Daily Papers

Learning a policy with great generalization to unseen environments remains challenging but critical in visual reinforcement learning. Despite the success of augmentation combination in the supervised learning generalization, naively applying it to visual RL algorithms may damage the training efficiency, suffering from serve performance degradation. In this paper, we first conduct qualitative analysis and illuminate the main causes: (i) high-variance gradient magnitudes and (ii) gradient conflicts existed in various augmentation methods. To alleviate these issues, we propose a general policy gradient optimization framework, named Conflict-aware Gradient Agreement Augmentation (CG2A), and better integrate augmentation combination into visual RL algorithms to address the generalization bias. In particular, CG2A develops a Gradient Agreement Solver to adaptively balance the varying gradient magnitudes, and introduces a Soft Gradient Surgery strategy to alleviate the gradient conflicts. Extensive experiments demonstrate that CG2A significantly improves the generalization performance and sample efficiency of visual RL algorithms.

While deep learning and deep reinforcement learning (RL) systems have demonstrated impressive results in domains such as image classification, game playing, and robotic control, data efficiency remains a major challenge. Multi-task learning has emerged as a promising approach for sharing structure across multiple tasks to enable more efficient learning. However, the multi-task setting presents a number of optimization challenges, making it difficult to realize large efficiency gains compared to learning tasks independently. The reasons why multi-task learning is so challenging compared to single-task learning are not fully understood. In this work, we identify a set of three conditions of the multi-task optimization landscape that cause detrimental gradient interference, and develop a simple yet general approach for avoiding such interference between task gradients. We propose a form of gradient surgery that projects a task's gradient onto the normal plane of the gradient of any other task that has a conflicting gradient. On a series of challenging multi-task supervised and multi-task RL problems, this approach leads to substantial gains in efficiency and performance. Further, it is model-agnostic and can be combined with previously-proposed multi-task architectures for enhanced performance.

Beyond minimizing a single training loss, many deep learning estimation pipelines rely on an auxiliary objective to quantify and encourage desirable properties of the model (e.g. performance on another dataset, robustness, agreement with a prior). Although the simplest approach to incorporating an auxiliary loss is to sum it with the training loss as a regularizer, recent works have shown that one can improve performance by blending the gradients beyond a simple sum; this is known as gradient surgery. We cast the problem as a constrained minimization problem where the auxiliary objective is minimized among the set of minimizers of the training loss. To solve this bilevel problem, we follow a parameter update direction that combines the training loss gradient and the orthogonal projection of the auxiliary gradient to the training gradient. In a setting where gradients come from mini-batches, we explain how, using a moving average of the training loss gradients, we can carefully maintain this critical orthogonality property. We demonstrate that our method, Bloop, can lead to much better performances on NLP and vision experiments than other gradient surgery methods without EMA.

Dynamic reconstruction of deformable tissues in endoscopic video is a key technology for robot-assisted surgery. Recent reconstruction methods based on neural radiance fields (NeRFs) have achieved remarkable results in the reconstruction of surgical scenes. However, based on implicit representation, NeRFs struggle to capture the intricate details of objects in the scene and cannot achieve real-time rendering. In addition, restricted single view perception and occluded instruments also propose special challenges in surgical scene reconstruction. To address these issues, we develop SurgicalGaussian, a deformable 3D Gaussian Splatting method to model dynamic surgical scenes. Our approach models the spatio-temporal features of soft tissues at each time stamp via a forward-mapping deformation MLP and regularization to constrain local 3D Gaussians to comply with consistent movement. With the depth initialization strategy and tool mask-guided training, our method can remove surgical instruments and reconstruct high-fidelity surgical scenes. Through experiments on various surgical videos, our network outperforms existing method on many aspects, including rendering quality, rendering speed and GPU usage. The project page can be found at https://surgicalgaussian.github.io.

Medical image registration is a critical task that estimates the spatial correspondence between pairs of images. However, current traditional and deep-learning-based methods rely on similarity measures to generate a deforming field, which often results in disproportionate volume changes in dissimilar regions, especially in tumor regions. These changes can significantly alter the tumor size and underlying anatomy, which limits the practical use of image registration in clinical diagnosis. To address this issue, we have formulated image registration with tumors as a constraint problem that preserves tumor volumes while maximizing image similarity in other normal regions. Our proposed strategy involves a two-stage process. In the first stage, we use similarity-based registration to identify potential tumor regions by their volume change, generating a soft tumor mask accordingly. In the second stage, we propose a volume-preserving registration with a novel adaptive volume-preserving loss that penalizes the change in size adaptively based on the masks calculated from the previous stage. Our approach balances image similarity and volume preservation in different regions, i.e., normal and tumor regions, by using soft tumor masks to adjust the imposition of volume-preserving loss on each one. This ensures that the tumor volume is preserved during the registration process. We have evaluated our strategy on various datasets and network architectures, demonstrating that our method successfully preserves the tumor volume while achieving comparable registration results with state-of-the-art methods. Our codes is available at: https://dddraxxx.github.io/Volume-Preserving-Registration/.

The softmax function is crucial in Transformer attention, which normalizes each row of the attention scores with summation to one, achieving superior performances over other alternative functions. However, the softmax function can face a gradient vanishing issue when some elements of the attention scores approach extreme values, such as probabilities close to one or zero. In this paper, we propose Self-Adjust Softmax (SA-Softmax) to address this issue by modifying softmax(x) to x cdot softmax(x) and its normalized variant (x - min(x_{min,0))}{max(0,x_{max})-min(x_{min},0)} cdot softmax(x). We theoretically show that SA-Softmax provides enhanced gradient properties compared to the vanilla softmax function. Moreover, SA-Softmax Attention can be seamlessly integrated into existing Transformer models to their attention mechanisms with minor adjustments. We conducted experiments to evaluate the empirical performance of Transformer models using SA-Softmax compared to the vanilla softmax function. These experiments, involving models with up to 2.7 billion parameters, are conducted across diverse datasets, language tasks, and positional encoding methods.

While significant research progress has been made in robot learning for control, unique challenges arise when simultaneously co-optimizing morphology. Existing work has typically been tailored for particular environments or representations. In order to more fully understand inherent design and performance tradeoffs and accelerate the development of new breeds of soft robots, a comprehensive virtual platform with well-established tasks, environments, and evaluation metrics is needed. In this work, we introduce SoftZoo, a soft robot co-design platform for locomotion in diverse environments. SoftZoo supports an extensive, naturally-inspired material set, including the ability to simulate environments such as flat ground, desert, wetland, clay, ice, snow, shallow water, and ocean. Further, it provides a variety of tasks relevant for soft robotics, including fast locomotion, agile turning, and path following, as well as differentiable design representations for morphology and control. Combined, these elements form a feature-rich platform for analysis and development of soft robot co-design algorithms. We benchmark prevalent representations and co-design algorithms, and shed light on 1) the interplay between environment, morphology, and behavior; 2) the importance of design space representations; 3) the ambiguity in muscle formation and controller synthesis; and 4) the value of differentiable physics. We envision that SoftZoo will serve as a standard platform and template an approach toward the development of novel representations and algorithms for co-designing soft robots' behavioral and morphological intelligence.

In the realm of robot-assisted minimally invasive surgery, dynamic scene reconstruction can significantly enhance downstream tasks and improve surgical outcomes. Neural Radiance Fields (NeRF)-based methods have recently risen to prominence for their exceptional ability to reconstruct scenes but are hampered by slow inference speed, prolonged training, and inconsistent depth estimation. Some previous work utilizes ground truth depth for optimization but is hard to acquire in the surgical domain. To overcome these obstacles, we present Endo-4DGS, a real-time endoscopic dynamic reconstruction approach that utilizes 3D Gaussian Splatting (GS) for 3D representation. Specifically, we propose lightweight MLPs to capture temporal dynamics with Gaussian deformation fields. To obtain a satisfactory Gaussian Initialization, we exploit a powerful depth estimation foundation model, Depth-Anything, to generate pseudo-depth maps as a geometry prior. We additionally propose confidence-guided learning to tackle the ill-pose problems in monocular depth estimation and enhance the depth-guided reconstruction with surface normal constraints and depth regularization. Our approach has been validated on two surgical datasets, where it can effectively render in real-time, compute efficiently, and reconstruct with remarkable accuracy.

The lack of labeled datasets in 3D vision for surgical scenes inhibits the development of robust 3D reconstruction algorithms in the medical domain. Despite the popularity of Neural Radiance Fields and 3D Gaussian Splatting in the general computer vision community, these systems have yet to find consistent success in surgical scenes due to challenges such as non-stationary lighting and non-Lambertian surfaces. As a result, the need for labeled surgical datasets continues to grow. In this work, we introduce a differentiable rendering framework for material and lighting estimation from endoscopic images and known geometry. Compared to previous approaches that model lighting and material jointly as radiance, we explicitly disentangle these scene properties for robust and photorealistic novel view synthesis. To disambiguate the training process, we formulate domain-specific properties inherent in surgical scenes. Specifically, we model the scene lighting as a simple spotlight and material properties as a bidirectional reflectance distribution function, parameterized by a neural network. By grounding color predictions in the rendering equation, we can generate photorealistic images at arbitrary camera poses. We evaluate our method with various sequences from the Colonoscopy 3D Video Dataset and show that our method produces competitive novel view synthesis results compared with other approaches. Furthermore, we demonstrate that synthetic data can be used to develop 3D vision algorithms by finetuning a depth estimation model with our rendered outputs. Overall, we see that the depth estimation performance is on par with fine-tuning with the original real images.

Differentiable architecture search (DARTS) yields highly efficient gradient-based neural architecture search (NAS) by relaxing the discrete operation selection to optimize continuous architecture parameters that maps NAS from the discrete optimization to a continuous problem. DARTS then remaps the relaxed supernet back to the discrete space by one-off post-search pruning to obtain the final architecture (finalnet). Some emerging works argue that this remap is inherently prone to mismatch the network between training and evaluation which leads to performance discrepancy and even model collapse in extreme cases. We propose to close the gap between the relaxed supernet in training and the pruned finalnet in evaluation through utilizing small temperature to sparsify the continuous distribution in the training phase. To this end, we first formulate sparse-noisy softmax to get around gradient saturation. We then propose an exponential temperature schedule to better control the outbound distribution and elaborate an entropy-based adaptive scheme to finally achieve the enhancement. We conduct extensive experiments to verify the efficiency and efficacy of our method.

The skeleton of a digital image is a compact representation of its topology, geometry, and scale. It has utility in many computer vision applications, such as image description, segmentation, and registration. However, skeletonization has only seen limited use in contemporary deep learning solutions. Most existing skeletonization algorithms are not differentiable, making it impossible to integrate them with gradient-based optimization. Compatible algorithms based on morphological operations and neural networks have been proposed, but their results often deviate from the geometry and topology of the true medial axis. This work introduces the first three-dimensional skeletonization algorithm that is both compatible with gradient-based optimization and preserves an object's topology. Our method is exclusively based on matrix additions and multiplications, convolutional operations, basic non-linear functions, and sampling from a uniform probability distribution, allowing it to be easily implemented in any major deep learning library. In benchmarking experiments, we prove the advantages of our skeletonization algorithm compared to non-differentiable, morphological, and neural-network-based baselines. Finally, we demonstrate the utility of our algorithm by integrating it with two medical image processing applications that use gradient-based optimization: deep-learning-based blood vessel segmentation, and multimodal registration of the mandible in computed tomography and magnetic resonance images.

Vision transformers (ViTs) have pushed the state-of-the-art for visual perception tasks. The self-attention mechanism underpinning the strength of ViTs has a quadratic complexity in both computation and memory usage. This motivates the development of approximating the self-attention at linear complexity. However, an in-depth analysis in this work reveals that existing methods are either theoretically flawed or empirically ineffective for visual recognition. We identify that their limitations are rooted in the inheritance of softmax-based self-attention during approximations, that is, normalizing the scaled dot-product between token feature vectors using the softmax function. As preserving the softmax operation challenges any subsequent linearization efforts. By this insight, a family of Softmax-Free Transformers (SOFT) are proposed. Specifically, a Gaussian kernel function is adopted to replace the dot-product similarity, enabling a full self-attention matrix to be approximated under low-rank matrix decomposition. For computational robustness, we estimate the Moore-Penrose inverse using an iterative Newton-Raphson method in the forward process only, while calculating its theoretical gradients only once in the backward process. To further expand applicability (e.g., dense prediction tasks), an efficient symmetric normalization technique is introduced. Extensive experiments on ImageNet, COCO, and ADE20K show that our SOFT significantly improves the computational efficiency of existing ViT variants. With linear complexity, much longer token sequences are permitted by SOFT, resulting in superior trade-off between accuracy and complexity. Code and models are available at https://github.com/fudan-zvg/SOFT.

Physical simulators have been widely used in robot planning and control. Among them, differentiable simulators are particularly favored, as they can be incorporated into gradient-based optimization algorithms that are efficient in solving inverse problems such as optimal control and motion planning. Simulating deformable objects is, however, more challenging compared to rigid body dynamics. The underlying physical laws of deformable objects are more complex, and the resulting systems have orders of magnitude more degrees of freedom and therefore they are significantly more computationally expensive to simulate. Computing gradients with respect to physical design or controller parameters is typically even more computationally challenging. In this paper, we propose a real-time, differentiable hybrid Lagrangian-Eulerian physical simulator for deformable objects, ChainQueen, based on the Moving Least Squares Material Point Method (MLS-MPM). MLS-MPM can simulate deformable objects including contact and can be seamlessly incorporated into inference, control and co-design systems. We demonstrate that our simulator achieves high precision in both forward simulation and backward gradient computation. We have successfully employed it in a diverse set of control tasks for soft robots, including problems with nearly 3,000 decision variables.

Restart techniques are common in gradient-free optimization to deal with multimodal functions. Partial warm restarts are also gaining popularity in gradient-based optimization to improve the rate of convergence in accelerated gradient schemes to deal with ill-conditioned functions. In this paper, we propose a simple warm restart technique for stochastic gradient descent to improve its anytime performance when training deep neural networks. We empirically study its performance on the CIFAR-10 and CIFAR-100 datasets, where we demonstrate new state-of-the-art results at 3.14% and 16.21%, respectively. We also demonstrate its advantages on a dataset of EEG recordings and on a downsampled version of the ImageNet dataset. Our source code is available at https://github.com/loshchil/SGDR

In recent years, artificial intelligence has significantly advanced medical image segmentation. Nonetheless, challenges remain, including efficient 3D medical image processing across diverse modalities and handling data variability. In this work, we introduce Hierarchical Soft Mixture-of-Experts (HoME), a two-level token-routing layer for efficient long-context modeling, specifically designed for 3D medical image segmentation. Built on the Mamba Selective State Space Model (SSM) backbone, HoME enhances sequential modeling through adaptive expert routing. In the first level, a Soft Mixture-of-Experts (SMoE) layer partitions input sequences into local groups, routing tokens to specialized per-group experts for localized feature extraction. The second level aggregates these outputs through a global SMoE layer, enabling cross-group information fusion and global context refinement. This hierarchical design, combining local expert routing with global expert refinement, enhances generalizability and segmentation performance, surpassing state-of-the-art results across datasets from the three most widely used 3D medical imaging modalities and varying data qualities. The code is publicly available at https://github.com/gmum/MambaHoME.

