Strategies to Improve Real-World Applicability of Laparoscopic Anatomy Segmentation Models

Accurate identification and localization of anatomical structures of varying size and appearance in laparoscopic imaging are necessary to leverage the potential of computer vision techniques for surgical decision support. Segmentation performance of such models is traditionally reported using metrics of overlap such as IoU. However, imbalanced and unrealistic representation of classes in the training data and suboptimal selection of reported metrics have the potential to skew nominal segmentation performance and thereby ultimately limit clinical translation. In this work, we systematically analyze the impact of class characteristics (i.e., organ size differences), training and test data composition (i.e., representation of positive and negative examples), and modeling parameters (i.e., foreground-to-background class weight) on eight segmentation metrics: accuracy, precision, recall, IoU, F1 score (Dice Similarity Coefficient), specificity, Hausdorff Distance, and Average Symmetric Surface Distance. Our findings support two adjustments to account for data biases in surgical data science: First, training on datasets that are similar to the clinical real-world scenarios in terms of class distribution, and second, class weight adjustments to optimize segmentation model performance with regard to metrics of particular relevance in the respective clinical setting.