Reasoning Text-to-Video Retrieval for Operating Room Clips via Action-Driven Digital Twins
Authors: Yiqing Shen, Hao Ding, Mathias Unberath
Organizations: Johns Hopkins University, Baltimore, MD, USA
Abstract
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.
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.
CoVR-R studies reason-aware composed video retrieval: given a reference video and an edit instruction, the system must retrieve the target video that satisfies the edit. The main difficulty is that the target is not described directly; it must be inferred from fine-grained changes in object identity, action order, final state, hand interaction, and scene transition. We build a zero-shot reason-then-retrieve pipeline around Qwen3.5-27B. For each gallery video, the model generates a retrieval-oriented structured description and a dense embedding by pooling generated-token hidden states with token-dependent weights. For each query, the model first performs edit reasoning over the reference video and instruction, then generates a target-video description whose hidden states serve as the query embedding. We complement dense retrieval with a TF-IDF branch over the generated texts and fuse the two rankings with split-specific weights. On validation, the current best submission reaches 80.81 at R@1, 94.86 at R@5, 97.11 at R@10, and 98.59 at R@50. On the blind test split, it reaches 89.73 at R@1, 95.79 at R@5, 96.63 at R@10, and 97.98 at R@50.
The CoVR-R challenge evaluates composed video retrieval, where a system must retrieve a target video from a large gallery given a reference video and a textual edit instruction. This setting is not a standard video-text retrieval problem: the query is defined by both the visual evidence in the source video and the transformation implied by the edit. A strong embedding model can provide scalable candidate recall, but it may under-express target-side consequences such as state changes, action replacement, object preservation, or temporal consistency. A pairwise multimodal reranker can verify such details more directly, but exhaustive reranking over the full gallery is computationally infeasible. We present R3, a zero-shot composed video retrieval pipeline built around Reasoning-guided Recalling and Reranking. The core idea is to turn the source-edit query into a reasoning-grounded retrieval program rather than treating the edit text as a short caption. First, the model generates a reasoning trace that describes the expected target video after applying the edit. Then the trace is encoded together with the source video as a reasoning-augmented query, and its retrieval score is fused with the base composed query through an agreement-gated residual rule. At last, a re-ranker verifies the recalled candidates with direct source-candidate comparison. Experiments have demonstrated the effectiveness of our method in addressing this challenge. Codes are available on https://github.com/Lee-zixu/R-3.