In this paper, we propose a novel text promptable surgical instrument segmentation approach to overcome challenges associated with diversity and differentiation of surgical instruments in minimally invasive surgeries. We redefine the task as text promptable, thereby enabling a more nuanced comprehension of surgical instruments and adaptability to new instrument types. Inspired by recent advancements in vision-language models, we leverage pretrained image and text encoders as our model backbone and design a text promptable mask decoder consisting of attention- and convolution-based prompting schemes for surgical instrument segmentation prediction. Our model leverages multiple text prompts for each surgical instrument through a new mixture of prompts mechanism, resulting in enhanced segmentation performance. Additionally, we introduce a hard instrument area reinforcement module to improve image feature comprehension and segmentation precision. Extensive experiments on EndoVis2017 and EndoVis2018 datasets demonstrate our model's superior performance and promising generalization capability. To our knowledge, this is the first implementation of a promptable approach to surgical instrument segmentation, offering significant potential for practical application in the field of robotic-assisted surgery.

Recent advances in multimodal large language models (LLMs) have highlighted their potential for medical and surgical applications. However, existing surgical datasets predominantly adopt a Visual Question Answering (VQA) format with heterogeneous taxonomies and lack support for pixel-level segmentation, limiting consistent evaluation and applicability. We present SurgMLLMBench, a unified multimodal benchmark explicitly designed for developing and evaluating interactive multimodal LLMs for surgical scene understanding, including the newly collected Micro-surgical Artificial Vascular anastomosIS (MAVIS) dataset. It integrates pixel-level instrument segmentation masks and structured VQA annotations across laparoscopic, robot-assisted, and micro-surgical domains under a unified taxonomy, enabling comprehensive evaluation beyond traditional VQA tasks and richer visual-conversational interactions. Extensive baseline experiments show that a single model trained on SurgMLLMBench achieves consistent performance across domains and generalizes effectively to unseen datasets. SurgMLLMBench will be publicly released as a robust resource to advance multimodal surgical AI research, supporting reproducible evaluation and development of interactive surgical reasoning models.

In this work, we develop new optimization algorithms that use approximate second-order information combined with the gradient regularization technique to achieve fast global convergence rates for both convex and non-convex objectives. The key innovation of our analysis is a novel notion called Gradient-Normalized Smoothness, which characterizes the maximum radius of a ball around the current point that yields a good relative approximation of the gradient field. Our theory establishes a natural intrinsic connection between Hessian approximation and the linearization of the gradient. Importantly, Gradient-Normalized Smoothness does not depend on the specific problem class of the objective functions, while effectively translating local information about the gradient field and Hessian approximation into the global behavior of the method. This new concept equips approximate second-order algorithms with universal global convergence guarantees, recovering state-of-the-art rates for functions with H\"older-continuous Hessians and third derivatives, quasi-self-concordant functions, as well as smooth classes in first-order optimization. These rates are achieved automatically and extend to broader classes, such as generalized self-concordant functions. We demonstrate direct applications of our results for global linear rates in logistic regression and softmax problems with approximate Hessians, as well as in non-convex optimization using Fisher and Gauss-Newton approximations.

Recent advances in Vision Transformers (ViTs) have significantly enhanced medical image segmentation by facilitating the learning of global relationships. However, these methods face a notable challenge in capturing diverse local and global long-range sequential feature representations, particularly evident in whole-body CT (WBCT) scans. To overcome this limitation, we introduce Swin Soft Mixture Transformer (Swin SMT), a novel architecture based on Swin UNETR. This model incorporates a Soft Mixture-of-Experts (Soft MoE) to effectively handle complex and diverse long-range dependencies. The use of Soft MoE allows for scaling up model parameters maintaining a balance between computational complexity and segmentation performance in both training and inference modes. We evaluate Swin SMT on the publicly available TotalSegmentator-V2 dataset, which includes 117 major anatomical structures in WBCT images. Comprehensive experimental results demonstrate that Swin SMT outperforms several state-of-the-art methods in 3D anatomical structure segmentation, achieving an average Dice Similarity Coefficient of 85.09%. The code and pre-trained weights of Swin SMT are publicly available at https://github.com/MI2DataLab/SwinSMT.

Model-free deep reinforcement learning (RL) algorithms have been successfully applied to a range of challenging sequential decision making and control tasks. However, these methods typically suffer from two major challenges: high sample complexity and brittleness to hyperparameters. Both of these challenges limit the applicability of such methods to real-world domains. In this paper, we describe Soft Actor-Critic (SAC), our recently introduced off-policy actor-critic algorithm based on the maximum entropy RL framework. In this framework, the actor aims to simultaneously maximize expected return and entropy. That is, to succeed at the task while acting as randomly as possible. We extend SAC to incorporate a number of modifications that accelerate training and improve stability with respect to the hyperparameters, including a constrained formulation that automatically tunes the temperature hyperparameter. We systematically evaluate SAC on a range of benchmark tasks, as well as real-world challenging tasks such as locomotion for a quadrupedal robot and robotic manipulation with a dexterous hand. With these improvements, SAC achieves state-of-the-art performance, outperforming prior on-policy and off-policy methods in sample-efficiency and asymptotic performance. Furthermore, we demonstrate that, in contrast to other off-policy algorithms, our approach is very stable, achieving similar performance across different random seeds. These results suggest that SAC is a promising candidate for learning in real-world robotics tasks.

Gradient methods have become mainstream techniques for Bi-Level Optimization (BLO) in learning fields. The validity of existing works heavily rely on either a restrictive Lower- Level Strong Convexity (LLSC) condition or on solving a series of approximation subproblems with high accuracy or both. In this work, by averaging the upper and lower level objectives, we propose a single loop Bi-level Averaged Method of Multipliers (sl-BAMM) for BLO that is simple yet efficient for large-scale BLO and gets rid of the limited LLSC restriction. We further provide non-asymptotic convergence analysis of sl-BAMM towards KKT stationary points, and the comparative advantage of our analysis lies in the absence of strong gradient boundedness assumption, which is always required by others. Thus our theory safely captures a wider variety of applications in deep learning, especially where the upper-level objective is quadratic w.r.t. the lower-level variable. Experimental results demonstrate the superiority of our method.

Modern medical image registration approaches predict deformations using deep networks. These approaches achieve state-of-the-art (SOTA) registration accuracy and are generally fast. However, deep learning (DL) approaches are, in contrast to conventional non-deep-learning-based approaches, anatomy-specific. Recently, a universal deep registration approach, uniGradICON, has been proposed. However, uniGradICON focuses on monomodal image registration. In this work, we therefore develop multiGradICON as a first step towards universal *multimodal* medical image registration. Specifically, we show that 1) we can train a DL registration model that is suitable for monomodal *and* multimodal registration; 2) loss function randomization can increase multimodal registration accuracy; and 3) training a model with multimodal data helps multimodal generalization. Our code and the multiGradICON model are available at https://github.com/uncbiag/uniGradICON.

Recent advances in robot-assisted surgery have resulted in progressively more precise, efficient, and minimally invasive procedures, sparking a new era of robotic surgical intervention. This enables doctors, in collaborative interaction with robots, to perform traditional or minimally invasive surgeries with improved outcomes through smaller incisions. Recent efforts are working toward making robotic surgery more autonomous which has the potential to reduce variability of surgical outcomes and reduce complication rates. Deep reinforcement learning methodologies offer scalable solutions for surgical automation, but their effectiveness relies on extensive data acquisition due to the absence of prior knowledge in successfully accomplishing tasks. Due to the intensive nature of simulated data collection, previous works have focused on making existing algorithms more efficient. In this work, we focus on making the simulator more efficient, making training data much more accessible than previously possible. We introduce Surgical Gym, an open-source high performance platform for surgical robot learning where both the physics simulation and reinforcement learning occur directly on the GPU. We demonstrate between 100-5000x faster training times compared with previous surgical learning platforms. The code is available at: https://github.com/SamuelSchmidgall/SurgicalGym.

Research on autonomous surgery has largely focused on simple task automation in controlled environments. However, real-world surgical applications demand dexterous manipulation over extended durations and generalization to the inherent variability of human tissue. These challenges remain difficult to address using existing logic-based or conventional end-to-end learning approaches. To address this gap, we propose a hierarchical framework for performing dexterous, long-horizon surgical steps. Our approach utilizes a high-level policy for task planning and a low-level policy for generating robot trajectories. The high-level planner plans in language space, generating task-level or corrective instructions that guide the robot through the long-horizon steps and correct for the low-level policy's errors. We validate our framework through ex vivo experiments on cholecystectomy, a commonly-practiced minimally invasive procedure, and conduct ablation studies to evaluate key components of the system. Our method achieves a 100\% success rate across eight unseen ex vivo gallbladders, operating fully autonomously without human intervention. This work demonstrates step-level autonomy in a surgical procedure, marking a milestone toward clinical deployment of autonomous surgical systems.

Multi-organ segmentation is a critical yet challenging task due to complex anatomical backgrounds, blurred boundaries, and diverse morphologies. This study introduces the Gradient-aware Adaptive Momentum Evolution Deep Snake (GAMED-Snake) model, which establishes a novel paradigm for contour-based segmentation by integrating gradient-based learning with adaptive momentum evolution mechanisms. The GAMED-Snake model incorporates three major innovations: First, the Distance Energy Map Prior (DEMP) generates a pixel-level force field that effectively attracts contour points towards the true boundaries, even in scenarios with complex backgrounds and blurred edges. Second, the Differential Convolution Inception Module (DCIM) precisely extracts comprehensive energy gradients, significantly enhancing segmentation accuracy. Third, the Adaptive Momentum Evolution Mechanism (AMEM) employs cross-attention to establish dynamic features across different iterations of evolution, enabling precise boundary alignment for diverse morphologies. Experimental results on four challenging multi-organ segmentation datasets demonstrate that GAMED-Snake improves the mDice metric by approximately 2% compared to state-of-the-art methods. Code will be available at https://github.com/SYSUzrc/GAMED-Snake.

The field of computer vision applied to videos of minimally invasive surgery is ever-growing. Workflow recognition pertains to the automated recognition of various aspects of a surgery: including which surgical steps are performed; and which surgical instruments are used. This information can later be used to assist clinicians when learning the surgery; during live surgery; and when writing operation notes. The Pituitary Vision (PitVis) 2023 Challenge tasks the community to step and instrument recognition in videos of endoscopic pituitary surgery. This is a unique task when compared to other minimally invasive surgeries due to the smaller working space, which limits and distorts vision; and higher frequency of instrument and step switching, which requires more precise model predictions. Participants were provided with 25-videos, with results presented at the MICCAI-2023 conference as part of the Endoscopic Vision 2023 Challenge in Vancouver, Canada, on 08-Oct-2023. There were 18-submissions from 9-teams across 6-countries, using a variety of deep learning models. A commonality between the top performing models was incorporating spatio-temporal and multi-task methods, with greater than 50% and 10% macro-F1-score improvement over purely spacial single-task models in step and instrument recognition respectively. The PitVis-2023 Challenge therefore demonstrates state-of-the-art computer vision models in minimally invasive surgery are transferable to a new dataset, with surgery specific techniques used to enhance performance, progressing the field further. Benchmark results are provided in the paper, and the dataset is publicly available at: https://doi.org/10.5522/04/26531686.

Foundation models have revolutionized computer vision by achieving vastly superior performance across diverse tasks through large-scale pretraining on extensive datasets. However, their application in surgical computer vision has been limited. This study addresses this gap by introducing SurgeNetXL, a novel surgical foundation model that sets a new benchmark in surgical computer vision. Trained on the largest reported surgical dataset to date, comprising over 4.7 million video frames, SurgeNetXL achieves consistent top-tier performance across six datasets spanning four surgical procedures and three tasks, including semantic segmentation, phase recognition, and critical view of safety (CVS) classification. Compared with the best-performing surgical foundation models, SurgeNetXL shows mean improvements of 2.4, 9.0, and 12.6 percent for semantic segmentation, phase recognition, and CVS classification, respectively. Additionally, SurgeNetXL outperforms the best-performing ImageNet-based variants by 14.4, 4.0, and 1.6 percent in the respective tasks. In addition to advancing model performance, this study provides key insights into scaling pretraining datasets, extending training durations, and optimizing model architectures specifically for surgical computer vision. These findings pave the way for improved generalizability and robustness in data-scarce scenarios, offering a comprehensive framework for future research in this domain. All models and a subset of the SurgeNetXL dataset, including over 2 million video frames, are publicly available at: https://github.com/TimJaspers0801/SurgeNet.

Soft Actor-Critic is a state-of-the-art reinforcement learning algorithm for continuous action settings that is not applicable to discrete action settings. Many important settings involve discrete actions, however, and so here we derive an alternative version of the Soft Actor-Critic algorithm that is applicable to discrete action settings. We then show that, even without any hyperparameter tuning, it is competitive with the tuned model-free state-of-the-art on a selection of games from the Atari suite.

Convolutional neural network training can suffer from diverse issues like exploding or vanishing gradients, scaling-based weight space symmetry and covariant-shift. In order to address these issues, researchers develop weight regularization methods and activation normalization methods. In this work we propose a weight soft-regularization method based on the Oblique manifold. The proposed method uses a loss function which pushes each weight vector to have a norm close to one, i.e. the weight matrix is smoothly steered toward the so-called Oblique manifold. We evaluate our method on the very popular CIFAR-10, CIFAR-100 and ImageNet 2012 datasets using two state-of-the-art architectures, namely the ResNet and wide-ResNet. Our method introduces negligible computational overhead and the results show that it is competitive to the state-of-the-art and in some cases superior to it. Additionally, the results are less sensitive to hyperparameter settings such as batch size and regularization factor.

Turning the weights to zero when training a neural network helps in reducing the computational complexity at inference. To progressively increase the sparsity ratio in the network without causing sharp weight discontinuities during training, our work combines soft-thresholding and straight-through gradient estimation to update the raw, i.e. non-thresholded, version of zeroed weights. Our method, named ST-3 for straight-through/soft-thresholding/sparse-training, obtains SoA results, both in terms of accuracy/sparsity and accuracy/FLOPS trade-offs, when progressively increasing the sparsity ratio in a single training cycle. In particular, despite its simplicity, ST-3 favorably compares to the most recent methods, adopting differentiable formulations or bio-inspired neuroregeneration principles. This suggests that the key ingredients for effective sparsification primarily lie in the ability to give the weights the freedom to evolve smoothly across the zero state while progressively increasing the sparsity ratio. Source code and weights available at https://github.com/vanderschuea/stthree

Gradient regularization (GR) is a method that penalizes the gradient norm of the training loss during training. While some studies have reported that GR can improve generalization performance, little attention has been paid to it from the algorithmic perspective, that is, the algorithms of GR that efficiently improve the performance. In this study, we first reveal that a specific finite-difference computation, composed of both gradient ascent and descent steps, reduces the computational cost of GR. Next, we show that the finite-difference computation also works better in the sense of generalization performance. We theoretically analyze a solvable model, a diagonal linear network, and clarify that GR has a desirable implicit bias to so-called rich regime and finite-difference computation strengthens this bias. Furthermore, finite-difference GR is closely related to some other algorithms based on iterative ascent and descent steps for exploring flat minima. In particular, we reveal that the flooding method can perform finite-difference GR in an implicit way. Thus, this work broadens our understanding of GR for both practice and theory.

