Show and Segment: Universal Medical Image Segmentation via In-Context Learning

Medical image segmentation remains challenging due to the vast diversity of anatomical structures, imaging modalities, and segmentation tasks. While deep learning has made significant advances, current approaches struggle to generalize as they require task-specific training or fine-tuning on unseen classes. We present Iris, a novel In-context Reference Image guided Segmentation framework that enables flexible adaptation to novel tasks through the use of reference examples without fine-tuning. At its core, Iris features a lightweight context task encoding module that distills task-specific information from reference context image-label pairs. This rich context embedding information is used to guide the segmentation of target objects. By decoupling task encoding from inference, Iris supports diverse strategies from one-shot inference and context example ensemble to object-level context example retrieval and in-context tuning. Through comprehensive evaluation across twelve datasets, we demonstrate that Iris performs strongly compared to task-specific models on in-distribution tasks. On seven held-out datasets, Iris shows superior generalization to out-of-distribution data and unseen classes. Further, Iris's task encoding module can automatically discover anatomical relationships across datasets and modalities, offering insights into medical objects without explicit anatomical supervision.

The Hidden Life of Tokens: Reducing Hallucination of Large Vision-Language Models via Visual Information Steering

Large Vision-Language Models (LVLMs) can reason effectively over both textual and visual inputs, but they tend to hallucinate syntactically coherent yet visually ungrounded contents. In this paper, we investigate the internal dynamics of hallucination by examining the tokens logits rankings throughout the generation process, revealing three key patterns in how LVLMs process information: (1) gradual visual information loss -- visually grounded tokens gradually become less favored throughout generation, and (2) early excitation -- semantically meaningful tokens achieve peak activation in the layers earlier than the final layer. (3) hidden genuine information -- visually grounded tokens though not being eventually decided still retain relatively high rankings at inference. Based on these insights, we propose VISTA (Visual Information Steering with Token-logit Augmentation), a training-free inference-time intervention framework that reduces hallucination while promoting genuine information. VISTA works by combining two complementary approaches: reinforcing visual information in activation space and leveraging early layer activations to promote semantically meaningful decoding. Compared to existing methods, VISTA requires no external supervision and is applicable to various decoding strategies. Extensive experiments show that VISTA on average reduces hallucination by abount 40% on evaluated open-ended generation task, and it consistently outperforms existing methods on four benchmarks across four architectures under three decoding strategies.

RadAlign: Advancing Radiology Report Generation with Vision-Language Concept Alignment

Automated chest radiographs interpretation requires both accurate disease classification and detailed radiology report generation, presenting a significant challenge in the clinical workflow. Current approaches either focus on classification accuracy at the expense of interpretability or generate detailed but potentially unreliable reports through image captioning techniques. In this study, we present RadAlign, a novel framework that combines the predictive accuracy of vision-language models (VLMs) with the reasoning capabilities of large language models (LLMs). Inspired by the radiologist's workflow, RadAlign first employs a specialized VLM to align visual features with key medical concepts, achieving superior disease classification with an average AUC of 0.885 across multiple diseases. These recognized medical conditions, represented as text-based concepts in the aligned visual-language space, are then used to prompt LLM-based report generation. Enhanced by a retrieval-augmented generation mechanism that grounds outputs in similar historical cases, RadAlign delivers superior report quality with a GREEN score of 0.678, outperforming state-of-the-art methods' 0.634. Our framework maintains strong clinical interpretability while reducing hallucinations, advancing automated medical imaging and report analysis through integrated predictive and generative AI. Code is available at https://github.com/difeigu/RadAlign.

VerSe: Integrating Multiple Queries as Prompts for Versatile Cardiac MRI Segmentation

Despite the advances in learning-based image segmentation approach, the accurate segmentation of cardiac structures from magnetic resonance imaging (MRI) remains a critical challenge. While existing automatic segmentation methods have shown promise, they still require extensive manual corrections of the segmentation results by human experts, particularly in complex regions such as the basal and apical parts of the heart. Recent efforts have been made on developing interactive image segmentation methods that enable human-in-the-loop learning. However, they are semi-automatic and inefficient, due to their reliance on click-based prompts, especially for 3D cardiac MRI volumes. To address these limitations, we propose VerSe, a Versatile Segmentation framework to unify automatic and interactive segmentation through mutiple queries. Our key innovation lies in the joint learning of object and click queries as prompts for a shared segmentation backbone. VerSe supports both fully automatic segmentation, through object queries, and interactive mask refinement, by providing click queries when needed. With the proposed integrated prompting scheme, VerSe demonstrates significant improvement in performance and efficiency over existing methods, on both cardiac MRI and out-of-distribution medical imaging datasets. The code is available at https://github.com/bangwayne/Verse.

Aligning Human Knowledge with Visual Concepts Towards Explainable Medical Image Classification

Although explainability is essential in the clinical diagnosis, most deep learning models still function as black boxes without elucidating their decision-making process. In this study, we investigate the explainable model development that can mimic the decision-making process of human experts by fusing the domain knowledge of explicit diagnostic criteria. We introduce a simple yet effective framework, Explicd, towards Explainable language-informed criteria-based diagnosis. Explicd initiates its process by querying domain knowledge from either large language models (LLMs) or human experts to establish diagnostic criteria across various concept axes (e.g., color, shape, texture, or specific patterns of diseases). By leveraging a pretrained vision-language model, Explicd injects these criteria into the embedding space as knowledge anchors, thereby facilitating the learning of corresponding visual concepts within medical images. The final diagnostic outcome is determined based on the similarity scores between the encoded visual concepts and the textual criteria embeddings. Through extensive evaluation of five medical image classification benchmarks, Explicd has demonstrated its inherent explainability and extends to improve classification performance compared to traditional black-box models.

