Tristan Kirscher

Tristan Kirscher, Alexandra Ertl, Klaus Maier-Hein et al.

Pancreatic ductal adenocarcinoma (PDAC) segmentation on contrast-enhanced CT is inherently ambiguous: inter-rater disagreement among experts reflects genuine uncertainty rather than annotation noise. Standard deep learning approaches assume a single ground truth, producing probabilistic outputs that can be poorly calibrated and difficult to interpret under such ambiguity. We present TwinTrack, a framework that addresses this gap through post-hoc calibration of ensemble segmentation probabilities to the empirical mean human response (MHR) -the fraction of expert annotators labeling a voxel as tumor. Calibrated probabilities are thus directly interpretable as the expected proportion of annotators assigning the tumor label, explicitly modeling inter-rater disagreement. The proposed post-hoc calibration procedure is simple and requires only a small multi-rater calibration set. It consistently improves calibration metrics over standard approaches when evaluated on the MICCAI 2025 CURVAS-PDACVI multi-rater benchmark.

Tristan Kirscher, Sylvain Faisan, Xavier Coubez et al.

Pediatric medical imaging presents unique challenges due to significant anatomical and developmental differences compared to adults. Direct application of segmentation models trained on adult data often yields suboptimal performance, particularly for small or rapidly evolving structures. To address these challenges, several strategies leveraging the nnU-Net framework have been proposed, differing along four key axes: (i) the fingerprint dataset (adult, pediatric, or a combination thereof) from which the Training Plan -including the network architecture-is derived; (ii) the Learning Set (adult, pediatric, or mixed), (iii) Data Augmentation parameters, and (iv) the Transfer learning method (finetuning versus continual learning). In this work, we introduce PSAT (Pediatric Segmentation Approaches via Adult Augmentations and Transfer learning), a systematic study that investigates the impact of these axes on segmentation performance. We benchmark the derived strategies on two pediatric CT datasets and compare them with state-of-theart methods, including a commercial radiotherapy solution. PSAT highlights key pitfalls and provides actionable insights for improving pediatric segmentation. Our experiments reveal that a training plan based on an adult fingerprint dataset is misaligned with pediatric anatomy-resulting in significant performance degradation, especially when segmenting fine structures-and that continual learning strategies mitigate institutional shifts, thus enhancing generalization across diverse pediatric datasets. The code is available at https://github.com/ICANS-Strasbourg/PSAT.

Tristan Kirscher, Kim-Celine Kahl, Balint Kovacs et al.

Reliable confidence estimates are essential in semantic segmentation, especially in safety-critical settings where overconfident errors can mislead downstream decisions. Yet modern segmentation models often remain miscalibrated. Post-hoc calibration offers a practical way to correct confidence estimates without retraining the segmentation model, but its use in dense prediction raises structural issues that are often overlooked. We study two such issues. First, adding a constant to all logits leaves the softmax probabilities unchanged, but several standard calibrators can still depend on this arbitrary offset. As a result, two logit representations encoding the same predictive distribution may yield different calibrated probabilities. We define translation-invariant (TI) calibrators as those whose outputs are unchanged under such shifts, characterize which common calibrators satisfy this property, and construct TI counterparts of shift-sensitive calibrators to isolate the effect of removing representation dependence. Second, post-hoc calibration is typically fitted by minimizing a likelihood-based objective, whereas segmentation models are trained with task-specific metrics such as Dice. This mismatch can cause calibration to alter class orderings and degrade the deployed segmentation map. We study decision-preserving calibration under argmax- and order-preservation constraints. Since enforcing these constraints collapses affine softmax calibrators to temperature scaling, we introduce class-conditional affine calibrators that can be made argmax- or order-preserving while retaining greater expressivity, allowing us to quantify the calibration-segmentation trade-off induced by decision preservation. Across natural-image and medical segmentation benchmarks, and under corruption-based covariate shift, matched comparisons show that TI variants generally improve calibration metrics, while decision-preserving variants prevent segmentation degradation and retain strong calibration performance. These results provide practical design principles for well-defined post-hoc calibration pipelines in semantic segmentation.