arXiv subjects

Annette Kopp-Schneider

Publications and source records attributed to Annette Kopp-Schneider.

At least 19 recordsLinked to original sources

arXiv2026

Principled type I error rate inflation in two-arm clinical trial designs with external control information borrowing

External information borrowing is often considered in order to improve a clinical trial's efficiency. The Bayesian approach borrows such external information by specifying an informative prior distribution. A potential issue with this procedure is that external and current information may conflict, but such inconsistency may not be predictable a priori. Robust prior choices are typically proposed to limit extreme worsening of operating characteristics (OCs) in these situations. However, trade-offs are still present and in general strict control of type I error (TIE) rate prevents any power gains. In this context, principled justifications for TIE rate inflation can be of interest. We investigate two-arm trials, with a focus on external/historical control information borrowing. We illustrate OCs trade-offs and propose an interpretable approach for external information borrowing. The approach analytically links observed prior-data conflict with allowances for TIE rate inflation and power loss. The approach does not rely on a robust prior specification, but can instead be interpreted as an adaptive choice of Bayes - or, equivalently, frequentist - test decision thresholds under the available informative prior. In addition, it can be used to evaluate any dynamic borrowing approach from a frequentist testing standpoint, and to guarantee robustness with respect to misspecification of the data generating process (i.e., design prior) in Bayesian evaluations. A development for both Normal and binomial outcomes is provided.

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arXiv2025

Information borrowing in Bayesian clinical trials: choice of tuning parameters for the robust mixture prior

External data borrowing in clinical trial designs has increased in recent years. This is accomplished in the Bayesian framework by specifying informative prior distributions. To mitigate the impact of potential inconsistency (bias) between external and current data, robust approaches have been proposed. One such approach is the robust mixture prior arising as a mixture of an informative prior and a more dispersed prior inducing dynamic borrowing. This prior requires the choice of four quantities: the mixture weight, mean, dispersion and parametric form of the robust component. To address the challenge associated with choosing these quantities, we perform a case-by-case study of their impact on specific operating characteristics in one-arm and hybrid-control trials with a normal endpoint. All four quantities were found to strongly impact the operating characteristics. As already known, variance of the robust component is linked to robustness. Less known, however, is that its location can have severe impact on test and estimation error. Further, the impact of the weight choice is strongly linked with the robust component's location and variance. We provide recommendations for the choice of the robust component parameters, prior weight, alternative functional form for this component and considerations for evaluating operating characteristics.

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arXiv2025

False Promises in Medical Imaging AI? Assessing Validity of Outperformance Claims

Performance comparisons are fundamental in medical imaging Artificial Intelligence (AI) research, often driving claims of superiority based on relative improvements in common performance metrics. However, such claims frequently rely solely on empirical mean performance. In this paper, we investigate whether newly proposed methods genuinely outperform the state of the art by analyzing a representative cohort of medical imaging papers. We quantify the probability of false claims based on a Bayesian approach that leverages reported results alongside empirically estimated model congruence to estimate whether the relative ranking of methods is likely to have occurred by chance. According to our results, the majority (>80%) of papers claims outperformance when introducing a new method. Our analysis further revealed a high probability (>5%) of false outperformance claims in 86% of classification papers and 53% of segmentation papers. These findings highlight a critical flaw in current benchmarking practices: claims of outperformance in medical imaging AI are frequently unsubstantiated, posing a risk of misdirecting future research efforts.

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arXiv2025

Xeno-learning: knowledge transfer across species in deep learning-based spectral image analysis

Novel optical imaging techniques, such as hyperspectral imaging (HSI) combined with machine learning-based (ML) analysis, have the potential to revolutionize clinical surgical imaging. However, these novel modalities face a shortage of large-scale, representative clinical data for training ML algorithms, while preclinical animal data is abundantly available through standardized experiments and allows for controlled induction of pathological tissue states, which is not ethically possible in patients. To leverage this situation, we propose a novel concept called "xeno-learning", a cross-species knowledge transfer paradigm inspired by xeno-transplantation, where organs from a donor species are transplanted into a recipient species. Using a total of 13,874 HSI images from humans as well as porcine and rat models, we show that although spectral signatures of organs differ substantially across species, relative changes resulting from pathologies or surgical manipulation (e.g., malperfusion; injection of contrast agent) are comparable. Such changes learnt in one species can thus be transferred to a new species via a novel "physiology-based data augmentation" method, enabling the large-scale secondary use of preclinical animal data for humans. The resulting ethical, monetary, and performance benefits promise a high impact of the proposed knowledge transfer paradigm on future developments in the field.

