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Tom Vercauteren

Tom Vercauteren contributes to research discovery and scholarly infrastructure.

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Published work

21 published item(s)

preprint2026arXiv

Towards Real-Time Autonomous Navigation: Transformer-Based Catheter Tip Tracking in Fluoroscopy

Purpose: Mechanical thrombectomy (MT) improves stroke outcomes, but is limited by a lack of local treatment access. Widespread distribution of reinforcement learning (RL)-based robotic systems can be used to alleviate this challenge through autonomous navigation, but current RL methods require live device tip coordinate tracking to function. This paper aims to develop and evaluate a real-time catheter tip tracking pipeline under fluoroscopy, addressing challenges such as low contrast, noise, and device occlusion. Methods: A multi-threaded pipeline was designed, incorporating frame reading, preprocessing, inference, and post-processing. Deep learning segmentation models, including U-Net, U-Net+Transformer, and SegFormer, were trained and benchmarked using two-class and three-class formulations. Post-processing involved two-step component filtering, one-pixel medial skeletonization, and greedy arc-length path following with contour fall-back. Results: On manually-labeled moderate complexity fluoroscopic video data, the two-class SegFormer achieved a mean absolute error of 4.44 mm, outperforming U-Net (4.60 mm), U-Net+Transformer (6.20 mm) and all three-class models (5.19-7.74 mm). On segmentation benchmarks, the system exceeded state-of-the-art CathAction results with improvements of up to +5% in Dice scores for three-segmentation. Conclusion: The results demonstrate that the proposed multi-threaded tracking framework maintains stable performance under challenging imaging conditions, outperforming prior benchmarks, while providing a reliable and efficient foundation for RL-based autonomous MT navigation.

preprint2025arXiv

Beyond one-hot encoding? Journey into compact encoding for large multi-class segmentation

This work presents novel methods to reduce computational and memory requirements for medical image segmentation with a large number of classes. We curiously observe challenges in maintaining state-of-the-art segmentation performance with all of the explored options. Standard learning-based methods typically employ one-hot encoding of class labels. The computational complexity and memory requirements thus increase linearly with the number of classes. We propose a family of binary encoding approaches instead of one-hot encoding to reduce the computational complexity and memory requirements to logarithmic in the number of classes. In addition to vanilla binary encoding, we investigate the effects of error-correcting output codes (ECOCs), class weighting, hard/soft decoding, class-to-codeword assignment, and label embedding trees. We apply the methods to the use case of whole brain parcellation with 108 classes based on 3D MRI images. While binary encodings have proven efficient in so-called extreme classification problems in computer vision, we faced challenges in reaching state-of-the-art segmentation quality with binary encodings. Compared to one-hot encoding (Dice Similarity Coefficient (DSC) = 82.4 (2.8)), we report reduced segmentation performance with the binary segmentation approaches, achieving DSCs in the range from 39.3 to 73.8. Informative negative results all too often go unpublished. We hope that this work inspires future research of compact encoding strategies for large multi-class segmentation tasks.

preprint2025arXiv

X-RAFT: Cross-Modal Non-Rigid Registration of Blue and White Light Neurosurgical Hyperspectral Images

Integration of hyperspectral imaging into fluorescence-guided neurosurgery has the potential to improve surgical decision making by providing quantitative fluorescence measurements in real-time. Quantitative fluorescence requires paired spectral data in fluorescence (blue light) and reflectance (white light) mode. Blue and white image acquisition needs to be performed sequentially in a potentially dynamic surgical environment. A key component to the fluorescence quantification process is therefore the ability to find dense cross-modal image correspondences between two hyperspectral images taken under these drastically different lighting conditions. We address this challenge with the introduction of X-RAFT, a Recurrent All-Pairs Field Transforms (RAFT) optical flow model modified for cross-modal inputs. We propose using distinct image encoders for each modality pair, and fine-tune these in a self-supervised manner using flow-cycle-consistency on our neurosurgical hyperspectral data. We show an error reduction of 36.6% across our evaluation metrics when comparing to a naive baseline and 27.83% reduction compared to an existing cross-modal optical flow method (CrossRAFT). Our code and models will be made publicly available after the review process.

preprint2022arXiv

Comparative study of deep learning methods for the automatic segmentation of lung, lesion and lesion type in CT scans of COVID-19 patients

