搜索结果：General thoracic and cardiovascular surgery

Stereotactic body radiation therapy (SBRT) and hypofractionation using pencil-beam scanning (PBS) proton therapy (PBSPT) is an attractive option for thoracic malignancies. Combining the advantages of target coverage conformity and critical organ sparing from both PBSPT and SBRT, this new delivery technique has great potential to improve the therapeutic ratio, particularly for tumors near critical organs. Safe and effective implementation of PBSPT SBRT/hypofractionation to treat thoracic malignancies is more challenging than the conventionally-fractionated PBSPT due to concerns of amplified uncertainties at the larger dose per fraction. NRG Oncology and Particle Therapy Cooperative Group (PTCOG) Thoracic Subcommittee surveyed US proton centers to identify practice patterns of thoracic PBSPT SBRT/hypofractionation. From these patterns, we present recommendations for future technical development of proton SBRT/hypofractionation for thoracic treatment. Amongst other points, the recommendations highlight the need for volumetric image guidance and multiple CT-based robust optimization and robustness tools to minimize further the impact of uncertainties associated with respiratory motion.

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

Video-assisted thoracic surgery (VATS) is a minimally invasive approach for treating early-stage non-small-cell lung cancer. Optimal trocar placement during VATS ensures comprehensive access to the thoracic cavity, provides a panoramic endoscopic view, and prevents instrument crowding. While established principles such as the Baseball Diamond Principle (BDP) and Triangle Target Principle (TTP) exist, surgeons mainly rely on experience and patient-specific anatomy for trocar placement, potentially leading to sub-optimal surgical plans that increase operative time and fatigue. To address this, we present the first virtual reality (VR)-based pre-operative planning tool with tailored data visualization and interaction designs for efficient and optimal VATS trocar placement, following the established surgical principles and consultation with an experienced surgeon. In our preliminary study, we demonstrate the system's application in right upper lung lobectomy, a common thoracic procedure typically using three trocars. A preliminary user study of our system indicates it is efficient, robust, and user-friendly for planning optimal trocar placement, with a great promise for clinical applic

Zero-dimensional cardiovascular models provide a computationally efficient framework for studying global hemodynamic behavior, yet the influence of model complexity on parameter sensitivity remains insufficiently understood. This work investigates two lumped-parameter cardiovascular models, a simplified single-ventricle configuration and a detailed four-chamber representation, to examine how physiological parameter sensitivities vary with model structure. Time-varying elastance functions are used to represent cardiac dynamics, and global sensitivity analysis is performed using Sobol and Morris methods to quantify the impact of key physiological parameters, including venous return, myocardial contractility, total peripheral resistance, and arterial compliance. The results demonstrate that sensitivity rankings differ substantially between the two models, highlighting the role of model granularity and parameter interactions in shaping cardiovascular responses. These findings support sensitivity-driven model reduction and provide a foundation for scalable, non-invasive cardiovascular simulation frameworks.

Implicit neural representations (INRs, also known as neural fields) have recently emerged as a powerful framework for knowledge representation, synthesis, and compression. By encoding fields as continuous functions within the weights and biases of deep neural networks-rather than relying on voxel- or mesh-based structured or unstructured representations-INRs offer both resolution independence and high memory efficiency. However, their accuracy in domain-specific applications remains insufficiently understood. In this work, we assess the performance of state-of-the-art INRs for compressing hemodynamic fields derived from numerical simulations and for representing cardiovascular anatomies via signed distance functions. We investigate several strategies to mitigate spectral bias, including specialized activation functions, both fixed and trainable positional encoding, and linear combinations of nonlinear kernels. On realistic, space- and time-varying hemodynamic fields in the thoracic aorta, INRs achieved remarkable compression ratios of up to approximately 230, with maximum absolute errors of 1 mmHg for pressure and 5-10 cm/s for velocity, without extensive hyperparameter tuning. Acr

Recent rising interests in patient-specific thoracic surgical planning and simulation require efficient and robust creation of digital anatomical models from automatic medical image segmentation algorithms. Deep learning (DL) is now state-of-the-art in various radiological tasks, and U-shaped DL models have particularly excelled in medical image segmentation since the inception of the 2D UNet. To date, many variants of U-shaped models have been proposed by the integration of different attention mechanisms and network configurations. Systematic benchmark studies which analyze the architecture of these models by leveraging the recent development of the multi-label databases, can provide valuable insights for clinical deployment and future model designs, but such studies are still rare. We conduct the first systematic benchmark study for variants of 3D U-shaped models (3DUNet, STUNet, AttentionUNet, SwinUNETR, FocalSegNet, and a novel 3D SwinUnet with four variants) with a focus on CT-based anatomical segmentation for thoracic surgery. Our study systematically examines the impact of different attention mechanisms, the number of resolution stages, and network configurations on segmenta

