Foundation models for volumetric medical image segmentation have emerged as powerful tools in clinical workflows, enabling radiologists to delineate regions of interest through intuitive clicks. While these models demonstrate promising capabilities in segmenting previously unseen anatomical structures, their performance is strongly influenced by prompt quality. In clinical settings, radiologists often provide suboptimal prompts, which affects segmentation reliability and accuracy. To address this limitation, we present SafeClick, an error-tolerant interactive segmentation approach for medical volumes based on hierarchical expert consensus. SafeClick operates as a plug-and-play module compatible with foundation models including SAM 2 and MedSAM 2. The framework consists of two key components: a collaborative expert layer (CEL) that generates diverse feature representations through specialized transformer modules, and a consensus reasoning layer (CRL) that performs cross-referencing and adaptive integration of these features. This architecture transforms the segmentation process from a prompt-dependent operation to a robust framework capable of producing accurate results despite imperfect user inputs. Extensive experiments across 15 public datasets demonstrate that our plug-and-play approach consistently improves the performance of base foundation models, with particularly significant gains when working with imperfect prompts. The source code is available at https://github.com/yifangao112/SafeClick.
Deep learning has demonstrated remarkable success in medical image segmentation and computer-aided diagnosis. In particular, numerous advanced methods have achieved state-of-the-art performance in brain tumor segmentation from MRI scans. While recent studies in other medical imaging domains have revealed that integrating textual reports with visual data can enhance segmentation accuracy, the field of brain tumor analysis lacks a comprehensive dataset that combines radiological images with corresponding textual annotations. This limitation has hindered the exploration of multimodal approaches that leverage both imaging and textual data. To bridge this critical gap, we introduce the TextBraTS dataset, the first publicly available volume-level multimodal dataset that contains paired MRI volumes and rich textual annotations, derived from the widely adopted BraTS2020 benchmark. Building upon this novel dataset, we propose a novel baseline framework and sequential cross-attention method for text-guided volumetric medical image segmentation. Through extensive experiments with various text-image fusion strategies and templated text formulations, our approach demonstrates significant improvements in brain tumor segmentation accuracy, offering valuable insights into effective multimodal integration techniques. Our dataset, implementation code, and pre-trained models are publicly available at https://github.com/Jupitern52/TextBraTS.
Recent advances in medical imaging have established deep learning-based segmentation as the predominant approach, though it typically requires large amounts of manually annotated data. However, obtaining annotations for intracranial hemorrhage (ICH) remains particularly challenging due to the tedious and costly labeling process. Semi-supervised learning (SSL) has emerged as a promising solution to address the scarcity of labeled data, especially in volumetric medical image segmentation. Unlike conventional SSL methods that primarily focus on high-confidence pseudo-labels or consistency regularization, we propose SWDL-Net, a novel SSL framework that exploits the complementary advantages of Laplacian pyramid and deep convolutional upsampling. The Laplacian pyramid excels at edge sharpening, while deep convolutions enhance detail precision through flexible feature mapping. Our framework achieves superior segmentation of lesion details and boundaries through a difference learning mechanism that effectively integrates these complementary approaches. Extensive experiments on a 271-case ICH dataset and public benchmarks demonstrate that SWDL-Net outperforms current state-of-the-art methods in scenarios with only 2% labeled data. Additional evaluations on the publicly available Brain Hemorrhage Segmentation Dataset (BHSD) with 5% labeled data further confirm the superiority of our approach. Code and data have been released at https://github.com/SIAT-CT-LAB/SWDL.
Accurate segmentation of anatomical structures in volumetric medical images is crucial for clinical applications, including disease monitoring and cancer treatment planning. Contemporary interactive segmentation models, such as Segment Anything Model 2 (SAM-2) and its medical variant (MedSAM-2), rely on manually provided prompts like bounding boxes and mouse clicks. In this study, we introduce eye gaze as a novel informational modality for interactive segmentation, marking the application of eye-tracking for 3D medical image segmentation. We evaluate the performance of using gaze-based prompts with SAM-2 and MedSAM-2 using both synthetic and real gaze data. Compared to bounding boxes, gaze-based prompts offer a time-efficient interaction approach with slightly lower segmentation quality. Our findings highlight the potential of using gaze as a complementary input modality for interactive 3D medical image segmentation.