Recent research on COVID-19 suggests that CT imaging provides useful information to assess disease progression and assist diagnosis, in addition to help understanding the disease. There is an increasing number of studies that propose to use deep learning to provide fast and accurate quantification of COVID-19 using chest CT scans. The main tasks of interest are the automatic segmentation of lung and lung lesions in chest CT scans of confirmed or suspected COVID-19 patients. In this study, we compare twelve deep learning algorithms using a multi-center dataset, including both open-source and in-house developed algorithms. Results show that ensembling different methods can boost the overall test set performance for lung segmentation, binary lesion segmentation and multiclass lesion segmentation, resulting in mean Dice scores of 0.982, 0.724 and 0.469, respectively. The resulting binary lesions were segmented with a mean absolute volume error of 91.3 ml. In general, the task of distinguishing different lesion types was more difficult, with a mean absolute volume difference of 152 ml and mean Dice scores of 0.369 and 0.523 for consolidation and ground glass opacity, respectively. All methods perform binary lesion segmentation with an average volume error that is better than visual assessment by human raters, suggesting these methods are mature enough for a large-scale evaluation for use in clinical practice.

preprint2022arXiv

Cross-Modality Image Registration using a Training-Time Privileged Third Modality

In this work, we consider the task of pairwise cross-modality image registration, which may benefit from exploiting additional images available only at training time from an additional modality that is different to those being registered. As an example, we focus on aligning intra-subject multiparametric Magnetic Resonance (mpMR) images, between T2-weighted (T2w) scans and diffusion-weighted scans with high b-value (DWI$_{high-b}$). For the application of localising tumours in mpMR images, diffusion scans with zero b-value (DWI$_{b=0}$) are considered easier to register to T2w due to the availability of corresponding features. We propose a learning from privileged modality algorithm, using a training-only imaging modality DWI$_{b=0}$, to support the challenging multi-modality registration problems. We present experimental results based on 369 sets of 3D multiparametric MRI images from 356 prostate cancer patients and report, with statistical significance, a lowered median target registration error of 4.34 mm, when registering the holdout DWI$_{high-b}$ and T2w image pairs, compared with that of 7.96 mm before registration. Results also show that the proposed learning-based registration networks enabled efficient registration with comparable or better accuracy, compared with a classical iterative algorithm and other tested learning-based methods with/without the additional modality. These compared algorithms also failed to produce any significantly improved alignment between DWI$_{high-b}$ and T2w in this challenging application.

preprint2022arXiv

Deep Quality Estimation: Creating Surrogate Models for Human Quality Ratings

Human ratings are abstract representations of segmentation quality. To approximate human quality ratings on scarce expert data, we train surrogate quality estimation models. We evaluate on a complex multi-class segmentation problem, specifically glioma segmentation, following the BraTS annotation protocol. The training data features quality ratings from 15 expert neuroradiologists on a scale ranging from 1 to 6 stars for various computer-generated and manual 3D annotations. Even though the networks operate on 2D images and with scarce training data, we can approximate segmentation quality within a margin of error comparable to human intra-rater reliability. Segmentation quality prediction has broad applications. While an understanding of segmentation quality is imperative for successful clinical translation of automatic segmentation quality algorithms, it can play an essential role in training new segmentation models. Due to the split-second inference times, it can be directly applied within a loss function or as a fully-automatic dataset curation mechanism in a federated learning setting.

preprint2022arXiv

Motion Correction and Volumetric Reconstruction for Fetal Functional Magnetic Resonance Imaging Data

Motion correction is an essential preprocessing step in functional Magnetic Resonance Imaging (fMRI) of the fetal brain with the aim to remove artifacts caused by fetal movement and maternal breathing and consequently to suppress erroneous signal correlations. Current motion correction approaches for fetal fMRI choose a single 3D volume from a specific acquisition timepoint with least motion artefacts as reference volume, and perform interpolation for the reconstruction of the motion corrected time series. The results can suffer, if no low-motion frame is available, and if reconstruction does not exploit any assumptions about the continuity of the fMRI signal. Here, we propose a novel framework, which estimates a high-resolution reference volume by using outlier-robust motion correction, and by utilizing Huber L2 regularization for intra-stack volumetric reconstruction of the motion-corrected fetal brain fMRI. We performed an extensive parameter study to investigate the effectiveness of motion estimation and present in this work benchmark metrics to quantify the effect of motion correction and regularised volumetric reconstruction approaches on functional connectivity computations. We demonstrate the proposed framework's ability to improve functional connectivity estimates, reproducibility and signal interpretability, which is clinically highly desirable for the establishment of prognostic noninvasive imaging biomarkers. The motion correction and volumetric reconstruction framework is made available as an open-source package of NiftyMIC.

