Daily Papers

Accurate quantification of lung disease severity from chest imaging is critical for clinical decision-making and resource allocation. We propose a tri-modal deep learning framework, TMF-RSE (Tri-Modal Fusion with Regional Semantics and Evidential Uncertainty), that combines appearance features from two-dimensional chest inputs, structural features from lung segmentation masks, and semantic features from vision-language models (VLMs) for severity quantification. Our approach employs complementary fusion mechanisms that integrate semantic guidance, structural priors, and hierarchical interactions across modalities. The model employs evidential regression to provide both severity predictions and uncertainty estimates. Experiments on the Per-COVID-19 CT and RALO datasets show that TMF-RSE outperforms recent transformer-based baselines, achieving MAE of 4.02 and Pearson correlation of 0.9629 on Per-COVID-19 validation, and 0.339 MAE / 0.973 PC on RALO geographic extent.

Automatic radiology report generation is a promising application of multimodal deep learning, aiming to reduce reporting workload and improve consistency. However, current state-of-the-art (SOTA) systems - such as Multimodal AI for Radiology Applications (MAIRA-2) and Medical Pathways Language Model-Multimodal (MedPaLM-M) - depend on large-scale multimodal training, clinical metadata, and multiple imaging views, making them resource-intensive and inaccessible for most settings. We introduce a compact image-to-text architecture that generates the Findings section of chest X-ray reports from a single frontal image. The model combines a frozen Self-Distillation with No Labels v3 (DINOv3) Vision Transformer (ViT) encoder with a Generative Pre-trained Transformer 2 (GPT-2) decoder enhanced by layer-wise anatomical attention. This mechanism integrates lung and heart segmentation masks through hierarchical Gaussian smoothing, biasing attention toward clinically relevant regions without adding trainable parameters. Evaluated on the official Medical Information Mart for Intensive Care-Chest X-ray (MIMIC-CXR) dataset using Chest Radiograph Expert (CheXpert) and Radiology Graph (RadGraph) metrics, our approach achieved substantial gains: CheXpert Macro-F1 for five key pathologies increased by 168% (0.083 -> 0.238) and Micro-F1 by 146% (0.137 -> 0.337), while broader performance across 14 observations improved by 86% (0.170 -> 0.316). Structural coherence also improved, with RadGraph F1 rising by 9.7%. Despite its small size and purely image-conditioned design, the model demonstrates that decoder-level anatomical guidance improves spatial grounding and enhances coherence in clinically relevant regions. The source code is publicly available at: https://github.com/devMuniz02/UDEM-CXR-Reporting-Thesis-2025.

This paper proposes a novel framework for lung segmentation in chest X-rays. It consists of two key contributions, a criss-cross attention based segmentation network and radiorealistic chest X-ray image synthesis (i.e. a synthesized radiograph that appears anatomically realistic) for data augmentation. The criss-cross attention modules capture rich global contextual information in both horizontal and vertical directions for all the pixels thus facilitating accurate lung segmentation. To reduce the manual annotation burden and to train a robust lung segmentor that can be adapted to pathological lungs with hazy lung boundaries, an image-to-image translation module is employed to synthesize radiorealistic abnormal CXRs from the source of normal ones for data augmentation. The lung masks of synthetic abnormal CXRs are propagated from the segmentation results of their normal counterparts, and then serve as pseudo masks for robust segmentor training. In addition, we annotate 100 CXRs with lung masks on a more challenging NIH Chest X-ray dataset containing both posterioranterior and anteroposterior views for evaluation. Extensive experiments validate the robustness and effectiveness of the proposed framework. The code and data can be found from https://github.com/rsummers11/CADLab/tree/master/Lung_Segmentation_XLSor .

The coronavirus disease (COVID-19) has resulted in a pandemic crippling the a breadth of services critical to daily life. Segmentation of lung infections in computerized tomography (CT) slices could be be used to improve diagnosis and understanding of COVID-19 in patients. Deep learning systems lack interpretability because of their black box nature. Inspired by human communication of complex ideas through language, we propose a symbolic framework based on emergent languages for the segmentation of COVID-19 infections in CT scans of lungs. We model the cooperation between two artificial agents - a Sender and a Receiver. These agents synergistically cooperate using emergent symbolic language to solve the task of semantic segmentation. Our game theoretic approach is to model the cooperation between agents unlike Generative Adversarial Networks (GANs). The Sender retrieves information from one of the higher layers of the deep network and generates a symbolic sentence sampled from a categorical distribution of vocabularies. The Receiver ingests the stream of symbols and cogenerates the segmentation mask. A private emergent language is developed that forms the communication channel used to describe the task of segmentation of COVID infections. We augment existing state of the art semantic segmentation architectures with our symbolic generator to form symbolic segmentation models. Our symbolic segmentation framework achieves state of the art performance for segmentation of lung infections caused by COVID-19. Our results show direct interpretation of symbolic sentences to discriminate between normal and infected regions, infection morphology and image characteristics. We show state of the art results for segmentation of COVID-19 lung infections in CT.

This paper introduces an innovative methodology for producing high-quality 3D lung CT images guided by textual information. While diffusion-based generative models are increasingly used in medical imaging, current state-of-the-art approaches are limited to low-resolution outputs and underutilize radiology reports' abundant information. The radiology reports can enhance the generation process by providing additional guidance and offering fine-grained control over the synthesis of images. Nevertheless, expanding text-guided generation to high-resolution 3D images poses significant memory and anatomical detail-preserving challenges. Addressing the memory issue, we introduce a hierarchical scheme that uses a modified UNet architecture. We start by synthesizing low-resolution images conditioned on the text, serving as a foundation for subsequent generators for complete volumetric data. To ensure the anatomical plausibility of the generated samples, we provide further guidance by generating vascular, airway, and lobular segmentation masks in conjunction with the CT images. The model demonstrates the capability to use textual input and segmentation tasks to generate synthesized images. The results of comparative assessments indicate that our approach exhibits superior performance compared to the most advanced models based on GAN and diffusion techniques, especially in accurately retaining crucial anatomical features such as fissure lines, airways, and vascular structures. This innovation introduces novel possibilities. This study focuses on two main objectives: (1) the development of a method for creating images based on textual prompts and anatomical components, and (2) the capability to generate new images conditioning on anatomical elements. The advancements in image generation can be applied to enhance numerous downstream tasks.

The development of successful artificial intelligence models for chest X-ray analysis relies on large, diverse datasets with high-quality annotations. While several databases of chest X-ray images have been released, most include disease diagnosis labels but lack detailed pixel-level anatomical segmentation labels. To address this gap, we introduce an extensive chest X-ray multi-center segmentation dataset with uniform and fine-grain anatomical annotations for images coming from six well-known publicly available databases: CANDID-PTX, ChestX-ray8, Chexpert, MIMIC-CXR-JPG, Padchest, and VinDr-CXR, resulting in 676,803 segmentation masks. Our methodology utilizes the HybridGNet model to ensure consistent and high-quality segmentations across all datasets. Rigorous validation, including expert physician evaluation and automatic quality control, was conducted to validate the resulting masks. Additionally, we provide individualized quality indices per mask and an overall quality estimation per dataset. This dataset serves as a valuable resource for the broader scientific community, streamlining the development and assessment of innovative methodologies in chest X-ray analysis. The CheXmask dataset is publicly available at: https://physionet.org/content/chexmask-cxr-segmentation-data/.

An essential stage in computer aided diagnosis of chest X rays is automated lung segmentation. Due to rib cages and the unique modalities of each persons lungs, it is essential to construct an effective automated lung segmentation model. This paper presents a reliable model for the segmentation of lungs in chest radiographs. Our model overcomes the challenges by learning to ignore unimportant areas in the source Chest Radiograph and emphasize important features for lung segmentation. We evaluate our model on public datasets, Montgomery and Shenzhen. The proposed model has a DICE coefficient of 98.1 percent which demonstrates the reliability of our model.

Developing generalist foundation model has recently attracted tremendous attention among researchers in the field of AI for Medicine (AI4Medicine). A pivotal insight in developing these models is their reliance on dataset scaling, which emphasizes the requirements on developing open-source medical image datasets that incorporate diverse supervision signals across various imaging modalities. In this paper, we introduce RadGenome-Chest CT, a comprehensive, large-scale, region-guided 3D chest CT interpretation dataset based on CT-RATE. Specifically, we leverage the latest powerful universal segmentation and large language models, to extend the original datasets (over 25,692 non-contrast 3D chest CT volume and reports from 20,000 patients) from the following aspects: (i) organ-level segmentation masks covering 197 categories, which provide intermediate reasoning visual clues for interpretation; (ii) 665 K multi-granularity grounded reports, where each sentence of the report is linked to the corresponding anatomical region of CT volume in the form of a segmentation mask; (iii) 1.3 M grounded VQA pairs, where questions and answers are all linked with reference segmentation masks, enabling models to associate visual evidence with textual explanations. All grounded reports and VQA pairs in the validation set have gone through manual verification to ensure dataset quality. We believe that RadGenome-Chest CT can significantly advance the development of multimodal medical foundation models, by training to generate texts based on given segmentation regions, which is unattainable with previous relevant datasets. We will release all segmentation masks, grounded reports, and VQA pairs to facilitate further research and development in this field.

