arXiv subjects

Konstantinos Kamnitsas

Publications and source records attributed to Konstantinos Kamnitsas.

At least 19 recordsLinked to original sources

arXiv2026

Counterfactual Marginalisation: Framework for Evaluating Robustness to Nuisance Variables

Machine learning models can achieve strong test performance while relying on demographic or acquisition-related shortcuts. We propose counterfactual (CF) marginalisation as a test-time evaluation procedure for assessing robustness of classification models to such variables. Given a CF image generator, we intervene on nuisance parent variables such as age or sex, generate CF versions of each test image, and average predictions over a target intervention distribution. This produces intervention-aware predictions that marginalise demographic effects while preserving patient-specific latent information. We use these predictions to define metrics for CF risk, calibration, stability and worst-case sensitivity. We demonstrate this framework's utility for quantitative robustness evaluation.

cs.LG↗

arXiv2026

Error Detection for PET/CT Radiology Reports: Domain-Specific vs Large Language Models

Errors in radiology reports can adversely affect patient treatment, yet automated report quality assurance remains challenging because errors are often subtle and require domain expertise to detect. Although large language models (LLMs) have recently been proposed for radiology report verification, their ability to detect clinically meaningful errors beyond chest X-ray datasets remains under-explored. To this end, we present the first systematic evaluation of language models for PET/CT report error detection, comparing compact domain-specific models with SOTA open-weight LLMs. We collected 30,633 oncology FDG PET/CT reports from 23 radiologists over 10 years. We trained domain-specific BERT models to detect clinically motivated synthetic reporting errors and evaluated alongside zero-/few-shot Qwen3-32B, Gemma-3-27B and Llama-3.3-70B on a held-out benchmark of 11,500 reports. A 15M-parameter model achieved 94.4% balanced accuracy with a 5.8% false-positive rate, compared with 84.0% for the strongest prompted LLM. Task-specific adaptation of Llama-3.3-70B closed this performance gap (94.4%) but retained substantially greater computational requirements. Our results suggest that domain-specific training matters more than model scale for PET/CT report error detection, supporting compact models as an accurate and computationally efficient approach to automated radiology report quality assurance.

cs.LG↗

arXiv2026

You Point, I Learn: Online Adaptation of Interactive Segmentation Models for Handling Distribution Shifts in Medical Imaging

Interactive segmentation uses real-time user inputs, such as mouse clicks, to iteratively refine model predictions. Although not originally designed to address distribution shifts, this paradigm naturally lends itself to such challenges. In medical imaging, where distribution shifts are common, interactive methods can use user inputs to guide models towards improved predictions. Moreover, once a model is deployed, user corrections can be used to adapt the network parameters to the new data distribution, mitigating distribution shift. Based on these insights, we aim to develop a practical, effective method for improving the adaptive capabilities of interactive segmentation models to new data distributions in medical imaging. Firstly, we found that strengthening the model's responsiveness to clicks is important for the initial training process. Moreover, we show that by treating the post-interaction user-refined model output as pseudo-ground-truth, we can design a lean, practical online adaptation method that enables a model to learn effectively across sequential test images. The framework includes two components: (i) a Post-Interaction adaptation process, updating the model after the user has completed interactive refinement of an image, and (ii) a Mid-Interaction adaptation process, updating incrementally after each click. Both processes include a Click-Centered Gaussian loss that strengthens the model's reaction to clicks and enhances focus on user-guided, clinically relevant regions. Experiments on 5 fundus and 4 brain-MRI databases show that our approach consistently outperforms existing methods under diverse distribution shifts, including unseen imaging modalities and pathologies. Code and pretrained models will be released upon publication.

