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Paul F. Jäger

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Deep Interactive Segmentation of Medical Images: A Systematic Review and Taxonomy

Nov 23, 2023
Zdravko Marinov, Paul F. Jäger, Jan Egger, Jens Kleesiek, Rainer Stiefelhagen

Interactive segmentation is a crucial research area in medical image analysis aiming to boost the efficiency of costly annotations by incorporating human feedback. This feedback takes the form of clicks, scribbles, or masks and allows for iterative refinement of the model output so as to efficiently guide the system towards the desired behavior. In recent years, deep learning-based approaches have propelled results to a new level causing a rapid growth in the field with 121 methods proposed in the medical imaging domain alone. In this review, we provide a structured overview of this emerging field featuring a comprehensive taxonomy, a systematic review of existing methods, and an in-depth analysis of current practices. Based on these contributions, we discuss the challenges and opportunities in the field. For instance, we find that there is a severe lack of comparison across methods which needs to be tackled by standardized baselines and benchmarks.

* 26 pages, 8 figures, 10 tables; Zdravko Marinov and Paul F. J\"ager and co-first authors; This work has been submitted to the IEEE for possible publication. Copyright may be transferred without notice, after which this version may no longer be accessible 
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Why is the winner the best?

Mar 30, 2023
Matthias Eisenmann, Annika Reinke, Vivienn Weru, Minu Dietlinde Tizabi, Fabian Isensee, Tim J. Adler, Sharib Ali, Vincent Andrearczyk, Marc Aubreville, Ujjwal Baid, Spyridon Bakas, Niranjan Balu, Sophia Bano, Jorge Bernal, Sebastian Bodenstedt, Alessandro Casella, Veronika Cheplygina, Marie Daum, Marleen de Bruijne, Adrien Depeursinge, Reuben Dorent, Jan Egger, David G. Ellis, Sandy Engelhardt, Melanie Ganz, Noha Ghatwary, Gabriel Girard, Patrick Godau, Anubha Gupta, Lasse Hansen, Kanako Harada, Mattias Heinrich, Nicholas Heller, Alessa Hering, Arnaud Huaulmé, Pierre Jannin, Ali Emre Kavur, Oldřich Kodym, Michal Kozubek, Jianning Li, Hongwei Li, Jun Ma, Carlos Martín-Isla, Bjoern Menze, Alison Noble, Valentin Oreiller, Nicolas Padoy, Sarthak Pati, Kelly Payette, Tim Rädsch, Jonathan Rafael-Patiño, Vivek Singh Bawa, Stefanie Speidel, Carole H. Sudre, Kimberlin van Wijnen, Martin Wagner, Donglai Wei, Amine Yamlahi, Moi Hoon Yap, Chun Yuan, Maximilian Zenk, Aneeq Zia, David Zimmerer, Dogu Baran Aydogan, Binod Bhattarai, Louise Bloch, Raphael Brüngel, Jihoon Cho, Chanyeol Choi, Qi Dou, Ivan Ezhov, Christoph M. Friedrich, Clifton Fuller, Rebati Raman Gaire, Adrian Galdran, Álvaro García Faura, Maria Grammatikopoulou, SeulGi Hong, Mostafa Jahanifar, Ikbeom Jang, Abdolrahim Kadkhodamohammadi, Inha Kang, Florian Kofler, Satoshi Kondo, Hugo Kuijf, Mingxing Li, Minh Huan Luu, Tomaž Martinčič, Pedro Morais, Mohamed A. Naser, Bruno Oliveira, David Owen, Subeen Pang, Jinah Park, Sung-Hong Park, Szymon Płotka, Elodie Puybareau, Nasir Rajpoot, Kanghyun Ryu, Numan Saeed, Adam Shephard, Pengcheng Shi, Dejan Štepec, Ronast Subedi, Guillaume Tochon, Helena R. Torres, Helene Urien, João L. Vilaça, Kareem Abdul Wahid, Haojie Wang, Jiacheng Wang, Liansheng Wang, Xiyue Wang, Benedikt Wiestler, Marek Wodzinski, Fangfang Xia, Juanying Xie, Zhiwei Xiong, Sen Yang, Yanwu Yang, Zixuan Zhao, Klaus Maier-Hein, Paul F. Jäger, Annette Kopp-Schneider, Lena Maier-Hein