Rapid advancements in medical image segmentation performance have been significantly driven by the development of Convolutional Neural Networks (CNNs) and Vision Transformers (ViTs). These models follow the discriminative pixel-wise classification learning paradigm and often have limited ability to generalize across diverse medical imaging datasets. In this manuscript, we introduce Generative Medical Segmentation (GMS), a novel approach leveraging a generative model to perform image segmentation. Concretely, GMS employs a robust pre-trained vision foundation model to extract latent representations for images and corresponding ground truth masks, followed by a model that learns a mapping function from the image to the mask in the latent space. Once trained, the model generates an estimated segmentation mask using the pre-trained vision foundation model to decode the predicted latent representation back into the image space. The design of GMS leads to fewer trainable parameters in the model which reduces the risk of overfitting and enhances its generalization capability. Our experimental analysis across five public datasets in different medical imaging domains demonstrates GMS outperforms existing discriminative and generative segmentation models. Furthermore, GMS is able to generalize well across datasets from different centers within the same imaging modality. Our experiments suggest GMS offers a scalable and effective solution for medical image segmentation. GMS implementation and trained model weights are available at https://github.com/King-HAW/GMS.

Open international challenges are becoming the de facto standard for assessing computer vision and image analysis algorithms. In recent years, new methods have extended the reach of pulmonary airway segmentation that is closer to the limit of image resolution. Since EXACT'09 pulmonary airway segmentation, limited effort has been directed to quantitative comparison of newly emerged algorithms driven by the maturity of deep learning based approaches and clinical drive for resolving finer details of distal airways for early intervention of pulmonary diseases. Thus far, public annotated datasets are extremely limited, hindering the development of data-driven methods and detailed performance evaluation of new algorithms. To provide a benchmark for the medical imaging community, we organized the Multi-site, Multi-domain Airway Tree Modeling (ATM'22), which was held as an official challenge event during the MICCAI 2022 conference. ATM'22 provides large-scale CT scans with detailed pulmonary airway annotation, including 500 CT scans (300 for training, 50 for validation, and 150 for testing). The dataset was collected from different sites and it further included a portion of noisy COVID-19 CTs with ground-glass opacity and consolidation. Twenty-three teams participated in the entire phase of the challenge and the algorithms for the top ten teams are reviewed in this paper. Quantitative and qualitative results revealed that deep learning models embedded with the topological continuity enhancement achieved superior performance in general. ATM'22 challenge holds as an open-call design, the training data and the gold standard evaluation are available upon successful registration via its homepage.

Image segmentation is about grouping pixels with different semantics, e.g., category or instance membership, where each choice of semantics defines a task. While only the semantics of each task differ, current research focuses on designing specialized architectures for each task. We present Masked-attention Mask Transformer (Mask2Former), a new architecture capable of addressing any image segmentation task (panoptic, instance or semantic). Its key components include masked attention, which extracts localized features by constraining cross-attention within predicted mask regions. In addition to reducing the research effort by at least three times, it outperforms the best specialized architectures by a significant margin on four popular datasets. Most notably, Mask2Former sets a new state-of-the-art for panoptic segmentation (57.8 PQ on COCO), instance segmentation (50.1 AP on COCO) and semantic segmentation (57.7 mIoU on ADE20K).

Accurate medical image segmentation is crucial for precise anatomical delineation. Deep learning models like U-Net have shown great success but depend heavily on large datasets and struggle with domain shifts, complex structures, and limited training samples. Recent studies have explored diffusion models for segmentation by iteratively refining masks. However, these methods still retain the conventional image-to-mask mapping, making them highly sensitive to input data, which hampers stability and generalization. In contrast, we introduce DiffAtlas, a novel generative framework that models both images and masks through diffusion during training, effectively ``GenAI-fying'' atlas-based segmentation. During testing, the model is guided to generate a specific target image-mask pair, from which the corresponding mask is obtained. DiffAtlas retains the robustness of the atlas paradigm while overcoming its scalability and domain-specific limitations. Extensive experiments on CT and MRI across same-domain, cross-modality, varying-domain, and different data-scale settings using the MMWHS and TotalSegmentator datasets demonstrate that our approach outperforms existing methods, particularly in limited-data and zero-shot modality segmentation. Code is available at https://github.com/M3DV/DiffAtlas.

Instance segmentation datasets play a crucial role in training accurate and robust computer vision models. However, obtaining accurate mask annotations to produce high-quality segmentation datasets is a costly and labor-intensive process. In this work, we show how this issue can be mitigated by starting with small annotated instance segmentation datasets and augmenting them to effectively obtain a sizeable annotated dataset. We achieve that by creating variations of the available annotated object instances in a way that preserves the provided mask annotations, thereby resulting in new image-mask pairs to be added to the set of annotated images. Specifically, we generate new images using a diffusion-based inpainting model to fill out the masked area with a desired object class by guiding the diffusion through the object outline. We show that the object outline provides a simple, but also reliable and convenient training-free guidance signal for the underlying inpainting model that is often sufficient to fill out the mask with an object of the correct class without further text guidance and preserve the correspondence between generated images and the mask annotations with high precision. Our experimental results reveal that our method successfully generates realistic variations of object instances, preserving their shape characteristics while introducing diversity within the augmented area. We also show that the proposed method can naturally be combined with text guidance and other image augmentation techniques.

Modern approaches typically formulate semantic segmentation as a per-pixel classification task, while instance-level segmentation is handled with an alternative mask classification. Our key insight: mask classification is sufficiently general to solve both semantic- and instance-level segmentation tasks in a unified manner using the exact same model, loss, and training procedure. Following this observation, we propose MaskFormer, a simple mask classification model which predicts a set of binary masks, each associated with a single global class label prediction. Overall, the proposed mask classification-based method simplifies the landscape of effective approaches to semantic and panoptic segmentation tasks and shows excellent empirical results. In particular, we observe that MaskFormer outperforms per-pixel classification baselines when the number of classes is large. Our mask classification-based method outperforms both current state-of-the-art semantic (55.6 mIoU on ADE20K) and panoptic segmentation (52.7 PQ on COCO) models.

Medical image segmentation is crucial for clinical diagnosis and treatment planning. Traditional methods typically produce a single segmentation mask, failing to capture inherent uncertainty. Recent generative models enable the creation of multiple plausible masks per image, mimicking the collaborative interpretation of several clinicians. However, these approaches remain computationally heavy. We propose MedSegLatDiff, a diffusion based framework that combines a variational autoencoder (VAE) with a latent diffusion model for efficient medical image segmentation. The VAE compresses the input into a low dimensional latent space, reducing noise and accelerating training, while the diffusion process operates directly in this compact representation. We further replace the conventional MSE loss with weighted cross entropy in the VAE mask reconstruction path to better preserve tiny structures such as small nodules. MedSegLatDiff is evaluated on ISIC-2018 (skin lesions), CVC-Clinic (polyps), and LIDC-IDRI (lung nodules). It achieves state of the art or highly competitive Dice and IoU scores while simultaneously generating diverse segmentation hypotheses and confidence maps. This provides enhanced interpretability and reliability compared to deterministic baselines, making the model particularly suitable for clinical deployment.

Tumor segmentation in CT scans is key for diagnosis, surgery, and prognosis, yet segmentation masks are scarce because their creation requires time and expertise. Public abdominal CT datasets have from dozens to a couple thousand tumor masks, but hospitals have hundreds of thousands of tumor CTs with radiology reports. Thus, leveraging reports to improve segmentation is key for scaling. In this paper, we propose a report-supervision loss (R-Super) that converts radiology reports into voxel-wise supervision for tumor segmentation AI. We created a dataset with 6,718 CT-Report pairs (from the UCSF Hospital), and merged it with public CT-Mask datasets (from AbdomenAtlas 2.0). We used our R-Super to train with these masks and reports, and strongly improved tumor segmentation in internal and external validation--F1 Score increased by up to 16% with respect to training with masks only. By leveraging readily available radiology reports to supplement scarce segmentation masks, R-Super strongly improves AI performance both when very few training masks are available (e.g., 50), and when many masks were available (e.g., 1.7K). Project: https://github.com/MrGiovanni/R-Super

Inpainting has recently been proposed as a successful deep learning technique for unsupervised medical image model discovery. The masks used for inpainting are generally independent of the dataset and are not tailored to perform on different given classes of anatomy. In this work, we introduce a method for generating shape-aware masks for inpainting, which aims at learning the statistical shape prior. We hypothesize that although the variation of masks improves the generalizability of inpainting models, the shape of the masks should follow the topology of the organs of interest. Hence, we propose an unsupervised guided masking approach based on an off-the-shelf inpainting model and a superpixel over-segmentation algorithm to generate a wide range of shape-dependent masks. Experimental results on abdominal MR image reconstruction show the superiority of our proposed masking method over standard methods using square-shaped or dataset of irregular shape masks.