The absence of openly accessible data and specialized foundation models is a major barrier for computational research in surgery. Toward this, (i) we open-source the largest dataset of general surgery videos to-date, consisting of 680 hours of surgical videos, including data from robotic and laparoscopic techniques across 28 procedures; (ii) we propose a technique for video pre-training a general surgery vision transformer (GSViT) on surgical videos based on forward video prediction that can run in real-time for surgical applications, toward which we open-source the code and weights of GSViT; (iii) we also release code and weights for procedure-specific fine-tuned versions of GSViT across 10 procedures; (iv) we demonstrate the performance of GSViT on the Cholec80 phase annotation task, displaying improved performance over state-of-the-art single frame predictors.

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.

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.

Low-dose chest computed tomography (LDCT) captures pulmonary and cardiac structures in a single scan, enabling joint assessment of lung and cardiovascular health. Existing approaches typically model these domains independently and do not explicitly represent their physiological interactions. We propose an Explainable Cross-Disease Reasoning Framework for cardiovascular risk assessment from LDCT. The framework follows a constrained clinical-information pathway: it extracts pulmonary findings, grounds cross-organ mechanisms in medical knowledge, and produces a cardiovascular prediction with a natural-language rationale. It combines four components: a frozen lung-risk prior, a pulmonary perception module, an agentic reasoning module, and a cardiac subvolume feature extractor. Their outputs are fused to integrate localized cardiac evidence with mechanism-level pulmonary context. On the National Lung Screening Trial cohort, the framework achieves an AUC of 0.919 for CVD screening and up to 0.838 for CVD mortality prediction, outperforming cardiac-specific, single-disease, and foundation-model baselines. Targeted controls indicate that the gains are not explained by additional thoracic v

The aim of this paper is to show the importance of the Steenrod construction of homology theories for the disassembly process in surgery on a generalized $n$-manifold $X^n$, in order to produce an element of generalized homology theory, which is basic for calculations. In particular, we show how to construct an element of the $n$-th Steenrod homology group $H^{st}_{n} (X^{n}, \mathbb{L}^+),$ where $\mathbb{L}^+$ is the connected covering spectrum of the periodic surgery spectrum $\mathbb{L}$, avoiding the use of the geometric splitting procedure, which is standardly used in surgery on topological manifolds.

In this paper, we set up two surgery theories and two kinds of Whitehead torsion for foliations. First, we construct a bounded surgery theory and bounded Whitehead torsion for foliations, which correspond to the Connes' foliation algebra in the K-theory of operator algebras, in the sense that there is an analogy between surgery theory and index theory, and a Novikov Conjecture for bounded surgery on foliations in analogy with the foliated Novikov conjecture of P.Baum and A.Connes in operator theory. This surgery theory classifies the leaves topologically. Secondly, we construct a bounded geometry surgery for foliations, which is a generalization of blocked surgery, and a bounded geometry Whitehead torsion. The classifications in this surgery theory include the specification of the Riemannian metrics of the leaves up to quasi=isometry. We state Borel conjectures for foliations, which solves a problem posed by S.Weinberger \cite{Wein}, and verify these in some cases of geometrical interest.

Chest X-rays is one of the most commonly available and affordable radiological examinations in clinical practice. While detecting thoracic diseases on chest X-rays is still a challenging task for machine intelligence, due to 1) the highly varied appearance of lesion areas on X-rays from patients of different thoracic disease and 2) the shortage of accurate pixel-level annotations by radiologists for model training. Existing machine learning methods are unable to deal with the challenge that thoracic diseases usually happen in localized disease-specific areas. In this article, we propose a weakly supervised deep learning framework equipped with squeeze-and-excitation blocks, multi-map transfer, and max-min pooling for classifying thoracic diseases as well as localizing suspicious lesion regions. The comprehensive experiments and discussions are performed on the ChestX-ray14 dataset. Both numerical and visual results have demonstrated the effectiveness of the proposed model and its better performance against the state-of-the-art pipelines.

