{ "export_format": "kindly-labeling-export/1.0", "schema_version": "0.1.0", "vocab_ref": "vocab/OR.instrument_count@0.1.json", "synthetic": true, "_readme": { "what_this_is": "A single fully-worked SYNTHETIC sample episode conforming to the Kindly Robotics clinical-workflow annotation schema v0.1, from a DIFFERENT workflow family than the SPD tray-assembly sample. This one is an intraoperative surgical instrument count + handling workflow (scrub-tech / circulating-nurse domain). It exists so a foundation-model lab or surgical-robot OEM engineer can load, inspect, and validate the schema across more than one workflow family without any data-sharing agreement.", "guardrails": "Every value in this file is synthetic. No clinical capture has occurred. There is NO real PHI, no patient data, no patient in frame, no real site, no real staff, no real consent or DPA. Identifiers prefixed SYNTH/synth/op-synth/ann-synth are placeholders. This episode is intentionally scoped to workflow/logistics — instrument counting, passing, and reconciliation — and contains NO surgeon technique, no clinical decision-making, and no procedure-specific detail.", "status": "v0.1 / in development / pre-capture. The schema is what first-cohort design partners shape; this is a paper example used to surface gaps before real footage exists. SYNTHETIC + STRUCTURAL — flag for Carmina/Thomas clinical review before treating as canonical.", "structure": "episode_envelope -> labels.L1 (phase/step segments) -> labels.L2 (action triplets) -> labels.L3 (instrument-state tracks) -> labels.L4 (workflow-context events) -> rlds_excerpt (a 2-second derived RLDS slice). The sidecar (L1-L4) is the source of truth; the RLDS view is a regenerable flattening.", "scenario": "~7-minute intraoperative surgical instrument count workflow: initial (baseline) count -> surgical time-out verification -> instrument passing/handling during the case -> closing count, in which a sharps (suture needle) count comes up one short, triggering a recount and an item search that is reconciled when the missing needle is located on the field. Workflow/logistics level only." }, "episode_envelope": { "episode_id": "kr-or-synthetic-0001", "schema_version": "0.1.0", "synthetic": true, "data_provenance": "synthetic_paper_example_no_capture", "site_pseudonym": "SITE_SYNTH", "workflow_family": "OR.instrument_count", "boundary_def": "OR.instrument_count@0.1", "vocab_ref": "vocab/OR.instrument_count@0.1.json", "tray_map_ref": "traymap/GEN-LAP-REV-A@1", "program_phase": "pilot", "capture_rig_id": "RIG_SYNTH_02", "operator_pseudonyms": ["op-synth-03", "op-synth-04"], "session_log": { "task_type": "instrument_count", "tray_set_type": "general_laparotomy_generic", "anomaly_flag": true, "note": "SYNTHETIC: closing-count sharps discrepancy resolved via recount + reconciliation (needle located on field)" }, "expected_contents": { "count_sheet_ref": "GEN-LAP-REV-A", "items": [ { "object_class": "lap_sponge", "qty": 10 }, { "object_class": "raytec_sponge", "qty": 10 }, { "object_class": "suture_needle", "qty": 4 }, { "object_class": "hemostat", "qty": 8 }, { "object_class": "kelly_clamp", "qty": 4 }, { "object_class": "needle_driver", "qty": 2 }, { "object_class": "scalpel_blade", "qty": 2 } ] }, "capture": { "fps": 30, "duration_s": 420.0, "modalities": ["rgb_egocentric", "rgb_overhead"], "frame_count": 12600 }, "deid": { "status": "verified", "method": "face_blur+badge_blur+ocr_text_review+screen_hard_mask", "reviewed_by": "deid-reviewer-synthetic", "reviewed_at": "2026-06-12T00:00:00Z", "phi_residual_risk": "low" }, "consent": { "staff_consent_ref": "SYNTHETIC-NO-CONSENT-EXISTS", "facility_dpa_ref": "SYNTHETIC-NO-DPA-EXISTS", "patient_in_frame": false }, "task_summary": "SYNTHETIC: Intraoperative surgical instrument count workflow against count sheet GEN-LAP-REV-A — baseline count, time-out verification, instrument