We propose SegGen, a highly-effective training data generation method for image segmentation, which pushes the performance limits of state-of-the-art segmentation models to a significant extent. SegGen designs and integrates two data generation strategies: MaskSyn and ImgSyn. (i) MaskSyn synthesizes new mask-image pairs via our proposed text-to-mask generation model and mask-to-image generation model, greatly improving the diversity in segmentation masks for model supervision; (ii) ImgSyn synthesizes new images based on existing masks using the mask-to-image generation model, strongly improving image diversity for model inputs. On the highly competitive ADE20K and COCO benchmarks, our data generation method markedly improves the performance of state-of-the-art segmentation models in semantic segmentation, panoptic segmentation, and instance segmentation. Notably, in terms of the ADE20K mIoU, Mask2Former R50 is largely boosted from 47.2 to 49.9 (+2.7); Mask2Former Swin-L is also significantly increased from 56.1 to 57.4 (+1.3). These promising results strongly suggest the effectiveness of our SegGen even when abundant human-annotated training data is utilized. Moreover, training with our synthetic data makes the segmentation models more robust towards unseen domains. Project website: https://seggenerator.github.io

Interactive Medical Image Segmentation (IMIS) has long been constrained by the limited availability of large-scale, diverse, and densely annotated datasets, which hinders model generalization and consistent evaluation across different models. In this paper, we introduce the IMed-361M benchmark dataset, a significant advancement in general IMIS research. First, we collect and standardize over 6.4 million medical images and their corresponding ground truth masks from multiple data sources. Then, leveraging the strong object recognition capabilities of a vision foundational model, we automatically generated dense interactive masks for each image and ensured their quality through rigorous quality control and granularity management. Unlike previous datasets, which are limited by specific modalities or sparse annotations, IMed-361M spans 14 modalities and 204 segmentation targets, totaling 361 million masks-an average of 56 masks per image. Finally, we developed an IMIS baseline network on this dataset that supports high-quality mask generation through interactive inputs, including clicks, bounding boxes, text prompts, and their combinations. We evaluate its performance on medical image segmentation tasks from multiple perspectives, demonstrating superior accuracy and scalability compared to existing interactive segmentation models. To facilitate research on foundational models in medical computer vision, we release the IMed-361M and model at https://github.com/uni-medical/IMIS-Bench.

Recent segmentation methods leveraging Multi-modal Large Language Models (MLLMs) have shown reliable object-level segmentation and enhanced spatial perception. However, almost all previous methods predominantly rely on specialist mask decoders to interpret masks from generated segmentation-related embeddings and visual features, or incorporate multiple additional tokens to assist. This paper aims to investigate whether and how we can unlock segmentation from MLLM itSELF with 1 segmentation Embedding (SELF1E) while achieving competitive results, which eliminates the need for external decoders. To this end, our approach targets the fundamental limitation of resolution reduction in pixel-shuffled image features from MLLMs. First, we retain image features at their original uncompressed resolution, and refill them with residual features extracted from MLLM-processed compressed features, thereby improving feature precision. Subsequently, we integrate pixel-unshuffle operations on image features with and without LLM processing, respectively, to unleash the details of compressed features and amplify the residual features under uncompressed resolution, which further enhances the resolution of refilled features. Moreover, we redesign the attention mask with dual perception pathways, i.e., image-to-image and image-to-segmentation, enabling rich feature interaction between pixels and the segmentation token. Comprehensive experiments across multiple segmentation tasks validate that SELF1E achieves performance competitive with specialist mask decoder-based methods, demonstrating the feasibility of decoder-free segmentation in MLLMs. Project page: https://github.com/ANDYZAQ/SELF1E.

Acquiring and annotating sufficient labeled data is crucial in developing accurate and robust learning-based models, but obtaining such data can be challenging in many medical image segmentation tasks. One promising solution is to synthesize realistic data with ground-truth mask annotations. However, no prior studies have explored generating complete 3D volumetric images with masks. In this paper, we present MedGen3D, a deep generative framework that can generate paired 3D medical images and masks. First, we represent the 3D medical data as 2D sequences and propose the Multi-Condition Diffusion Probabilistic Model (MC-DPM) to generate multi-label mask sequences adhering to anatomical geometry. Then, we use an image sequence generator and semantic diffusion refiner conditioned on the generated mask sequences to produce realistic 3D medical images that align with the generated masks. Our proposed framework guarantees accurate alignment between synthetic images and segmentation maps. Experiments on 3D thoracic CT and brain MRI datasets show that our synthetic data is both diverse and faithful to the original data, and demonstrate the benefits for downstream segmentation tasks. We anticipate that MedGen3D's ability to synthesize paired 3D medical images and masks will prove valuable in training deep learning models for medical imaging tasks.

The recent release of RadGenome-Chest CT has significantly advanced CT-based report generation. However, existing methods primarily focus on global features, making it challenging to capture region-specific details, which may cause certain abnormalities to go unnoticed. To address this, we propose MedRegion-CT, a region-focused Multi-Modal Large Language Model (MLLM) framework, featuring three key innovations. First, we introduce Region Representative (R^2) Token Pooling, which utilizes a 2D-wise pretrained vision model to efficiently extract 3D CT features. This approach generates global tokens representing overall slice features and region tokens highlighting target areas, enabling the MLLM to process comprehensive information effectively. Second, a universal segmentation model generates pseudo-masks, which are then processed by a mask encoder to extract region-centric features. This allows the MLLM to focus on clinically relevant regions, using six predefined region masks. Third, we leverage segmentation results to extract patient-specific attributions, including organ size, diameter, and locations. These are converted into text prompts, enriching the MLLM's understanding of patient-specific contexts. To ensure rigorous evaluation, we conducted benchmark experiments on report generation using the RadGenome-Chest CT. MedRegion-CT achieved state-of-the-art performance, outperforming existing methods in natural language generation quality and clinical relevance while maintaining interpretability. The code for our framework is publicly available.

Pulmonary opacification is the inflammation in the lungs caused by many respiratory ailments, including the novel corona virus disease 2019 (COVID-19). Chest X-rays (CXRs) with such opacifications render regions of lungs imperceptible, making it difficult to perform automated image analysis on them. In this work, we focus on segmenting lungs from such abnormal CXRs as part of a pipeline aimed at automated risk scoring of COVID-19 from CXRs. We treat the high opacity regions as missing data and present a modified CNN-based image segmentation network that utilizes a deep generative model for data imputation. We train this model on normal CXRs with extensive data augmentation and demonstrate the usefulness of this model to extend to cases with extreme abnormalities.

Existing open-vocabulary image segmentation methods require a fine-tuning step on mask annotations and/or image-text datasets. Mask labels are labor-intensive, which limits the number of categories in segmentation datasets. As a result, the open-vocabulary capacity of pre-trained VLMs is severely reduced after fine-tuning. However, without fine-tuning, VLMs trained under weak image-text supervision tend to make suboptimal mask predictions when there are text queries referring to non-existing concepts in the image. To alleviate these issues, we introduce a novel recurrent framework that progressively filters out irrelevant texts and enhances mask quality without training efforts. The recurrent unit is a two-stage segmenter built upon a VLM with frozen weights. Thus, our model retains the VLM's broad vocabulary space and strengthens its segmentation capability. Experimental results show that our method outperforms not only the training-free counterparts, but also those fine-tuned with millions of additional data samples, and sets new state-of-the-art records for both zero-shot semantic and referring image segmentation tasks. Specifically, we improve the current record by 28.8, 16.0, and 6.9 mIoU on Pascal VOC, COCO Object, and Pascal Context.

Segment Anything Model (SAM) has demonstrated impressive zero-shot performance and brought a range of unexplored capabilities to natural image segmentation tasks. However, as a very important branch of image segmentation, the performance of SAM remains uncertain when applied to medical image segmentation due to the significant differences between natural images and medical images. Meanwhile, it is harsh to meet the SAM's requirements of extra prompts provided, such as points or boxes to specify medical regions. In this paper, we propose a novel self-prompt SAM adaptation framework for medical image segmentation, named Self-Prompt-SAM. We design a multi-scale prompt generator combined with the image encoder in SAM to generate auxiliary masks. Then, we use the auxiliary masks to generate bounding boxes as box prompts and use Distance Transform to select the most central points as point prompts. Meanwhile, we design a 3D depth-fused adapter (DfusedAdapter) and inject the DFusedAdapter into each transformer in the image encoder and mask decoder to enable pre-trained 2D SAM models to extract 3D information and adapt to 3D medical images. Extensive experiments demonstrate that our method achieves state-of-the-art performance and outperforms nnUNet by 2.3% on AMOS2022, 1.6% on ACDCand 0.5% on Synapse datasets.

Uncertainty estimation is essential for the safe clinical deployment of medical image segmentation systems, enabling the identification of unreliable predictions and supporting human oversight. While prior work has largely focused on pixel-level uncertainty, landmark-based segmentation offers inherent topological guarantees yet remains underexplored from an uncertainty perspective. In this work, we study uncertainty estimation for anatomical landmark-based segmentation on chest X-rays. Inspired by hybrid neural network architectures that combine standard image convolutional encoders with graph-based generative decoders, and leveraging their variational latent space, we derive two complementary measures: (i) latent uncertainty, captured directly from the learned distribution parameters, and (ii) predictive uncertainty, obtained by generating multiple stochastic output predictions from latent samples. Through controlled corruption experiments we show that both uncertainty measures increase with perturbation severity, reflecting both global and local degradation. We demonstrate that these uncertainty signals can identify unreliable predictions by comparing with manual ground-truth, and support out-of-distribution detection on the CheXmask dataset. More importantly, we release CheXmask-U (huggingface.co/datasets/mcosarinsky/CheXmask-U), a large scale dataset of 657,566 chest X-ray landmark segmentations with per-node uncertainty estimates, enabling researchers to account for spatial variations in segmentation quality when using these anatomical masks. Our findings establish uncertainty estimation as a promising direction to enhance robustness and safe deployment of landmark-based anatomical segmentation methods in chest X-ray. A fully working interactive demo of the method is available at huggingface.co/spaces/matiasky/CheXmask-U and the source code at github.com/mcosarinsky/CheXmask-U.

