  Most image segmentation algorithms are trained on binary masks formulated as
a classification task per pixel. However, in applications such as medical
imaging, this "black-and-white" approach is too constraining because the
contrast between two tissues is often ill-defined, i.e., the voxels located on
objects' edges contain a mixture of tissues. Consequently, assigning a single
"hard" label can result in a detrimental approximation. Instead, a soft
prediction containing non-binary values would overcome that limitation. We
introduce SoftSeg, a deep learning training approach that takes advantage of
soft ground truth labels, and is not bound to binary predictions. SoftSeg aims
at solving a regression instead of a classification problem. This is achieved
by using (i) no binarization after preprocessing and data augmentation, (ii) a
normalized ReLU final activation layer (instead of sigmoid), and (iii) a
regression loss function (instead of the traditional Dice loss). We assess the
impact of these three features on three open-source MRI segmentation datasets
from the spinal cord gray matter, the multiple sclerosis brain lesion, and the
multimodal brain tumor segmentation challenges. Across multiple
cross-validation iterations, SoftSeg outperformed the conventional approach,
leading to an increase in Dice score of 2.0% on the gray matter dataset
(p=0.001), 3.3% for the MS lesions, and 6.5% for the brain tumors. SoftSeg
produces consistent soft predictions at tissues' interfaces and shows an
increased sensitivity for small objects. The richness of soft labels could
represent the inter-expert variability, the partial volume effect, and
complement the model uncertainty estimation. The developed training pipeline
can easily be incorporated into most of the existing deep learning
architectures. It is already implemented in the freely-available deep learning
toolbox ivadomed (https://ivadomed.org).