Organ at risk (OAR) segmentation is a critical process in radiotherapy treatment planning such as head and neck tumors. Nevertheless, in clinical practice, radiation oncologists predominantly perform OAR segmentations manually on CT scans. This manual process is highly time-consuming and expensive, limiting the number of patients who can receive timely radiotherapy. Additionally, CT scans offer lower soft-tissue contrast compared to MRI. Despite MRI providing superior soft-tissue visualization, its time-consuming nature makes it infeasible for real-time treatment planning. To address these challenges, we propose a method called SegReg, which utilizes Elastic Symmetric Normalization for registering MRI to perform OAR segmentation. SegReg outperforms the CT-only baseline by 16.78% in mDSC and 18.77% in mIoU, showing that it effectively combines the geometric accuracy of CT with the superior soft-tissue contrast of MRI, making accurate automated OAR segmentation for clinical practice become possible. See project website https://steve-zeyu-zhang.github.io/SegReg

Accurate segmentation of thin structures is critical for microsurgical scene understanding but remains challenging due to resolution loss, low contrast, and class imbalance. We propose Microsurgery Instrument Segmentation for Robotic Assistance(MISRA), a segmentation framework that augments RGB input with luminance channels, integrates skip attention to preserve elongated features, and employs an Iterative Feedback Module(IFM) for continuity restoration across multiple passes. In addition, we introduce a dedicated microsurgical dataset with fine-grained annotations of surgical instruments including thin objects, providing a benchmark for robust evaluation Dataset available at https://huggingface.co/datasets/KIST-HARILAB/MISAW-Seg. Experiments demonstrate that MISRA achieves competitive performance, improving the mean class IoU by 5.37% over competing methods, while delivering more stable predictions at instrument contacts and overlaps. These results position MISRA as a promising step toward reliable scene parsing for computer-assisted and robotic microsurgery.

Endoscopic procedures are essential for diagnosing and treating internal diseases, and multi-modal large language models (MLLMs) are increasingly applied to assist in endoscopy analysis. However, current benchmarks are limited, as they typically cover specific endoscopic scenarios and a small set of clinical tasks, failing to capture the real-world diversity of endoscopic scenarios and the full range of skills needed in clinical workflows. To address these issues, we introduce EndoBench, the first comprehensive benchmark specifically designed to assess MLLMs across the full spectrum of endoscopic practice with multi-dimensional capacities. EndoBench encompasses 4 distinct endoscopic scenarios, 12 specialized clinical tasks with 12 secondary subtasks, and 5 levels of visual prompting granularities, resulting in 6,832 rigorously validated VQA pairs from 21 diverse datasets. Our multi-dimensional evaluation framework mirrors the clinical workflow--spanning anatomical recognition, lesion analysis, spatial localization, and surgical operations--to holistically gauge the perceptual and diagnostic abilities of MLLMs in realistic scenarios. We benchmark 23 state-of-the-art models, including general-purpose, medical-specialized, and proprietary MLLMs, and establish human clinician performance as a reference standard. Our extensive experiments reveal: (1) proprietary MLLMs outperform open-source and medical-specialized models overall, but still trail human experts; (2) medical-domain supervised fine-tuning substantially boosts task-specific accuracy; and (3) model performance remains sensitive to prompt format and clinical task complexity. EndoBench establishes a new standard for evaluating and advancing MLLMs in endoscopy, highlighting both progress and persistent gaps between current models and expert clinical reasoning. We publicly release our benchmark and code.

Sparse training is emerging as a promising avenue for reducing the computational cost of training neural networks. Several recent studies have proposed pruning methods using learnable thresholds to efficiently explore the non-uniform distribution of sparsity inherent within the models. In this paper, we propose Gradient Annealing (GA), where gradients of masked weights are scaled down in a non-linear manner. GA provides an elegant trade-off between sparsity and accuracy without the need for additional sparsity-inducing regularization. We integrated GA with the latest learnable pruning methods to create an automated sparse training algorithm called AutoSparse, which achieves better accuracy and/or training/inference FLOPS reduction than existing learnable pruning methods for sparse ResNet50 and MobileNetV1 on ImageNet-1K: AutoSparse achieves (2x, 7x) reduction in (training,inference) FLOPS for ResNet50 on ImageNet at 80% sparsity. Finally, AutoSparse outperforms sparse-to-sparse SotA method MEST (uniform sparsity) for 80% sparse ResNet50 with similar accuracy, where MEST uses 12% more training FLOPS and 50% more inference FLOPS.

Model-free deep reinforcement learning (RL) algorithms have been demonstrated on a range of challenging decision making and control tasks. However, these methods typically suffer from two major challenges: very high sample complexity and brittle convergence properties, which necessitate meticulous hyperparameter tuning. Both of these challenges severely limit the applicability of such methods to complex, real-world domains. In this paper, we propose soft actor-critic, an off-policy actor-critic deep RL algorithm based on the maximum entropy reinforcement learning framework. In this framework, the actor aims to maximize expected reward while also maximizing entropy. That is, to succeed at the task while acting as randomly as possible. Prior deep RL methods based on this framework have been formulated as Q-learning methods. By combining off-policy updates with a stable stochastic actor-critic formulation, our method achieves state-of-the-art performance on a range of continuous control benchmark tasks, outperforming prior on-policy and off-policy methods. Furthermore, we demonstrate that, in contrast to other off-policy algorithms, our approach is very stable, achieving very similar performance across different random seeds.

Surgical scene segmentation is critical in computer-assisted surgery and is vital for enhancing surgical quality and patient outcomes. Recently, referring surgical segmentation is emerging, given its advantage of providing surgeons with an interactive experience to segment the target object. However, existing methods are limited by low efficiency and short-term tracking, hindering their applicability in complex real-world surgical scenarios. In this paper, we introduce ReSurgSAM2, a two-stage surgical referring segmentation framework that leverages Segment Anything Model 2 to perform text-referred target detection, followed by tracking with reliable initial frame identification and diversity-driven long-term memory. For the detection stage, we propose a cross-modal spatial-temporal Mamba to generate precise detection and segmentation results. Based on these results, our credible initial frame selection strategy identifies the reliable frame for the subsequent tracking. Upon selecting the initial frame, our method transitions to the tracking stage, where it incorporates a diversity-driven memory mechanism that maintains a credible and diverse memory bank, ensuring consistent long-term tracking. Extensive experiments demonstrate that ReSurgSAM2 achieves substantial improvements in accuracy and efficiency compared to existing methods, operating in real-time at 61.2 FPS. Our code and datasets will be available at https://github.com/jinlab-imvr/ReSurgSAM2.

Gradient inversion attacks aim to reconstruct local training data from intermediate gradients exposed in the federated learning framework. Despite successful attacks, all previous methods, starting from reconstructing a single data point and then relaxing the single-image limit to batch level, are only tested under hard label constraints. Even for single-image reconstruction, we still lack an analysis-based algorithm to recover augmented soft labels. In this work, we change the focus from enlarging batchsize to investigating the hard label constraints, considering a more realistic circumstance where label smoothing and mixup techniques are used in the training process. In particular, we are the first to initiate a novel algorithm to simultaneously recover the ground-truth augmented label and the input feature of the last fully-connected layer from single-input gradients, and provide a necessary condition for any analytical-based label recovery methods. Extensive experiments testify to the label recovery accuracy, as well as the benefits to the following image reconstruction. We believe soft labels in classification tasks are worth further attention in gradient inversion attacks.

Precise camera tracking, high-fidelity 3D tissue reconstruction, and real-time online visualization are critical for intrabody medical imaging devices such as endoscopes and capsule robots. However, existing SLAM (Simultaneous Localization and Mapping) methods often struggle to achieve both complete high-quality surgical field reconstruction and efficient computation, restricting their intraoperative applications among endoscopic surgeries. In this paper, we introduce EndoGSLAM, an efficient SLAM approach for endoscopic surgeries, which integrates streamlined Gaussian representation and differentiable rasterization to facilitate over 100 fps rendering speed during online camera tracking and tissue reconstructing. Extensive experiments show that EndoGSLAM achieves a better trade-off between intraoperative availability and reconstruction quality than traditional or neural SLAM approaches, showing tremendous potential for endoscopic surgeries. The project page is at https://EndoGSLAM.loping151.com

High-fidelity reconstruction of deformable tissues from endoscopic videos remains challenging due to the limitations of existing methods in capturing subtle color variations and modeling global deformations. While 3D Gaussian Splatting (3DGS) enables efficient dynamic reconstruction, its fixed per-Gaussian color assignment struggles with intricate textures, and linear deformation modeling fails to model consistent global deformation. To address these issues, we propose ColorGS, a novel framework that integrates spatially adaptive color encoding and enhanced deformation modeling for surgical scene reconstruction. First, we introduce Colored Gaussian Primitives, which employ dynamic anchors with learnable color parameters to adaptively encode spatially varying textures, significantly improving color expressiveness under complex lighting and tissue similarity. Second, we design an Enhanced Deformation Model (EDM) that combines time-aware Gaussian basis functions with learnable time-independent deformations, enabling precise capture of both localized tissue deformations and global motion consistency caused by surgical interactions. Extensive experiments on DaVinci robotic surgery videos and benchmark datasets (EndoNeRF, StereoMIS) demonstrate that ColorGS achieves state-of-the-art performance, attaining a PSNR of 39.85 (1.5 higher than prior 3DGS-based methods) and superior SSIM (97.25\%) while maintaining real-time rendering efficiency. Our work advances surgical scene reconstruction by balancing high fidelity with computational practicality, critical for intraoperative guidance and AR/VR applications.

Precise lesion resection depends on accurately identifying fine-grained anatomical structures. While many coarse-grained segmentation (CGS) methods have been successful in large-scale segmentation (e.g., organs), they fall short in clinical scenarios requiring fine-grained segmentation (FGS), which remains challenging due to frequent individual variations in small-scale anatomical structures. Although recent Mamba-based models have advanced medical image segmentation, they often rely on fixed manually-defined scanning orders, which limit their adaptability to individual variations in FGS. To address this, we propose ASM-UNet, a novel Mamba-based architecture for FGS. It introduces adaptive scan scores to dynamically guide the scanning order, generated by combining group-level commonalities and individual-level variations. Experiments on two public datasets (ACDC and Synapse) and a newly proposed challenging biliary tract FGS dataset, namely BTMS, demonstrate that ASM-UNet achieves superior performance in both CGS and FGS tasks. Our code and dataset are available at https://github.com/YqunYang/ASM-UNet.

Data diversity and volume are crucial to the success of training deep learning models, while in the medical imaging field, the difficulty and cost of data collection and annotation are especially huge. Specifically in robotic surgery, data scarcity and imbalance have heavily affected the model accuracy and limited the design and deployment of deep learning-based surgical applications such as surgical instrument segmentation. Considering this, we rethink the surgical instrument segmentation task and propose a one-to-many data generation solution that gets rid of the complicated and expensive process of data collection and annotation from robotic surgery. In our method, we only utilize a single surgical background tissue image and a few open-source instrument images as the seed images and apply multiple augmentations and blending techniques to synthesize amounts of image variations. In addition, we also introduce the chained augmentation mixing during training to further enhance the data diversities. The proposed approach is evaluated on the real datasets of the EndoVis-2018 and EndoVis-2017 surgical scene segmentation. Our empirical analysis suggests that without the high cost of data collection and annotation, we can achieve decent surgical instrument segmentation performance. Moreover, we also observe that our method can deal with novel instrument prediction in the deployment domain. We hope our inspiring results will encourage researchers to emphasize data-centric methods to overcome demanding deep learning limitations besides data shortage, such as class imbalance, domain adaptation, and incremental learning. Our code is available at https://github.com/lofrienger/Single_SurgicalScene_For_Segmentation.

We introduce an inference-time scene optimization algorithm utilizing triangle soup, a collection of disconnected translucent triangle primitives, as the representation for the geometry and appearance of a scene. Unlike full-rank Gaussian kernels, triangles are a natural, locally-flat proxy for surfaces that can be connected to achieve highly complex geometry. When coupled with per-vertex Spherical Harmonics (SH), triangles provide a rich visual representation without incurring an expensive increase in primitives. We leverage our new representation to incorporate optimization objectives and enforce spatial regularization directly on the underlying primitives. The main differentiator of our approach is the definition and enforcement of soft connectivity forces between triangles during optimization, encouraging explicit, but soft, surface continuity in 3D. Experiments on representative 3D reconstruction and novel view synthesis datasets show improvements in geometric accuracy compared to current state-of-the-art algorithms without sacrificing visual fidelity.

As deep learning models gain attraction in medical data, ensuring transparent and trustworthy decision-making is essential. In skin cancer diagnosis, while advancements in lesion detection and classification have improved accuracy, the black-box nature of these methods poses challenges in understanding their decision processes, leading to trust issues among physicians. This study leverages the CLIP (Contrastive Language-Image Pretraining) model, trained on different skin lesion datasets, to capture meaningful relationships between visual features and diagnostic criteria terms. To further enhance transparency, we propose a method called MedGrad E-CLIP, which builds on gradient-based E-CLIP by incorporating a weighted entropy mechanism designed for complex medical imaging like skin lesions. This approach highlights critical image regions linked to specific diagnostic descriptions. The developed integrated pipeline not only classifies skin lesions by matching corresponding descriptions but also adds an essential layer of explainability developed especially for medical data. By visually explaining how different features in an image relates to diagnostic criteria, this approach demonstrates the potential of advanced vision-language models in medical image analysis, ultimately improving transparency, robustness, and trust in AI-driven diagnostic systems.

The softmax (also called softargmax) function is widely used in machine learning models to normalize real-valued scores into a probability distribution. To avoid floating-point overflow, the softmax function is conventionally implemented in three passes: the first pass to compute the normalization constant, and two other passes to compute outputs from normalized inputs. We analyze two variants of the Three-Pass algorithm and demonstrate that in a well-optimized implementation on HPC-class processors performance of all three passes is limited by memory bandwidth. We then present a novel algorithm for softmax computation in just two passes. The proposed Two-Pass algorithm avoids both numerical overflow and the extra normalization pass by employing an exotic representation for intermediate values, where each value is represented as a pair of floating-point numbers: one representing the "mantissa" and another representing the "exponent". Performance evaluation demonstrates that on out-of-cache inputs on an Intel Skylake-X processor the new Two-Pass algorithm outperforms the traditional Three-Pass algorithm by up to 28% in AVX512 implementation, and by up to 18% in AVX2 implementation. The proposed Two-Pass algorithm also outperforms the traditional Three-Pass algorithm on Intel Broadwell and AMD Zen 2 processors. To foster reproducibility, we released an open-source implementation of the new Two-Pass Softmax algorithm and other experiments in this paper as a part of XNNPACK library at GitHub.com/google/XNNPACK.

Growing evidence indicates that only a sparse subset from a pool of sensory neurons is active for the encoding of visual stimuli at any instant in time. Traditionally, to replicate such biological sparsity, generative models have been using the ell_1 norm as a penalty due to its convexity, which makes it amenable to fast and simple algorithmic solvers. In this work, we use biological vision as a test-bed and show that the soft thresholding operation associated to the use of the ell_1 norm is highly suboptimal compared to other functions suited to approximating ell_q with 0 leq q < 1 (including recently proposed Continuous Exact relaxations), both in terms of performance and in the production of features that are akin to signatures of the primary visual cortex. We show that ell_1 sparsity produces a denser code or employs a pool with more neurons, i.e. has a higher degree of overcompleteness, in order to maintain the same reconstruction error as the other methods considered. For all the penalty functions tested, a subset of the neurons develop orientation selectivity similarly to V1 neurons. When their code is sparse enough, the methods also develop receptive fields with varying functionalities, another signature of V1. Compared to other methods, soft thresholding achieves this level of sparsity at the expense of much degraded reconstruction performance, that more likely than not is not acceptable in biological vision. Our results indicate that V1 uses a sparsity inducing regularization that is closer to the ell_0 pseudo-norm rather than to the ell_1 norm.

