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arXiv2026

SAM-aware Test-time Adaptation for Universal Medical Image Segmentation

Leveraging the Segment Anything Model (SAM) for medical image segmentation remains challenging due to its limited adaptability across diverse medical domains. Although fine-tuned variants, such as MedSAM, improve performance in scenarios similar to the training modalities or organs, they may lack generalizability to unseen data. To overcome this limitation, we propose SAM-aware Test-time Adaptation (SAM-TTA), a lightweight and flexible framework that preserves SAM's inherent generalization ability while enhancing segmentation accuracy for medical images. SAM-TTA tackles two major challenges: (1) input-level discrepancy caused by channel mismatches between natural and medical images, and (2) semantic-level discrepancy due to different object characteristics in natural versus medical images (e.g., with clear boundaries vs. ambiguous structures). To this end, we introduce two complementary components: a self-adaptive Bezier Curve-based Transformation (SBCT), which maps single-channel medical images into SAM-compatible three-channel images via a few learnable parameters to be optimized at test time; and IoU-guided Multi-scale Adaptation (IMA), which leverages SAM's intrinsic IoU scores to enforce high output confidence, dual-scale prediction consistency, and intermediate feature consistency, to improve semantic-level alignments. Extensive experiments on eight public medical image segmentation tasks, covering six grayscale and two color (endoscopic) tasks, demonstrate that SAM-TTA consistently outperforms state-of-the-art test-time adaptation methods. Notably, on six grayscale datasets, SAM-TTA even surpasses fully fine-tuned models, achieving significant Dice improvements (i.e., average 4.8% and 7.4% gains over MedSAM and SAM-Med2D) and establishing a new paradigm for universal medical image segmentation. Code is available at https://github.com/JianghaoWu/SAM-TTA.

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arXiv2023

Dilated-UNet: A Fast and Accurate Medical Image Segmentation Approach using a Dilated Transformer and U-Net Architecture

Medical image segmentation is crucial for the development of computer-aided diagnostic and therapeutic systems, but still faces numerous difficulties. In recent years, the commonly used encoder-decoder architecture based on CNNs has been applied effectively in medical image segmentation, but has limitations in terms of learning global context and spatial relationships. Some researchers have attempted to incorporate transformers into both the decoder and encoder components, with promising results, but this approach still requires further improvement due to its high computational complexity. This paper introduces Dilated-UNet, which combines a Dilated Transformer block with the U-Net architecture for accurate and fast medical image segmentation. Image patches are transformed into tokens and fed into the U-shaped encoder-decoder architecture, with skip-connections for local-global semantic feature learning. The encoder uses a hierarchical Dilated Transformer with a combination of Neighborhood Attention and Dilated Neighborhood Attention Transformer to extract local and sparse global attention. The results of our experiments show that Dilated-UNet outperforms other models on several challenging medical image segmentation datasets, such as ISIC and Synapse.

cs.CV↗

arXiv2023

Active learning for medical image segmentation with stochastic batches

The performance of learning-based algorithms improves with the amount of labelled data used for training. Yet, manually annotating data is particularly difficult for medical image segmentation tasks because of the limited expert availability and intensive manual effort required. To reduce manual labelling, active learning (AL) targets the most informative samples from the unlabelled set to annotate and add to the labelled training set. On the one hand, most active learning works have focused on the classification or limited segmentation of natural images, despite active learning being highly desirable in the difficult task of medical image segmentation. On the other hand, uncertainty-based AL approaches notoriously offer sub-optimal batch-query strategies, while diversity-based methods tend to be computationally expensive. Over and above methodological hurdles, random sampling has proven an extremely difficult baseline to outperform when varying learning and sampling conditions. This work aims to take advantage of the diversity and speed offered by random sampling to improve the selection of uncertainty-based AL methods for segmenting medical images. More specifically, we propose to compute uncertainty at the level of batches instead of samples through an original use of stochastic batches (SB) during sampling in AL. Stochastic batch querying is a simple and effective add-on that can be used on top of any uncertainty-based metric. Extensive experiments on two medical image segmentation datasets show that our strategy consistently improves conventional uncertainty-based sampling methods. Our method can hence act as a strong baseline for medical image segmentation. The code is available on: https://github.com/Minimel/StochasticBatchAL.git.