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arXiv2024

Variable selection via fused sparse-group lasso penalized multi-state models incorporating molecular data

In multi-state models based on high-dimensional data, effective modeling strategies are required to determine an optimal, ideally parsimonious model. In particular, linking covariate effects across transitions is needed to conduct joint variable selection. A useful technique to reduce model complexity is to address homogeneous covariate effects for distinct transitions. We integrate this approach to data-driven variable selection by extended regularization methods within multi-state model building. We propose the fused sparse-group lasso (FSGL) penalized Cox-type regression in the framework of multi-state models combining the penalization concepts of pairwise differences of covariate effects along with transition grouping. For optimization, we adapt the alternating direction method of multipliers (ADMM) algorithm to transition-specific hazards regression in the multi-state setting. In a simulation study and application to acute myeloid leukemia (AML) data, we evaluate the algorithm's ability to select a sparse model incorporating relevant transition-specific effects and similar cross-transition effects. We investigate settings in which the combined penalty is beneficial compared to global lasso regularization.

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arXiv2024

Confidence intervals uncovered: Are we ready for real-world medical imaging AI?

Medical imaging is spearheading the AI transformation of healthcare. Performance reporting is key to determine which methods should be translated into clinical practice. Frequently, broad conclusions are simply derived from mean performance values. In this paper, we argue that this common practice is often a misleading simplification as it ignores performance variability. Our contribution is threefold. (1) Analyzing all MICCAI segmentation papers (n = 221) published in 2023, we first observe that more than 50% of papers do not assess performance variability at all. Moreover, only one (0.5%) paper reported confidence intervals (CIs) for model performance. (2) To address the reporting bottleneck, we show that the unreported standard deviation (SD) in segmentation papers can be approximated by a second-order polynomial function of the mean Dice similarity coefficient (DSC). Based on external validation data from 56 previous MICCAI challenges, we demonstrate that this approximation can accurately reconstruct the CI of a method using information provided in publications. (3) Finally, we reconstructed 95% CIs around the mean DSC of MICCAI 2023 segmentation papers. The median CI width was 0.03 which is three times larger than the median performance gap between the first and second ranked method. For more than 60% of papers, the mean performance of the second-ranked method was within the CI of the first-ranked method. We conclude that current publications typically do not provide sufficient evidence to support which models could potentially be translated into clinical practice.

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arXiv2024

Quality Assured: Rethinking Annotation Strategies in Imaging AI

This paper does not describe a novel method. Instead, it studies an essential foundation for reliable benchmarking and ultimately real-world application of AI-based image analysis: generating high-quality reference annotations. Previous research has focused on crowdsourcing as a means of outsourcing annotations. However, little attention has so far been given to annotation companies, specifically regarding their internal quality assurance (QA) processes. Therefore, our aim is to evaluate the influence of QA employed by annotation companies on annotation quality and devise methodologies for maximizing data annotation efficacy. Based on a total of 57,648 instance segmented images obtained from a total of 924 annotators and 34 QA workers from four annotation companies and Amazon Mechanical Turk (MTurk), we derived the following insights: (1) Annotation companies perform better both in terms of quantity and quality compared to the widely used platform MTurk. (2) Annotation companies' internal QA only provides marginal improvements, if any. However, improving labeling instructions instead of investing in QA can substantially boost annotation performance. (3) The benefit of internal QA depends on specific image characteristics. Our work could enable researchers to derive substantially more value from a fixed annotation budget and change the way annotation companies conduct internal QA.

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arXiv2024

Understanding metric-related pitfalls in image analysis validation

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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arXiv2024

Metrics reloaded: Recommendations for image analysis validation

Increasing evidence shows that flaws in machine learning (ML) algorithm validation are an underestimated global problem. Particularly in automatic biomedical image analysis, chosen performance metrics often do not reflect the domain interest, thus failing to adequately measure scientific progress and hindering translation of ML techniques into practice. To overcome this, our large international expert consortium created Metrics Reloaded, a comprehensive framework guiding researchers in the problem-aware selection of metrics. Following the convergence of ML methodology across application domains, Metrics Reloaded fosters the convergence of validation methodology. The framework was developed in a multi-stage Delphi process and is based on the novel concept of a problem fingerprint - a structured representation of the given problem that captures all aspects that are relevant for metric selection, from the domain interest to the properties of the target structure(s), data set and algorithm output. Based on the problem fingerprint, users are guided through the process of choosing and applying appropriate validation metrics while being made aware of potential pitfalls. Metrics Reloaded targets image analysis problems that can be interpreted as a classification task at image, object or pixel level, namely image-level classification, object detection, semantic segmentation, and instance segmentation tasks. To improve the user experience, we implemented the framework in the Metrics Reloaded online tool, which also provides a point of access to explore weaknesses, strengths and specific recommendations for the most common validation metrics. The broad applicability of our framework across domains is demonstrated by an instantiation for various biological and medical image analysis use cases.