The widespread use of vector graphics creates a significant demand for vectorization methods. While recent learning-based techniques have shown their capability to create vector images of clear topology, filling these primitives with gradients remains a challenge. In this paper, we propose a segmentation-guided vectorization framework to convert raster images into concise vector graphics with radial gradient fills. With the guidance of an embedded gradient-aware segmentation subroutine, our approach progressively appends gradient-filled B\'ezier paths to the output, where primitive parameters are initiated with our newly designed initialization technique and are optimized to minimize our novel loss function. We build our method on a differentiable renderer with traditional segmentation algorithms to develop it as a model-free tool for raster-to-vector conversion. It is tested on various inputs to demonstrate its feasibility, independent of datasets, to synthesize vector graphics with improved visual quality and layer-wise topology compared to prior work.

We introduce DIFFTACTILE, a physics-based differentiable tactile simulation system designed to enhance robotic manipulation with dense and physically accurate tactile feedback. In contrast to prior tactile simulators which primarily focus on manipulating rigid bodies and often rely on simplified approximations to model stress and deformations of materials in contact, DIFFTACTILE emphasizes physics-based contact modeling with high fidelity, supporting simulations of diverse contact modes and interactions with objects possessing a wide range of material properties. Our system incorporates several key components, including a Finite Element Method (FEM)-based soft body model for simulating the sensing elastomer, a multi-material simulator for modeling diverse object types (such as elastic, elastoplastic, cables) under manipulation, a penalty-based contact model for handling contact dynamics. The differentiable nature of our system facilitates gradient-based optimization for both 1) refining physical properties in simulation using real-world data, hence narrowing the sim-to-real gap and 2) efficient learning of tactile-assisted grasping and contact-rich manipulation skills. Additionally, we introduce a method to infer the optical response of our tactile sensor to contact using an efficient pixel-based neural module. We anticipate that DIFFTACTILE will serve as a useful platform for studying contact-rich manipulations, leveraging the benefits of dense tactile feedback and differentiable physics. Code and supplementary materials are available at the project website https://difftactile.github.io/.

In recent years, the application of machine learning to minimally invasive surgery (MIS) has attracted considerable interest. Datasets are critical to the use of such techniques. This paper presents a unique dataset recorded during ex vivo pseudo-cholecystectomy procedures on pig livers using the da Vinci Research Kit (dVRK). Unlike existing datasets, it addresses a critical gap by providing comprehensive kinematic data, recordings of all pedal inputs, and offers a time-stamped record of the endoscope's movements. This expanded version also includes segmentation and keypoint annotations of images, enhancing its utility for computer vision applications. Contributed by seven surgeons with varied backgrounds and experience levels that are provided as a part of this expanded version, the dataset is an important new resource for surgical robotics research. It enables the development of advanced methods for evaluating surgeon skills, tools for providing better context awareness, and automation of surgical tasks. Our work overcomes the limitations of incomplete recordings and imprecise kinematic data found in other datasets. To demonstrate the potential of the dataset for advancing automation in surgical robotics, we introduce two models that predict clutch usage and camera activation, a 3D scene reconstruction example, and the results from our keypoint and segmentation models.

Wasserstein gradient flow has emerged as a promising approach to solve optimization problems over the space of probability distributions. A recent trend is to use the well-known JKO scheme in combination with input convex neural networks to numerically implement the proximal step. The most challenging step, in this setup, is to evaluate functions involving density explicitly, such as entropy, in terms of samples. This paper builds on the recent works with a slight but crucial difference: we propose to utilize a variational formulation of the objective function formulated as maximization over a parametric class of functions. Theoretically, the proposed variational formulation allows the construction of gradient flows directly for empirical distributions with a well-defined and meaningful objective function. Computationally, this approach replaces the computationally expensive step in existing methods, to handle objective functions involving density, with inner loop updates that only require a small batch of samples and scale well with the dimension. The performance and scalability of the proposed method are illustrated with the aid of several numerical experiments involving high-dimensional synthetic and real datasets.

Medical image segmentation exhibits intra- and inter-annotator variability due to ambiguous object boundaries, annotator preferences, expertise, and tools, among other factors. Lesions with ambiguous boundaries, e.g., spiculated or infiltrative nodules, or irregular borders per the ABCD rule, are particularly prone to disagreement and are often associated with malignancy. In this work, we curate IMA++, the largest multi-annotator skin lesion segmentation dataset, on which we conduct an in-depth study of variability due to annotator, malignancy, tool, and skill factors. We find a statistically significant (p<0.001) association between inter-annotator agreement (IAA), measured using Dice, and the malignancy of skin lesions. We further show that IAA can be accurately predicted directly from dermoscopic images, achieving a mean absolute error of 0.108. Finally, we leverage this association by utilizing IAA as a "soft" clinical feature within a multi-task learning objective, yielding a 4.2% improvement in balanced accuracy averaged across multiple model architectures and across IMA++ and four public dermoscopic datasets. The code is available at https://github.com/sfu-mial/skin-IAV.

Over the past decade, computer vision applications in minimally invasive surgery have rapidly increased. Despite this growth, the impact of surgical computer vision remains limited compared to other medical fields like pathology and radiology, primarily due to the scarcity of representative annotated data. Whereas transfer learning from large annotated datasets such as ImageNet has been conventionally the norm to achieve high-performing models, recent advancements in self-supervised learning (SSL) have demonstrated superior performance. In medical image analysis, in-domain SSL pretraining has already been shown to outperform ImageNet-based initialization. Although unlabeled data in the field of surgical computer vision is abundant, the diversity within this data is limited. This study investigates the role of dataset diversity in SSL for surgical computer vision, comparing procedure-specific datasets against a more heterogeneous general surgical dataset across three different downstream surgical applications. The obtained results show that using solely procedure-specific data can lead to substantial improvements of 13.8%, 9.5%, and 36.8% compared to ImageNet pretraining. However, extending this data with more heterogeneous surgical data further increases performance by an additional 5.0%, 5.2%, and 2.5%, suggesting that increasing diversity within SSL data is beneficial for model performance. The code and pretrained model weights are made publicly available at https://github.com/TimJaspers0801/SurgeNet.

It is desired to equip robots with the capability of interacting with various soft materials as they are ubiquitous in the real world. While physics simulations are one of the predominant methods for data collection and robot training, simulating soft materials presents considerable challenges. Specifically, it is significantly more costly than simulating rigid objects in terms of simulation speed and storage requirements. These limitations typically restrict the scope of studies on soft materials to small and bounded areas, thereby hindering the learning of skills in broader spaces. To address this issue, we introduce UBSoft, a new simulation platform designed to support unbounded soft environments for robot skill acquisition. Our platform utilizes spatially adaptive resolution scales, where simulation resolution dynamically adjusts based on proximity to active robotic agents. Our framework markedly reduces the demand for extensive storage space and computation costs required for large-scale scenarios involving soft materials. We also establish a set of benchmark tasks in our platform, including both locomotion and manipulation tasks, and conduct experiments to evaluate the efficacy of various reinforcement learning algorithms and trajectory optimization techniques, both gradient-based and sampling-based. Preliminary results indicate that sampling-based trajectory optimization generally achieves better results for obtaining one trajectory to solve the task. Additionally, we conduct experiments in real-world environments to demonstrate that advancements made in our UBSoft simulator could translate to improved robot interactions with large-scale soft material. More videos can be found at https://vis-www.cs.umass.edu/ubsoft/.

Transformer-based video diffusion models (VDMs) deliver state-of-the-art video generation quality but are constrained by the quadratic cost of self-attention, making long sequences and high resolutions computationally expensive. While linear attention offers sub-quadratic complexity, prior attempts fail to match the expressiveness of softmax attention without costly retraining. We introduce Attention Surgery, an efficient framework for linearizing or hybridizing attention in pretrained VDMs without training from scratch. Inspired by recent advances in language models, our method combines a novel hybrid attention mechanism-mixing softmax and linear tokens-with a lightweight distillation and fine-tuning pipeline requiring only a few GPU-days. Additionally, we incorporate a cost-aware block-rate strategy to balance expressiveness and efficiency across layers. Applied to Wan2.1 1.3B, a state-of-the-art DiT-based VDM, Attention Surgery achieves the first competitive sub-quadratic attention video diffusion models, reducing attention cost by up to 40\% in terms of FLOPs, while maintaining generation quality as measured on the standard VBench and VBench-2.0 benchmarks.

Recent approximations to backpropagation (BP) have mitigated many of BP's computational inefficiencies and incompatibilities with biology, but important limitations still remain. Moreover, the approximations significantly decrease accuracy in benchmarks, suggesting that an entirely different approach may be more fruitful. Here, grounded on recent theory for Hebbian learning in soft winner-take-all networks, we present multilayer SoftHebb, i.e. an algorithm that trains deep neural networks, without any feedback, target, or error signals. As a result, it achieves efficiency by avoiding weight transport, non-local plasticity, time-locking of layer updates, iterative equilibria, and (self-) supervisory or other feedback signals -- which were necessary in other approaches. Its increased efficiency and biological compatibility do not trade off accuracy compared to state-of-the-art bio-plausible learning, but rather improve it. With up to five hidden layers and an added linear classifier, accuracies on MNIST, CIFAR-10, STL-10, and ImageNet, respectively reach 99.4%, 80.3%, 76.2%, and 27.3%. In conclusion, SoftHebb shows with a radically different approach from BP that Deep Learning over few layers may be plausible in the brain and increases the accuracy of bio-plausible machine learning. Code is available at https://github.com/NeuromorphicComputing/SoftHebb.

Vision-language pre-training (VLP) offers unique advantages for surgery by aligning language with surgical videos, enabling workflow understanding and transfer across tasks without relying on expert-labeled datasets. However, progress in surgical VLP remains constrained by the limited scale, procedural diversity, semantic quality, and hierarchical structure of existing datasets. In this work, we present SurgLaVi, the largest and most diverse surgical vision-language dataset to date, comprising nearly 240k clip-caption pairs from more than 200 procedures, and comprising hierarchical levels at phase-, step-, and task-level. At the core of SurgLaVi lies a fully automated pipeline that systematically generates fine-grained transcriptions of surgical videos and segments them into coherent procedural units. To ensure high-quality annotations, it applies dual-modality filtering to remove irrelevant and noisy samples. Within this framework, the resulting captions are enriched with contextual detail, producing annotations that are both semantically rich and easy to interpret. To ensure accessibility, we release SurgLaVi-eta, an open-source derivative of 113k clip-caption pairs constructed entirely from public data, which is over four times larger than existing surgical VLP datasets. To demonstrate the value of SurgLaVi datasets, we introduce SurgCLIP, a CLIP-style video-text contrastive framework with dual encoders, as a representative base model. SurgCLIP achieves consistent improvements across phase, step, action, and tool recognition, surpassing prior state-of-the-art methods, often by large margins. These results validate that large-scale, semantically rich, and hierarchically structured datasets directly translate into stronger and more generalizable representations, establishing SurgLaVi as a key resource for developing surgical foundation models.

There are two widely known issues with properly training Recurrent Neural Networks, the vanishing and the exploding gradient problems detailed in Bengio et al. (1994). In this paper we attempt to improve the understanding of the underlying issues by exploring these problems from an analytical, a geometric and a dynamical systems perspective. Our analysis is used to justify a simple yet effective solution. We propose a gradient norm clipping strategy to deal with exploding gradients and a soft constraint for the vanishing gradients problem. We validate empirically our hypothesis and proposed solutions in the experimental section.

We investigate how both the adaptation of a generic foundation model via transfer learning and the integration of complementary modalities from the operating room (OR) can support surgical data science. To this end, we use V-JEPA as the single-modality foundation of a multimodal model for minimally invasive surgery support. We analyze how the model's downstream performance can benefit (a) from finetuning on unlabeled surgical video data and (b) from providing additional time-resolved data streams from the OR in a multimodal setup. In an in-house dataset of liver surgery videos, we analyze the tasks of predicting hospital length of stay and postoperative complications. In videos of the public HeiCo dataset, we analyze the task of surgical phase recognition. As a baseline, we apply pretrained V-JEPA to all tasks. We then finetune it on unlabeled, held-out videos to investigate its change in performance after domain adaptation. Following the idea of modular decision support networks, we integrate additional data streams from the OR by training a separate encoder to form a shared representation space with V-JEPA's embeddings. Our experiments show that finetuning on domain-specific data increases model performance. On the in-house data, integrating additional time-resolved data likewise benefits the model. On the HeiCo data, accuracy of the pretrained video-only, single-modality baseline setup is on par with the top-performing submissions of the EndoVis2017 challenge, while finetuning on domain-specific data increases accuracy further. Our results thus demonstrate how surgical data science can leverage public, generic foundation models. Likewise, they indicate the potential of domain adaptation and of integrating suitable complementary data streams from the OR. To support further research, we release our code and model weights at https://github.com/DigitalSurgeryLab-Basel/ML-CDS-2025.

Gradient-based optimization has been critical to the success of machine learning, updating a single set of parameters to minimize a single loss. A growing number of applications rely on a generalization of this, where we have a bilevel or nested optimization of which subsets of parameters update on different objectives nested inside each other. We focus on motivating examples of hyperparameter optimization and generative adversarial networks. However, naively applying classical methods often fails when we look at solving these nested problems on a large scale. In this thesis, we build tools for nested optimization that scale to deep learning setups.

In this work, we develop an open-source surgical simulation environment that includes a realistic model obtained by MRI-scanning a physical phantom, for the purpose of training and evaluating a Learning from Demonstration (LfD) algorithm for autonomous suturing. The LfD algorithm utilizes Dynamic Movement Primitives (DMP) and Locally Weighted Regression (LWR), but focuses on the needle trajectory, rather than the instruments, to obtain better generality with respect to needle grasps. We conduct a user study to collect multiple suturing demonstrations and perform a comprehensive analysis of the ability of the LfD algorithm to generalize from a demonstration at one location in one phantom to different locations in the same phantom and to a different phantom. Our results indicate good generalization, on the order of 91.5%, when learning from more experienced subjects, indicating the need to integrate skill assessment in the future.

High-resolution imaging is crucial for enhancing visual clarity and enabling precise computer-assisted guidance in minimally invasive surgery (MIS). Despite the increasing adoption of 4K endoscopic systems, there remains a significant gap in publicly available native 4K datasets tailored specifically for robotic-assisted MIS. We introduce SurgiSR4K, the first publicly accessible surgical imaging and video dataset captured at a native 4K resolution, representing realistic conditions of robotic-assisted procedures. SurgiSR4K comprises diverse visual scenarios including specular reflections, tool occlusions, bleeding, and soft tissue deformations, meticulously designed to reflect common challenges faced during laparoscopic and robotic surgeries. This dataset opens up possibilities for a broad range of computer vision tasks that might benefit from high resolution data, such as super resolution (SR), smoke removal, surgical instrument detection, 3D tissue reconstruction, monocular depth estimation, instance segmentation, novel view synthesis, and vision-language model (VLM) development. SurgiSR4K provides a robust foundation for advancing research in high-resolution surgical imaging and fosters the development of intelligent imaging technologies aimed at enhancing performance, safety, and usability in image-guided robotic surgeries.

