  We introduce CASED, a novel curriculum sampling algorithm that facilitates
the optimization of deep learning segmentation or detection models on data sets
with extreme class imbalance. We evaluate the CASED learning framework on the
task of lung nodule detection in chest CT. In contrast to two-stage solutions,
wherein nodule candidates are first proposed by a segmentation model and
refined by a second detection stage, CASED improves the training of deep nodule
segmentation models (e.g. UNet) to the point where state of the art results are
achieved using only a trivial detection stage. CASED improves the optimization
of deep segmentation models by allowing them to first learn how to distinguish
nodules from their immediate surroundings, while continuously adding a greater
proportion of difficult-to-classify global context, until uniformly sampling
from the empirical data distribution. Using CASED during training yields a
minimalist proposal to the lung nodule detection problem that tops the LUNA16
nodule detection benchmark with an average sensitivity score of 88.35%.
Furthermore, we find that models trained using CASED are robust to nodule
annotation quality by showing that comparable results can be achieved when only
a point and radius for each ground truth nodule are provided during training.
Finally, the CASED learning framework makes no assumptions with regard to
imaging modality or segmentation target and should generalize to other medical
imaging problems where class imbalance is a persistent problem.