passing/handling, and closing count; closing sharps count came up one suture needle short, prompting a recount and field search, reconciled when the needle was located. Workflow/logistics only; no surgeon technique or clinical decision-making.", "annotation_provenance": { "annotators": ["ann-synth-03", "ann-synth-04"], "clinical_reviewer": "rev-clin-synth", "consensus_method": "double+adjudication" } }, "labels": { "L1": [ { "layer": "L1", "t_start_s": 0.0, "t_end_s": 14.0, "phase": "baseline_count", "step": "retrieve_count_sheet", "confidence": "high", "note": "t=0 = scrub field set up, count board blank (capture-protocol boundary)" }, { "layer": "L1", "t_start_s": 14.0, "t_end_s": 78.0, "phase": "baseline_count", "step": "count_aloud_with_circulator", "confidence": "high", "note": "scrub + circulator concurrent two-person count" }, { "layer": "L1", "t_start_s": 78.0, "t_end_s": 96.0, "phase": "baseline_count", "step": "record_count_board", "confidence": "high" }, { "layer": "L1", "t_start_s": 96.0, "t_end_s": 126.0, "phase": "time_out", "step": "surgical_time_out", "confidence": "high", "note": "team time-out; count status confirmed verbally" }, { "layer": "L1", "t_start_s": 126.0, "t_end_s": 150.0, "phase": "intraop_handling", "step": "organize_mayo_stand", "confidence": "high" }, { "layer": "L1", "t_start_s": 150.0, "t_end_s": 300.0, "phase": "intraop_handling", "step": "pass_and_receive_instruments", "confidence": "medium", "note": "representative passing/handling span; un-tripleted gaps are case dead-time (legal)" }, { "layer": "L1", "t_start_s": 300.0, "t_end_s": 330.0, "phase": "intraop_handling", "step": "track_sharps_on_field", "confidence": "medium", "note": "needle counter / magnet management" }, { "layer": "L1", "t_start_s": 330.0, "t_end_s": 366.0, "phase": "closing_count", "step": "count_aloud_with_circulator", "confidence": "high", "note": "sharps discrepancy found ~t=356" }, { "layer": "L1", "t_start_s": 366.0, "t_end_s": 396.0, "phase": "closing_count", "step": "recount_and_search", "confidence": "low", "note": "covers recount + field/floor search span" }, { "layer": "L1", "t_start_s": 396.0, "t_end_s": 408.0, "phase": "closing_count", "step": "reconcile_count", "confidence": "high", "note": "missing needle located on field; count reconciled" }, { "layer": "L1", "t_start_s": 408.0, "t_end_s": 420.0, "phase": "closing_count", "step": "record_final_count", "confidence": "medium", "out_of_episode": true, "note": "past boundary_def end (count reconciled); follow-on documentation footage, flagged" } ], "L2": [ { "layer": "L2", "actor_role": "scrub", "verb": "grasp", "object": "count_sheet", "t_start_s": 0.0, "t_end_s": 6.0, "target_zone": "back_table", "confidence": "high" }, { "layer": "L2", "actor_role": "scrub", "verb": "read", "object": "count_sheet", "t_start_s": 6.0, "t_end_s": 14.0, "target_zone": "back_table", "confidence": "high" }, { "layer": "L2", "actor_role": "scrub", "verb": "count", "object": "lap_sponge", "count": 10, "t_start_s": 14.0, "t_end_s": 28.0, "target_zone": "back_table", "confidence": "high", "note": "counted aloud in packs of five" }, { "layer": "L2", "actor_role": "scrub", "verb": "count", "object": "raytec_sponge", "count": 10, "t_start_s": 28.0, "t_end_s": 40.0, "target_zone": "back_table", "confidence": "high" }, { "layer": "L2", "actor_role": "scrub", "verb": "count", "object": "suture_needle", "count": 4, "t_start_s": 40.0, "t_end_s": 50.0, "target_zone": "needle_counter", "confidence": "high", "note": "loaded into needle counter box" }, { "layer": "L2", "actor_role": "scrub", "verb": "count", "object": "instrument_set", "t_start_s": 50.0, "t_end_s": 78.0, "target_zone": "back_table", "confidence": "high", "note": "hemostats, kelly clamps, needle drivers, blades" }, { "layer": "L2", "actor_role": "circulator", "verb": "record", "object": "count_board", "counterparty_role": "scrub", "t_start_s": 