REVIEW 3 major objections 6 minor 72 references
Video Denoising in Fluorescence Guided Surgery
T0 review · 3 major / 6 minor · reviewed 2026-08-12 · deepseek-v4-flash
Pith's one-line read The paper argues that fluorescence guided surgery video can be denoised by simulating laser leakage light from a co-located reference video, and that a simple recurrent network built on a single-image denoiser outperforms adapted…
desk verdict A solid FGS denoising paper with a genuinely useful simulate-then-train pipeline and a surprising single-image-over-video result, though the 'accurate' noise simulation claim is only partially validated and a few numbers need explanation. read the letter →
The pith
A machine-rendered reading of the paper's core claim, the machinery that carries it, and where it could break.
The reading
What carries the argument
Two objects carry the argument. The LLL-PN (a lightweight NafNet32 trained on OL-LLL with a median-seeking L1 loss) predicts the laser leakage frame from the reference video and supplies the bias term for Eq. (1); it is load-bearing because without it the simulated LLL distribution would not match the real one. The second is the noise simulator of Eq. (1), which combines clean fluorescence frames, predicted LLL, Poisson shot noise with calibrated camera gain K, and real dark frames for read noise. The third is BL-RNN, a recurrent network that feeds the previous denoised frame back into a NafNet32 U-net with ReLU activations, giving temporal integration without the unstable propagation of the BasicVSR++ style recurrence the paper tried first.
What would settle it
Acquire human FGS frames with the excitation laser on and no fluorophore present, as in the paper's OL-LLL protocol, and measure how much of the true LLL energy a LLL-PN trained on chicken-thigh data can predict; if the predicted energy share falls well below the 40% observed in OL-LLL, or if a denoiser trained on LLL-PN-simulated data fails to remove a hand or tool shadow on real human video, the transfer claim collapses.
Extended reading notes
Core claim
The central claim is that FGS video denoising should be treated as a noise-formation problem with three terms—Poisson shot noise, sampled read noise, and spatially varying LLL—and that the LLL term can be approximated by a network fLLL that maps each reference-video frame Rv_t to a predicted LLL frame. The noisy fluorescence frame is modeled as F̃ = Quant(K Pois(Sm S + Lm LLL_pred) + R) / (K Sm), with calibrated gain K = 1/1764 and dark frames sampled from OL-Dark. Trained on OL-LLL in a Noise2Noise fashion with L1 loss, the LLL-PN accounts for 40% of the energy in noisy LLL frames, capturing large structure while missing specular reflections and 3D-dependent shadows. On simulated test data, NafNet32 reaches 34.8 dB PSNR versus 30.5 dB for causal BasicVSR++, while FastDVDnetC and OFDVDnetC fall below 7 dB; the paper attributes this to the bias and causality violations in FGS, and shows on the Davis dataset that the advantage reverses in conventional video denoising. The paper's proposed baselines combine NafNet blocks with sliding-window, align-and-merge, and recurrent temporal strategies, with BL-RNN giving the best LPIPS in the middle noise region and being the only model that removes LLL from a real no-fluorescence scene.
Load-bearing premise
The load-bearing premise is that the reference video can predict the laser leakage light strongly enough that the simulated LLL distribution matches reality; the authors find this true in their mock-surgery data but flag that it must be checked on human tissue, and their LLL-PN only explains 40% of the energy in noisy LLL frames, missing specular reflections and 3D-dependent shadows.
Editorial extensions
If this is right
- Simulated training data that includes LLL should let denoisers trained on mock-surgery videos transfer to real FGS systems, as long as the reference video remains informative.
- Causal FGS denoising is feasible: the proposed baselines use only past and current frames, which fits the clinical workflow.
- Conventional video denoisers designed for zero-mean, non-causal noise will need structural changes—especially access to the reference video and robustness to biased noise—before they can serve FGS.
- The two-dimensional (Sm, Lm) noise space provides a cost landscape that could rank candidate hardware configurations by denoiser performance.
- Dim fluorescent contrast agents become more clinically viable if post-capture denoising can recover signal near the noise floor.
Reading between the lines
- Editorial inference: if the RV-to-LLL correlation holds in human tissue, the same simulator could model autofluorescence, which is also correlated with the reference view; the paper notes this possibility.
- Editorial inference: the repeated-frame experiment suggests current recurrent models underuse temporal information, so an architecture that explicitly forces long averages, like the align-and-merge baseline, may be necessary as signal drops.
- Editorial inference: the qualitative success on the no-fluorescence real scene implies BL-RNN has learned a physical prior about LLL structure rather than memorizing simulated noise; a quantitative real-data test with injected fluorescence of known concentration would settle how far this extends.
- Editorial inference: the gain calibration and dark-frame sampling procedures are transferable to other FGS cameras, so the simulate-and-train pipeline could be reproduced without the authors' hardware.
Signed reviews
Editorial analysis
A structured set of objections, weighed in public.