Lung diseases represent a significant global health challenge, with Chest X-Ray (CXR) being a key diagnostic tool due to their accessibility and affordability. Nonetheless, the detection of pulmonary lesions is often hindered by overlapping bone structures in CXR images, leading to potential misdiagnoses. To address this issue, we developed an end-to-end framework called BS-LDM, designed to effectively suppress bone in high-resolution CXR images. This framework is based on conditional latent diffusion models and incorporates a multi-level hybrid loss-constrained vector-quantized generative adversarial network which is crafted for perceptual compression, ensuring the preservation of details. To further enhance the framework's performance, we introduce offset noise and a temporal adaptive thresholding strategy. These additions help minimize discrepancies in generating low-frequency information, thereby improving the clarity of the generated soft tissue images. Additionally, we have compiled a high-quality bone suppression dataset named SZCH-X-Rays. This dataset includes 818 pairs of high-resolution CXR and dual-energy subtraction soft tissue images collected from a partner hospital. Moreover, we processed 241 data pairs from the JSRT dataset into negative images, which are more commonly used in clinical practice. Our comprehensive experimental and clinical evaluations reveal that BS-LDM excels in bone suppression, underscoring its significant clinical value.

Recent open-vocabulary segmentation methods adopt mask generators to predict segmentation masks and leverage pre-trained vision-language models, e.g., CLIP, to classify these masks via mask pooling. Although these approaches show promising results, it is counterintuitive that accurate masks often fail to yield accurate classification results through pooling CLIP image embeddings within the mask regions. In this paper, we reveal the performance limitations of mask pooling and introduce Mask-Adapter, a simple yet effective method to address these challenges in open-vocabulary segmentation. Compared to directly using proposal masks, our proposed Mask-Adapter extracts semantic activation maps from proposal masks, providing richer contextual information and ensuring alignment between masks and CLIP. Additionally, we propose a mask consistency loss that encourages proposal masks with similar IoUs to obtain similar CLIP embeddings to enhance models' robustness to varying predicted masks. Mask-Adapter integrates seamlessly into open-vocabulary segmentation methods based on mask pooling in a plug-and-play manner, delivering more accurate classification results. Extensive experiments across several zero-shot benchmarks demonstrate significant performance gains for the proposed Mask-Adapter on several well-established methods. Notably, Mask-Adapter also extends effectively to SAM and achieves impressive results on several open-vocabulary segmentation datasets. Code and models are available at https://github.com/hustvl/MaskAdapter.

Polyp segmentation, a contentious issue in medical imaging, has seen numerous proposed methods aimed at improving the quality of segmented masks. While current state-of-the-art techniques yield impressive results, the size and computational cost of these models create challenges for practical industry applications. To address this challenge, we present KDAS, a Knowledge Distillation framework that incorporates attention supervision, and our proposed Symmetrical Guiding Module. This framework is designed to facilitate a compact student model with fewer parameters, allowing it to learn the strengths of the teacher model and mitigate the inconsistency between teacher features and student features, a common challenge in Knowledge Distillation, via the Symmetrical Guiding Module. Through extensive experiments, our compact models demonstrate their strength by achieving competitive results with state-of-the-art methods, offering a promising approach to creating compact models with high accuracy for polyp segmentation and in the medical imaging field. The implementation is available on https://github.com/huyquoctrinh/KDAS.

The remarkable performance of large multimodal models (LMMs) has attracted significant interest from the image segmentation community. To align with the next-token-prediction paradigm, current LMM-driven segmentation methods either use object boundary points to represent masks or introduce special segmentation tokens, whose hidden states are decoded by a segmentation model requiring the original image as input. However, these approaches often suffer from inadequate mask representation and complex architectures, limiting the potential of LMMs. In this work, we propose the Hierarchical Mask Tokenizer (HiMTok), which represents segmentation masks with up to 32 tokens and eliminates the need for the original image during mask de-tokenization. HiMTok allows for compact and coarse-to-fine mask representations, aligning well with the LLM next-token-prediction paradigm and facilitating the direct acquisition of segmentation capabilities. We develop a 3-stage training recipe for progressive learning of segmentation and visual capabilities, featuring a hierarchical mask loss for effective coarse-to-fine learning. Additionally, we enable bidirectional information flow, allowing conversion between bounding boxes and mask tokens to fully leverage multi-task training potential. Extensive experiments demonstrate that our method achieves state-of-the-art performance across various segmentation tasks,while also enhancing visual grounding and maintaining overall visual understanding.

Existing methodologies in open vocabulary 3D semantic segmentation primarily concentrate on establishing a unified feature space encompassing 3D, 2D, and textual modalities. Nevertheless, traditional techniques such as global feature alignment or vision-language model distillation tend to impose only approximate correspondence, struggling notably with delineating fine-grained segmentation boundaries. To address this gap, we propose a more meticulous mask-level alignment between 3D features and the 2D-text embedding space through a cross-modal mask reasoning framework, XMask3D. In our approach, we developed a mask generator based on the denoising UNet from a pre-trained diffusion model, leveraging its capability for precise textual control over dense pixel representations and enhancing the open-world adaptability of the generated masks. We further integrate 3D global features as implicit conditions into the pre-trained 2D denoising UNet, enabling the generation of segmentation masks with additional 3D geometry awareness. Subsequently, the generated 2D masks are employed to align mask-level 3D representations with the vision-language feature space, thereby augmenting the open vocabulary capability of 3D geometry embeddings. Finally, we fuse complementary 2D and 3D mask features, resulting in competitive performance across multiple benchmarks for 3D open vocabulary semantic segmentation. Code is available at https://github.com/wangzy22/XMask3D.

Although new vision foundation models such as Segment Anything Model 2 (SAM2) have significantly enhanced zero-shot image segmentation capabilities, reliance on human-provided prompts poses significant challenges in adapting SAM2 to medical image segmentation tasks. Moreover, SAM2's performance in medical image segmentation was limited by the domain shift issue, since it was originally trained on natural images and videos. To address these challenges, we proposed SAM2 with support-set guided prompting (SAM2-SGP), a framework that eliminated the need for manual prompts. The proposed model leveraged the memory mechanism of SAM2 to generate pseudo-masks using image-mask pairs from a support set via a Pseudo-mask Generation (PMG) module. We further introduced a novel Pseudo-mask Attention (PMA) module, which used these pseudo-masks to automatically generate bounding boxes and enhance localized feature extraction by guiding attention to relevant areas. Furthermore, a low-rank adaptation (LoRA) strategy was adopted to mitigate the domain shift issue. The proposed framework was evaluated on both 2D and 3D datasets across multiple medical imaging modalities, including fundus photography, X-ray, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and ultrasound. The results demonstrated a significant performance improvement over state-of-the-art models, such as nnUNet and SwinUNet, as well as foundation models, such as SAM2 and MedSAM2, underscoring the effectiveness of the proposed approach. Our code is publicly available at https://github.com/astlian9/SAM_Support.

Anatomical structure labels for chest radiographs are essential for medical image segmentation and a broad range of downstream diagnostic tasks. However, annotating anatomy directly on 2D chest radiographs is labor-intensive and intrinsically ambiguous, as 3D anatomical structures are projected onto a single 2D plane where boundaries may overlap, be occluded, or appear only partially visible. Consequently, existing anatomy-labeled chest radiograph datasets remain limited in scale, anatomy coverage, and label reliability. To address these limitations, we introduce RadGenome-Anatomy, the largest anatomy-labeled chest radiograph dataset, containing over 10 million segmentation masks across 210 anatomical structures in 25,692 studies. It is constructed by projecting large-scale 3D anatomical masks from CT volumes into 2D radiographic space through canonical radiographic geometry. This shifts annotation from directly tracing uncertain 2D boundaries to defining anatomy in volumetric space, where structures that overlap or become partially invisible in radiographs remain spatially separable. As a result, each 2D mask represents the physically grounded projected footprint of a volumetrically defined structure. The scale and broad anatomical coverage of RadGenome-Anatomy, including structures that are overlapping, partially visible, or difficult to delineate directly, enable research on geometric measurements as explicit evidence for chest radiograph interpretation. We demonstrate this by training XAnatomy to predict structure-specific masks and derive clinically relevant measurements, achieving diagnostic accuracies of 96.4%, 95.6%, and 89.2% for cardiomegaly, kyphosis, and scoliosis, respectively.

In this study, we present seg2med, an advanced medical image synthesis framework that uses Denoising Diffusion Probabilistic Models (DDPM) to generate high-quality synthetic medical images conditioned on anatomical masks from TotalSegmentator. The framework synthesizes CT and MR images from segmentation masks derived from real patient data and XCAT digital phantoms, achieving a Structural Similarity Index Measure (SSIM) of 0.94 +/- 0.02 for CT and 0.89 +/- 0.04 for MR images compared to ground-truth images of real patients. It also achieves a Feature Similarity Index Measure (FSIM) of 0.78 +/- 0.04 for CT images from XCAT. The generative quality is further supported by a Fr\'echet Inception Distance (FID) of 3.62 for CT image generation. Additionally, seg2med can generate paired CT and MR images with consistent anatomical structures and convert images between CT and MR modalities, achieving SSIM values of 0.91 +/- 0.03 for MR-to-CT and 0.77 +/- 0.04 for CT-to-MR conversion. Despite the limitations of incomplete anatomical details in segmentation masks, the framework shows strong performance in cross-modality synthesis and multimodal imaging. seg2med also demonstrates high anatomical fidelity in CT synthesis, achieving a mean Dice coefficient greater than 0.90 for 11 abdominal organs and greater than 0.80 for 34 organs out of 59 in 58 test cases. The highest Dice of 0.96 +/- 0.01 was recorded for the right scapula. Leveraging the TotalSegmentator toolkit, seg2med enables segmentation mask generation across diverse datasets, supporting applications in clinical imaging, data augmentation, multimodal synthesis, and diagnostic algorithm development.

