Zhongliang Jiang

Yuan Bi, Zhongliang Jiang, Yuan Gao et al.

Ultrasound (US) is one of the most common medical imaging modalities since it is radiation-free, low-cost, and real-time. In freehand US examinations, sonographers often navigate a US probe to visualize standard examination planes with rich diagnostic information. However, reproducibility and stability of the resulting images often suffer from intra- and inter-operator variation. Reinforcement learning (RL), as an interaction-based learning method, has demonstrated its effectiveness in visual navigating tasks; however, RL is limited in terms of generalization. To address this challenge, we propose a simulation-based RL framework for real-world navigation of US probes towards the standard longitudinal views of vessels. A UNet is used to provide binary masks from US images; thereby, the RL agent trained on simulated binary vessel images can be applied in real scenarios without further training. To accurately characterize actual states, a multi-modality state representation structure is introduced to facilitate the understanding of environments. Moreover, considering the characteristics of vessels, a novel standard view recognition approach based on the minimum bounding rectangle is proposed to terminate the searching process. To evaluate the effectiveness of the proposed method, the trained policy is validated virtually on 3D volumes of a volunteer's in-vivo carotid artery, and physically on custom-designed gel phantoms using robotic US. The results demonstrate that proposed approach can effectively and accurately navigate the probe towards the longitudinal view of vessels.

Zhongliang Jiang, Yuan Gao, Le Xie et al.

Robotic ultrasound (US) imaging aims at overcoming some of the limitations of free-hand US examinations, e.g. difficulty in guaranteeing intra- and inter-operator repeatability. However, due to anatomical and physiological variations between patients and relative movement of anatomical substructures, it is challenging to robustly generate optimal trajectories to examine the anatomies of interest, in particular, when they comprise articulated joints. To address this challenge, this paper proposes a vision-based approach allowing autonomous robotic US limb scanning. To this end, an atlas MRI template of a human arm with annotated vascular structures is used to generate trajectories and register and project them onto patients' skin surfaces for robotic US acquisition. To effectively segment and accurately reconstruct the targeted 3D vessel, we make use of spatial continuity in consecutive US frames by incorporating channel attention modules into a U-Net-type neural network. The automatic trajectory generation method is evaluated on six volunteers with various articulated joint angles. In all cases, the system can successfully acquire the planned vascular structure on volunteers' limbs. For one volunteer the MRI scan was also available, which allows the evaluation of the average radius of the scanned artery from US images, resulting in a radius estimation ($1.2\pm0.05~mm$) comparable to the MRI ground truth ($1.2\pm0.04~mm$).

Feng Li, Ziyuan Li, Zhongliang Jiang et al.

Intraoperative Cone Beam Computed Tomography (CBCT) provides a reliable 3D anatomical context essential for interventional planning. However, its static nature fails to provide continuous monitoring of soft-tissue deformations induced by respiration, probe pressure, and surgical manipulation, leading to navigation discrepancies. We propose a deformation-aware CBCT updating framework that leverages robotic ultrasound as a dynamic proxy to infer tissue motion and update static CBCT slices in real time. Starting from calibration-initialized alignment with linear correlation of linear combination (LC2)-based rigid refinement, our method establishes accurate multimodal correspondence. To capture intraoperative dynamics, we introduce the ultrasound correlation UNet (USCorUNet), a lightweight network trained with optical flow-guided supervision to learn deformation-aware correlation representations, enabling accurate, real-time dense deformation field estimation from ultrasound streams. The inferred deformation is spatially regularized and transferred to the CBCT reference to produce deformation-consistent visualizations without repeated radiation exposure. We validate the proposed approach through deformation estimation and ultrasound-guided CBCT updating experiments. Results demonstrate real-time end-to-end CBCT slice updating and physically plausible deformation estimation, enabling dynamic refinement of static CBCT guidance during robotic ultrasound-assisted interventions. The source code is publicly available at https://github.com/anonymous-codebase/us-cbct-demo.

Yuan Bi, Zhongliang Jiang, Ricarda Clarenbach et al.

Generalization capabilities of learning-based medical image segmentation across domains are currently limited by the performance degradation caused by the domain shift, particularly for ultrasound (US) imaging. The quality of US images heavily relies on carefully tuned acoustic parameters, which vary across sonographers, machines, and settings. To improve the generalizability on US images across domains, we propose MI-SegNet, a novel mutual information (MI) based framework to explicitly disentangle the anatomical and domain feature representations; therefore, robust domain-independent segmentation can be expected. Two encoders are employed to extract the relevant features for the disentanglement. The segmentation only uses the anatomical feature map for its prediction. In order to force the encoders to learn meaningful feature representations a cross-reconstruction method is used during training. Transformations, specific to either domain or anatomy are applied to guide the encoders in their respective feature extraction task. Additionally, any MI present in both feature maps is punished to further promote separate feature spaces. We validate the generalizability of the proposed domain-independent segmentation approach on several datasets with varying parameters and machines. Furthermore, we demonstrate the effectiveness of the proposed MI-SegNet serving as a pre-trained model by comparing it with state-of-the-art networks.

Zhongliang Jiang, Yuan Bi, Mingchuan Zhou et al.

