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| Main Authors: | , , |
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| Format: | Preprint |
| Published: |
2026
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| Subjects: | |
| Online Access: | https://arxiv.org/abs/2605.27306 |
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| _version_ | 1866913164501712896 |
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| author | Harvey, Ethan Loevlie, Dennis Johan Hughes, Michael C. |
| author_facet | Harvey, Ethan Loevlie, Dennis Johan Hughes, Michael C. |
| contents | We consider training classifiers for 3D medical images using only one binary label for the entire volume rather than a label for each 2D slice. In such weakly supervised settings, can we learn accurate classifiers for slice-level predictions? Attention-based multiple instance learning (MIL) can produce an attention score for every slice. Yet recent work demonstrates that a simple center-focused baseline that ignores image content can outperform attention-based and transformer-based MIL at slice-level classification of 3D brain scans. We show this baseline also outperforms existing MIL at slice-level classification of thoracic and abdominal CT scans. Motivated by this baseline, we propose Normal Guidance, a regularization technique that encourages the learned attention distribution to follow a bell-shaped curve. Across three medical imaging datasets totaling over 4 million 2D slices, we show our Normal Guidance enables attention-based and transformer-based MIL methods to deliver significantly better slice-level localization than the state-of-the-art while remaining competitive at whole-scan classification. |
| format | Preprint |
| id |
arxiv_https___arxiv_org_abs_2605_27306 |
| institution | arXiv |
| publishDate | 2026 |
| record_format | arxiv |
| spellingShingle | Normal Guidance is what Attention Needs Harvey, Ethan Loevlie, Dennis Johan Hughes, Michael C. Machine Learning We consider training classifiers for 3D medical images using only one binary label for the entire volume rather than a label for each 2D slice. In such weakly supervised settings, can we learn accurate classifiers for slice-level predictions? Attention-based multiple instance learning (MIL) can produce an attention score for every slice. Yet recent work demonstrates that a simple center-focused baseline that ignores image content can outperform attention-based and transformer-based MIL at slice-level classification of 3D brain scans. We show this baseline also outperforms existing MIL at slice-level classification of thoracic and abdominal CT scans. Motivated by this baseline, we propose Normal Guidance, a regularization technique that encourages the learned attention distribution to follow a bell-shaped curve. Across three medical imaging datasets totaling over 4 million 2D slices, we show our Normal Guidance enables attention-based and transformer-based MIL methods to deliver significantly better slice-level localization than the state-of-the-art while remaining competitive at whole-scan classification. |
| title | Normal Guidance is what Attention Needs |
| topic | Machine Learning |
| url | https://arxiv.org/abs/2605.27306 |