# DeferredSeg:A Multi-Expert Deferral Framework for Medical Image Segmentation

arXiv: https://arxiv.org/abs/2604.12411 · HTML: https://mlsanity.com/paper/2604.12411/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 25 of its 47 references that are in the map.
- First posted on arXiv 14 Apr 2026.

## Builds on (most cited first, 25 of 25)

- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [Segment Anything](https://mlsanity.com/paper/2304.02643/) (2023)
- [Attention U-Net: Learning Where to Look for the Pancreas](https://mlsanity.com/paper/1804.03999/) (2018)
- [A Survey on Deep Learning in Medical Image Analysis](https://mlsanity.com/paper/1702.05747/) (2017)
- [UNETR: Transformers for 3D Medical Image Segmentation](https://mlsanity.com/paper/2103.10504/) (2021)
- [The Liver Tumor Segmentation Benchmark (LiTS)](https://mlsanity.com/paper/1901.04056/) (2019)
- [AMOS: A Large-Scale Abdominal Multi-Organ Benchmark for Versatile Medical Image Segmentation](https://mlsanity.com/paper/2206.08023/) (2022)
- [Consistent Estimators for Learning to Defer to an Expert](https://mlsanity.com/paper/2006.01862/) (2020)
- [Efficient Multi-Scale 3D CNN with Fully Connected CRF for Accurate Brain Lesion Segmentation](https://mlsanity.com/paper/1603.05959/) (2016)
- [nnU-Net Revisited: A Call for Rigorous Validation in 3D Medical Image Segmentation](https://mlsanity.com/paper/2404.09556/) (2024)
- [Predict Responsibly: Improving Fairness and Accuracy by Learning to Defer](https://mlsanity.com/paper/1711.06664/) (2017)
- [Confidence Calibration and Predictive Uncertainty Estimation for Deep Medical Image Segmentation](https://mlsanity.com/paper/1911.13273/) (2019)
- [Calibrated Learning to Defer with One-vs-All Classifiers](https://mlsanity.com/paper/2202.03673/) (2022)
- [SAM: Self-supervised Learning of Pixel-wise Anatomical Embeddings in Radiological Images](https://mlsanity.com/paper/2012.02383/) (2020)
- [Learning to Defer to Multiple Experts: Consistent Surrogate Losses, Confidence Calibration, and Conformal Ensembles](https://mlsanity.com/paper/2210.16955/) (2022)
- [MIDeepSeg: Minimally Interactive Segmentation of Unseen Objects from Medical Images Using Deep Learning](https://mlsanity.com/paper/2104.12166/) (2021)
- [Classification Under Human Assistance](https://mlsanity.com/paper/2006.11845/) (2020)
- [Regression Under Human Assistance](https://mlsanity.com/paper/1909.02963/) (2019)
- [Bridging the Gap Between Vision Transformers and Convolutional Neural Networks on Small Datasets](https://mlsanity.com/paper/2210.05958/) (2022)
- [Regression with Multi-Expert Deferral](https://mlsanity.com/paper/2403.19494/) (2024)
- [Transforming the Interactive Segmentation for Medical Imaging](https://mlsanity.com/paper/2208.09592/) (2022)
- [TBConvL-Net: A Hybrid Deep Learning Architecture for Robust Medical Image Segmentation](https://mlsanity.com/paper/2409.03367/) (2024)
- [Survey on Leveraging Uncertainty Estimation Towards Trustworthy Deep Neural Networks: The Case of Reject Option and Post-training Processing](https://mlsanity.com/paper/2304.04906/) (2023)
- [Uncertainty Weighted Gradients for Model Calibration](https://mlsanity.com/paper/2503.22725/) (2025)
- [CENet: Context Enhancement Network for Medical Image Segmentation](https://mlsanity.com/paper/2505.18423/) (2025)

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

- [From Few-Shot Segmentation to Clinician-in-the-Loop Medical Image Analysis](https://mlsanity.com/paper/2609.10001/) (2026)

## Abstract (arXiv)

Segmentation models based on deep neural networks demonstrate strong generalization for medical image segmentation. However, they often exhibit overconfidence or underconfidence, leading to unreliable confidence scores for segmentation masks, especially in ambiguous regions. This undermines the trustworthiness required for clinical deployment. Motivated by the learning-to-defer (L2D) paradigm, we introduce DeferredSeg, a deferral-aware segmentation framework, i.e., a Human--AI collaboration system that determines whether to defer predictions to human experts in specific regions. DeferredSeg extends the base segmentor with an aggregated deferral predictor and additional routing channels that dynamically route each pixel to either the base segmentor or a human expert. To train this routing efficiently, we introduce a pixel-wise surrogate collaboration loss that supervises deferral decisions. In addition, to preserve spatial coherence within deferral regions, we propose a spatial-coherence loss that enforces smooth deferral masks, thereby enhancing reliability. Beyond single-expert deferral, we further extend the framework to a multi-expert setting by introducing multiple discrepancy experts for collaborative decision-making. To prevent overloading or underutilizing individual experts, we further design a load-balancing penalty that evenly distributes workload across expert branches. We evaluate DeferredSeg on three challenging medical datasets using MedSAM and CENet as the base segmentor for fair comparison. Experimental results show that DeferredSeg consistently outperforms the baseline, demonstrating its effectiveness for trustworthy dense medical segmentation. Moreover, the proposed framework is model-agnostic and can be readily applied to other segmentation architectures.