The Segment Anything Model (SAM) has exhibited outstanding performance in various image segmentation tasks. Despite being trained with over a billion masks, SAM faces challenges in mask prediction quality in numerous scenarios, especially in real-world contexts. In this paper, we introduce a novel prompt-driven adapter into SAM, namely Prompt Adapter Segment Anything Model (PA-SAM), aiming to enhance the segmentation mask quality of the original SAM. By exclusively training the prompt adapter, PA-SAM extracts detailed information from images and optimizes the mask decoder feature at both sparse and dense prompt levels, improving the segmentation performance of SAM to produce high-quality masks. Experimental results demonstrate that our PA-SAM outperforms other SAM-based methods in high-quality, zero-shot, and open-set segmentation. We're making the source code and models available at https://github.com/xzz2/pa-sam.

Vision-language models (VLMs) pretrained on large-scale image-text pairs demonstrate strong image-level understanding, but are primarily optimized for global alignment and do not explicitly encode fine-grained anatomical structure, limiting their suitability for spatially precise tasks such as segmentation. We introduce CheXanatomy, a framework that integrates explicit anatomical knowledge into a pretrained VLM through autoregressive token-space supervision. Instead of adding task-specific decoder heads, the model is trained to generate anatomical segmentation masks via next-token prediction. To enable scalable supervision, we synthesize realistic chest radiographs from CT volumes and forward-project CT segmentation labels to obtain anatomically consistent 2D masks. We evaluate the approach on synthetic and real chest radiographs against a U-Net baseline, including ablations on model scale, input resolution, and vision encoder fine-tuning. Autoregressive anatomical supervision achieves performance comparable to specialized convolutional models in-distribution and demonstrates improved geometric robustness under domain shift to real CXR data. In addition, anatomy-pretrained models exhibit improved sample efficiency when adapting to novel localization tasks under limited supervision. Larger models and higher input image resolution improve performance, while vision encoder fine-tuning has limited effect. These results show that embedding anatomical structure directly into the generative objective promotes spatially grounded representations and supports anatomy-aware medical vision-language modeling.

Accurate delineation of pathological lungs from computed tomography (CT) images remains mostly unsolved because available methods fail to provide a reliable generic solution due to high variability of abnormality appearance. Local descriptor-based classification methods have shown to work well in annotating pathologies; however, these methods are usually computationally intensive which restricts their widespread use in real-time or near-real-time clinical applications. In this paper, we present a novel approach for fast, accurate, reliable segmentation of pathological lungs from CT scans by combining region-based segmentation method with local descriptor classification that is performed on an optimized sampling grid. Our method works in two stages; during stage one, we adapted the fuzzy connectedness (FC) image segmentation algorithm to perform initial lung parenchyma extraction. In the second stage, texture-based local descriptors are utilized to segment abnormal imaging patterns using a near optimal keypoint analysis by employing centroid of supervoxel as grid points. The quantitative results show that our pathological lung segmentation method is fast, robust, and improves on current standards and has potential to enhance the performance of routine clinical tasks.

Instance level detection and segmentation of thoracic diseases or abnormalities are crucial for automatic diagnosis in chest X-ray images. Leveraging on constant structure and disease relations extracted from domain knowledge, we propose a structure-aware relation network (SAR-Net) extending Mask R-CNN. The SAR-Net consists of three relation modules: 1. the anatomical structure relation module encoding spatial relations between diseases and anatomical parts. 2. the contextual relation module aggregating clues based on query-key pair of disease RoI and lung fields. 3. the disease relation module propagating co-occurrence and causal relations into disease proposals. Towards making a practical system, we also provide ChestX-Det, a chest X-Ray dataset with instance-level annotations (boxes and masks). ChestX-Det is a subset of the public dataset NIH ChestX-ray14. It contains ~3500 images of 13 common disease categories labeled by three board-certified radiologists. We evaluate our SAR-Net on it and another dataset DR-Private. Experimental results show that it can enhance the strong baseline of Mask R-CNN with significant improvements. The ChestX-Det is released at https://github.com/Deepwise-AILab/ChestX-Det-Dataset.

Modern studies in radiograph representation learning rely on either self-supervision to encode invariant semantics or associated radiology reports to incorporate medical expertise, while the complementarity between them is barely noticed. To explore this, we formulate the self- and report-completion as two complementary objectives and present a unified framework based on masked record modeling (MRM). In practice, MRM reconstructs masked image patches and masked report tokens following a multi-task scheme to learn knowledge-enhanced semantic representations. With MRM pre-training, we obtain pre-trained models that can be well transferred to various radiography tasks. Specifically, we find that MRM offers superior performance in label-efficient fine-tuning. For instance, MRM achieves 88.5% mean AUC on CheXpert using 1% labeled data, outperforming previous R^2L methods with 100% labels. On NIH ChestX-ray, MRM outperforms the best performing counterpart by about 3% under small labeling ratios. Besides, MRM surpasses self- and report-supervised pre-training in identifying the pneumonia type and the pneumothorax area, sometimes by large margins.

This work introduces a new framework, ProtoSAM, for one-shot medical image segmentation. It combines the use of prototypical networks, known for few-shot segmentation, with SAM - a natural image foundation model. The method proposed creates an initial coarse segmentation mask using the ALPnet prototypical network, augmented with a DINOv2 encoder. Following the extraction of an initial mask, prompts are extracted, such as points and bounding boxes, which are then input into the Segment Anything Model (SAM). State-of-the-art results are shown on several medical image datasets and demonstrate automated segmentation capabilities using a single image example (one shot) with no need for fine-tuning of the foundation model. Our code is available at: https://github.com/levayz/ProtoSAM

Pixel-wise image segmentation is a highly demanding task in medical-image analysis. In practice, it is difficult to find annotated medical images with corresponding segmentation masks. In this paper, we present Kvasir-SEG: an open-access dataset of gastrointestinal polyp images and corresponding segmentation masks, manually annotated by a medical doctor and then verified by an experienced gastroenterologist. Moreover, we also generated the bounding boxes of the polyp regions with the help of segmentation masks. We demonstrate the use of our dataset with a traditional segmentation approach and a modern deep-learning based Convolutional Neural Network (CNN) approach. The dataset will be of value for researchers to reproduce results and compare methods. By adding segmentation masks to the Kvasir dataset, which only provide frame-wise annotations, we enable multimedia and computer vision researchers to contribute in the field of polyp segmentation and automatic analysis of colonoscopy images.

We propose a simple yet efficient anchor-free instance segmentation, called CenterMask, that adds a novel spatial attention-guided mask (SAG-Mask) branch to anchor-free one stage object detector (FCOS) in the same vein with Mask R-CNN. Plugged into the FCOS object detector, the SAG-Mask branch predicts a segmentation mask on each box with the spatial attention map that helps to focus on informative pixels and suppress noise. We also present an improved backbone networks, VoVNetV2, with two effective strategies: (1) residual connection for alleviating the optimization problem of larger VoVNet lee2019energy and (2) effective Squeeze-Excitation (eSE) dealing with the channel information loss problem of original SE. With SAG-Mask and VoVNetV2, we deign CenterMask and CenterMask-Lite that are targeted to large and small models, respectively. Using the same ResNet-101-FPN backbone, CenterMask achieves 38.3%, surpassing all previous state-of-the-art methods while at a much faster speed. CenterMask-Lite also outperforms the state-of-the-art by large margins at over 35fps on Titan Xp. We hope that CenterMask and VoVNetV2 can serve as a solid baseline of real-time instance segmentation and backbone network for various vision tasks, respectively. The Code is available at https://github.com/youngwanLEE/CenterMask.

The rapid development of pretrained foundation models has enabled more general image segmentation. Multimodal large language models (MLLMs) have been widely explored for image segmentation with complex queries that require high-level reasoning. Despite promising progress, existing methods are often constrained by limited training data and the gap between MLLMs and mask generation modules. To better transfer MLLMs' perception and reasoning ability to complex reasoning-based segmentation tasks, we propose a two-stage framework Rea2Seg for mask generation and selection. Specifically, the framework first identifies potential regions as candidate masks based on the attention maps of a segmentation MLLM. It then employs an MLLM to reason over the question and candidate masks and assign scores to each mask. The final segmentation result is obtained by reranking the candidates and selecting the highest-scoring mask, reformulating image segmentation as candidate discovery followed by discriminative mask selection. We also notice that a large portion of questions in existing benchmarks focus on commonsense reasoning, and these questions usually do not fully require joint visual observation and reasoning. To address this issue, we introduce a new benchmark called ReasonSeg-SGDR that comprehensively evaluates a model's perception, grounding, and reasoning abilities across multiple dimensions, including discriminative recognition, spatial reasoning, geometric reasoning, and multi-step reasoning, with fine-grained mask generation. In addition, we collect training data to enhance MLLMs' ability to jointly understand multimodal queries and candidate masks, and to assign scores through reasoning. Experimental results on the proposed benchmark and ReasonSeg demonstrate the effectiveness of the unified mask generation and selection framework.

Self-attention is of vital importance in semantic segmentation as it enables modeling of long-range context, which translates into improved performance. We argue that it is equally important to model short-range context, especially to tackle cases where not only the regions of interest are small and ambiguous, but also when there exists an imbalance between the semantic classes. To this end, we propose Masked Supervised Learning (MaskSup), an effective single-stage learning paradigm that models both short- and long-range context, capturing the contextual relationships between pixels via random masking. Experimental results demonstrate the competitive performance of MaskSup against strong baselines in both binary and multi-class segmentation tasks on three standard benchmark datasets, particularly at handling ambiguous regions and retaining better segmentation of minority classes with no added inference cost. In addition to segmenting target regions even when large portions of the input are masked, MaskSup is also generic and can be easily integrated into a variety of semantic segmentation methods. We also show that the proposed method is computationally efficient, yielding an improved performance by 10\% on the mean intersection-over-union (mIoU) while requiring 3times less learnable parameters.