cs.CV↗

arXiv2026

The Invisible Gorilla Effect in Out-of-distribution Detection

Deep Neural Networks achieve high performance in vision tasks by learning features from regions of interest (ROI) within images, but their performance degrades when deployed on out-of-distribution (OOD) data that differs from training data. This challenge has led to OOD detection methods that aim to identify and reject unreliable predictions. Although prior work shows that OOD detection performance varies by artefact type, the underlying causes remain underexplored. To this end, we identify a previously unreported bias in OOD detection: for hard-to-detect artefacts (near-OOD), detection performance typically improves when the artefact shares visual similarity (e.g. colour) with the model's ROI and drops when it does not - a phenomenon we term the Invisible Gorilla Effect. For example, in a skin lesion classifier with red lesion ROI, we show the method Mahalanobis Score achieves a 31.5% higher AUROC when detecting OOD red ink (similar to ROI) compared to black ink (dissimilar) annotations. We annotated artefacts by colour in 11,355 images from three public datasets (e.g. ISIC) and generated colour-swapped counterfactuals to rule out dataset bias. We then evaluated 40 OOD methods across 7 benchmarks and found significant performance drops for most methods when artefacts differed from the ROI. Our findings highlight an overlooked failure mode in OOD detection and provide guidance for more robust detectors. Code and annotations are available at: https://github.com/HarryAnthony/Invisible_Gorilla_Effect.

cs.CV↗

arXiv2025

DIsoN: Decentralized Isolation Networks for Out-of-Distribution Detection in Medical Imaging

Safe deployment of machine learning (ML) models in safety-critical domains such as medical imaging requires detecting inputs with characteristics not seen during training, known as out-of-distribution (OOD) detection, to prevent unreliable predictions. Effective OOD detection after deployment could benefit from access to the training data, enabling direct comparison between test samples and the training data distribution to identify differences. State-of-the-art OOD detection methods, however, either discard the training data after deployment or assume that test samples and training data are centrally stored together, an assumption that rarely holds in real-world settings. This is because shipping the training data with the deployed model is usually impossible due to the size of training databases, as well as proprietary or privacy constraints. We introduce the Isolation Network, an OOD detection framework that quantifies the difficulty of separating a target test sample from the training data by solving a binary classification task. We then propose Decentralized Isolation Networks (DIsoN), which enables the comparison of training and test data when data-sharing is impossible, by exchanging only model parameters between the remote computational nodes of training and deployment. We further extend DIsoN with class-conditioning, comparing a target sample solely with training data of its predicted class. We evaluate DIsoN on four medical imaging datasets (dermatology, chest X-ray, breast ultrasound, histopathology) across 12 OOD detection tasks. DIsoN performs favorably against existing methods while respecting data-privacy. This decentralized OOD detection framework opens the way for a new type of service that ML developers could provide along with their models: providing remote, secure utilization of their training data for OOD detection services. Code: https://github.com/FelixWag/DIsoN

cs.CV↗

arXiv2025

IterMask3D: Unsupervised Anomaly Detection and Segmentation with Test-Time Iterative Mask Refinement in 3D Brain MR

Unsupervised anomaly detection and segmentation methods train a model to learn the training distribution as `normal'. In the testing phase, they identify patterns that deviate from this normal distribution as `anomalies'. To learn the `normal' distribution, prevailing methods corrupt the images and train a model to reconstruct them. During testing, the model attempts to reconstruct corrupted inputs based on the learned `normal' distribution. Deviations from this distribution lead to high reconstruction errors, which indicate potential anomalies. However, corrupting an input image inevitably causes information loss even in normal regions, leading to suboptimal reconstruction and an increased risk of false positives. To alleviate this, we propose $\rm{IterMask3D}$, an iterative spatial mask-refining strategy designed for 3D brain MRI. We iteratively spatially mask areas of the image as corruption and reconstruct them, then shrink the mask based on reconstruction error. This process iteratively unmasks `normal' areas to the model, whose information further guides reconstruction of `normal' patterns under the mask to be reconstructed accurately, reducing false positives. In addition, to achieve better reconstruction performance, we also propose using high-frequency image content as additional structural information to guide the reconstruction of the masked area. Extensive experiments on the detection of both synthetic and real-world imaging artifacts, as well as segmentation of various pathological lesions across multiple MRI sequences, consistently demonstrate the effectiveness of our proposed method. Code is available at https://github.com/ZiyunLiang/IterMask3D.