Segment Anything Model 2 (SAM 2), a prompt-driven foundation model extending SAM to both image and video domains, has shown superior zero-shot performance compared to its predecessor. Building on SAM's success in medical image segmentation, SAM 2 presents significant potential for further advancement. However, similar to SAM, SAM 2 is limited by its output of binary masks, inability to infer semantic labels, and dependence on precise prompts for the target object area. Additionally, direct application of SAM and SAM 2 to medical image segmentation tasks yields suboptimal results. In this paper, we explore the upper performance limit of SAM 2 using custom fine-tuning adapters, achieving a Dice Similarity Coefficient (DSC) of 92.30% on the BTCV dataset, surpassing the state-of-the-art nnUNet by 12%. Following this, we address the prompt dependency by investigating various prompt generators. We introduce a UNet to autonomously generate predicted masks and bounding boxes, which serve as input to SAM 2. Subsequent dual-stage refinements by SAM 2 further enhance performance. Extensive experiments show that our method achieves state-of-the-art results on the AMOS2022 dataset, with a Dice improvement of 2.9% compared to nnUNet, and outperforms nnUNet by 6.4% on the BTCV dataset.
Segment Anything Models (SAMs) have gained increasing attention in medical image analysis due to their zero-shot generalization capability in segmenting objects of unseen classes and domains when provided with appropriate user prompts. Addressing this performance gap is important to fully leverage the pre-trained weights of SAMs, particularly in the domain of volumetric medical image segmentation, where accuracy is important but well-annotated 3D medical data for fine-tuning is limited. In this work, we investigate whether introducing the memory mechanism as a plug-in, specifically the ability to memorize and recall internal representations of past inputs, can improve the performance of SAM with limited computation cost. To this end, we propose Memorizing SAM, a novel 3D SAM architecture incorporating a memory Transformer as a plug-in. Unlike conventional memorizing Transformers that save the internal representation during training or inference, our Memorizing SAM utilizes existing highly accurate internal representation as the memory source to ensure the quality of memory. We evaluate the performance of Memorizing SAM in 33 categories from the TotalSegmentator dataset, which indicates that Memorizing SAM can outperform state-of-the-art 3D SAM variant i.e., FastSAM3D with an average Dice increase of 11.36% at the cost of only 4.38 millisecond increase in inference time. The source code is publicly available at https://github.com/swedfr/memorizingSAM
Vision Transformer shows great superiority in medical image segmentation due to the ability in learning long-range dependency. For medical image segmentation from 3D data, such as computed tomography (CT), existing methods can be broadly classified into 2D-based and 3D-based methods. One key limitation in 2D-based methods is that the intra-slice information is ignored, while the limitation in 3D-based methods is the high computation cost and memory consumption, resulting in a limited feature representation for inner-slice information. During the clinical examination, radiologists primarily use the axial plane and then routinely review both axial and coronal planes to form a 3D understanding of anatomy. Motivated by this fact, our key insight is to design a hybrid model which can first learn fine-grained inner-slice information and then generate a 3D understanding of anatomy by incorporating 3D information. We present a novel \textbf{H}ybrid \textbf{Res}idual trans\textbf{Former} \textbf{(HResFormer)} for 3D medical image segmentation. Building upon standard 2D and 3D Transformer backbones, HResFormer involves two novel key designs: \textbf{(1)} a \textbf{H}ybrid \textbf{L}ocal-\textbf{G}lobal fusion \textbf{M}odule \textbf{(HLGM)} to effectively and adaptively fuse inner-slice information from 2D Transformer and intra-slice information from 3D volumes for 3D Transformer with local fine-grained and global long-range representation. \textbf{(2)} a residual learning of the hybrid model, which can effectively leverage the inner-slice and intra-slice information for better 3D understanding of anatomy. Experiments show that our HResFormer outperforms prior art on widely-used medical image segmentation benchmarks. This paper sheds light on an important but neglected way to design Transformers for 3D medical image segmentation.