A major obstacle to building models for effective semantic segmentation, and particularly video semantic segmentation, is a lack of large and well annotated datasets. This bottleneck is particularly prohibitive in highly specialized and regulated fields such as medicine and surgery, where video semantic segmentation could have important applications but data and expert annotations are scarce. In these settings, temporal clues and anatomical constraints could be leveraged during training to improve performance. Here, we present Temporally Constrained Neural Networks (TCNN), a semi-supervised framework used for video semantic segmentation of surgical videos. In this work, we show that autoencoder networks can be used to efficiently provide both spatial and temporal supervisory signals to train deep learning models. We test our method on a newly introduced video dataset of laparoscopic cholecystectomy procedures, Endoscapes, and an adaptation of a public dataset of cataract surgeries, CaDIS. We demonstrate that lower-dimensional representations of predicted masks can be leveraged to provide a consistent improvement on both sparsely labeled datasets with no additional computational cost at inference time. Further, the TCNN framework is model-agnostic and can be used in conjunction with other model design choices with minimal additional complexity.

Objective: Although medical imaging datasets are increasingly available, abnormal and annotation-intensive findings critical to lung cancer screening, particularly small pulmonary nodules, remain underrepresented and inconsistently curated. Methods: We introduce NodMAISI, an anatomically constrained, nodule-oriented CT synthesis and augmentation framework trained on a unified multi-source cohort (7,042 patients, 8,841 CTs, 14,444 nodules). The framework integrates: (i) a standardized curation and annotation pipeline linking each CT with organ masks and nodule-level annotations, (ii) a ControlNet-conditioned rectified-flow generator built on MAISI-v2's foundational blocks to enforce anatomy- and lesion-consistent synthesis, and (iii) lesion-aware augmentation that perturbs nodule masks (controlled shrinkage) while preserving surrounding anatomy to generate paired CT variants. Results: Across six public test datasets, NodMAISI improved distributional fidelity relative to MAISI-v2 (real-to-synthetic FID range 1.18 to 2.99 vs 1.69 to 5.21). In lesion detectability analysis using a MONAI nodule detector, NodMAISI substantially increased average sensitivity and more closely matched clinical scans (IMD-CT: 0.69 vs 0.39; DLCS24: 0.63 vs 0.20), with the largest gains for sub-centimeter nodules where MAISI-v2 frequently failed to reproduce the conditioned lesion. In downstream nodule-level malignancy classification trained on LUNA25 and externally evaluated on LUNA16, LNDbv4, and DLCS24, NodMAISI augmentation improved AUC by 0.07 to 0.11 at <=20% clinical data and by 0.12 to 0.21 at 10%, consistently narrowing the performance gap under data scarcity.

In this paper we present Mask DINO, a unified object detection and segmentation framework. Mask DINO extends DINO (DETR with Improved Denoising Anchor Boxes) by adding a mask prediction branch which supports all image segmentation tasks (instance, panoptic, and semantic). It makes use of the query embeddings from DINO to dot-product a high-resolution pixel embedding map to predict a set of binary masks. Some key components in DINO are extended for segmentation through a shared architecture and training process. Mask DINO is simple, efficient, and scalable, and it can benefit from joint large-scale detection and segmentation datasets. Our experiments show that Mask DINO significantly outperforms all existing specialized segmentation methods, both on a ResNet-50 backbone and a pre-trained model with SwinL backbone. Notably, Mask DINO establishes the best results to date on instance segmentation (54.5 AP on COCO), panoptic segmentation (59.4 PQ on COCO), and semantic segmentation (60.8 mIoU on ADE20K) among models under one billion parameters. Code is available at https://github.com/IDEACVR/MaskDINO.

The applicability of current lesion segmentation models for chest X-rays (CXRs) has been limited both by a small number of target labels and the reliance on long, detailed expert-level text inputs, creating a barrier to practical use. To address these limitations, we introduce a new paradigm: instruction-guided lesion segmentation (ILS), which is designed to segment diverse lesion types based on simple, user-friendly instructions. Under this paradigm, we construct MIMIC-ILS, the first large-scale instruction-answer dataset for CXR lesion segmentation, using our fully automated multimodal pipeline that generates annotations from chest X-ray images and their corresponding reports. MIMIC-ILS contains 1.1M instruction-answer pairs derived from 192K images and 91K unique segmentation masks, covering seven major lesion types. To empirically demonstrate its utility, we introduce ROSALIA, a vision-language model fine-tuned on MIMIC-ILS. ROSALIA can segment diverse lesions and provide textual explanations in response to user instructions. The model achieves high segmentation and textual accuracy in our newly proposed task, highlighting the effectiveness of our pipeline and the value of MIMIC-ILS as a foundational resource for pixel-level CXR lesion grounding.

Medical image segmentation poses challenges due to domain gaps, data modality variations, and dependency on domain knowledge or experts, especially for low- and middle-income countries (LMICs). Whereas for humans, given a few exemplars (with corresponding labels), we are able to segment different medical images even without exten-sive domain-specific clinical training. In addition, current SAM-based medical segmentation models use fine-grained visual prompts, such as the bounding rectangle generated from manually annotated target segmentation mask, as the bounding box (bbox) prompt during the testing phase. However, in actual clinical scenarios, no such precise prior knowledge is available. Our experimental results also reveal that previous models nearly fail to predict when given coarser bbox prompts. Considering these issues, in this paper, we introduce a domain-aware selective adaptation approach to adapt the general knowledge learned from a large model trained with natural images to the corresponding medical domains/modalities, with access to only a few (e.g. less than 5) exemplars. Our method mitigates the aforementioned limitations, providing an efficient and LMICs-friendly solution. Extensive experimental analysis showcases the effectiveness of our approach, offering potential advancements in healthcare diagnostics and clinical applications in LMICs.

Chest X-Ray (CXR) imaging for pulmonary diagnosis raises significant challenges, primarily because bone structures can obscure critical details necessary for accurate diagnosis. Recent advances in deep learning, particularly with diffusion models, offer significant promise for effectively minimizing the visibility of bone structures in CXR images, thereby improving clarity and diagnostic accuracy. Nevertheless, existing diffusion-based methods for bone suppression in CXR imaging struggle to balance the complete suppression of bones with preserving local texture details. Additionally, their high computational demand and extended processing time hinder their practical use in clinical settings. To address these limitations, we introduce a Global-Local Latent Consistency Model (GL-LCM) architecture. This model combines lung segmentation, dual-path sampling, and global-local fusion, enabling fast high-resolution bone suppression in CXR images. To tackle potential boundary artifacts and detail blurring in local-path sampling, we further propose Local-Enhanced Guidance, which addresses these issues without additional training. Comprehensive experiments on a self-collected dataset SZCH-X-Rays, and the public dataset JSRT, reveal that our GL-LCM delivers superior bone suppression and remarkable computational efficiency, significantly outperforming several competitive methods. Our code is available at https://github.com/diaoquesang/GL-LCM.

Two-stage and query-based instance segmentation methods have achieved remarkable results. However, their segmented masks are still very coarse. In this paper, we present Mask Transfiner for high-quality and efficient instance segmentation. Instead of operating on regular dense tensors, our Mask Transfiner decomposes and represents the image regions as a quadtree. Our transformer-based approach only processes detected error-prone tree nodes and self-corrects their errors in parallel. While these sparse pixels only constitute a small proportion of the total number, they are critical to the final mask quality. This allows Mask Transfiner to predict highly accurate instance masks, at a low computational cost. Extensive experiments demonstrate that Mask Transfiner outperforms current instance segmentation methods on three popular benchmarks, significantly improving both two-stage and query-based frameworks by a large margin of +3.0 mask AP on COCO and BDD100K, and +6.6 boundary AP on Cityscapes. Our code and trained models will be available at http://vis.xyz/pub/transfiner.

Early tumor detection save lives. Each year, more than 300 million computed tomography (CT) scans are performed worldwide, offering a vast opportunity for effective cancer screening. However, detecting small or early-stage tumors on these CT scans remains challenging, even for experts. Artificial intelligence (AI) models can assist by highlighting suspicious regions, but training such models typically requires extensive tumor masks--detailed, voxel-wise outlines of tumors manually drawn by radiologists. Drawing these masks is costly, requiring years of effort and millions of dollars. In contrast, nearly every CT scan in clinical practice is already accompanied by medical reports describing the tumor's size, number, appearance, and sometimes, pathology results--information that is rich, abundant, and often underutilized for AI training. We introduce R-Super, which trains AI to segment tumors that match their descriptions in medical reports. This approach scales AI training with large collections of readily available medical reports, substantially reducing the need for manually drawn tumor masks. When trained on 101,654 reports, AI models achieved performance comparable to those trained on 723 masks. Combining reports and masks further improved sensitivity by +13% and specificity by +8%, surpassing radiologists in detecting five of the seven tumor types. Notably, R-Super enabled segmentation of tumors in the spleen, gallbladder, prostate, bladder, uterus, and esophagus, for which no public masks or AI models previously existed. This study challenges the long-held belief that large-scale, labor-intensive tumor mask creation is indispensable, establishing a scalable and accessible path toward early detection across diverse tumor types. We plan to release our trained models, code, and dataset at https://github.com/MrGiovanni/R-Super

Purpose: Automating tasks such as lung tumor localization and segmentation in radiological images can free valuable time for radiologists and other clinical personnel. Convolutional neural networks may be suited for such tasks, but require substantial amounts of labeled data to train. Obtaining labeled data is a challenge, especially in the medical domain. Methods: This paper investigates the use of a teacher-student design to utilize datasets with different types of supervision to train an automatic model performing pulmonary tumor segmentation on computed tomography images. The framework consists of two models: the student that performs end-to-end automatic tumor segmentation and the teacher that supplies the student additional pseudo-annotated data during training. Results: Using only a small proportion of semantically labeled data and a large number of bounding box annotated data, we achieved competitive performance using a teacher-student design. Models trained on larger amounts of semantic annotations did not perform better than those trained on teacher-annotated data. Conclusions: Our results demonstrate the potential of utilizing teacher-student designs to reduce the annotation load, as less supervised annotation schemes may be performed, without any real degradation in segmentation accuracy.

