Computer-aided diagnosis offers a promising solution to reduce variation in colonoscopy performance. Pooled miss rates for polyps are as high as 22%, and associated interval colorectal cancers after colonoscopy are of concern. Optical biopsy, whereby in-vivo classification of polyps based on enhanced imaging replaces histopathology, has not been incorporated into routine practice because it is limited by interobserver variability and generally only meets accepted standards in expert settings. Real-time decision-support software has been developed to detect and characterise polyps, and also to offer feedback on the technical quality of inspection. Some of the current algorithms, particularly with recent advances in artificial intelligence techniques, match human expert performance for optical biopsy. In this Review, we summarise the evidence for clinical applications of computer-aided diagnosis and artificial intelligence in colonoscopy.

The use of artificial intelligence (AI) is rapidly growing across many domains, of which the medical field is no exception. AI is an umbrella term defining the practical application of algorithms to generate useful output, without the need of human cognition. Owing to the expanding volume of patient information collected, known as ‘big data’, AI is showing promise as a useful tool in healthcare research and across all aspects of patient care pathways. Practical applications in orthopaedic surgery include: diagnostics, such as fracture recognition and tumour detection; predictive models of clinical and patient-reported outcome measures, such as calculating mortality rates and length of hospital stay; and real-time rehabilitation monitoring and surgical training. However, clinicians should remain cognizant of AI’s limitations, as the development of robust reporting and validation frameworks is of paramount importance to prevent avoidable errors and biases. The aim of this review article is to provide a comprehensive understanding of AI and its subfields, as well as to delineate its existing clinical applications in trauma and orthopaedic surgery. Furthermore, this narrative review expands upon the limitations of AI and future direction.Cite this article: Bone Joint Res 2023;12(7):447–454.

This paper introduces a low-complexity algorithm for the extraction of the fiducial points from the electrocardiogram (ECG). The application area we consider is that of remote cardiovascular monitoring, where continuous sensing and processing takes place in low-power, computationally constrained devices, thus the power consumption and complexity of the processing algorithms should remain at a minimum level. Under this context, we choose to employ the discrete wavelet transform (DWT) with the Haar function being the mother wavelet, as our principal analysis method. From the modulus-maxima analysis on the DWT coefficients, an approximation of the ECG fiducial points is extracted. These initial findings are complimented with a refinement stage, based on the time-domain morphological properties of the ECG, which alleviates the decreased temporal resolution of the DWT. The resulting algorithm is a hybrid scheme of time- and frequency-domain signal processing. Feature extraction results from 27 ECG signals from QTDB were tested against manual annotations and used to compare our approach against the state-of-the art ECG delineators. In addition, 450 signals from the 15-lead PTBDB are used to evaluate the obtained performance against the CSE tolerance limits. Our findings indicate that all but one CSE limits are satisfied. This level of performance combined with a complexity analysis, where the upper bound of the proposed algorithm, in terms of arithmetic operations, is calculated as 2.423 N +214 additions and 1.093 N +12 multiplications for N ≤ 861 or 2.553 N +102 additions and 1.093 N +10 multiplications for N > 861 ( N being the number of input samples), reveals that the proposed method achieves an ideal tradeoff between computational complexity and performance, a key requirement in remote cardiovascular disease monitoring systems.

Background: The utilization of artificial intelligence and machine learning as diagnostic and predictive tools in perioperative medicine holds great promise. Indeed, many studies have been performed in recent years to explore the potential. The purpose of this systematic review is to assess the current state of machine learning in perioperative medicine, its utility in prediction of complications and prognostication, and limitations related to bias and validation. Methods: A multidisciplinary team of clinicians and engineers conducted a systematic review using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol. Multiple databases were searched, including Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, PubMed, Medline, Embase, and Web of Science. The systematic review focused on study design, type of machine learning model used, validation techniques applied, and reported model performance on prediction of complications and prognostication. This review further classified outcomes and machine learning applications using an ad hoc classification system. The Prediction model Risk Of Bias Assessment Tool (PROBAST) was used to assess risk of bias and applicability of the studies. Results: A total of 103 studies were identified. The models reported in the literature were primarily based on single-center validations (75%), with only 13% being externally validated across multiple centers. Most of the mortality models demonstrated a limited ability to discriminate and classify effectively. The PROBAST assessment indicated a high risk of systematic errors in predicted outcomes and artificial intelligence or machine learning applications. Conclusions: The findings indicate that the development of this field is still in its early stages. This systematic review indicates that application of machine learning in perioperative medicine is still at an early stage. While many studies suggest potential utility, several key challenges must be first overcome before their introduction into clinical practice. Editor’s Perspective: What We Already Know about This Topic: What This Article Tells Us That Is New:

Reconstructing the 3D geometry of the surgical site and detecting instruments within it are important tasks for surgical navigation systems and robotic surgery automation. Traditional approaches treat each problem in isolation and do not account for the intrinsic relationship between segmentation and stereo matching. In this paper, we present a learning-based framework that jointly estimates disparity and binary tool segmentation masks. The core component of our architecture is a shared feature encoder which allows strong interaction between the aforementioned tasks. Experimentally, we train two variants of our network with different capacities and explore different training schemes including both multi-task and single-task learning. Our results show that supervising the segmentation task improves our network’s disparity estimation accuracy. We demonstrate a domain adaptation scheme where we supervise the segmentation task with monocular data and achieve domain adaptation of the adjacent disparity task, reducing disparity End-Point-Error and depth mean absolute error by 77.73% and 61.73% respectively compared to the pre-trained baseline model. Our best overall multi-task model, trained with both disparity and segmentation data in subsequent phases, achieves 89.15% mean Intersection-over-Union in RIS and 3.18 millimetre depth mean absolute error in SCARED test sets. Our proposed multi-task architecture is real-time, able to process ( $1280\times 1024$ ) stereo input and simultaneously estimate disparity maps and segmentation masks at 22 frames per second. The model code and pre-trained models are made available: https://github.com/dimitrisPs/msdesis