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Article ; Online: A novel approach to quantifying surgical workflow in robotic-assisted lobectomy.

Metchik, Ariana / Bhattacharyya, Kiran / Yousaf, Sadia / Jarc, Anthony / Oh, Daniel / Lazar, John F

The international journal of medical robotics + computer assisted surgery : MRCAS

2023 , Page(s) e2546

Abstract: Introduction: Understanding surgical workflow is critical for optimizing efficiencies and outcomes; however, most research evaluating workflow is impacted by observer subjectivity, limiting its reproducibility, scalability, and actionability. To address ...

Abstract	Introduction: Understanding surgical workflow is critical for optimizing efficiencies and outcomes; however, most research evaluating workflow is impacted by observer subjectivity, limiting its reproducibility, scalability, and actionability. To address this, we developed a novel approach to quantitatively describe workflow within robotic-assisted lobectomy (RL). We demonstrate the utility of this approach by analysing features of surgical workflow that correlate with procedure duration. Methods: RL was deconstructed into 12 tasks by expert thoracic surgeons. Task start and stop times were annotated across videos of 10 upper RLs (5 right and 5 left). Markov Networks were used to estimate both the likelihood of transitioning from one task to another and each task-transition entropy (i.e. complexity). Associations between the frequency with which each task was revisited intraoperatively and procedure duration were assessed using Pearson's correlation coefficient. Results: Entropy calculations identified fissure dissection and hilar node dissection as tasks with especially complex transitions, while mediastinal lymph node dissection and division of pulmonary veins were less complex. The number of transitions to three tasks significantly correlated with case duration (fissure dissection (R = 0.69, p = 0.01), dissect arteries (R = 0.59, p = 0.03), and divide arteries (R = 0.63, p = 0.03)). Conclusion: This pilot demonstrates the feasibility of objectively quantifying workflow between RL tasks and introduces entropy as a new metric of task-transition complexity. These innovative measures of surgical workflow enable detailed characterization of a given surgery and might indicate behaviour that impacts case progression. We discuss how these measures can serve as a foundation and be combined with relevant clinical information to better understand factors influencing surgical inefficiency.
Language	English
Publishing date	2023-07-19
Publishing country	England
Document type	Journal Article
ZDB-ID	2151860-9
ISSN	1478-596X ; 1478-5951
ISSN (online)	1478-596X
ISSN	1478-5951
DOI	10.1002/rcs.2546
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Article ; Online: A Probabilistic Approach to Surgical Tasks and Skill Metrics.

Berniker, Max / Bhattacharyya, Kiran D / Brown, Kristen C / Jarc, Anthony

IEEE transactions on bio-medical engineering

2022 Volume 69, Issue 7, Page(s) 2212–2219

Abstract: Identifying and quantifying the activities that compose surgery is essential for effective interventions, computer-aided analyses and the advancement of surgical data science. For example, recent studies have shown that objective metrics (referred to as ... ...

Abstract	Identifying and quantifying the activities that compose surgery is essential for effective interventions, computer-aided analyses and the advancement of surgical data science. For example, recent studies have shown that objective metrics (referred to as objective performance indicators, OPIs) computed during key surgical tasks correlate with surgeon skill and clinical outcomes. Unambiguous identification of these surgical tasks can be particularly challenging for both human annotators and algorithms. Each surgical procedure has multiple approaches, each surgeon has their own level of skill, and the initiation and termination of surgical tasks can be subject to interpretation. As such, human annotators and machine learning models face the same basic problem, accurately identifying the boundaries of surgical tasks despite variable and unstructured information. For use in surgeon feedback, OPIs should also be robust to the variability and diversity in this data. To mitigate this difficulty, we propose a probabilistic approach to surgical task identification and calculation of OPIs. Rather than relying on tasks that are identified by hard temporal boundaries, we demonstrate an approach that relies on distributions of start and stop times, for a probabilistic interpretation of when the task was performed. We first use hypothetical data to outline how this approach is superior to other conventional approaches. Then we present similar analyses on surgical data. We find that when surgical tasks are identified by their individual probabilities, the resulting OPIs are less sensitive to noise in the identification of the start and stop times. These results suggest that this probabilistic approach holds promise for the future of surgical data science.
MeSH term(s)	Benchmarking ; Clinical Competence ; Feedback ; Humans ; Machine Learning ; Surgeons
Language	English
Publishing date	2022-06-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	160429-6
ISSN	1558-2531 ; 0018-9294
ISSN (online)	1558-2531
ISSN	0018-9294
DOI	10.1109/TBME.2021.3139538
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Article ; Online: Intersection of motor volumes predicts the outcome of ambush predation of larval zebrafish.