cs.CV↗

arXiv2025

Unsupervised Domain Adaptation via Content Alignment for Hippocampus Segmentation

Deep learning models for medical image segmentation often struggle when deployed across different datasets due to domain shifts - variations in both image appearance, known as style, and population-dependent anatomical characteristics, referred to as content. This paper presents a novel unsupervised domain adaptation framework that directly addresses domain shifts encountered in cross-domain hippocampus segmentation from MRI, with specific emphasis on content variations. Our approach combines efficient style harmonisation through z-normalisation with a bidirectional deformable image registration (DIR) strategy. The DIR network is jointly trained with segmentation and discriminator networks to guide the registration with respect to a region of interest and generate anatomically plausible transformations that align source images to the target domain. We validate our approach through comprehensive evaluations on both a synthetic dataset using Morpho-MNIST (for controlled validation of core principles) and three MRI hippocampus datasets representing populations with varying degrees of atrophy. Across all experiments, our method outperforms existing baselines. For hippocampus segmentation, when transferring from young, healthy populations to clinical dementia patients, our framework achieves up to 15% relative improvement in Dice score compared to standard augmentation methods, with the largest gains observed in scenarios with substantial content shift. These results highlight the efficacy of our approach for accurate hippocampus segmentation across diverse populations.

cs.CV↗

arXiv2025

Modality-Agnostic Input Channels Enable Segmentation of Brain lesions in Multimodal MRI with Sequences Unavailable During Training

Segmentation models are important tools for the detection and analysis of lesions in brain MRI. Depending on the type of brain pathology that is imaged, MRI scanners can acquire multiple, different image modalities (contrasts). Most segmentation models for multimodal brain MRI are restricted to fixed modalities and cannot effectively process new ones at inference. Some models generalize to unseen modalities but may lose discriminative modality-specific information. This work aims to develop a model that can perform inference on data that contain image modalities unseen during training, previously seen modalities, and heterogeneous combinations of both, thus allowing a user to utilize any available imaging modalities. We demonstrate this is possible with a simple, thus practical alteration to the U-net architecture, by integrating a modality-agnostic input channel or pathway, alongside modality-specific input channels. To train this modality-agnostic component, we develop an image augmentation scheme that synthesizes artificial MRI modalities. Augmentations differentially alter the appearance of pathological and healthy brain tissue to create artificial contrasts between them while maintaining realistic anatomical integrity. We evaluate the method using 8 MRI databases that include 5 types of pathologies (stroke, tumours, traumatic brain injury, multiple sclerosis and white matter hyperintensities) and 8 modalities (T1, T1+contrast, T2, PD, SWI, DWI, ADC and FLAIR). The results demonstrate that the approach preserves the ability to effectively process MRI modalities encountered during training, while being able to process new, unseen modalities to improve its segmentation. Project code: https://github.com/Anthony-P-Addison/AGN-MOD-SEG

cs.CV↗

arXiv2025

Specialised or Generic? Tokenization Choices for Radiology Language Models

The vocabulary used by language models (LM) - defined by the tokenizer - plays a key role in text generation quality. However, its impact remains under-explored in radiology. In this work, we address this gap by systematically comparing general, medical, and domain-specific tokenizers on the task of radiology report summarisation across three imaging modalities. We also investigate scenarios with and without LM pre-training on PubMed abstracts. Our findings demonstrate that medical and domain-specific vocabularies outperformed widely used natural language alternatives when models are trained from scratch. Pre-training partially mitigates performance differences between tokenizers, whilst the domain-specific tokenizers achieve the most favourable results. Domain-specific tokenizers also reduce memory requirements due to smaller vocabularies and shorter sequences. These results demonstrate that adapting the vocabulary of LMs to the clinical domain provides practical benefits, including improved performance and reduced computational demands, making such models more accessible and effective for both research and real-world healthcare settings.

cs.CL↗

arXiv2025

SPA: Efficient User-Preference Alignment against Uncertainty in Medical Image Segmentation