Ultrasound (US) imaging is widely used for biometric measurement and diagnosis of internal organs due to the advantages of being real-time and radiation-free. However, due to inter-operator variations, resulting images highly depend on the experience of sonographers. This work proposes an intelligent robotic sonographer to autonomously "explore" target anatomies and navigate a US probe to a relevant 2D plane by learning from the expert. The underlying high-level physiological knowledge from experts is inferred by a neural reward function, using a ranked pairwise image comparisons approach in a self-supervised fashion. This process can be referred to as understanding the "language of sonography". Considering the generalization capability to overcome inter-patient variations, mutual information is estimated by a network to explicitly disentangle the task-related and domain features in latent space. The robotic localization is carried out in coarse-to-fine mode based on the predicted reward associated with B-mode images. To validate the effectiveness of the proposed reward inference network, representative experiments were performed on vascular phantoms ("line" target), two types of ex-vivo animal organs (chicken heart and lamb kidney) phantoms ("point" target) and in-vivo human carotids, respectively. To further validate the performance of the autonomous acquisition framework, physical robotic acquisitions were performed on three phantoms (vascular, chicken heart, and lamb kidney). The results demonstrated that the proposed advanced framework can robustly work on a variety of seen and unseen phantoms as well as in-vivo human carotid data.

Dianye Huang, Yuan Bi, Nassir Navab et al.

Ultrasound (US) imaging is widely used for diagnosing and monitoring arterial diseases, mainly due to the advantages of being non-invasive, radiation-free, and real-time. In order to provide additional information to assist clinicians in diagnosis, the tubular structures are often segmented from US images. To improve the artery segmentation accuracy and stability during scans, this work presents a novel pulsation-assisted segmentation neural network (PAS-NN) by explicitly taking advantage of the cardiac-induced motions. Motion magnification techniques are employed to amplify the subtle motion within the frequency band of interest to extract the pulsation signals from sequential US images. The extracted real-time pulsation information can help to locate the arteries on cross-section US images; therefore, we explicitly integrated the pulsation into the proposed PAS-NN as attention guidance. Notably, a robotic arm is necessary to provide stable movement during US imaging since magnifying the target motions from the US images captured along a scan path is not manually feasible due to the hand tremor. To validate the proposed robotic US system for imaging arteries, experiments are carried out on volunteers' carotid and radial arteries. The results demonstrated that the PAS-NN could achieve comparable results as state-of-the-art on carotid and can effectively improve the segmentation performance for small vessels (radial artery).

Open-H-Embodiment Consortium, Nigel Nelson, Juo-Tung Chen et al.

Autonomous medical robots hold promise to improve patient outcomes, reduce provider workload, democratize access to care, and enable superhuman precision. However, autonomous medical robotics has been limited by a fundamental data problem: existing medical robotic datasets are small, single-embodiment, and rarely shared openly, restricting the development of foundation models that the field needs to advance. We introduce Open-H-Embodiment, the largest open dataset of medical robotic video with synchronized kinematics to date, spanning more than 49 institutions and multiple robotic platforms including the CMR Versius, Intuitive Surgical's da Vinci, da Vinci Research Kit (dVRK), Rob Surgical BiTrack, Virtual Incision's MIRA, Moon Surgical Maestro, and a variety of custom systems, spanning surgical manipulation, robotic ultrasound, and endoscopy procedures. We demonstrate the research enabled by this dataset through two foundation models. GR00T-H is the first open foundation vision-language-action model for medical robotics, which is the only evaluated model to achieve full end-to-end task completion on a structured suturing benchmark (25% of trials vs. 0% for all others) and achieves 64% average success across a 29-step ex vivo suturing sequence. We also train Cosmos-H-Surgical-Simulator, the first action-conditioned world model to enable multi-embodiment surgical simulation from a single checkpoint, spanning nine robotic platforms and supporting in silico policy evaluation and synthetic data generation for the medical domain. These results suggest that open, large-scale medical robot data collection can serve as critical infrastructure for the research community, enabling advances in robot learning, world modeling, and beyond.

Zhongliang Jiang, Yue Zhou, Dongliang Cao et al.

The recovery of morphologically accurate anatomical images from deformed ones is challenging in ultrasound (US) image acquisition, but crucial to accurate and consistent diagnosis, particularly in the emerging field of computer-assisted diagnosis. This article presents a novel anatomy-aware deformation correction approach based on a coarse-to-fine, multi-scale deep neural network (DefCor-Net). To achieve pixel-wise performance, DefCor-Net incorporates biomedical knowledge by estimating pixel-wise stiffness online using a U-shaped feature extractor. The deformation field is then computed using polynomial regression by integrating the measured force applied by the US probe. Based on real-time estimation of pixel-by-pixel tissue properties, the learning-based approach enables the potential for anatomy-aware deformation correction. To demonstrate the effectiveness of the proposed DefCor-Net, images recorded at multiple locations on forearms and upper arms of six volunteers are used to train and validate DefCor-Net. The results demonstrate that DefCor-Net can significantly improve the accuracy of deformation correction to recover the original geometry (Dice Coefficient: from $14.3\pm20.9$ to $82.6\pm12.1$ when the force is $6N$).

Zhongliang Jiang, Chenyang Li, Xuesong Li et al.

Autonomous ultrasound (US) imaging has gained increased interest recently, and it has been seen as a potential solution to overcome the limitations of free-hand US examinations, such as inter-operator variations. However, it is still challenging to accurately map planned paths from a generic atlas to individual patients, particularly for thoracic applications with high acoustic-impedance bone structures under the skin. To address this challenge, a graph-based non-rigid registration is proposed to enable transferring planned paths from the atlas to the current setup by explicitly considering subcutaneous bone surface features instead of the skin surface. To this end, the sternum and cartilage branches are segmented using a template matching to assist coarse alignment of US and CT point clouds. Afterward, a directed graph is generated based on the CT template. Then, the self-organizing map using geographical distance is successively performed twice to extract the optimal graph representations for CT and US point clouds, individually. To evaluate the proposed approach, five cartilage point clouds from distinct patients are employed. The results demonstrate that the proposed graph-based registration can effectively map trajectories from CT to the current setup for displaying US views through limited intercostal space. The non-rigid registration results in terms of Hausdorff distance (Mean$\pm$SD) is 9.48$\pm$0.27 mm and the path transferring error in terms of Euclidean distance is 2.21$\pm$1.11 mm.