78.0, "t_end_s": 96.0, "target_zone": "count_board", "confidence": "high", "note": "circulator transcribes scrub's verbal baseline" }, { "layer": "L2", "actor_role": "circulator", "verb": "verify", "object": "time_out_checklist", "t_start_s": 96.0, "t_end_s": 126.0, "target_zone": "wall_display", "evidence": "masked", "confidence": "medium", "note": "checklist screen HARD-MASKED in shipped video — flagged via evidence field" }, { "layer": "L2", "actor_role": "scrub", "verb": "organize", "object": "mayo_stand", "t_start_s": 126.0, "t_end_s": 150.0, "target_zone": "mayo_stand", "confidence": "high" }, { "layer": "L2", "actor_role": "scrub", "verb": "hand_off", "object": "scalpel", "counterparty_role": "surgeon", "t_start_s": 152.0, "t_end_s": 156.0, "target_zone": "neutral_zone", "confidence": "high", "note": "hands-free neutral-zone pass; giver = actor_role, receiver = counterparty_role" }, { "layer": "L2", "actor_role": "surgeon", "verb": "return", "object": "scalpel", "counterparty_role": "scrub", "t_start_s": 168.0, "t_end_s": 172.0, "target_zone": "neutral_zone", "confidence": "high", "note": "return pass back to scrub via neutral zone" }, { "layer": "L2", "actor_role": "scrub", "verb": "hand_off", "object": "hemostat", "count": 2, "counterparty_role": "surgeon", "t_start_s": 180.0, "t_end_s": 188.0, "target_zone": "operative_field", "confidence": "medium" }, { "layer": "L2", "actor_role": "scrub", "verb": "hand_off", "object": "needle_driver_loaded", "counterparty_role": "surgeon", "t_start_s": 206.0, "t_end_s": 212.0, "target_zone": "operative_field", "confidence": "medium", "note": "needle driver loaded with suture_needle" }, { "layer": "L2", "actor_role": "surgeon", "verb": "return", "object": "needle_driver_loaded", "counterparty_role": "scrub", "t_start_s": 236.0, "t_end_s": 242.0, "target_zone": "operative_field", "confidence": "medium" }, { "layer": "L2", "actor_role": "scrub", "verb": "place", "object": "suture_needle", "t_start_s": 242.0, "t_end_s": 248.0, "target_zone": "needle_counter", "confidence": "medium", "note": "spent needle returned to counter box" }, { "layer": "L2", "actor_role": "scrub", "verb": "hand_off", "object": "raytec_sponge", "count": 2, "counterparty_role": "surgeon", "t_start_s": 262.0, "t_end_s": 268.0, "target_zone": "operative_field", "confidence": "medium" }, { "layer": "L2", "actor_role": "scrub", "verb": "receive", "object": "lap_sponge", "count": 2, "counterparty_role": "surgeon", "t_start_s": 284.0, "t_end_s": 290.0, "target_zone": "kick_bucket", "confidence": "low", "note": "soiled sponges off the field; receiver = actor_role here" }, { "layer": "L2", "actor_role": "scrub", "verb": "inspect", "object": "needle_counter", "t_start_s": 300.0, "t_end_s": 312.0, "target_zone": "mayo_stand", "confidence": "medium", "note": "interim sharps check" }, { "layer": "L2", "actor_role": "scrub", "verb": "organize", "object": "back_table", "t_start_s": 312.0, "t_end_s": 330.0, "target_zone": "back_table", "confidence": "medium", "note": "pre-closing-count tidy" }, { "layer": "L2", "actor_role": "scrub", "verb": "count", "object": "lap_sponge", "count": 10, "t_start_s": 330.0, "t_end_s": 340.0, "target_zone": "back_table", "confidence": "high", "note": "closing count begins" }, { "layer": "L2", "actor_role": "scrub", "verb": "count", "object": "raytec_sponge", "count": 10, "t_start_s": 340.0, "t_end_s": 348.0, "target_zone": "back_table", "confidence": "high" }, { "layer": "L2", "actor_role": "scrub", "verb": "count", "object": "suture_needle", "count": 3, "t_start_s": 348.0, "t_end_s": 356.0, "target_zone": "needle_counter", "confidence": "high", "note": "only 3 of 4 accounted for — discrepancy" }, { "layer": "L2", "actor_role": "scrub", "verb": "inspect", "object": "count_board", "t_start_s": 356.0, "t_end_s": 366.0, "target_zone": "count_board", "confidence": "high", "note": "recheck