Few-Shot Adaptation of Training-Free Foundation Model for 3D Medical Image Segmentation

Vision foundation models have achieved remarkable progress across various image analysis tasks. In the image segmentation task, foundation models like the Segment Anything Model (SAM) enable generalizable zero-shot segmentation through user-provided prompts. However, SAM primarily trained on natural images, lacks the domain-specific expertise of medical imaging. This limitation poses challenges when applying SAM to medical image segmentation, including the need for extensive fine-tuning on specialized medical datasets and a dependency on manual prompts, which are both labor-intensive and require intervention from medical experts. This work introduces the Few-shot Adaptation of Training-frEe SAM (FATE-SAM), a novel method designed to adapt the advanced Segment Anything Model 2 (SAM2) for 3D medical image segmentation. FATE-SAM reassembles pre-trained modules of SAM2 to enable few-shot adaptation, leveraging a small number of support examples to capture anatomical knowledge and perform prompt-free segmentation, without requiring model fine-tuning. To handle the volumetric nature of medical images, we incorporate a Volumetric Consistency mechanism that enhances spatial coherence across 3D slices. We evaluate FATE-SAM on multiple medical imaging datasets and compare it with supervised learning methods, zero-shot SAM approaches, and fine-tuned medical SAM methods. Results show that FATE-SAM delivers robust and accurate segmentation while eliminating the need for large annotated datasets and expert intervention. FATE-SAM provides a practical, efficient solution for medical image segmentation, making it more accessible for clinical applications.

Diff-Ensembler: Learning to Ensemble 2D Diffusion Models for Volume-to-Volume Medical Image Translation

Despite success in volume-to-volume translations in medical images, most existing models struggle to effectively capture the inherent volumetric distribution using 3D representations. The current state-of-the-art approach combines multiple 2D-based networks through weighted averaging, thereby neglecting the 3D spatial structures. Directly training 3D models in medical imaging presents significant challenges due to high computational demands and the need for large-scale datasets. To address these challenges, we introduce Diff-Ensembler, a novel hybrid 2D-3D model for efficient and effective volumetric translations by ensembling perpendicularly trained 2D diffusion models with a 3D network in each diffusion step. Moreover, our model can naturally be used to ensemble diffusion models conditioned on different modalities, allowing flexible and accurate fusion of input conditions. Extensive experiments demonstrate that Diff-Ensembler attains superior accuracy and volumetric realism in 3D medical image super-resolution and modality translation. We further demonstrate the strength of our model's volumetric realism using tumor segmentation as a downstream task.

Memorizing SAM: 3D Medical Segment Anything Model with Memorizing Transformer

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

HResFormer: Hybrid Residual Transformer for Volumetric Medical Image Segmentation

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.

SGTC: Semantic-Guided Triplet Co-training for Sparsely Annotated Semi-Supervised Medical Image Segmentation

Although semi-supervised learning has made significant advances in the field of medical image segmentation, fully annotating a volumetric sample slice by slice remains a costly and time-consuming task. Even worse, most of the existing approaches pay much attention to image-level information and ignore semantic features, resulting in the inability to perceive weak boundaries. To address these issues, we propose a novel Semantic-Guided Triplet Co-training (SGTC) framework, which achieves high-end medical image segmentation by only annotating three orthogonal slices of a few volumetric samples, significantly alleviating the burden of radiologists. Our method consist of two main components. Specifically, to enable semantic-aware, fine-granular segmentation and enhance the quality of pseudo-labels, a novel semantic-guided auxiliary learning mechanism is proposed based on the pretrained CLIP. In addition, focusing on a more challenging but clinically realistic scenario, a new triple-view disparity training strategy is proposed, which uses sparse annotations (i.e., only three labeled slices of a few volumes) to perform co-training between three sub-networks, significantly improving the robustness. Extensive experiments on three public medical datasets demonstrate that our method outperforms most state-of-the-art semi-supervised counterparts under sparse annotation settings. The source code is available at https://github.com/xmeimeimei/SGTC.

PointVoxelFormer -- Reviving point cloud networks for 3D medical imaging

Point clouds are a very efficient way to represent volumetric data in medical imaging. First, they do not occupy resources for empty spaces and therefore can avoid trade-offs between resolution and field-of-view for voxel-based 3D convolutional networks (CNNs) - leading to smaller and robust models. Second, they provide a modality agnostic representation of anatomical surfaces and shapes to avoid domain gaps for generic geometric models. Third, they remove identifiable patient-specific information and may increase privacy preservation when publicly sharing data. Despite their benefits, point clouds are still underexplored in medical imaging compared to volumetric 3D CNNs and vision transformers. To date both datasets and stringent studies on comparative strengths and weaknesses of methodological choices are missing. Interactions and information exchange of spatially close points - e.g. through k-nearest neighbour graphs in edge convolutions or point transformations - within points clouds are crucial for learning geometrically meaningful features but may incur computational bottlenecks. This work presents a hybrid approach that combines point-wise operations with intermediate differentiable rasterisation and dense localised CNNs. For deformable point cloud registration, we devise an early fusion scheme for coordinate features that joins both clouds within a common reference frame and is coupled with an inverse consistent, two-step alignment architecture. Our extensive experiments on three different datasets for segmentation and registration demonstrate that our method, PointVoxelFormer, enables very compact models that excel with threefold speed-ups, fivefold memory reduction and over 30% registration error reduction against edge convolutions and other state-of-the-art models in geometric deep learning.