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arXiv2026

VLM-Guided Iterative Refinement for Surgical Image Segmentation with Foundation Models

Surgical image segmentation is essential for robot-assisted surgery and intraoperative guidance. However, existing methods are constrained to predefined categories, produce one-shot predictions without adaptive refinement, and lack mechanisms for clinician interaction. We propose IR-SIS, an iterative refinement system for surgical image segmentation that accepts natural language descriptions. IR-SIS leverages a fine-tuned SAM3 for initial segmentation, employs a Vision-Language Model to detect instruments and assess segmentation quality, and applies an agentic workflow that adaptively selects refinement strategies. The system supports clinician-in-the-loop interaction through natural language feedback. We also construct a multi-granularity language-annotated dataset from EndoVis2017 and EndoVis2018 benchmarks. Experiments demonstrate state-of-the-art performance on both in-domain and out-of-distribution data, with clinician interaction providing additional improvements. Our work establishes the first language-based surgical segmentation framework with adaptive self-refinement capabilities.

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arXiv2025

Text-driven Multiplanar Visual Interaction for Semi-supervised Medical Image Segmentation

Semi-supervised medical image segmentation is a crucial technique for alleviating the high cost of data annotation. When labeled data is limited, textual information can provide additional context to enhance visual semantic understanding. However, research exploring the use of textual data to enhance visual semantic embeddings in 3D medical imaging tasks remains scarce. In this paper, we propose a novel text-driven multiplanar visual interaction framework for semi-supervised medical image segmentation (termed Text-SemiSeg), which consists of three main modules: Text-enhanced Multiplanar Representation (TMR), Category-aware Semantic Alignment (CSA), and Dynamic Cognitive Augmentation (DCA). Specifically, TMR facilitates text-visual interaction through planar mapping, thereby enhancing the category awareness of visual features. CSA performs cross-modal semantic alignment between the text features with introduced learnable variables and the intermediate layer of visual features. DCA reduces the distribution discrepancy between labeled and unlabeled data through their interaction, thus improving the model's robustness. Finally, experiments on three public datasets demonstrate that our model effectively enhances visual features with textual information and outperforms other methods. Our code is available at https://github.com/taozh2017/Text-SemiSeg.

cs.CV↗

arXiv2025

Understanding What Is Not Said:Referring Remote Sensing Image Segmentation with Scarce Expressions

Referring Remote Sensing Image Segmentation (RRSIS) aims to segment instances in remote sensing images according to referring expressions. Unlike Referring Image Segmentation on general images, acquiring high-quality referring expressions in the remote sensing domain is particularly challenging due to the prevalence of small, densely distributed objects and complex backgrounds. This paper introduces a new learning paradigm, Weakly Referring Expression Learning (WREL) for RRSIS, which leverages abundant class names as weakly referring expressions together with a small set of accurate ones to enable efficient training under limited annotation conditions. Furthermore, we provide a theoretical analysis showing that mixed-referring training yields a provable upper bound on the performance gap relative to training with fully annotated referring expressions, thereby establishing the validity of this new setting. We also propose LRB-WREL, which integrates a Learnable Reference Bank (LRB) to refine weakly referring expressions through sample-specific prompt embeddings that enrich coarse class-name inputs. Combined with a teacher-student optimization framework using dynamically scheduled EMA updates, LRB-WREL stabilizes training and enhances cross-modal generalization under noisy weakly referring supervision. Extensive experiments on our newly constructed benchmark with varying weakly referring data ratios validate both the theoretical insights and the practical effectiveness of WREL and LRB-WREL, demonstrating that they can approach or even surpass models trained with fully annotated referring expressions.

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arXiv2023

Transferring Knowledge for Food Image Segmentation using Transformers and Convolutions

Food image segmentation is an important task that has ubiquitous applications, such as estimating the nutritional value of a plate of food. Although machine learning models have been used for segmentation in this domain, food images pose several challenges. One challenge is that food items can overlap and mix, making them difficult to distinguish. Another challenge is the degree of inter-class similarity and intra-class variability, which is caused by the varying preparation methods and dishes a food item may be served in. Additionally, class imbalance is an inevitable issue in food datasets. To address these issues, two models are trained and compared, one based on convolutional neural networks and the other on Bidirectional Encoder representation for Image Transformers (BEiT). The models are trained and valuated using the FoodSeg103 dataset, which is identified as a robust benchmark for food image segmentation. The BEiT model outperforms the previous state-of-the-art model by achieving a mean intersection over union of 49.4 on FoodSeg103. This study provides insights into transfering knowledge using convolution and Transformer-based approaches in the food image domain.

