OR-Action: Multi-Role Video Understanding with Fine-Grained Actions
Authors: Felix Tristram, Ege Özsoy, Christian Benz, Marcel Walch, Ghazal Ghazaei, Nassir Navab
Abstract
Fine-grained understanding of operating room (OR) activity could enable workflow-aware assistance, yet remains difficult due to clutter, occlusions, and limited sensing. The prevailing approach to model this environment is scene graphs as an interpretable representation of OR interactions. Converting their frame-wise relational predictions into temporally extended, fine-grained actions however, is challenging without explicit temporal modeling. To enable a principled temporal evaluation of current OR understanding methods, we introduce the first action-centric benchmark built on a publicly available ego-exocentric OR dataset by defining a fine-grained, multi-role action taxonomy and generating dense action segments via distillation from ground-truth scene graph state changes. Experiments on this benchmark show that current scene graph prediction methods struggle to model temporal structure, even when adding explicit modeling through Graph Neural Networks. We therefore introduce a vision-only temporal model that outperforms graph-based methods significantly when using all available egocentric video as input. Building on this model we also introduce a novel multi- to single-view feature alignment strategy that improves single-view performance on multi-role action recognition, mitigating the need for extensive egocentric video capture. Benchmark and code will be released upon acceptance.
Text-to-video retrieval in operating rooms (OR) is an enabling technology for OR safety, as it allows stakeholders to retrieve and inspect recordings of specific events. However, because the most safety-critical events may not follow the common structure, to unlock its full potential text-to-video retrieval must be able to handle implicit queries that require reasoning to identify the right video (e.g., the step right before clipping). However, existing methods rely on global embeddings that cannot reason over such queries. We propose OR3, a text-to-video retrieval method that converts clips into action-driven digital twins (ActDTs), grouping concurrent subject-action-object triplets under non-overlapping temporal intervals. Moreover, rather than cross-modal matching through paired encoders, OR3 performs imagination-based retrieval where an LLM generates hypothetical ActDTs from queries. This enables intra-modal matching via a single encoder trained with ActDT-tailored hard negatives. Finally, evidence-grounded refinement revises imagined ActDTs based on discrepancies with top candidates to capture procedure-specific patterns. We construct a benchmark from MM-OR with 276 implicit queries across four reasoning categories over 386 clips from robotic knee procedures. OR3 achieves 57.6 R@1 and 77.3 R@5, outperforming the strongest baseline. These results demonstrate that OR3 enables fine-grained discrimination between visually similar OR video clips through temporal action reasoning.
Action reasoning in egocentric video requires capturing fine-grained transitions of hand-object interactions, a task where general-purpose Vision-Language Models (VLMs) often struggle when operating directly on raw pixels. We propose to decouple visual perception from symbolic reasoning by converting videos into Temporal Action Graphs. In a multi-stage prompting pipeline, we first generate dense natural language narratives over short temporal windows as a semantic bottleneck, then formalize them into structured, open-vocabulary graph representations. On the EGTEA and Epic-Kitchens-100 datasets, the symbolic representation unlocks efficient in-context learning: few-shot graph demonstrations yield substantial accuracy gains over zero-shot frame and graph-based inference alike. Even in the zero-shot setting, graph-based reasoning remains competitive with pixel-based inference despite potential pretraining contamination favoring the latter. Across 11 open-weight VLMs from 6 model families ranging from 2B to 235B parameters, our findings indicate that current VLMs are more effective as symbolic reasoners than as direct visual observers. By projecting video into the language domain, we provide a scalable, fine-tuning-free alternative to end-to-end approaches that better leverages these models' latent reasoning strengths. The code will be made public.
Bessie Dominguez-Dager, Francisco Gomez-Donoso, Miguel Cazorla +3
Multimodal large language models (MLLMs) are increasingly expected to act on visual information, yet the same scene may require different actions under different task contexts. How reliably can a model turn the same visual evidence into the action required by the current context? To answer this question, we introduce \textsc{ROSE} (\textbf{R}eference-conditioned \textbf{O}ddity and \textbf{S}ymbolic \textbf{E}xecution), a controlled benchmark that holds the visual scene fixed while varying region constraints and required symbolic outputs. Through coupled counting and coordinate-action tasks, \textsc{ROSE} tests whether models can infer an implicit majority reference and act on the resulting fine-grained visual evidence under changing contexts. Across nine recent MLLMs, performance drops by as much as 44.5 percentage points from counting-oriented tasks to region-conditioned action, despite 98.8% human performance. The gap persists on paired scenes and regions for which the same model returns the correct count, while global-click and matched local controls show that coordinate grounding explains only part of the loss, revealing a distinct, model-dependent bottleneck in turning shared visual evidence into context-specific actions.