Gradient based Severity Labeling for Biomarker Classification in OCT

The advanced retinal disease diagnosing imaging modality, optical coherence tomography (OCT), encounters a lack of automation because of the high expenses for annotations performed by specialists. The use of SSL solves the problem of insufficient annotations using unlabeled B-scans; however, most of the current techniques for generating pseudo-labels are based on prediction confidence without considering the asymmetry between different types of errors. This paper proposes TRIAGE, a risk-controlled semi-supervised framework for OCT scans classification, which uses the concept of a patient-level conformal risk controller with an asymmetric cost matrix. TRIAGE unites three crucial modules: a hierarchical classifier that is capable of working with partially abnormal supervision of the disease subtypes, a patient-grouped conformal risk controller with primal-dual coverage control, and a context-aware Transformer teacher for cross-slice verification. On the dataset from Noor Eye Hospital (16,822 B-scans, 161 patients, and 554 volumes) with a test set of unseen patients, TRIAGE demonstrates 89.66% scan-level accuracy, 0.8805 macro-F1, 0.9641 macro-AUC, and an 8.34% under-grading rate when using only 20% of the labeled data. With only 5% of the labeled data, TRIAGE keeps 76.88% accuracy and a 0.1656 under-grading rate. Compared with the other six state-of-the-art semi-supervised methods, TRIAGE significantly outperforms them with ablation study demonstrating the contribution of each module in the overall framework performance (by 42.7% in terms of under-grading rate comparing to fixed threshold methods). TRIAGE demonstrates 98.00% accuracy for 3-class classification with 1% labeled data and 95.94% accuracy for 8-class classification with 10% labeled data on the OCT-C8 dataset.

Quantitative disease severity scoring in medical imaging is costly, time-consuming, and subject to inter-reader variability. At the same time, clinical archives contain far more longitudinal imaging data than expert-annotated severity scores. Existing self-supervised methods typically ignore this chronological structure. We introduce ChronoCon, a contrastive learning approach that replaces label-based ranking losses with rankings derived solely from the visitation order of a patient's longitudinal scans. Under the clinically plausible assumption of monotonic progression in irreversible diseases, the method learns disease-relevant representations without using any expert labels. This generalizes the idea of Rank-N-Contrast from label distances to temporal ordering. Evaluated on rheumatoid arthritis radiographs for severity assessment, the learned representations substantially improve label efficiency. In low-label settings, ChronoCon significantly outperforms a fully supervised baseline initialized from ImageNet weights. In a few-shot learning experiment, fine-tuning ChronoCon on expert scores from only five patients yields an intraclass correlation coefficient of 86% for severity score prediction. These results demonstrate the potential of chronological contrastive learning to exploit routinely available imaging metadata to reduce annotation requirements in the irreversible disease domain. Code is available at https://github.com/cirmuw/ChronoCon.

Image segmentation relies on large annotated datasets, which are expensive and slow to produce. Silver-standard (AI-generated) labels are easier to obtain, but they risk introducing bias. Self-supervised learning, needing only images, has become key for pre-training. Recent work combining contrastive learning with counterfactual generation improves representation learning for classification but does not readily extend to pixel-level tasks. We propose a pipeline combining counterfactual generation with dense contrastive learning via Dual-View (DVD-CL) and Multi-View (MVD-CL) methods, along with supervised variants that utilize available silver-standard annotations. A new visualisation algorithm, the Color-coded High Resolution Overlay map (CHRO-map) is also introduced. Experiments show annotation-free DVD-CL outperforms other dense contrastive learning methods, while supervised variants using silver-standard labels outperform training on the silver-standard labeled data directly, achieving $\sim$94% DSC on challenging data. These results highlight that pixel-level contrastive learning, enhanced by counterfactuals and silver-standard annotations, improves robustness to acquisition and pathological variations.