Zhicheng He, Xiaohan Xing, Hongqiu Wang, Kun Yuan, Guankun Wang, Yanheng Li, Haoxuan Che, Nassir Navab 等 10 位作者
Multimodal large language models (MLLMs) have shown strong potential in robotic surgery for question answering, scene understanding, and grounded assistance, but their high computational cost limits real clinical deployment. Knowledge distillation provides a practical way to build compact surgical MLLMs, yet direct distillation is not well suited to surgical data because surgical samples vary greatly in difficulty, visual ambiguity, and required clinical context, making uniform teacher-student transfer unstable. In addition, the role of supervision changes during training: early stages require stronger teacher guidance for multimodal alignment, while later stages rely more on task supervision for effective optimization. To address these challenges, we propose SurgPace, a complexity-aware continuous curriculum framework for progressive distillation of surgical vision-language models. SurgPace estimates sample complexity using predictive confidence and Lorentz geometric consistency, and uses the fused score to guide a continuous easy-to-hard training process. We further introduce hierarchical representation alignment, which aligns the student with the teacher at the feature, logit, and probability levels, while gradually shifting the training focus from teacher imitation to task supervision. This design separates sample-level curriculum from objective-level scheduling, leading to more stable and effective distillation. We evaluate SurgPace on Surg-396K, a benchmark built from four public surgical datasets and covering five dialogue paradigms. SurgPace consistently outperforms strong MLLM distillation baselines, demonstrating its effectiveness for building compact, memory-efficient surgical MLLMs with faster decoding under controlled benchmarks. Code is available at https://github.com/hezhicheng2002/SurgPace.
Zhichun Jin, Zhicheng He, Hao Xu, Dongyang Li, Lin Wang, Hongliang Ren, Long Bai
Malocclusion skeletal grading is a fundamental task in orthodontics, critical for diagnosis and treatment planning. Traditionally, cone-beam computed tomography (CBCT) is used for visual measurement, and the reconstructed lateral cephalograms are handed over to expert dentists for diagnosis. However, manual review is time-consuming, labor-intensive, and subject to inter-operator variability. Therefore, an automatic CBCT-based system is needed for reliable malocclusion skeletal grading. In this case, we develop TeethGNN, a novel graph-based framework designed to combine CBCT image features with morphological information for accurate and efficient malocclusion grading. TeethGNN utilizes a decoupled learnable decoder to directly predict key morphological indicators from CBCT images, eliminating the need for manual measurements. These morphological features are then fused with image features using a graph neural network (GNN), which effectively models the relationships between the modalities. To further enhance robustness and calibration, we introduce a collaborative calibration strategy. This strategy combines multi-scale graph adversarial perturbation for explicit calibration and nonlinear topological graph calibration for implicit confidence adjustment. Extensive experiments and ablation studies on our collected clinical dataset demonstrate that our malocclusion measurement system achieves 77.08\% in accuracy and 89.61\% in AUC, outperforming the compared state-of-the-art methods. These results validate the effectiveness of graph-based multimodal fusion and collaborative calibration in improving malocclusion grading performance. Our system shows strong potential for advancing computer-aided orthodontic diagnosis, providing an accurate and reliable solution for vision-based clinical measurement and diagnosis.
Xiangyu Li, Jincheng Li, Tianle Du, Yanheng Li, Haoxuan Che, Yuxin Sun, Long Bai, Liangliang Liu 等 9 位作者
A question about a whole-slide image rarely names every morphological finding needed to answer it. Question-guided patch selection can therefore overlook supporting morphology, while slide-level compression can dilute focal evidence. Inspired by how pathologists combine broad slide review, question-directed examination, and integration of their findings, we introduce BEYONDPATH, a Preserve-Focus-Fuse framework for whole-slide image question answering. Preserve learns a question-agnostic Morphology Bank through answer supervision across multiple questions about each training slide. Focus retrieves questionspecific evidence from all foreground patches, including regions outside the Bank. Fuse integrates the preserved morphology at the retrieved evidence positions through Morphology-on-Visual-Evidence Fusion, producing a fixed 96-token visual prefix. On WSI-Bench, BEYONDPATH achieves an Avg-9 of 0.769 and leads all eight reported report-generation metrics using the same checkpoint. It also achieves 0.639 zero-shot overall accuracy on SlideBench-BCNB. Controlled ablations show complementary benefits from morphology preservation and question-directed retrieval, and support cross-question supervision and fusion at the evidence positions. These results support looking beyond the question's explicit cues: preserving broader slide morphology while retaining the ability to seek evidence for each question.
Shifang Zhao, Long Bai, Kun Yuan, Feng Li, Jieming Yu, Wenzhen Dong, Guankun Wang, Mobarakol Islam 等 11 位作者
In surgical instrument segmentation, the increasing variety of instruments over time poses a significant challenge for existing neural networks, as they are unable to effectively learn such incremental tasks and suffer from catastrophic forgetting. When learning new data, the model experiences a sharp performance drop on previously learned data. Although several continual learning methods have been proposed for incremental understanding tasks in surgical scenarios, the issue of data imbalance often leads to a strong bias in the segmentation head, resulting in poor performance. Data imbalance can occur in two forms: (i) class imbalance between new and old data, and (ii) class imbalance within the same time point of data. Such imbalances often cause the dominant classes to take over the training process of continual semantic segmentation (CSS). To address this issue, we propose SurgCSS, a novel plug-and-play CSS framework for surgical instrument segmentation under data imbalance. Specifically, we generate realistic surgical backgrounds through inpainting and blend instrument foregrounds with the generated backgrounds in a class-aware manner to balance the data distribution in various scenarios. We further propose the Class Desensitization Loss by employing contrastive learning to correct edge biases caused by data imbalance. Moreover, we dynamically fuse the weight parameters of the old and new models to achieve a better trade-off between the biased and unbiased model weights. To investigate the data imbalance problem in surgical scenarios, we construct a new benchmark for surgical instrument CSS by integrating datasets. Extensive experiments demonstrate the effectiveness of the proposed framework, achieving significant performance improvement against existing baselines.