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Confidence Calibration and Predictive Uncertainty Estimation for Deep Medical Image Segmentation
Open accessAbstract
Fully convolutional neural networks (FCNs), and in particular U-Nets, have achieved state-of-the-art results in semantic segmentation for numerous medical imaging applications. Moreover, batch normalization and Dice loss have been used successfully to stabilize and accelerate training. However, these networks are poorly calibrated i.e. they tend to produce overconfident predictions for both correct and erroneous classifications, making them unreliable and hard to interpret. In this paper, we study predictive uncertainty estimation in FCNs for medical image segmentation. We make the following contributions: 1) We systematically compare cross-entropy loss with Dice loss in terms of segmentation quality and uncertainty estimation of FCNs; 2) We propose model ensembling for confidence calibration of the FCNs trained with batch normalization and Dice loss; 3) We assess the ability of calibrated FCNs to predict segmentation quality of structures and detect out-of-distribution test examples. We conduct extensive experiments across three medical image segmentation applications of the brain, the heart, and the prostate to evaluate our contributions. The results of this study offer considerable insight into the predictive uncertainty estimation and out-of-distribution detection in medical image segmentation and provide practical recipes for confidence calibration. Moreover, we consistently demonstrate that model ensembling improves confidence calibration.
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“Natekar al. [694] | et | 2020 | DenseUnet, ResUnet, SimUnet | Segmentation | Brain tumor | 1 | TTD (test time dropout) for VI”
From A review of uncertainty quantification in deep learning: Techniques, applications and challenges (2021) · cites this paper as [694]
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“Increasingly, disagreement among these CV models is reused as a proxy for epistemic uncertainty in downstream applications such as quality control and human-in-the-loop review [11,18,15].”
From Lost in the Folds: When Cross-Validation Is Not a Deep Ensemble for Uncertainty Estimation (2026) · cites this paper as [18]
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Metadata
- Authors
- Mehrtash, A., Wells, W. M., Tempany, C. M., Abolmaesumi, P., & Kapur, T.
- Affiliations
- Brigham and Women's Hospital (US)
- University of British Columbia (CA)
- Venue
- IEEE Transactions on Medical Imaging
- Published
- 2020-12
- Volume
- 39
- Issue
- 12
- Pages
- 3868-3878
- ISSN
- 0278-0062 (ISSN-L)
- 1558-254X
- PMC
- PMC7704933
- OpenAlex
- W2991523350
- Cited by
- 428
- References
- 55
- Citations by year
- 2026: 91 · 2025: 92 · 2024: 71 · 2023: 71 · 2022: 56 · 2021: 41 · 2020: 6
- FWCI
- 16.91
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- IEEE Transactions on Medical Imaging (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- arXiv (Cornell University) (submittedVersion)
- arXiv (Cornell University)
- Funders
- U.S. National Institutes of Health (P41EB015898)
- Natural Sciences and Engineering Research Council (NSERC) of Canada
- Canadian Institutes of Health Research
- Topics
- Physical Sciences › Computer Science › Computer Vision and Pattern Recognition › Medical Image Segmentation Techniques
- Physical Sciences › Computer Science › Computer Vision and Pattern Recognition › Advanced Neural Network Applications
- Physical Sciences › Computer Science › Artificial Intelligence › Domain Adaptation and Few-Shot Learning
- Keywords
- confidence calibration, predictive uncertainty estimation, medical image segmentation, fully convolutional network, U-Net, Dice loss, cross-entropy loss, model ensembling, out-of-distribution detection, batch normalization, brain segmentation, cardiac image segmentation, prostate segmentation
- MeSH terms
- Brain, Calibration, Humans, Image Processing, Computer-Assisted, Male, Neural Networks, Computer, Uncertainty
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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