Nassir Navab, Zhongliang Jiang

For the past decades medical robotic solutions were mostly based on the concept of tele-manipulation. While their design was extremely intelligent, allowing for better access, improved dexterity, reduced tremor, and improved imaging, their intelligence was limited. They therefore left cognition and decision making to the surgeon. As medical robotics advances towards high-level autonomy, the scientific community needs to explore the required pathway towards partial and full autonomy. Here, we introduce the concept of Dyadic Partnership(DP), a new paradigm in which robots and clinicians engage in intelligent, expert interaction and collaboration. The Dyadic Partners would discuss and agree on decisions and actions during their dynamic and interactive collaboration relying also on intuitive advanced media using generative AI, such as a world model, and advanced multi-modal visualization. This article outlines the foundational components needed to enable such systems, including foundation models for clinical intelligence, multi-modal intent recognition, co-learning frameworks, advanced visualization, and explainable, trust-aware interaction. We further discuss key challenges such as data scarcity, lack of standardization, and ethical acceptance. Dyadic partnership is introduced and is positioned as a powerful yet achievable, acceptable milestone offering a promising pathway toward safer, more intuitive collaboration and a gradual transition to full autonomy across diverse clinical settings.

Feng Li, Yuan Bi, Tianyu Song et al.

Purpose: Spinal instability is a widespread condition that causes pain, fatigue, and restricted mobility, profoundly affecting patients' quality of life. In clinical practice, the gold standard for diagnosis is dynamic X-ray imaging. However, X-ray provides only 2D motion information, while 3D modalities such as computed tomography (CT) or cone beam computed tomography (CBCT) cannot efficiently capture motion. Therefore, there is a need for a system capable of visualizing real-time 3D spinal motion while minimizing radiation exposure. Methods: We propose ultrasound as an auxiliary modality for 3D spine visualization. Due to acoustic limitations, ultrasound captures only the superficial spinal surface. Therefore, the partially compounded ultrasound volume is registered to preoperative 3D imaging. In this study, CBCT provides the neutral spine configuration, while robotic ultrasound acquisition is performed at maximal spinal bending. A kinematic model is applied to the CBCT-derived spine model for coarse registration, followed by ICP for fine registration, with kinematic parameters optimized based on the registration results. Real-time ultrasound motion tracking is then used to estimate continuous 3D spinal motion by interpolating between the neutral and maximally bent states. Results: The pipeline was evaluated on a bendable 3D-printed lumbar spine phantom. The registration error was $1.941 \pm 0.199$ mm and the interpolated spinal motion error was $2.01 \pm 0.309$ mm (median). Conclusion: The proposed robotic ultrasound framework enables radiation-reduced, real-time 3D visualization of spinal motion, offering a promising 3D alternative to conventional dynamic X-ray imaging for assessing spinal instability.

Yuan Bi, Yiping Zhou, Pei Liu et al.

Robotic ultrasound offers advantages over free-hand scanning, including improved reproducibility and reduced operator dependency. In clinical practice, US acquisition relies heavily on the sonographer's experience and situational judgment. When transferring this process to robotic systems, such expertise is often encoded explicitly through fixed procedures and task-specific models, yielding pipelines that can be difficult to adapt to new scanning tasks. In this work, we propose a unified framework for autonomous robotic US scanning that leverages a LLM-based agent to interpret US scanning guidelines and execute scans by dynamically invoking a set of provided software tools. Instead of encoding fixed scanning procedures, the LLM agent retrieves and reasons over guideline steps from scanning handbooks and adapts its planning decisions based on observations and the current scanning state. This enables the system to handle variable and decision-dependent workflows, such as adjusting scanning strategies, repeating steps, or selecting the appropriate next tool call in response to image quality or anatomical findings. Because the reasoning underlying tool selection is also critical for transparent and trustworthy planning, we further fine tune the LLM agent using a RL based strategy to improve both its reasoning quality and the correctness of tool selection and parameterization, while maintaining robust generalization to unseen guidelines and related tasks. We first validate the approach via verbal execution on 10 US scanning guidelines, assessing reasoning as well as tool selection and parameterization, and showing the benefit of RL fine tuning. We then demonstrate real world feasibility on robotic scanning of the gallbladder, spine, and kidney. Overall, the framework follows diverse guidelines and enables reliable autonomous scanning across multiple anatomical targets within a unified system.

Yue Zhou, Erxuan Wu, Yikang Sun et al.

Vision-Language Models (VLMs) have significantly advanced medical visual question answering, yet their performance in ultrasound remains suboptimal. In clinical practice, sonographers explicitly focus on lesion regions to formulate reports, though diagnostic interpretations sometimes vary due to inherent subjectivity. However, existing VLMs are not explicitly structured to interactively zoom into lesions prior to diagnosis; moreover, they typically treat annotations as unbiased ground truths, failing to account for their inherent subjectivity and ambiguity. In this paper, we propose a framework specifically designed to consider the sonographer's cognitive workflow. We first introduce a structured Zoom-then-Diagnose paradigm, which replicates the interactive search process to enable lesion-focused reasoning. Furthermore, within the Group Relative Policy Optimization (GRPO) framework, we introduce an uncertainty-aware reward derived from stochastic group-wise rollouts to estimate prediction consistency as a proxy for model confidence. Together, these two components encourage the model to reinforce accurate predictions on clear cases while remaining cautious under ambiguity. Experiments across liver, breast, and thyroid datasets show that our framework improves lesion localization by 39.3\%, demonstrating that our model has learned the ability to actively look closer and diagnose.