Bhattacharyya, Kiran / McLean, David L / MacIver, Malcolm A

The Journal of experimental biology

2021 Volume 224, Issue Pt 5

Abstract: Escape maneuvers are key determinants of animal survival and are under intense selection pressure. A number of escape maneuver parameters contribute to survival, including response latency, escape speed and direction. However, the relative importance of ... ...

Abstract	Escape maneuvers are key determinants of animal survival and are under intense selection pressure. A number of escape maneuver parameters contribute to survival, including response latency, escape speed and direction. However, the relative importance of these parameters is context dependent, suggesting that interactions between parameters and predatory context determine the likelihood of escape success. To better understand how escape maneuver parameters interact and contribute to survival, we analyzed the responses of larval zebrafish (
MeSH term(s)	Animals ; Escape Reaction ; Larva ; Odonata ; Predatory Behavior ; Zebrafish
Language	English
Publishing date	2021-03-01
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	218085-6
ISSN	1477-9145 ; 0022-0949
ISSN (online)	1477-9145
ISSN	0022-0949
DOI	10.1242/jeb.235481
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Article: How to Bring Surgery to the Next Level: Interpretable Skills Assessment in Robotic-Assisted Surgery.

Brown, Kristen C / Bhattacharyya, Kiran D / Kulason, Sue / Zia, Aneeq / Jarc, Anthony

Visceral medicine

2020 Volume 36, Issue 6, Page(s) 463–470

Abstract: Introduction: A surgeon's technical skills are an important factor in delivering optimal patient care. Most existing methods to estimate technical skills remain subjective and resource intensive. Robotic-assisted surgery (RAS) provides a unique ... ...

Abstract	Introduction: A surgeon's technical skills are an important factor in delivering optimal patient care. Most existing methods to estimate technical skills remain subjective and resource intensive. Robotic-assisted surgery (RAS) provides a unique opportunity to develop objective metrics using key elements of intraoperative surgeon behavior which can be captured unobtrusively, such as instrument positions and button presses. Recent studies have shown that objective metrics based on these data (referred to as objective performance indicators [OPIs]) correlate to select clinical outcomes during robotic-assisted radical prostatectomy. However, the current OPIs remain difficult to interpret directly and, therefore, to use within structured feedback to improve surgical efficiencies. Methods: We analyzed kinematic and event data from da Vinci surgical systems (Intuitive Surgical, Inc., Sunnyvale, CA, USA) to calculate values that can summarize the use of robotic instruments, referred to as OPIs. These indicators were mapped to broader technical skill categories of established training protocols. A data-driven approach was then applied to further sub-select OPIs that distinguish skill for each technical skill category within each training task. This subset of OPIs was used to build a set of logistic regression classifiers that predict the probability of expertise in that skill to identify targeted improvement and practice. The final, proposed feedback using OPIs was based on the coefficients of the logistic regression model to highlight specific actions that can be taken to improve. Results: We determine that for the majority of skills, only a small subset of OPIs (2-10) are required to achieve the highest model accuracies (80-95%) for estimating technical skills within clinical-like tasks on a porcine model. The majority of the skill models have similar accuracy as models predicting overall expertise for a task (80-98%). Skill models can divide a prediction into interpretable categories for simpler, targeted feedback. Conclusion: We define and validate a methodology to create interpretable metrics for key technical skills during clinical-like tasks when performing RAS. Using this framework for evaluating technical skills, we believe that surgical trainees can better understand both what can be improved and how to improve.
Language	English
Publishing date	2020-10-28
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2850733-2
ISSN	2297-475X ; 2297-4725
ISSN (online)	2297-475X
ISSN	2297-4725
DOI	10.1159/000512437
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Zs.A 2103: Show issues

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Article ; Online: Detection and capture of breast cancer cells with photoacoustic flow cytometry.

