Evaluating Few-Shot Pill Recognition Under Visual Domain Shift

Adverse drug events are a significant source of preventable harm, which has led to the development of automated pill recognition systems to enhance medication safety. Real-world deployment of these systems is hindered by visually complex conditions, including cluttered scenes, overlapping pills, reflections, and diverse acquisition environments. This study investigates few-shot pill recognition from a deployment-oriented perspective, prioritizing generalization under realistic cross-dataset domain shifts over architectural innovation. A two-stage object detection framework is employed, involving base training followed by few-shot fine-tuning. Models are adapted to novel pill classes using one, five, or ten labeled examples per class and are evaluated on a separate deployment dataset featuring multi-object, cluttered scenes. The evaluation focuses on classification-centric and error-based metrics to address heterogeneous annotation strategies. Findings indicate that semantic pill recognition adapts rapidly with few-shot supervision, with classification performance reaching saturation even with a single labeled example. However, stress testing under overlapping and occluded conditions demonstrates a marked decline in localization and recall, despite robust semantic classification. Models trained on visually realistic, multi-pill data consistently exhibit greater robustness in low-shot scenarios, underscoring the importance of training data realism and the diagnostic utility of few-shot fine-tuning for deployment readiness.

A dataset of medication images with instance segmentation masks for preventing adverse drug events

Medication errors and adverse drug events (ADEs) pose significant risks to patient safety, often arising from difficulties in reliably identifying pharmaceuticals in real-world settings. AI-based pill recognition models offer a promising solution, but the lack of comprehensive datasets hinders their development. Existing pill image datasets rarely capture real-world complexities such as overlapping pills, varied lighting, and occlusions. MEDISEG addresses this gap by providing instance segmentation annotations for 32 distinct pill types across 8262 images, encompassing diverse conditions from individual pill images to cluttered dosette boxes. We trained YOLOv8 and YOLOv9 on MEDISEG to demonstrate their usability, achieving mean average precision at IoU 0.5 of 99.5 percent on the 3-Pills subset and 80.1 percent on the 32-Pills subset. We further evaluate MEDISEG under a few-shot detection protocol, demonstrating that base training on MEDISEG significantly improves recognition of unseen pill classes in occluded multi-pill scenarios compared to existing datasets. These results highlight the dataset's ability not only to support robust supervised training but also to promote transferable representations under limited supervision, making it a valuable resource for developing and benchmarking AI-driven systems for medication safety.