Dianye Huang, Chenyang Li, Angelos Karlas et al.

Precise percutaneous needle detection is crucial for ultrasound (US)-guided interventions. However, inherent limitations such as speckles, needle-like artifacts, and low resolution make it challenging to robustly detect needles, especially when their visibility is reduced or imperceptible. To address this challenge, we propose VibNet, a learning-based framework designed to enhance the robustness and accuracy of needle detection in US images by leveraging periodic vibration applied externally to the needle shafts. VibNet integrates neural Short-Time Fourier Transform and Hough Transform modules to achieve successive sub-goals, including motion feature extraction in the spatiotemporal space, frequency feature aggregation, and needle detection in the Hough space. Due to the periodic subtle vibration, the features are more robust in the frequency domain than in the image intensity domain, making VibNet more effective than traditional intensity-based methods. To demonstrate the effectiveness of VibNet, we conducted experiments on distinct \textit{ex vivo} porcine and bovine tissue samples. The results obtained on porcine samples demonstrate that VibNet effectively detects needles even when their visibility is severely reduced, with a tip error of $1.61\pm1.56~mm$ compared to $8.15\pm9.98~mm$ for UNet and $6.63\pm7.58~mm$ for WNet, and a needle direction error of $1.64\pm1.86^{\circ}$ compared to $9.29\pm15.30^{\circ}$ for UNet and $8.54\pm17.92^{\circ}$ for WNet. Code: https://github.com/marslicy/VibNet.

Dianye Huang, Chenguang Yang, Mingchuan Zhou et al.

Deep Venous Thrombosis (DVT) is a common vascular disease with blood clots inside deep veins, which may block blood flow or even cause a life-threatening pulmonary embolism. A typical exam for DVT using ultrasound (US) imaging is by pressing the target vein until its lumen is fully compressed. However, the compression exam is highly operator-dependent. To alleviate intra- and inter-variations, we present a robotic US system with a novel hybrid force motion control scheme ensuring position and force tracking accuracy, and soft landing of the probe onto the target surface. In addition, a path-based virtual fixture is proposed to realize easy human-robot interaction for repeat compression operation at the lesion location. To ensure the biometric measurements obtained in different examinations are comparable, the 6D scanning path is determined in a coarse-to-fine manner using both an external RGBD camera and US images. The RGBD camera is first used to extract a rough scanning path on the object. Then, the segmented vascular lumen from US images are used to optimize the scanning path to ensure the visibility of the target object. To generate a continuous scan path for developing virtual fixtures, an arc-length based path fitting model considering both position and orientation is proposed. Finally, the whole system is evaluated on a human-like arm phantom with an uneven surface.

Yuan Bi, Cheng Qian, Zhicheng Zhang et al.

Ultrasound (US) has been widely used in daily clinical practice for screening internal organs and guiding interventions. However, due to the acoustic shadow cast by the subcutaneous rib cage, the US examination for thoracic application is still challenging. To fully cover and reconstruct the region of interest in US for diagnosis, an intercostal scanning path is necessary. To tackle this challenge, we present a reinforcement learning (RL) approach for planning scanning paths between ribs to monitor changes in lesions on internal organs, such as the liver and heart, which are covered by rib cages. Structured anatomical information of the human skeleton is crucial for planning these intercostal paths. To obtain such anatomical insight, an RL agent is trained in a virtual environment constructed using computational tomography (CT) templates with randomly initialized tumors of various shapes and locations. In addition, task-specific state representation and reward functions are introduced to ensure the convergence of the training process while minimizing the effects of acoustic attenuation and shadows during scanning. To validate the effectiveness of the proposed approach, experiments have been carried out on unseen CTs with randomly defined single or multiple scanning targets. The results demonstrate the efficiency of the proposed RL framework in planning non-shadowed US scanning trajectories in areas with limited acoustic access.

Jiamei Guo, Zhehao Duan, Maria Neiiendam et al.

Purpose: Ultrasound-guided needle interventions are widely used in clinical practice, but their success critically depends on accurate needle placement, which is frequently hindered by the poor and intermittent visibility of needles in ultrasound images. Existing approaches remain limited by artifacts, occlusions, and low contrast, and often fail to support real-time continuous insertion. To overcome these challenges, this study introduces a robust real-time framework for continuous needle detection. Methods: We present ConVibNet, an extension of VibNet for detecting needles with significantly reduced visibility, addressing real-time, continuous needle tracking during insertion. ConVibNet leverages temporal dependencies across successive ultrasound frames to enable continuous estimation of both needle tip position and shaft angle in dynamic scenarios. To strengthen temporal awareness of needle-tip motion, we introduce a novel intersection-and-difference loss that explicitly leverages motion correlations across consecutive frames. In addition, we curated a dedicated dataset for model development and evaluation. Results: The performance of the proposed ConVibNet model was evaluated on our dataset, demonstrating superior accuracy compared to the baseline VibNet and UNet-LSTM models. Specifically, ConVibNet achieved a tip error of 2.80+-2.42 mm and an angle error of 1.69+-2.00 deg. These results represent a 0.75 mm improvement in tip localization accuracy over the best-performing baseline, while preserving real-time inference capability. Conclusion: ConVibNet advances real-time needle detection in ultrasound-guided interventions by integrating temporal correlation modeling with a novel intersection-and-difference loss, thereby improving accuracy and robustness and demonstrating high potential for integration into autonomous insertion systems.