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arXiv2023

Common Limitations of Image Processing Metrics: A Picture Story

While the importance of automatic image analysis is continuously increasing, recent meta-research revealed major flaws with respect to algorithm validation. Performance metrics are particularly key for meaningful, objective, and transparent performance assessment and validation of the used automatic algorithms, but relatively little attention has been given to the practical pitfalls when using specific metrics for a given image analysis task. These are typically related to (1) the disregard of inherent metric properties, such as the behaviour in the presence of class imbalance or small target structures, (2) the disregard of inherent data set properties, such as the non-independence of the test cases, and (3) the disregard of the actual biomedical domain interest that the metrics should reflect. This living dynamically document has the purpose to illustrate important limitations of performance metrics commonly applied in the field of image analysis. In this context, it focuses on biomedical image analysis problems that can be phrased as image-level classification, semantic segmentation, instance segmentation, or object detection task. The current version is based on a Delphi process on metrics conducted by an international consortium of image analysis experts from more than 60 institutions worldwide.

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arXiv2023

Simulating and reporting frequentist operating characteristics of clinical trials that borrow external information

Borrowing of information from historical or external data to inform inference in a current trial is an expanding field in the era of precision medicine, where trials are often performed in small patient cohorts for practical or ethical reasons. Many approaches for borrowing from external data have been proposed. Even though these methods are mainly based on Bayesian approaches by incorporating external information into the prior for the current analysis, frequentist operating characteristics of the analysis strategy are of interest. In particular, type I error and power at a prespecified point alternative are in the focus. It is well-known that borrowing from external information may lead to the alteration of type I error rate. We propose a procedure to investigate and report the frequentist operating characteristics in this context. The approach evaluates type I error rate of the test with borrowing from external data and calibrates the test without borrowing to this type I error rate. On this basis, a fair comparison of power between the test with and without borrowing is achieved.

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arXiv2022

Tree-based exploratory identification of predictive biomarkers in observational data

The idea of "stratified medicine" is an important driver of methodological research on the identification of predictive biomarkers. Most methods proposed so far for this purpose have been developed for the use on randomized data only. However, especially for rare cancers, data from clinical registries or observational studies might be the only available data source. For such data, methods for an unbiased estimation of the average treatment effect are well established. Research on confounder adjustment when investigating the heterogeneity of treatment effects and the variables responsible for this is usually restricted to regression modelling. In this paper, we demonstrate how the predMOB, a tree-based method that specifically searches for predictive factors, can be combined with common strategies for confounder adjustment (covariate adjustment, matching, Inverse Probability of Treatment Weighting (IPTW)). In an extensive simulation study, we show that covariate adjustment allows the correct identification of predictive factors in the presence of confounding whereas IPTW fails in situations in which the true predictive factor is not completely independent of the confounding mechanism. A combination of both, covariate adjustment and IPTW performs as well as covariate adjustment alone, but might be more robust in complex settings. An application to the German Breast Cancer Study Group (GBSG) Trial 2 illustrates these conclusions.

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arXiv2022

Robust incorporation of historical information with known type I error rate inflation

Bayesian clinical trials can benefit of available historical information through the elicitation of informative prior distributions. Concerns are however often raised about the potential for prior-data conflict and the impact of Bayes test decisions on frequentist operating characteristics, with particular attention being assigned to inflation of type I error rates. This motivates the development of principled borrowing mechanisms, that strike a balance between frequentist and Bayesian decisions. Ideally, the trust assigned to historical information defines the degree of robustness to prior-data conflict one is willing to sacrifice. However, such relationship is often not directly available when explicitly considering inflation of type I error rates. We build on available literature relating frequentist and Bayesian test decisions, and investigate a rationale for inflation of type I error rate which explicitly and linearly relates the amount of borrowing and the amount of type I error rate inflation in one-arm studies. A novel dynamic borrowing mechanism tailored to hypothesis testing is additionally proposed. We show that, while dynamic borrowing prevents the possibility to obtain a simple closed form type I error rate computation, an explicit upper bound can still be enforced. Connections with the robust mixture prior approach, particularly in relation to the choice of the mixture weight and robust component, are made. Simulations are performed to show the properties of the approach for normal and binomial outcomes.