Medical image segmentation data inherently contain uncertainty. This can stem from both imperfect image quality and variability in labeling preferences on ambiguous pixels, which depend on annotator expertise and the clinical context of the annotations. For instance, a boundary pixel might be labeled as tumor in diagnosis to avoid under-estimation of severity, but as normal tissue in radiotherapy to prevent damage to sensitive structures. As segmentation preferences vary across downstream applications, it is often desirable for an image segmentation model to offer user-adaptable predictions rather than a fixed output. While prior uncertainty-aware and interactive methods offer adaptability, they are inefficient at test time: uncertainty-aware models require users to choose from numerous similar outputs, while interactive models demand significant user input through click or box prompts to refine segmentation. To address these challenges, we propose \textbf{SPA}, a new \textbf{S}egmentation \textbf{P}reference \textbf{A}lignment framework that efficiently adapts to diverse test-time preferences with minimal human interaction. By presenting users with a select few, distinct segmentation candidates that best capture uncertainties, it reduces the user workload to reach the preferred segmentation. To accommodate user preference, we introduce a probabilistic mechanism that leverages user feedback to adapt a model's segmentation preference. The proposed framework is evaluated on several medical image segmentation tasks: color fundus images, lung lesion and kidney CT scans, MRI scans of brain and prostate. SPA shows 1) a significant reduction in user time and effort compared to existing interactive segmentation approaches, 2) strong adaptability based on human feedback, and 3) state-of-the-art image segmentation performance across different imaging modalities and semantic labels.

eess.IV↗

arXiv2025

F$^3$OCUS -- Federated Finetuning of Vision-Language Foundation Models with Optimal Client Layer Updating Strategy via Multi-objective Meta-Heuristics

Effective training of large Vision-Language Models (VLMs) on resource-constrained client devices in Federated Learning (FL) requires the usage of parameter-efficient fine-tuning (PEFT) strategies. To this end, we demonstrate the impact of two factors \textit{viz.}, client-specific layer importance score that selects the most important VLM layers for fine-tuning and inter-client layer diversity score that encourages diverse layer selection across clients for optimal VLM layer selection. We first theoretically motivate and leverage the principal eigenvalue magnitude of layerwise Neural Tangent Kernels and show its effectiveness as client-specific layer importance score. Next, we propose a novel layer updating strategy dubbed F$^3$OCUS that jointly optimizes the layer importance and diversity factors by employing a data-free, multi-objective, meta-heuristic optimization on the server. We explore 5 different meta-heuristic algorithms and compare their effectiveness for selecting model layers and adapter layers towards PEFT-FL. Furthermore, we release a new MedVQA-FL dataset involving overall 707,962 VQA triplets and 9 modality-specific clients and utilize it to train and evaluate our method. Overall, we conduct more than 10,000 client-level experiments on 6 Vision-Language FL task settings involving 58 medical image datasets and 4 different VLM architectures of varying sizes to demonstrate the effectiveness of the proposed method.

cs.CV↗

arXiv2024

FedPIA -- Permuting and Integrating Adapters leveraging Wasserstein Barycenters for Finetuning Foundation Models in Multi-Modal Federated Learning

Large Vision-Language Models typically require large text and image datasets for effective fine-tuning. However, collecting data from various sites, especially in healthcare, is challenging due to strict privacy regulations. An alternative is to fine-tune these models on end-user devices, such as in medical clinics, without sending data to a server. These local clients typically have limited computing power and small datasets, which are not enough for fully fine-tuning large VLMs on their own. A naive solution to these scenarios is to leverage parameter-efficient fine-tuning (PEFT) strategies and apply federated learning (FL) algorithms to combine the learned adapter weights, thereby respecting the resource limitations and data privacy. However, this approach does not fully leverage the knowledge from multiple adapters trained on diverse data distributions and for diverse tasks. The adapters are adversely impacted by data heterogeneity and task heterogeneity across clients resulting in suboptimal convergence. To this end, we propose a novel framework called FedPIA that improves upon the naive combinations of FL and PEFT by introducing Permutation and Integration of the local Adapters in the server and global Adapters in the clients exploiting Wasserstein barycenters for improved blending of client-specific and client-agnostic knowledge. This layerwise permutation helps to bridge the gap in the parameter space of local and global adapters before integration. We conduct over 2000 client-level experiments utilizing 48 medical image datasets across five different medical vision-language FL task settings encompassing visual question answering as well as image and report-based multi-label disease detection. Our experiments involving diverse client settings, ten different modalities, and two VLM backbones demonstrate that FedPIA consistently outperforms the state-of-the-art PEFT-FL baselines.