Breast-conserving surgery (BCS) aims to completely remove malignant lesions while maximizing healthy tissue preservation. Intraoperative margin assessment is essential to achieve a balance between thorough cancer resection and tissue conservation. A deep ultraviolet fluorescence scanning microscope (DUV-FSM) enables rapid acquisition of whole surface images (WSIs) for excised tissue, providing contrast between malignant and normal tissues. However, breast cancer classification with DUV WSIs is challenged by high resolutions and complex histopathological features. This study introduces a DUV WSI classification framework using a patch-level vision transformer (ViT) model, capturing local and global features. Grad-CAM++ saliency weighting highlights relevant spatial regions, enhances result interpretability, and improves diagnostic accuracy for benign and malignant tissue classification. A comprehensive 5-fold cross-validation demonstrates the proposed approach significantly outperforms conventional deep learning methods, achieving a classification accuracy of 98.33%.

Over the past few years, softmax and SGD have become a commonly used component and the default training strategy in CNN frameworks, respectively. However, when optimizing CNNs with SGD, the saturation behavior behind softmax always gives us an illusion of training well and then is omitted. In this paper, we first emphasize that the early saturation behavior of softmax will impede the exploration of SGD, which sometimes is a reason for model converging at a bad local-minima, then propose Noisy Softmax to mitigating this early saturation issue by injecting annealed noise in softmax during each iteration. This operation based on noise injection aims at postponing the early saturation and further bringing continuous gradients propagation so as to significantly encourage SGD solver to be more exploratory and help to find a better local-minima. This paper empirically verifies the superiority of the early softmax desaturation, and our method indeed improves the generalization ability of CNN model by regularization. We experimentally find that this early desaturation helps optimization in many tasks, yielding state-of-the-art or competitive results on several popular benchmark datasets.

Surgical simulation plays a pivotal role in training novice surgeons, accelerating their learning curve and reducing intra-operative errors. However, conventional simulation tools fall short in providing the necessary photorealism and the variability of human anatomy. In response, current methods are shifting towards generative model-based simulators. Yet, these approaches primarily focus on using increasingly complex conditioning for precise synthesis while neglecting the fine-grained human control aspect. To address this gap, we introduce SG2VID, the first diffusion-based video model that leverages Scene Graphs for both precise video synthesis and fine-grained human control. We demonstrate SG2VID's capabilities across three public datasets featuring cataract and cholecystectomy surgery. While SG2VID outperforms previous methods both qualitatively and quantitatively, it also enables precise synthesis, providing accurate control over tool and anatomy's size and movement, entrance of new tools, as well as the overall scene layout. We qualitatively motivate how SG2VID can be used for generative augmentation and present an experiment demonstrating its ability to improve a downstream phase detection task when the training set is extended with our synthetic videos. Finally, to showcase SG2VID's ability to retain human control, we interact with the Scene Graphs to generate new video samples depicting major yet rare intra-operative irregularities.

Brain tumor growth is unique to each glioma patient and extends beyond what is visible in imaging scans, infiltrating surrounding brain tissue. Understanding these hidden patient-specific progressions is essential for effective therapies. Current treatment plans for brain tumors, such as radiotherapy, typically involve delineating a uniform margin around the visible tumor on pre-treatment scans to target this invisible tumor growth. This "one size fits all" approach is derived from population studies and often fails to account for the nuances of individual patient conditions. We present the GliODIL framework, which infers the full spatial distribution of tumor cell concentration from available multi-modal imaging, leveraging a Fisher-Kolmogorov type physics model to describe tumor growth. This is achieved through the newly introduced method of Optimizing the Discrete Loss (ODIL), where both data and physics-based constraints are softly assimilated into the solution. Our test dataset comprises 152 glioblastoma patients with pre-treatment imaging and post-treatment follow-ups for tumor recurrence monitoring. By blending data-driven techniques with physics-based constraints, GliODIL enhances recurrence prediction in radiotherapy planning, challenging traditional uniform margins and strict adherence to the Fisher-Kolmogorov partial differential equation (PDE) model, which is adapted for complex cases.

We consider the training of the first layer of vision models and notice the clear relationship between pixel values and gradient update magnitudes: the gradients arriving at the weights of a first layer are by definition directly proportional to (normalized) input pixel values. Thus, an image with low contrast has a smaller impact on learning than an image with higher contrast, and a very bright or very dark image has a stronger impact on the weights than an image with moderate brightness. In this work, we propose performing gradient descent on the embeddings produced by the first layer of the model. However, switching to discrete inputs with an embedding layer is not a reasonable option for vision models. Thus, we propose the conceptual procedure of (i) a gradient descent step on first layer activations to construct an activation proposal, and (ii) finding the optimal weights of the first layer, i.e., those weights which minimize the squared distance to the activation proposal. We provide a closed form solution of the procedure and adjust it for robust stochastic training while computing everything efficiently. Empirically, we find that TrAct (Training Activations) speeds up training by factors between 1.25x and 4x while requiring only a small computational overhead. We demonstrate the utility of TrAct with different optimizers for a range of different vision models including convolutional and transformer architectures.

The integration of artificial intelligence in image-guided interventions holds transformative potential, promising to extract 3D geometric and quantitative information from conventional 2D imaging modalities during complex procedures. Achieving this requires the rapid and precise alignment of 2D intraoperative images (e.g., X-ray) with 3D preoperative volumes (e.g., CT, MRI). However, current 2D/3D registration methods fail across the broad spectrum of procedures dependent on X-ray guidance: traditional optimization techniques require custom parameter tuning for each subject, whereas neural networks trained on small datasets do not generalize to new patients or require labor-intensive manual annotations, increasing clinical burden and precluding application to new anatomical targets. To address these challenges, we present xvr, a fully automated framework for training patient-specific neural networks for 2D/3D registration. xvr uses physics-based simulation to generate abundant high-quality training data from a patient's own preoperative volumetric imaging, thereby overcoming the inherently limited ability of supervised models to generalize to new patients and procedures. Furthermore, xvr requires only 5 minutes of training per patient, making it suitable for emergency interventions as well as planned procedures. We perform the largest evaluation of a 2D/3D registration algorithm on real X-ray data to date and find that xvr robustly generalizes across a diverse dataset comprising multiple anatomical structures, imaging modalities, and hospitals. Across surgical tasks, xvr achieves submillimeter-accurate registration at intraoperative speeds, improving upon existing methods by an order of magnitude. xvr is released as open-source software freely available at https://github.com/eigenvivek/xvr.

Dynamic garment reconstruction from monocular video is an important yet challenging task due to the complex dynamics and unconstrained nature of the garments. Recent advancements in neural rendering have enabled high-quality geometric reconstruction with image/video supervision. However, implicit representation methods that use volume rendering often provide smooth geometry and fail to model high-frequency details. While template reconstruction methods model explicit geometry, they use vertex displacement for deformation, which results in artifacts. Addressing these limitations, we propose NGD, a Neural Gradient-based Deformation method to reconstruct dynamically evolving textured garments from monocular videos. Additionally, we propose a novel adaptive remeshing strategy for modelling dynamically evolving surfaces like wrinkles and pleats of the skirt, leading to high-quality reconstruction. Finally, we learn dynamic texture maps to capture per-frame lighting and shadow effects. We provide extensive qualitative and quantitative evaluations to demonstrate significant improvements over existing SOTA methods and provide high-quality garment reconstructions.

Using backpropagation to compute gradients of objective functions for optimization has remained a mainstay of machine learning. Backpropagation, or reverse-mode differentiation, is a special case within the general family of automatic differentiation algorithms that also includes the forward mode. We present a method to compute gradients based solely on the directional derivative that one can compute exactly and efficiently via the forward mode. We call this formulation the forward gradient, an unbiased estimate of the gradient that can be evaluated in a single forward run of the function, entirely eliminating the need for backpropagation in gradient descent. We demonstrate forward gradient descent in a range of problems, showing substantial savings in computation and enabling training up to twice as fast in some cases.

Endoscopic Submucosal Dissection (ESD) is a minimally invasive procedure initially developed for early gastric cancer treatment and has expanded to address diverse gastrointestinal lesions. While computer-assisted surgery (CAS) systems enhance ESD precision and safety, their efficacy hinges on accurate real-time surgical phase recognition, a task complicated by ESD's inherent complexity, including heterogeneous lesion characteristics and dynamic tissue interactions. Existing video-based phase recognition algorithms, constrained by inefficient temporal context modeling, exhibit limited performance in capturing fine-grained phase transitions and long-range dependencies. To overcome these limitations, we propose SPRMamba, a novel framework integrating a Mamba-based architecture with a Scaled Residual TranMamba (SRTM) block to synergize long-term temporal modeling and localized detail extraction. SPRMamba further introduces the Hierarchical Sampling Strategy to optimize computational efficiency, enabling real-time processing critical for clinical deployment. Evaluated on the ESD385 dataset and the cholecystectomy benchmark Cholec80, SPRMamba achieves state-of-the-art performance (87.64% accuracy on ESD385, +1.0% over prior methods), demonstrating robust generalizability across surgical workflows. This advancement bridges the gap between computational efficiency and temporal sensitivity, offering a transformative tool for intraoperative guidance and skill assessment in ESD surgery. The code is accessible at https://github.com/Zxnyyyyy/SPRMamba.

Non-maximum suppression is an integral part of the object detection pipeline. First, it sorts all detection boxes on the basis of their scores. The detection box M with the maximum score is selected and all other detection boxes with a significant overlap (using a pre-defined threshold) with M are suppressed. This process is recursively applied on the remaining boxes. As per the design of the algorithm, if an object lies within the predefined overlap threshold, it leads to a miss. To this end, we propose Soft-NMS, an algorithm which decays the detection scores of all other objects as a continuous function of their overlap with M. Hence, no object is eliminated in this process. Soft-NMS obtains consistent improvements for the coco-style mAP metric on standard datasets like PASCAL VOC 2007 (1.7% for both R-FCN and Faster-RCNN) and MS-COCO (1.3% for R-FCN and 1.1% for Faster-RCNN) by just changing the NMS algorithm without any additional hyper-parameters. Using Deformable-RFCN, Soft-NMS improves state-of-the-art in object detection from 39.8% to 40.9% with a single model. Further, the computational complexity of Soft-NMS is the same as traditional NMS and hence it can be efficiently implemented. Since Soft-NMS does not require any extra training and is simple to implement, it can be easily integrated into any object detection pipeline. Code for Soft-NMS is publicly available on GitHub (http://bit.ly/2nJLNMu).

Endoscopic surgery relies on two-dimensional views, posing challenges for surgeons in depth perception and instrument manipulation. While Monocular Visual Simultaneous Localization and Mapping (MVSLAM) has emerged as a promising solution, its implementation in endoscopic procedures faces significant challenges due to hardware limitations, such as the use of a monocular camera and the absence of odometry sensors. This study presents BodySLAM, a robust deep learning-based MVSLAM approach that addresses these challenges through three key components: CycleVO, a novel unsupervised monocular pose estimation module; the integration of the state-of-the-art Zoe architecture for monocular depth estimation; and a 3D reconstruction module creating a coherent surgical map. The approach is rigorously evaluated using three publicly available datasets (Hamlyn, EndoSLAM, and SCARED) spanning laparoscopy, gastroscopy, and colonoscopy scenarios, and benchmarked against four state-of-the-art methods. Results demonstrate that CycleVO exhibited competitive performance with the lowest inference time among pose estimation methods, while maintaining robust generalization capabilities, whereas Zoe significantly outperformed existing algorithms for depth estimation in endoscopy. BodySLAM's strong performance across diverse endoscopic scenarios demonstrates its potential as a viable MVSLAM solution for endoscopic applications.

We introduce softpick, a rectified, not sum-to-one, drop-in replacement for softmax in transformer attention mechanisms that eliminates attention sink and massive activations. Our experiments with 340M parameter models demonstrate that softpick maintains performance parity with softmax on standard benchmarks while achieving 0% sink rate. The softpick transformer produces hidden states with significantly lower kurtosis (340 vs 33,510) and creates sparse attention maps (46.97% sparsity). Models using softpick consistently outperform softmax when quantized, with particularly pronounced advantages at lower bit precisions. Our analysis and discussion shows how softpick has the potential to open new possibilities for quantization, low-precision training, sparsity optimization, pruning, and interpretability. Our code is available at https://github.com/zaydzuhri/softpick-attention.

This paper addresses the challenge of grading visual features in lumbar spine MRI using Deep Learning. Such a method is essential for the automatic quantification of structural changes in the spine, which is valuable for understanding low back pain. Multiple recent studies investigated different architecture designs, and the most recent success has been attributed to the use of transformer architectures. In this work, we argue that with a well-tuned three-stage pipeline comprising semantic segmentation, localization, and classification, convolutional networks outperform the state-of-the-art approaches. We conducted an ablation study of the existing methods in a population cohort, and report performance generalization across various subgroups. Our code is publicly available to advance research on disc degeneration and low back pain.

Intra-fraction motion in radiotherapy is commonly modeled using deformable image registration (DIR). However, existing methods often struggle to balance speed and accuracy, limiting their applicability in clinical scenarios. This study introduces a novel approach that harnesses Neural Graphics Primitives (NGP) to optimize the displacement vector field (DVF). Our method leverages learned primitives, processed as splats, and interpolates within space using a shallow neural network. Uniquely, it enables self-supervised optimization at an ultra-fast speed, negating the need for pre-training on extensive datasets and allowing seamless adaptation to new cases. We validated this approach on the 4D-CT lung dataset DIR-lab, achieving a target registration error (TRE) of 1.15\pm1.15 mm within a remarkable time of 1.77 seconds. Notably, our method also addresses the sliding boundary problem, a common challenge in conventional DIR methods.

Foundation models in video generation are demonstrating remarkable capabilities as potential world models for simulating the physical world. However, their application in high-stakes domains like surgery, which demand deep, specialized causal knowledge rather than general physical rules, remains a critical unexplored gap. To systematically address this challenge, we present SurgVeo, the first expert-curated benchmark for video generation model evaluation in surgery, and the Surgical Plausibility Pyramid (SPP), a novel, four-tiered framework tailored to assess model outputs from basic appearance to complex surgical strategy. On the basis of the SurgVeo benchmark, we task the advanced Veo-3 model with a zero-shot prediction task on surgical clips from laparoscopic and neurosurgical procedures. A panel of four board-certified surgeons evaluates the generated videos according to the SPP. Our results reveal a distinct "plausibility gap": while Veo-3 achieves exceptional Visual Perceptual Plausibility, it fails critically at higher levels of the SPP, including Instrument Operation Plausibility, Environment Feedback Plausibility, and Surgical Intent Plausibility. This work provides the first quantitative evidence of the chasm between visually convincing mimicry and causal understanding in surgical AI. Our findings from SurgVeo and the SPP establish a crucial foundation and roadmap for developing future models capable of navigating the complexities of specialized, real-world healthcare domains.

Gradient descent is the method of choice for training large artificial intelligence systems. As these systems become larger, a better understanding of the mechanisms behind gradient training would allow us to alleviate compute costs and help steer these systems away from harmful behaviors. To that end, we suggest utilizing the circuit perspective brought forward by mechanistic interpretability. After laying out our intuition, we illustrate how it enables us to design a curriculum for efficient learning in a controlled setting. The code is available at https://github.com/facebookresearch/pal.