Computed Tomography (CT) is one of the most popular modalities for medical imaging. By far, CT images have contributed to the largest publicly available datasets for volumetric medical segmentation tasks, covering full-body anatomical structures. Large amounts of full-body CT images provide the opportunity to pre-train powerful models, e.g., STU-Net pre-trained in a supervised fashion, to segment numerous anatomical structures. However, it remains unclear in which conditions these pre-trained models can be transferred to various downstream medical segmentation tasks, particularly segmenting the other modalities and diverse targets. To address this problem, a large-scale benchmark for comprehensive evaluation is crucial for finding these conditions. Thus, we collected 87 public datasets varying in modality, target, and sample size to evaluate the transfer ability of full-body CT pre-trained models. We then employed a representative model, STU-Net with multiple model scales, to conduct transfer learning across modalities and targets. Our experimental results show that (1) there may be a bottleneck effect concerning the dataset size in fine-tuning, with more improvement on both small- and large-scale datasets than medium-size ones. (2) Models pre-trained on full-body CT demonstrate effective modality transfer, adapting well to other modalities such as MRI. (3) Pre-training on the full-body CT not only supports strong performance in structure detection but also shows efficacy in lesion detection, showcasing adaptability across target tasks. We hope that this large-scale open evaluation of transfer learning can direct future research in volumetric medical image segmentation.
Volumetric medical image segmentation is a fundamental problem in medical image analysis where the objective is to accurately classify a given 3D volumetric medical image with voxel-level precision. In this work, we propose a novel hierarchical encoder-decoder-based framework that strives to explicitly capture the local and global dependencies for volumetric 3D medical image segmentation. The proposed framework exploits local volume-based self-attention to encode the local dependencies at high resolution and introduces a novel volumetric MLP-mixer to capture the global dependencies at low-resolution feature representations, respectively. The proposed volumetric MLP-mixer learns better associations among volumetric feature representations. These explicit local and global feature representations contribute to better learning of the shape-boundary characteristics of the organs. Extensive experiments on three different datasets reveal that the proposed method achieves favorable performance compared to state-of-the-art approaches. On the challenging Synapse Multi-organ dataset, the proposed method achieves an absolute 3.82\% gain over the state-of-the-art approaches in terms of HD95 evaluation metrics {while a similar improvement pattern is exhibited in MSD Liver and Pancreas tumor datasets}. We also provide a detailed comparison between recent architectural design choices in the 2D computer vision literature by adapting them for the problem of 3D medical image segmentation. Finally, our experiments on the ZebraFish 3D cell membrane dataset having limited training data demonstrate the superior transfer learning capabilities of the proposed vMixer model on the challenging 3D cell instance segmentation task, where accurate boundary prediction plays a vital role in distinguishing individual cell instances.
Recent attention-based volumetric segmentation (VS) methods have achieved remarkable performance in the medical domain which focuses on modeling long-range dependencies. However, for voxel-wise prediction tasks, discriminative local features are key components for the performance of the VS models which is missing in attention-based VS methods. Aiming at resolving this issue, we deliberately incorporate the convolutional encoder branch with transformer backbone to extract local and global features in a parallel manner and aggregate them in Cross Feature Mixer Module (CFMM) for better prediction of segmentation mask. Consequently, we observe that the derived model, Y-CT-Net, achieves competitive performance on multiple medical segmentation tasks. For example, on multi-organ segmentation, Y-CT-Net achieves an 82.4% dice score, surpassing well-tuned VS Transformer/CNN-like baselines UNETR/ResNet-3D by 2.9%/1.4%. With the success of Y-CT-Net, we extend this concept with hybrid attention models, that derived Y-CH-Net model, which brings a 3% improvement in terms of HD95 score for same segmentation task. The effectiveness of both models Y-CT-Net and Y-CH-Net verifies our hypothesis and motivates us to initiate the concept of Y-CA-Net, a versatile generic architecture based upon any two encoders and a decoder backbones, to fully exploit the complementary strengths of both convolution and attention mechanisms. Based on experimental results, we argue Y-CA-Net is a key player in achieving superior results for volumetric segmentation.
