Identifying Surgical Positions using GPT4

Building digital nurses of the future.

Introduction

Surgical positions are an essential aspect of surgical practice, playing a crucial role in the success and safety of operative procedures. These positions are carefully selected and prepared based on the type of surgery being performed, the area of the body being operated on, and the overall physical condition of a patient. Understanding various surgical positions is key for both medical professionals and patients.

This article presents the results of surgical pose detection using RGB images. With the preliminary results, we have drawn the following conclusions:

1. To the best of my knowledge, GPT4 has significantly outperformed all known methods (as of November 2023). Although it is not known what model GPT4 uses surely it is magic.
2. There is no need to segment a patient, identify key points, and then perform post-processing analysis to classify images.
3. In some cases, GPT4 suffers from hallucinations and the results are clinically not correct. It was observed that asking a simple question to GPT4 “Are you sure” after the response usually corrects the answer.

Common Surgical Positions:

Known Deep Learning Methods for Pose-Estimation

There are several deep learning models that can perform reasonably well to detect key points in an image that could be used to classify surgical positions.

1. OpenPose
2. MediaPipe
3. Yolo8
4. YoloNAS
5. GPT4-Vision (Main theme of this post)

Mediapipe Keypoints:

Openpose keypoints:

Yolo8 Keypoints:

Challenges in classifying surgical positions:

Identifying surgical positions using key points may be challenging as some external factors may lead to ambiguous detection.

1. Patients are usually surrounded by surgical tools,
2. Doctors may be present at the scene.
3. Patients may wear masks, gowns or some medical instruments may be inserted in the body.

Pose classification using the GPT4-Vision model:

Results:

Image-1

GPT4 Response: The position in the image is the lateral decubitus position. It is used for surgeries on the side of the body, such as thoracic or hip procedures, with the patient lying on their side.

Image 2:

GPT4 Response: The surgical position depicted in the image appears to be a variation of the lithotomy position, which is commonly used for gynecological surgeries and procedures involving the lower abdomen or pelvis. In a typical lithotomy position, the patient lies on their back with hips and knees flexed, thighs apart, and feet supported in stirrups. The specific variation here seems to be with the addition of a tilt, possibly a Trendelenburg tilt where the body is laid back with the feet higher than the head, which is useful for better exposure and access in certain surgical procedures. The exact type of lithotomy position can vary depending on the surgery and the patient’s needs.

Image 3:

GPT4 Response: The surgical position shown in the image is the supine position. This is the most common position used in surgery. The patient is lying on their back with the head, neck, and spine in a neutral position. The arms are typically placed at the sides or extended out to the side on arm boards. This position is used for most abdominal, facial, and cardiac surgeries, as it allows surgeons easy access to the chest and abdomen while the patient is comfortably flat on their back.

Image 4:

GPT4 Response: The surgical position shown in the image is the Trendelenburg position. This position involves the patient being placed on their back with the head lower than the feet, which is facilitated by tilting the entire operating table backward. The Trendelenburg position is often used in abdominal and gynecological surgeries to move the abdominal organs toward the chest, providing better access to the pelvic organs. It’s also used in some cases for prostate surgery and is known to be helpful during central venous line placements to improve the filling of the veins.

Image 5:

GPT4 Response-1: The surgical position shown in the image is the prone position. This position is typically used for surgeries on the back or spine where the patient lies face down on the operating table.

GPT4 Response 2: Apologies for any confusion. Upon re-examining the image, the position looks like a variation of the lateral decubitus position, where the patient lies on their side. However, this setup includes a tilt, making it slightly different from the standard lateral decubitus position. It is designed to provide surgical access to the side, hip, or kidney of the patient while allowing the surgeon to adjust the angle for optimal exposure of the surgical site.

Image 6:

The position in the image is the supine position. It’s the standard position for many types of surgeries, with the patient lying on their back, facing upwards.

Image 7

The surgical position in the image is the prone position. This is where the patient is lying face down on the operating table. It is often used for procedures on the back or spine, such as lumbar surgery, and can also be utilized for certain types of surgeries on the lower limbs or for posterior brain surgery.

Image 8

The position in the image is the Trendelenburg position. It is characterized by the patient being placed on their back with the body inclined so that the feet are higher than the head. This position is often used in abdominal and gynecological surgeries to shift the abdominal contents towards the head, improving exposure of the pelvic organs.

Image 9:

GPT4-Response: The position shown in the image is the beach chair position, which is commonly used for shoulder surgeries and some types of head and neck surgeries. The patient is seated with the back elevated to various degrees, providing surgical access to the shoulder area.

Image 10:

GPT4 Response: The position shown in the image is a variation of the Trendelenburg position, specifically the reverse Trendelenburg position. In this position, the patient’s body is tilted with the head higher than the feet. It’s often used for surgeries of the upper abdomen or during some head and neck surgeries, as it allows better access to the surgical site and can help reduce blood flow to the area for clearer visibility during the procedure.

Image 11:

GPT4 Response: The image shows a patient in what appears to be a modified version of the sitting position, sometimes referred to as the “beach chair” position. This position is typically used for shoulder surgeries, such as arthroscopy, or certain types of neurosurgery. It allows the surgeon to access the shoulder joint directly and is favorable for reducing blood loss in the surgical field. The patient’s head is supported and secured to maintain airway patency and spinal alignment.