Bhattacharyya, Kiran / Goldschmidt, Benjamin S / Viator, John A

Journal of biomedical optics

2016 Volume 21, Issue 8, Page(s) 87007

Abstract: According to the Centers for Disease Control and Prevention, breast cancer is the most common cancer and the second leading cause of cancer related deaths among women. Metastasis—the presence of secondary tumors caused by the spread of cancer cells via ... ...

Abstract	According to the Centers for Disease Control and Prevention, breast cancer is the most common cancer and the second leading cause of cancer related deaths among women. Metastasis—the presence of secondary tumors caused by the spread of cancer cells via the circulatory or lymphatic systems—significantly worsens the prognosis of any breast cancer patient. A technique is developed to detect circulating breast cancer cells in human blood using a photoacoustic flow cytometry method. A Q-switched laser is used to interrogate thousands of blood cells with one pulse as they flow through the beam path. Cells that are optically absorbing, either naturally or artificially, emit an ultrasound wave as a result of the photoacoustic (PA) effect. Breast cancer cells are targeted with chromophores through immunochemistry in order to enhance optical absorption. After which, the PA cytometry device is calibrated to demonstrate the ability to detect single cells. Cultured breast cancer cells are added to whole blood to reach a biologically relevant concentration of about 25 to 45 breast cancer cells per 1 mL of blood. An in vitro PA flow cytometer is used to detect and isolate these cells followed by capture with the use of a micromanipulator. This method can not only be used to determine the disease state of the patient and the response to therapy but also it can be used for genetic testing and in vitro drug trials since the circulating cell can be captured and studied.
MeSH term(s)	Breast Neoplasms/blood ; Breast Neoplasms/diagnosis ; Cell Separation/instrumentation ; Cell Separation/methods ; Flow Cytometry ; Humans ; Lasers ; Neoplastic Cells, Circulating ; Photoacoustic Techniques
Language	English
Publishing date	2016-06-29
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1309154-2
ISSN	1560-2281 ; 1083-3668
ISSN (online)	1560-2281
ISSN	1083-3668
DOI	10.1117/1.JBO.21.8.087007
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Zs.A 4699: Show issues

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Article ; Online: Visual Threat Assessment and Reticulospinal Encoding of Calibrated Responses in Larval Zebrafish.

Bhattacharyya, Kiran / McLean, David L / MacIver, Malcolm A

Current biology : CB

2017 Volume 27, Issue 18, Page(s) 2751–2762.e6

Abstract: All visual animals must decide whether approaching objects are a threat. Our current understanding of this process has identified a proximity-based mechanism where an evasive maneuver is triggered when a looming stimulus passes a subtended visual angle ... ...

Abstract	All visual animals must decide whether approaching objects are a threat. Our current understanding of this process has identified a proximity-based mechanism where an evasive maneuver is triggered when a looming stimulus passes a subtended visual angle threshold. However, some escape strategies are more costly than others, and so it would be beneficial to additionally encode the level of threat conveyed by the predator's approach rate to select the most appropriate response. Here, using naturalistic rates of looming visual stimuli while simultaneously monitoring escape behavior and the recruitment of multiple reticulospinal neurons, we find that larval zebrafish do indeed perform a calibrated assessment of threat. While all fish generate evasive maneuvers at the same subtended visual angle, lower approach rates evoke slower, more kinematically variable escape responses with relatively long latencies as well as the unilateral recruitment of ventral spinal projecting nuclei (vSPNs) implicated in turning. In contrast, higher approach rates evoke faster, more kinematically stereotyped responses with relatively short latencies, as well as bilateral recruitment of vSPNs and unilateral recruitment of giant fiber neurons in fish and amphibians called Mauthner cells. In addition to the higher proportion of more costly, shorter-latency Mauthner-active responses to greater perceived threats, we observe a higher incidence of freezing behavior at higher approach rates. Our results provide a new framework to understand how behavioral flexibility is grounded in the appropriate balancing of trade-offs between fast and slow movements when deciding to respond to a visually perceived threat.
MeSH term(s)	Animals ; Biomechanical Phenomena ; Escape Reaction/physiology ; Neurons/physiology ; Reaction Time/physiology ; Visual Perception/physiology ; Zebrafish/physiology
Language	English
Publishing date	2017-09-07
Publishing country	England
Document type	Journal Article
ZDB-ID	1071731-6
ISSN	1879-0445 ; 0960-9822
ISSN (online)	1879-0445
ISSN	0960-9822
DOI	10.1016/j.cub.2017.08.012
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Zs.A 3208: Show issues

