Adaptive Confidence-Wise Loss for Improved Lens Structure Segmentation in AS-OCT

Precise lens structure segmentation is essential for the design of intraocular lenses (IOLs) in cataract surgery. Existing deep segmentation networks typically weight all pixels equally under cross-entropy (CE) loss, overlooking the fact that sub-regions of lens structures are inhomogeneous (e.g., some regions perform better than others) and that boundary regions often suffer from poor segmentation calibration at the pixel level. Clinically, experts annotate different sub-regions of lens structures with varying confidence levels, considering factors such as sub-region proportions, ambiguous boundaries, and lens structure shapes. Motivated by this observation, we propose an Adaptive Confidence-Wise (ACW) loss to group each lens structure sub-region into different confidence sub-regions via a confidence threshold from the unique region aspect, aiming to exploit the potential of expert annotation confidence prior. Specifically, ACW clusters each target region into low-confidence and high-confidence groups and then applies a region-weighted loss to reweigh each confidence group. Moreover, we design an adaptive confidence threshold optimization algorithm to adjust the confidence threshold of ACW dynamically. Additionally, to better quantify the miscalibration errors in boundary region segmentation, we propose a new metric, termed Boundary Expected Calibration Error (BECE). Extensive experiments on a clinical lens structure AS-OCT dataset and other multi-structure datasets demonstrate that our ACW significantly outperforms competitive segmentation loss methods across different deep segmentation networks (e.g., MedSAM). Notably, our method surpasses CE with 6.13% IoU gain, 4.33% DSC increase, and 4.79% BECE reduction in lens structure segmentation under U-Net. The code of this paper is available at https://github.com/XiaoLing12138/Adaptive-Confidence-Wise-Loss.

Expert-Like Reparameterization of Heterogeneous Pyramid Receptive Fields in Efficient CNNs for Fair Medical Image Classification

Efficient convolutional neural network (CNN) architecture designs have attracted growing research interests. However, they usually apply single receptive field (RF), small asymmetric RFs, or pyramid RFs to learn different feature representations, still encountering two significant challenges in medical image classification tasks: 1) They have limitations in capturing diverse lesion characteristics efficiently, e.g., tiny, coordination, small and salient, which have unique roles on results, especially imbalanced medical image classification. 2) The predictions generated by those CNNs are often unfair/biased, bringing a high risk by employing them to real-world medical diagnosis conditions. To tackle these issues, we develop a new concept, Expert-Like Reparameterization of Heterogeneous Pyramid Receptive Fields (ERoHPRF), to simultaneously boost medical image classification performance and fairness. This concept aims to mimic the multi-expert consultation mode by applying the well-designed heterogeneous pyramid RF bags to capture different lesion characteristics effectively via convolution operations with multiple heterogeneous kernel sizes. Additionally, ERoHPRF introduces an expert-like structural reparameterization technique to merge its parameters with the two-stage strategy, ensuring competitive computation cost and inference speed through comparisons to a single RF. To manifest the effectiveness and generalization ability of ERoHPRF, we incorporate it into mainstream efficient CNN architectures. The extensive experiments show that our method maintains a better trade-off than state-of-the-art methods in terms of medical image classification, fairness, and computation overhead. The codes of this paper will be released soon.