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International benchmarking competitions have become fundamental for the comparative performance assessment of image analysis methods. However, little attention has been given to investigating what can be learnt from these competitions. Do they really generate scientific progress? What are common and successful participation strategies? What makes a solution superior to a competing method? To address this gap in the literature, we performed a multi-center study with all 80 competitions that were conducted in the scope of IEEE ISBI 2021 and MICCAI 2021. Statistical analyses performed based on comprehensive descriptions of the submitted algorithms linked to their rank as well as the underlying participation strategies revealed common characteristics of winning solutions. These typically include the use of multi-task learning (63%) and/or multi-stage pipelines (61%), and a focus on augmentation (100%), image preprocessing (97%), data curation (79%), and postprocessing (66%). The "typical" lead of a winning team is a computer scientist with a doctoral degree, five years of experience in biomedical image analysis, and four years of experience in deep learning. Two core general development strategies stood out for highly-ranked teams: the reflection of the metrics in the method design and the focus on analyzing and handling failure cases. According to the organizers, 43% of the winning algorithms exceeded the state of the art but only 11% completely solved the respective domain problem. The insights of our study could help researchers (1) improve algorithm development strategies when approaching new problems, and (2) focus on open research questions revealed by this work.

* accepted to CVPR 2023 
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Understanding metric-related pitfalls in image analysis validation

Feb 09, 2023
Annika Reinke, Minu D. Tizabi, Michael Baumgartner, Matthias Eisenmann, Doreen Heckmann-Nötzel, A. Emre Kavur, Tim Rädsch, Carole H. Sudre, Laura Acion, Michela Antonelli, Tal Arbel, Spyridon Bakas, Arriel Benis, Matthew Blaschko, Florian Büttner, M. Jorge Cardoso, Veronika Cheplygina, Jianxu Chen, Evangelia Christodoulou, Beth A. Cimini, Gary S. Collins, Keyvan Farahani, Luciana Ferrer, Adrian Galdran, Bram van Ginneken, Ben Glocker, Patrick Godau, Robert Haase, Daniel A. Hashimoto, Michael M. Hoffman, Merel Huisman, Fabian Isensee, Pierre Jannin, Charles E. Kahn, Dagmar Kainmueller, Bernhard Kainz, Alexandros Karargyris, Alan Karthikesalingam, Hannes Kenngott, Jens Kleesiek, Florian Kofler, Thijs Kooi, Annette Kopp-Schneider, Michal Kozubek, Anna Kreshuk, Tahsin Kurc, Bennett A. Landman, Geert Litjens, Amin Madani, Klaus Maier-Hein, Anne L. Martel, Peter Mattson, Erik Meijering, Bjoern Menze, Karel G. M. Moons, Henning Müller, Brennan Nichyporuk, Felix Nickel, Jens Petersen, Susanne M. Rafelski, Nasir Rajpoot, Mauricio Reyes, Michael A. Riegler, Nicola Rieke, Julio Saez-Rodriguez, Clara I. Sánchez, Shravya Shetty, Maarten van Smeden, Ronald M. Summers, Abdel A. Taha, Aleksei Tiulpin, Sotirios A. Tsaftaris, Ben Van Calster, Gaël Varoquaux, Manuel Wiesenfarth, Ziv R. Yaniv, Paul F. Jäger, Lena Maier-Hein

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Validation metrics are key for the reliable tracking of scientific progress and for bridging the current chasm between artificial intelligence (AI) research and its translation into practice. However, increasing evidence shows that particularly in image analysis, metrics are often chosen inadequately in relation to the underlying research problem. This could be attributed to a lack of accessibility of metric-related knowledge: While taking into account the individual strengths, weaknesses, and limitations of validation metrics is a critical prerequisite to making educated choices, the relevant knowledge is currently scattered and poorly accessible to individual researchers. Based on a multi-stage Delphi process conducted by a multidisciplinary expert consortium as well as extensive community feedback, the present work provides the first reliable and comprehensive common point of access to information on pitfalls related to validation metrics in image analysis. Focusing on biomedical image analysis but with the potential of transfer to other fields, the addressed pitfalls generalize across application domains and are categorized according to a newly created, domain-agnostic taxonomy. To facilitate comprehension, illustrations and specific examples accompany each pitfall. As a structured body of information accessible to researchers of all levels of expertise, this work enhances global comprehension of a key topic in image analysis validation.