preprint2022arXiv

Robotic Endoscope Control via Autonomous Instrument Tracking

Many keyhole interventions rely on bi-manual handling of surgical instruments, forcing the main surgeon to rely on a second surgeon to act as a camera assistant. In addition to the burden of excessively involving surgical staff, this may lead to reduced image stability, increased task completion time and sometimes errors due to the monotony of the task. Robotic endoscope holders, controlled by a set of basic instructions, have been proposed as an alternative, but their unnatural handling may increase the cognitive load of the (solo) surgeon, which hinders their clinical acceptance. More seamless integration in the surgical workflow would be achieved if robotic endoscope holders collaborated with the operating surgeon via semantically rich instructions that closely resemble instructions that would otherwise be issued to a human camera assistant, such as "focus on my right-hand instrument". As a proof of concept, this paper presents a novel system that paves the way towards a synergistic interaction between surgeons and robotic endoscope holders. The proposed platform allows the surgeon to perform a bimanual coordination and navigation task, while a robotic arm autonomously performs the endoscope positioning tasks. Within our system, we propose a novel tooltip localization method based on surgical tool segmentation and a novel visual servoing approach that ensures smooth and appropriate motion of the endoscope camera. We validate our vision pipeline and run a user study of this system. The clinical relevance of the study is ensured through the use of a laparoscopic exercise validated by the European Academy of Gynaecological Surgery which involves bi-manual coordination and navigation. Successful application of our proposed system provides a promising starting point towards broader clinical adoption of robotic endoscope holders.

preprint2021arXiv

Deep Homography Estimation in Dynamic Surgical Scenes for Laparoscopic Camera Motion Extraction

Current laparoscopic camera motion automation relies on rule-based approaches or only focuses on surgical tools. Imitation Learning (IL) methods could alleviate these shortcomings, but have so far been applied to oversimplified setups. Instead of extracting actions from oversimplified setups, in this work we introduce a method that allows to extract a laparoscope holder's actions from videos of laparoscopic interventions. We synthetically add camera motion to a newly acquired dataset of camera motion free da Vinci surgery image sequences through a novel homography generation algorithm. The synthetic camera motion serves as a supervisory signal for camera motion estimation that is invariant to object and tool motion. We perform an extensive evaluation of state-of-the-art (SOTA) Deep Neural Networks (DNNs) across multiple compute regimes, finding our method transfers from our camera motion free da Vinci surgery dataset to videos of laparoscopic interventions, outperforming classical homography estimation approaches in both, precision by 41%, and runtime on a CPU by 43%.

preprint2021arXiv

Distributionally Robust Segmentation of Abnormal Fetal Brain 3D MRI

The performance of deep neural networks typically increases with the number of training images. However, not all images have the same importance towards improved performance and robustness. In fetal brain MRI, abnormalities exacerbate the variability of the developing brain anatomy compared to non-pathological cases. A small number of abnormal cases, as is typically available in clinical datasets used for training, are unlikely to fairly represent the rich variability of abnormal developing brains. This leads machine learning systems trained by maximizing the average performance to be biased toward non-pathological cases. This problem was recently referred to as hidden stratification. To be suited for clinical use, automatic segmentation methods need to reliably achieve high-quality segmentation outcomes also for pathological cases. In this paper, we show that the state-of-the-art deep learning pipeline nnU-Net has difficulties to generalize to unseen abnormal cases. To mitigate this problem, we propose to train a deep neural network to minimize a percentile of the distribution of per-volume loss over the dataset. We show that this can be achieved by using Distributionally Robust Optimization (DRO). DRO automatically reweights the training samples with lower performance, encouraging nnU-Net to perform more consistently on all cases. We validated our approach using a dataset of 368 fetal brain T2w MRIs, including 124 MRIs of open spina bifida cases and 51 MRIs of cases with other severe abnormalities of brain development.