Referee Report
Summary. The paper addresses video denoising for fluorescence-guided surgery (FGS), where the fluorescence video is corrupted by shot noise, read noise, and a spatially varying laser leakage light (LLL) term. The authors propose a noise simulation pipeline that predicts LLL from a co-located reference video using a learned LLL-PN, generates synthetic noisy FV frames via Eq. (1), and trains denoising networks on these data. They introduce OL-2024, expanding existing FGS datasets, and propose three causal baseline models (BL-SW, BL-A&M, BL-RNN) built on a NAFNet backbone. They report that an image denoiser (NafNet32) outperforms adapted causal video denoisers (BasicVSR++, FastDVDnet, OFDVDnet) on their simulated FGS test set, and they analyze LLL robustness, ablations, and temporal behavior.
Significance. If the claims hold, the paper provides a valuable simulate-and-train pipeline for FGS, a new public dataset, and strong baselines for a clinically relevant problem. The surprising result that a single-image denoiser outperforms temporal video denoisers on LLL-dominated noise, with a Davis control showing the opposite on conventional noise, is an important empirical finding. The paper also includes useful robustness analyses (mlll, LLL-PN switching) and makes data/code available. However, the significance is contingent on whether the simulated LLL distribution matches real deployment conditions, which the current validation does not establish quantitatively.
major comments (3)
- [Sec. III / Eq. (1) / Sec. III-A / Fig. 4] The 'accurate noise simulation' claim (Abstract; Sec. III) is not validated at the point that matters. Eq. (1) generates both training and test noise using the same LLL-PN, fLLL(Rv_t), so the test set is in-distribution by construction; this does not demonstrate that the simulated noise matches real LLL. Sec. III-A reports that fLLL accounts for 40% of the L2 energy of noisy LLL frames and that specular reflections and 3D-dependent shadows (Fig. 4) are not predicted. Those structures are absent from the synthetic noise, so the trained models are never asked to remove them, while the OL-Real evaluation (Sec. V-E) has no ground truth and cannot show whether they are handled. The authors' own caveat in Sec. III-A that the RV-to-LLL assumption 'will be important to check in human data' concedes exactly this gap. I request a quantitative comparison of synthetic and real noise (e.g., patch statistics, noise power spectra, or detection rates on held-out OL-LLL frames with known LLL) and either simulation of the missing LLL structures or real-data evaluation with ground truth LLL.
- [Table I / Sec. IV-A2] The reported PSNR/SSIM values for FastDVDnetC (6.1/0.020) and OFDVDnetC (2.5/0.000) are below what a trivial baseline (e.g., outputting the noisy input) would achieve, strongly suggesting an implementation or training failure in the adaptations rather than a genuine property of temporal denoisers. As written, the conclusion that 'SOTA video denoisers are unsuitable' (Sec. IV-A2) rests on a comparison in which the baseline models may not be functioning correctly. The authors should verify that their causal adaptations train correctly, for example by reporting training curves, comparing against the original non-causal models on the same data, or checking performance on clean/unnoisy inputs. Without this, the headline comparison of Table I is not interpretable.
- [Sec. V-B / Table III] The LLL robustness test with a second LLL-PN f2 changes only the training data split of the same OL-LLL set. It therefore measures sensitivity to LLL-PN weights, but not to the structural failure modes the paper identifies in Sec. III-A: specular reflections and shadows that depend on 3D scene geometry. The mlll slope measure is useful for quantifying sensitivity to Lm, but it cannot test whether models handle those missing components. To support the claim that the proposed baselines are robust to LLL in practice, the authors need a test that includes those structures, e.g., by injecting synthetic specular/shadow LLL into the simulation or by collecting real LLL frames with paired RV and evaluating where the denoisers fail.
minor comments (6)
- [Sec. IV] There are typographical errors: 'We simulate simulate noisy frames' in Sec. IV and 'LLL rmeoval' in Sec. V-C should be corrected.
- [Eq. (1)] The notation '1/KS m' is ambiguous; please write it as a single fraction with K and Sm clearly separated, and state explicitly whether Quant is applied before or after the multiplication by 1/(K Sm).
- [Sec. III-A] The statement that fLLL 'accounts for 40% of the total energy' is ambiguous because it does not specify what fraction of the remaining energy is shot/read noise versus unmodeled LLL structure; please provide a decomposition of the residual energy.
- [Fig. 7] The red polygon indicating 'realistic noise scenarios' is not defined in the text; please provide the criterion used to draw it.
- [Sec. IV-C] The training budget of 'maximum 2 weeks' is a hardware-specific statement; report iterations/epochs and early-stopping criteria instead of wall-clock time as the primary convergence measure.
- [References] The dataset reference [12] is listed as 'Forthcoming 2024'; if the dataset and code are now available, update the citation to the final DOI.
Circularity Check
Simulated LLL test frames are generated by the same LLL-PN used to synthesize training noise, so the reported PSNR/SSIM rankings measure inversion of the LLL-PN's own output rather than real LLL removal; the paper's own 40%-energy and specular/shadow caveats confirm the loop omits the hardest real LLL structures.
