Surgical data science for next-generation interventions.
German Cancer Research Center1, Johns Hopkins University2, Technische Universität München3, Brigham and Women's Hospital4, University of Bremen5, Johns Hopkins University School of Medicine6, University of Upper Alsace7, Imperial College London8, Kyushu University9, Karlsruhe Institute of Technology10, Heidelberg University11, Leipzig University12, University of Strasbourg13, University of Wisconsin-Madison14, University College London15, French Institute of Health and Medical Research16, University of Rennes17
TL;DR: Interventional healthcare will evolve from an artisanal craft based on the individual experiences, preferences and traditions of physicians into a discipline that relies on objective decision-making on the basis of large-scale data from heterogeneous sources.
Abstract: Interventional healthcare will evolve from an artisanal craft based on the individual experiences, preferences and traditions of physicians into a discipline that relies on objective decision-making on the basis of large-scale data from heterogeneous sources.
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TL;DR: Over time, marked improvements in accuracy, productivity, and workflow will likely be actualized, but whether that will be used to improve the patient–doctor relationship or facilitate its erosion remains to be seen.
Abstract: The use of artificial intelligence, and the deep-learning subtype in particular, has been enabled by the use of labeled big data, along with markedly enhanced computing power and cloud storage, across all sectors. In medicine, this is beginning to have an impact at three levels: for clinicians, predominantly via rapid, accurate image interpretation; for health systems, by improving workflow and the potential for reducing medical errors; and for patients, by enabling them to process their own data to promote health. The current limitations, including bias, privacy and security, and lack of transparency, along with the future directions of these applications will be discussed in this article. Over time, marked improvements in accuracy, productivity, and workflow will likely be actualized, but whether that will be used to improve the patient-doctor relationship or facilitate its erosion remains to be seen.
2,574 citations
TL;DR: The results suggest that if anaesthesiologists currently anticipate 15% of hypoxaemia events, with the assistance of this system they could anticipate 30%, a large portion of which may benefit from early intervention because they are associated with modifiable factors.
Abstract: Although anaesthesiologists strive to avoid hypoxemia during surgery, reliably predicting future intraoperative hypoxemia is not currently possible. Here, we report the development and testing of a machine-learning-based system that, in real time during general anaesthesia, predicts the risk of hypoxemia and provides explanations of the risk factors. The system, which was trained on minute-by-minute data from the electronic medical records of over fifty thousand surgeries, improved the performance of anaesthesiologists when providing interpretable hypoxemia risks and contributing factors. The explanations for the predictions are broadly consistent with the literature and with prior knowledge from anaesthesiologists. Our results suggest that if anaesthesiologists currently anticipate 15% of hypoxemia events, with this system's assistance they would anticipate 30% of them, a large portion of which may benefit from early intervention because they are associated with modifiable factors. The system can help improve the clinical understanding of hypoxemia risk during anaesthesia care by providing general insights into the exact changes in risk induced by certain patient or procedure characteristics.
956 citations
08 Jan 2021
TL;DR: In this paper, the authors survey recent progress in the development of modern computer vision techniques-powered by deep learning-for medical applications, focusing on medical imaging, medical video, and clinical deployment.
Abstract: A decade of unprecedented progress in artificial intelligence (AI) has demonstrated the potential for many fields-including medicine-to benefit from the insights that AI techniques can extract from data. Here we survey recent progress in the development of modern computer vision techniques-powered by deep learning-for medical applications, focusing on medical imaging, medical video, and clinical deployment. We start by briefly summarizing a decade of progress in convolutional neural networks, including the vision tasks they enable, in the context of healthcare. Next, we discuss several example medical imaging applications that stand to benefit-including cardiology, pathology, dermatology, ophthalmology-and propose new avenues for continued work. We then expand into general medical video, highlighting ways in which clinical workflows can integrate computer vision to enhance care. Finally, we discuss the challenges and hurdles required for real-world clinical deployment of these technologies.
296 citations
TL;DR: An overview of ML models and data streams utilized for automated surgical phase recognition can be performed with high accuracy, depending on the model, data type, and complexity of surgery.
Abstract: Objective To provide an overview of ML models and data streams utilized for automated surgical phase recognition. Background Phase recognition identifies different steps and phases of an operation. ML is an evolving technology that allows analysis and interpretation of huge data sets. Automation of phase recognition based on data inputs is essential for optimization of workflow, surgical training, intraoperative assistance, patient safety, and efficiency. Methods A systematic review was performed according to the Cochrane recommendations and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. PubMed, Web of Science, IEEExplore, GoogleScholar, and CiteSeerX were searched. Literature describing phase recognition based on ML models and the capture of intraoperative signals during general surgery procedures was included. Results A total of 2254 titles/abstracts were screened, and 35 full-texts were included. Most commonly used ML models were Hidden Markov Models and Artificial Neural Networks with a trend towards higher complexity over time. Most frequently used data types were feature learning from surgical videos and manual annotation of instrument use. Laparoscopic cholecystectomy was used most commonly, often achieving accuracy rates over 90%, though there was no consistent standardization of defined phases. Conclusions ML for surgical phase recognition can be performed with high accuracy, depending on the model, data type, and complexity of surgery. Different intraoperative data inputs such as video and instrument type can successfully be used. Most ML models still require significant amounts of manual expert annotations for training. The ML models may drive surgical workflow towards standardization, efficiency, and objectiveness to improve patient outcome in the future. Registration prospero CRD42018108907.
113 citations
TL;DR: In this article, the authors proposed a self-supervised learning approach for pre-training of CNNs for medical instrument segmentation using unlabeled video data from the target domain.
Abstract: Surgical data science is a new research field that aims to observe all aspects of the patient treatment process in order to provide the right assistance at the right time. Due to the breakthrough successes of deep learning-based solutions for automatic image annotation, the availability of reference annotations for algorithm training is becoming a major bottleneck in the field. The purpose of this paper was to investigate the concept of self-supervised learning to address this issue. Our approach is guided by the hypothesis that unlabeled video data can be used to learn a representation of the target domain that boosts the performance of state-of-the-art machine learning algorithms when used for pre-training. Core of the method is an auxiliary task based on raw endoscopic video data of the target domain that is used to initialize the convolutional neural network (CNN) for the target task. In this paper, we propose the re-colorization of medical images with a conditional generative adversarial network (cGAN)-based architecture as auxiliary task. A variant of the method involves a second pre-training step based on labeled data for the target task from a related domain. We validate both variants using medical instrument segmentation as target task. The proposed approach can be used to radically reduce the manual annotation effort involved in training CNNs. Compared to the baseline approach of generating annotated data from scratch, our method decreases exploratively the number of labeled images by up to 75% without sacrificing performance. Our method also outperforms alternative methods for CNN pre-training, such as pre-training on publicly available non-medical (COCO) or medical data (MICCAI EndoVis2017 challenge) using the target task (in this instance: segmentation). As it makes efficient use of available (non-)public and (un-)labeled data, the approach has the potential to become a valuable tool for CNN (pre-)training.
113 citations
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TL;DR: In view of the high death and complication rates of major surgical procedures, surgical safety should now be a substantial global public-health concern.
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"Surgical data science for next-gene..." refers background in this paper
...Despite increased expectation for outcomes and safety from patients, hospitals and insurers, studies estimate that 9 million (4) of an estimated 300 million surgical procedures per year worldwide (5) will encounter major complications....
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