preprint2021arXiv

Image Compositing for Segmentation of Surgical Tools without Manual Annotations

Producing manual, pixel-accurate, image segmentation labels is tedious and time-consuming. This is often a rate-limiting factor when large amounts of labeled images are required, such as for training deep convolutional networks for instrument-background segmentation in surgical scenes. No large datasets comparable to industry standards in the computer vision community are available for this task. To circumvent this problem, we propose to automate the creation of a realistic training dataset by exploiting techniques stemming from special effects and harnessing them to target training performance rather than visual appeal. Foreground data is captured by placing sample surgical instruments over a chroma key (a.k.a. green screen) in a controlled environment, thereby making extraction of the relevant image segment straightforward. Multiple lighting conditions and viewpoints can be captured and introduced in the simulation by moving the instruments and camera and modulating the light source. Background data is captured by collecting videos that do not contain instruments. In the absence of pre-existing instrument-free background videos, minimal labeling effort is required, just to select frames that do not contain surgical instruments from videos of surgical interventions freely available online. We compare different methods to blend instruments over tissue and propose a novel data augmentation approach that takes advantage of the plurality of options. We show that by training a vanilla U-Net on semi-synthetic data only and applying a simple post-processing, we are able to match the results of the same network trained on a publicly available manually labeled real dataset.

preprint2021arXiv

Intrapapillary Capillary Loop Classification in Magnification Endoscopy: Open Dataset and Baseline Methodology

Purpose. Early squamous cell neoplasia (ESCN) in the oesophagus is a highly treatable condition. Lesions confined to the mucosal layer can be curatively treated endoscopically. We build a computer-assisted detection (CADe) system that can classify still images or video frames as normal or abnormal with high diagnostic accuracy. Methods. We present a new benchmark dataset containing 68K binary labeled frames extracted from 114 patient videos whose imaged areas have been resected and correlated to histopathology. Our novel convolutional network (CNN) architecture solves the binary classification task and explains what features of the input domain drive the decision-making process of the network. Results. The proposed method achieved an average accuracy of 91.7 % compared to the 94.7 % achieved by a group of 12 senior clinicians. Our novel network architecture produces deeply supervised activation heatmaps that suggest the network is looking at intrapapillary capillary loop (IPCL) patterns when predicting abnormality. Conclusion. We believe that this dataset and baseline method may serve as a reference for future benchmarks on both video frame classification and explainability in the context of ESCN detection. A future work path of high clinical relevance is the extension of the classification to ESCN types.

preprint2021arXiv

Scale factor point spread function matching: Beyond aliasing in image resampling

Imaging devices exploit the Nyquist-Shannon sampling theorem to avoid both aliasing and redundant oversampling by design. Conversely, in medical image resampling, images are considered as continuous functions, are warped by a spatial transformation, and are then sampled on a regular grid. In most cases, the spatial warping changes the frequency characteristics of the continuous function and no special care is taken to ensure that the resampling grid respects the conditions of the sampling theorem. This paper shows that this oversight introduces artefacts, including aliasing, that can lead to important bias in clinical applications. One notable exception to this common practice is when multi-resolution pyramids are constructed, with low-pass &#34;anti-aliasing&#34; filters being applied prior to downsampling. In this work, we illustrate why similar caution is needed when resampling images under general spatial transformations and propose a novel method that is more respectful of the sampling theorem, minimising aliasing and loss of information. We introduce the notion of scale factor point spread function (sfPSF) and employ Gaussian kernels to achieve a computationally tractable resampling scheme that can cope with arbitrary non-linear spatial transformations and grid sizes. Experiments demonstrate significant (p<1e-4) technical and clinical implications of the proposed method.

preprint2020arXiv

Active Annotation of Informative Overlapping Frames in Video Mosaicking Applications

Video mosaicking requires the registration of overlapping frames located at distant timepoints in the sequence to ensure global consistency of the reconstructed scene. However, fully automated registration of such long-range pairs is (i) challenging when the registration of images itself is difficult; and (ii) computationally expensive for long sequences due to the large number of candidate pairs for registration. In this paper, we introduce an efficient framework for the active annotation of long-range pairwise correspondences in a sequence. Our framework suggests pairs of images that are sought to be informative to an oracle agent (e.g., a human user, or a reliable matching algorithm) who provides visual correspondences on each suggested pair. Informative pairs are retrieved according to an iterative strategy based on a principled annotation reward coupled with two complementary and online adaptable models of frame overlap. In addition to the efficient construction of a mosaic, our framework provides, as a by-product, ground truth landmark correspondences which can be used for evaluation or learning purposes. We evaluate our approach in both automated and interactive scenarios via experiments on synthetic sequences, on a publicly available dataset for aerial imaging and on a clinical dataset for placenta mosaicking during fetal surgery.

