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<export-example>
  <doc>
    <id>3539</id>
    <completedYear/>
    <publishedYear>2022</publishedYear>
    <thesisYearAccepted/>
    <language>eng</language>
    <pageFirst>S175</pageFirst>
    <pageLast/>
    <pageNumber/>
    <edition/>
    <issue>S01</issue>
    <volume>54</volume>
    <type>article</type>
    <publisherName>Thieme</publisherName>
    <publisherPlace/>
    <creatingCorporation/>
    <contributingCorporation/>
    <belongsToBibliography>0</belongsToBibliography>
    <completedDate>2022-04-19</completedDate>
    <publishedDate>--</publishedDate>
    <thesisDateAccepted>--</thesisDateAccepted>
    <title language="eng">ARTIFICIAL INTELLIGENCE (AI) – ASSISTED VESSEL AND TISSUE RECOGNITION IN THIRD-SPACE ENDOSCOPY</title>
    <abstract language="eng">Aims &#13;
Third-space endoscopy procedures such as endoscopic submucosal dissection (ESD) and peroral endoscopic myotomy (POEM) are complex interventions with elevated risk of operator-dependent adverse events, such as intra-procedural bleeding and perforation. We aimed to design an artificial intelligence clinical decision support solution (AI-CDSS, “Smart ESD”) for the detection and delineation of vessels, tissue structures, and instruments during third-space endoscopy procedures.&#13;
&#13;
Methods&#13;
Twelve full-length third-space endoscopy videos were extracted from the Augsburg University Hospital database. 1686 frames were annotated for the following categories: Submucosal layer, blood vessels, electrosurgical knife and endoscopic instrument. A DeepLabv3+neural network with a 101-layer ResNet backbone was trained and validated internally. Finally, the ability of the AI system to detect visible vessels during ESD and POEM was determined on 24 separate video clips of 7 to 46 seconds duration and showing 33 predefined vessels. These video clips were also assessed by an expert in third-space endoscopy.&#13;
&#13;
Results &#13;
Smart ESD showed a vessel detection rate (VDR) of 93.94%, while an average of 1.87 false positive signals were recorded per minute. VDR of the expert endoscopist was 90.1% with no false positive findings. On the internal validation data set using still images, the AI system demonstrated an Intersection over Union (IoU), mean Dice score and pixel accuracy of 63.47%, 76.18% and 86.61%, respectively.&#13;
&#13;
Conclusions &#13;
This is the first AI-CDSS aiming to mitigate operator-dependent limitations during third-space endoscopy. Further clinical trials are underway to better understand the role of AI in such procedures.</abstract>
    <parentTitle language="eng">Endoscopy</parentTitle>
    <identifier type="doi">10.1055/s-0042-1745037</identifier>
    <enrichment key="ConferenceStatement">ESGE Days 2022</enrichment>
    <enrichment key="opus.source">publish</enrichment>
    <enrichment key="BegutachtungStatus">peer-reviewed</enrichment>
    <licence>Keine Lizenz - Es gilt das deutsche Urheberrecht: § 53 UrhG</licence>
    <author>Markus W. Scheppach</author>
    <author>Robert Mendel</author>
    <author>Andreas Probst</author>
    <author>Michael Meinikheim</author>
    <author>Christoph Palm</author>
    <author>Helmut Messmann</author>
    <author>Alanna Ebigbo</author>
    <subject>
      <language>eng</language>
      <type>uncontrolled</type>
      <value>Artificial Intelligence</value>
    </subject>
    <subject>
      <language>eng</language>
      <type>uncontrolled</type>
      <value>Third-Space Endoscopy</value>
    </subject>
    <subject>
      <language>eng</language>
      <type>uncontrolled</type>
      <value>Smart ESD</value>
    </subject>
    <collection role="ddc" number="0">Informatik, Informationswissenschaft, allgemeine Werke</collection>
    <collection role="ddc" number="6">Technik, Medizin, angewandte Wissenschaften</collection>
    <collection role="institutes" number="FakIM">Fakultät Informatik und Mathematik</collection>
    <collection role="persons" number="palmremic">Palm, Christoph (Prof. Dr.) - ReMIC</collection>
    <collection role="othforschungsschwerpunkt" number="16314">Lebenswissenschaften und Ethik</collection>
    <collection role="institutes" number="">Labor Regensburg Medical Image Computing (ReMIC)</collection>
  </doc>
  <doc>
    <id>5436</id>
    <completedYear/>
    <publishedYear>2022</publishedYear>
    <thesisYearAccepted/>
    <language>eng</language>
    <pageFirst/>
    <pageLast/>
    <pageNumber/>
    <edition/>
    <issue>08</issue>
    <volume>60</volume>
    <type>conferencepresentation</type>
    <publisherName>Georg Thieme Verlag</publisherName>
    <publisherPlace>Stuttgart</publisherPlace>
    <creatingCorporation/>
    <contributingCorporation/>
    <belongsToBibliography>0</belongsToBibliography>
    <completedDate>2022-09-16</completedDate>
    <publishedDate>--</publishedDate>
    <thesisDateAccepted>--</thesisDateAccepted>
    <title language="eng">Artificial Intelligence (AI) – assisted vessel and tissue recognition during third space endoscopy (Smart ESD)</title>
    <abstract language="eng">Clinical setting &#13;
Third space procedures such as endoscopic submucosal dissection (ESD) and peroral endoscopic myotomy (POEM) are complex minimally invasive techniques with an elevated risk for operator-dependent adverse events such as bleeding and perforation. This risk arises from accidental dissection into the muscle layer or through submucosal blood vessels as the submucosal cutting plane within the expanding resection site is not always apparent. Deep learning algorithms have shown considerable potential for the detection and characterization of gastrointestinal lesions. So-called AI – clinical decision support solutions (AI-CDSS) are commercially available for polyp detection during colonoscopy. Until now, these computer programs have concentrated on diagnostics whereas an AI-CDSS for interventional endoscopy has not yet been introduced. We aimed to develop an AI-CDSS („Smart ESD“) for real-time intra-procedural detection and delineation of blood vessels, tissue structures and endoscopic instruments during third-space endoscopic procedures.&#13;