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arXiv2021

A Unified Framework for Generalized Low-Shot Medical Image Segmentation with Scarce Data

Medical image segmentation has achieved remarkable advancements using deep neural networks (DNNs). However, DNNs often need big amounts of data and annotations for training, both of which can be difficult and costly to obtain. In this work, we propose a unified framework for generalized low-shot (one- and few-shot) medical image segmentation based on distance metric learning (DML). Unlike most existing methods which only deal with the lack of annotations while assuming abundance of data, our framework works with extreme scarcity of both, which is ideal for rare diseases. Via DML, the framework learns a multimodal mixture representation for each category, and performs dense predictions based on cosine distances between the pixels' deep embeddings and the category representations. The multimodal representations effectively utilize the inter-subject similarities and intraclass variations to overcome overfitting due to extremely limited data. In addition, we propose adaptive mixing coefficients for the multimodal mixture distributions to adaptively emphasize the modes better suited to the current input. The representations are implicitly embedded as weights of the fc layer, such that the cosine distances can be computed efficiently via forward propagation. In our experiments on brain MRI and abdominal CT datasets, the proposed framework achieves superior performances for low-shot segmentation towards standard DNN-based (3D U-Net) and classical registration-based (ANTs) methods, e.g., achieving mean Dice coefficients of 81%/69% for brain tissue/abdominal multiorgan segmentation using a single training sample, as compared to 52%/31% and 72%/35% by the U-Net and ANTs, respectively.

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arXiv2025

Estimating Appearance Models for Image Segmentation via Tensor Factorization

Image Segmentation is one of the core tasks in Computer Vision and solving it often depends on modeling the image appearance data via the color distributions of each it its constituent regions. Whereas many segmentation algorithms handle the appearance models dependence using alternation or implicit methods, we propose here a new approach to directly estimate them from the image without prior information on the underlying segmentation. Our method uses local high order color statistics from the image as an input to tensor factorization-based estimator for latent variable models. This approach is able to estimate models in multiregion images and automatically output the regions proportions without prior user interaction, overcoming the drawbacks from a prior attempt to this problem. We also demonstrate the performance of our proposed method in many challenging synthetic and real imaging scenarios and show that it leads to an efficient segmentation algorithm.

cs.CV↗

arXiv2023

Shatter and Gather: Learning Referring Image Segmentation with Text Supervision

Referring image segmentation, the task of segmenting any arbitrary entities described in free-form texts, opens up a variety of vision applications. However, manual labeling of training data for this task is prohibitively costly, leading to lack of labeled data for training. We address this issue by a weakly supervised learning approach using text descriptions of training images as the only source of supervision. To this end, we first present a new model that discovers semantic entities in input image and then combines such entities relevant to text query to predict the mask of the referent. We also present a new loss function that allows the model to be trained without any further supervision. Our method was evaluated on four public benchmarks for referring image segmentation, where it clearly outperformed the existing method for the same task and recent open-vocabulary segmentation models on all the benchmarks.

cs.CV↗

arXiv2024

DiffRect: Latent Diffusion Label Rectification for Semi-supervised Medical Image Segmentation

Semi-supervised medical image segmentation aims to leverage limited annotated data and rich unlabeled data to perform accurate segmentation. However, existing semi-supervised methods are highly dependent on the quality of self-generated pseudo labels, which are prone to incorrect supervision and confirmation bias. Meanwhile, they are insufficient in capturing the label distributions in latent space and suffer from limited generalization to unlabeled data. To address these issues, we propose a Latent Diffusion Label Rectification Model (DiffRect) for semi-supervised medical image segmentation. DiffRect first utilizes a Label Context Calibration Module (LCC) to calibrate the biased relationship between classes by learning the category-wise correlation in pseudo labels, then apply Latent Feature Rectification Module (LFR) on the latent space to formulate and align the pseudo label distributions of different levels via latent diffusion. It utilizes a denoising network to learn the coarse to fine and fine to precise consecutive distribution transportations. We evaluate DiffRect on three public datasets: ACDC, MS-CMRSEG 2019, and Decathlon Prostate. Experimental results demonstrate the effectiveness of DiffRect, e.g. it achieves 82.40\% Dice score on ACDC with only 1\% labeled scan available, outperforms the previous state-of-the-art by 4.60\% in Dice, and even rivals fully supervised performance. Code is released at \url{https://github.com/CUHK-AIM-Group/DiffRect}.