Accurate segmentation of anatomical structures and pathological regions in medical images is crucial for diagnosis, treatment planning, and disease monitoring. While the Segment Anything Model (SAM) and its variants have demonstrated impressive interactive segmentation capabilities on image types not seen during training without the need for domain adaptation or retraining, their practical application in volumetric 3D medical imaging workflows has been hindered by the lack of a user-friendly interface. To address this challenge, we introduce FastSAM-3DSlicer, a 3D Slicer extension that integrates both 2D and 3D SAM models, including SAM-Med2D, MedSAM, SAM-Med3D, and FastSAM-3D. Building on the well-established open-source 3D Slicer platform, our extension enables efficient, real-time segmentation of 3D volumetric medical images, with seamless interaction and visualization. By automating the handling of raw image data, user prompts, and segmented masks, FastSAM-3DSlicer provides a streamlined, user-friendly interface that can be easily incorporated into medical image analysis workflows. Performance evaluations reveal that the FastSAM-3DSlicer extension running FastSAM-3D achieves low inference times of only 1.09 seconds per volume on CPU and 0.73 seconds per volume on GPU, making it well-suited for real-time interactive segmentation. Moreover, we introduce an uncertainty quantification scheme that leverages the rapid inference capabilities of FastSAM-3D for practical implementation, further enhancing its reliability and applicability in medical settings. FastSAM-3DSlicer offers an interactive platform and user interface for 2D and 3D interactive volumetric medical image segmentation, offering a powerful combination of efficiency, precision, and ease of use with SAMs. The source code and a video demonstration are publicly available at https://github.com/arcadelab/FastSAM3D_slicer.
Volumetric medical image segmentation is pivotal in enhancing disease diagnosis, treatment planning, and advancing medical research. While existing volumetric foundation models for medical image segmentation, such as SAM-Med3D and SegVol, have shown remarkable performance on general organs and tumors, their ability to segment certain categories in clinical downstream tasks remains limited. Supervised Finetuning (SFT) serves as an effective way to adapt such foundation models for task-specific downstream tasks but at the cost of degrading the general knowledge previously stored in the original foundation model.To address this, we propose SAM-Med3D-MoE, a novel framework that seamlessly integrates task-specific finetuned models with the foundational model, creating a unified model at minimal additional training expense for an extra gating network. This gating network, in conjunction with a selection strategy, allows the unified model to achieve comparable performance of the original models in their respective tasks both general and specialized without updating any parameters of them.Our comprehensive experiments demonstrate the efficacy of SAM-Med3D-MoE, with an average Dice performance increase from 53 to 56.4 on 15 specific classes. It especially gets remarkable gains of 29.6, 8.5, 11.2 on the spinal cord, esophagus, and right hip, respectively. Additionally, it achieves 48.9 Dice on the challenging SPPIN2023 Challenge, significantly surpassing the general expert's performance of 32.3. We anticipate that SAM-Med3D-MoE can serve as a new framework for adapting the foundation model to specific areas in medical image analysis. Codes and datasets will be publicly available.
This paper investigates an extremely challenging problem: barely-supervised volumetric medical image segmentation (BSS). A BSS training dataset consists of two parts: 1) a barely-annotated labeled set, where each labeled image contains only a single-slice annotation, and 2) an unlabeled set comprising numerous unlabeled volumetric images. State-of-the-art BSS methods employ a registration-based paradigm, which uses inter-slice image registration to propagate single-slice annotations into volumetric pseudo labels, constructing a completely annotated labeled set, to which a semi-supervised segmentation scheme can be applied. However, the paradigm has a critical limitation: the pseudo-labels generated by image registration are unreliable and noisy. Motivated by this, we propose a new perspective: instead of solving BSS within a semi-supervised learning scheme, this work formulates BSS as an unsupervised domain adaptation problem. To this end, we propose a novel BSS framework, \textbf{B}arely-supervised learning \textbf{via} unsupervised domain \textbf{A}daptation (BvA), as an alternative to the dominant registration paradigm. Specifically, we first design a novel noise-free labeled data construction algorithm (NFC) for slice-to-volume labeled data synthesis. Then, we introduce a frequency and spatial Mix-Up strategy (FSX) to mitigate the domain shifts. Extensive experiments demonstrate that our method provides a promising alternative for BSS. Remarkably, the proposed method, trained on the left atrial segmentation dataset with \textbf{only one} barely-labeled image, achieves a Dice score of 81.20%, outperforming the state-of-the-art by 61.71%. The code is available at https://github.com/Senyh/BvA.
