# Monte Carlo Dropout Uncertainty and Entropy-Thresholded Selective Prediction for Architecture-Agnostic Brain Tumor MRI Triage

arXiv: https://arxiv.org/abs/2607.16317 · HTML: https://mlsanity.com/paper/2607.16317/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 12 of its 18 references that are in the map.
- First posted on arXiv 15 Jul 2026.

## Builds on (most cited first, 12 of 12)

- [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)
- [Grad-CAM: Visual Explanations from Deep Networks via Gradient-based Localization](https://mlsanity.com/paper/1610.02391/) (2016)
- [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)
- [Selective Classification for Deep Neural Networks](https://mlsanity.com/paper/1705.08500/) (2017)
- [Quantifying Attention Flow in Transformers](https://mlsanity.com/paper/2005.00928/) (2020)
- [Evidential Deep Learning to Quantify Classification Uncertainty](https://mlsanity.com/paper/1806.01768/) (2018)
- [Inflation of test accuracy due to data leakage in deep learning-based classification of OCT images](https://mlsanity.com/paper/2202.12267/) (2022)
- [How You Split Matters: Data Leakage and Subject Characteristics Studies in Longitudinal Brain MRI Analysis](https://mlsanity.com/paper/2309.00350/) (2023)

## Abstract (arXiv)

Deep networks now subtype brain tumors on MRI about as well as specialist readers, yet accuracy is not what keeps them out of the clinic. What matters at the point of care is whether a model's confidence can be trusted to flag the cases it is likely to misclassify and defer them to a human. Deterministic estimates cannot: an auxiliary confidence head trained alongside the classifier collapses to a near-constant output that says nothing about correctness. This study proposes an uncertainty-first pipeline for four-class brain tumor MRI (glioma, meningioma, pituitary, no tumor) that reads predictive uncertainty from Monte Carlo (MC) Dropout over T = 20 passes and turns the resulting entropy into an explicit rule for deferring uncertain cases to a radiologist. We partitioned 7,200 images by perceptual-hash cluster, closing the near-duplicate leakage that inflates accuracy under naive splitting, and evaluated the pipeline on ViT-B/16 and ResNet-50 across five seeds along three axes: discrimination, calibration, and selective prediction. Both discriminate strongly (macro-AUC 0.994; accuracy 0.962 and 0.964), and no seed separates them (0 of 5 significant, p < 0.05), so the result is driven by the uncertainty pipeline, not the network. A single temperature scalar pulls the deterministic softmax into tight calibration (expected calibration error 0.016-0.020), and deferring the most uncertain 5% of cases lifts accuracy on the rest to about 0.98 on both (area under the risk-coverage curve 0.010-0.011). MC-Dropout uncertainty here is thus calibrated, non-collapsing, and directly actionable through a concrete deferral rule, providing an architecture-agnostic basis for calibrated, defer-to-human brain tumor MRI triage under internal validation.