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Biomedical image analysis competitions: The state of current participation practice

Dec 16, 2022
Matthias Eisenmann, Annika Reinke, Vivienn Weru, Minu Dietlinde Tizabi, Fabian Isensee, Tim J. Adler, Patrick Godau, Veronika Cheplygina, Michal Kozubek, Sharib Ali, Anubha Gupta, Jan Kybic, Alison Noble, Carlos Ortiz de Solórzano, Samiksha Pachade, Caroline Petitjean, Daniel Sage, Donglai Wei, Elizabeth Wilden, Deepak Alapatt, Vincent Andrearczyk, Ujjwal Baid, Spyridon Bakas, Niranjan Balu, Sophia Bano, Vivek Singh Bawa, Jorge Bernal, Sebastian Bodenstedt, Alessandro Casella, Jinwook Choi, Olivier Commowick, Marie Daum, Adrien Depeursinge, Reuben Dorent, Jan Egger, Hannah Eichhorn, Sandy Engelhardt, Melanie Ganz, Gabriel Girard, Lasse Hansen, Mattias Heinrich, Nicholas Heller, Alessa Hering, Arnaud Huaulmé, Hyunjeong Kim, Bennett Landman, Hongwei Bran Li, Jianning Li, Jun Ma, Anne Martel, Carlos Martín-Isla, Bjoern Menze, Chinedu Innocent Nwoye, Valentin Oreiller, Nicolas Padoy, Sarthak Pati, Kelly Payette, Carole Sudre, Kimberlin van Wijnen, Armine Vardazaryan, Tom Vercauteren, Martin Wagner, Chuanbo Wang, Moi Hoon Yap, Zeyun Yu, Chun Yuan, Maximilian Zenk, Aneeq Zia, David Zimmerer, Rina Bao, Chanyeol Choi, Andrew Cohen, Oleh Dzyubachyk, Adrian Galdran, Tianyuan Gan, Tianqi Guo, Pradyumna Gupta, Mahmood Haithami, Edward Ho, Ikbeom Jang, Zhili Li, Zhengbo Luo, Filip Lux, Sokratis Makrogiannis, Dominik Müller, Young-tack Oh, Subeen Pang, Constantin Pape, Gorkem Polat, Charlotte Rosalie Reed, Kanghyun Ryu, Tim Scherr, Vajira Thambawita, Haoyu Wang, Xinliang Wang, Kele Xu, Hung Yeh, Doyeob Yeo, Yixuan Yuan, Yan Zeng, Xin Zhao, Julian Abbing, Jannes Adam, Nagesh Adluru, Niklas Agethen, Salman Ahmed, Yasmina Al Khalil, Mireia Alenyà, Esa Alhoniemi, Chengyang An, Talha Anwar, Tewodros Weldebirhan Arega, Netanell Avisdris, Dogu Baran Aydogan, Yingbin Bai, Maria Baldeon Calisto, Berke Doga Basaran, Marcel Beetz, Cheng Bian, Hao Bian, Kevin Blansit, Louise Bloch, Robert Bohnsack, Sara Bosticardo, Jack Breen, Mikael Brudfors, Raphael Brüngel, Mariano Cabezas, Alberto Cacciola, Zhiwei Chen, Yucong Chen, Daniel Tianming Chen, Minjeong Cho, Min-Kook Choi, Chuantao Xie Chuantao Xie, Dana Cobzas, Julien Cohen-Adad, Jorge Corral Acero, Sujit Kumar Das, Marcela de Oliveira, Hanqiu Deng, Guiming Dong, Lars Doorenbos, Cory Efird, Di Fan, Mehdi Fatan Serj, Alexandre Fenneteau, Lucas Fidon, Patryk Filipiak, René Finzel, Nuno R. Freitas, Christoph M. Friedrich, Mitchell Fulton, Finn Gaida, Francesco Galati, Christoforos Galazis, Chang Hee Gan, Zheyao Gao, Shengbo Gao, Matej Gazda, Beerend Gerats, Neil Getty, Adam Gibicar, Ryan Gifford, Sajan Gohil, Maria Grammatikopoulou, Daniel Grzech, Orhun Güley, Timo Günnemann, Chunxu