STRATUM is a Horizon Europe multi-partner project developing a clinically validated, real-time 3D decision support tool for brain tumour surgery. The system integrates Hyperspectral Imaging (HSI), AI-based multimodal data fusion, and heterogeneous High-Performance Computing (HPC) architectures combining Graphics Processing Units (GPUs), Field-Programmable Gate Arrays (FPGAs), and Processing-In-Memory (PIM) technologies. A touchless augmented reality interface facilitates safe and intuitive intraoperative interaction. The distinguishing characteristic of STRATUM is its end-to-end co-designed approach, which integrates advanced computing, state-of-the-art imaging and clinical expertise into a unified Point-of-Care (PoC) platform. Utilising a structured co-creation methodology involving surgeons, engineers, and social scientists, the project ensures usability, safety and regulatory compliance from its early design stages to its clinical validation. The usability of STRATUM will be tested in three hospitals located in different European regions with diverse conditions and regulations. This will allow to collect advice and remarks from surgical staff in a continuous co-creation and co-tuning protocol. Beyond its clinical objectives, STRATUM contributes to the advancement of heterogeneous computing for real-time diagnostics, AI acceleration in critical medical environments and energy-efficient system integration. Furthermore, it delivers open datasets, validated AI pipelines, and performance benchmarks with a view to fostering future research and industrial innovation in digital surgery. The STRATUM project establishes a replicable model for intelligent, human-centred computing integrating microelectronics, AI and medicine.The paper presents an overview of the project in terms of aims, concepts and technologies and the description of the state of the work when approaching the end of the second of the five years planned. Specifically, the outcomes of the steps related to the collaboration with surgeons and medical staff (co-creation process) and the intelligent Graphical User Interface (GUI) development will be described. The latter allows for contactless interaction of the surgeon with several functions that have already been developed in the system.

Integrated digital diagnostics can support complex surgical procedures in many anatomical sites, brain tumour surgery being the most complex. STRATUM is a 5-year Horizon Europe funded project with the goal of developing an innovative 3D decision support tool for brain tumour surgeries, based on real-time multimodal data processing using artificial intelligence algorithms. The proposed tool is envisioned as an energy-efficient Point-of-Care computing system to be integrated within neurosurgical workflows to aid surgeons to make informed, efficient, and accurate decisions during surgical procedures. The expected long-term impact of STRATUM is to reduce the duration of surgical procedures, thus decreasing patients' risks, but also optimising the resources of European health care systems.

Hyperspectral imaging analyzed by machine learning algorithms is a powerful tool to classify materials, tissues, molecules and pathogens. By analyzing the electromagnetic spectrum of liquid serum samples, it has been demonstrated that it is possible to predict which patients with possible head trauma injury will have a possible result on computer tomography. This process is being carried out with very complex, slow and expensive spectrometric techniques. To tackle this problem, this study presents a simple hyperspectral imaging system that allows the capture of multiple serum samples with one single scan, without light artifacts as it works in transmittance and without a high data redundancy rate. Throughout this paper, the main characteristics of this system, the preprocessing chain necessary to extract the information from these captures, the working methodology, and the analysis performed are presented. Hyperspectral images of plasma from 405 patients were captured and the signatures obtained from this system were compared with the signatures captured by a spectrometer, which served as a reference system. With a mean correlation of 97.3% and a standard deviation of 3.6%, the presented system not only captures correctly liquid samples, but also provides spatial information and can capture many more samples in a single scan. In addition, a statistical study is presented on which spectrum bands present a higher concentration of information, which will be very beneficial for future analysis.

Over the last two decades, augmented reality (AR) has led to the rapid development of new interfaces in various fields of social and technological application domains. One such domain is medicine, and to a higher extent surgery, where these visualization techniques help to improve the effectiveness of preoperative and intraoperative procedures. Following this trend, this paper presents SLIMBRAIN, a real-time acquisition and processing AR system suitable to classify and display brain tumor tissue from hyperspectral (HS) information. This system captures and processes HS images at 14 frames per second (FPS) during the course of a tumor resection operation to detect and delimit cancer tissue at the same time the neurosurgeon operates. The result is represented in an AR visualization where the classification results are overlapped with the RGB point cloud captured by a LiDAR camera. This representation allows natural navigation of the scene at the same time it is captured and processed, improving the visualization and hence effectiveness of the HS technology to delimit tumors. The whole system has been verified in real brain tumor resection operations.

Hyperspectral (HS) imaging (HSI) techniques have demonstrated to be useful in the medical field to characterize tissues without any contact and without ionizing the patient. Besides, HSI combined with supervised machine learning (ML) algorithms have proven to be an effective technique to assist neurosurgeons to resect brain tumors. This research looks at the effects of hyperparameter optimization on two common supervised ML algorithms used for brain tumor classification: support vector machines (SVM) and random forest (RF). Correctly classifying brain tumor with HS data containing low spatial and spectral information can be challenging. To tackle this problem, this study has applied hyperparameter optimization techniques on SVM and RF with 10 brain images of patients suffering from glioblastoma multiforme (GBM) with non-mutated isocitrate dehydrogenase (IDH) enzymes. These captures have 409x217 spatial resolution and 25 normalized reflectance wavelengths gathered from 665 to 960 nm with a HS snapshot camera. Results show how this work has been able to obtain 98,60% of weighted area under the curve (AUC) on the test score by employing naive optimizations like grid search (GS) or random search (RS) and even more complex methods based on Bayesian optimization (BO). Not only the weighted AUC of SVM has been improved by 8%, but BO have also enhanced the AUC of the tumor class by 22.50% in comparison with non-optimized SVM models in the state-of-the-art, achieving AUC values of 95,49% on the tumor class. Furthermore, these improvements have been illustrated with classification maps to demonstrate the importance of hyperparameter optimization on SVM to clearly classify brain tumor, whereas non-optimized models from previous studies are unable to detect the tumor.

BACKGROUND: Outcome prediction for subarachnoid hemorrhage (SAH) helps guide care and compare global management strategies. Logistic regression models for outcome prediction may be cumbersome to apply in clinical practice. OBJECTIVE: To use machine learning techniques to build a model of outcome prediction that makes the knowledge discovered from the data explicit and communicable to domain experts. MATERIAL AND METHODS: A derivation cohort (n = 441) of nonselected SAH cases was analyzed using different classification algorithms to generate decision trees and decision rules. Algorithms used were C4.5, fast decision tree learner, partial decision trees, repeated incremental pruning to produce error reduction, nearest neighbor with generalization, and ripple down rule learner. Outcome was dichotomized in favorable [Glasgow outcome scale (GOS) = I-II] and poor (GOS = III-V). An independent cohort (n = 193) was used for validation. An exploratory questionnaire was given to potential users (specialist doctors) to gather their opinion on the classifier and its usability in clinical routine. RESULTS: The best classifier was obtained with the C4.5 algorithm. It uses only two attributes [World Federation of Neurological Surgeons (WFNS) and Fisher's scale] and leads to a simple decision tree. The accuracy of the classifier [area under the ROC curve (AUC) = 0.84; confidence interval (CI) = 0.80-0.88] is similar to that obtained by a logistic regression model (AUC = 0.86; CI = 0.83-0.89) derived from the same data and is considered better fit for clinical use.