Yue Zhou, Yuan Bi, Wenjuan Tong et al.

Precise anomaly detection in medical images is critical for clinical decision-making. While recent unsupervised or semi-supervised anomaly detection methods trained on large-scale normal data show promising results, they lack fine-grained differentiation, such as benign vs. malignant tumors. Additionally, ultrasound (US) imaging is highly sensitive to devices and acquisition parameter variations, creating significant domain gaps in the resulting US images. To address these challenges, we propose UltraAD, a vision-language model (VLM)-based approach that leverages few-shot US examples for generalized anomaly localization and fine-grained classification. To enhance localization performance, the image-level token of query visual prototypes is first fused with learnable text embeddings. This image-informed prompt feature is then further integrated with patch-level tokens, refining local representations for improved accuracy. For fine-grained classification, a memory bank is constructed from few-shot image samples and corresponding text descriptions that capture anatomical and abnormality-specific features. During training, the stored text embeddings remain frozen, while image features are adapted to better align with medical data. UltraAD has been extensively evaluated on three breast US datasets, outperforming state-of-the-art methods in both lesion localization and fine-grained medical classification. The code will be released upon acceptance.

Yuan Bi, Lucie Huang, Ricarda Clarenbach et al.

Anomaly detection in medical imaging plays a crucial role in identifying pathological regions across various imaging modalities, such as brain MRI, liver CT, and carotid ultrasound (US). However, training fully supervised segmentation models is often hindered by the scarcity of expert annotations and the complexity of diverse anatomical structures. To address these issues, we propose a novel unsupervised anomaly detection framework based on a diffusion model that incorporates a synthetic anomaly (Synomaly) noise function and a multi-stage diffusion process. Synomaly noise introduces synthetic anomalies into healthy images during training, allowing the model to effectively learn anomaly removal. The multi-stage diffusion process is introduced to progressively denoise images, preserving fine details while improving the quality of anomaly-free reconstructions. The generated high-fidelity counterfactual healthy images can further enhance the interpretability of the segmentation models, as well as provide a reliable baseline for evaluating the extent of anomalies and supporting clinical decision-making. Notably, the unsupervised anomaly detection model is trained purely on healthy images, eliminating the need for anomalous training samples and pixel-level annotations. We validate the proposed approach on brain MRI, liver CT datasets, and carotid US. The experimental results demonstrate that the proposed framework outperforms existing state-of-the-art unsupervised anomaly detection methods, achieving performance comparable to fully supervised segmentation models in the US dataset. Ablation studies further highlight the contributions of Synomaly noise and the multi-stage diffusion process in improving anomaly segmentation. These findings underscore the potential of our approach as a robust and annotation-efficient alternative for medical anomaly detection.

Xin You, Runze Yang, Chuyan Zhang et al.

The temporal interpolation task for 4D medical imaging, plays a crucial role in clinical practice of respiratory motion modeling. Following the simplified linear-motion hypothesis, existing approaches adopt optical flow-based models to interpolate intermediate frames. However, realistic respiratory motions should be nonlinear and quasi-periodic with specific frequencies. Intuited by this property, we resolve the temporal interpolation task from the frequency perspective, and propose a Fourier basis-guided Diffusion model, termed FB-Diff. Specifically, due to the regular motion discipline of respiration, physiological motion priors are introduced to describe general characteristics of temporal data distributions. Then a Fourier motion operator is elaborately devised to extract Fourier bases by incorporating physiological motion priors and case-specific spectral information in the feature space of Variational Autoencoder. Well-learned Fourier bases can better simulate respiratory motions with motion patterns of specific frequencies. Conditioned on starting and ending frames, the diffusion model further leverages well-learned Fourier bases via the basis interaction operator, which promotes the temporal interpolation task in a generative manner. Extensive results demonstrate that FB-Diff achieves state-of-the-art (SOTA) perceptual performance with better temporal consistency while maintaining promising reconstruction metrics. Codes are available.

Long Bai, Boyi Ma, Ruohan Wang et al.

Surgical workflow recognition is vital for automating tasks, supporting decision-making, and training novice surgeons, ultimately improving patient safety and standardizing procedures. However, data corruption can lead to performance degradation due to issues like occlusion from bleeding or smoke in surgical scenes and problems with data storage and transmission. In this case, we explore a robust graph-based multimodal approach to integrating vision and kinematic data to enhance accuracy and reliability. Vision data captures dynamic surgical scenes, while kinematic data provides precise movement information, overcoming limitations of visual recognition under adverse conditions. We propose a multimodal Graph Representation network with Adversarial feature Disentanglement (GRAD) for robust surgical workflow recognition in challenging scenarios with domain shifts or corrupted data. Specifically, we introduce a Multimodal Disentanglement Graph Network that captures fine-grained visual information while explicitly modeling the complex relationships between vision and kinematic embeddings through graph-based message modeling. To align feature spaces across modalities, we propose a Vision-Kinematic Adversarial framework that leverages adversarial training to reduce modality gaps and improve feature consistency. Furthermore, we design a Contextual Calibrated Decoder, incorporating temporal and contextual priors to enhance robustness against domain shifts and corrupted data. Extensive comparative and ablation experiments demonstrate the effectiveness of our model and proposed modules. Moreover, our robustness experiments show that our method effectively handles data corruption during storage and transmission, exhibiting excellent stability and robustness. Our approach aims to advance automated surgical workflow recognition, addressing the complexities and dynamism inherent in surgical procedures.

Zhen Zhang, Xiangyu Chu, Yunxi Tang et al.

