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Purpose: We propose a formal framework for the modeling and segmentation of minimally invasive surgical tasks using a unified set of motion primitives (MPs) to enable more objective labeling and the aggregation of different datasets. Methods: We model dry-lab surgical tasks as finite state machines, representing how the execution of MPs as the basic surgical actions results in the change of surgical context, which characterizes the physical interactions among tools and objects in the surgical environment. We develop methods for labeling surgical context based on video data and for automatic translation of context to MP labels. We then use our framework to create the COntext and Motion Primitive Aggregate Surgical Set (COMPASS), including six dry-lab surgical tasks from three publicly available datasets (JIGSAWS, DESK, and ROSMA), with kinematic and video data and context and MP labels. Results: Our context labeling method achieves near-perfect agreement between consensus labels from crowd-sourcing and expert surgeons. Segmentation of tasks to MPs results in the creation of the COMPASS dataset that nearly triples the amount of data for modeling and analysis and enables the generation of separate transcripts for the left and right tools. Conclusion: The proposed framework results in high quality labeling of surgical data based on context and fine-grained MPs. Modeling surgical tasks with MPs enables the aggregation of different datasets and the separate analysis of left and right hands for bimanual coordination assessment. Our formal framework and aggregate dataset can support the development of explainable and multi-granularity models for improved surgical process analysis, skill assessment, error detection, and autonomy. 

Machine Learning (ML) technologies have been increasingly adopted in Medical Cyber-Physical Systems (MCPS) to enable smart healthcare. Assuring the safety and effectiveness of learning-enabled MCPS is challenging, as such systems must account for diverse patient profiles and physiological dynamics and handle operational uncertainties. In this paper, we develop a safety assurance case for ML controllers in learning-enabled MCPS, with an emphasis on establishing confidence in the ML-based predictions. We present the safety assurance case in detail for Artificial Pancreas Systems (APS) as a representative application of learning-enabled MCPS, and provide a detailed analysis by implementing a deep neural network for the prediction in APS. We check the sufficiency of the ML data and analyze the correctness of the ML-based prediction using formal verification. Finally, we outline open research problems based on our experience in this paper. 

The development of fully autonomous artificial pancreas systems (APS) that independently regulate the glucose levels of patients with Type 1 diabetes has been a long-standing goal of diabetes research. A significant barrier to progress is the difficulty of testing new control algorithms and safety features, since clinical trials are time- and resource-intensive. To facilitate ease of validation, we propose an open-source APS testbed that can integrate state-of-the-art APS controllers and glucose simulators with a novel fault injection engine. The testbed is used to reproduce the blood glucose trajectories of real patients from a clinical trial conducted over six months. We evaluate the performance of two closed-loop control algorithms (OpenAPS and Basal Bolus) using the testbed and find that these control algorithms are able to keep blood glucose in a safe region 93.49% and 79.46% of the time on average, compared with 66.18% of the time for the clinical trial. The fault injection engine simulates the real recalls and adverse events reported to the U.S. Food and Drug Administration (FDA) and demonstrates the resilience of the controller in hazardous conditions. We use the testbed to generate 2.5 years of synthetic data representing 20 different patient profiles with realistic adverse event scenarios, which would have been expensive and risky to collect in a clinical trial.