News Release

AI-supported image analysis: metrics determine quality

Peer-Reviewed Publication

German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ)

How well do the algorithms used in the AI-supported analysis of medical images perform their respective tasks? This depends to a large extent on the metrics used to evaluate their performance. An international consortium led by scientists from the German Cancer Research Center (DKFZ) and the National Center for Tumor Diseases (NCT) in Heidelberg has compiled the knowledge available worldwide on the specific strengths, weaknesses and limitations of the various validation metrics. With "Metrics Reloaded", the researchers are now providing a widely available online tool that supports users in selecting the most suitable algorithm for their task.

More and more areas of medicine are relying on support from artificial intelligence (AI). This is particularly true for the wide range of questions based on the evaluation of image data: for example, doctors search mammograms for the tiny foci of cancer or calculate the volume of a brain tumor based on the tomographic images from an MRI. They use endoscopic images of the intestine to track down polyps, and when evaluating microscopic tissue sections, subtle changes in individual cells have to be detected.

But are the algorithms used for these different types of image analysis really always suitable for the task in hand? This depends to a large extent on which measured variables, referred to as "metrics" in technical terms, they record - and whether these are actually suitable for the task in question.

"We often notice that validation metrics are used that are not at all relevant to the task from a clinical perspective," says Lena Maier-Hein from the DKFZ, citing an example: "When searching for metastases in the brain, it is initially more important that the algorithm detects even the tiniest lesions than that it can define the contours of each individual metastasis with high precision."

Lena Maier-Hein and her colleagues fear that the use of unsuitable validation metrics can hinder scientific progress and delay the introduction of important image analysis methods into clinical practice.

But which metrics are suitable for a given clinical question, taking into account all strengths, weaknesses and limitations? To find out, the DKFZ data scientists used a multi-stage, structured process to survey opinion leaders from academia and industry from over 70 research institutions worldwide. The survey allowed them to gather information that was previously only available in scattered locations around the world.

"With this work, we are making reliable and comprehensive information on the problems and pitfalls associated with validation metrics in image analysis available to experts for the first time," says Annika Reinke, one of the lead authors.

As a structured body of information that can be accessed by researchers from all disciplines, the work aims to increase understanding of a key problem in AI-assisted image analysis. Although the focus is on the analysis of medical images, the information can also be transferred to other areas of image analysis.

In a second paper, the expert consortium led by the Heidelberg researchers now describes "Metrics Reloaded": A comprehensive framework to help physicians and scientists select metrics that are appropriate to the problem. "Metrics Reloaded" can be used as an online tool. "Users are guided through a comprehensive set of questions to create a precise fingerprint of their image analysis problem. The tool also draws attention to specific problems that arise in certain biomedical issues," explains Paul Jäger, one of the senior authors of the two publications

Metrics Reloaded is suitable for all different categories of problems in image analysis, i.e. for the classification of images, object detection or the assignment of individual pixels (semantic segmentation). The tool works completely independently of the image source, so it can be used just as well for CT or MRI images as for microscopic images. Metrics Reloaded is also suitable for image analyses beyond biomedical issues.

"Metrics Reloaded is the first systematic guide that shows users of AI-based image analyses the way to the right algorithm. We hope that Metrics Reloaded will be used as widely as possible as quickly as possible, as this could significantly improve the quality and reliability of the results of AI-supported image analyses. This would also promote confidence in AI-supported image analysis in routine clinical practice," says Minu Tizabi, one of the lead authors.

The projects were funded by Helmholtz Imaging, one of five research platforms initiated by the Helmholtz Information & Data Science Incubator.


Reinke, A./Tizabi, M., … Jäger, P., Maier-Hein L.: Understandig Metric-Related Pitfalls in Image Analysis Validation.

Nature Methods 2024, DOI: 10.1038/s41592-023-02150-0

Maier-Hein, L./Reinke, A., … Jäger, P.: Metrics Reloaded: Recommendations for Image Analysis Validation.

Nature Methods 2024, DOI 10.1038/s41592-023-02151-z



With more than 3,000 employees, the German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) is Germany’s largest biomedical research institute. DKFZ scientists identify cancer risk factors, investigate how cancer progresses and develop new cancer prevention strategies. They are also developing new methods to diagnose tumors more precisely and treat cancer patients more successfully. The DKFZ's Cancer Information Service (KID) provides patients, interested citizens and experts with individual answers to questions relating to cancer.

To transfer promising approaches from cancer research to the clinic and thus improve the prognosis of cancer patients, the DKFZ cooperates with excellent research institutions and university hospitals throughout Germany:


National Center for Tumor Diseases (NCT, 6 sites)

German Cancer Consortium (DKTK, 8 sites)

Hopp Children's Cancer Center (KiTZ) Heidelberg

Helmholtz Institute for Translational Oncology (HI-TRON Mainz) - A Helmholtz Institute of the DKFZ

DKFZ-Hector Cancer Institute at the University Medical Center Mannheim

National Cancer Prevention Center (jointly with German Cancer Aid)


The DKFZ is 90 percent financed by the Federal Ministry of Education and Research and 10 percent by the state of Baden-Württemberg. The DKFZ is a member of the Helmholtz Association of German Research Centers.

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