Manipulating elasto-plastic objects remains a significant challenge due to severe self-occlusion, difficulties of representation, and complicated dynamics. This work proposes a novel framework for elasto-plastic object manipulation with a quasi-static assumption for motions, leveraging 3D occupancy to represent such objects, a learned dynamics model trained with 3D occupancy, and a learning-based predictive control algorithm to address these challenges effectively. We build a novel data collection platform to collect full spatial information and propose a pipeline for generating a 3D occupancy dataset. To infer the 3D occupancy during manipulation, an occupancy prediction network is trained with multiple RGB images supervised by the generated dataset. We design a deep neural network empowered by a 3D convolution neural network (CNN) and a graph neural network (GNN) to predict the complex deformation with the inferred 3D occupancy results. A learning-based predictive control algorithm is introduced to plan the robot actions, incorporating a novel shape-based action initialization module specifically designed to improve the planner efficiency. The proposed framework in this paper can successfully shape the elasto-plastic objects into a given goal shape and has been verified in various experiments both in simulation and the real world.

Feng Li, Pei Liu, Shiting Wang et al.

Imitation learning has shown strong potential for automating complex robotic manipulation. In medical robotics, ultrasound-guided needle insertion demands precise bimanual coordination, as clinicians must simultaneously manipulate an ultrasound probe to maintain an optimal acoustic view while steering an interventional needle. Automating this asymmetric workflow -- and reliably transferring expert strategies to robots -- remains highly challenging. In this paper, we present the Dual-Arm Interventional Surgical System (DAISS), a teleoperated platform that collects high-fidelity dual-arm demonstrations and learns a phase-aware imitation policy for ultrasound-guided interventions. To avoid constraining the operator's natural behavior, DAISS uses a flexible NDI-based leader interface for teleoperating two coordinated follower arms. To support robust execution under real-time ultrasound feedback, we develop a lightweight, data-efficient imitation policy. Specifically, the policy incorporates a phase-aware architecture and a dynamic mask loss tailored to asymmetric bimanual control. Conditioned on a planned trajectory, the network fuses real-time ultrasound with external visual observations to generate smooth, coordinated dual-arm motions. Experimental results show that DAISS can learn personalized expert strategies from limited demonstrations. Overall, these findings highlight the promise of phase-aware imitation-learning-driven dual-arm robots for improving precision and reducing cognitive workload in image-guided interventions.

Zhongyu Chen, Chenyang Li, Xuesong Li et al.

Precise needle alignment is essential for percutaneous needle insertion in robotic ultrasound-guided procedures. However, inherent challenges such as speckle noise, needle-like artifacts, and low image resolution make robust needle detection difficult, particularly when visibility is reduced or lost. In this paper, we propose a method to restore needle alignment when the ultrasound imaging plane and the needle insertion plane are misaligned. Unlike many existing approaches that rely heavily on needle visibility in ultrasound images, our method uses a more robust feature by periodically vibrating the needle using a mechanical system. Specifically, we propose a vibration-based energy metric that remains effective even when the needle is fully out of plane. Using this metric, we develop a control strategy to reposition the ultrasound probe in response to misalignments between the imaging plane and the needle insertion plane in both translation and rotation. Experiments conducted on ex-vivo porcine tissue samples using a dual-arm robotic ultrasound-guided needle insertion system demonstrate the effectiveness of the proposed approach. The experimental results show the translational error of 0.41$\pm$0.27 mm and the rotational error of 0.51$\pm$0.19 degrees.

Xuesong Li, Nassir Navab, Zhongliang Jiang

Image denoising is a fundamental task in computer vision, particularly in medical ultrasound (US) imaging, where speckle noise significantly degrades image quality. Although recent advancements in deep neural networks have led to substantial improvements in denoising for natural images, these methods cannot be directly applied to US speckle noise, as it is not purely random. Instead, US speckle arises from complex wave interference within the body microstructure, making it tissue-dependent. This dependency means that obtaining two independent noisy observations of the same scene, as required by pioneering Noise2Noise, is not feasible. Additionally, blind-spot networks also cannot handle US speckle noise due to its high spatial dependency. To address this challenge, we introduce Speckle2Self, a novel self-supervised algorithm for speckle reduction using only single noisy observations. The key insight is that applying a multi-scale perturbation (MSP) operation introduces tissue-dependent variations in the speckle pattern across different scales, while preserving the shared anatomical structure. This enables effective speckle suppression by modeling the clean image as a low-rank signal and isolating the sparse noise component. To demonstrate its effectiveness, Speckle2Self is comprehensively compared with conventional filter-based denoising algorithms and SOTA learning-based methods, using both realistic simulated US images and human carotid US images. Additionally, data from multiple US machines are employed to evaluate model generalization and adaptability to images from unseen domains. Project page: https://noseefood.github.io/us-speckle2self/

Xuesong Li, Dianye Huang, Yameng Zhang et al.

Understanding medical ultrasound imaging remains a long-standing challenge due to significant visual variability caused by differences in imaging and acquisition parameters. Recent advancements in large language models (LLMs) have been used to automatically generate terminology-rich summaries orientated to clinicians with sufficient physiological knowledge. Nevertheless, the increasing demand for improved ultrasound interpretability and basic scanning guidance among non-expert users, e.g., in point-of-care settings, has not yet been explored. In this study, we first introduce the scene graph (SG) for ultrasound images to explain image content to ordinary and provide guidance for ultrasound scanning. The ultrasound SG is first computed using a transformer-based one-stage method, eliminating the need for explicit object detection. To generate a graspable image explanation for ordinary, the user query is then used to further refine the abstract SG representation through LLMs. Additionally, the predicted SG is explored for its potential in guiding ultrasound scanning toward missing anatomies within the current imaging view, assisting ordinary users in achieving more standardized and complete anatomical exploration. The effectiveness of this SG-based image explanation and scanning guidance has been validated on images from the left and right neck regions, including the carotid and thyroid, across five volunteers. The results demonstrate the potential of the method to maximally democratize ultrasound by enhancing its interpretability and usability for ordinaries.

