Ulrich Eck

Ege Özsoy, Evin Pınar Örnek, Ulrich Eck et al.

Surgical procedures are conducted in highly complex operating rooms (OR), comprising different actors, devices, and interactions. To date, only medically trained human experts are capable of understanding all the links and interactions in such a demanding environment. This paper aims to bring the community one step closer to automated, holistic and semantic understanding and modeling of OR domain. Towards this goal, for the first time, we propose using semantic scene graphs (SSG) to describe and summarize the surgical scene. The nodes of the scene graphs represent different actors and objects in the room, such as medical staff, patients, and medical equipment, whereas edges are the relationships between them. To validate the possibilities of the proposed representation, we create the first publicly available 4D surgical SSG dataset, 4D-OR, containing ten simulated total knee replacement surgeries recorded with six RGB-D sensors in a realistic OR simulation center. 4D-OR includes 6734 frames and is richly annotated with SSGs, human and object poses, and clinical roles. We propose an end-to-end neural network-based SSG generation pipeline, with a rate of success of 0.75 macro F1, indeed being able to infer semantic reasoning in the OR. We further demonstrate the representation power of our scene graphs by using it for the problem of clinical role prediction, where we achieve 0.85 macro F1. The code and dataset will be made available upon acceptance.

Lennart Bastian, Tobias Czempiel, Christian Heiliger et al.

The surgical operating room (OR) presents many opportunities for automation and optimization. Videos from various sources in the OR are becoming increasingly available. The medical community seeks to leverage this wealth of data to develop automated methods to advance interventional care, lower costs, and improve overall patient outcomes. Existing datasets from OR room cameras are thus far limited in size or modalities acquired, leaving it unclear which sensor modalities are best suited for tasks such as recognizing surgical action from videos. This study demonstrates that surgical action recognition performance can vary depending on the image modalities used. We perform a methodical analysis on several commonly available sensor modalities, presenting two fusion approaches that improve classification performance. The analyses are carried out on a set of multi-view RGB-D video recordings of 18 laparoscopic procedures.

Tianyu Song, Felix Pabst, Feng Li et al.

Accurate needle placement in spine interventions is critical for effective pain management, yet it depends on reliable identification of anatomical landmarks and careful trajectory planning. Conventional imaging guidance often relies both on CT and X-ray fluoroscopy, exposing patients and staff to high dose of radiation while providing limited real-time 3D feedback. We present an optical see-through augmented reality (OST-AR)-guided robotic system for spine procedures that provides in situ visualization of spinal structures to support needle trajectory planning. We integrate a cone-beam CT (CBCT)-derived 3D spine model which is co-registered with live ultrasound, enabling users to combine global anatomical context with local, real-time imaging. We evaluated the system in a phantom user study involving two representative spine procedures: facet joint injection and lumbar puncture. Sixteen participants performed insertions under two visualization conditions: conventional screen vs. AR. Results show that AR significantly reduces execution time and across-task placement error, while also improving usability, trust, and spatial understanding and lowering cognitive workload. These findings demonstrate the feasibility of AR-guided robotic ultrasound for spine interventions, highlighting its potential to enhance accuracy, efficiency, and user experience in image-guided procedures.

Ege Özsoy, Chantal Pellegrini, Tobias Czempiel et al.

Operating rooms (ORs) are complex, high-stakes environments requiring precise understanding of interactions among medical staff, tools, and equipment for enhancing surgical assistance, situational awareness, and patient safety. Current datasets fall short in scale, realism and do not capture the multimodal nature of OR scenes, limiting progress in OR modeling. To this end, we introduce MM-OR, a realistic and large-scale multimodal spatiotemporal OR dataset, and the first dataset to enable multimodal scene graph generation. MM-OR captures comprehensive OR scenes containing RGB-D data, detail views, audio, speech transcripts, robotic logs, and tracking data and is annotated with panoptic segmentations, semantic scene graphs, and downstream task labels. Further, we propose MM2SG, the first multimodal large vision-language model for scene graph generation, and through extensive experiments, demonstrate its ability to effectively leverage multimodal inputs. Together, MM-OR and MM2SG establish a new benchmark for holistic OR understanding, and open the path towards multimodal scene analysis in complex, high-stakes environments. Our code, and data is available at https://github.com/egeozsoy/MM-OR.

Constantin Kleinbeck, Luisa Theelke, Hannah Schieber et al.

