# Failure Detection in Medical Image Classification: A Reality Check and Benchmarking Testbed

arXiv: https://arxiv.org/abs/2205.14094 · HTML: https://mlsanity.com/paper/2205.14094/

## Key facts

- Cited by 12 papers in the map (data through 14 Oct 2026).
- Builds on 14 of its 42 references that are in the map.
- First posted on arXiv 27 May 2022.

## Builds on (most cited first, 14 of 14)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [On Calibration of Modern Neural Networks](https://mlsanity.com/paper/1706.04599/) (2017)
- [Dropout as a Bayesian Approximation: Representing Model Uncertainty in Deep Learning](https://mlsanity.com/paper/1506.02142/) (2015)
- [Simple and Scalable Predictive Uncertainty Estimation using Deep Ensembles](https://mlsanity.com/paper/1612.01474/) (2016)
- [A Baseline for Detecting Misclassified and Out-of-Distribution Examples in Neural Networks](https://mlsanity.com/paper/1610.02136/) (2016)
- [Can You Trust Your Model's Uncertainty? Evaluating Predictive Uncertainty Under Dataset Shift](https://mlsanity.com/paper/1906.02530/) (2019)
- [Averaging Weights Leads to Wider Optima and Better Generalization](https://mlsanity.com/paper/1803.05407/) (2018)
- [MedMNIST v2 -- A large-scale lightweight benchmark for 2D and 3D biomedical image classification](https://mlsanity.com/paper/2110.14795/) (2021)
- [A Simple Baseline for Bayesian Uncertainty in Deep Learning](https://mlsanity.com/paper/1902.02476/) (2019)
- [Laplace Redux -- Effortless Bayesian Deep Learning](https://mlsanity.com/paper/2106.14806/) (2021)
- [To Trust Or Not To Trust A Classifier](https://mlsanity.com/paper/1805.11783/) (2018)
- [Addressing Failure Prediction by Learning Model Confidence](https://mlsanity.com/paper/1910.04851/) (2019)
- [DOCTOR: A Simple Method for Detecting Misclassification Errors](https://mlsanity.com/paper/2106.02395/) (2021)
- [Active label cleaning for improved dataset quality under resource constraints](https://mlsanity.com/paper/2109.00574/) (2021)

## Built on by (most cited first, 12 of 12)

- [A Call to Reflect on Evaluation Practices for Failure Detection in Image Classification](https://mlsanity.com/paper/2211.15259/) (2022)
- [OpenMix: Exploring Outlier Samples for Misclassification Detection](https://mlsanity.com/paper/2303.17093/) (2023)
- [A noisy elephant in the room: Is your out-of-distribution detector robust to label noise?](https://mlsanity.com/paper/2404.01775/) (2024)
- [Multi-Head Multi-Loss Model Calibration](https://mlsanity.com/paper/2303.01099/) (2023)
- [Calibration and Uncertainty for multiRater Volume Assessment in multiorgan Segmentation (CURVAS) challenge results](https://mlsanity.com/paper/2505.08685/) (2025)
- [ReliCD: A Reliable Cognitive Diagnosis Framework with Confidence Awareness](https://mlsanity.com/paper/2401.10749/) (2023)
- [Understanding Silent Failures in Medical Image Classification](https://mlsanity.com/paper/2307.14729/) (2023)
- [Flow Stochastic Segmentation Networks](https://mlsanity.com/paper/2507.18838/) (2025)
- [Finer Disentanglement of Aleatoric Uncertainty Can Accelerate Chemical Histopathology Imaging](https://mlsanity.com/paper/2502.20532/) (2025)
- [One Model, Many Behaviors: Training-Induced Effects on Out-of-Distribution Detection](https://mlsanity.com/paper/2601.10836/) (2026)
- [From Misclassifications to Outliers: Joint Reliability Assessment in Classification](https://mlsanity.com/paper/2603.03903/) (2026)
- [Entropy Minimization without Model Collapse: Mitigating Prediction Bias in Medical Imaging](https://mlsanity.com/paper/2606.02339/) (2026)

## Abstract (arXiv)

Failure detection in automated image classification is a critical safeguard for clinical deployment. Detected failure cases can be referred to human assessment, ensuring patient safety in computer-aided clinical decision making. Despite its paramount importance, there is insufficient evidence about the ability of state-of-the-art confidence scoring methods to detect test-time failures of classification models in the context of medical imaging. This paper provides a reality check, establishing the performance of in-domain misclassification detection methods, benchmarking 9 widely used confidence scores on 6 medical imaging datasets with different imaging modalities, in multiclass and binary classification settings. Our experiments show that the problem of failure detection is far from being solved. We found that none of the benchmarked advanced methods proposed in the computer vision and machine learning literature can consistently outperform a simple softmax baseline, demonstrating that improved out-of-distribution detection or model calibration do not necessarily translate to improved in-domain misclassification detection. Our developed testbed facilitates future work in this important area