MedSAM-Agent: Empowering Interactive Medical Image Segmentation with Multi-turn Agentic Reinforcement Learning

Medical image segmentation is evolving from task-specific models toward generalizable frameworks. Recent research leverages Multi-modal Large Language Models (MLLMs) as autonomous agents, employing reinforcement learning with verifiable reward (RLVR) to orchestrate specialized tools like the Segment Anything Model (SAM). However, these approaches often rely on single-turn, rigid interaction strategies and lack process-level supervision during training, which hinders their ability to fully exploit the dynamic potential of interactive tools and leads to redundant actions. To bridge this gap, we propose MedSAM-Agent, a framework that reformulates interactive segmentation as a multi-step autonomous decision-making process. First, we introduce a hybrid prompting strategy for expert-curated trajectory generation, enabling the model to internalize human-like decision heuristics and adaptive refinement strategies. Furthermore, we develop a two-stage training pipeline that integrates multi-turn, end-to-end outcome verification with a clinical-fidelity process reward design to promote interaction parsimony and decision efficiency. Extensive experiments across 6 medical modalities and 21 datasets demonstrate that MedSAM-Agent achieves state-of-the-art performance, effectively unifying autonomous medical reasoning with robust, iterative optimization. Code is available \href{https://github.com/CUHK-AIM-Group/MedSAM-Agent}{here}.

Quality-aware Selective Fusion Network for V-D-T Salient Object Detection

Depth images and thermal images contain the spatial geometry information and surface temperature information, which can act as complementary information for the RGB modality. However, the quality of the depth and thermal images is often unreliable in some challenging scenarios, which will result in the performance degradation of the two-modal based salient object detection (SOD). Meanwhile, some researchers pay attention to the triple-modal SOD task, where they attempt to explore the complementarity of the RGB image, the depth image, and the thermal image. However, existing triple-modal SOD methods fail to perceive the quality of depth maps and thermal images, which leads to performance degradation when dealing with scenes with low-quality depth and thermal images. Therefore, we propose a quality-aware selective fusion network (QSF-Net) to conduct VDT salient object detection, which contains three subnets including the initial feature extraction subnet, the quality-aware region selection subnet, and the region-guided selective fusion subnet. Firstly, except for extracting features, the initial feature extraction subnet can generate a preliminary prediction map from each modality via a shrinkage pyramid architecture. Then, we design the weakly-supervised quality-aware region selection subnet to generate the quality-aware maps. Concretely, we first find the high-quality and low-quality regions by using the preliminary predictions, which further constitute the pseudo label that can be used to train this subnet. Finally, the region-guided selective fusion subnet purifies the initial features under the guidance of the quality-aware maps, and then fuses the triple-modal features and refines the edge details of prediction maps through the intra-modality and inter-modality attention (IIA) module and the edge refinement (ER) module, respectively. Extensive experiments are performed on VDT-2048