The field of surgical computer vision has undergone considerable breakthroughs in recent years with the rising popularity of deep neural network-based methods. However, standard fully-supervised approaches for training such models require vast amounts of annotated data, imposing a prohibitively high cost; especially in the clinical domain. Self-Supervised Learning (SSL) methods, which have begun to gain traction in the general computer vision community, represent a potential solution to these annotation costs, allowing to learn useful representations from only unlabeled data. Still, the effectiveness of SSL methods in more complex and impactful domains, such as medicine and surgery, remains limited and unexplored. In this work, we address this critical need by investigating four state-of-the-art SSL methods (MoCo v2, SimCLR, DINO, SwAV) in the context of surgical computer vision. We present an extensive analysis of the performance of these methods on the Cholec80 dataset for two fundamental and popular tasks in surgical context understanding, phase recognition and tool presence detection. We examine their parameterization, then their behavior with respect to training data quantities in semi-supervised settings. Correct transfer of these methods to surgery, as described and conducted in this work, leads to substantial performance gains over generic uses of SSL - up to 7.4% on phase recognition and 20% on tool presence detection - as well as state-of-the-art semi-supervised phase recognition approaches by up to 14%. Further results obtained on a highly diverse selection of surgical datasets exhibit strong generalization properties. The code is available at https://github.com/CAMMA-public/SelfSupSurg.

Advancements in computer-assisted surgical procedures heavily rely on accurate visual data interpretation from camera systems used during surgeries. Traditional open-access datasets focusing on surgical procedures are often limited by their small size, typically consisting of fewer than 100 videos with less than 100K images. To address these constraints, a new dataset called Surg-3M has been compiled using a novel aggregation pipeline that collects high-resolution videos from online sources. Featuring an extensive collection of over 4K surgical videos and more than 3 million high-quality images from multiple procedure types, Surg-3M offers a comprehensive resource surpassing existing alternatives in size and scope, including two novel tasks. To demonstrate the effectiveness of this dataset, we present SurgFM, a self-supervised foundation model pretrained on Surg-3M that achieves impressive results in downstream tasks such as surgical phase recognition, action recognition, and tool presence detection. Combining key components from ConvNeXt, DINO, and an innovative augmented distillation method, SurgFM exhibits exceptional performance compared to specialist architectures across various benchmarks. Our experimental results show that SurgFM outperforms state-of-the-art models in multiple downstream tasks, including significant gains in surgical phase recognition (+8.9pp, +4.7pp, and +3.9pp of Jaccard in AutoLaparo, M2CAI16, and Cholec80), action recognition (+3.1pp of mAP in CholecT50) and tool presence detection (+4.6pp of mAP in Cholec80). Moreover, even when using only half of the data, SurgFM outperforms state-of-the-art models in AutoLaparo and achieves state-of-the-art performance in Cholec80. Both Surg-3M and SurgFM have significant potential to accelerate progress towards developing autonomous robotic surgery systems.

Ensuring reliable confidence scores from deep networks is of pivotal importance in critical decision-making systems, notably in the medical domain. While recent literature on calibrating deep segmentation networks has led to significant progress, their uncertainty is usually modeled by leveraging the information of individual pixels, which disregards the local structure of the object of interest. In particular, only the recent Spatially Varying Label Smoothing (SVLS) approach addresses this issue by softening the pixel label assignments with a discrete spatial Gaussian kernel. In this work, we first present a constrained optimization perspective of SVLS and demonstrate that it enforces an implicit constraint on soft class proportions of surrounding pixels. Furthermore, our analysis shows that SVLS lacks a mechanism to balance the contribution of the constraint with the primary objective, potentially hindering the optimization process. Based on these observations, we propose a principled and simple solution based on equality constraints on the logit values, which enables to control explicitly both the enforced constraint and the weight of the penalty, offering more flexibility. Comprehensive experiments on a variety of well-known segmentation benchmarks demonstrate the superior performance of the proposed approach.

Depth estimation plays a crucial role in various tasks within endoscopic surgery, including navigation, surface reconstruction, and augmented reality visualization. Despite the significant achievements of foundation models in vision tasks, including depth estimation, their direct application to the medical domain often results in suboptimal performance. This highlights the need for efficient adaptation methods to adapt these models to endoscopic depth estimation. We propose Endoscopic Depth Any Camera (EndoDAC) which is an efficient self-supervised depth estimation framework that adapts foundation models to endoscopic scenes. Specifically, we develop the Dynamic Vector-Based Low-Rank Adaptation (DV-LoRA) and employ Convolutional Neck blocks to tailor the foundational model to the surgical domain, utilizing remarkably few trainable parameters. Given that camera information is not always accessible, we also introduce a self-supervised adaptation strategy that estimates camera intrinsics using the pose encoder. Our framework is capable of being trained solely on monocular surgical videos from any camera, ensuring minimal training costs. Experiments demonstrate that our approach obtains superior performance even with fewer training epochs and unaware of the ground truth camera intrinsics. Code is available at https://github.com/BeileiCui/EndoDAC.

In this paper, by introducing Generalized Bernstein condition, we propose the first Obig(sqrt{p}{nepsilon}big) high probability excess population risk bound for differentially private algorithms under the assumptions G-Lipschitz, L-smooth, and Polyak-{\L}ojasiewicz condition, based on gradient perturbation method. If we replace the properties G-Lipschitz and L-smooth by alpha-H{\"o}lder smoothness (which can be used in non-smooth setting), the high probability bound comes to Obig(n^{-alpha{1+2alpha}}big) w.r.t n, which cannot achieve Oleft(1/nright) when alphain(0,1]. To solve this problem, we propose a variant of gradient perturbation method, max{1,g-Normalized Gradient Perturbation} (m-NGP). We further show that by normalization, the high probability excess population risk bound under assumptions alpha-H{\"o}lder smooth and Polyak-{\L}ojasiewicz condition can achieve Obig(sqrt{p}{nepsilon}big), which is the first Oleft(1/nright) high probability excess population risk bound w.r.t n for differentially private algorithms under non-smooth conditions. Moreover, we evaluate the performance of the new proposed algorithm m-NGP, the experimental results show that m-NGP improves the performance of the differentially private model over real datasets. It demonstrates that m-NGP improves the utility bound and the accuracy of the DP model on real datasets simultaneously.

Automatic and consistent meningioma segmentation in T1-weighted MRI volumes and corresponding volumetric assessment is of use for diagnosis, treatment planning, and tumor growth evaluation. In this paper, we optimized the segmentation and processing speed performances using a large number of both surgically treated meningiomas and untreated meningiomas followed at the outpatient clinic. We studied two different 3D neural network architectures: (i) a simple encoder-decoder similar to a 3D U-Net, and (ii) a lightweight multi-scale architecture (PLS-Net). In addition, we studied the impact of different training schemes. For the validation studies, we used 698 T1-weighted MR volumes from St. Olav University Hospital, Trondheim, Norway. The models were evaluated in terms of detection accuracy, segmentation accuracy and training/inference speed. While both architectures reached a similar Dice score of 70% on average, the PLS-Net was more accurate with an F1-score of up to 88%. The highest accuracy was achieved for the largest meningiomas. Speed-wise, the PLS-Net architecture tended to converge in about 50 hours while 130 hours were necessary for U-Net. Inference with PLS-Net takes less than a second on GPU and about 15 seconds on CPU. Overall, with the use of mixed precision training, it was possible to train competitive segmentation models in a relatively short amount of time using the lightweight PLS-Net architecture. In the future, the focus should be brought toward the segmentation of small meningiomas (less than 2ml) to improve clinical relevance for automatic and early diagnosis as well as speed of growth estimates.

We present an algorithm for minimizing an objective with hard-to-compute gradients by using a related, easier-to-access function as a proxy. Our algorithm is based on approximate proximal point iterations on the proxy combined with relatively few stochastic gradients from the objective. When the difference between the objective and the proxy is delta-smooth, our algorithm guarantees convergence at a rate matching stochastic gradient descent on a delta-smooth objective, which can lead to substantially better sample efficiency. Our algorithm has many potential applications in machine learning, and provides a principled means of leveraging synthetic data, physics simulators, mixed public and private data, and more.

Reconstructing deformable tissues from endoscopic videos is essential in many downstream surgical applications. However, existing methods suffer from slow rendering speed, greatly limiting their practical use. In this paper, we introduce EndoGaussian, a real-time endoscopic scene reconstruction framework built on 3D Gaussian Splatting (3DGS). By integrating the efficient Gaussian representation and highly-optimized rendering engine, our framework significantly boosts the rendering speed to a real-time level. To adapt 3DGS for endoscopic scenes, we propose two strategies, Holistic Gaussian Initialization (HGI) and Spatio-temporal Gaussian Tracking (SGT), to handle the non-trivial Gaussian initialization and tissue deformation problems, respectively. In HGI, we leverage recent depth estimation models to predict depth maps of input binocular/monocular image sequences, based on which pixels are re-projected and combined for holistic initialization. In SPT, we propose to model surface dynamics using a deformation field, which is composed of an efficient encoding voxel and a lightweight deformation decoder, allowing for Gaussian tracking with minor training and rendering burden. Experiments on public datasets demonstrate our efficacy against prior SOTAs in many aspects, including better rendering speed (195 FPS real-time, 100times gain), better rendering quality (37.848 PSNR), and less training overhead (within 2 min/scene), showing significant promise for intraoperative surgery applications. Code is available at: https://yifliu3.github.io/EndoGaussian/.

Recent advancements in surgical computer vision have been driven by vision-only models, which lack language semantics, relying on manually annotated videos to predict fixed object categories. This limits their generalizability to unseen surgical procedures and tasks. We propose leveraging surgical video lectures from e-learning platforms to provide effective vision and language supervisory signals for multi-modal representation learning, bypassing manual annotations. We address surgery-specific linguistic challenges using multiple automatic speech recognition systems for text transcriptions. We introduce SurgVLP - Surgical Vision Language Pre-training - a novel method for multi-modal representation learning. SurgVLP employs a new contrastive learning objective, aligning video clip embeddings with corresponding multiple text embeddings in a joint latent space. We demonstrate the representational capability of this space through several vision-and-language surgical tasks and vision-only tasks specific to surgery. Unlike current fully supervised approaches, SurgVLP adapts to different surgical procedures and tasks without specific fine-tuning, achieving zero-shot adaptation to tasks such as surgical tool, phase, and triplet recognition without manual annotation. These results highlight the transferability and versatility of the learned multi-modal representations in surgical video analysis. The code is available at https://github.com/CAMMA-public/SurgVLP

Most studies on surgical activity recognition utilizing Artificial intelligence (AI) have focused mainly on recognizing one type of activity from small and mono-centric surgical video datasets. It remains speculative whether those models would generalize to other centers. In this work, we introduce a large multi-centric multi-activity dataset consisting of 140 videos (MultiBypass140) of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgeries performed at two medical centers: the University Hospital of Strasbourg (StrasBypass70) and Inselspital, Bern University Hospital (BernBypass70). The dataset has been fully annotated with phases and steps. Furthermore, we assess the generalizability and benchmark different deep learning models in 7 experimental studies: 1) Training and evaluation on BernBypass70; 2) Training and evaluation on StrasBypass70; 3) Training and evaluation on the MultiBypass140; 4) Training on BernBypass70, evaluation on StrasBypass70; 5) Training on StrasBypass70, evaluation on BernBypass70; Training on MultiBypass140, evaluation 6) on BernBypass70 and 7) on StrasBypass70. The model's performance is markedly influenced by the training data. The worst results were obtained in experiments 4) and 5) confirming the limited generalization capabilities of models trained on mono-centric data. The use of multi-centric training data, experiments 6) and 7), improves the generalization capabilities of the models, bringing them beyond the level of independent mono-centric training and validation (experiments 1) and 2)). MultiBypass140 shows considerable variation in surgical technique and workflow of LRYGB procedures between centers. Therefore, generalization experiments demonstrate a remarkable difference in model performance. These results highlight the importance of multi-centric datasets for AI model generalization to account for variance in surgical technique and workflows.

Ultrasound (US) is a widely used medical imaging modality due to its real-time capabilities, non-invasive nature, and cost-effectiveness. Robotic ultrasound can further enhance its utility by reducing operator dependence and improving access to complex anatomical regions. For this, while deep reinforcement learning (DRL) and imitation learning (IL) have shown potential for autonomous navigation, their use in complex surgical tasks such as anatomy reconstruction and surgical guidance remains limited -- largely due to the lack of realistic and efficient simulation environments tailored to these tasks. We introduce SonoGym, a scalable simulation platform for complex robotic ultrasound tasks that enables parallel simulation across tens to hundreds of environments. Our framework supports realistic and real-time simulation of US data from CT-derived 3D models of the anatomy through both a physics-based and a generative modeling approach. Sonogym enables the training of DRL and recent IL agents (vision transformers and diffusion policies) for relevant tasks in robotic orthopedic surgery by integrating common robotic platforms and orthopedic end effectors. We further incorporate submodular DRL -- a recent method that handles history-dependent rewards -- for anatomy reconstruction and safe reinforcement learning for surgery. Our results demonstrate successful policy learning across a range of scenarios, while also highlighting the limitations of current methods in clinically relevant environments. We believe our simulation can facilitate research in robot learning approaches for such challenging robotic surgery applications. Dataset, codes, and videos are publicly available at https://sonogym.github.io/.

The soft Dice loss (SDL) has taken a pivotal role in numerous automated segmentation pipelines in the medical imaging community. Over the last years, some reasons behind its superior functioning have been uncovered and further optimizations have been explored. However, there is currently no implementation that supports its direct utilization in scenarios involving soft labels. Hence, a synergy between the use of SDL and research leveraging the use of soft labels, also in the context of model calibration, is still missing. In this work, we introduce Dice semimetric losses (DMLs), which (i) are by design identical to SDL in a standard setting with hard labels, but (ii) can be employed in settings with soft labels. Our experiments on the public QUBIQ, LiTS and KiTS benchmarks confirm the potential synergy of DMLs with soft labels (e.g.\ averaging, label smoothing, and knowledge distillation) over hard labels (e.g.\ majority voting and random selection). As a result, we obtain superior Dice scores and model calibration, which supports the wider adoption of DMLs in practice. The code is available at https://github.com/zifuwanggg/JDTLosses{https://github.com/zifuwanggg/JDTLosses}.

The softmax function is widely used in artificial neural networks for the multiclass classification problems, where the softmax transformation enforces the output to be positive and sum to one, and the corresponding loss function allows to use maximum likelihood principle to optimize the model. However, softmax leaves a large margin for loss function to conduct optimizing operation when it comes to high-dimensional classification, which results in low-performance to some extent. In this paper, we provide an empirical study on a simple and concise softmax variant, namely sparse-softmax, to alleviate the problem that occurred in traditional softmax in terms of high-dimensional classification problems. We evaluate our approach in several interdisciplinary tasks, the experimental results show that sparse-softmax is simpler, faster, and produces better results than the baseline models.

Surgical video segmentation is a critical task in computer-assisted surgery and is vital for enhancing surgical quality and patient outcomes. Recently, the Segment Anything Model 2 (SAM2) framework has shown superior advancements in image and video segmentation. However, SAM2 struggles with efficiency due to the high computational demands of processing high-resolution images and complex and long-range temporal dynamics in surgical videos. To address these challenges, we introduce Surgical SAM 2 (SurgSAM-2), an advanced model to utilize SAM2 with an Efficient Frame Pruning (EFP) mechanism, to facilitate real-time surgical video segmentation. The EFP mechanism dynamically manages the memory bank by selectively retaining only the most informative frames, reducing memory usage and computational cost while maintaining high segmentation accuracy. Our extensive experiments demonstrate that SurgSAM-2 significantly improves both efficiency and segmentation accuracy compared to the vanilla SAM2. Remarkably, SurgSAM-2 achieves a 3times FPS compared with SAM2, while also delivering state-of-the-art performance after fine-tuning with lower-resolution data. These advancements establish SurgSAM-2 as a leading model for surgical video analysis, making real-time surgical video segmentation in resource-constrained environments a feasible reality.

