# Safeguarding AI in Medical Imaging: Post-Hoc Out-of-Distribution Detection with Normalizing Flows

arXiv: https://arxiv.org/abs/2502.11638 · HTML: https://mlsanity.com/paper/2502.11638/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 36 of its 62 references that are in the map.
- First posted on arXiv 17 Feb 2025.

## Builds on (most cited first, 30 of 36)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Swin Transformer: Hierarchical Vision Transformer using Shifted Windows](https://mlsanity.com/paper/2103.14030/) (2021)
- [Densely Connected Convolutional Networks](https://mlsanity.com/paper/1608.06993/) (2016)
- [A Baseline for Detecting Misclassified and Out-of-Distribution Examples in Neural Networks](https://mlsanity.com/paper/1610.02136/) (2016)
- [Variational Inference with Normalizing Flows](https://mlsanity.com/paper/1505.05770/) (2015)
- [Density estimation using Real NVP](https://mlsanity.com/paper/1605.08803/) (2016)
- [Glow: Generative Flow with Invertible 1x1 Convolutions](https://mlsanity.com/paper/1807.03039/) (2018)
- [A Simple Unified Framework for Detecting Out-of-Distribution Samples and Adversarial Attacks](https://mlsanity.com/paper/1807.03888/) (2018)
- [Enhancing The Reliability of Out-of-distribution Image Detection in Neural Networks](https://mlsanity.com/paper/1706.02690/) (2017)
- [ChestX-ray8: Hospital-scale Chest X-ray Database and Benchmarks on Weakly-Supervised Classification and Localization of Common Thorax Diseases](https://mlsanity.com/paper/1705.02315/) (2017)
- [MedMNIST v2 -- A large-scale lightweight benchmark for 2D and 3D biomedical image classification](https://mlsanity.com/paper/2110.14795/) (2021)
- [Neural Spline Flows](https://mlsanity.com/paper/1906.04032/) (2019)
- [Can Spatiotemporal 3D CNNs Retrace the History of 2D CNNs and ImageNet?](https://mlsanity.com/paper/1711.09577/) (2017)
- [Identifying the Best Machine Learning Algorithms for Brain Tumor Segmentation, Progression Assessment, and Overall Survival Prediction in the BRATS Challenge](https://mlsanity.com/paper/1811.02629/) (2018)
- [The Liver Tumor Segmentation Benchmark (LiTS)](https://mlsanity.com/paper/1901.04056/) (2019)
- [ReAct: Out-of-distribution Detection With Rectified Activations](https://mlsanity.com/paper/2111.12797/) (2021)
- [ViM: Out-Of-Distribution with Virtual-logit Matching](https://mlsanity.com/paper/2203.10807/) (2022)
- [CHAOS Challenge -- Combined (CT-MR) Healthy Abdominal Organ Segmentation](https://mlsanity.com/paper/2001.06535/) (2020)
- [OpenOOD: Benchmarking Generalized Out-of-Distribution Detection](https://mlsanity.com/paper/2210.07242/) (2022)
- [Residual Flows for Invertible Generative Modeling](https://mlsanity.com/paper/1906.02735/) (2019)
- [Why Normalizing Flows Fail to Detect Out-of-Distribution Data](https://mlsanity.com/paper/2006.08545/) (2020)
- [Extremely Simple Activation Shaping for Out-of-Distribution Detection](https://mlsanity.com/paper/2209.09858/) (2022)
- [OpenOOD v1.5: Enhanced Benchmark for Out-of-Distribution Detection](https://mlsanity.com/paper/2306.09301/) (2023)
- [DICE: Leveraging Sparsification for Out-of-Distribution Detection](https://mlsanity.com/paper/2111.09805/) (2021)
- [Automated brain extraction of multi-sequence MRI using artificial neural networks](https://mlsanity.com/paper/1901.11341/) (2019)
- [Standardized Assessment of Automatic Segmentation of White Matter Hyperintensities and Results of the WMH Segmentation Challenge](https://mlsanity.com/paper/1904.00682/) (2019)
- [Understanding Failures in Out-of-Distribution Detection with Deep Generative Models](https://mlsanity.com/paper/2107.06908/) (2021)
- [Scaling for Training Time and Post-hoc Out-of-distribution Detection Enhancement](https://mlsanity.com/paper/2310.00227/) (2023)
- [Full-Spectrum Out-of-Distribution Detection](https://mlsanity.com/paper/2204.05306/) (2022)
- [The Brain Tumor Segmentation (BraTS) Challenge 2023: Focus on Pediatrics (CBTN-CONNECT-DIPGR-ASNR-MICCAI BraTS-PEDs)](https://mlsanity.com/paper/2305.17033/) (2023)

## Built on by (most cited first, 1 of 1)

- [Self-Aware Object Detection via Degradation Manifolds](https://mlsanity.com/paper/2602.18394/) (2026)

## Abstract (arXiv)

In AI-driven medical imaging, the failure to detect out-of-distribution (OOD) data poses a severe risk to clinical reliability, potentially leading to critical diagnostic errors. Current OOD detection methods often demand impractical retraining or modifications to pre-trained models, hindering their adoption in regulated clinical environments. To address this challenge, we propose a post-hoc normalizing flow-based approach that seamlessly integrates with existing pre-trained models without altering their weights. We evaluate the approach on our in-house-curated MedOOD dataset, designed to capture clinically relevant distribution shifts, and on the MedMNIST benchmark. The proposed method achieves an AUROC of 84.61% on MedOOD, outperforming ViM (80.65%) and MDS (80.87%), and reaches 93.8% AUROC on MedMNIST, surpassing ViM (88.08%) and ReAct (87.05%). This combination of strong performance and post-hoc integration capability makes our approach a practical and effective safeguard for clinical imaging workflows. The model and code to build OOD datasets are publicly accessible at https://github.com/dlotfi/MedOODFlow.