of sharps line item against baseline" }, { "layer": "L2", "actor_role": "circulator", "verb": "announce", "object": "count_discrepancy", "counterparty_role": "surgeon", "t_start_s": 360.0, "t_end_s": 366.0, "target_zone": "operative_field", "confidence": "high", "note": "circulator notifies team of incorrect sharps count" }, { "layer": "L2", "actor_role": "scrub", "verb": "count", "object": "suture_needle", "count": 3, "t_start_s": 366.0, "t_end_s": 376.0, "target_zone": "needle_counter", "confidence": "medium", "note": "recount — still 3" }, { "layer": "L2", "actor_role": "circulator", "verb": "search", "object": "floor_and_kick_bucket", "t_start_s": 372.0, "t_end_s": 396.0, "target_zone": "room_floor", "confidence": "low", "note": "circulator sweeps floor and kick bucket" }, { "layer": "L2", "actor_role": "scrub", "verb": "search", "object": "operative_field", "counterparty_role": "surgeon", "t_start_s": 380.0, "t_end_s": 396.0, "target_zone": "operative_field", "confidence": "low", "note": "field search with surgeon" }, { "layer": "L2", "actor_role": "scrub", "verb": "retrieve", "object": "suture_needle", "t_start_s": 396.0, "t_end_s": 400.0, "target_zone": "operative_field", "confidence": "high", "note": "missing needle located in drape fold on field" }, { "layer": "L2", "actor_role": "scrub", "verb": "place", "object": "suture_needle", "t_start_s": 400.0, "t_end_s": 404.0, "target_zone": "needle_counter", "confidence": "high", "note": "returned to counter — now 4 of 4" }, { "layer": "L2", "actor_role": "scrub", "verb": "count", "object": "suture_needle", "count": 4, "t_start_s": 404.0, "t_end_s": 408.0, "target_zone": "needle_counter", "confidence": "high", "note": "reconciled — count correct" }, { "layer": "L2", "actor_role": "circulator", "verb": "record", "object": "count_board", "counterparty_role": "scrub", "t_start_s": 408.0, "t_end_s": 420.0, "target_zone": "count_board", "confidence": "medium", "note": "final correct count documented" } ], "L3": [ { "layer": "L3", "object_id": "obj_suture_needle_box_01", "object_class": "suture_needle", "state": { "zone": "needle_counter", "sterility": "sterile", "in_count": true }, "transition_from": { "zone": "peel_pack", "sterility": "sterile", "in_count": false }, "t_s": 50.0, "count_event": "added_to_tray", "confidence": "high", "note": "baseline: 4 needles loaded into counter box; counter box tracked as the sharps container instance" }, { "layer": "L3", "object_id": "obj_suture_needle_box_01", "object_class": "suture_needle", "state": { "zone": "needle_counter", "sterility": "sterile", "in_count": true }, "transition_from": { "zone": "needle_counter", "sterility": "sterile", "in_count": true }, "t_s": 94.0, "count_event": "recount", "confidence": "high", "note": "baseline count recorded to board" }, { "layer": "L3", "object_id": "obj_suture_needle_03", "object_class": "suture_needle", "state": { "zone": "operative_field", "sterility": "sterile", "in_count": true }, "transition_from": { "zone": "needle_counter", "sterility": "sterile", "in_count": true }, "t_s": 212.0, "count_event": null, "confidence": "medium", "note": "single needle out to field loaded on driver — remains in_count while on field" }, { "layer": "L3", "object_id": "obj_suture_needle_03", "object_class": "suture_needle", "state": { "zone": "needle_counter", "sterility": "sterile", "in_count": true }, "transition_from": { "zone": "operative_field", "sterility": "sterile", "in_count": true }, "t_s": 242.0, "count_event": "relocated_within_tray", "confidence": "medium", "note": "spent needle returned to counter box" }, { "layer": "L3", "object_id": "obj_lap_sponge_set_01", "object_class": "lap_sponge", "state": { "zone": "back_table", "sterility": "sterile", "in_count": true }, "transition_from": { "zone": "peel_pack", "sterility": "sterile", "in_count": false }, "t_s": 