Implicit In-context Learning

In-context Learning (ICL) empowers large language models (LLMs) to adapt to unseen tasks during inference by prefixing a few demonstration examples prior to test queries. Despite its versatility, ICL incurs substantial computational and memory overheads compared to zero-shot learning and is susceptible to the selection and order of demonstration examples. In this work, we introduce Implicit In-context Learning (I2CL), an innovative paradigm that addresses the challenges associated with traditional ICL by absorbing demonstration examples within the activation space. I2CL first generates a condensed vector representation, namely a context vector, from the demonstration examples. It then integrates the context vector during inference by injecting a linear combination of the context vector and query activations into the model's residual streams. Empirical evaluation on nine real-world tasks across three model architectures demonstrates that I2CL achieves few-shot performance with zero-shot cost and exhibits robustness against the variation of demonstration examples. Furthermore, I2CL facilitates a novel representation of "task-ids", enhancing task similarity detection and enabling effective transfer learning. We provide a comprehensive analysis of I2CL, offering deeper insights into its mechanisms and broader implications for ICL. The source code is available at: https://github.com/LzVv123456/I2CL.

Deep Deformable Models: Learning 3D Shape Abstractions with Part Consistency

The task of shape abstraction with semantic part consistency is challenging due to the complex geometries of natural objects. Recent methods learn to represent an object shape using a set of simple primitives to fit the target. \textcolor{black}{However, in these methods, the primitives used do not always correspond to real parts or lack geometric flexibility for semantic interpretation.} In this paper, we investigate salient and efficient primitive descriptors for accurate shape abstractions, and propose \textit{Deep Deformable Models (DDMs)}. DDM employs global deformations and diffeomorphic local deformations. These properties enable DDM to abstract complex object shapes with significantly fewer primitives that offer broader geometry coverage and finer details. DDM is also capable of learning part-level semantic correspondences due to the differentiable and invertible properties of our primitive deformation. Moreover, DDM learning formulation is based on dynamic and kinematic modeling, which enables joint regularization of each sub-transformation during primitive fitting. Extensive experiments on \textit{ShapeNet} demonstrate that DDM outperforms the state-of-the-art in terms of reconstruction and part consistency by a notable margin.

Training Like a Medical Resident: Universal Medical Image Segmentation via Context Prior Learning

A major enduring focus of clinical workflows is disease analytics and diagnosis, leading to medical imaging datasets where the modalities and annotations are strongly tied to specific clinical objectives. To date, building task-specific segmentation models is intuitive yet a restrictive approach, lacking insights gained from widespread imaging cohorts. Inspired by the training of medical residents, we explore universal medical image segmentation, whose goal is to learn from diverse medical imaging sources covering a range of clinical targets, body regions, and image modalities. Following this paradigm, we propose Hermes, a context prior learning approach that addresses the challenges related to the heterogeneity on data, modality, and annotations in the proposed universal paradigm. In a collection of seven diverse datasets, we demonstrate the appealing merits of the universal paradigm over the traditional task-specific training paradigm. By leveraging the synergy among various tasks, Hermes shows superior performance and model scalability. Our in-depth investigation on two additional datasets reveals Hermes' strong capabilities for transfer learning, incremental learning, and generalization to different downstream tasks. The code is available: https://github.com/yhygao/universal-medical-image-segmentation.

Visual Prompt Tuning for Test-time Domain Adaptation

Models should have the ability to adapt to unseen data during test-time to avoid performance drop caused by inevitable distribution shifts in real-world deployment scenarios. In this work, we tackle the practical yet challenging test-time adaptation (TTA) problem, where a model adapts to the target domain without accessing the source data. We propose a simple recipe called data-efficient prompt tuning (DePT) with two key ingredients. First, DePT plugs visual prompts into the vision Transformer and only tunes these source-initialized prompts during adaptation. We find such parameter-efficient finetuning can efficiently adapt the model representation to the target domain without overfitting to the noise in the learning objective. Second, DePT bootstraps the source representation to the target domain by memory bank-based online pseudo labeling. A hierarchical self-supervised regularization specially designed for prompts is jointly optimized to alleviate error accumulation during self-training. With much fewer tunable parameters, DePT demonstrates not only state-of-the-art performance on major adaptation benchmarks, but also superior data efficiency, i.e., adaptation with only 1\% or 10\% data without much performance degradation compared to 100\% data. In addition, DePT is also versatile to be extended to online or multi-source TTA settings.

TransFusion: Multi-view Divergent Fusion for Medical Image Segmentation with Transformers

Combining information from multi-view images is crucial to improve the performance and robustness of automated methods for disease diagnosis. However, due to the non-alignment characteristics of multi-view images, building correlation and data fusion across views largely remain an open problem. In this study, we present TransFusion, a Transformer-based architecture to merge divergent multi-view imaging information using convolutional layers and powerful attention mechanisms. In particular, the Divergent Fusion Attention (DiFA) module is proposed for rich cross-view context modeling and semantic dependency mining, addressing the critical issue of capturing long-range correlations between unaligned data from different image views. We further propose the Multi-Scale Attention (MSA) to collect global correspondence of multi-scale feature representations. We evaluate TransFusion on the Multi-Disease, Multi-View \& Multi-Center Right Ventricular Segmentation in Cardiac MRI (M\&Ms-2) challenge cohort. TransFusion demonstrates leading performance against the state-of-the-art methods and opens up new perspectives for multi-view imaging integration towards robust medical image segmentation.