搜索结果：Seminars in pediatric surgery

Pediatric medical imaging presents unique challenges due to significant anatomical and developmental differences compared to adults. Direct application of segmentation models trained on adult data often yields suboptimal performance, particularly for small or rapidly evolving structures. To address these challenges, several strategies leveraging the nnU-Net framework have been proposed, differing along four key axes: (i) the fingerprint dataset (adult, pediatric, or a combination thereof) from which the Training Plan -including the network architecture-is derived; (ii) the Learning Set (adult, pediatric, or mixed), (iii) Data Augmentation parameters, and (iv) the Transfer learning method (finetuning versus continual learning). In this work, we introduce PSAT (Pediatric Segmentation Approaches via Adult Augmentations and Transfer learning), a systematic study that investigates the impact of these axes on segmentation performance. We benchmark the derived strategies on two pediatric CT datasets and compare them with state-of-theart methods, including a commercial radiotherapy solution. PSAT highlights key pitfalls and provides actionable insights for improving pediatric segmentation.

Pediatric chest X-ray imaging is essential for early diagnosis, particularly in low-resource settings where advanced imaging modalities are often inaccessible. Low-dose protocols reduce radiation exposure in children but introduce substantial noise that can obscure critical anatomical details. Conventional denoising methods often degrade fine details, compromising diagnostic accuracy. In this paper, we present SharpXR, a structure-aware dual-decoder U-Net designed to denoise low-dose pediatric X-rays while preserving diagnostically relevant features. SharpXR combines a Laplacian-guided edge-preserving decoder with a learnable fusion module that adaptively balances noise suppression and structural detail retention. To address the scarcity of paired training data, we simulate realistic Poisson-Gaussian noise on the Pediatric Pneumonia Chest X-ray dataset. SharpXR outperforms state-of-the-art baselines across all evaluation metrics while maintaining computational efficiency suitable for resource-constrained settings. SharpXR-denoised images improved downstream pneumonia classification accuracy from 88.8% to 92.5%, underscoring its diagnostic value in low-resource pediatric care.

Large language models (LLMs) and vision-augmented LLMs (VLMs) have significantly advanced medical informatics, diagnostics, and decision support. However, these models exhibit systematic biases, particularly age bias, compromising their reliability and equity. This is evident in their poorer performance on pediatric-focused text and visual question-answering tasks. This bias reflects a broader imbalance in medical research, where pediatric studies receive less funding and representation despite the significant disease burden in children. To address these issues, a new comprehensive multi-modal pediatric question-answering benchmark, PediatricsMQA, has been introduced. It consists of 3,417 text-based multiple-choice questions (MCQs) covering 131 pediatric topics across seven developmental stages (prenatal to adolescent) and 2,067 vision-based MCQs using 634 pediatric images from 67 imaging modalities and 256 anatomical regions. The dataset was developed using a hybrid manual-automatic pipeline, incorporating peer-reviewed pediatric literature, validated question banks, existing benchmarks, and existing QA resources. Evaluating state-of-the-art open models, we find dramatic performan

Purpose: We developed an artificial neural network (ANN) combining radiomics with clinical and dosimetric features to predict the extent of body mass index (BMI) increase after surgery and proton therapy, with advantage of improved accuracy and integrated key feature selection. Methods and Materials: Uniform treatment protocol composing of limited surgery and proton radiotherapy was given to 84 pediatric craniopharyngioma patients (aged 1-20 years). Post-treatment obesity was classified into 3 groups (<10%, 10-20%, and >20%) based on the normalized BMI increase during a 5-year follow-up. We developed a densely connected 4-layer ANN with radiomics calculated from pre-surgery MRI (T1w, T2w, and FLAIR), combining clinical and dosimetric features as input. Accuracy, area under operative curve (AUC), and confusion matrices were compared with random forest (RF) models in a 5-fold cross-validation. The Group lasso regularization optimized a sparse connection to input neurons to identify key features from high-dimensional input. Results: Classification accuracy of the ANN reached above 0.9 for T1w, T2w, and FLAIR MRI. Confusion matrices showed high true positive rates of above 0.9 wh

Recent advancements in deep learning for Medical Artificial Intelligence have demonstrated that models can match the diagnostic performance of clinical experts in adult chest X-ray (CXR) interpretation. However, their application in the pediatric context remains limited due to the scarcity of large annotated pediatric image datasets. Additionally, significant challenges arise from the substantial variability in pediatric CXR images across different hospitals and the diverse age range of patients from 0 to 18 years. To address these challenges, we propose SCC, a novel approach that combines transfer learning with self-supervised contrastive learning, augmented by an unsupervised contrast enhancement technique. Transfer learning from a well-trained adult CXR model mitigates issues related to the scarcity of pediatric training data. Contrastive learning with contrast enhancement focuses on the lungs, reducing the impact of image variations and producing high-quality embeddings across diverse pediatric CXR images. We train SCC on one pediatric CXR dataset and evaluate its performance on two other pediatric datasets from different sources. Our results show that SCC's out-of-distribution