Evaluating explanations of image classifiers regarding ground truth, e.g. segmentation masks defined by human perception, primarily evaluates the quality of the models under consideration rather than the explanation methods themselves. Driven by this observation, we propose a framework for jointly evaluating the robustness of safety-critical systems that combine a deep neural network with an explanation method. These are increasingly used in real-world applications like medical image analysis or robotics. We introduce a fine-tuning procedure to (mis)align modelx2013explanation pipelines with ground truth and use it to quantify the potential discrepancy between worst and best-case scenarios of human alignment. Experiments across various model architectures and post-hoc local interpretation methods provide insights into the robustness of vision transformers and the overall vulnerability of such AI systems to potential adversarial attacks.

Multimodal Large Language Models (MLLMs) have shown exceptional capabilities in vision-language tasks. However, effectively integrating image segmentation into these models remains a significant challenge. In this work, we propose a novel text-as-mask paradigm that casts image segmentation as a text generation problem, eliminating the need for additional decoders and significantly simplifying the segmentation process. Our key innovation is semantic descriptors, a new textual representation of segmentation masks where each image patch is mapped to its corresponding text label. We first introduce image-wise semantic descriptors, a patch-aligned textual representation of segmentation masks that integrates naturally into the language modeling pipeline. To enhance efficiency, we introduce the Row-wise Run-Length Encoding (R-RLE), which compresses redundant text sequences, reducing the length of semantic descriptors by 74% and accelerating inference by 3times, without compromising performance. Building upon this, our initial framework Text4Seg achieves strong segmentation performance across a wide range of vision tasks. To further improve granularity and compactness, we propose box-wise semantic descriptors, which localizes regions of interest using bounding boxes and represents region masks via structured mask tokens called semantic bricks. This leads to our refined model, Text4Seg++, which formulates segmentation as a next-brick prediction task, combining precision, scalability, and generative efficiency. Comprehensive experiments on natural and remote sensing datasets show that Text4Seg++ consistently outperforms state-of-the-art models across diverse benchmarks without any task-specific fine-tuning, while remaining compatible with existing MLLM backbones. Our work highlights the effectiveness, scalability, and generalizability of text-driven image segmentation within the MLLM framework.

Recent approaches for segmentation have leveraged pretrained generative models as feature extractors, treating segmentation as a downstream adaptation task via indirect feature retrieval. This implicit use suffers from a fundamental misalignment in representation. It also depends heavily on indirect feature extraction pipelines, which complicate the workflow and limit adaptation. In this paper, we argue that instead of indirect adaptation, segmentation tasks should be trained directly in a generative manner. We identify a key obstacle to this unified formulation: VAE latents of binary masks are sharply distributed, noise robust, and linearly separable, distinct from natural image latents. To bridge this gap, we introduce timesteps sampling strategy for binary masks that emphasizes extreme noise levels for segmentation and moderate noise for image generation, enabling harmonious joint training. We present GenMask, a DiT trains to generate black-and-white segmentation masks as well as colorful images in RGB space under the original generative objective. GenMask preserves the original DiT architecture while removing the need of feature extraction pipelines tailored for segmentation tasks. Empirically, GenMask attains state-of-the-art performance on referring and reasoning segmentation benchmarks and ablations quantify the contribution of each component.

Analyses based on the body posture are crucial for top-class athletes in many sports disciplines. If at all, coaches label only the most important keypoints, since manual annotations are very costly. This paper proposes a method to detect arbitrary keypoints on the limbs and skis of professional ski jumpers that requires a few, only partly correct segmentation masks during training. Our model is based on the Vision Transformer architecture with a special design for the input tokens to query for the desired keypoints. Since we use segmentation masks only to generate ground truth labels for the freely selectable keypoints, partly correct segmentation masks are sufficient for our training procedure. Hence, there is no need for costly hand-annotated segmentation masks. We analyze different training techniques for freely selected and standard keypoints, including pseudo labels, and show in our experiments that only a few partly correct segmentation masks are sufficient for learning to detect arbitrary keypoints on limbs and skis.

Segment Anything Model (SAM) has demonstrated impressive performance on a wide range of natural image segmentation tasks. However, its performance significantly deteriorates when directly applied to medical domain, due to the remarkable differences between natural images and medical images. Some researchers have attempted to train SAM on large scale medical datasets. However, poor zero-shot performance is observed from the experimental results. In this context, inspired by the superior performance of U-Net-like models in medical image segmentation, we propose SAMUNet, a new foundation model which incorporates U-Net to the original SAM, to fully leverage the powerful contextual modeling ability of convolutions. To be specific, we parallel a convolutional branch in the image encoder, which is trained independently with the vision Transformer branch frozen. Additionally, we employ multi-scale fusion in the mask decoder, to facilitate accurate segmentation of objects with different scales. We train SAM-UNet on SA-Med2D-16M, the largest 2-dimensional medical image segmentation dataset to date, yielding a universal pretrained model for medical images. Extensive experiments are conducted to evaluate the performance of the model, and state-of-the-art result is achieved, with a dice similarity coefficient score of 0.883 on SA-Med2D-16M dataset. Specifically, in zero-shot segmentation experiments, our model not only significantly outperforms previous large medical SAM models across all modalities, but also substantially mitigates the performance degradation seen on unseen modalities. It should be highlighted that SAM-UNet is an efficient and extensible foundation model, which can be further fine-tuned for other downstream tasks in medical community. The code is available at https://github.com/Hhankyangg/sam-unet.

Training accurate medical image segmentation models requires large amounts of densely annotated data, which is costly and time-consuming to obtain. Semi-supervised learning (SSL) alleviates this by learning from both abundant unlabeled data and limited labeled data. However, most modern SSL methods rely on pseudolabels for unlabeled data, and typically assess their reliability through model confidence or uncertainty, measures that are self-referential and lack explicit grounding in segmentation quality. Instead, we propose a quality-guided SSL framework that trains a dedicated network to estimate segmentation quality from image-mask pairs. The predictor is trained on variable-quality masks generated through synthetic corruptions augmented with imperfect outputs from partially trained segmentation models, capturing realistic error patterns encountered during training. We integrate the quality predictor into SSL through two complementary mechanisms: a quality-aware regularization loss and a quality-based pseudolabel sample reweighting scheme. We show that our method serves as a drop-in enhancement to existing SSL frameworks. Extensive experiments across five datasets and multiple architectures demonstrate consistent improvements over competing SSL methods, advancing the state-of-the-art in semi-supervised medical image segmentation.

Accurate anatomical labeling and analysis of the pulmonary structure and its surrounding anatomy from thoracic CT is getting increasingly important for understanding the etilogy of abnormalities or supporting targetted therapy and early interventions. Whilst lung and airway cell atlases have been attempted, there is a lack of fine-grained morphological atlases that are clinically deployable. In this work, we introduce AirMorph, a robust, end-to-end deep learning pipeline enabling fully automatic and comprehensive airway anatomical labeling at lobar, segmental, and subsegmental resolutions that can be used to create digital atlases of the lung. Evaluated across large-scale multi-center datasets comprising diverse pulmonary conditions, the AirMorph consistently outperformed existing segmentation and labeling methods in terms of accuracy, topological consistency, and completeness. To simplify clinical interpretation, we further introduce a compact anatomical signature quantifying critical morphological airway features, including stenosis, ectasia, tortuosity, divergence, length, and complexity. When applied to various pulmonary diseases such as pulmonary fibrosis, emphysema, atelectasis, consolidation, and reticular opacities, it demonstrates strong discriminative power, revealing disease-specific morphological patterns with high interpretability and explainability. Additionally, AirMorph supports efficient automated branching pattern analysis, potentially enhancing bronchoscopic navigation planning and procedural safety, offering a valuable clinical tool for improved diagnosis, targeted treatment, and personalized patient care.