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arXiv2023

Curriculum-Based Augmented Fourier Domain Adaptation for Robust Medical Image Segmentation

Accurate and robust medical image segmentation is fundamental and crucial for enhancing the autonomy of computer-aided diagnosis and intervention systems. Medical data collection normally involves different scanners, protocols, and populations, making domain adaptation (DA) a highly demanding research field to alleviate model degradation in the deployment site. To preserve the model performance across multiple testing domains, this work proposes the Curriculum-based Augmented Fourier Domain Adaptation (Curri-AFDA) for robust medical image segmentation. In particular, our curriculum learning strategy is based on the causal relationship of a model under different levels of data shift in the deployment phase, where the higher the shift is, the harder to recognize the variance. Considering this, we progressively introduce more amplitude information from the target domain to the source domain in the frequency space during the curriculum-style training to smoothly schedule the semantic knowledge transfer in an easier-to-harder manner. Besides, we incorporate the training-time chained augmentation mixing to help expand the data distributions while preserving the domain-invariant semantics, which is beneficial for the acquired model to be more robust and generalize better to unseen domains. Extensive experiments on two segmentation tasks of Retina and Nuclei collected from multiple sites and scanners suggest that our proposed method yields superior adaptation and generalization performance. Meanwhile, our approach proves to be more robust under various corruption types and increasing severity levels. In addition, we show our method is also beneficial in the domain-adaptive classification task with skin lesion datasets. The code is available at https://github.com/lofrienger/Curri-AFDA.

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arXiv2021

Deep Class-Specific Affinity-Guided Convolutional Network for Multimodal Unpaired Image Segmentation

Multi-modal medical image segmentation plays an essential role in clinical diagnosis. It remains challenging as the input modalities are often not well-aligned spatially. Existing learning-based methods mainly consider sharing trainable layers across modalities and minimizing visual feature discrepancies. While the problem is often formulated as joint supervised feature learning, multiple-scale features and class-specific representation have not yet been explored. In this paper, we propose an affinity-guided fully convolutional network for multimodal image segmentation. To learn effective representations, we design class-specific affinity matrices to encode the knowledge of hierarchical feature reasoning, together with the shared convolutional layers to ensure the cross-modality generalization. Our affinity matrix does not depend on spatial alignments of the visual features and thus allows us to train with unpaired, multimodal inputs. We extensively evaluated our method on two public multimodal benchmark datasets and outperform state-of-the-art methods.

cs.CV↗

arXiv2022

Personalizing Federated Medical Image Segmentation via Local Calibration

Medical image segmentation under federated learning (FL) is a promising direction by allowing multiple clinical sites to collaboratively learn a global model without centralizing datasets. However, using a single model to adapt to various data distributions from different sites is extremely challenging. Personalized FL tackles this issue by only utilizing partial model parameters shared from global server, while keeping the rest to adapt to its own data distribution in the local training of each site. However, most existing methods concentrate on the partial parameter splitting, while do not consider the \textit{inter-site in-consistencies} during the local training, which in fact can facilitate the knowledge communication over sites to benefit the model learning for improving the local accuracy. In this paper, we propose a personalized federated framework with \textbf{L}ocal \textbf{C}alibration (LC-Fed), to leverage the inter-site in-consistencies in both \textit{feature- and prediction- levels} to boost the segmentation. Concretely, as each local site has its alternative attention on the various features, we first design the contrastive site embedding coupled with channel selection operation to calibrate the encoded features. Moreover, we propose to exploit the knowledge of prediction-level in-consistency to guide the personalized modeling on the ambiguous regions, e.g., anatomical boundaries. It is achieved by computing a disagreement-aware map to calibrate the prediction. Effectiveness of our method has been verified on three medical image segmentation tasks with different modalities, where our method consistently shows superior performance to the state-of-the-art personalized FL methods. Code is available at https://github.com/jcwang123/FedLC.