Image 12:

GPT4 Response: The image shows the lithotomy position, typically used for gynecological surgeries, urological procedures, and rectal surgeries. The patient is lying on their back with their legs elevated and supported by stirrups, providing access to the pelvic area.

Image 13:

GPT4 Response: The position shown in the image is the lateral decubitus position. This position is used for thoracic, renal, or hip surgeries. The patient is lying on their side, with the surgical site facing up, allowing the surgeon access to the side of the body. The lower arm is typically extended for support, with the upper arm flexed. Special padding or supports are used to maintain the position, stabilize the patient, and relieve pressure on the downside arm and leg.

Image 14:

GPT4 Response: The position depicted in the image is Fowler’s position. In this position, the patient is placed on their back with the head and upper half of the body elevated, which can vary from a slight to a semi-sitting position (45 to 60 degrees). It’s frequently used during shoulder surgeries or other procedures where access to the upper body is necessary and can also help to improve breathing and reduce stress on the heart.

Image 15:

GPT4 Response: The position shown in the image is the Trendelenburg position. This is characterized by the patient being laid back with the feet elevated above the head, which is particularly useful for pelvic and lower abdominal surgeries as it allows better access to the surgical site by shifting the organs away from the pelvis.

Image 16:

GPT4 Response; The position in the image is the lateral decubitus position. This position is used for surgeries on the side of the body, such as thoracic or hip procedures, where the patient lies on one side with the surgical site facing upwards.

Image 17:

GPT4 Response 1: The position in the image appears to be the lateral decubitus position, where the patient is lying on their side, commonly used for procedures involving the hips, thorax, or the side of the body.

Question to GPT4: Are you sure?

GPT4 Response 2: Upon re-evaluating the image, it seems that I misspoke. The position shown appears to be a variation of the lateral decubitus, specifically the lateral tilt or a modified lateral position. In this position, the patient is placed on their side with a tilt that elevates the upper part of the body, providing access to the lateral aspect of the body while allowing drainage or working with gravity in a surgical procedure.

Image 18:

GPT4 Response: The position shown in the image is Fowler’s position, specifically a low or semi-Fowler’s position. This involves the patient sitting up at a lower angle between 15 and 45 degrees and is commonly used in procedures that require access to the patient’s upper body, such as certain types of surgery or for comfort during recovery when full sitting is not possible.

Image 19:

GPT4 Response: The position depicted in the image is the jackknife position, also known as the Kraske position. It is characterized by the patient being prone with the hips at the highest point, bent at the waist, and the head and feet lowered. This position is typically used for rectal or posterior pelvic surgeries.

Image 20:

GPT4 Response: The position shown in the image is the Trendelenburg position. This involves the patient being laid on their back with the feet elevated higher than the head, often used in surgeries requiring access to the pelvic organs or during central venous line placements.

Image 21:

GPT4 Response: The position in the image is the lithotomy position, commonly used for gynecological procedures, urological surgeries, and lower gastrointestinal surgeries. The patient is on their back with the legs elevated and supported by stirrups.

Image 22:

GPt4 Response: The position in this image is the supine position. It’s the most common surgical position, with the patient lying on their back, arms typically out to the sides or secured, and is used for a wide range of procedures.

Image 23:

GPT4 Response 1: The position in the image is the lithotomy position. It is commonly used for genital, urinary tract, and colorectal surgeries, as it provides good exposure of the pelvic area. The patient is lying on their back with legs elevated and supported by stirrups.

Question to GPT4: Are you sure?

GPT4 Response 2: Apologies for the oversight. The image does not depict the lithotomy position. The position shown is Fowler’s position, where the patient is placed with the head higher than the lower body, and the knees may be slightly elevated or bent. This position is commonly used for respiratory comfort, certain types of surgery, or during recovery.

Image 24:

GPT4 Response 1; The position shown in the image is the lateral decubitus position. This surgical position involves the patient lying on their side, which is commonly used for procedures on the side of the body such as thoracic surgery or kidney operations.

Question to GPT4: Are you sure?

GPT4 Response 2: Upon closer inspection, the image depicts the lateral tilt or a modified lateral decubitus position, where the patient is on their side with an additional tilt, angling the body so that the side requiring surgical access is more exposed. This position is often used for kidney surgeries and some thoracic procedures to allow better access and visibility to the operative field.

Image 25:

GPT4 Response 1: The position shown in the image is the lateral decubitus position. This position is used in surgeries to access the side of the body, such as thoracic or hip procedures, where the patient lies on one side.

Question to GPT4: Are you sure?

GPT4 Response: My apologies for the confusion. The position in the image seems to be the lateral decubitus position with a flexion at the hip, which might be described as a modified lateral position. It is used for accessing the hip or lateral aspects of the body during surgical procedures.

Conclusions:

1. GPT4-Vision is remarkable in detecting surgical position. With a simple one-line command, it is able to give an answer with reasonable accuracy.
2. There is no need to apply different components such as image segmentation, fine-tuning large vision models, or distilling large models to Yolo models.

How may it impact Medical Science:

Medical science is usually slow and conservative in adopting new technology. The cycle of testing, validation, and approval from Medical Councils can be pretty long. Moreover, clinical acceptance is very hard to get unless the technology is foolproof and supported by rational, deterministic, and reliable methods. So, my personal opinion is that the present tool is a proof of concept and it may not be likely to change anything in medical science.