Lightweight Method for Interactive 3D Medical Image Segmentation with Multi-Round Result Fusion

In medical imaging, precise annotation of lesions or organs is often required. However, 3D volumetric images typically consist of hundreds or thousands of slices, making the annotation process extremely time-consuming and laborious. Recently, the Segment Anything Model (SAM) has drawn widespread attention due to its remarkable zero-shot generalization capabilities in interactive segmentation. While researchers have explored adapting SAM for medical applications, such as using SAM adapters or constructing 3D SAM models, a key question remains: Can traditional CNN networks achieve the same strong zero-shot generalization in this task? In this paper, we propose the Lightweight Interactive Network for 3D Medical Image Segmentation (LIM-Net), a novel approach demonstrating the potential of compact CNN-based models. Built upon a 2D CNN backbone, LIM-Net initiates segmentation by generating a 2D prompt mask from user hints. This mask is then propagated through the 3D sequence via the Memory Module. To refine and stabilize results during interaction, the Multi-Round Result Fusion (MRF) Module selects and merges optimal masks from multiple rounds. Our extensive experiments across multiple datasets and modalities demonstrate LIM-Net's competitive performance. It exhibits stronger generalization to unseen data compared to SAM-based models, with competitive accuracy while requiring fewer interactions. Notably, LIM-Net's lightweight design offers significant advantages in deployment and inference efficiency, with low GPU memory consumption suitable for resource-constrained environments. These promising results demonstrate LIM-Net can serve as a strong baseline, complementing and contrasting with popular SAM models to further boost effective interactive medical image segmentation. The code will be released at \url{https://github.com/goodtime-123/LIM-Net}.

Reconstruction of 3D lumbar spine models from incomplete segmentations using landmark detection

Patient-specific 3D spine models serve as a foundation for spinal treatment and surgery planning as well as analysis of loading conditions in biomechanical and biomedical research. Despite advancements in imaging technologies, the reconstruction of complete 3D spine models often faces challenges due to limitations in imaging modalities such as planar X-Ray and missing certain spinal structures, such as the spinal or transverse processes, in volumetric medical images and resulting segmentations. In this study, we present a novel accurate and time-efficient method to reconstruct complete 3D lumbar spine models from incomplete 3D vertebral bodies obtained from segmented magnetic resonance images (MRI). In our method, we use an affine transformation to align artificial vertebra models with patient-specific incomplete vertebrae. The transformation matrix is derived from vertebra landmarks, which are automatically detected on the vertebra endplates. The results of our evaluation demonstrate the high accuracy of the performed registration, achieving an average point-to-model distance of 1.95 mm. Additionally, in assessing the morphological properties of the vertebrae and intervertebral characteristics, our method demonstrated a mean absolute error (MAE) of 3.4{\deg} in the angles of functional spine units (FSUs), emphasizing its effectiveness in maintaining important spinal features throughout the transformation process of individual vertebrae. Our method achieves the registration of the entire lumbar spine, spanning segments L1 to L5, in just 0.14 seconds, showcasing its time-efficiency. Clinical relevance: the fast and accurate reconstruction of spinal models from incomplete input data such as segmentations provides a foundation for many applications in spine diagnostics, treatment planning, and the development of spinal healthcare solutions.

RefSAM3D: Adapting SAM with Cross-modal Reference for 3D Medical Image Segmentation

The Segment Anything Model (SAM), originally built on a 2D Vision Transformer (ViT), excels at capturing global patterns in 2D natural images but struggles with 3D medical imaging modalities like CT and MRI. These modalities require capturing spatial information in volumetric space for tasks such as organ segmentation and tumor quantification. To address this challenge, we introduce RefSAM3D, which adapts SAM for 3D medical imaging by incorporating a 3D image adapter and cross-modal reference prompt generation. Our approach modifies the visual encoder to handle 3D inputs and enhances the mask decoder for direct 3D mask generation. We also integrate textual prompts to improve segmentation accuracy and consistency in complex anatomical scenarios. By employing a hierarchical attention mechanism, our model effectively captures and integrates information across different scales. Extensive evaluations on multiple medical imaging datasets demonstrate the superior performance of RefSAM3D over state-of-the-art methods. Our contributions advance the application of SAM in accurately segmenting complex anatomical structures in medical imaging.

SegBook: A Simple Baseline and Cookbook for Volumetric 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.