Impact on Cost and Expert Time of Data-Efficient Deep Learning for Medical Image Segmentation
Astha Jaiswal, Miriam Rinneburger, Franziska Meyer, Sita Arjune, Laura Oberlinkels, Philomena Alice Wawer Matos Reimer, Lars Lotter-Becker, Ünal Akünal, Markus Bujotzek, Stefan Denner, Klaus Maier-Hein, Leonard Stepansky, Matthias Stefan May, Markus Habert, Alexander Köhn, Mirjam Schöneck, Robert Peter Wawer Matos Reimer, Roman-Ulrich Müller, Simon Lennartz, Nils Große Hokamp, Andreas Bucher, Thorsten Persigehl, Liliana CaldeiraPurpose To develop and systematically evaluate an iterative training approach, termed the expert-guided annotation loop, for efficient reference standard medical image segmentation, including assessment of two sample-selection strategies and real-world clinical implementation. Materials and Methods This retrospective study included ten datasets comprising 1948 CT or MRI examinations from autosomal dominant polycystic kidney disease, prostate cancer, uveal melanoma, thyroid eye disease, and non-small cell lung cancer patients. nnU-Net segmentation models were iteratively trained using an expert-guided annotation loop with random or active learning-based sample selection. In each iteration, additional samples were added to the training set, and model-generated presegmentations were corrected by expert radiologists to create reference standard annotations. Expert time required for manual segmentation versus presegmentations correction was measured. Model performance and efficiency were assessed using nonparametric tests, and cost savings were estimated for kidney and tumor segmentation using probabilistic sensitivity analysis. Feasibility of end-to-end no-code implementation was evaluated. Results Fifty-seven segmentation models were trained and evaluated. Final model Dice scores ranged from 0.67–0.97 for organ segmentation and from 0.64–0.69 for lung tumor segmentation across internal and external test sets. Maximum expert time savings were 90.3% for kidney and 48.2% for tumor segmentation ( P < .001 and P = .003), corresponding to estimated per-examination cost savings of $14.30[95% CI: $5.94, $26.87] and $5.63[95% CI: $-7.26, $26.09], respectively. No-code execution of the expert-guided annotation loop was feasible. Conclusion The expert-guided annotation loop reduced expert annotation time and enabled estimated cost savings while producing high-quality reference standard CT and MRI segmentations. The no-code workflow was implemented in a clinical environment. © RSNA, 2026