cs.CV↗

arXiv2024

Feasibility of Federated Learning from Client Databases with Different Brain Diseases and MRI Modalities

Segmentation models for brain lesions in MRI are typically developed for a specific disease and trained on data with a predefined set of MRI modalities. Such models cannot segment the disease using data with a different set of MRI modalities, nor can they segment other types of diseases. Moreover, this training paradigm prevents a model from using the advantages of learning from heterogeneous databases that may contain scans and segmentation labels for different brain pathologies and diverse sets of MRI modalities. Additionally, the confidentiality of patient data often prevents central data aggregation, necessitating a decentralized approach. Is it feasible to use Federated Learning (FL) to train a single model on client databases that contain scans and labels of different brain pathologies and diverse sets of MRI modalities? We demonstrate promising results by combining appropriate, simple, and practical modifications to the model and training strategy: Designing a model with input channels that cover the whole set of modalities available across clients, training with random modality drop, and exploring the effects of feature normalization methods. Evaluation on 7 brain MRI databases with 5 different diseases shows that this FL framework can train a single model achieving very promising results in segmenting all disease types seen during training. Importantly, it can segment these diseases in new databases that contain sets of modalities different from those in training clients. These results demonstrate, for the first time, the feasibility and effectiveness of using FL to train a single 3D segmentation model on decentralised data with diverse brain diseases and MRI modalities, a necessary step towards leveraging heterogeneous real-world databases. Code: https://github.com/FelixWag/FedUniBrain

eess.IV↗

arXiv2024

Evaluating Reliability in Medical DNNs: A Critical Analysis of Feature and Confidence-Based OOD Detection

Reliable use of deep neural networks (DNNs) for medical image analysis requires methods to identify inputs that differ significantly from the training data, called out-of-distribution (OOD), to prevent erroneous predictions. OOD detection methods can be categorised as either confidence-based (using the model's output layer for OOD detection) or feature-based (not using the output layer). We created two new OOD benchmarks by dividing the D7P (dermatology) and BreastMNIST (ultrasound) datasets into subsets which either contain or don't contain an artefact (rulers or annotations respectively). Models were trained with artefact-free images, and images with the artefacts were used as OOD test sets. For each OOD image, we created a counterfactual by manually removing the artefact via image processing, to assess the artefact's impact on the model's predictions. We show that OOD artefacts can boost a model's softmax confidence in its predictions, due to correlations in training data among other factors. This contradicts the common assumption that OOD artefacts should lead to more uncertain outputs, an assumption on which most confidence-based methods rely. We use this to explain why feature-based methods (e.g. Mahalanobis score) typically have greater OOD detection performance than confidence-based methods (e.g. MCP). However, we also show that feature-based methods typically perform worse at distinguishing between inputs that lead to correct and incorrect predictions (for both OOD and ID data). Following from these insights, we argue that a combination of feature-based and confidence-based methods should be used within DNN pipelines to mitigate their respective weaknesses. These project's code and OOD benchmarks are available at: https://github.com/HarryAnthony/Evaluating_OOD_detection.

cs.CV↗

arXiv2024

Quality Control for Radiology Report Generation Models via Auxiliary Auditing Components

