A personalized Uncertainty Quantification framework for patient survival models: estimating individual uncertainty of patients with metastatic brain tumors in the absence of ground truth

TodevelopanovelUncertaintyQuantification (UQ) framework to estimate the uncertainty of patient survival models in the absence of ground truth, we developed and evaluated our approach based on a dataset of 1383 patients treated with stereotactic radiosurgery (SRS) for brain metastases between January 2015 and December 2020. Our motivating hypothesis is that a time-to-event prediction of a test patient on inference is more certain given a higher feature-space-similarity to patients in the training set. Therefore, the uncertainty for a particular patient-of-interest is represented by the concordance index between a patient similarity rank and a prediction similarity rank. Model uncertainty was defined as the increased percentage of the max uncertainty-constrained-AUC compared to the model AUC. We evaluated our method on multiple clinically-relevant endpoints, including time to intracranial progression (ICP), progression-free survival (PFS) after SRS, overall survival (OS), and time to ICP and/or death (ICPD), on a variety of both statistical and non-statistical models, including CoxPH, conditional survival forest (CSF), and neural multi-task linear regression (NMTLR). Our results show that all models had the lowest uncertainty on ICP (2.21%) and the highest uncertainty (17.28%) on ICPD. OS models demonstrated high variation in uncertainty performance, where NMTLR had the lowest uncertainty(1.96%)and CSF had the highest uncertainty (14.29%). In conclusion, our method can estimate the uncertainty of individual patient survival modeling results. As expected, our data empirically demonstrate that as model uncertainty measured via our technique increases, the similarity between a feature-space and its predicted outcome decreases.

Quantifying U-Net Uncertainty in Multi-Parametric MRI-based Glioma Segmentation by Spherical Image Projection

Purpose: To develop a U-Net segmentation uncertainty quantification method based on spherical image projection of multi-parametric MRI (MP-MRI) in glioma segmentation. Methods: The projection of planar MRI onto a spherical surface retains global anatomical information. By incorporating such image transformation in our proposed spherical projection-based U-Net (SPU-Net) segmentation model design, multiple segmentation predictions can be obtained for a single MRI. The final segmentation is the average of all predictions, and the variation can be shown as an uncertainty map. An uncertainty score was introduced to compare the uncertainty measurements' performance. The SPU-Net model was implemented on 369 glioma patients with MP-MRI scans. Three SPU-Nets were trained to segment enhancing tumor (ET), tumor core (TC), and whole tumor (WT), respectively. The SPU-Net was compared with (1) classic U-Net with test-time augmentation (TTA) and (2) linear scaling-based U-Net (LSU-Net) in both segmentation accuracy (Dice coefficient) and uncertainty (uncertainty map and uncertainty score). Results: The SPU-Net achieved low uncertainty for correct segmentation predictions (e.g., tumor interior or healthy tissue interior) and high uncertainty for incorrect results (e.g., tumor boundaries). This model could allow the identification of missed tumor targets or segmentation errors in U-Net. The SPU-Net achieved the highest uncertainty scores for 3 targets (ET/TC/WT): 0.826/0.848/0.936, compared to 0.784/0.643/0.872 for the U-Net with TTA and 0.743/0.702/0.876 for the LSU-Net. The SPU-Net also achieved statistically significantly higher Dice coefficients. Conclusion: The SPU-Net offers a powerful tool to quantify glioma segmentation uncertainty while improving segmentation accuracy. The proposed method can be generalized to other medical image-related deep-learning applications for uncertainty evaluation.