The rise of Transformer architectures has revolutionized medical image segmentation, leading to hybrid models that combine Convolutional Neural Networks (CNNs) and Transformers for enhanced accuracy. However, these models often suffer from increased complexity and overlook the interplay between spatial and channel features, which is vital for segmentation precision. We introduce LHU-Net, a streamlined Hybrid U-Net for volumetric medical image segmentation, designed to first analyze spatial and then channel features for effective feature extraction. Tested on five benchmark datasets (Synapse, LA, Pancreas, ACDC, BRaTS 2018), LHU-Net demonstrated superior efficiency and accuracy, notably achieving a 92.66 Dice score on ACDC with 85\% fewer parameters and a quarter of the computational demand compared to leading models. This performance, achieved without pre-training, extra data, or model ensembles, sets new benchmarks for computational efficiency and accuracy in segmentation, using under 11 million parameters. This achievement highlights that balancing computational efficiency with high accuracy in medical image segmentation is feasible. Our implementation of LHU-Net is freely accessible to the research community on GitHub (https://github.com/xmindflow/LHUNet).
Hierarchical transformers have achieved significant success in medical image segmentation due to their large receptive field and capabilities of effectively leveraging global long-range contextual information. Convolutional neural networks (CNNs) can also deliver a large receptive field by using large kernels, enabling them to achieve competitive performance with fewer model parameters. However, CNNs incorporated with large convolutional kernels remain constrained in adaptively capturing multi-scale features from organs with large variations in shape and size due to the employment of fixed-sized kernels. Additionally, they are unable to utilize global contextual information efficiently. To address these limitations, we propose Dynamic Large Kernel (DLK) and Dynamic Feature Fusion (DFF) modules. The DLK module employs multiple large kernels with varying kernel sizes and dilation rates to capture multi-scale features. Subsequently, a dynamic selection mechanism is utilized to adaptively highlight the most important spatial features based on global information. Additionally, the DFF module is proposed to adaptively fuse multi-scale local feature maps based on their global information. We integrate DLK and DFF in a hierarchical transformer architecture to develop a novel architecture, termed D-Net. D-Net is able to effectively utilize a multi-scale large receptive field and adaptively harness global contextual information. Extensive experimental results demonstrate that D-Net outperforms other state-of-the-art models in the two volumetric segmentation tasks, including abdominal multi-organ segmentation and multi-modality brain tumor segmentation. Our code is available at https://github.com/sotiraslab/DLK.
Volume-wise labeling in 3D medical images is a time-consuming task that requires expertise. As a result, there is growing interest in using semi-supervised learning (SSL) techniques to train models with limited labeled data. However, the challenges and practical applications extend beyond SSL to settings such as unsupervised domain adaptation (UDA) and semi-supervised domain generalization (SemiDG). This work aims to develop a generic SSL framework that can handle all three settings. We identify two main obstacles to achieving this goal in the existing SSL framework: 1) the weakness of capturing distribution-invariant features; and 2) the tendency for unlabeled data to be overwhelmed by labeled data, leading to over-fitting to the labeled data during training. To address these issues, we propose an Aggregating & Decoupling framework. The aggregating part consists of a Diffusion encoder that constructs a common knowledge set by extracting distribution-invariant features from aggregated information from multiple distributions/domains. The decoupling part consists of three decoders that decouple the training process with labeled and unlabeled data, thus avoiding over-fitting to labeled data, specific domains and classes. We evaluate our proposed framework on four benchmark datasets for SSL, Class-imbalanced SSL, UDA and SemiDG. The results showcase notable improvements compared to state-of-the-art methods across all four settings, indicating the potential of our framework to tackle more challenging SSL scenarios. Code and models are available at: https://github.com/xmed-lab/GenericSSL.