Automation of medical image interpretation could alleviate bottlenecks in diagnostic workflows, and has become of particular interest in recent years due to advancements in natural language processing. Great strides have been made towards automated radiology report generation via AI, yet ensuring clinical accuracy in generated reports is a significant challenge, hindering deployment of such methods in clinical practice. In this work we propose a quality control framework for assessing the reliability of AI-generated radiology reports with respect to semantics of diagnostic importance using modular auxiliary auditing components (AC). Evaluating our pipeline on the MIMIC-CXR dataset, our findings show that incorporating ACs in the form of disease-classifiers can enable auditing that identifies more reliable reports, resulting in higher F1 scores compared to unfiltered generated reports. Additionally, leveraging the confidence of the AC labels further improves the audit's effectiveness.

cs.AI↗

arXiv2024

Semi-Supervised Learning for Deep Causal Generative Models

Developing models that are capable of answering questions of the form "How would x change if y had been z?'" is fundamental to advancing medical image analysis. Training causal generative models that address such counterfactual questions, though, currently requires that all relevant variables have been observed and that the corresponding labels are available in the training data. However, clinical data may not have complete records for all patients and state of the art causal generative models are unable to take full advantage of this. We thus develop, for the first time, a semi-supervised deep causal generative model that exploits the causal relationships between variables to maximise the use of all available data. We explore this in the setting where each sample is either fully labelled or fully unlabelled, as well as the more clinically realistic case of having different labels missing for each sample. We leverage techniques from causal inference to infer missing values and subsequently generate realistic counterfactuals, even for samples with incomplete labels.

cs.LG↗

arXiv2024

An Organism Starts with a Single Pix-Cell: A Neural Cellular Diffusion for High-Resolution Image Synthesis

Generative modeling seeks to approximate the statistical properties of real data, enabling synthesis of new data that closely resembles the original distribution. Generative Adversarial Networks (GANs) and Denoising Diffusion Probabilistic Models (DDPMs) represent significant advancements in generative modeling, drawing inspiration from game theory and thermodynamics, respectively. Nevertheless, the exploration of generative modeling through the lens of biological evolution remains largely untapped. In this paper, we introduce a novel family of models termed Generative Cellular Automata (GeCA), inspired by the evolution of an organism from a single cell. GeCAs are evaluated as an effective augmentation tool for retinal disease classification across two imaging modalities: Fundus and Optical Coherence Tomography (OCT). In the context of OCT imaging, where data is scarce and the distribution of classes is inherently skewed, GeCA significantly boosts the performance of 11 different ophthalmological conditions, achieving a 12% increase in the average F1 score compared to conventional baselines. GeCAs outperform both diffusion methods that incorporate UNet or state-of-the art variants with transformer-based denoising models, under similar parameter constraints. Code is available at: https://github.com/xmed-lab/GeCA.

cs.CV↗

arXiv2024

IterMask2: Iterative Unsupervised Anomaly Segmentation via Spatial and Frequency Masking for Brain Lesions in MRI

Unsupervised anomaly segmentation approaches to pathology segmentation train a model on images of healthy subjects, that they define as the 'normal' data distribution. At inference, they aim to segment any pathologies in new images as 'anomalies', as they exhibit patterns that deviate from those in 'normal' training data. Prevailing methods follow the 'corrupt-and-reconstruct' paradigm. They intentionally corrupt an input image, reconstruct it to follow the learned 'normal' distribution, and subsequently segment anomalies based on reconstruction error. Corrupting an input image, however, inevitably leads to suboptimal reconstruction even of normal regions, causing false positives. To alleviate this, we propose a novel iterative spatial mask-refining strategy IterMask2. We iteratively mask areas of the image, reconstruct them, and update the mask based on reconstruction error. This iterative process progressively adds information about areas that are confidently normal as per the model. The increasing content guides reconstruction of nearby masked areas, improving reconstruction of normal tissue under these areas, reducing false positives. We also use high-frequency image content as an auxiliary input to provide additional structural information for masked areas. This further improves reconstruction error of normal in comparison to anomalous areas, facilitating segmentation of the latter. We conduct experiments on several brain lesion datasets and demonstrate effectiveness of our method. Code is available at: https://github.com/ZiyunLiang/IterMask2

eess.IV↗