David Black

Ryan Yeung, David Black, Patrick B. Chen et al.

To address the lack of access to ultrasound in remote communities, previous work introduced human teleoperation, a mixed reality and haptics-based tele-ultrasound system. In this approach, a novice takes the role of a cognitive robot controlled remotely by an expert through mixed reality. In this manuscript we summarize new developments to this system and describe a feasibility study assessing its use for long-distance remote abdominal ultrasound examinations. To provide simple but effective haptic feedback, we used an ellipsoid model of the patient with its parameters calibrated using our system's position and force sensors. We tested the system in Skidegate, Haida Gwaii, Canada, with the experts positioned 754 km away in Vancouver, Canada. We performed 11 total scans with 10 novices and 2 sonographers. The sonographers were tasked with acquiring 5 target images in the epigastric region. The image acquisition quality was assessed by 2 radiologists. We collected alignment data and the novices completed task load and usability questionnaires. Both the novices and sonographers provided written and verbal feedback to inform future design iterations. 92% of the acquired images had sufficient quality for interpretation by both radiologists. The mean task load reported by the novices was below reference values reported in literature and the usability was unanimously positive. No correlation was found between image quality and the follower's alignment error with the virtual transducer. Overall, we show that human teleoperation enables sonographers to perform remote abdominal ultrasound imaging with high performance, even across large distances and with novice followers. Future work will compare human teleoperation to conventional, robotic and tele-mentored ultrasound.

David Black, Declan Byrne, Anna Walke et al.

Complete resection of malignant gliomas is hampered by the difficulty in distinguishing tumor cells at the infiltration zone. Fluorescence guidance with 5-ALA assists in reaching this goal. Using hyperspectral imaging, previous work characterized five fluorophores' emission spectra in most human brain tumors. In this paper, the effectiveness of these five spectra was explored for different tumor and tissue classification tasks in 184 patients (891 hyperspectral measurements) harboring low- (n=30) and high-grade gliomas (n=115), non-glial primary brain tumors (n=19), radiation necrosis (n=2), miscellaneous (n=10) and metastases (n=8). Four machine learning models were trained to classify tumor type, grade, glioma margins and IDH mutation. Using random forests and multi-layer perceptrons, the classifiers achieved average test accuracies of 84-87%, 96%, 86%, and 93% respectively. All five fluorophore abundances varied between tumor margin types and tumor grades (p < 0.01). For tissue type, at least four of the five fluorophore abundances were found to be significantly different (p < 0.01) between all classes. These results demonstrate the fluorophores' differing abundances in different tissue classes, as well as the value of the five fluorophores as potential optical biomarkers, opening new opportunities for intraoperative classification systems in fluorescence-guided neurosurgery.

Tobias Jaeggi, David Gregory Black, Septimiu Salcudean

Tele-ultrasound through teleoperation allows experts to perform examinations remotely in communities, but limited connectivity can lead to communication delays that reduce usability and diagnostic performance. Visual-haptic model mediated teleoperation reslices a pre-acquired ultrasound volume in real time to provide an accurate, delay-independent preview image for the sonographer. This enables fast and robust exploration before using the live image for fine tuning. However, existing reslicing techniques do not account for the directional nature of ultrasound - the fact that a structure looks different when imaged from different directions. This paper presents Directionality-Aware Reslicing (DARE), an ultrasound volume reconstruction and reslicing framework that takes directionality into account. The presented GPU-accelerated algorithm allows real-time reslicing from arbitrary viewpoints to generate accurate preview images. The method is evaluated quantitatively through image similarity metrics and qualitatively through a user study, and significantly outperforms existing reslicing methods in image similarity and realism compared to a ground truth. This can improve the effectiveness and robustness of tele-ultrasound in low-resource areas.

Yu Chung Lee, David G. Black, Ryan S. Yeung et al.

Cardiac and lung ultrasound are technically demanding because operators must identify patient-specific intercostal acoustic windows and then navigate between standard views by adjusting probe position, rotation, and force across different imaging planes. These challenges are amplified in teleultrasound when a novice or robot faces the difficult task of first placing the probe on the patient without in-person expert assistance. We present a framework for automating Patient registration and anatomy-informed Initial Probe placement Guidance (PIPG) using only RGB images from a calibrated camera. The novice first captures the patient using the camera on a mixed reality (MR) head-mounted display (HMD). An edge server then infers a patient-specific body-surface and skeleton model, with spatial smoothing across multiple views. Using bony landmarks from the predicted skeleton, we estimate the intercostal region and project the guidance back onto the reconstructed body surface. To validate the framework, we overlaid the reconstructed body mesh and the virtual probe pose guidance across multiple transthoracic echocardiography scan planes in situ and measured the quantitative placement error. Pilot experiments with healthy volunteers suggest that the proposed probe placement prediction and MR guidance yield consistent initial placement within anatomical variability acceptable for teleultrasound setup

David Black, Jaidev Gill, Andrew Xie et al.

Hyperspectral Imaging (HSI) for fluorescence-guided brain tumor resection enables visualization of differences between tissues that are not distinguishable to humans. This augmentation can maximize brain tumor resection, improving patient outcomes. However, much of the processing in HSI uses simplified linear methods that are unable to capture the non-linear, wavelength-dependent phenomena that must be modeled for accurate recovery of fluorophore abundances. We therefore propose two deep learning models for correction and unmixing, which can account for the nonlinear effects and produce more accurate estimates of abundances. Both models use an autoencoder-like architecture to process the captured spectra. One is trained with protoporphyrin IX (PpIX) concentration labels. The other undergoes semi-supervised training, first learning hyperspectral unmixing self-supervised and then learning to correct fluorescence emission spectra for heterogeneous optical and geometric properties using a reference white-light reflectance spectrum in a few-shot manner. The models were evaluated against phantom and pig brain data with known PpIX concentration; the supervised model achieved Pearson correlation coefficients (R values) between the known and computed PpIX concentrations of 0.997 and 0.990, respectively, whereas the classical approach achieved only 0.93 and 0.82. The semi-supervised approach's R values were 0.98 and 0.91, respectively. On human data, the semi-supervised model gives qualitatively more realistic results than the classical method, better removing bright spots of specular reflectance and reducing the variance in PpIX abundance over biopsies that should be relatively homogeneous. These results show promise for using deep learning to improve HSI in fluorescence-guided neurosurgery.