Rethinking Uncertainty in Segmentation: From Estimation to Decision

arXiv:2604.13262v1 Announce Type: cross Abstract: In medical image segmentation, uncertainty estimates are often reported but rarely used to guide decisions. We study the missing step: how uncertainty maps are converted into actionable policies such as accepting, flagging, or deferring predictions. We formulate segmentation as a two-stage pipeline, estimation followed by decision, and show that optimizing uncertainty alone fails to capture most of the achievable safety gains. Using retinal vesse