-
fitted input called prediction
[Sec. III Eq. (1); Sec. III-A LLL-PN; Sec. IV (test set); Table I]
"Let St be the fluorescent signal of interest, LLLt be a predicted LLL frame, and Rt be the read noise of the camera at frame t, all scaled between 0 and 1. Then a noisy FV frame, ˜Fvt, is given by, ... (1) ... We simulate simulate noisy frames using the clean FV in OL-Combined as St in our noise model and train the algorithms to recover St. Unless otherwise noted the test set used is from OL-Combined."
The LLL injected by Eq. (1) is the output of the LLL-PN, fLLL(Rvt), trained on OL-LLL (Sec. III-A). The same Eq. (1) generates both training and test frames from OL-Combined, so the LLL component of the test distribution is produced by the very function the denoisers are trained to invert. Tables I-III therefore rank models on removal of the LLL-PN's own predictions, not on removal of real LLL. The paper concedes fLLL captures only 40% of the L2 energy of noisy LLL frames and misses specular reflections and 3D-dependent shadows, structures that never appear in the closed-loop benchmark. The Davis control and f2lll robustness test are independent checks, but f2lll is itself another fitted LLL-PN, so neither breaks the same-generator loop for real LLL validation.
full rationale
No load-bearing self-citation circularity was found: the authors' prior OFDVDnet work is used as a dataset source, an alignment strategy, and a retrained comparison baseline, all of which are empirical resources rather than assumed conclusions. The paper also provides independent grounding for its central simulation claim: the LLL-PN is evaluated against real OL-LLL frames (qualitatively and via the 40% energy figure), the noise model's gain and read noise are calibrated on physical phantoms and dark frames, the Davis experiment shows the surprising NafNet-over-BasicVSR++ ranking reverses on conventional noise, and a second LLL-PN is used to test robustness to simulator changes. The remaining mild circularity is that the main simulated benchmark uses the same LLL-PN to create both training and test LLL, so the reported PSNR/SSIM tables measure in-distribution inversion of the fitted LLL-PN, not generalization to the real LLL structures the paper itself identifies as missing (specular reflections, 3D shadows). The authors acknowledge the load-bearing RV-to-LLL assumption must 'be important to check in human data,' which further limits external validity. This partial same-generator circularity warrants a score of 3, not higher, because the central claim has independent content and the circular element is confined to the simulated evaluation loop.
Assumptions & free parameters
free parameters (4)
- Camera gain K =
1/1764 (scaled to [0,1])
- Signal photon scaling Sm =
Evaluated at 10-200; training range [10, 1/(2K)]
- LLL photon scaling Lm =
Evaluated at 0 to Sm
- Read-noise scaling Rm =
6 at test; trained over [4,8]
assumptions (5)
- domain assumption Reference video (RV) predicts near-infrared LLL.
- domain assumption Clean FV from high-concentration ICG is LLL-free ground truth.
- domain assumption Noise decomposes as Eq. 1: read noise, shot noise, and additive LLL photon count.
- domain assumption Time-contiguous dark frames from OL-Dark model the sensor read noise.
- domain assumption Simulated noise transfers to real FGS data.
Cite this review
Pith. "Pith review of Video Denoising in Fluorescence Guided Surgery." pith.science (2026). https://pith.science/paper/HBC3EQSS
@misc{pith2026241109798,
author = {Pith},
title = {Pith review of: Video Denoising in Fluorescence Guided Surgery},
year = {2026},
howpublished = {\url{https://pith.science/paper/HBC3EQSS}},
note = {Machine review of arXiv:2411.09798}
}
read the original abstract
Fluorescence guided surgery (FGS) is a promising surgical technique that gives surgeons a unique view of tissue that is used to guide their practice by delineating tissue types and diseased areas. As new fluorescent contrast agents are developed that have low fluorescent photon yields, it becomes increasingly important to develop computational models to allow FGS systems to maintain good video quality in real time environments. To further complicate this task, FGS has a difficult bias noise term from laser leakage light (LLL) that represents unfiltered excitation light that can be on the order of the fluorescent signal. Most conventional video denoising methods focus on zero mean noise, and non-causal processing, both of which are violated in FGS. Luckily in FGS, often a co-located reference video is also captured which we use to simulate the LLL and assist in the denoising processes. In this work, we propose an accurate noise simulation pipeline that includes LLL and propose three baseline deep learning based algorithms for FGS video denoising.
Figures
Figures from the paper (11 more)
Reference graph
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real_short.mp4
"real_short.mp4" : baseline results on OL-Real
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Short_sm25_lm_25.mp4
"Short_sm25_lm_25.mp4" : baseline results on Lm = 25 = Sm simulated data
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Short_sm50_lm_50.mp4
"Short_sm50_lm_50.mp4" : all model results on Lm = 50 = Sm simulated data. In general the baseline models obtain better temporal consistency than either NafNet32 or BasicVSR++ C. Full video results are available at [12]. Reviewer link to dataset with video results: https://dat...
Reviewed August 12, 2026 · model on record in the stance chip above.
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