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Computer Vision for Real-Time Anatomical Navigation in Neurosurgery: First-in-Human Clinical Evaluation and Iterative Development (IDEAL Stage 1)

Introduction: Precise anatomical navigation is fundamental to safe endoscopic pituitary surgery, a high-stakes procedure characterised by a challenging learning curve. While traditional navigation systems often rely on workflow-disrupting probes or static preoperative imaging, advancements in computer vision AI (CVAI) now enable dynamic, real-time anatomical segmentation directly from live surgical video1-3. Our group has previously conducted a series of preclinical human-computer interaction studies to refine the system's design, alongside digital and high-fidelity physical simulations demonstrating the benefit of AI assistance in improving overall performance, training, and safety4-8. Building on this foundation, the current study represents a first-in-human application of real-time CVAI assistance in the neurosurgical operating room, serving to assess feasibility and safety, and to iteratively improve the system. Method: Guided by DECIDE-AI and IDEAL frameworks, this single-centre evaluation comprises an initial proof-of-concept phase (n=6) for endoscopic transsphenoidal pituitary surgeries. The AI model utilised a DINOv3-derived vision transformer architecture, deployed via a high-performance edge computing unit to achieve low-latency, real-time inference without reliance on cloud infrastructure2. Given the high-risk nature of the procedure and the early stage of clinical AI integration, the system was initially deployed as an educational adjunct on a secondary monitor, ensuring the primary surgical feed remains uncompromised. Functionality and safety were assessed via structured questionnaire, prospective observation, and blinded retrospective review of the recordings of the endoscopic surgical video feed and wider operating room environment. Continuous multi-stakeholder feedback through validated human factors surveys drove iterative technical refinements between cases. Results: Six patients with pituitary adenomas were enrolled. The CVAI system was successfully deployed in four cases, demonstrating acceptable real-time sella segmentation accuracy. Deployment failed pre-operatively in two cases owing to a single recurring system reboot bug. Iterative refinement between cases were driven by our experience and surgical team feedback. This resulted in the integration of additional anatomical structure segmentations (e.g., carotid arteries), enhanced model accuracy via training dataset expansion, and hardware firmware upgrades. Multi-stakeholder surveys demonstrated satisfactory system feasibility, usability, and acceptability among the surgical team. Both prospective observation and retrospective video review confirmed the absence of adverse events, including no significant distraction to the primary surgeon, and there were no AI-related clinical complications. Conclusion: This first-in-human early clinical evaluation demonstrates the feasibility, safety and iterative development of real-time, CVAI-based anatomical navigation during high-stakes neurosurgery. Future work will include a larger single-centre case series (IDEAL Stage 2a) with more surgical teams to further iterate the system and explore its impact on training and workflow. As the underpinning technology improves, deployment will transition to direct intra-operative decision support and integration with other intra-operative navigational technologies.

KIGNet: Physics-Motivated Multi-Graph Representation Learning for Explainable Jet Tagging

arXiv:2512.07420v3 Announce Type: replace-cross Abstract: Jet identification plays a central role in analyzing data from high-energy collider experiments. While deep learning has improved jet classification, it often lacks interpretability. We introduce the Kinematic Interaction Graph Network (KIGNet), a graph neural network that integrates kinematic variables into jet classification by constructing four graph representations per jet, each weighted by a distinct variable: angular separation ($\Delta$), relative transverse momentum ($k_T$), momentum fraction ($z$), and invariant mass squared ($m^2$). Three of these ($\Delta$, $k_T$, $z$) are motivated by the Lund jet plane, grounded in perturbative QCD factorization; the fourth ($m^2$) adds complementary mass-scale sensitivity for heavy-flavor identification. Using Gradient-weighted Class Activation Mapping (Grad-CAM), we determine which variables dominate classification. Angular separation and relative transverse momentum account for about 76% of the total Grad-CAM attribution (40.72% and 35.67%), with momentum fraction and invariant mass contributing the remaining 24%. This hierarchy is consistent with the soft-collinear structure of QCD radiation in the training data, showing that the network learns physically interpretable representations rather than spurious correlations. On the JetClass dataset, KIGNet achieves a macro-accuracy of 95.07%, macro-AUC of 96.61%, and macro-AUPR of 81.52%, relative improvements of 2.45%, 3.40%, and 19.11% over the state-of-the-art baseline. On the Aspen Open Jets dataset of real CMS collision data, KIGNet produces substantially more structured latent representations than the baseline, reducing the Davies-Bouldin Index by 52.15% ($0.8395 \rightarrow 0.4017$) and increasing the Dunn Index by 42.33% ($0.0189 \rightarrow 0.0269$), confirming that physics-informed kinematic encoding generalizes beyond idealized simulation to experimental detector conditions.