# Uncertainty-Guided Handshake: Efficient Human-in-the-Loop Refinement for Surgical-Grade Glioma Segmentation

arXiv: https://arxiv.org/abs/2610.01452 · HTML: https://mlsanity.com/paper/2610.01452/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 19 of its 32 references that are in the map.
- First posted on arXiv 1 Oct 2026.

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

- [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)
- [Evidential Deep Learning to Quantify Classification Uncertainty](https://mlsanity.com/paper/1806.01768/) (2018)
- [The RSNA-ASNR-MICCAI BraTS 2021 Benchmark on Brain Tumor Segmentation and Radiogenomic Classification](https://mlsanity.com/paper/2107.02314/) (2021)
- [Aleatoric uncertainty estimation with test-time augmentation for medical image segmentation with convolutional neural networks](https://mlsanity.com/paper/1807.07356/) (2018)
- [Topology-Preserving Deep Image Segmentation](https://mlsanity.com/paper/1906.05404/) (2019)
- [A Survey on Active Learning and Human-in-the-Loop Deep Learning for Medical Image Analysis](https://mlsanity.com/paper/1910.02923/) (2019)
- [Exploring Uncertainty Measures in Deep Networks for Multiple Sclerosis Lesion Detection and Segmentation](https://mlsanity.com/paper/1808.01200/) (2018)
- [A Topological Loss Function for Deep-Learning based Image Segmentation using Persistent Homology](https://mlsanity.com/paper/1910.01877/) (2019)
- [Interactive Medical Image Segmentation using Deep Learning with Image-specific Fine-tuning](https://mlsanity.com/paper/1710.04043/) (2017)
- [DeepIGeoS: A Deep Interactive Geodesic Framework for Medical Image Segmentation](https://mlsanity.com/paper/1707.00652/) (2017)
- [Topologically faithful image segmentation via induced matching of persistence barcodes](https://mlsanity.com/paper/2211.15272/) (2022)
- [Bayesian QuickNAT: Model Uncertainty in Deep Whole-Brain Segmentation for Structure-wise Quality Control](https://mlsanity.com/paper/1811.09800/) (2018)
- [MONAI Label: A framework for AI-assisted Interactive Labeling of 3D Medical Images](https://mlsanity.com/paper/2203.12362/) (2022)
- [A review of uncertainty quantification in medical image analysis: probabilistic and non-probabilistic methods](https://mlsanity.com/paper/2310.06873/) (2023)
- [Reverse Classification Accuracy: Predicting Segmentation Performance in the Absence of Ground Truth](https://mlsanity.com/paper/1702.03407/) (2017)
- [How we won BraTS 2023 Adult Glioma challenge? Just faking it! Enhanced Synthetic Data Augmentation and Model Ensemble for brain tumour segmentation](https://mlsanity.com/paper/2402.17317/) (2024)
- [MedUHIP: Towards Human-In-the-Loop Medical Segmentation](https://mlsanity.com/paper/2408.01620/) (2024)

## Abstract (arXiv)

While state-of-the-art automated models for medical image segmentation achieve high mean performance, they frequently suffer from localized, catastrophic failures that preclude safe clinical deployment, particularly in neuro-oncology. Interactive segmentation frameworks mitigate this by incorporating human oversight, but traditionally impose prohibitive cognitive and temporal workloads by requiring clinicians to manually search for errors. In this project, we present an efficient, Hybrid Structural-Aleatoric Human-in-the-Loop framework for glioma segmentation that bridges the gap between automated baseline performance and surgical-grade precision, achieving sub-2.0 mm HD95 on curated benchmarks while providing safety-net routing for structural failures across real-world clinical data. By extracting voxel-wise Test-Time Augmentation (TTA) uncertainty and applying hierarchical topological filtering, our method proactively isolates high-risk structural anomalies. We comprehensively evaluated our approach on a challenging out-of-distribution clinical stress-test cohort (N = 362). Operating under a simulated Human Oracle, the framework improved the Whole Tumor (WT) Dice score from 0.891 to 0.914 and reduced the 95th percentile Hausdorff Distance (HD95) from 5.82 mm to 4.76 mm. Critically for surgical safety, the system rescued severe boundary failures in the Tumor Core, reducing mean HD95 from 17.96 mm to 14.83 mm (improving absolute TC Dice to 0.356). These spatial rescues were achieved while demanding a median interactive workload of just 11.3% of the target volume. Acknowledging this as a simulated upper bound lacking real-world cognitive friction, the framework nevertheless demonstrates a highly Pareto-efficient pathway for safely deploying clinical AI.