High-fidelity modeling of blood flow is crucial for enhancing our understanding of cardiovascular disease. Despite significant advances in computational and experimental characterization of blood flow, the knowledge that we can acquire from such investigations remains limited by the presence of uncertainty in parameters, low spatiotemporal resolution, and measurement noise. Additionally, extracting useful information from these datasets is challenging. Data-driven modeling techniques have the potential to overcome these challenges and transform cardiovascular flow modeling. In this paper, we review several data-driven modeling techniques, highlight the common ideas and principles that emerge across numerous such techniques, and provide illustrative examples of how they could be used in the context of cardiovascular fluid mechanics. In particular, we discuss principal component analysis (PCA), robust PCA, compressed sensing, the Kalman filter for data assimilation, low-rank data recovery, and several additional methods for reduced-order modeling for cardiovascular flows, including the dynamic mode decomposition (DMD), and the sparse identification of nonlinear dynamics (SINDy). All

Echocardiography (echo) is an ultrasound imaging modality that is widely used for various cardiovascular diagnosis tasks. Due to inter-observer variability in echo-based diagnosis, which arises from the variability in echo image acquisition and the interpretation of echo images based on clinical experience, vision-based machine learning (ML) methods have gained popularity to act as secondary layers of verification. For such safety-critical applications, it is essential for any proposed ML method to present a level of explainability along with good accuracy. In addition, such methods must be able to process several echo videos obtained from various heart views and the interactions among them to properly produce predictions for a variety of cardiovascular measurements or interpretation tasks. Prior work lacks explainability or is limited in scope by focusing on a single cardiovascular task. To remedy this, we propose a General, Echo-based, Multi-Level Transformer (GEMTrans) framework that provides explainability, while simultaneously enabling multi-video training where the inter-play among echo image patches in the same frame, all frames in the same video, and inter-video relationshi

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).

Generating Natural Language Explanations (NLEs) for model predictions on medical images, particularly those depicting thoracic pathologies, remains a critical and challenging task. Existing methodologies often struggle due to general models' insufficient domain-specific medical knowledge and privacy concerns associated with retrieval-based augmentation techniques. To address these issues, we propose a novel Vision-Language framework augmented with a Knowledge Graph (KG)-based datastore, which enhances the model's understanding by incorporating additional domain-specific medical knowledge essential for generating accurate and informative NLEs. Our framework employs a KG-based retrieval mechanism that not only improves the precision of the generated explanations but also preserves data privacy by avoiding direct data retrieval. The KG datastore is designed as a plug-and-play module, allowing for seamless integration with various model architectures. We introduce and evaluate three distinct frameworks within this paradigm: KG-LLaVA, which integrates the pre-trained LLaVA model with KG-RAG; Med-XPT, a custom framework combining MedCLIP, a transformer-based projector, and GPT-2; and Bio

Understanding the causes and patient impacts of surgical adverse events will help improve systems and operational practices to avoid incidents in the future. We analyzed the adverse events data related to robotic systems and instruments used in minimally invasive surgery, reported to the U.S. FDA MAUDE database from January 2000 to December 2013. We determined the number of events reported per procedure and per surgical specialty, the most common types of device malfunctions and their impact on patients, and the causes for catastrophic events such as major complications, patient injuries, and deaths. During the study period, 144 deaths (1.4% of the 10,624 reports), 1,391 patient injuries (13.1%), and 8,061 device malfunctions (75.9%) were reported. The numbers of injury and death events per procedure have stayed relatively constant since 2007 (mean = 83.4, 95% CI, 74.2-92.7). Surgical specialties, for which robots are extensively used, such as gynecology and urology, had lower number of injuries, deaths, and conversions per procedure than more complex surgeries, such as cardiothoracic and head and neck (106.3 vs. 232.9, Risk Ratio = 2.2, 95% CI, 1.9-2.6). Device and instrument malf

It is known that any contact 3-manifold can be obtained by rational contact Dehn surgery along a Legendrian link L in the standard tight contact 3-sphere. We define and study various versions of contact surgery numbers, the minimal number of components of a surgery link L describing a given contact 3-manifold under consideration. In the first part of the paper, we relate contact surgery numbers to other invariants in terms of various inequalities. In particular, we show that the contact surgery number of a contact manifold is bounded from above by the topological surgery number of the underlying topological manifold plus three. In the second part, we compute contact surgery numbers of all contact structures on the 3-sphere. Moreover, we completely classify the contact structures with contact surgery number one on $S^1\times S^2$, the Poincaré homology sphere, and the Brieskorn sphere $Σ(2,3,7)$. We conclude that there exist infinitely many non-isotopic contact structures on each of the above manifolds which cannot be obtained by a single rational contact surgery from the standard tight contact $3$-sphere. We further obtain results for the 3-torus and lens spaces. As one ingredient