Beilei Cui, Long Bai, Mobarakol Islam et al.

Accurate 3D scene reconstruction is essential for numerous medical tasks. Given the challenges in obtaining ground truth data, there has been an increasing focus on self-supervised learning (SSL) for endoscopic depth estimation as a basis for scene reconstruction. While foundation models have shown remarkable progress in visual tasks, their direct application to the medical domain often leads to suboptimal results. However, the visual features from these models can still enhance endoscopic tasks, emphasizing the need for efficient adaptation strategies, which still lack exploration currently. In this paper, we introduce Endo3DAC, a unified framework for endoscopic scene reconstruction that efficiently adapts foundation models. We design an integrated network capable of simultaneously estimating depth maps, relative poses, and camera intrinsic parameters. By freezing the backbone foundation model and training only the specially designed Gated Dynamic Vector-Based Low-Rank Adaptation (GDV-LoRA) with separate decoder heads, Endo3DAC achieves superior depth and pose estimation while maintaining training efficiency. Additionally, we propose a 3D scene reconstruction pipeline that optimizes depth maps' scales, shifts, and a few parameters based on our integrated network. Extensive experiments across four endoscopic datasets demonstrate that Endo3DAC significantly outperforms other state-of-the-art methods while requiring fewer trainable parameters. To our knowledge, we are the first to utilize a single network that only requires surgical videos to perform both SSL depth estimation and scene reconstruction tasks. The code will be released upon acceptance.

Zhongliang Jiang, Yunfeng Kang, Yuan Bi et al.

Ultrasound imaging has been widely used in clinical examinations owing to the advantages of being portable, real-time, and radiation-free. Considering the potential of extensive deployment of autonomous examination systems in hospitals, robotic US imaging has attracted increased attention. However, due to the inter-patient variations, it is still challenging to have an optimal path for each patient, particularly for thoracic applications with limited acoustic windows, e.g., intercostal liver imaging. To address this problem, a class-aware cartilage bone segmentation network with geometry-constraint post-processing is presented to capture patient-specific rib skeletons. Then, a dense skeleton graph-based non-rigid registration is presented to map the intercostal scanning path from a generic template to individual patients. By explicitly considering the high-acoustic impedance bone structures, the transferred scanning path can be precisely located in the intercostal space, enhancing the visibility of internal organs by reducing the acoustic shadow. To evaluate the proposed approach, the final path mapping performance is validated on five distinct CTs and two volunteer US data, resulting in ten pairs of CT-US combinations. Results demonstrate that the proposed graph-based registration method can robustly and precisely map the path from CT template to individual patients (Euclidean error: $2.21\pm1.11~mm$).

Jun Li, Tongkun Su, Baoliang Zhao et al.

Automatic report generation has arisen as a significant research area in computer-aided diagnosis, aiming to alleviate the burden on clinicians by generating reports automatically based on medical images. In this work, we propose a novel framework for automatic ultrasound report generation, leveraging a combination of unsupervised and supervised learning methods to aid the report generation process. Our framework incorporates unsupervised learning methods to extract potential knowledge from ultrasound text reports, serving as the prior information to guide the model in aligning visual and textual features, thereby addressing the challenge of feature discrepancy. Additionally, we design a global semantic comparison mechanism to enhance the performance of generating more comprehensive and accurate medical reports. To enable the implementation of ultrasound report generation, we constructed three large-scale ultrasound image-text datasets from different organs for training and validation purposes. Extensive evaluations with other state-of-the-art approaches exhibit its superior performance across all three datasets. Code and dataset are valuable at this link.

Zhongliang Jiang, Felix Duelmer, Nassir Navab

Medical ultrasound (US) is widely used to evaluate and stage vascular diseases, in particular for the preliminary screening program, due to the advantage of being radiation-free. However, automatic segmentation of small tubular structures (e.g., the ulnar artery) from cross-sectional US images is still challenging. To address this challenge, this paper proposes the DopUS-Net and a vessel re-identification module that leverage the Doppler effect to enhance the final segmentation result. Firstly, the DopUS-Net combines the Doppler images with B-mode images to increase the segmentation accuracy and robustness of small blood vessels. It incorporates two encoders to exploit the maximum potential of the Doppler signal and recurrent neural network modules to preserve sequential information. Input to the first encoder is a two-channel duplex image representing the combination of the grey-scale Doppler and B-mode images to ensure anatomical spatial correctness. The second encoder operates on the pure Doppler images to provide a region proposal. Secondly, benefiting from the Doppler signal, this work first introduces an online artery re-identification module to qualitatively evaluate the real-time segmentation results and automatically optimize the probe pose for enhanced Doppler images. This quality-aware module enables the closed-loop control of robotic screening to further improve the confidence and robustness of image segmentation. The experimental results demonstrate that the proposed approach with the re-identification process can significantly improve the accuracy and robustness of the segmentation results (dice score: from 0:54 to 0:86; intersection over union: from 0:47 to 0:78).

Zhongliang Jiang, Xuesong Li, Chenyu Zhang et al.

