubric for identifying task and gesture-specific Executional and Procedural errors and evaluate dry-lab demonstrations of Suturing and Needle Passing tasks from the JIGSAWS dataset. We characterize erroneous parts of demonstrations by labeling video data, and use distribution similarity analysis and trajectory averaging on kinematic data to identify parameters that distinguish erroneous gestures. Results Executional error frequency varies by task and gesture, and correlates with skill level. Some predominant error modes in each gesture are distinguishable by analyzing error-specific kinematic parameters. Procedural errors could lead to lower performance scores and increased demonstration times but also depend on surgical style. Conclusions This study provides insights into context-dependent errors that can be used to design automated error detection mechanisms and improve training and skill assessment.

With the advent of robot-assisted surgery, the role of data-driven approaches to integrate statistics and machine learning is growing rapidly with prominent interests in objective surgical skill assessment. However, most existing work requires translating robot motion kinematics into intermediate features or gesture segments that are expensive to extract, lack efficiency, and require significant domain-specific knowledge. We propose an analytical deep learning framework for skill assessment in surgical training. A deep convolutional neural network is implemented to map multivariate time series data of the motion kinematics to individual skill levels. We perform experiments on the public minimally invasive surgical robotic dataset, JHU-ISI Gesture and Skill Assessment Working Set (JIGSAWS). Our proposed learning model achieved a competitive accuracy of 92.5%, 95.4%, and 91.3%, in the standard training tasks: Suturing, Needle-passing, and Knot-tying, respectively. Without the need of engineered features or carefully-tuned gesture segmentation, our model can successfully decode skill information from raw motion profiles via end-to-end learning. Meanwhile, the proposed model is able to

Adaptive radiation therapy (ART) could protect organs at risk (OARs) while maintain high dose coverage to targets. However, there still lack efficient online patient QA methods. We aim to develop a clinically relevant online patient quality assurance (QA) solution for ART using daily CT scans and electronic portal imaging device (EPID)-based in vivo dosimetry. Ten patients with rectal cancer at our center were included. Patients' daily CT scans and portal images were collected to generate reconstructed 3D dose distributions. Contours of targets and OARs were recontoured on these daily CT scans by a clinician or an auto-segmentation algorithm, then dose-volume indices were calculated, and the percent deviation of these indices to their original plans were determined. This deviation was regarded as the metric for clinically relevant patient QA. The tolerance level was obtained using a 95% interval of the QA metric distribution. These deviations could be further divided into anatomically relevant or delivery relevant indicators for error source analysis. Finally, our QA solution was validated on an additional six clinical patients. In rectal cancer, the lower and upper tolerance of th

Concept erasure in text-to-image diffusion models is crucial for mitigating harmful content, yet existing methods often compromise generative quality. We introduce Semantic Surgery, a novel training-free, zero-shot framework for concept erasure that operates directly on text embeddings before the diffusion process. It dynamically estimates the presence of target concepts in a prompt and performs a calibrated vector subtraction to neutralize their influence at the source, enhancing both erasure completeness and locality. The framework includes a Co-Occurrence Encoding module for robust multi-concept erasure and a visual feedback loop to address latent concept persistence. As a training-free method, Semantic Surgery adapts dynamically to each prompt, ensuring precise interventions. Extensive experiments on object, explicit content, artistic style, and multi-celebrity erasure tasks show our method significantly outperforms state-of-the-art approaches. We achieve superior completeness and robustness while preserving locality and image quality (e.g., 93.58 H-score in object erasure, reducing explicit content to just 1 instance, and 8.09 H_a in style erasure with no quality degradation).

Deep neural networks power most recent successes of artificial intelligence, spanning from self-driving cars to computer aided diagnosis in radiology and pathology. The high-stake data intensive process of surgery could highly benefit from such computational methods. However, surgeons and computer scientists should partner to develop and assess deep learning applications of value to patients and healthcare systems. This chapter and the accompanying hands-on material were designed for surgeons willing to understand the intuitions behind neural networks, become familiar with deep learning concepts and tasks, grasp what implementing a deep learning model in surgery means, and finally appreciate the specific challenges and limitations of deep neural networks in surgery. For the associated hands-on material, please see https://github.com/CAMMA-public/ai4surgery.

Colonoscopy is the choice procedure to diagnose colon and rectum cancer, from early detection of small precancerous lesions (polyps), to confirmation of malign masses. However, the high variability of the organ appearance and the complex shape of both the colon wall and structures of interest make this exploration difficult. Learned visuospatial and perceptual abilities mitigate technical limitations in clinical practice by proper estimation of the intestinal depth. This work introduces a novel methodology to estimate colon depth maps in single frames from monocular colonoscopy videos. The generated depth map is inferred from the shading variation of the colon wall with respect to the light source, as learned from a realistic synthetic database. Briefly, a classic convolutional neural network architecture is trained from scratch to estimate the depth map, improving sharp depth estimations in haustral folds and polyps by a custom loss function that minimizes the estimation error in edges and curvatures. The network was trained by a custom synthetic colonoscopy database herein constructed and released, composed of 248,400 frames (47 videos), with depth annotations at the level of pix

Rectal cancer is one of the most common diseases and a major cause of mortality. For deciding rectal cancer treatment plans, T-staging is important. However, evaluating the index from preoperative MRI images requires high radiologists' skill and experience. Therefore, the aim of this study is to segment the mesorectum, rectum, and rectal cancer region so that the system can predict T-stage from segmentation results. Generally, shortage of large and diverse dataset and high quality annotation are known to be the bottlenecks in computer aided diagnostics development. Regarding rectal cancer, advanced cancer images are very rare, and per-pixel annotation requires high radiologists' skill and time. Therefore, it is not feasible to collect comprehensive disease patterns in a training dataset. To tackle this, we propose two kinds of approaches of image synthesis-based late stage cancer augmentation and semi-supervised learning which is designed for T-stage prediction. In the image synthesis data augmentation approach, we generated advanced cancer images from labels. The real cancer labels were deformed to resemble advanced cancer labels by artificial cancer progress simulation. Next, we

The aim of this work is to describe the technical characteristics of an AI-powered radiotherapy workflow that enables full-process automation (All-in-One), evaluate its performance implemented for on-couch initial treatment of rectal cancer, and provide insight into the behavior of full-workflow automation in the specialty of radiotherapy. The All-in-One workflow was developed based on a CT-integrated linear accelerator. It incorporates routine radiotherapy procedures from simulation, autosegmentation, autoplanning, image guidance, beam delivery, and in vivo quality assurance (QA) into one scheme, with critical decision points involved, while the patient is on the treatment couch during the whole process. For the enrolled ten patients with rectal cancer, minor modifications of the autosegmented target volumes were required, and the Dice similarity coefficient and 95% Hausdorff distance before and after modifications were 0.892{\pm}0.061 and 18.2{\pm}13.0 mm, respectively. The autosegmented normal tissues and automatic plans were clinically acceptable without any modifications or reoptimization. The pretreatment IGRT corrections were within 2 mm in all directions, and the EPID-based