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Article ; Online: Quantitative photoacoustics to measure single cell melanin production and nanoparticle attachment.

Bhattacharyya, Kiran / Eshein, Adam / Chandrasekhar, Anand / Viator, John A

Physics in medicine and biology

2015 Volume 60, Issue 8, Page(s) 3081–3096

Abstract: Photoacoustics can be used as a label-free spectroscopic method of identifying pigmented proteins and characterizing their intracellular concentration over time in a single living cell. The authors use a microscopic laser irradiation system with a 5 ns, ... ...

Abstract	Photoacoustics can be used as a label-free spectroscopic method of identifying pigmented proteins and characterizing their intracellular concentration over time in a single living cell. The authors use a microscopic laser irradiation system with a 5 ns, Q-switched laser focused onto single cells in order to collect photoacoustic responses of melanoma cells from the HS936 cell line and gold nanoparticle labeled breast cancer cells from the T47D cell line. The volume averaged intracellular concentration of melanin is found to range from 29-270 mM for single melanoma cells and the number of gold nanoparticles (AuNP) is shown to range from 850-5900 AuNPs/cell. Additionally, the melanin production response to UV-A light stimulus is measured in four melanoma cells to find a mass production rate of 5.7 pg of melanin every 15 min.
MeSH term(s)	Cell Line, Tumor ; Gold/chemistry ; Humans ; Lasers ; Melanins/metabolism ; Metal Nanoparticles/chemistry ; Photoacoustic Techniques/methods ; Single-Cell Analysis/methods ; Ultraviolet Rays
Chemical Substances	Melanins ; Gold (7440-57-5)
Language	English
Publishing date	2015-04-21
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	208857-5
ISSN	1361-6560 ; 0031-9155
ISSN (online)	1361-6560
ISSN	0031-9155
DOI	10.1088/0031-9155/60/8/3081
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Article ; Online: Optically absorbing nanoparticle mediated cell membrane permeabilization.

Bhattacharyya, Kiran / Mehta, Smit / Viator, John

Optics letters

2012 Volume 37, Issue 21, Page(s) 4474–4476

Abstract: Membrane permeabilization is imperative for gene and drug delivery systems, along with other cell manipulation methods, since the average eukaryotic cell membrane is not permeable to polar and large nonpolar molecules. Antibody conjugated optically ... ...

Abstract	Membrane permeabilization is imperative for gene and drug delivery systems, along with other cell manipulation methods, since the average eukaryotic cell membrane is not permeable to polar and large nonpolar molecules. Antibody conjugated optically absorbing gold nanospheres are targeted to the cell membrane of T47D breast cancer cell line and irradiated with 5 ns pulse, 20 Hz, 532 nm light to increase membrane permeability. Up to 90% permeabilization with less than 6% death is reported at radiant exposures up to 10 times lower than those of other comparable studies.
MeSH term(s)	Absorption ; Cell Line, Tumor ; Cell Membrane Permeability/radiation effects ; Gold/chemistry ; Gold/metabolism ; Humans ; Lasers ; Metal Nanoparticles ; Optical Phenomena
Chemical Substances	Gold (7440-57-5)
Language	English
Publishing date	2012-11-01
Publishing country	United States
Document type	Journal Article
ISSN	1539-4794
ISSN (online)	1539-4794
DOI	10.1364/OL.37.004474
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Book ; Online: Objective Surgical Skills Assessment and Tool Localization

