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Unified Focal loss: Generalising Dice and cross entropy-based losses to handle class imbalanced medical image segmentation

arXiv 2102.04525 ↗First posted 8 Feb 2021eess.IV cs.CV cs.LGcited by 88

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Abstract (arXiv)

Automatic segmentation methods are an important advancement in medical image analysis. Machine learning techniques, and deep neural networks in particular, are the state-of-the-art for most medical image segmentation tasks. Issues with class imbalance pose a significant challenge in medical datasets, with lesions often occupying a considerably smaller volume relative to the background. Loss functions used in the training of deep learning algorithms differ in their robustness to class imbalance, with direct consequences for model convergence. The most commonly used loss functions for segmentation are based on either the cross entropy loss, Dice loss or a combination of the two. We propose the Unified Focal loss, a new hierarchical framework that generalises Dice and cross entropy-based losses for handling class imbalance. We evaluate our proposed loss function on five publicly available, class imbalanced medical imaging datasets: CVC-ClinicDB, Digital Retinal Images for Vessel Extraction (DRIVE), Breast Ultrasound 2017 (BUS2017), Brain Tumour Segmentation 2020 (BraTS20) and Kidney Tumour Segmentation 2019 (KiTS19). We compare our loss function performance against six Dice or cross entropy-based loss functions, across 2D binary, 3D binary and 3D multiclass segmentation tasks, demonstrating that our proposed loss function is robust to class imbalance and consistently outperforms the other loss functions. Source code is available at: https://github.com/mlyg/unified-focal-loss

Key facts. Cited by 88 papers in the map (data through 7 Oct 2026). Builds on 33 of its 75 references that are in the map. First posted on arXiv 8 Feb 2021.

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33 of 75 references.

References · 33

  1. 2015U-Net: Convolutional Networks for Biomedical Image Segmentationcited by 19,604
  2. 2016V-Net: Fully Convolutional Neural Networks for Volumetric Medical Image Segmentationcited by 2,284
  3. 2015SegNet: A Deep Convolutional Encoder-Decoder Architecture for Image Segmentationcited by 1,483
  4. 20163D U-Net: Learning Dense Volumetric Segmentation from Sparse Annotationcited by 1,471
  5. 2017Generalised Dice overlap as a deep learning loss function for highly unbalanced segmentationscited by 614
  6. 2018Identifying the Best Machine Learning Algorithms for Brain Tumor Segmentation, Progression Assessment, and Overall Survival Prediction in the BRATS Challengecited by 508
  7. 2018nnU-Net: Self-adapting Framework for U-Net-Based Medical Image Segmentationcited by 291
  8. 2018Attention Gated Networks: Learning to Leverage Salient Regions in Medical Imagescited by 271
  9. 2016Efficient Multi-Scale 3D CNN with Fully Connected CRF for Accurate Brain Lesion Segmentationcited by 263
  10. 2017Tversky loss function for image segmentation using 3D fully convolutional deep networkscited by 228
  11. 2020A survey of loss functions for semantic segmentationcited by 216
  12. 2019The state of the art in kidney and kidney tumor segmentation in contrast-enhanced CT imaging: Results of the KiTS19 Challengecited by 188
21 more
  1. 2018Boundary loss for highly unbalanced segmentationcited by 187
  2. 2018A Novel Focal Tversky loss function with improved Attention U-Net for lesion segmentationcited by 171
  3. 2019The KiTS19 Challenge Data: 300 Kidney Tumor Cases with Clinical Context, CT Semantic Segmentations, and Surgical Outcomescited by 168
  4. 2015DeepOrgan: Multi-level Deep Convolutional Networks for Automated Pancreas Segmentationcited by 158
  5. 2018MedGAN: Medical Image Translation using GANscited by 152
  6. 2015Brain Tumor Segmentation with Deep Neural Networkscited by 137
  7. 2018Combo Loss: Handling Input and Output Imbalance in Multi-Organ Segmentationcited by 76
  8. 2020Robust Multimodal Brain Tumor Segmentation via Feature Disentanglement and Gated Fusioncited by 67
  9. 2018AnatomyNet: Deep Learning for Fast and Fully Automated Whole-volume Segmentation of Head and Neck Anatomycited by 54
  10. 20183D Segmentation with Exponential Logarithmic Loss for Highly Unbalanced Object Sizescited by 42
  11. 2019USE-Net: incorporating Squeeze-and-Excitation blocks into U-Net for prostate zonal segmentation of multi-institutional MRI datasetscited by 27
  12. 2019Overfitting of neural nets under class imbalance: Analysis and improvements for segmentationcited by 27
  13. 2019Combining Noise-to-Image and Image-to-Image GANs: Brain MR Image Augmentation for Tumor Detectioncited by 23
  14. 2018Asymmetric Loss Functions and Deep Densely Connected Networks for Highly Imbalanced Medical Image Segmentation: Application to Multiple Sclerosis Lesion Detectioncited by 22
  15. 2019Boundary-weighted Domain Adaptive Neural Network for Prostate MR Image Segmentationcited by 22
  16. 2017Generalised Wasserstein Dice Score for Imbalanced Multi-class Segmentation using Holistic Convolutional Networkscited by 21
  17. 2020Brain tumor segmentation with self-ensembled, deeply-supervised 3D U-net neural networks: a BraTS 2020 challenge solutioncited by 20
  18. 2019MIScnn: A Framework for Medical Image Segmentation with Convolutional Neural Networks and Deep Learningcited by 18
  19. 2019Model-Based and Data-Driven Strategies in Medical Image Computingcited by 16
  20. 2018Normalization in Training U-Net for 2D Biomedical Semantic Segmentationcited by 15
  21. 2019Optimization with soft Dice can lead to a volumetric biascited by 9

