# Rethinking Uncertainty in Segmentation: From Estimation to Decision

arXiv: https://arxiv.org/abs/2604.13262 · HTML: https://mlsanity.com/paper/2604.13262/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 19 of its 39 references that are in the map.
- First posted on arXiv 14 Apr 2026.

## Builds on (most cited first, 19 of 19)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [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)
- [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)
- [TransUNet: Transformers Make Strong Encoders for Medical Image Segmentation](https://mlsanity.com/paper/2102.04306/) (2021)
- [UNet++: A Nested U-Net Architecture for Medical Image Segmentation](https://mlsanity.com/paper/1807.10165/) (2018)
- [Attention U-Net: Learning Where to Look for the Pancreas](https://mlsanity.com/paper/1804.03999/) (2018)
- [Can You Trust Your Model's Uncertainty? Evaluating Predictive Uncertainty Under Dataset Shift](https://mlsanity.com/paper/1906.02530/) (2019)
- [Selective Classification for Deep Neural Networks](https://mlsanity.com/paper/1705.08500/) (2017)
- [Weight Uncertainty in Neural Networks](https://mlsanity.com/paper/1505.05424/) (2015)
- [Aleatoric uncertainty estimation with test-time augmentation for medical image segmentation with convolutional neural networks](https://mlsanity.com/paper/1807.07356/) (2018)
- [Consistent Estimators for Learning to Defer to an Expert](https://mlsanity.com/paper/2006.01862/) (2020)
- [Learning Confidence for Out-of-Distribution Detection in Neural Networks](https://mlsanity.com/paper/1802.04865/) (2018)
- [Predict Responsibly: Improving Fairness and Accuracy by Learning to Defer](https://mlsanity.com/paper/1711.06664/) (2017)
- [Addressing Failure Prediction by Learning Model Confidence](https://mlsanity.com/paper/1910.04851/) (2019)
- [Confidence Calibration and Predictive Uncertainty Estimation for Deep Medical Image Segmentation](https://mlsanity.com/paper/1911.13273/) (2019)
- [Exploring Uncertainty Measures in Deep Networks for Multiple Sclerosis Lesion Detection and Segmentation](https://mlsanity.com/paper/1808.01200/) (2018)
- [On the Effect of Inter-observer Variability for a Reliable Estimation of Uncertainty of Medical Image Segmentation](https://mlsanity.com/paper/1806.02562/) (2018)

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

- [Observer Choice and Threshold Selection in Retinal Vessel Segmentation: A Subject-Separated Evaluation](https://mlsanity.com/paper/2609.25597/) (2026)

## Abstract (arXiv)

In medical image segmentation, uncertainty estimates are often reported but rarely used to guide decisions. We study the missing step: how uncertainty maps are converted into actionable policies such as accepting, flagging, or deferring predictions. We formulate segmentation as a two-stage pipeline, estimation followed by decision, and show that optimizing uncertainty alone fails to capture most of the achievable safety gains. Using retinal vessel segmentation benchmarks (DRIVE, STARE, CHASE_DB1), we evaluate two uncertainty sources (Monte Carlo Dropout and Test-Time Augmentation) combined with three deferral strategies, and introduce a simple confidence-aware deferral rule that prioritizes uncertain and low-confidence predictions. Our results show that the best method and policy combination removes up to 80 percent of segmentation errors at only 25 percent pixel deferral, while achieving strong cross-dataset robustness. We further show that calibration improvements do not translate to better decision quality, highlighting a disconnect between standard uncertainty metrics and real-world utility. These findings suggest that uncertainty should be evaluated based on the decisions it enables, rather than in isolation.