Guo, Sylvain Guy, Heonjin Ha, Luyi Han, Il Song Han, Ali Hatamizadeh, Tian He, Jimin Heo, Sebastian Hitziger, SeulGi Hong, SeungBum Hong, Rian Huang, Ziyan Huang, Markus Huellebrand, Stephan Huschauer, Mustaffa Hussain, Tomoo Inubushi, Ece Isik Polat, Mojtaba Jafaritadi, SeongHun Jeong, Bailiang Jian, Yuanhong Jiang, Zhifan Jiang, Yueming Jin, Smriti Joshi, Abdolrahim Kadkhodamohammadi, Reda Abdellah Kamraoui, Inha Kang, Junghwa Kang, Davood Karimi, April Khademi, Muhammad Irfan Khan, Suleiman A. Khan, Rishab Khantwal, Kwang-Ju Kim, Timothy Kline, Satoshi Kondo, Elina Kontio, Adrian Krenzer, Artem Kroviakov, Hugo Kuijf, Satyadwyoom Kumar, Francesco La Rosa, Abhi Lad, Doohee Lee, Minho Lee, Chiara Lena, Hao Li, Ling Li, Xingyu Li, Fuyuan Liao, KuanLun Liao, Arlindo Limede Oliveira, Chaonan Lin, Shan Lin, Akis Linardos, Marius George Linguraru, Han Liu, Tao Liu, Di Liu, Yanling Liu, João Lourenço-Silva, Jingpei Lu, Jiangshan Lu, Imanol Luengo, Christina B. Lund, Huan Minh Luu, Yi Lv, Yi Lv, Uzay Macar, Leon Maechler, Sina Mansour L., Kenji Marshall, Moona Mazher, Richard McKinley, Alfonso Medela, Felix Meissen, Mingyuan Meng, Dylan Miller, Seyed Hossein Mirjahanmardi, Arnab Mishra, Samir Mitha, Hassan Mohy-ud-Din, Tony Chi Wing Mok, Gowtham Krishnan Murugesan, Enamundram Naga Karthik, Sahil Nalawade, Jakub Nalepa, Mohamed Naser, Ramin Nateghi, Hammad Naveed, Quang-Minh Nguyen, Cuong Nguyen Quoc, Brennan Nichyporuk, Bruno Oliveira, David Owen, Jimut Bahan Pal, Junwen Pan, Wentao Pan, Winnie Pang, Bogyu Park, Vivek Pawar, Kamlesh Pawar, Michael Peven, Lena Philipp, Tomasz Pieciak, Szymon Plotka, Marcel Plutat, Fattaneh Pourakpour, Domen Preložnik, Kumaradevan Punithakumar, Abdul Qayyum, Sandro Queirós, Arman Rahmim, Salar Razavi, Jintao Ren, Mina Rezaei, Jonathan Adam Rico, ZunHyan Rieu, Markus Rink, Johannes Roth, Yusely Ruiz-Gonzalez, Numan Saeed, Anindo Saha, Mostafa Salem, Ricardo Sanchez-Matilla, Kurt Schilling, Wei Shao, Zhiqiang Shen, Ruize Shi, Pengcheng Shi, Daniel Sobotka, Théodore Soulier, Bella Specktor Fadida, Danail Stoyanov, Timothy Sum Hon Mun, Xiaowu Sun, Rong Tao, Franz Thaler, Antoine Théberge, Felix Thielke, Helena Torres, Kareem A. Wahid, Jiacheng Wang, YiFei Wang, Wei Wang, Xiong Wang, Jianhui Wen, Ning Wen, Marek Wodzinski, Ye Wu, Fangfang Xia, Tianqi Xiang, Chen Xiaofei, Lizhan Xu, Tingting Xue, Yuxuan Yang, Lin Yang, Kai Yao, Huifeng Yao, Amirsaeed Yazdani, Michael Yip, Hwanseung Yoo, Fereshteh Yousefirizi, Shunkai Yu, Lei Yu, Jonathan Zamora, Ramy Ashraf Zeineldin, Dewen Zeng, Jianpeng Zhang, Bokai Zhang, Jiapeng Zhang, Fan Zhang, Huahong Zhang, Zhongchen Zhao, Zixuan Zhao, Jiachen Zhao, Can Zhao, Qingshuo Zheng, Yuheng Zhi, Ziqi Zhou, Baosheng Zou, Klaus Maier-Hein, Paul F. Jäger, Annette Kopp-Schneider, Lena Maier-Hein

