Vision Foundation Models in Medical Image Analysis: Advances and Challenges

The rapid development of Vision Foundation Models (VFMs), particularly Vision Transformers (ViT) and Segment Anything Model (SAM), has sparked significant advances in the field of medical image analysis. These models have demonstrated exceptional capabilities in capturing long-range dependencies and achieving high generalization in segmentation tasks. However, adapting these large models to medical image analysis presents several challenges, including domain differences between medical and natural images, the need for efficient model adaptation strategies, and the limitations of small-scale medical datasets. This paper reviews the state-of-the-art research on the adaptation of VFMs to medical image segmentation, focusing on the challenges of domain adaptation, model compression, and federated learning. We discuss the latest developments in adapter-based improvements, knowledge distillation techniques, and multi-scale contextual feature modeling, and propose future directions to overcome these bottlenecks. Our analysis highlights the potential of VFMs, along with emerging methodologies such as federated learning and model compression, to revolutionize medical image analysis and enhance clinical applications. The goal of this work is to provide a comprehensive overview of current approaches and suggest key areas for future research that can drive the next wave of innovation in medical image segmentation.

Topology-Aware Wavelet Mamba for Airway Structure Segmentation in Postoperative Recurrent Nasopharyngeal Carcinoma CT Scans

Nasopharyngeal carcinoma (NPC) patients often undergo radiotherapy and chemotherapy, which can lead to postoperative complications such as limited mouth opening and joint stiffness, particularly in recurrent cases that require re-surgery. These complications can affect airway function, making accurate postoperative airway risk assessment essential for managing patient care. Accurate segmentation of airway-related structures in postoperative CT scans is crucial for assessing these risks. This study introduces TopoWMamba (Topology-aware Wavelet Mamba), a novel segmentation model specifically designed to address the challenges of postoperative airway risk evaluation in recurrent NPC patients. TopoWMamba combines wavelet-based multi-scale feature extraction, state-space sequence modeling, and topology-aware modules to segment airway-related structures in CT scans robustly. By leveraging the Wavelet-based Mamba Block (WMB) for hierarchical frequency decomposition and the Snake Conv VSS (SCVSS) module to preserve anatomical continuity, TopoWMamba effectively captures both fine-grained boundaries and global structural context, crucial for accurate segmentation in complex postoperative scenarios. Through extensive testing on the NPCSegCT dataset, TopoWMamba achieves an average Dice score of 88.02%, outperforming existing models such as UNet, Attention UNet, and SwinUNet. Additionally, TopoWMamba is tested on the SegRap 2023 Challenge dataset, where it shows a significant improvement in trachea segmentation with a Dice score of 95.26%. The proposed model provides a strong foundation for automated segmentation, enabling more accurate postoperative airway risk evaluation.