Volumetric medical imaging offers great potential for understanding complex pathologies. Yet, traditional 2D slices provide little support for interpreting spatial relationships, forcing users to mentally reconstruct anatomy into three dimensions. Direct volumetric path tracing and VR rendering can improve perception but are computationally expensive, while precomputed representations, like Gaussian Splatting, require planning ahead. Both approaches limit interactive use. We propose a hybrid rendering approach for high-quality, interactive, and immersive anatomical visualization. Our method combines streamed foveated path tracing with a lightweight Gaussian Splatting approximation of the periphery. The peripheral model generation is optimized with volume data and continuously refined using foveal renderings, enabling interactive updates. Depth-guided reprojection further improves robustness to latency and allows users to balance fidelity with refresh rate. We compare our method against direct path tracing and Gaussian Splatting. Our results highlight how their combination can preserve strengths in visual quality while re-generating the peripheral model in under a second, eliminating extensive preprocessing and approximations. This opens new options for interactive medical visualization.

Laura Schütz, Sasan Matinfar, Ulrich Eck et al.

In Augmented Reality (AR), virtual objects interact with real objects. However, the lack of physicality of virtual objects leads to the absence of natural sonic interactions. When virtual and real objects collide, either no sound or a generic sound is played. Both lead to an incongruent multisensory experience, reducing interaction and object realism. Unlike in Virtual Reality (VR) and games, where predefined scenes and interactions allow for the playback of pre-recorded sound samples, AR requires real-time sound synthesis that dynamically adapts to novel contexts and objects to provide audiovisual congruence during interaction. To enhance real-virtual object interactions in AR, we propose a framework for context-aware sounds using methods from computer vision to recognize and segment the materials of real objects. The material's physical properties and the impact dynamics of the interaction are used to generate material-based sounds in real-time using physical modelling synthesis. In a user study with 24 participants, we compared our congruent material-based sounds to a generic sound effect, mirroring the current standard of non-context-aware sounds in AR applications. The results showed that material-based sounds led to significantly more realistic sonic interactions. Material-based sounds also enabled participants to distinguish visually similar materials with significantly greater accuracy and confidence. These findings show that context-aware, material-based sonic interactions in AR foster a stronger sense of realism and enhance our perception of real-world surroundings.

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.

Ege Özsoy, Evin Pınar Örnek, Ulrich Eck et al.

From a computer science viewpoint, a surgical domain model needs to be a conceptual one incorporating both behavior and data. It should therefore model actors, devices, tools, their complex interactions and data flow. To capture and model these, we take advantage of the latest computer vision methodologies for generating 3D scene graphs from camera views. We then introduce the Multimodal Semantic Scene Graph (MSSG) which aims at providing a unified symbolic, spatiotemporal and semantic representation of surgical procedures. This methodology aims at modeling the relationship between different components in surgical domain including medical staff, imaging systems, and surgical devices, opening the path towards holistic understanding and modeling of surgical procedures. We then use MSSG to introduce a dynamically generated graphical user interface tool for surgical procedure analysis which could be used for many applications including process optimization, OR design and automatic report generation. We finally demonstrate that the proposed MSSGs could also be used for synchronizing different complex surgical procedures. While the system still needs to be integrated into real operating rooms before getting validated, this conference paper aims mainly at providing the community with the basic principles of this novel concept through a first prototypal partial realization based on MVOR dataset.

Felix Bork, Roghayeh Barmaki, Ulrich Eck et al.

Screen-based Augmented Reality (AR) systems can be built as a window into the real world as often done in mobile AR applications or using the Magic Mirror metaphor, where users can see themselves with augmented graphics on a large display. Such Magic Mirror systems have been used in digital clothing environments to create virtual dressing rooms, to teach human anatomy, and for collaborative design tasks. The term Magic Mirror implies that the display shows the users enantiomorph, i.e. the mirror image, such that the system mimics a real-world physical mirror. However, the question arises whether one should design a traditional mirror, or instead display the true mirror image by means of a non-reversing mirror? This is an intriguing perceptual question, as the image one observes in a mirror is not a real view, as it would be seen by an external observer, but a reflection, i.e. a front-to-back reversed image. In this paper, we discuss the perceptual differences between these two mirror visualization concepts and present a first comparative study in the context of Magic Mirror anatomy teaching. We investigate the ability of users to identify the correct placement of virtual anatomical structures in our screen-based AR system for two conditions: a regular mirror and a non-reversing mirror setup. The results of our study indicate that the latter is more suitable for applications where previously acquired domain-specific knowledge plays an important role. The lessons learned open up new research directions in the fields of user interfaces and interaction in non-reversing mirror environments and could impact the implementation of general screen-based AR systems in other domains.