# Principle-Guided Supervision for Interpretable Uncertainty in Medical Image Segmentation

arXiv: https://arxiv.org/abs/2605.10984 · HTML: https://mlsanity.com/paper/2605.10984/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 22 of its 42 references that are in the map.
- First posted on arXiv 9 May 2026.

## Builds on (most cited first, 22 of 22)

- [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)
- [What Uncertainties Do We Need in Bayesian Deep Learning for Computer Vision?](https://mlsanity.com/paper/1703.04977/) (2017)
- [Can You Trust Your Model's Uncertainty? Evaluating Predictive Uncertainty Under Dataset Shift](https://mlsanity.com/paper/1906.02530/) (2019)
- [Evidential Deep Learning to Quantify Classification Uncertainty](https://mlsanity.com/paper/1806.01768/) (2018)
- [Skin Lesion Analysis Toward Melanoma Detection 2018: A Challenge Hosted by the International Skin Imaging Collaboration (ISIC)](https://mlsanity.com/paper/1902.03368/) (2019)
- [Aleatoric uncertainty estimation with test-time augmentation for medical image segmentation with convolutional neural networks](https://mlsanity.com/paper/1807.07356/) (2018)
- [Mix-n-Match: Ensemble and Compositional Methods for Uncertainty Calibration in Deep Learning](https://mlsanity.com/paper/2003.07329/) (2020)
- [Confidence Calibration and Predictive Uncertainty Estimation for Deep Medical Image Segmentation](https://mlsanity.com/paper/1911.13273/) (2019)
- [Uncertainty Quantification and Deep Ensembles](https://mlsanity.com/paper/2007.08792/) (2020)
- [Multivariate mixture model for myocardium segmentation combining multi-source images](https://mlsanity.com/paper/1612.08820/) (2016)
- [PHiSeg: Capturing Uncertainty in Medical Image Segmentation](https://mlsanity.com/paper/1906.04045/) (2019)
- [Benchmarking the Robustness of Semantic Segmentation Models](https://mlsanity.com/paper/1908.05005/) (2019)
- [Assessing Reliability and Challenges of Uncertainty Estimations for Medical Image Segmentation](https://mlsanity.com/paper/1907.03338/) (2019)
- [Prior and Posterior Networks: A Survey on Evidential Deep Learning Methods For Uncertainty Estimation](https://mlsanity.com/paper/2110.03051/) (2021)
- [Uncertainty Estimation by Fisher Information-based Evidential Deep Learning](https://mlsanity.com/paper/2303.02045/) (2023)
- [Accurate Uncertainty Estimation and Decomposition in Ensemble Learning](https://mlsanity.com/paper/1911.04061/) (2019)
- [BayeSeg: Bayesian Modeling for Medical Image Segmentation with Interpretable Generalizability](https://mlsanity.com/paper/2303.01710/) (2023)
- [A Comprehensive Survey on Evidential Deep Learning and Its Applications](https://mlsanity.com/paper/2409.04720/) (2024)
- [Uncertainty-Supervised Interpretable and Robust Evidential Segmentation](https://mlsanity.com/paper/2509.17098/) (2025)
- [EDUE: Expert Disagreement-Guided One-Pass Uncertainty Estimation for Medical Image Segmentation](https://mlsanity.com/paper/2403.16594/) (2024)

## Abstract (arXiv)

Uncertainty quantification complements model predictions by characterizing their reliability, which is essential for high-stakes decision making such as medical image segmentation. However, most existing methods reduce uncertainty to a scalar confidence estimate, leaving its spatial distribution semantically underconstrained. In this work, we focus on uncertainty interpretability, namely, whether estimated uncertainty behaves in a human-understandable manner with respect to sources of ambiguity. We identify three perception-aligned principles requiring the spatial distribution of uncertainty to reflect: (1) image contrast between structures, (2) severity of image corruption, and (3) geometric complexity in anatomical structures. Accordingly, we develop a principle-guided uncertainty supervision framework (PriUS) based on evidential learning, in which the corresponding supervision objectives are explicitly enforced during training. We further introduce quantitative metrics to measure the consistency between predicted uncertainty and image attributes that induce ambiguity. Experiments on ACDC, ISIC, and WHS datasets showed that, compared with state-of-the-art methods, PriUS produced more consistent uncertainty estimates while maintaining competitive segmentation performance.