Zia, Aneeq / Bhattacharyya, Kiran / Liu, Xi / Wang, Ziheng / Berniker, Max / Kondo, Satoshi / Colleoni, Emanuele / Psychogyios, Dimitris / Jin, Yueming / Zhou, Jinfan / Mazomenos, Evangelos / Maier-Hein, Lena / Stoyanov, Danail / Speidel, Stefanie / Jarc, Anthony

Results from the MICCAI 2021 SimSurgSkill Challenge

2022

Abstract: Timely and effective feedback within surgical training plays a critical role in developing the skills required to perform safe and efficient surgery. Feedback from expert surgeons, while especially valuable in this regard, is challenging to acquire due ... ...

Abstract	Timely and effective feedback within surgical training plays a critical role in developing the skills required to perform safe and efficient surgery. Feedback from expert surgeons, while especially valuable in this regard, is challenging to acquire due to their typically busy schedules, and may be subject to biases. Formal assessment procedures like OSATS and GEARS attempt to provide objective measures of skill, but remain time-consuming. With advances in machine learning there is an opportunity for fast and objective automated feedback on technical skills. The SimSurgSkill 2021 challenge (hosted as a sub-challenge of EndoVis at MICCAI 2021) aimed to promote and foster work in this endeavor. Using virtual reality (VR) surgical tasks, competitors were tasked with localizing instruments and predicting surgical skill. Here we summarize the winning approaches and how they performed. Using this publicly available dataset and results as a springboard, future work may enable more efficient training of surgeons with advances in surgical data science. The dataset can be accessed from https://console.cloud.google.com/storage/browser/isi-simsurgskill-2021. Comment: arXiv admin note: substantial text overlap with arXiv:1910.04071
Keywords	Computer Science - Computer Vision and Pattern Recognition
Publishing date	2022-12-08
Publishing country	us
Document type	Book ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Book ; Online: Surgical Visual Domain Adaptation

Zia, Aneeq / Bhattacharyya, Kiran / Liu, Xi / Wang, Ziheng / Kondo, Satoshi / Colleoni, Emanuele / van Amsterdam, Beatrice / Hussain, Razeen / Hussain, Raabid / Maier-Hein, Lena / Stoyanov, Danail / Speidel, Stefanie / Jarc, Anthony

Results from the MICCAI 2020 SurgVisDom Challenge

2021

Abstract: Surgical data science is revolutionizing minimally invasive surgery by enabling context-aware applications. However, many challenges exist around surgical data (and health data, more generally) needed to develop context-aware models. This work - ... ...

Abstract	Surgical data science is revolutionizing minimally invasive surgery by enabling context-aware applications. However, many challenges exist around surgical data (and health data, more generally) needed to develop context-aware models. This work - presented as part of the Endoscopic Vision (EndoVis) challenge at the Medical Image Computing and Computer Assisted Intervention (MICCAI) 2020 conference - seeks to explore the potential for visual domain adaptation in surgery to overcome data privacy concerns. In particular, we propose to use video from virtual reality (VR) simulations of surgical exercises in robotic-assisted surgery to develop algorithms to recognize tasks in a clinical-like setting. We present the performance of the different approaches to solve visual domain adaptation developed by challenge participants. Our analysis shows that the presented models were unable to learn meaningful motion based features form VR data alone, but did significantly better when small amount of clinical-like data was also made available. Based on these results, we discuss promising methods and further work to address the problem of visual domain adaptation in surgical data science. We also release the challenge dataset publicly at https://www.synapse.org/surgvisdom2020. Comment: Results from SurgVisDom 2020 challenge held at MICCAI 2020
Keywords	Computer Science - Computer Vision and Pattern Recognition
Subject code	004
Publishing date	2021-02-26
Publishing country	us
Document type	Book ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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