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  <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>
  <doc>
    <id>8471</id>
    <completedYear/>
    <publishedYear>2025</publishedYear>
    <thesisYearAccepted/>
    <language>eng</language>
    <pageFirst/>
    <pageLast/>
    <pageNumber>36</pageNumber>
    <edition/>
    <issue/>
    <volume/>
    <type>preprint</type>
    <publisherName/>
    <publisherPlace/>
    <creatingCorporation/>
    <contributingCorporation/>
    <belongsToBibliography>0</belongsToBibliography>
    <completedDate>--</completedDate>
    <publishedDate>--</publishedDate>
    <thesisDateAccepted>--</thesisDateAccepted>
    <title language="eng">Comparative validation of surgical phase recognition, instrument keypoint estimation, and instrument instance segmentation in endoscopy: Results of the PhaKIR 2024 challenge</title>
    <abstract language="eng">Reliable recognition and localization of surgical instruments in endoscopic video recordings are foundational for a wide range of applications in computer- and robot-assisted minimally invasive surgery (RAMIS), including surgical training, skill assessment, and autonomous assistance. However, robust performance under real-world conditions remains a significant challenge. Incorporating surgical context - such as the current procedural phase - has emerged as a promising strategy to improve robustness and interpretability. To address these challenges, we organized the Surgical Procedure Phase, Keypoint, and Instrument Recognition (PhaKIR) sub-challenge as part of the Endoscopic Vision (EndoVis) challenge at MICCAI 2024. We introduced a novel, multi-center dataset comprising thirteen full-length laparoscopic cholecystectomy videos collected from three distinct medical institutions, with unified annotations for three interrelated tasks: surgical phase recognition, instrument keypoint estimation, and instrument instance segmentation. Unlike existing datasets, ours enables joint investigation of instrument localization and procedural context within the same data while supporting the integration of temporal information across entire procedures. We report results and findings in accordance with the BIAS guidelines for biomedical image analysis challenges. The PhaKIR sub-challenge advances the field by providing a unique benchmark for developing temporally aware, context-driven methods in RAMIS and offers a high-quality resource to support future research in surgical scene understanding.</abstract>
    <identifier type="arxiv">2507.16559</identifier>
    <note>Der Aufsatz wurde peer-reviewed veröffentlicht und ist ebenfalls in diesem Repositorium verzeichnet unter: https://opus4.kobv.de/opus4-oth-regensburg/frontdoor/index/index/start/0/rows/10/sortfield/score/sortorder/desc/searchtype/simple/query/10.1016%2Fj.media.2026.103945/docId/8846</note>
    <enrichment key="opus.import.date">2025-08-11T19:43:46+00:00</enrichment>
    <enrichment key="opus.source">sword</enrichment>
    <enrichment key="opus.import.user">importuser</enrichment>
    <licence>Creative Commons - CC BY-NC-SA - Namensnennung - Nicht kommerziell -  Weitergabe unter gleichen Bedingungen 4.0 International</licence>
    <author>Tobias Rückert</author>
    <author>David Rauber</author>
    <author>Raphaela Maerkl</author>
    <author>Leonard Klausmann</author>
    <author>Suemeyye R. Yildiran</author>
    <author>Max Gutbrod</author>
    <author>Danilo Weber Nunes</author>
    <author>Alvaro Fernandez Moreno</author>
    <author>Imanol Luengo</author>
    <author>Danail Stoyanov</author>
    <author>Nicolas Toussaint</author>
    <author>Enki Cho</author>
    <author>Hyeon Bae Kim</author>
    <author>Oh Sung Choo</author>
    <author>Ka Young Kim</author>
    <author>Seong Tae Kim</author>
    <author>Gonçalo Arantes</author>
    <author>Kehan Song</author>
    <author>Jianjun Zhu</author>
    <author>Junchen Xiong</author>
    <author>Tingyi Lin</author>
    <author>Shunsuke Kikuchi</author>
    <author>Hiroki Matsuzaki</author>
    <author>Atsushi Kouno</author>
    <author>João Renato Ribeiro Manesco</author>
    <author>João Paulo Papa</author>
    <author>Tae-Min Choi</author>
    <author>Tae Kyeong Jeong</author>
    <author>Juyoun Park</author>
    <author>Oluwatosin Alabi</author>
    <author>Meng Wei</author>
    <author>Tom Vercauteren</author>
    <author>Runzhi Wu</author>
    <author>Mengya Xu</author>
    <author> an Wang</author>
    <author>Long Bai</author>
    <author>Hongliang Ren</author>
    <author>Amine Yamlahi</author>
    <author>Jakob Hennighausen</author>
    <author>Lena Maier-Hein</author>
    <author>Satoshi Kondo</author>
    <author>Satoshi Kasai</author>
    <author>Kousuke Hirasawa</author>
    <author>Shu Yang</author>
    <author>Yihui Wang</author>
    <author>Hao Chen</author>
    <author>Santiago Rodríguez</author>
    <author>Nicolás Aparicio</author>
    <author>Leonardo Manrique</author>
    <author>Juan Camilo Lyons</author>
    <author>Olivia Hosie</author>
    <author>Nicolás Ayobi</author>
    <author>Pablo Arbeláez</author>
    <author>Yiping Li</author>
    <author>Yasmina Al Khalil</author>
    <author>Sahar Nasirihaghighi</author>
    <author>Stefanie Speidel</author>
    <author>Daniel Rückert</author>
    <author>Hubertus Feussner</author>
    <author>Dirk Wilhelm</author>
    <author>Christoph Palm</author>
    <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="institutes" number="">Labor Regensburg Medical Image Computing (ReMIC)</collection>
    <collection role="DFGFachsystematik" number="1">Ingenieurwissenschaften</collection>
    <collection role="othforschungsschwerpunkt" number="">Gesundheit und Soziales</collection>
  </doc>
</export-example>