cs.CV↗

arXiv2024

LKM-UNet: Large Kernel Vision Mamba UNet for Medical Image Segmentation

In clinical practice, medical image segmentation provides useful information on the contours and dimensions of target organs or tissues, facilitating improved diagnosis, analysis, and treatment. In the past few years, convolutional neural networks (CNNs) and Transformers have dominated this area, but they still suffer from either limited receptive fields or costly long-range modeling. Mamba, a State Space Sequence Model (SSM), recently emerged as a promising paradigm for long-range dependency modeling with linear complexity. In this paper, we introduce a Large Kernel Vision Mamba U-shape Network, or LKM-UNet, for medical image segmentation. A distinguishing feature of our LKM-UNet is its utilization of large Mamba kernels, excelling in locally spatial modeling compared to small kernel-based CNNs and Transformers, while maintaining superior efficiency in global modeling compared to self-attention with quadratic complexity. Additionally, we design a novel hierarchical and bidirectional Mamba block to further enhance Mamba's global and neighborhood spatial modeling capability for vision inputs. Comprehensive experiments demonstrate the feasibility and the effectiveness of using large-size Mamba kernels to achieve large receptive fields. Codes are available at https://github.com/wjh892521292/LKM-UNet.

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arXiv2025

MLRU++: Multiscale Lightweight Residual UNETR++ with Attention for Efficient 3D Medical Image Segmentation

Accurate and efficient medical image segmentation is crucial but challenging due to anatomical variability and high computational demands on volumetric data. Recent hybrid CNN-Transformer architectures achieve state-of-the-art results but add significant complexity. In this paper, we propose MLRU++, a Multiscale Lightweight Residual UNETR++ architecture designed to balance segmentation accuracy and computational efficiency. It introduces two key innovations: a Lightweight Channel and Bottleneck Attention Module (LCBAM) that enhances contextual feature encoding with minimal overhead, and a Multiscale Bottleneck Block (M2B) in the decoder that captures fine-grained details via multi-resolution feature aggregation. Experiments on four publicly available benchmark datasets (Synapse, BTCV, ACDC, and Decathlon Lung) demonstrate that MLRU++ achieves state-of-the-art performance, with average Dice scores of 87.57% (Synapse), 93.00% (ACDC), and 81.12% (Lung). Compared to existing leading models, MLRU++ improves Dice scores by 5.38% and 2.12% on Synapse and ACDC, respectively, while significantly reducing parameter count and computational cost. Ablation studies evaluating LCBAM and M2B further confirm the effectiveness of the proposed architectural components. Results suggest that MLRU++ offers a practical and high-performing solution for 3D medical image segmentation tasks. Source code is available at: https://github.com/1027865/MLRUPP

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arXiv2023

ScribbleVC: Scribble-supervised Medical Image Segmentation with Vision-Class Embedding

Medical image segmentation plays a critical role in clinical decision-making, treatment planning, and disease monitoring. However, accurate segmentation of medical images is challenging due to several factors, such as the lack of high-quality annotation, imaging noise, and anatomical differences across patients. In addition, there is still a considerable gap in performance between the existing label-efficient methods and fully-supervised methods. To address the above challenges, we propose ScribbleVC, a novel framework for scribble-supervised medical image segmentation that leverages vision and class embeddings via the multimodal information enhancement mechanism. In addition, ScribbleVC uniformly utilizes the CNN features and Transformer features to achieve better visual feature extraction. The proposed method combines a scribble-based approach with a segmentation network and a class-embedding module to produce accurate segmentation masks. We evaluate ScribbleVC on three benchmark datasets and compare it with state-of-the-art methods. The experimental results demonstrate that our method outperforms existing approaches in terms of accuracy, robustness, and efficiency. The datasets and code are released on GitHub.

cs.CV↗

arXiv2025

Dual-Alignment Knowledge Retention for Continual Medical Image Segmentation

Continual learning in medical image segmentation involves sequential data acquisition across diverse domains (e.g., clinical sites), where task interference between past and current domains often leads to catastrophic forgetting. Existing continual learning methods fail to capture the complex dependencies between tasks. We introduce a novel framework that mitigates forgetting by establishing and enhancing complex dependencies between historical data and the network in the present task. Our framework features a dual-alignment strategy, the cross-network alignment (CNA) module aligns the features extracted from the bottleneck layers of the current and previous networks, respectively, while the cross-representation alignment (CRA) module aligns the features learned by the current network from historical buffered data and current input data, respectively. Implementing both types of alignment is a non-trivial task. To address this, we further analyze the linear and nonlinear forms of the well-established Hilbert-Schmidt Independence Criterion (HSIC) and deliberately design feature mapping and feature pairing blocks within the CRA module. Experiments on medical image segmentation task demonstrate our framework's effectiveness in mitigating catastrophic forgetting under domain shifts.

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