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Citing papers per year: 2021: 5; 2022: 14; 2023: 17; 2024: 14; 2025: 24; 2026: 14.

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  3. 2023Loss Functions in the Era of Semantic Segmentation: A Survey and Outlookcited by 33
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  7. 2021Calibrating the Dice loss to handle neural network overconfidence for biomedical image segmentationcited by 17
  8. 2022On the Optimal Combination of Cross-Entropy and Soft Dice Losses for Lesion Segmentation with Out-of-Distribution Robustnesscited by 11
  9. 2023TransRadar: Adaptive-Directional Transformer for Real-Time Multi-View Radar Semantic Segmentationcited by 9
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  4. 2022Understanding the Tricks of Deep Learning in Medical Image Segmentation: Challenges and Future Directionscited by 5
  5. 2021Incorporating Boundary Uncertainty into loss functions for biomedical image segmentationcited by 3
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  11. 2024Deep Multimodal Fusion of Data with Heterogeneous Dimensionality via Projective Networkscited by 3
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  13. 2025Multi-Scale Spectral Attention Module-based Hyperspectral Segmentation in Autonomous Driving Scenarioscited by 3
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  19. 2021Effect of the output activation function on the probabilities and errors in medical image segmentationcited by 1
  20. 2022Color Space-based HoVer-Net for Nuclei Instance Segmentation and Classificationcited by 1
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  27. 2025Adaptive Voxel-Weighted Loss Using L1 Norms in Deep Neural Networks for Detection and Segmentation of Prostate Cancer Lesions in PET/CT Imagescited by 1
  28. 2025Performance Analysis of Deep Learning Models for Femur Segmentation in MRI Scancited by 1
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  30. 2025GazeLT: Visual attention-guided long-tailed disease classification in chest radiographscited by 1
  31. 2026SEMIR: Semantic Minor-Induced Representation Learning on Graphs for Visual Segmentationcited by 1
  32. 2021Focal Attention Networks: optimising attention for biomedical image segmentationcited by 0
  33. 2022Comparison of automatic prostate zones segmentation models in MRI images using U-net-like architecturescited by 0
  34. 2022Harmonizing output imbalance for defect segmentation on extremely-imbalanced photovoltaic module cells imagescited by 0
  35. 2022Kidney and Kidney Tumour Segmentation in CT Imagescited by 0
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  37. 2023Decomposing and Coupling Saliency Map for Lesion Segmentation in Ultrasound Imagescited by 0
  38. 2023Microscale 3-D Capacitance Tomography with a CMOS Sensor Arraycited by 0

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