Skull-stripping is the removal of background and non-brain anatomical features from brain images. While many skull-stripping tools exist, few target pediatric populations. With the emergence of multi-institutional pediatric data acquisition efforts to broaden the understanding of perinatal brain development, it is essential to develop robust and well-tested tools ready for the relevant data processing. However, the broad range of neuroanatomical variation in the developing brain, combined with additional challenges such as high motion levels, as well as shoulder and chest signal in the images, leaves many adult-specific tools ill-suited for pediatric skull-stripping. Building on an existing framework for robust and accurate skull-stripping, we propose developmental SynthStrip (d-SynthStrip), a skull-stripping model tailored to pediatric images. This framework exposes networks to highly variable images synthesized from label maps. Our model substantially outperforms pediatric baselines across scan types and age cohorts. In addition, the <1-minute runtime of our tool compares favorably to the fastest baselines. We distribute our model at https://w3id.org/synthstrip.

Virtual reality (VR) is increasingly used across psychology, from research and assessment to counseling, psychological treatment, and psychotherapy, with growing applications for children and adolescents. In these contexts, VR is often treated as a relatively neutral delivery medium. This assumption may be misleading. Most consumer head-mounted displays (HMDs) have been designed primarily for adult anthropometry, including adult interpupillary distance (IPD) ranges. As a result, some children may be excluded from participation or may receive a systematically degraded perceptual experience because the device cannot be adequately aligned to their visual anatomy. This paper argues that IPD constraints in consumer VR headsets represent an underrecognized methodological and clinical problem in pediatric psychology and psychotherapy. If headset fit affects visual comfort, depth perception, attentional load, cybersickness, willingness to remain in the simulation, and sense of presence, it may also influence engagement, emotional processing, dropout, and treatment response. The headset may therefore function as a selection mechanism, shaping who is included in studies, who can tolerate int

In this paper, we present a novel approach for segmenting pediatric brain tumors using a deep learning architecture, inspired by expert radiologists' segmentation strategies. Our model delineates four distinct tumor labels and is benchmarked on a held-out PED BraTS 2024 test set (i.e., pediatric brain tumor datasets introduced by BraTS). Furthermore, we evaluate our model's performance against the state-of-the-art (SOTA) model using a new external dataset of 30 patients from CBTN (Children's Brain Tumor Network), labeled in accordance with the PED BraTS 2024 guidelines and 2023 BraTS Adult Glioma dataset. We compare segmentation outcomes with the winning algorithm from the PED BraTS 2023 challenge as the SOTA model. Our proposed algorithm achieved an average Dice score of 0.642 and an HD95 of 73.0 mm on the CBTN test data, outperforming the SOTA model, which achieved a Dice score of 0.626 and an HD95 of 84.0 mm. Moreover, our model exhibits strong generalizability, attaining a 0.877 Dice score in whole tumor segmentation on the BraTS 2023 Adult Glioma dataset, surpassing existing SOTA. Our results indicate that the proposed model is a step towards providing more accurate segmentati

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

Pediatric critical care is a dynamic, high-stakes process involving constant monitoring and adjustments in life-saving treatments. Modeling these interventions is crucial for effective decision support. To address the challenges of high complexity and data scarcity in pediatric Extracorporeal Membrane Oxygenation (ECMO), we frame clinical decision-making as learning to act from trajectories, i.e., imitation learning that learns action models from observational data, with a key feature that actions are not directly observed. We consider TabPFN, a recent transformer-based approach for tabular data, and traditional baselines including XGBoost and Multi-Layer Perceptrons(MLPs) on real-world pediatric ECMO data to learn the action models. We find that the TabPFN-based approach consistently outperforms these classical baselines, supporting its use as a strong clinician-behavior baseline for pediatric ECMO decision support.

Brain tumors are the most common solid tumors in children and young adults, but the scarcity of large histopathology datasets has limited the application of computational pathology in this group. This study implements two weakly supervised multiple-instance learning (MIL) approaches on patch-features obtained from state-of-the-art histology-specific foundation models to classify pediatric brain tumors in hematoxylin and eosin whole slide images (WSIs) from a multi-center Swedish cohort. WSIs from 540 subjects (age 8.5$\pm$4.9 years) diagnosed with brain tumor were gathered from the six Swedish university hospitals. Instance (patch)-level features were obtained from WSIs using three pre-trained feature extractors: ResNet50, UNI, and CONCH. Instances were aggregated using attention-based MIL (ABMIL) or clustering-constrained attention MIL (CLAM) for patient-level classification. Models were evaluated on three classification tasks based on the hierarchical classification of pediatric brain tumors: tumor category, family, and type. Model generalization was assessed by training on data from two of the centers and testing on data from four other centers. Model interpretability was evalua

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).

