# Beyond Uncertainty: Generalizable Failure Monitoring for Surgical Segmentation under Acquisition Degradation

arXiv: https://arxiv.org/abs/2608.16748 · HTML: https://mlsanity.com/paper/2608.16748/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 30 of its 33 references that are in the map.
- First posted on arXiv 17 Aug 2026.

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

- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [Segment Anything](https://mlsanity.com/paper/2304.02643/) (2023)
- [XGBoost: A Scalable Tree Boosting System](https://mlsanity.com/paper/1603.02754/) (2016)
- [On Calibration of Modern Neural Networks](https://mlsanity.com/paper/1706.04599/) (2017)
- [Simple and Scalable Predictive Uncertainty Estimation using Deep Ensembles](https://mlsanity.com/paper/1612.01474/) (2016)
- [Benchmarking Neural Network Robustness to Common Corruptions and Perturbations](https://mlsanity.com/paper/1903.12261/) (2019)
- [SAM 2: Segment Anything in Images and Videos](https://mlsanity.com/paper/2408.00714/) (2024)
- [A Baseline for Detecting Misclassified and Out-of-Distribution Examples in Neural Networks](https://mlsanity.com/paper/1610.02136/) (2016)
- [A Simple Unified Framework for Detecting Out-of-Distribution Samples and Adversarial Attacks](https://mlsanity.com/paper/1807.03888/) (2018)
- [Selective Classification for Deep Neural Networks](https://mlsanity.com/paper/1705.08500/) (2017)
- [A Gentle Introduction to Conformal Prediction and Distribution-Free Uncertainty Quantification](https://mlsanity.com/paper/2107.07511/) (2021)
- [Predictive Uncertainty Estimation via Prior Networks](https://mlsanity.com/paper/1802.10501/) (2018)
- [SelectiveNet: A Deep Neural Network with an Integrated Reject Option](https://mlsanity.com/paper/1901.09192/) (2019)
- [Conformal Risk Control](https://mlsanity.com/paper/2208.02814/) (2022)
- [Addressing Failure Prediction by Learning Model Confidence](https://mlsanity.com/paper/1910.04851/) (2019)
- [2017 Robotic Instrument Segmentation Challenge](https://mlsanity.com/paper/1902.06426/) (2019)
- [Confidence Calibration and Predictive Uncertainty Estimation for Deep Medical Image Segmentation](https://mlsanity.com/paper/1911.13273/) (2019)
- [Polyp-PVT: Polyp Segmentation with Pyramid Vision Transformers](https://mlsanity.com/paper/2108.06932/) (2021)
- [Image-to-Image Regression with Distribution-Free Uncertainty Quantification and Applications in Imaging](https://mlsanity.com/paper/2202.05265/) (2022)
- [CholecSeg8k: A Semantic Segmentation Dataset for Laparoscopic Cholecystectomy Based on Cholec80](https://mlsanity.com/paper/2012.12453/) (2020)
- [Continual Semantic Segmentation via Repulsion-Attraction of Sparse and Disentangled Latent Representations](https://mlsanity.com/paper/2103.06342/) (2021)
- [Automatic Instrument Segmentation in Robot-Assisted Surgery Using Deep Learning](https://mlsanity.com/paper/1803.01207/) (2018)
- [Assessing Reliability and Challenges of Uncertainty Estimations for Medical Image Segmentation](https://mlsanity.com/paper/1907.03338/) (2019)
- [Prediction Error Meta Classification in Semantic Segmentation: Detection via Aggregated Dispersion Measures of Softmax Probabilities](https://mlsanity.com/paper/1811.00648/) (2018)
- [DOCTOR: A Simple Method for Detecting Misclassification Errors](https://mlsanity.com/paper/2106.02395/) (2021)
- [Surgical SAM 2: Real-time Segment Anything in Surgical Video by Efficient Frame Pruning](https://mlsanity.com/paper/2408.07931/) (2024)
- [Improving Trustworthiness of AI Disease Severity Rating in Medical Imaging with Ordinal Conformal Prediction Sets](https://mlsanity.com/paper/2207.02238/) (2022)
- [Comparative evaluation of instrument segmentation and tracking methods in minimally invasive surgery](https://mlsanity.com/paper/1805.02475/) (2018)
- [FSNet: A Failure Detection Framework for Semantic Segmentation](https://mlsanity.com/paper/2108.08748/) (2021)
- [SegSTRONG-C: Segmenting Surgical Tools Robustly On Non-adversarial Generated Corruptions -- An EndoVis'24 Challenge](https://mlsanity.com/paper/2407.11906/) (2024)

## Abstract (arXiv)

Surgical segmentation networks can fail silently under acquisition degradation: predicted masks may be wrong even when model confidence remains high. Existing deployment-time monitors rely primarily on uncertainty estimates and can therefore miss confident failures. We present TCSR-Monitor (Temporal Conformal Surgical Risk Monitor), a post-hoc failure-monitoring framework that combines confidence with observable shape, temporal-consistency, and image-quality cues. TCSR-Monitor wraps a frozen segmentation model, requires no model internals, and operates without ground truth at deployment. We also introduce a validation protocol to assess whether alarms remain credible under distribution shift. On EndoVis 2017, leave-one-corruption-out evaluation shows that TCSR-Monitor generalizes to unseen acquisition degradations and substantially outperforms confidence-based baselines. A circularity control confirms that it predicts segmentation failure rather than simply detecting corrupted images. Mondrian conformal calibration balances miss-rates across degradation severities, but a single global threshold still produces false alarms on up to 40% of correctly segmented frames at moderate corruption. Zero-shot transfer to SAM2 demonstrates feature portability, although entropy outperforms the transferred monitor at both evaluated thresholds. Overall, reliable monitoring under acquisition degradation benefits from complementary observable signals beyond confidence alone, but substantial false-alarm and transfer limitations remain.