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This research introduces RF-Deep, a lightweight random forest framework that enhances the safety of AI-driven lung tumor segmentation by effectively detecting out-of-distribution inputs in clinical CT scans. By repurposing hierarchical features from existing transformer backbones with minimal labeled data, it significantly reduces the risk of confidently incorrect predictions during automated treatment planning. The method demonstrates robust performance across diverse pathological conditions and different model architectures, offering a practical post-hoc safety filter for deploying AI systems in healthcare settings.
Tumor-anchored deep feature random forests for out-of-distribution detection in lung cancer segmentation
arXiv:2512.08216v4 Announce Type: replace-cross Abstract: Accurate segmentation of lung tumors from 3D computed tomography (CT) scans is essential for automated treatment planning and response assessment. Despite self-supervised pretraining on numerous datasets, state-of-the-art transformer backbones remain susceptible to out-of-distribution (OOD) inputs, often producing confidently incorrect segmentations with potential for risk in clinical deployment. Hence, we introduce RF-Deep, a lightweight post-hoc random forests-based framework that leverages deep features trained with limited outlier exposure, requiring as few as 40 labeled scans (20 in-distribution and 20 OOD), to improve scan-level OOD detection. RF-Deep repurposes the hierarchical features from the pretrained-then-finetuned segmentation backbones, aggregating features from multiple regions-of-interest anchored to predicted tumor regions to capture OOD likelihood. We evaluated RF-Deep on 2,232 CT volumes spanning near-OOD (pulmonary embolism, COVID-19 negative) and far-OOD (kidney cancer, healthy pancreas) datasets. RF-Deep achieved AUROC >~93 on the challenging near-OOD datasets, where it outperformed the next best method by 4--7 percentage points, and produced near-perfect detection (AUROC >~99) on far-OOD datasets. The approach also showed transferability to two blinded validation datasets under the ensemble configuration (COVID-19 positive and breast cancer; AUROC >~94). RF-Deep maintained consistent performance across backbones of different depths and pretraining strategies, demonstrating applicability of post-hoc detectors as a safety filter for clinical deployment of tumor segmentation pipelines.
Abstract:Accurate segmentation of lung tumors from 3D computed tomography (CT) scans is essential for automated treatment planning and response assessment. Despite self-supervised pretraining on numerous datasets, state-of-the-art transformer backbones remain susceptible to out-of-distribution (OOD) inputs, often producing confidently incorrect segmentations with potential for risk in clinical deployment. Hence, we introduce RF-Deep, a lightweight post-hoc random forests-based framework that leverages deep features trained with limited outlier exposure, requiring as few as 40 labeled scans (20 in-distribution and 20 OOD), to improve scan-level OOD detection. RF-Deep repurposes the hierarchical features from the pretrained-then-finetuned segmentation backbones, aggregating features from multiple regions-of-interest anchored to predicted tumor regions to capture OOD likelihood. We evaluated RF-Deep on 2,232 CT volumes spanning near-OOD (pulmonary embolism, COVID-19 negative) and far-OOD (kidney cancer, healthy pancreas) datasets. RF-Deep achieved AUROC >~93 on the challenging near-OOD datasets, where it outperformed the next best method by 4--7 percentage points, and produced near-perfect detection (AUROC >~99) on far-OOD datasets. The approach also showed transferability to two blinded validation datasets under the ensemble configuration (COVID-19 positive and breast cancer; AUROC >~94). RF-Deep maintained consistent performance across backbones of different depths and pretraining strategies, demonstrating applicability of post-hoc detectors as a safety filter for clinical deployment of tumor segmentation pipelines.
Accepted for publication in Transactions on Machine Learning Research (TMLR), 2026. Code available at: this https URL
Image and Video Processing (eess.IV); Computer Vision and Pattern Recognition (cs.CV); Machine Learning (cs.LG)
arXiv:2512.08216 [eess.IV]
(or arXiv:2512.08216v4 [eess.IV] for this version)
Full text under the publisher's open licence · 244 words