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arXiv2022

Labeling instructions matter in biomedical image analysis

Biomedical image analysis algorithm validation depends on high-quality annotation of reference datasets, for which labeling instructions are key. Despite their importance, their optimization remains largely unexplored. Here, we present the first systematic study of labeling instructions and their impact on annotation quality in the field. Through comprehensive examination of professional practice and international competitions registered at the MICCAI Society, we uncovered a discrepancy between annotators' needs for labeling instructions and their current quality and availability. Based on an analysis of 14,040 images annotated by 156 annotators from four professional companies and 708 Amazon Mechanical Turk (MTurk) crowdworkers using instructions with different information density levels, we further found that including exemplary images significantly boosts annotation performance compared to text-only descriptions, while solely extending text descriptions does not. Finally, professional annotators constantly outperform MTurk crowdworkers. Our study raises awareness for the need of quality standards in biomedical image analysis labeling instructions.

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arXiv2021

How can we learn (more) from challenges? A statistical approach to driving future algorithm development

Challenges have become the state-of-the-art approach to benchmark image analysis algorithms in a comparative manner. While the validation on identical data sets was a great step forward, results analysis is often restricted to pure ranking tables, leaving relevant questions unanswered. Specifically, little effort has been put into the systematic investigation on what characterizes images in which state-of-the-art algorithms fail. To address this gap in the literature, we (1) present a statistical framework for learning from challenges and (2) instantiate it for the specific task of instrument instance segmentation in laparoscopic videos. Our framework relies on the semantic meta data annotation of images, which serves as foundation for a General Linear Mixed Models (GLMM) analysis. Based on 51,542 meta data annotations performed on 2,728 images, we applied our approach to the results of the Robust Medical Instrument Segmentation Challenge (ROBUST-MIS) challenge 2019 and revealed underexposure, motion and occlusion of instruments as well as the presence of smoke or other objects in the background as major sources of algorithm failure. Our subsequent method development, tailored to the specific remaining issues, yielded a deep learning model with state-of-the-art overall performance and specific strengths in the processing of images in which previous methods tended to fail. Due to the objectivity and generic applicability of our approach, it could become a valuable tool for validation in the field of medical image analysis and beyond. and segmentation of small, crossing, moving and transparent instrument(s) (parts).

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arXiv2021

Machine learning-based analysis of hyperspectral images for automated sepsis diagnosis

Sepsis is a leading cause of mortality and critical illness worldwide. While robust biomarkers for early diagnosis are still missing, recent work indicates that hyperspectral imaging (HSI) has the potential to overcome this bottleneck by monitoring microcirculatory alterations. Automated machine learning-based diagnosis of sepsis based on HSI data, however, has not been explored to date. Given this gap in the literature, we leveraged an existing data set to (1) investigate whether HSI-based automated diagnosis of sepsis is possible and (2) put forth a list of possible confounders relevant for HSI-based tissue classification. While we were able to classify sepsis with an accuracy of over $98\,\%$ using the existing data, our research also revealed several subject-, therapy- and imaging-related confounders that may lead to an overestimation of algorithm performance when not balanced across the patient groups. We conclude that further prospective studies, carefully designed with respect to these confounders, are necessary to confirm the preliminary results obtained in this study.

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arXiv2021

Heidelberg Colorectal Data Set for Surgical Data Science in the Sensor Operating Room

Image-based tracking of medical instruments is an integral part of surgical data science applications. Previous research has addressed the tasks of detecting, segmenting and tracking medical instruments based on laparoscopic video data. However, the proposed methods still tend to fail when applied to challenging images and do not generalize well to data they have not been trained on. This paper introduces the Heidelberg Colorectal (HeiCo) data set - the first publicly available data set enabling comprehensive benchmarking of medical instrument detection and segmentation algorithms with a specific emphasis on method robustness and generalization capabilities. Our data set comprises 30 laparoscopic videos and corresponding sensor data from medical devices in the operating room for three different types of laparoscopic surgery. Annotations include surgical phase labels for all video frames as well as information on instrument presence and corresponding instance-wise segmentation masks for surgical instruments (if any) in more than 10,000 individual frames. The data has successfully been used to organize international competitions within the Endoscopic Vision Challenges 2017 and 2019.

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arXiv2020

BIAS: Transparent reporting of biomedical image analysis challenges

The number of biomedical image analysis challenges organized per year is steadily increasing. These international competitions have the purpose of benchmarking algorithms on common data sets, typically to identify the best method for a given problem. Recent research, however, revealed that common practice related to challenge reporting does not allow for adequate interpretation and reproducibility of results. To address the discrepancy between the impact of challenges and the quality (control), the Biomedical I mage Analysis ChallengeS (BIAS) initiative developed a set of recommendations for the reporting of challenges. The BIAS statement aims to improve the transparency of the reporting of a biomedical image analysis challenge regardless of field of application, image modality or task category assessed. This article describes how the BIAS statement was developed and presents a checklist which authors of biomedical image analysis challenges are encouraged to include in their submission when giving a paper on a challenge into review. The purpose of the checklist is to standardize and facilitate the review process and raise interpretability and reproducibility of challenge results by making relevant information explicit.

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