The number of international benchmarking competitions is steadily increasing in various fields of machine learning (ML) research and practice. So far, however, little is known about the common practice as well as bottlenecks faced by the community in tackling the research questions posed. To shed light on the status quo of algorithm development in the specific field of biomedical imaging analysis, we designed an international survey that was issued to all participants of challenges conducted in conjunction with the IEEE ISBI 2021 and MICCAI 2021 conferences (80 competitions in total). The survey covered participants' expertise and working environments, their chosen strategies, as well as algorithm characteristics. A median of 72% challenge participants took part in the survey. According to our results, knowledge exchange was the primary incentive (70%) for participation, while the reception of prize money played only a minor role (16%). While a median of 80 working hours was spent on method development, a large portion of participants stated that they did not have enough time for method development (32%). 25% perceived the infrastructure to be a bottleneck. Overall, 94% of all solutions were deep learning-based. Of these, 84% were based on standard architectures. 43% of the respondents reported that the data samples (e.g., images) were too large to be processed at once. This was most commonly addressed by patch-based training (69%), downsampling (37%), and solving 3D analysis tasks as a series of 2D tasks. K-fold cross-validation on the training set was performed by only 37% of the participants and only 50% of the participants performed ensembling based on multiple identical models (61%) or heterogeneous models (39%). 48% of the respondents applied postprocessing steps.

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From Correlation to Causation: Formalizing Interpretable Machine Learning as a Statistical Process

Jul 11, 2022
Lukas Klein, Mennatallah El-Assady, Paul F. Jäger

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Explainable AI (XAI) is a necessity in safety-critical systems such as in clinical diagnostics due to a high risk for fatal decisions. Currently, however, XAI resembles a loose collection of methods rather than a well-defined process. In this work, we elaborate on conceptual similarities between the largest subgroup of XAI, interpretable machine learning (IML), and classical statistics. Based on these similarities, we present a formalization of IML along the lines of a statistical process. Adopting this statistical view allows us to interpret machine learning models and IML methods as sophisticated statistical tools. Based on this interpretation, we infer three key questions, which we identify as crucial for the success and adoption of IML in safety-critical settings. By formulating these questions, we further aim to spark a discussion about what distinguishes IML from classical statistics and what our perspective implies for the future of the field.

* Accepted at IJCAI 2022 Workshop on Explainable Artificial Intelligence (XAI) 
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Metrics reloaded: Pitfalls and recommendations for image analysis validation

Jun 03, 2022
Lena Maier-Hein, Annika Reinke, Evangelia Christodoulou, Ben Glocker, Patrick Godau, Fabian Isensee, Jens Kleesiek, Michal Kozubek, Mauricio Reyes, Michael A. Riegler, Manuel Wiesenfarth, Michael Baumgartner, Matthias Eisenmann, Doreen Heckmann-Nötzel, A. Emre Kavur, Tim Rädsch, Minu D. Tizabi, Laura Acion, Michela Antonelli, Tal Arbel, Spyridon Bakas, Peter Bankhead, Arriel Benis, M. Jorge Cardoso, Veronika Cheplygina, Beth Cimini, Gary S. Collins, Keyvan Farahani, Bram van Ginneken, Daniel A. Hashimoto, Michael M. Hoffman, Merel Huisman, Pierre Jannin, Charles E. Kahn, Alexandros Karargyris, Alan Karthikesalingam, Hannes Kenngott, Annette Kopp-Schneider, Anna Kreshuk, Tahsin Kurc, Bennett A. Landman, Geert Litjens, Amin Madani, Klaus Maier-Hein, Anne L. Martel, Peter Mattson, Erik Meijering, Bjoern Menze, David Moher, Karel G. M. Moons, Henning Müller, Felix Nickel, Brennan Nichyporuk, Jens Petersen, Nasir Rajpoot, Nicola Rieke, Julio Saez-Rodriguez, Clarisa Sánchez Gutiérrez, Shravya Shetty, Maarten van Smeden, Carole H. Sudre, Ronald M. Summers, Abdel A. Taha, Sotirios A. Tsaftaris, Ben Van Calster, Gaël Varoquaux, Paul F. Jäger

