Uncertainty-Guided Handshake: Efficient Human-in-the-Loop Refinement for Surgical-Grade Glioma Segmentation

Samuel Hart, Ahmad Yahya, Ahmed Karam Eldaly

While state-of-the-art automated models for medical image segmentation achieve high mean performance, they frequently suffer from localized, catastrophic failures that preclude safe clinical deployment, particularly in neuro-oncology. Interactive segmentation frameworks mitigate this by incorporating human oversight, but traditionally impose prohibitive cognitive and temporal workloads by requiring clinicians to manually search for errors. In this project, we present an efficient, Hybrid Structural-Aleatoric Human-in-the-Loop framework for glioma segmentation that bridges the gap between automated baseline performance and surgical-grade precision, achieving sub-2.0 mm HD95 on curated benchmarks while providing safety-net routing for structural failures across real-world clinical data. By extracting voxel-wise Test-Time Augmentation (TTA) uncertainty and applying hierarchical topological filtering, our method proactively isolates high-risk structural anomalies. We comprehensively evaluated our approach on a challenging out-of-distribution clinical stress-test cohort (N = 362). Operating under a simulated Human Oracle, the framework improved the Whole Tumor (WT) Dice score from…