&#13;
Characteristics of Smart ESD &#13;
An AI-CDSS was invented that delineates blood vessels, tissue structures and endoscopic instruments during third-space endoscopy in real-time. The output can be displayed by an overlay over the endoscopic image with different modes of visualization, such as a color-coded semitransparent area overlay, or border tracing (demonstration video). Hereby the optimal layer for dissection can be visualized, which is close above or directly at the muscle layer, depending on the applied technique (ESD or POEM). Furthermore, relevant blood vessels (thickness&gt; 1mm) are delineated. Spatial proximity between the electrosurgical knife and a blood vessel triggers a warning signal. By this guidance system, inadvertent dissection through blood vessels could be averted.&#13;
&#13;
Technical specifications &#13;
A DeepLabv3+ neural network architecture with KSAC and a 101-layer ResNeSt backbone was used for the development of Smart ESD. It was trained and validated with 2565 annotated still images from 27 full length third-space endoscopic videos. The annotation classes were blood vessel, submucosal layer, muscle layer, electrosurgical knife and endoscopic instrument shaft. A test on a separate data set yielded an intersection over union (IoU) of 68%, a Dice Score of 80% and a pixel accuracy of 87%, demonstrating a high overlap between expert and AI segmentation. Further experiments on standardized video clips showed a mean vessel detection rate (VDR) of 85% with values of 92%, 70% and 95% for POEM, rectal ESD and esophageal ESD respectively. False positive measurements occurred 0.75 times per minute. 7 out of 9 vessels which caused intraprocedural bleeding were caught by the algorithm, as well as both vessels which required hemostasis via hemostatic forceps.&#13;
&#13;
Future perspectives &#13;
Smart ESD performed well for vessel and tissue detection and delineation on still images, as well as on video clips. During a live demonstration in the endoscopy suite, clinical applicability of the innovation was examined. The lag time for processing of the live endoscopic image was too short to be visually detectable for the interventionist. Even though the algorithm could not be applied during actual dissection by the interventionist, Smart ESD appeared readily deployable during visual assessment by ESD experts. Therefore, we plan to conduct a clinical trial in order to obtain CE-certification of the algorithm. This new technology may improve procedural safety and speed, as well as training of modern minimally invasive endoscopic resection techniques.</abstract>
    <parentTitle language="deu">Zeitschrift für Gastroenterologie</parentTitle>
    <identifier type="doi">10.1055/s-0042-1755110</identifier>
    <enrichment key="ConferenceStatement">Jahrestagung der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten mit Sektion Endoskopie, 76, 2022, Hamburg</enrichment>
    <enrichment key="opus.source">publish</enrichment>
    <enrichment key="BegutachtungStatus">peer-reviewed</enrichment>
    <licence>Keine Lizenz - Es gilt das deutsche Urheberrecht: § 53 UrhG</licence>
    <author>Markus W. Scheppach</author>
    <author>Robert Mendel</author>
    <author>Andreas Probst</author>
    <author>Michael Meinikheim</author>
    <author>Christoph Palm</author>
    <author>Helmut Messmann</author>
    <author>Alanna Ebigbo</author>
    <subject>
      <language>eng</language>
      <type>uncontrolled</type>
      <value>Artificial Intelligence</value>
    </subject>
    <subject>
      <language>eng</language>
      <type>uncontrolled</type>
      <value>Medical Image Computing</value>
    </subject>
    <subject>
      <language>eng</language>
      <type>uncontrolled</type>
      <value>Endoscopy</value>
    </subject>
    <subject>
      <language>deu</language>
      <type>swd</type>
      <value>Bildgebendes Verfahren</value>
    </subject>
    <subject>
      <language>deu</language>
      <type>swd</type>
      <value>Medizin</value>
    </subject>
    <subject>
      <language>deu</language>
      <type>swd</type>
      <value>Künstliche Intelligenz</value>
    </subject>
    <subject>
      <language>deu</language>
      <type>swd</type>
      <value>Endoskopie</value>
    </subject>
    <collection role="ddc" number="004">Datenverarbeitung; Informatik</collection>
    <collection role="ddc" number="617">Chirurgie und verwandte medizinische Fachrichtungen</collection>
    <collection role="institutes" number="FakIM">Fakultät Informatik und Mathematik</collection>
    <collection role="institutes" number="RCBE">Regensburg Center of Biomedical Engineering - RCBE</collection>
    <collection role="institutes" number="RCHST">Regensburg Center of Health Sciences and Technology - RCHST</collection>
    <collection role="persons" number="palmremic">Palm, Christoph (Prof. Dr.) - ReMIC</collection>
    <collection role="othforschungsschwerpunkt" number="16314">Lebenswissenschaften und Ethik</collection>
    <collection role="institutes" number="">Labor Regensburg Medical Image Computing (ReMIC)</collection>
  </doc>
</export-example>
