DOSE: Dominance-Guided Ordinal Severity Estimation from Sparse Relative Annotations

Semi-supervised domain adaptation leverages a few labeled and many unlabeled target samples, making it promising for addressing domain shifts in medical image analysis. However, existing methods struggle with severity classification due to unclear class boundaries. Severity classification involves naturally ordered class labels, complicating adaptation. We propose a novel method that aligns source and target domains using rank scores learned via ranking with class order. Specifically, Cross-Domain Ranking ranks sample pairs across domains, while Continuous Distribution Alignment aligns rank score distributions. Experiments on ulcerative colitis and diabetic retinopathy classification validate the effectiveness of our approach, demonstrating successful alignment of class-specific rank score distributions.

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 mixup is a widely adopted data augmentation strategy, yet it is ill-suited for ordinal classification tasks such as medical disease grading, where labels encode a progression of severity. By indiscriminately blending disease-severity cues (ordinal) with appearance-level variation (non-ordinal), standard mixup produces samples that distort the very ordinal structure that underpins clinical severity grading. We introduce DisMix, an order-aware mixup framework for ordinal classification. DisMix disentangles ordinal and non-ordinal features via a dual-codebook VQ-VAE, allowing each subspace to be mixed independently: ordinal codes are interpolated to produce meaningful intermediate ranks, while non-ordinal codes are varied to introduce appearance diversity without corrupting the ordinal signal. Across four medical imaging datasets, DisMix shows the best aggregate performance among six image mixup baselines paired with six ordinal classifiers and remains effective under data scarcity and clinical grading variability.