preprint2020arXiv

Manual segmentation versus semi-automated segmentation for quantifying vestibular schwannoma volume on MRI

Management of vestibular schwannoma (VS) is based on tumour size as observed on T1 MRI scans with contrast agent injection. Current clinical practice is to measure the diameter of the tumour in its largest dimension. It has been shown that volumetric measurement is more accurate and more reliable as a measure of VS size. The reference approach to achieve such volumetry is to manually segment the tumour, which is a time intensive task. We suggest that semi-automated segmentation may be a clinically applicable solution to this problem and that it could replace linear measurements as the clinical standard. Using high-quality software available for academic purposes, we ran a comparative study of manual versus semi-automated segmentation of VS on MRI with 5 clinicians and scientists. We gathered both quantitative and qualitative data to compare the two approaches; including segmentation time, segmentation effort and segmentation accuracy. We found that the selected semi-automated segmentation approach is significantly faster (167s versus 479s, p<0.001), less temporally and physically demanding and has approximately equal performance when compared with manual segmentation, with some improvements in accuracy. There were some limitations, including algorithmic unpredictability and error, which produced more frustration and increased mental effort in comparison to manual segmentation. We suggest that semi-automated segmentation could be applied clinically for volumetric measurement of VS on MRI. In future, the generic software could be refined for use specifically for VS segmentation, thereby improving accuracy.

preprint2020arXiv

Real-Time Segmentation of Non-Rigid Surgical Tools based on Deep Learning and Tracking

Real-time tool segmentation is an essential component in computer-assisted surgical systems. We propose a novel real-time automatic method based on Fully Convolutional Networks (FCN) and optical flow tracking. Our method exploits the ability of deep neural networks to produce accurate segmentations of highly deformable parts along with the high speed of optical flow. Furthermore, the pre-trained FCN can be fine-tuned on a small amount of medical images without the need to hand-craft features. We validated our method using existing and new benchmark datasets, covering both ex vivo and in vivo real clinical cases where different surgical instruments are employed. Two versions of the method are presented, non-real-time and real-time. The former, using only deep learning, achieves a balanced accuracy of 89.6% on a real clinical dataset, outperforming the (non-real-time) state of the art by 3.8% points. The latter, a combination of deep learning with optical flow tracking, yields an average balanced accuracy of 78.2% across all the validated datasets.

preprint2020arXiv

Seeing through multimode fibers with real-valued intensity transmission matrices

Image transmission through multimode optical fibers has been an area of immense interests driven by the demand for miniature endoscopes in biomedicine and higher speed and capacity in telecommunications. Conventionally, a complex-valued transmission matrix is obtained experimentally to link the input and output light fields of a multimode fiber for image retrieval, which complicates the experimental setup and increases the computational complexity. Here, we report a simple and high-speed method for image retrieval based on our discovery of a pseudo-linearity between the input and output light intensity distributions of multimode fibers. We studied the impact of several key parameters to image retrieval, including image pixel count, fiber core diameter and numerical aperture. We further demonstrated that a wide variety of input binary images could be faithfully retrieved from measured output speckle patterns using this method, promising to be useful for highly miniaturized endoscopy in biomedicine and spatial-mode-division multiplexing in telecommunications.

preprint2019arXiv

Improved MR to CT synthesis for PET/MR attenuation correction using Imitation Learning

The ability to synthesise Computed Tomography images - commonly known as pseudo CT, or pCT - from MRI input data is commonly assessed using an intensity-wise similarity, such as an L2-norm between the ground truth CT and the pCT. However, given that the ultimate purpose is often to use the pCT as an attenuation map ($μ$-map) in Positron Emission Tomography Magnetic Resonance Imaging (PET/MRI), minimising the error between pCT and CT is not necessarily optimal. The main objective should be to predict a pCT that, when used as $μ$-map, reconstructs a pseudo PET (pPET) which is as close as possible to the gold standard PET. To this end, we propose a novel multi-hypothesis deep learning framework that generates pCTs by minimising a combination of the pixel-wise error between pCT and CT and a proposed metric-loss that itself is represented by a convolutional neural network (CNN) and aims to minimise subsequent PET residuals. The model is trained on a database of 400 paired MR/CT/PET image slices. Quantitative results show that the network generates pCTs that seem less accurate when evaluating the Mean Absolute Error on the pCT (69.68HU) compared to a baseline CNN (66.25HU), but lead to significant improvement in the PET reconstruction - 115a.u. compared to baseline 140a.u.

