# Do Sharpness-based Optimizers Improve Generalization in Medical Image Analysis?

arXiv: https://arxiv.org/abs/2408.04065 · HTML: https://mlsanity.com/paper/2408.04065/

## Key facts

- Cited by 3 papers in the map (data through 14 Oct 2026).
- Builds on 32 of its 45 references that are in the map.
- First posted on arXiv 7 Aug 2024.

## Builds on (most cited first, 30 of 32)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [Very Deep Convolutional Networks for Large-Scale Image Recognition](https://mlsanity.com/paper/1409.1556/) (2014)
- [Swin Transformer: Hierarchical Vision Transformer using Shifted Windows](https://mlsanity.com/paper/2103.14030/) (2021)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [Sharpness-Aware Minimization for Efficiently Improving Generalization](https://mlsanity.com/paper/2010.01412/) (2020)
- [On Large-Batch Training for Deep Learning: Generalization Gap and Sharp Minima](https://mlsanity.com/paper/1609.04836/) (2016)
- [Visualizing the Loss Landscape of Neural Nets](https://mlsanity.com/paper/1712.09913/) (2017)
- [MedMNIST v2 -- A large-scale lightweight benchmark for 2D and 3D biomedical image classification](https://mlsanity.com/paper/2110.14795/) (2021)
- [Exploring Generalization in Deep Learning](https://mlsanity.com/paper/1706.08947/) (2017)
- [Fantastic Generalization Measures and Where to Find Them](https://mlsanity.com/paper/1912.02178/) (2019)
- [Sharp Minima Can Generalize For Deep Nets](https://mlsanity.com/paper/1703.04933/) (2017)
- [Entropy-SGD: Biasing Gradient Descent Into Wide Valleys](https://mlsanity.com/paper/1611.01838/) (2016)
- [How Do Vision Transformers Work?](https://mlsanity.com/paper/2202.06709/) (2022)
- [ASAM: Adaptive Sharpness-Aware Minimization for Scale-Invariant Learning of Deep Neural Networks](https://mlsanity.com/paper/2102.11600/) (2021)
- [PyHessian: Neural Networks Through the Lens of the Hessian](https://mlsanity.com/paper/1912.07145/) (2019)
- [The large learning rate phase of deep learning: the catapult mechanism](https://mlsanity.com/paper/2003.02218/) (2020)
- [Spectral Norm Regularization for Improving the Generalizability of Deep Learning](https://mlsanity.com/paper/1705.10941/) (2017)
- [Surrogate Gap Minimization Improves Sharpness-Aware Training](https://mlsanity.com/paper/2203.08065/) (2022)
- [Generalization in Deep Learning](https://mlsanity.com/paper/1710.05468/) (2017)
- [Path-SGD: Path-Normalized Optimization in Deep Neural Networks](https://mlsanity.com/paper/1506.02617/) (2015)
- [Sharpness-Aware Minimization Improves Language Model Generalization](https://mlsanity.com/paper/2110.08529/) (2021)
- [Hessian-based Analysis of Large Batch Training and Robustness to Adversaries](https://mlsanity.com/paper/1802.08241/) (2018)
- [In Search of Robust Measures of Generalization](https://mlsanity.com/paper/2010.11924/) (2020)
- [Generalization Error Bounds of Gradient Descent for Learning Over-parameterized Deep ReLU Networks](https://mlsanity.com/paper/1902.01384/) (2019)
- [BUSIS: A Benchmark for Breast Ultrasound Image Segmentation](https://mlsanity.com/paper/1801.03182/) (2018)
- [SmoothOut: Smoothing Out Sharp Minima to Improve Generalization in Deep Learning](https://mlsanity.com/paper/1805.07898/) (2018)
- [Comparing Different Deep Learning Architectures for Classification of Chest Radiographs](https://mlsanity.com/paper/2002.08991/) (2020)
- [Sharpness-Aware Minimization Revisited: Weighted Sharpness as a Regularization Term](https://mlsanity.com/paper/2305.15817/) (2023)
- [HoVer-Trans: Anatomy-aware HoVer-Transformer for ROI-free Breast Cancer Diagnosis in Ultrasound Images](https://mlsanity.com/paper/2205.08390/) (2022)

## Built on by (most cited first, 3 of 3)

- [An Uncertainty-Aware Generalization Framework for Cardiovascular Image Segmentation](https://mlsanity.com/paper/2409.14305/) (2024)
- [GCSAM: Gradient Centralized Sharpness Aware Minimization](https://mlsanity.com/paper/2501.11584/) (2025)
- [Leveraging Extragradient for Effective Sharpness-Aware Minimization in Deep Learning](https://mlsanity.com/paper/2607.06151/) (2026)

## Abstract (arXiv)

Effective clinical deployment of deep learning models in healthcare demands high generalization performance to ensure accurate diagnosis and treatment planning. In recent years, significant research has focused on improving the generalization of deep learning models by regularizing the sharpness of the loss landscape. Among the optimization approaches that explicitly minimize sharpness, Sharpness-Aware Minimization (SAM) has shown potential in enhancing generalization performance on general domain image datasets. This success has led to the development of several advanced sharpness-based algorithms aimed at addressing the limitations of SAM, such as Adaptive SAM, surrogate-Gap SAM, Weighted SAM, and Curvature Regularized SAM. These sharpness-based optimizers have shown improvements in model generalization compared to conventional stochastic gradient descent optimizers and their variants on general domain image datasets, but they have not been thoroughly evaluated on medical images. This work provides a review of recent sharpness-based methods for improving the generalization of deep learning networks and evaluates the methods performance on medical breast ultrasound images. Our findings indicate that the initial SAM method successfully enhances the generalization of various deep learning models. While Adaptive SAM improves generalization of convolutional neural networks, it fails to do so for vision transformers. Other sharpness-based optimizers, however, do not demonstrate consistent results. The results reveal that, contrary to findings in the non-medical domain, SAM is the only recommended sharpness-based optimizer that consistently improves generalization in medical image analysis, and further research is necessary to refine the variants of SAM to enhance generalization performance in this field