Inability to express the confidence level and detect unseen classes has limited the clinical implementation of artificial intelligence in the real-world. We developed a foundation model with uncertainty estimation (FMUE) to detect 11 retinal conditions on optical coherence tomography (OCT). In the internal test set, FMUE achieved a higher F1 score of 96.76% than two state-of-the-art algorithms, RETFound and UIOS, and got further improvement with thresholding strategy to 98.44%. In the external test sets obtained from other OCT devices, FMUE achieved an accuracy of 88.75% and 92.73% before and after thresholding. Our model is superior to two ophthalmologists with a higher F1 score (95.17% vs. 61.93% &71.72%). Besides, our model correctly predicts high uncertainty scores for samples with ambiguous features, of non-target-category diseases, or with low-quality to prompt manual checks and prevent misdiagnosis. FMUE provides a trustworthy method for automatic retinal anomalies detection in the real-world clinical open set environment.

Automatic segmentation of curvilinear objects in medical images plays an important role in the diagnosis and evaluation of human diseases, yet it is a challenging uncertainty in the complex segmentation tasks due to different issues such as various image appearances, low contrast between curvilinear objects and their surrounding backgrounds, thin and uneven curvilinear structures, and improper background illumination conditions. To overcome these challenges, we present a unique curvilinear structure segmentation framework based on an oriented derivative of stick (ODoS) filter and a deep learning network for curvilinear object segmentation in medical images. Currently, a large number of deep learning models emphasize developing deep architectures and ignore capturing the structural features of curvilinear objects, which may lead to unsatisfactory results. Consequently, a new approach that incorporates an ODoS filter as part of a deep learning network is presented to improve the spatial attention of curvilinear objects. Specifically, the input image is transfered into four-channel image constructed by the ODoS filter. In which, the original image is considered the principal part to describe various image appearance and complex background illumination conditions, a multi-step strategy is used to enhance the contrast between curvilinear objects and their surrounding backgrounds, and a vector field is applied to discriminate thin and uneven curvilinear structures. Subsequently, a deep learning framework is employed to extract various structural features for curvilinear object segmentation in medical images. The performance of the computational model is validated in experiments conducted on the publicly available DRIVE, STARE and CHASEDB1 datasets. The experimental results indicate that the presented model yields surprising results compared with those of some state-of-the-art methods.

Failure to recognize samples from the classes unseen during training is a major limitation of artificial intelligence in the real-world implementation for recognition and classification of retinal anomalies. We established an uncertainty-inspired open-set (UIOS) model, which was trained with fundus images of 9 retinal conditions. Besides assessing the probability of each category, UIOS also calculated an uncertainty score to express its confidence. Our UIOS model with thresholding strategy achieved an F1 score of 99.55%, 97.01% and 91.91% for the internal testing set, external target categories (TC)-JSIEC dataset and TC-unseen testing set, respectively, compared to the F1 score of 92.20%, 80.69% and 64.74% by the standard AI model. Furthermore, UIOS correctly predicted high uncertainty scores, which would prompt the need for a manual check in the datasets of non-target categories retinal diseases, low-quality fundus images, and non-fundus images. UIOS provides a robust method for real-world screening of retinal anomalies.

Accurately segmenting blood vessels in retinal fundus images is crucial in the early screening, diagnosing, and evaluating some ocular diseases, yet it poses a nontrivial uncertainty for the segmentation task due to various factors such as significant light variations, uneven curvilinear structures, and non-uniform contrast. As a result, a multiple attention-guided fusion network (MAF-Net) is proposed to accurately detect blood vessels in retinal fundus images. Currently, traditional UNet-based models may lose partial information due to explicitly modeling long-distance dependencies, which may lead to unsatisfactory results. To enrich contextual information for the loss of scene information compensation, an attention fusion mechanism that combines the channel attention with spatial attention mechanisms constructed by Transformer is employed to extract various features of blood vessels from retinal fundus images. Subsequently, a unique spatial attention mechanism is applied in the skip connection to filter out redundant information and noise from low-level features, thus enabling better integration with high-level features. In addition, a DropOut layer is employed to randomly discard some neurons, which can prevent overfitting of the deep learning network and improve its generalization performance. Experimental results were verified in public datasets DRIVE, STARE and CHASEDB1 with F1 scores of 0.818, 0.836 and 0.811, and Acc values of 0.968, 0.973 and 0.973, respectively. Both visual inspection and quantitative evaluation demonstrate that our method produces satisfactory results compared to some state-of-the-art methods.