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

The limited workspace in pediatric endoscopic surgery makes surgical suturing one of the most difficult tasks. During suturing, surgeons have to prevent collisions between tools and also collisions with the surrounding tissues. Surgical robots have been shown to be effective in adult laparoscopy, but assistance for suturing in constrained workspaces has not been yet fully explored. In this letter, we propose guidance virtual fixtures to enhance the performance and the safety of suturing while generating the required task constraints using constrained optimization and Cartesian force feedback. We propose two guidance methods: looping virtual fixtures and a trajectory guidance cylinder, that are based on dynamic geometric elements. In simulations and experiments with a physical robot, we show that the proposed methods achieve a more precise and safer looping in robot-assisted pediatric endoscopy.

Despite the advancement of deep learning-based computer-aided diagnosis (CAD) methods for pneumonia from adult chest x-ray (CXR) images, the performance of CAD methods applied to pediatric images remains suboptimal, mainly due to the lack of large-scale annotated pediatric imaging datasets. Establishing a proper framework to leverage existing adult large-scale CXR datasets can thus enhance pediatric pneumonia detection performance. In this paper, we propose a three-branch parallel path learning-based framework that utilizes both adult and pediatric datasets to improve the performance of deep learning models on pediatric test datasets. The paths are trained with pediatric only, adult only, and both types of CXRs, respectively. Our proposed framework utilizes the multi-positive contrastive loss to cluster the classwise embeddings and the embedding similarity loss among these three parallel paths to make the classwise embeddings as close as possible to reduce the effect of domain shift. Experimental evaluations on open-access adult and pediatric CXR datasets show that the proposed method achieves a superior AUROC score of 0.8464 compared to 0.8348 obtained using the conventional appro

Pediatric appendicitis remains one of the most common causes of acute abdominal pain in children, and its diagnosis continues to challenge clinicians due to overlapping symptoms and variable imaging quality. This study aims to develop and evaluate a deep learning model based on a pretrained ResNet architecture for automated detection of appendicitis from ultrasound images. We used the Regensburg Pediatric Appendicitis Dataset, which includes ultrasound scans, laboratory data, and clinical scores from pediatric patients admitted with abdominal pain to Children Hospital. Hedwig in Regensburg, Germany. Each subject had 1 to 15 ultrasound views covering the right lower quadrant, appendix, lymph nodes, and related structures. For the image based classification task, ResNet was fine tuned to distinguish appendicitis from non-appendicitis cases. Images were preprocessed by normalization, resizing, and augmentation to enhance generalization. The proposed ResNet model achieved an overall accuracy of 93.44, precision of 91.53, and recall of 89.8, demonstrating strong performance in identifying appendicitis across heterogeneous ultrasound views. The model effectively learned discriminative sp

Materials science has a significant impact on society and its quality of life, e.g., through the development of safer, more durable, more economical, environmentally friendly, and sustainable materials. Visual computing in materials science integrates computer science disciplines from image processing, visualization, computer graphics, pattern recognition, computer vision, virtual and augmented reality, machine learning, to human-computer interaction, to support the acquisition, analysis, and synthesis of (visual) materials science data with computer resources. Therefore, visual computing may provide fundamentally new insights into materials science problems by facilitating the understanding, discovery, design, and usage of complex material systems. This seminar is considered as a follow-up of the Dagstuhl Seminar 19151 Visual Computing in Materials Sciences, held in April 2019. Since then, the field has kept evolving and many novel challenges have emerged, with regard to more traditional topics in visual computing, such as topology analysis or image processing and analysis, to recently emerging topics, such as uncertainty and ensemble analysis, and to the integration of new resear

For a nullhomologous Legendrian knot in a closed contact 3-manifold Y we consider a contact structure obtained by positive rational contact surgery. We prove that in this situation the Heegaard Floer contact invariant of Y is mapped by a surgery cobordism to the contact invariant of the result of contact surgery. In addition we characterize the spin-c structure on the cobordism that induces the relevant map. As a consequence we determine necessary and sufficient conditions for the nonvanishing of the contact invariant after rational surgery when Y is the standard 3-sphere, generalizing previous results of Lisca-Stipsicz and Golla. In fact our methods allow direct calculation of the contact invariant in terms of the rational surgery mapping cone of Ozsváth and Szabó. The proof involves a construction called reducible open book surgery, which reduces in special cases to the capping-off construction studied by Baldwin.

Background: While machine learning (ML) models are rapidly emerging as promising screening tools in critical care medicine, the identification of homogeneous subphenotypes within populations with heterogeneous conditions such as pediatric sepsis may facilitate attainment of high-predictive performance of these prognostic algorithms. This study is aimed to identify subphenotypes of pediatric sepsis and demonstrate the potential value of partitioned data/subtyping-based training. Methods: This was a retrospective study of clinical data extracted from medical records of 6,446 pediatric patients that were admitted at a major hospital system in the DC area. Vitals and labs associated with patients meeting the diagnostic criteria for sepsis were used to perform latent profile analysis. Modern ML algorithms were used to explore the predictive performance benefits of reduced training data heterogeneity via label profiling. Results: In total 134 (2.1%) patients met the diagnostic criteria for sepsis in this cohort and latent profile analysis identified four profiles/subphenotypes of pediatric sepsis. Profiles 1 and 3 had the lowest mortality and included pediatric patients from different ag