Toward Reliable Medical Image Segmentation by Modeling Evidential Calibrated Uncertainty

Medical image segmentation is critical for disease diagnosis and treatment assessment. However, concerns regarding the reliability of segmentation regions persist among clinicians, mainly attributed to the absence of confidence assessment, robustness, and calibration to accuracy. To address this, we introduce deep evidential segmentation model (DEviS), an easily implementable foundational model that seamlessly integrates into various medical image segmentation networks. DEviS not only enhances the calibration and robustness of baseline segmentation accuracy but also provides high-efficiency uncertainty estimation for reliable predictions. By leveraging subjective logic theory, we explicitly model probability and uncertainty for medical image segmentation. Here, the Dirichlet distribution parameterizes the distribution of probabilities for different classes of the segmentation results. To generate calibrated predictions and uncertainty, we develop a trainable calibrated uncertainty penalty. Furthermore, DEviS incorporates an uncertainty-aware filtering (UAF) module, which designs the metric of uncertainty-calibrated error to filter out-of-distribution (OOD) data. We conducted validation studies on publicly available datasets, including ISIC2018, KiTS2021, LiTS2017, and BraTS2019, to assess the accuracy and robustness of different backbone segmentation models enhanced by DEviS, as well as the efficiency and reliability of uncertainty estimation. Additionally, two potential clinical trials were conducted using the UAF module. The clinical application conducted on the Johns Hopkins OCT and Duke OCT-DME datasets demonstrated the effectiveness of the model in filtering OOD data. The second trial evaluated its efficacy in filtering high-quality data on the FIVES datasets. At last, the proposed DEviS method was extended to semi-supervised medical image segmentation, where it exhibited strong robustness under noisy conditions. Our code has been released in https://github.com/Cocofeat/DEviS.