28.0, "count_event": "added_to_tray", "confidence": "high", "note": "baseline 10 lap sponges; tracked as a set instance" }, { "layer": "L3", "object_id": "obj_lap_sponge_set_01", "object_class": "lap_sponge", "state": { "zone": "kick_bucket", "sterility": "soiled", "in_count": true }, "transition_from": { "zone": "operative_field", "sterility": "sterile", "in_count": true }, "t_s": 290.0, "count_event": "relocated_within_tray", "confidence": "low", "note": "2 of set soiled and moved to kick bucket; remain in_count (off-field, not discarded)" }, { "layer": "L3", "object_id": "obj_lap_sponge_set_01", "object_class": "lap_sponge", "state": { "zone": "back_table", "sterility": "soiled", "in_count": true }, "transition_from": { "zone": "kick_bucket", "sterility": "soiled", "in_count": true }, "t_s": 338.0, "count_event": "recount", "confidence": "high", "note": "closing count: all 10 lap sponges accounted for" }, { "layer": "L3", "object_id": "obj_suture_needle_box_01", "object_class": "suture_needle", "state": { "zone": "needle_counter", "sterility": "sterile", "in_count": false }, "transition_from": { "zone": "needle_counter", "sterility": "sterile", "in_count": true }, "t_s": 356.0, "count_event": "discrepancy_flagged", "confidence": "high", "note": "closing count: only 3 of 4 needles in counter — one unaccounted (count broken)" }, { "layer": "L3", "object_id": "obj_suture_needle_04", "object_class": "suture_needle", "state": { "zone": "absent", "sterility": "unknown", "in_count": false }, "transition_from": null, "t_s": 356.0, "count_event": "discrepancy_flagged", "confidence": "medium", "note": "EXPECTED-BUT-ABSENT object — the unaccounted needle; first-class in v0.1 via expected_contents manifest + 'absent' zone" }, { "layer": "L3", "object_id": "obj_suture_needle_04", "object_class": "suture_needle", "state": { "zone": "absent", "sterility": "unknown", "in_count": false }, "transition_from": { "zone": "absent", "sterility": "unknown", "in_count": false }, "t_s": 376.0, "count_event": "recount", "confidence": "low", "note": "recount still short; search initiated" }, { "layer": "L3", "object_id": "obj_suture_needle_04", "object_class": "suture_needle", "state": { "zone": "operative_field", "sterility": "sterile", "in_count": false }, "transition_from": { "zone": "absent", "sterility": "unknown", "in_count": false }, "t_s": 398.0, "count_event": "substituted_in", "confidence": "high", "note": "needle located in drape fold on field — re-observed; reusing substituted_in as the v0.1 'item recovered into count flow' event" }, { "layer": "L3", "object_id": "obj_suture_needle_04", "object_class": "suture_needle", "state": { "zone": "needle_counter", "sterility": "sterile", "in_count": true }, "transition_from": { "zone": "operative_field", "sterility": "sterile", "in_count": false }, "t_s": 402.0, "count_event": "added_to_tray", "confidence": "high", "note": "returned to counter box — now in_count" }, { "layer": "L3", "object_id": "obj_suture_needle_box_01", "object_class": "suture_needle", "state": { "zone": "needle_counter", "sterility": "sterile", "in_count": true }, "transition_from": { "zone": "needle_counter", "sterility": "sterile", "in_count": false }, "t_s": 406.0, "count_event": "recount", "confidence": "high", "note": "sharps count reconciled at 4 of 4" } ], "L4": [ { "layer": "L4", "label_id": "l4-synth-01", "event_type": "handoff", "subtype": "neutral_zone_sharps_pass", "t_start_s": 152.0, "t_end_s": 156.0, "triggered_by": "pass_and_receive_instruments", "resolution": "completed", "severity": "minor", "actor_role": "scrub", "counterparty_role": "surgeon", "deviation_from_protocol_ref": null, "protocol_followed_ref": "AORN-SHARPS-NEUTRAL-ZONE", "confidence": "high", "note": "PROTOCOL-CORRECT: hands-free neutral-zone technique cited via protocol_followed_ref; receiver via