Autonomous ultrasound (US) scanning has attracted increased attention, and it has been seen as a potential solution to overcome the limitations of conventional US examinations, such as inter-operator variations. However, it is still challenging to autonomously and accurately transfer a planned scan trajectory on a generic atlas to the current setup for different patients, particularly for thorax applications with limited acoustic windows. To address this challenge, we proposed a skeleton graph-based non-rigid registration to adapt patient-specific properties using subcutaneous bone surface features rather than the skin surface. To this end, the self-organization mapping is successively used twice to unify the input point cloud and extract the key points, respectively. Afterward, the minimal spanning tree is employed to generate a tree graph to connect all extracted key points. To appropriately characterize the rib cartilage outline to match the source and target point cloud, the path extracted from the tree graph is optimized by maximally maintaining continuity throughout each rib. To validate the proposed approach, we manually extract the US cartilage point cloud from one volunteer and seven CT cartilage point clouds from different patients. The results demonstrate that the proposed graph-based registration is more effective and robust in adapting to the inter-patient variations than the ICP (distance error mean/SD: 5.0/1.9 mm vs 8.6/6.7 mm on seven CTs).

Zhongliang Jiang, Yue Zhou, Yuan Bi et al.

Tissue deformation in ultrasound (US) imaging leads to geometrical errors when measuring tissues due to the pressure exerted by probes. Such deformation has an even larger effect on 3D US volumes as the correct compounding is limited by the inconsistent location and geometry. This work proposes a patient-specified stiffness-based method to correct the tissue deformations in robotic 3D US acquisitions. To obtain the patient-specified model, robotic palpation is performed at sampling positions on the tissue. The contact force, US images and the probe poses of the palpation procedure are recorded. The contact force and the probe poses are used to estimate the nonlinear tissue stiffness. The images are fed to an optical flow algorithm to compute the pixel displacement. Then the pixel-wise tissue deformation under different forces is characterized by a coupled quadratic regression. To correct the deformation at unseen positions on the trajectory for building 3D volumes, an interpolation is performed based on the stiffness values computed at the sampling positions. With the stiffness and recorded force, the tissue displacement could be corrected. The method was validated on two blood vessel phantoms with different stiffness. The results demonstrate that the method can effectively correct the force-induced deformation and finally generate 3D tissue geometries

Zhongliang Jiang, Hanyu Wang, Zhenyu Li et al.

Robotic three-dimensional (3D) ultrasound (US) imaging has been employed to overcome the drawbacks of traditional US examinations, such as high inter-operator variability and lack of repeatability. However, object movement remains a challenge as unexpected motion decreases the quality of the 3D compounding. Furthermore, attempted adjustment of objects, e.g., adjusting limbs to display the entire limb artery tree, is not allowed for conventional robotic US systems. To address this challenge, we propose a vision-based robotic US system that can monitor the object's motion and automatically update the sweep trajectory to provide 3D compounded images of the target anatomy seamlessly. To achieve these functions, a depth camera is employed to extract the manually planned sweep trajectory after which the normal direction of the object is estimated using the extracted 3D trajectory. Subsequently, to monitor the movement and further compensate for this motion to accurately follow the trajectory, the position of firmly attached passive markers is tracked in real-time. Finally, a step-wise compounding was performed. The experiments on a gel phantom demonstrate that the system can resume a sweep when the object is not stationary during scanning.

Zhongliang Jiang, Zhenyu Li, Matthias Grimm et al.

Ultrasound (US) imaging is widely employed for diagnosis and staging of peripheral vascular diseases (PVD), mainly due to its high availability and the fact it does not emit radiation. However, high inter-operator variability and a lack of repeatability of US image acquisition hinder the implementation of extensive screening programs. To address this challenge, we propose an end-to-end workflow for automatic robotic US screening of tubular structures using only the real-time US imaging feedback. We first train a U-Net for real-time segmentation of the vascular structure from cross-sectional US images. Then, we represent the detected vascular structure as a 3D point cloud and use it to estimate the longitudinal axis of the target tubular structure and its mean radius by solving a constrained non-linear optimization problem. Iterating the previous processes, the US probe is automatically aligned to the orientation normal to the target tubular tissue and adjusted online to center the tracked tissue based on the spatial calibration. The real-time segmentation result is evaluated both on a phantom and in-vivo on brachial arteries of volunteers. In addition, the whole process is validated both in simulation and physical phantoms. The mean absolute radius error and orientation error ($\pm$ SD) in the simulation are $1.16\pm0.1~mm$ and $2.7\pm3.3^{\circ}$, respectively. On a gel phantom, these errors are $1.95\pm2.02~mm$ and $3.3\pm2.4^{\circ}$. This shows that the method is able to automatically screen tubular tissues with an optimal probe orientation (i.e. normal to the vessel) and at the same to accurately estimate the mean radius, both in real-time.

Zhongliang Jiang, Long Lei, Yu Sun et al.

Drilling is one of the hardest parts of pedicle screw fixation, and it is one of the most dangerous operations because inaccurate screw placement would injury vital tissues, particularly when the vertebra is not stationary. Here we demonstrate the drilling state recognition method for moving tissue by compensating the displacement based on a simplified motion predication model of a vertebra with respect to the tidal volume. To adapt it to different patients, the prediction model was built based on the physiological data recorded from subjects themselves. In addition, the spindle speed of the drilling tool was investigated to find a suitable speed for the robotic-assisted system. To ensure patient safety, a monitoring system was built based on the thrusting force and tracked position information. Finally, experiments were carried out on a fresh porcine lamellar bone fixed on a 3-PRS parallel robot used to simulate the vertebra displacement. The success rate of the robotic-assisted drilling procedure reached 95% when the moving bone was compensated.