Xinkai Zhao

Hanna Hoffmann, Setareh Bady, Claas de Boer et al.

Achieving high levels of surgical skill through effective training is essential for optimal patient outcomes. Automated, data-driven skill assessment holds significant potential to improve surgical training. While machine learning-based methods are increasingly popular for assessing skills in minimally invasive surgery, their application to open surgery remains limited. We present the results of a dedicated MICCAI challenge designed to benchmark and advance vision-based skill assessment in open surgery. The challenge dataset comprises videos of an open suturing training task recorded with a static GoPro camera in a dry-lab setting, with instrument trajectories available in addition to the primary video modality. The OSS Challenge was hosted over two consecutive years, comprising two and three independent tasks, respectively: (1) classifying skill level into four classes, (2) predicting the full Objective Structured Assessment of Technical Skills across eight categories, and (3) tracking hands and surgical tools. Participants submitted diverse solutions including deep learning-based video models, tracking-driven methods, and hybrid approaches. General-purpose spatiotemporal video models consistently achieved the strongest performance, though conceptually diverse approaches reached competitive levels when well-executed. Predicting fine-grained OSATS scores remains challenging but benefits substantially from increased training data. Keypoint tracking proves difficult given frequent occlusions and out-of-frame instances, limiting current applicability for motion-based skill analysis. This work benchmarks innovative and diverse solutions for surgical skill assessment, highlighting both the promise and current limitations of video-based evaluation in open surgery and identifying critical directions for advancing automated skill assessment toward clinical impact.

Xinkai Zhao, Yuta Tokuoka, Junichiro Iwasawa et al.

The increasing use of diffusion models for image generation, especially in sensitive areas like medical imaging, has raised significant privacy concerns. Membership Inference Attack (MIA) has emerged as a potential approach to determine if a specific image was used to train a diffusion model, thus quantifying privacy risks. Existing MIA methods often rely on diffusion reconstruction errors, where member images are expected to have lower reconstruction errors than non-member images. However, applying these methods directly to medical images faces challenges. Reconstruction error is influenced by inherent image difficulty, and diffusion models struggle with high-frequency detail reconstruction. To address these issues, we propose a Frequency-Calibrated Reconstruction Error (FCRE) method for MIAs on medical image diffusion models. By focusing on reconstruction errors within a specific mid-frequency range and excluding both high-frequency (difficult to reconstruct) and low-frequency (less informative) regions, our frequency-selective approach mitigates the confounding factor of inherent image difficulty. Specifically, we analyze the reverse diffusion process, obtain the mid-frequency reconstruction error, and compute the structural similarity index score between the reconstructed and original images. Membership is determined by comparing this score to a threshold. Experiments on several medical image datasets demonstrate that our FCRE method outperforms existing MIA methods.

Xinkai Zhao, Chaowei Fang, De-Jun Fan et al.

Semi-supervised learning (SSL), which aims at leveraging a few labeled images and a large number of unlabeled images for network training, is beneficial for relieving the burden of data annotation in medical image segmentation. According to the experience of medical imaging experts, local attributes such as texture, luster and smoothness are very important factors for identifying target objects like lesions and polyps in medical images. Motivated by this, we propose a cross-level contrastive learning scheme to enhance representation capacity for local features in semi-supervised medical image segmentation. Compared to existing image-wise, patch-wise and point-wise contrastive learning algorithms, our devised method is capable of exploring more complex similarity cues, namely the relational characteristics between global and local patch-wise representations. Additionally, for fully making use of cross-level semantic relations, we devise a novel consistency constraint that compares the predictions of patches against those of the full image. With the help of the cross-level contrastive learning and consistency constraint, the unlabelled data can be effectively explored to improve segmentation performance on two medical image datasets for polyp and skin lesion segmentation respectively. Code of our approach is available.