Medical video generation has transformative potential for enhancing surgical understanding and pathology insights through precise and controllable visual representations. However, current models face limitations in controllability and authenticity. To bridge this gap, we propose SurgSora, a motion-controllable surgical video generation framework that uses a single input frame and user-controllable motion cues. SurgSora consists of three key modules: the Dual Semantic Injector (DSI), which extracts object-relevant RGB and depth features from the input frame and integrates them with segmentation cues to capture detailed spatial features of complex anatomical structures; the Decoupled Flow Mapper (DFM), which fuses optical flow with semantic-RGB-D features at multiple scales to enhance temporal understanding and object spatial dynamics; and the Trajectory Controller (TC), which allows users to specify motion directions and estimates sparse optical flow, guiding the video generation process. The fused features are used as conditions for a frozen Stable Diffusion model to produce realistic, temporally coherent surgical videos. Extensive evaluations demonstrate that SurgSora outperforms state-of-the-art methods in controllability and authenticity, showing its potential to advance surgical video generation for medical education, training, and research.

Explaining the output of a deep network remains a challenge. In the case of an image classifier, one type of explanation is to identify pixels that strongly influence the final decision. A starting point for this strategy is the gradient of the class score function with respect to the input image. This gradient can be interpreted as a sensitivity map, and there are several techniques that elaborate on this basic idea. This paper makes two contributions: it introduces SmoothGrad, a simple method that can help visually sharpen gradient-based sensitivity maps, and it discusses lessons in the visualization of these maps. We publish the code for our experiments and a website with our results.

Natural language could play an important role in developing generalist surgical models by providing a broad source of supervision from raw texts. This flexible form of supervision can enable the model's transferability across datasets and tasks as natural language can be used to reference learned visual concepts or describe new ones. In this work, we present HecVL, a novel hierarchical video-language pretraining approach for building a generalist surgical model. Specifically, we construct a hierarchical video-text paired dataset by pairing the surgical lecture video with three hierarchical levels of texts: at clip-level, atomic actions using transcribed audio texts; at phase-level, conceptual text summaries; and at video-level, overall abstract text of the surgical procedure. Then, we propose a novel fine-to-coarse contrastive learning framework that learns separate embedding spaces for the three video-text hierarchies using a single model. By disentangling embedding spaces of different hierarchical levels, the learned multi-modal representations encode short-term and long-term surgical concepts in the same model. Thanks to the injected textual semantics, we demonstrate that the HecVL approach can enable zero-shot surgical phase recognition without any human annotation. Furthermore, we show that the same HecVL model for surgical phase recognition can be transferred across different surgical procedures and medical centers. The code is available at https://github.com/CAMMA-public/SurgVLP

Scale-aware monocular depth estimation poses a significant challenge in computer-aided endoscopic navigation. However, existing depth estimation methods that do not consider the geometric priors struggle to learn the absolute scale from training with monocular endoscopic sequences. Additionally, conventional methods face difficulties in accurately estimating details on tissue and instruments boundaries. In this paper, we tackle these problems by proposing a novel enhanced scale-aware framework that only uses monocular images with geometric modeling for depth estimation. Specifically, we first propose a multi-resolution depth fusion strategy to enhance the quality of monocular depth estimation. To recover the precise scale between relative depth and real-world values, we further calculate the 3D poses of instruments in the endoscopic scenes by algebraic geometry based on the image-only geometric primitives (i.e., boundaries and tip of instruments). Afterwards, the 3D poses of surgical instruments enable the scale recovery of relative depth maps. By coupling scale factors and relative depth estimation, the scale-aware depth of the monocular endoscopic scenes can be estimated. We evaluate the pipeline on in-house endoscopic surgery videos and simulated data. The results demonstrate that our method can learn the absolute scale with geometric modeling and accurately estimate scale-aware depth for monocular scenes.

Disease progression simulation is a crucial area of research that has significant implications for clinical diagnosis, prognosis, and treatment. One major challenge in this field is the lack of continuous medical imaging monitoring of individual patients over time. To address this issue, we develop a novel framework termed Progressive Image Editing (PIE) that enables controlled manipulation of disease-related image features, facilitating precise and realistic disease progression simulation. Specifically, we leverage recent advancements in text-to-image generative models to simulate disease progression accurately and personalize it for each patient. We theoretically analyze the iterative refining process in our framework as a gradient descent with an exponentially decayed learning rate. To validate our framework, we conduct experiments in three medical imaging domains. Our results demonstrate the superiority of PIE over existing methods such as Stable Diffusion Walk and Style-Based Manifold Extrapolation based on CLIP score (Realism) and Disease Classification Confidence (Alignment). Our user study collected feedback from 35 veteran physicians to assess the generated progressions. Remarkably, 76.2% of the feedback agrees with the fidelity of the generated progressions. To our best knowledge, PIE is the first of its kind to generate disease progression images meeting real-world standards. It is a promising tool for medical research and clinical practice, potentially allowing healthcare providers to model disease trajectories over time, predict future treatment responses, and improve patient outcomes.

In recent years, the landscape of computer-assisted interventions and post-operative surgical video analysis has been dramatically reshaped by deep-learning techniques, resulting in significant advancements in surgeons' skills, operation room management, and overall surgical outcomes. However, the progression of deep-learning-powered surgical technologies is profoundly reliant on large-scale datasets and annotations. Particularly, surgical scene understanding and phase recognition stand as pivotal pillars within the realm of computer-assisted surgery and post-operative assessment of cataract surgery videos. In this context, we present the largest cataract surgery video dataset that addresses diverse requisites for constructing computerized surgical workflow analysis and detecting post-operative irregularities in cataract surgery. We validate the quality of annotations by benchmarking the performance of several state-of-the-art neural network architectures for phase recognition and surgical scene segmentation. Besides, we initiate the research on domain adaptation for instrument segmentation in cataract surgery by evaluating cross-domain instrument segmentation performance in cataract surgery videos. The dataset and annotations will be publicly available upon acceptance of the paper.

Since its introduction, softmax attention has become the backbone of modern transformer architectures due to its expressiveness and scalability across a wide range of tasks. However, the main drawback of softmax attention is the quadratic memory requirement and computational complexity with respect to the sequence length. By replacing the softmax nonlinearity, linear attention and similar methods have been introduced to avoid the quadratic bottleneck of softmax attention. Despite these linear forms of attention being derived from the original softmax formulation, they typically lag in terms of downstream accuracy. While strong intuition of the softmax nonlinearity on the query and key inner product suggests that it has desirable properties compared to other nonlinearities, the question of why this discrepancy exists still remains unanswered. This work demonstrates that linear attention is an approximation of softmax attention by deriving the recurrent form of softmax attention. Using this form, each part of softmax attention can be described in the language of recurrent neural networks (RNNs). Describing softmax attention as an RNN allows for the ablation of the components of softmax attention to understand the importance of each part and how they interact. In this way, our work helps explain why softmax attention is more expressive than its counterparts.

This paper reports Deep LOGISMOS approach to 3D tumor segmentation by incorporating boundary information derived from deep contextual learning to LOGISMOS - layered optimal graph image segmentation of multiple objects and surfaces. Accurate and reliable tumor segmentation is essential to tumor growth analysis and treatment selection. A fully convolutional network (FCN), UNet, is first trained using three adjacent 2D patches centered at the tumor, providing contextual UNet segmentation and probability map for each 2D patch. The UNet segmentation is then refined by Gaussian Mixture Model (GMM) and morphological operations. The refined UNet segmentation is used to provide the initial shape boundary to build a segmentation graph. The cost for each node of the graph is determined by the UNet probability maps. Finally, a max-flow algorithm is employed to find the globally optimal solution thus obtaining the final segmentation. For evaluation, we applied the method to pancreatic tumor segmentation on a dataset of 51 CT scans, among which 30 scans were used for training and 21 for testing. With Deep LOGISMOS, DICE Similarity Coefficient (DSC) and Relative Volume Difference (RVD) reached 83.2+-7.8% and 18.6+-17.4% respectively, both are significantly improved (p<0.05) compared with contextual UNet and/or LOGISMOS alone.

With the growing size of pre-trained models, full fine-tuning and storing all the parameters for various downstream tasks is costly and infeasible. In this paper, we propose a new parameter-efficient fine-tuning method, Gradient-based Parameter Selection (GPS), demonstrating that only tuning a few selected parameters from the pre-trained model while keeping the remainder of the model frozen can generate similar or better performance compared with the full model fine-tuning method. Different from the existing popular and state-of-the-art parameter-efficient fine-tuning approaches, our method does not introduce any additional parameters and computational costs during both the training and inference stages. Another advantage is the model-agnostic and non-destructive property, which eliminates the need for any other design specific to a particular model. Compared with the full fine-tuning, GPS achieves 3.33% (91.78% vs. 88.45%, FGVC) and 9.61% (73.1% vs. 65.57%, VTAB) improvement of the accuracy with tuning only 0.36% parameters of the pre-trained model on average over 24 image classification tasks; it also demonstrates a significant improvement of 17% and 16.8% in mDice and mIoU, respectively, on medical image segmentation task. Moreover, GPS achieves state-of-the-art performance compared with existing PEFT methods.

Tool tracking in surgical videos is essential for advancing computer-assisted interventions, such as skill assessment, safety zone estimation, and human-machine collaboration. However, the lack of context-rich datasets limits AI applications in this field. Existing datasets rely on overly generic tracking formalizations that fail to capture surgical-specific dynamics, such as tools moving out of the camera's view or exiting the body. This results in less clinically relevant trajectories and a lack of flexibility for real-world surgical applications. Methods trained on these datasets often struggle with visual challenges such as smoke, reflection, and bleeding, further exposing the limitations of current approaches. We introduce CholecTrack20, a specialized dataset for multi-class, multi-tool tracking in surgical procedures. It redefines tracking formalization with three perspectives: (i) intraoperative, (ii) intracorporeal, and (iii) visibility, enabling adaptable and clinically meaningful tool trajectories. The dataset comprises 20 full-length surgical videos, annotated at 1 fps, yielding over 35K frames and 65K labeled tool instances. Annotations include spatial location, category, identity, operator, phase, and scene visual challenge. Benchmarking state-of-the-art methods on CholecTrack20 reveals significant performance gaps, with current approaches (< 45\% HOTA) failing to meet the accuracy required for clinical translation. These findings motivate the need for advanced and intuitive tracking algorithms and establish CholecTrack20 as a foundation for developing robust AI-driven surgical assistance systems.

Integration of Vision-Language Models (VLMs) in surgical intelligence is hindered by hallucinations, domain knowledge gaps, and limited understanding of task interdependencies within surgical scenes, undermining clinical reliability. While recent VLMs demonstrate strong general reasoning and thinking capabilities, they still lack the domain expertise and task-awareness required for precise surgical scene interpretation. Although Chain-of-Thought (CoT) can structure reasoning more effectively, current approaches rely on self-generated CoT steps, which often exacerbate inherent domain gaps and hallucinations. To overcome this, we present SurgRAW, a CoT-driven multi-agent framework that delivers transparent, interpretable insights for most tasks in robotic-assisted surgery. By employing specialized CoT prompts across five tasks: instrument recognition, action recognition, action prediction, patient data extraction, and outcome assessment, SurgRAW mitigates hallucinations through structured, domain-aware reasoning. Retrieval-Augmented Generation (RAG) is also integrated to external medical knowledge to bridge domain gaps and improve response reliability. Most importantly, a hierarchical agentic system ensures that CoT-embedded VLM agents collaborate effectively while understanding task interdependencies, with a panel discussion mechanism promotes logical consistency. To evaluate our method, we introduce SurgCoTBench, the first reasoning-based dataset with structured frame-level annotations. With comprehensive experiments, we demonstrate the effectiveness of proposed SurgRAW with 29.32% accuracy improvement over baseline VLMs on 12 robotic procedures, achieving the state-of-the-art performance and advancing explainable, trustworthy, and autonomous surgical assistance.

Fully quantized training (FQT) accelerates the training of deep neural networks by quantizing the activations, weights, and gradients into lower precision. To explore the ultimate limit of FQT (the lowest achievable precision), we make a first attempt to 1-bit FQT. We provide a theoretical analysis of FQT based on Adam and SGD, revealing that the gradient variance influences the convergence of FQT. Building on these theoretical results, we introduce an Activation Gradient Pruning (AGP) strategy. The strategy leverages the heterogeneity of gradients by pruning less informative gradients and enhancing the numerical precision of remaining gradients to mitigate gradient variance. Additionally, we propose Sample Channel joint Quantization (SCQ), which utilizes different quantization strategies in the computation of weight gradients and activation gradients to ensure that the method is friendly to low-bitwidth hardware. Finally, we present a framework to deploy our algorithm. For fine-tuning VGGNet-16 and ResNet-18 on multiple datasets, our algorithm achieves an average accuracy improvement of approximately 6%, compared to per-sample quantization. Moreover, our training speedup can reach a maximum of 5.13x compared to full precision training.

Quantification of real-time informal feedback delivered by an experienced surgeon to a trainee during surgery is important for skill improvements in surgical training. Such feedback in the live operating room is inherently multimodal, consisting of verbal conversations (e.g., questions and answers) as well as non-verbal elements (e.g., through visual cues like pointing to anatomic elements). In this work, we leverage a clinically-validated five-category classification of surgical feedback: "Anatomic", "Technical", "Procedural", "Praise" and "Visual Aid". We then develop a multi-label machine learning model to classify these five categories of surgical feedback from inputs of text, audio, and video modalities. The ultimate goal of our work is to help automate the annotation of real-time contextual surgical feedback at scale. Our automated classification of surgical feedback achieves AUCs ranging from 71.5 to 77.6 with the fusion improving performance by 3.1%. We also show that high-quality manual transcriptions of feedback audio from experts improve AUCs to between 76.5 and 96.2, which demonstrates a clear path toward future improvements. Empirically, we find that the Staged training strategy, with first pre-training each modality separately and then training them jointly, is more effective than training different modalities altogether. We also present intuitive findings on the importance of modalities for different feedback categories. This work offers an important first look at the feasibility of automated classification of real-world live surgical feedback based on text, audio, and video modalities.

Pruning is an effective method to reduce the memory footprint and FLOPs associated with neural network models. However, existing structured-pruning methods often result in significant accuracy degradation for moderate pruning levels. To address this problem, we introduce a new Hessian Aware Pruning (HAP) method coupled with a Neural Implant approach that uses second-order sensitivity as a metric for structured pruning. The basic idea is to prune insensitive components and to use a Neural Implant for moderately sensitive components, instead of completely pruning them. For the latter approach, the moderately sensitive components are replaced with with a low rank implant that is smaller and less computationally expensive than the original component. We use the relative Hessian trace to measure sensitivity, as opposed to the magnitude based sensitivity metric commonly used in the literature. We test HAP for both computer vision tasks and natural language tasks, and we achieve new state-of-the-art results. Specifically, HAP achieves less than 0.1%/0.5% degradation on PreResNet29/ResNet50 (CIFAR-10/ImageNet) with more than 70\%/50\% of parameters pruned. Meanwhile, HAP also achieves significantly better performance (up to 0.8\% with 60\% of parameters pruned) as compared to gradient based method for head pruning on transformer-based models. The framework has been open sourced and available online.