Precise image segmentation provides clinical study with instructive information. Despite the remarkable progress achieved in medical image segmentation, there is still an absence of a 3D foundation segmentation model that can segment a wide range of anatomical categories with easy user interaction. In this paper, we propose a 3D foundation segmentation model, named SegVol, supporting universal and interactive volumetric medical image segmentation. By scaling up training data to 90K unlabeled Computed Tomography (CT) volumes and 6K labeled CT volumes, this foundation model supports the segmentation of over 200 anatomical categories using semantic and spatial prompts. To facilitate efficient and precise inference on volumetric images, we design a zoom-out-zoom-in mechanism. Extensive experiments on 22 anatomical segmentation tasks verify that SegVol outperforms the competitors in 19 tasks, with improvements up to 37.24% compared to the runner-up methods. We demonstrate the effectiveness and importance of specific designs by ablation study. We expect this foundation model can promote the development of volumetric medical image analysis. The model and code are publicly available at: https://github.com/BAAI-DCAI/SegVol.
A large portion of volumetric medical data, especially magnetic resonance imaging (MRI) data, is anisotropic, as the through-plane resolution is typically much lower than the in-plane resolution. Both 3D and purely 2D deep learning-based segmentation methods are deficient in dealing with such volumetric data since the performance of 3D methods suffers when confronting anisotropic data, and 2D methods disregard crucial volumetric information. Insufficient work has been done on 2.5D methods, in which 2D convolution is mainly used in concert with volumetric information. These models focus on learning the relationship across slices, but typically have many parameters to train. We offer a Cross-Slice Attention Module (CSAM) with minimal trainable parameters, which captures information across all the slices in the volume by applying semantic, positional, and slice attention on deep feature maps at different scales. Our extensive experiments using different network architectures and tasks demonstrate the usefulness and generalizability of CSAM. Associated code is available at https://github.com/aL3x-O-o-Hung/CSAM.
Existing volumetric medical image segmentation models are typically task-specific, excelling at specific target but struggling to generalize across anatomical structures or modalities. This limitation restricts their broader clinical use. In this paper, we introduce SAM-Med3D for general-purpose segmentation on volumetric medical images. Given only a few 3D prompt points, SAM-Med3D can accurately segment diverse anatomical structures and lesions across various modalities. To achieve this, we gather and process a large-scale 3D medical image dataset, SA-Med3D-140K, from a blend of public sources and licensed private datasets. This dataset includes 22K 3D images and 143K corresponding 3D masks. Then SAM-Med3D, a promptable segmentation model characterized by the fully learnable 3D structure, is trained on this dataset using a two-stage procedure and exhibits impressive performance on both seen and unseen segmentation targets. We comprehensively evaluate SAM-Med3D on 16 datasets covering diverse medical scenarios, including different anatomical structures, modalities, targets, and zero-shot transferability to new/unseen tasks. The evaluation shows the efficiency and efficacy of SAM-Med3D, as well as its promising application to diverse downstream tasks as a pre-trained model. Our approach demonstrates that substantial medical resources can be utilized to develop a general-purpose medical AI for various potential applications. Our dataset, code, and models are available at https://github.com/uni-medical/SAM-Med3D.
Recently, weakly-supervised image segmentation using weak annotations like scribbles has gained great attention in computer vision and medical image analysis, since such annotations are much easier to obtain compared to time-consuming and labor-intensive labeling at the pixel/voxel level. However, due to a lack of structure supervision on regions of interest (ROIs), existing scribble-based methods suffer from poor boundary localization. Furthermore, most current methods are designed for 2D image segmentation, which do not fully leverage the volumetric information if directly applied to each image slice. In this paper, we propose a scribble-based volumetric image segmentation, Scribble2D5, which tackles 3D anisotropic image segmentation and aims to its improve boundary prediction. To achieve this, we augment a 2.5D attention UNet with a proposed label propagation module to extend semantic information from scribbles and use a combination of static and active boundary prediction to learn ROI's boundary and regularize its shape. Also, we propose an optional add-on component, which incorporates the shape prior information from unpaired segmentation masks to further improve model accuracy. Extensive experiments on three public datasets and one private dataset demonstrate our Scribble2D5 achieves state-of-the-art performance on volumetric image segmentation using scribbles and shape prior if available.