  Automatic analysis of colonoscopy images has been an active field of research
motivated by the importance of early detection of precancerous polyps. However,
detecting polyps during the live examination can be challenging due to various
factors such as variation of skills and experience among the endoscopists, lack
of attentiveness, and fatigue leading to a high polyp miss-rate. Deep learning
has emerged as a promising solution to this challenge as it can assist
endoscopists in detecting and classifying overlooked polyps and abnormalities
in real time. In addition to the algorithm's accuracy, transparency and
interpretability are crucial to explaining the whys and hows of the algorithm's
prediction. Further, most algorithms are developed in private data, closed
source, or proprietary software, and methods lack reproducibility. Therefore,
to promote the development of efficient and transparent methods, we have
organized the "Medico automatic polyp segmentation (Medico 2020)" and "MedAI:
Transparency in Medical Image Segmentation (MedAI 2021)" competitions. We
present a comprehensive summary and analyze each contribution, highlight the
strength of the best-performing methods, and discuss the possibility of
clinical translations of such methods into the clinic. For the transparency
task, a multi-disciplinary team, including expert gastroenterologists, accessed
each submission and evaluated the team based on open-source practices, failure
case analysis, ablation studies, usability and understandability of evaluations
to gain a deeper understanding of the models' credibility for clinical
deployment. Through the comprehensive analysis of the challenge, we not only
highlight the advancements in polyp and surgical instrument segmentation but
also encourage qualitative evaluation for building more transparent and
understandable AI-based colonoscopy systems.