Gastrointestinal malignancies constitute a leading cause of cancer-related mortality worldwide, with advanced-stage prognosis remaining particularly dismal. Originating as a groundbreaking technique for early gastric cancer treatment, Endoscopic Submucosal Dissection has evolved into a versatile intervention for diverse gastrointestinal lesions. While computer-assisted systems significantly enhance procedural precision and safety in ESD, their clinical adoption faces a critical bottleneck: reliable surgical phase recognition within complex endoscopic workflows. Current state-of-the-art approaches predominantly rely on multi-stage refinement architectures that iteratively optimize temporal predictions. In this paper, we present Clinical Prior Knowledge-Constrained Diffusion (CPKD), a novel generative framework that reimagines phase recognition through denoising diffusion principles while preserving the core iterative refinement philosophy. This architecture progressively reconstructs phase sequences starting from random noise and conditioned on visual-temporal features. To better capture three domain-specific characteristics, including positional priors, boundary ambiguity, and relation dependency, we design a conditional masking strategy. Furthermore, we incorporate clinical prior knowledge into the model training to improve its ability to correct phase logical errors. Comprehensive evaluations on ESD820, Cholec80, and external multi-center demonstrate that our proposed CPKD achieves superior or comparable performance to state-of-the-art approaches, validating the effectiveness of diffusion-based generative paradigms for surgical phase recognition.

Robot co-design, where the morphology of a robot is optimized jointly with a learned policy to solve a specific task, is an emerging area of research. It holds particular promise for soft robots, which are amenable to novel manufacturing techniques that can realize learned morphologies and actuators. Inspired by nature and recent novel robot designs, we propose to go a step further and explore the novel reconfigurable robots, defined as robots that can change their morphology within their lifetime. We formalize control of reconfigurable soft robots as a high-dimensional reinforcement learning (RL) problem. We unify morphology change, locomotion, and environment interaction in the same action space, and introduce an appropriate, coarse-to-fine curriculum that enables us to discover policies that accomplish fine-grained control of the resulting robots. We also introduce DittoGym, a comprehensive RL benchmark for reconfigurable soft robots that require fine-grained morphology changes to accomplish the tasks. Finally, we evaluate our proposed coarse-to-fine algorithm on DittoGym and demonstrate robots that learn to change their morphology several times within a sequence, uniquely enabled by our RL algorithm. More results are available at https://dittogym.github.io.

Chest X-rays (CXRs) are commonly utilized as a low-dose modality for lung screening. Nonetheless, the efficacy of CXRs is somewhat impeded, given that approximately 75% of the lung area overlaps with bone, which in turn hampers the detection and diagnosis of diseases. As a remedial measure, bone suppression techniques have been introduced. The current dual-energy subtraction imaging technique in the clinic requires costly equipment and subjects being exposed to high radiation. To circumvent these issues, deep learning-based image generation algorithms have been proposed. However, existing methods fall short in terms of producing high-quality images and capturing texture details, particularly with pulmonary vessels. To address these issues, this paper proposes a new bone suppression framework, termed BS-Diff, that comprises a conditional diffusion model equipped with a U-Net architecture and a simple enhancement module to incorporate an autoencoder. Our proposed network cannot only generate soft tissue images with a high bone suppression rate but also possesses the capability to capture fine image details. Additionally, we compiled the largest dataset since 2010, including data from 120 patients with high-definition, high-resolution paired CXRs and soft tissue images collected by our affiliated hospital. Extensive experiments, comparative analyses, ablation studies, and clinical evaluations indicate that the proposed BS-Diff outperforms several bone-suppression models across multiple metrics. Our code can be accessed at https://github.com/Benny0323/BS-Diff.

Background: We evaluate SAM 2 for surgical scene understanding by examining its semantic segmentation capabilities for organs/tissues both in zero-shot scenarios and after fine-tuning. Methods: We utilized five public datasets to evaluate and fine-tune SAM 2 for segmenting anatomical tissues in surgical videos/images. Fine-tuning was applied to the image encoder and mask decoder. We limited training subsets from 50 to 400 samples per class to better model real-world constraints with data acquisition. The impact of dataset size on fine-tuning performance was evaluated with weighted mean Dice coefficient (WMDC), and the results were also compared against previously reported state-of-the-art (SOTA) results. Results: SurgiSAM 2, a fine-tuned SAM 2 model, demonstrated significant improvements in segmentation performance, achieving a 17.9% relative WMDC gain compared to the baseline SAM 2. Increasing prompt points from 1 to 10 and training data scale from 50/class to 400/class enhanced performance; the best WMDC of 0.92 on the validation subset was achieved with 10 prompt points and 400 samples per class. On the test subset, this model outperformed prior SOTA methods in 24/30 (80%) of the classes with a WMDC of 0.91 using 10-point prompts. Notably, SurgiSAM 2 generalized effectively to unseen organ classes, achieving SOTA on 7/9 (77.8%) of them. Conclusion: SAM 2 achieves remarkable zero-shot and fine-tuned performance for surgical scene segmentation, surpassing prior SOTA models across several organ classes of diverse datasets. This suggests immense potential for enabling automated/semi-automated annotation pipelines, thereby decreasing the burden of annotations facilitating several surgical applications.

This paper focuses on the development of a space-variant regularization model for solving an under-determined linear inverse problem. The case study is a medical image reconstruction from few-view tomographic noisy data. The primary objective of the proposed optimization model is to achieve a good balance between denoising and the preservation of fine details and edges, overcoming the performance of the popular and largely used Total Variation (TV) regularization through the application of appropriate pixel-dependent weights. The proposed strategy leverages the role of gradient approximations for the computation of the space-variant TV weights. For this reason, a convolutional neural network is designed, to approximate both the ground truth image and its gradient using an elastic loss function in its training. Additionally, the paper provides a theoretical analysis of the proposed model, showing the uniqueness of its solution, and illustrates a Chambolle-Pock algorithm tailored to address the specific problem at hand. This comprehensive framework integrates innovative regularization techniques with advanced neural network capabilities, demonstrating promising results in achieving high-quality reconstructions from low-sampled tomographic data.

Conversation agents powered by large language models are revolutionizing the way we interact with visual data. Recently, large vision-language models (LVLMs) have been extensively studied for both images and videos. However, these studies typically focus on common scenarios. In this work, we introduce an LVLM specifically designed for surgical scenarios. We integrate visual representations of surgical images and videos into the language feature space. Consequently, we establish a LVLM model, Surgical-LLaVA, fine-tuned on instruction following data of surgical scenarios. Our experiments demonstrate that Surgical-LLaVA exhibits impressive multi-modal chat abilities in surgical contexts, occasionally displaying multi-modal behaviors on unseen instructions. We conduct a quantitative evaluation of visual question-answering datasets for surgical scenarios. The results show superior performance compared to previous works, indicating the potential of our model to tackle more complex surgery scenarios.

A central challenge to many fields of science and engineering involves minimizing non-convex error functions over continuous, high dimensional spaces. Gradient descent or quasi-Newton methods are almost ubiquitously used to perform such minimizations, and it is often thought that a main source of difficulty for the ability of these local methods to find the global minimum is the proliferation of local minima with much higher error than the global minimum. Here we argue, based on results from statistical physics, random matrix theory, and neural network theory, that a deeper and more profound difficulty originates from the proliferation of saddle points, not local minima, especially in high dimensional problems of practical interest. Such saddle points are surrounded by high error plateaus that can dramatically slow down learning, and give the illusory impression of the existence of a local minimum. Motivated by these arguments, we propose a new algorithm, the saddle-free Newton method, that can rapidly escape high dimensional saddle points, unlike gradient descent and quasi-Newton methods. We apply this algorithm to deep neural network training, and provide preliminary numerical evidence for its superior performance.

Sparsely activated neural networks with conditional computation learn to route their inputs through different "expert" subnetworks, providing a form of modularity that densely activated models lack. Despite their possible benefits, models with learned routing often underperform their parameter-matched densely activated counterparts as well as models that use non-learned heuristic routing strategies. In this paper, we hypothesize that these shortcomings stem from the gradient estimation techniques used to train sparsely activated models that use non-differentiable discrete routing decisions. To address this issue, we introduce Soft Merging of Experts with Adaptive Routing (SMEAR), which avoids discrete routing by using a single "merged" expert constructed via a weighted average of all of the experts' parameters. By routing activations through a single merged expert, SMEAR does not incur a significant increase in computational costs and enables standard gradient-based training. We empirically validate that models using SMEAR outperform models that route based on metadata or learn sparse routing through gradient estimation. Furthermore, we provide qualitative analysis demonstrating that the experts learned via SMEAR exhibit a significant amount of specialization. All of the code used in our experiments is publicly available.

This paper introduces a network for volumetric segmentation that learns from sparsely annotated volumetric images. We outline two attractive use cases of this method: (1) In a semi-automated setup, the user annotates some slices in the volume to be segmented. The network learns from these sparse annotations and provides a dense 3D segmentation. (2) In a fully-automated setup, we assume that a representative, sparsely annotated training set exists. Trained on this data set, the network densely segments new volumetric images. The proposed network extends the previous u-net architecture from Ronneberger et al. by replacing all 2D operations with their 3D counterparts. The implementation performs on-the-fly elastic deformations for efficient data augmentation during training. It is trained end-to-end from scratch, i.e., no pre-trained network is required. We test the performance of the proposed method on a complex, highly variable 3D structure, the Xenopus kidney, and achieve good results for both use cases.

Assessing resection margins is central to pathological specimen evaluation and has profound implications for patient outcomes. Current practice employs physical inking, which is applied variably, and cautery artifacts can obscure the true margin on histological sections. We present a virtual inking network (VIN) that autonomously localizes the surgical cut surface on whole-slide images, reducing reliance on inks and standardizing margin-focused review. VIN uses a frozen foundation model as the feature extractor and a compact two-layer multilayer perceptron trained for patch-level classification of cautery-consistent features. The dataset comprised 120 hematoxylin and eosin (H&E) stained slides from 12 human tonsil tissue blocks, resulting in ~2 TB of uncompressed raw image data, where a board-certified pathologist provided boundary annotations. In blind testing with 20 slides from previously unseen blocks, VIN produced coherent margin overlays that qualitatively aligned with expert annotations across serial sections. Quantitatively, region-level accuracy was ~73.3% across the test set, with errors largely confined to limited areas that did not disrupt continuity of the whole-slide margin map. These results indicate that VIN captures cautery-related histomorphology and can provide a reproducible, ink-free margin delineation suitable for integration into routine digital pathology workflows and for downstream measurement of margin distances.

Patient data from real-world clinical practice often suffers from data scarcity and long-tail imbalances, leading to biased outcomes or algorithmic unfairness. This study addresses these challenges by generating lesion-containing image-segmentation pairs from lesion-free images. Previous efforts in medical imaging synthesis have struggled with separating lesion information from background, resulting in low-quality backgrounds and limited control over the synthetic output. Inspired by diffusion-based image inpainting, we propose LeFusion, a lesion-focused diffusion model. By redesigning the diffusion learning objectives to focus on lesion areas, we simplify the learning process and improve control over the output while preserving high-fidelity backgrounds by integrating forward-diffused background contexts into the reverse diffusion process. Additionally, we tackle two major challenges in lesion texture synthesis: 1) multi-peak and 2) multi-class lesions. We introduce two effective strategies: histogram-based texture control and multi-channel decomposition, enabling the controlled generation of high-quality lesions in difficult scenarios. Furthermore, we incorporate lesion mask diffusion, allowing control over lesion size, location, and boundary, thus increasing lesion diversity. Validated on 3D cardiac lesion MRI and lung nodule CT datasets, LeFusion-generated data significantly improves the performance of state-of-the-art segmentation models, including nnUNet and SwinUNETR. Code and model are available at https://github.com/M3DV/LeFusion.

In some medical imaging tasks and other settings where only small parts of the image are informative for the classification task, traditional CNNs can sometimes struggle to generalise. Manually annotated Regions of Interest (ROI) are sometimes used to isolate the most informative parts of the image. However, these are expensive to collect and may vary significantly across annotators. To overcome these issues, we propose a framework that employs saliency maps to obtain soft spatial attention masks that modulate the image features at different scales. We refer to our method as Adversarial Counterfactual Attention (ACAT). ACAT increases the baseline classification accuracy of lesions in brain CT scans from 71.39% to 72.55% and of COVID-19 related findings in lung CT scans from 67.71% to 70.84% and exceeds the performance of competing methods. We investigate the best way to generate the saliency maps employed in our architecture and propose a way to obtain them from adversarially generated counterfactual images. They are able to isolate the area of interest in brain and lung CT scans without using any manual annotations. In the task of localising the lesion location out of 6 possible regions, they obtain a score of 65.05% on brain CT scans, improving the score of 61.29% obtained with the best competing method.

We propose a categorical semantics of gradient-based machine learning algorithms in terms of lenses, parametrised maps, and reverse derivative categories. This foundation provides a powerful explanatory and unifying framework: it encompasses a variety of gradient descent algorithms such as ADAM, AdaGrad, and Nesterov momentum, as well as a variety of loss functions such as as MSE and Softmax cross-entropy, shedding new light on their similarities and differences. Our approach to gradient-based learning has examples generalising beyond the familiar continuous domains (modelled in categories of smooth maps) and can be realized in the discrete setting of boolean circuits. Finally, we demonstrate the practical significance of our framework with an implementation in Python.

The backpropagation algorithm has long been the canonical training method for neural networks. Modern paradigms are implicitly optimized for it, and numerous guidelines exist to ensure its proper use. Recently, synthetic gradients methods -where the error gradient is only roughly approximated - have garnered interest. These methods not only better portray how biological brains are learning, but also open new computational possibilities, such as updating layers asynchronously. Even so, they have failed to scale past simple tasks like MNIST or CIFAR-10. This is in part due to a lack of standards, leading to ill-suited models and practices forbidding such methods from performing to the best of their abilities. In this work, we focus on direct feedback alignment and present a set of best practices justified by observations of the alignment angles. We characterize a bottleneck effect that prevents alignment in narrow layers, and hypothesize it may explain why feedback alignment methods have yet to scale to large convolutional networks.

Imposing known physical constraints, such as conservation laws, during neural network training introduces an inductive bias that can improve accuracy, reliability, convergence, and data efficiency for modeling physical dynamics. While such constraints can be softly imposed via loss function penalties, recent advancements in differentiable physics and optimization improve performance by incorporating PDE-constrained optimization as individual layers in neural networks. This enables a stricter adherence to physical constraints. However, imposing hard constraints significantly increases computational and memory costs, especially for complex dynamical systems. This is because it requires solving an optimization problem over a large number of points in a mesh, representing spatial and temporal discretizations, which greatly increases the complexity of the constraint. To address this challenge, we develop a scalable approach to enforce hard physical constraints using Mixture-of-Experts (MoE), which can be used with any neural network architecture. Our approach imposes the constraint over smaller decomposed domains, each of which is solved by an "expert" through differentiable optimization. During training, each expert independently performs a localized backpropagation step by leveraging the implicit function theorem; the independence of each expert allows for parallelization across multiple GPUs. Compared to standard differentiable optimization, our scalable approach achieves greater accuracy in the neural PDE solver setting for predicting the dynamics of challenging non-linear systems. We also improve training stability and require significantly less computation time during both training and inference stages.