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The field of automatic biomedical image analysis crucially depends on robust and meaningful performance metrics for algorithm validation. Current metric usage, however, is often ill-informed and does not reflect the underlying domain interest. Here, we present a comprehensive framework that guides researchers towards choosing performance metrics in a problem-aware manner. Specifically, we focus on biomedical image analysis problems that can be interpreted as a classification task at image, object or pixel level. The framework first compiles domain interest-, target structure-, data set- and algorithm output-related properties of a given problem into a problem fingerprint, while also mapping it to the appropriate problem category, namely image-level classification, semantic segmentation, instance segmentation, or object detection. It then guides users through the process of selecting and applying a set of appropriate validation metrics while making them aware of potential pitfalls related to individual choices. In this paper, we describe the current status of the Metrics Reloaded recommendation framework, with the goal of obtaining constructive feedback from the image analysis community. The current version has been developed within an international consortium of more than 60 image analysis experts and will be made openly available as a user-friendly toolkit after community-driven optimization.

* Shared first authors: Lena Maier-Hein, Annika Reinke. arXiv admin note: substantial text overlap with arXiv:2104.05642 
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Continuous-Time Deep Glioma Growth Models

Jul 02, 2021
Jens Petersen, Fabian Isensee, Gregor Köhler, Paul F. Jäger, David Zimmerer, Ulf Neuberger, Wolfgang Wick, Jürgen Debus, Sabine Heiland, Martin Bendszus, Philipp Vollmuth, Klaus H. Maier-Hein

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The ability to estimate how a tumor might evolve in the future could have tremendous clinical benefits, from improved treatment decisions to better dose distribution in radiation therapy. Recent work has approached the glioma growth modeling problem via deep learning and variational inference, thus learning growth dynamics entirely from a real patient data distribution. So far, this approach was constrained to predefined image acquisition intervals and sequences of fixed length, which limits its applicability in more realistic scenarios. We overcome these limitations by extending Neural Processes, a class of conditional generative models for stochastic time series, with a hierarchical multi-scale representation encoding including a spatio-temporal attention mechanism. The result is a learned growth model that can be conditioned on an arbitrary number of observations, and that can produce a distribution of temporally consistent growth trajectories on a continuous time axis. On a dataset of 379 patients, the approach successfully captures both global and finer-grained variations in the images, exhibiting superior performance compared to other learned growth models.

* MICCAI 2021 
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GP-ConvCNP: Better Generalization for Convolutional Conditional Neural Processes on Time Series Data

Jun 11, 2021
Jens Petersen, Gregor Köhler, David Zimmerer, Fabian Isensee, Paul F. Jäger, Klaus H. Maier-Hein

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Neural Processes (NPs) are a family of conditional generative models that are able to model a distribution over functions, in a way that allows them to perform predictions at test time conditioned on a number of context points. A recent addition to this family, Convolutional Conditional Neural Processes (ConvCNP), have shown remarkable improvement in performance over prior art, but we find that they sometimes struggle to generalize when applied to time series data. In particular, they are not robust to distribution shifts and fail to extrapolate observed patterns into the future. By incorporating a Gaussian Process into the model, we are able to remedy this and at the same time improve performance within distribution. As an added benefit, the Gaussian Process reintroduces the possibility to sample from the model, a key feature of other members in the NP family.

* UAI 2021 
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