arXiv AI September 16, 2026 By Aniketh Vijesh, Shrisharanyan Vasu, Abhijit Ramesh, Clare Pomeroy-Ward, Harikrishnan Anil Maya, Sarin Xavier, Mahesh Kappanayil, Gilad Gressel

Beyond In-Distribution Metrics: A Systematic Out-of-Distribution Evaluation of Congenital Heart Disease Segmentation

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The paper presents the first systematic evaluation of out‑of‑distribution generalization for congenital heart disease (CHD) segmentation, using the ImageCHD cohort as a held‑out target. It compares several segmentation architectures under different training regimes, showing that in‑distribution performance is a poor predictor of cross‑cohort robustness: nnU‑Net drops from 0.77 to 0.51 Dice, while SwinUNETR maintains higher performance at 0.67 Dice. Limited target‑domain adaptation with only 11 labeled ImageCHD cases boosts all SwinUNETR variants above 0.76 Dice, highlighting the importance of explicit cross‑dataset testing.

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