preprint2019arXiv

Learning from Irregularly Sampled Data for Endomicroscopy Super-resolution: A Comparative Study of Sparse and Dense Approaches

Purpose: Probe-based Confocal Laser Endomicroscopy (pCLE) enables performing an optical biopsy, providing real-time microscopic images, via a probe. pCLE probes consist of multiple optical fibres arranged in a bundle, which taken together generate signals in an irregularly sampled pattern. Current pCLE reconstruction is based on interpolating irregular signals onto an over-sampled Cartesian grid, using a naive linear interpolation. It was shown that Convolutional Neural Networks (CNNs) could improve pCLE image quality. Although classical CNNs were applied to pCLE, input data were limited to reconstructed images in contrast to irregular data produced by pCLE. Methods: We compare pCLE reconstruction and super-resolution (SR) methods taking irregularly sampled or reconstructed pCLE images as input. We also propose to embed a Nadaraya-Watson (NW) kernel regression into the CNN framework as a novel trainable CNN layer. Using the NW layer and exemplar-based super-resolution, we design an NWNetSR architecture that allows for reconstructing high-quality pCLE images directly from the irregularly sampled input data. We created synthetic sparse pCLE images to evaluate our methodology. Results: The results were validated through an image quality assessment based on a combination of the following metrics: Peak signal-to-noise ratio, the Structural Similarity Index. Conclusion: Both dense and sparse CNNs outperform the reconstruction method currently used in the clinic. The main contributions of our study are a comparison of sparse and dense approach in pCLE image reconstruction, implementing trainable generalised NW kernel regression, and adaptation of synthetic data for training pCLE SR.

preprint2019arXiv

Learning joint lesion and tissue segmentation from task-specific hetero-modal datasets

Brain tissue segmentation from multimodal MRI is a key building block of many neuroscience analysis pipelines. It could also play an important role in many clinical imaging scenarios. Established tissue segmentation approaches have however not been developed to cope with large anatomical changes resulting from pathology. The effect of the presence of brain lesions, for example, on their performance is thus currently uncontrolled and practically unpredictable. Contrastingly, with the advent of deep neural networks (DNNs), segmentation of brain lesions has matured significantly and is achieving performance levels making it of interest for clinical use. However, few existing approaches allow for jointly segmenting normal tissue and brain lesions. Developing a DNN for such joint task is currently hampered by the fact that annotated datasets typically address only one specific task and rely on a task-specific hetero-modal imaging protocol. In this work, we propose a novel approach to build a joint tissue and lesion segmentation model from task-specific hetero-modal and partially annotated datasets. Starting from a variational formulation of the joint problem, we show how the expected risk can be decomposed and optimised empirically. We exploit an upper-bound of the risk to deal with missing imaging modalities. For each task, our approach reaches comparable performance than task-specific and fully-supervised models.

preprint2018arXiv

Image computing for fibre-bundle endomicroscopy: A review

Endomicroscopy is an emerging imaging modality, that facilitates the acquisition of in vivo, in situ optical biopsies, assisting diagnostic and potentially therapeutic interventions. While there is a diverse and constantly expanding range of commercial and experimental optical biopsy platforms available, fibre-bundle endomicroscopy is currently the most widely used platform and is approved for clinical use in a range of clinical indications. Miniaturised, flexible fibre-bundles, guided through the working channel of endoscopes, needles and catheters, enable high-resolution imaging across a variety of organ systems. Yet, the nature of image acquisition though a fibre-bundle gives rise to several inherent characteristics and limitations necessitating novel and effective image pre- and post-processing algorithms, ranging from image formation, enhancement and mosaicing to pathology detection and quantification. This paper introduces the underlying technology and most prevalent clinical applications of fibre-bundle endomicroscopy, and provides a comprehensive, up-to-date, review of relevant image reconstruction, analysis and understanding/inference methodologies. Furthermore, current limitations as well as future challenges and opportunities in fibre-bundle endomicroscopy computing are identified and discussed.