counterparty_role" }, { "layer": "L4", "label_id": "l4-synth-02", "event_type": "exception", "subtype": "incorrect_surgical_count", "t_start_s": 356.0, "t_end_s": 408.0, "triggered_by": "closing_count", "resolution": "resolved_reconciled", "severity": "major", "actor_role": "scrub", "counterparty_role": "circulator", "deviation_from_protocol_ref": null, "protocol_followed_ref": "AORN-COUNT-DISCREPANCY", "confidence": "high", "note": "task-intrinsic count discrepancy; managed per count-discrepancy protocol (not a protocol deviation) — major because a sharps count was broken" }, { "layer": "L4", "label_id": "l4-synth-03", "event_type": "rework", "subtype": "count_recount_and_search", "t_start_s": 366.0, "t_end_s": 396.0, "triggered_by": "incorrect_surgical_count", "resolution": "resolved_item_located", "severity": "major", "actor_role": "scrub", "counterparty_role": "circulator", "deviation_from_protocol_ref": null, "protocol_followed_ref": "AORN-COUNT-DISCREPANCY", "caused_by": ["l4-synth-02"], "confidence": "high", "note": "the recount + room/field search work caused by the discrepancy" }, { "layer": "L4", "label_id": "l4-synth-04", "event_type": "handoff", "subtype": "count_discrepancy_notification", "t_start_s": 360.0, "t_end_s": 366.0, "triggered_by": "closing_count", "resolution": "completed", "severity": "minor", "actor_role": "circulator", "counterparty_role": "surgeon", "deviation_from_protocol_ref": null, "protocol_followed_ref": "AORN-COUNT-DISCREPANCY", "caused_by": ["l4-synth-02"], "confidence": "high", "note": "circulator-to-surgeon communication handoff of the count status" } ] }, "rlds_excerpt": { "_note": "A 2-second derived RLDS slice (t=398.0-400.0 s) inside the reconciliation, with the exception and rework L4 events simultaneously active as the missing needle is recovered. Derived view at 1 Hz decimation; the sidecar above remains the source of truth. reward is 0.0 throughout: reward shaping is the buyer's job; we ship events only.", "episode_id": "kr-or-synthetic-0001", "synthetic": true, "slice": { "t_start_s": 398.0, "t_end_s": 400.0, "decimation_hz": 1 }, "rlds_steps": [ { "t_s": 398.0, "is_first": false, "is_last": false, "is_terminal": false, "observation": { "phase": "closing_count", "step": "reconcile_count", "active_triplet": ["scrub", "retrieve", "suture_needle"], "object_states": { "obj_suture_needle_box_01": { "zone": "needle_counter", "sterility": "sterile", "in_count": false }, "obj_suture_needle_04": { "zone": "operative_field", "sterility": "sterile", "in_count": false }, "obj_lap_sponge_set_01": { "zone": "back_table", "sterility": "soiled", "in_count": true } }, "context_events": [ { "label_id": "l4-synth-02", "event_type": "exception", "subtype": "incorrect_surgical_count", "severity": "major" }, { "label_id": "l4-synth-03", "event_type": "rework", "subtype": "count_recount_and_search", "severity": "major" } ] }, "action": { "actor_role": "scrub", "verb": "retrieve", "target_zone": "operative_field" }, "reward": 0.0, "discount": 1.0 }, { "t_s": 399.0, "is_first": false, "is_last": false, "is_terminal": false, "observation": { "phase": "closing_count", "step": "reconcile_count", "active_triplet": ["scrub", "retrieve", "suture_needle"], "object_states": { "obj_suture_needle_box_01": { "zone": "needle_counter", "sterility": "sterile", "in_count": false }, "obj_suture_needle_04": { "zone": "operative_field", "sterility": "sterile", "in_count": false }, "obj_lap_sponge_set_01": { "zone": "back_table", "sterility": "soiled", "in_count": true } }, "context_events": [ { "label_id": "l4-synth-02", "event_type": "exception", "subtype": "incorrect_surgical_count", "severity": "major" }, { "label_id": "l4-synth-03", "event_type": "rework", "subtype": "count_recount_and_search", "severity": "major" } ] }, "action": { "actor_role": "scrub", "verb": "retrieve", "target_zone": "operative_field" }, "reward": 0.0, "discount": 1.0 } ] } }