Abstract
Congenital heart disease (CHD) diagnosis and surgical planning often require patient-specific 3D anatomical models, but manual segmentation is labor-intensive, particularly in complex anatomies. Although deep-learning methods can automate this process, they are typically evaluated in-distribution, despite clinically relevant shifts in scanner, protocol, institution, population, and imaging modality. We present, to our knowledge, the first systematic evaluation of out-of-distribution (OOD) generalization in CHD segmentation, using ImageCHD as a held-out target cohort. We compare representative segmentation architectures under combined CT and CMR training,CT-only training, self-supervised pretraining, and limited target-domain adaptation. In-distribution performance proves to be a poor indicator of cross-cohort robustness: nnU-Net achieves the highest validation Dice (0.77) but falls to 0.51 on ImageCHD, while SwinUNETR generalizes substantially better, reaching 0.67 Dice. MAE and JEPA pretraining provide only modest additional benefit, suggesting that architecture contributes more to robustness than the tested pretraining strategies in this setting. When limited target- domain supervision is introduced, all SwinUNETR variants exceed 0.76 Dice with only 11 labeled ImageCHD cases. These findings demonstrate that conventional in-distribution evaluation can obscure clinically important generalization failures and support explicit cross-dataset testing as a key component of CHD segmentation evaluation.
Links to Paper and Supplementary Materials
Main Paper (Open Access Version): https://papers.miccai.org/miccai-2026-sat/paper/STACOM2026_041.pdf
SharedIt Link: Not yet available
SpringerLink (DOI): Not yet available
Supplementary Material: Not Submitted
Link to Open Review
Open Review Page: https://openreview.net/profile?id=~Gilad_Gressel1
BibTex
@InProceedings{VijAni_Beyond_MICCAISAT2026,
author = { Vijesh, Aniketh AND Vasu, Shrisharanyan AND Ramesh, Abhijit AND Pomeroy-Ward, Clare AND Maya, Harikrishnan Anil AND Xavier, Sarin AND Kappanayil, Mahesh AND Gressel, Gilad},
title = { { Beyond In-Distribution Metrics: A Systematic Out-of-Distribution Evaluation of Congenital Heart Disease Segmentation } },
booktitle = {Medical Image Computing and Computer Assisted Intervention -- MICCAI 2026 Workshops and Challenges},
year = {2026},
publisher = {Springer Nature Switzerland},
volume = {LNCS 17267},
month = {pending},
page = {pending}
}