# Can ultrasound confidence maps predict sonographers' labeling variability?

arXiv: https://arxiv.org/abs/2308.09433 · HTML: https://mlsanity.com/paper/2308.09433/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 18 of its 26 references that are in the map.
- First posted on arXiv 18 Aug 2023.

## Builds on (most cited first, 18 of 18)

- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [On Calibration of Modern Neural Networks](https://mlsanity.com/paper/1706.04599/) (2017)
- [Attention U-Net: Learning Where to Look for the Pancreas](https://mlsanity.com/paper/1804.03999/) (2018)
- [When Does Label Smoothing Help?](https://mlsanity.com/paper/1906.02629/) (2019)
- [UNETR: Transformers for 3D Medical Image Segmentation](https://mlsanity.com/paper/2103.10504/) (2021)
- [MONAI: An open-source framework for deep learning in healthcare](https://mlsanity.com/paper/2211.02701/) (2022)
- [PHiSeg: Capturing Uncertainty in Medical Image Segmentation](https://mlsanity.com/paper/1906.04045/) (2019)
- [Stochastic Segmentation Networks: Modelling Spatially Correlated Aleatoric Uncertainty](https://mlsanity.com/paper/2006.06015/) (2020)
- [DeepAtlas: Joint Semi-Supervised Learning of Image Registration and Segmentation](https://mlsanity.com/paper/1904.08465/) (2019)
- [Common Limitations of Image Processing Metrics: A Picture Story](https://mlsanity.com/paper/2104.05642/) (2021)
- [Disentangling Human Error from the Ground Truth in Segmentation of Medical Images](https://mlsanity.com/paper/2007.15963/) (2020)
- [Non-Parametric Calibration for Classification](https://mlsanity.com/paper/1906.04933/) (2019)
- [Multi-Atlas Segmentation of Biomedical Images: A Survey](https://mlsanity.com/paper/1412.3421/) (2014)
- [On the Effect of Inter-observer Variability for a Reliable Estimation of Uncertainty of Medical Image Segmentation](https://mlsanity.com/paper/1806.02562/) (2018)
- [Spatially Varying Label Smoothing: Capturing Uncertainty from Expert Annotations](https://mlsanity.com/paper/2104.05788/) (2021)
- [Tracked 3D Ultrasound and Deep Neural Network-based Thyroid Segmentation reduce Interobserver Variability in Thyroid Volumetry](https://mlsanity.com/paper/2108.10118/) (2021)
- [Post Training Uncertainty Calibration of Deep Networks For Medical Image Segmentation](https://mlsanity.com/paper/2010.14290/) (2020)
- [Using Soft Labels to Model Uncertainty in Medical Image Segmentation](https://mlsanity.com/paper/2109.12622/) (2021)

## Abstract (arXiv)

Measuring cross-sectional areas in ultrasound images is a standard tool to evaluate disease progress or treatment response. Often addressed today with supervised deep-learning segmentation approaches, existing solutions highly depend upon the quality of experts' annotations. However, the annotation quality in ultrasound is anisotropic and position-variant due to the inherent physical imaging principles, including attenuation, shadows, and missing boundaries, commonly exacerbated with depth. This work proposes a novel approach that guides ultrasound segmentation networks to account for sonographers' uncertainties and generate predictions with variability similar to the experts. We claim that realistic variability can reduce overconfident predictions and improve physicians' acceptance of deep-learning cross-sectional segmentation solutions. Our method provides CM's certainty for each pixel for minimal computational overhead as it can be precalculated directly from the image. We show that there is a correlation between low values in the confidence maps and expert's label uncertainty. Therefore, we propose to give the confidence maps as additional information to the networks. We study the effect of the proposed use of ultrasound CMs in combination with four state-of-the-art neural networks and in two configurations: as a second input channel and as part of the loss. We evaluate our method on 3D ultrasound datasets of the thyroid and lower limb muscles. Our results show ultrasound CMs increase the Dice score, improve the Hausdorff and Average Surface Distances, and decrease the number of isolated pixel predictions. Furthermore, our findings suggest that ultrasound CMs improve the penalization of uncertain areas in the ground truth data, thereby improving problematic interpolations. Our code and example data will be made public at https://github.com/IFL-CAMP/Confidence-segmentation.