The development of larger models for medical image analysis has led to increased performance. However, it also affected our ability to explain and validate model decisions. Models can use non-relevant parts of images, also called spurious correlations or shortcuts, to obtain high performance on benchmark datasets but fail in real-world scenarios. In this work, we challenge the capacity of convolutional neural networks (CNN) to classify chest X-rays and eye fundus images while masking out clinically relevant parts of the image. We show that all models trained on the PadChest dataset, irrespective of the masking strategy, are able to obtain an Area Under the Curve (AUC) above random. Moreover, the models trained on full images obtain good performance on images without the region of interest (ROI), even superior to the one obtained on images only containing the ROI. We also reveal a possible spurious correlation in the Chaksu dataset while the performances are more aligned with the expectation of an unbiased model. We go beyond the performance analysis with the usage of the explainability method SHAP and the analysis of embeddings. We asked a radiology resident to interpret chest X-rays under different masking to complement our findings with clinical knowledge. Our code is available at https://github.com/TheoSourget/MMC_Masking and https://github.com/TheoSourget/MMC_Masking_EyeFundus

Real-world medical image segmentation has tremendous long-tailed complexity of objects, among which tail conditions correlate with relatively rare diseases and are clinically significant. A trustworthy medical AI algorithm should demonstrate its effectiveness on tail conditions to avoid clinically dangerous damage in these out-of-distribution (OOD) cases. In this paper, we adopt the concept of object queries in Mask Transformers to formulate semantic segmentation as a soft cluster assignment. The queries fit the feature-level cluster centers of inliers during training. Therefore, when performing inference on a medical image in real-world scenarios, the similarity between pixels and the queries detects and localizes OOD regions. We term this OOD localization as MaxQuery. Furthermore, the foregrounds of real-world medical images, whether OOD objects or inliers, are lesions. The difference between them is less than that between the foreground and background, possibly misleading the object queries to focus redundantly on the background. Thus, we propose a query-distribution (QD) loss to enforce clear boundaries between segmentation targets and other regions at the query level, improving the inlier segmentation and OOD indication. Our proposed framework is tested on two real-world segmentation tasks, i.e., segmentation of pancreatic and liver tumors, outperforming previous state-of-the-art algorithms by an average of 7.39% on AUROC, 14.69% on AUPR, and 13.79% on FPR95 for OOD localization. On the other hand, our framework improves the performance of inlier segmentation by an average of 5.27% DSC when compared with the leading baseline nnUNet.

This paper presents a new mechanism to facilitate the training of mask transformers for efficient panoptic segmentation, democratizing its deployment. We observe that due to its high complexity, the training objective of panoptic segmentation will inevitably lead to much higher false positive penalization. Such unbalanced loss makes the training process of the end-to-end mask-transformer based architectures difficult, especially for efficient models. In this paper, we present ReMaX that adds relaxation to mask predictions and class predictions during training for panoptic segmentation. We demonstrate that via these simple relaxation techniques during training, our model can be consistently improved by a clear margin without any extra computational cost on inference. By combining our method with efficient backbones like MobileNetV3-Small, our method achieves new state-of-the-art results for efficient panoptic segmentation on COCO, ADE20K and Cityscapes. Code and pre-trained checkpoints will be available at https://github.com/google-research/deeplab2.

Airway segmentation on CT scans is critical for pulmonary disease diagnosis and endobronchial navigation. Manual extraction of airway requires strenuous efforts due to the complicated structure and various appearance of airway. For automatic airway extraction, convolutional neural networks (CNNs) based methods have recently become the state-of-the-art approach. However, there still remains a challenge for CNNs to perceive the tree-like pattern and comprehend the connectivity of airway. To address this, we propose a voxel-connectivity aware approach named AirwayNet for accurate airway segmentation. By connectivity modeling, conventional binary segmentation task is transformed into 26 tasks of connectivity prediction. Thus, our AirwayNet learns both airway structure and relationship between neighboring voxels. To take advantage of context knowledge, lung distance map and voxel coordinates are fed into AirwayNet as additional semantic information. Compared to existing approaches, AirwayNet achieved superior performance, demonstrating the effectiveness of the network's awareness of voxel connectivity.

Lung cancer is the deadliest type of cancer worldwide and late detection is the major factor for the low survival rate of patients. Low dose computed tomography has been suggested as a potential screening tool but manual screening is costly, time-consuming and prone to variability. This has fueled the development of automatic methods for the detection, segmentation and characterisation of pulmonary nodules but its application to clinical routine is challenging. In this study, a new database for the development and testing of pulmonary nodule computer-aided strategies is presented which intends to complement current databases by giving additional focus to radiologist variability and local clinical reality. State-of-the-art nodule detection, segmentation and characterization methods are tested and compared to manual annotations as well as collaborative strategies combining multiple radiologists and radiologists and computer-aided systems. It is shown that state-of-the-art methodologies can determine a patient's follow-up recommendation as accurately as a radiologist, though the nodule detection method used shows decreased performance in this database.

Considering the increased workload in pathology laboratories today, automated tools such as artificial intelligence models can help pathologists with their tasks and ease the workload. In this paper, we are proposing a segmentation model (DRU-Net) that can provide a delineation of human non-small cell lung carcinomas and an augmentation method that can improve classification results. The proposed model is a fused combination of truncated pre-trained DenseNet201 and ResNet101V2 as a patch-wise classifier followed by a lightweight U-Net as a refinement model. We have used two datasets (Norwegian Lung Cancer Biobank and Haukeland University Hospital lung cancer cohort) to create our proposed model. The DRU-Net model achieves an average of 0.91 Dice similarity coefficient. The proposed spatial augmentation method (multi-lens distortion) improved the network performance by 3%. Our findings show that choosing image patches that specifically include regions of interest leads to better results for the patch-wise classifier compared to other sampling methods. The qualitative analysis showed that the DRU-Net model is generally successful in detecting the tumor. On the test set, some of the cases showed areas of false positive and false negative segmentation in the periphery, particularly in tumors with inflammatory and reactive changes.

Image segmentation remains a challenging task in computer vision, demanding robust mask generation and precise classification. Recent mask-based approaches yield high-quality masks by capturing global context. However, accurately classifying these masks, especially in the presence of ambiguous boundaries and imbalanced class distributions, remains an open challenge. In this work, we introduce ViT-P, a novel two-stage segmentation framework that decouples mask generation from classification. The first stage employs a proposal generator to produce class-agnostic mask proposals, while the second stage utilizes a point-based classification model built on the Vision Transformer (ViT) to refine predictions by focusing on mask central points. ViT-P serves as a pre-training-free adapter, allowing the integration of various pre-trained vision transformers without modifying their architecture, ensuring adaptability to dense prediction tasks. Furthermore, we demonstrate that coarse and bounding box annotations can effectively enhance classification without requiring additional training on fine annotation datasets, reducing annotation costs while maintaining strong performance. Extensive experiments across COCO, ADE20K, and Cityscapes datasets validate the effectiveness of ViT-P, achieving state-of-the-art results with 54.0 PQ on ADE20K panoptic segmentation, 87.4 mIoU on Cityscapes semantic segmentation, and 63.6 mIoU on ADE20K semantic segmentation. The code and pretrained models are available at: https://github.com/sajjad-sh33/ViT-P}{https://github.com/sajjad-sh33/ViT-P.

We present an end-to-end deep learning segmentation method by combining a 3D UNet architecture with a graph neural network (GNN) model. In this approach, the convolutional layers at the deepest level of the UNet are replaced by a GNN-based module with a series of graph convolutions. The dense feature maps at this level are transformed into a graph input to the GNN module. The incorporation of graph convolutions in the UNet provides nodes in the graph with information that is based on node connectivity, in addition to the local features learnt through the downsampled paths. This information can help improve segmentation decisions. By stacking several graph convolution layers, the nodes can access higher order neighbourhood information without substantial increase in computational expense. We propose two types of node connectivity in the graph adjacency: i) one predefined and based on a regular node neighbourhood, and ii) one dynamically computed during training and using the nearest neighbour nodes in the feature space. We have applied this method to the task of segmenting the airway tree from chest CT scans. Experiments have been performed on 32 CTs from the Danish Lung Cancer Screening Trial dataset. We evaluate the performance of the UNet-GNN models with two types of graph adjacency and compare it with the baseline UNet.

The Segment Anything Model (SAM) has garnered significant attention for its versatile segmentation abilities and intuitive prompt-based interface. However, its application in medical imaging presents challenges, requiring either substantial training costs and extensive medical datasets for full model fine-tuning or high-quality prompts for optimal performance. This paper introduces H-SAM: a prompt-free adaptation of SAM tailored for efficient fine-tuning of medical images via a two-stage hierarchical decoding procedure. In the initial stage, H-SAM employs SAM's original decoder to generate a prior probabilistic mask, guiding a more intricate decoding process in the second stage. Specifically, we propose two key designs: 1) A class-balanced, mask-guided self-attention mechanism addressing the unbalanced label distribution, enhancing image embedding; 2) A learnable mask cross-attention mechanism spatially modulating the interplay among different image regions based on the prior mask. Moreover, the inclusion of a hierarchical pixel decoder in H-SAM enhances its proficiency in capturing fine-grained and localized details. This approach enables SAM to effectively integrate learned medical priors, facilitating enhanced adaptation for medical image segmentation with limited samples. Our H-SAM demonstrates a 4.78% improvement in average Dice compared to existing prompt-free SAM variants for multi-organ segmentation using only 10% of 2D slices. Notably, without using any unlabeled data, H-SAM even outperforms state-of-the-art semi-supervised models relying on extensive unlabeled training data across various medical datasets. Our code is available at https://github.com/Cccccczh404/H-SAM.

Diffusion models have enabled remarkably high-quality medical image generation, yet it is challenging to enforce anatomical constraints in generated images. To this end, we propose a diffusion model-based method that supports anatomically-controllable medical image generation, by following a multi-class anatomical segmentation mask at each sampling step. We additionally introduce a random mask ablation training algorithm to enable conditioning on a selected combination of anatomical constraints while allowing flexibility in other anatomical areas. We compare our method ("SegGuidedDiff") to existing methods on breast MRI and abdominal/neck-to-pelvis CT datasets with a wide range of anatomical objects. Results show that our method reaches a new state-of-the-art in the faithfulness of generated images to input anatomical masks on both datasets, and is on par for general anatomical realism. Finally, our model also enjoys the extra benefit of being able to adjust the anatomical similarity of generated images to real images of choice through interpolation in its latent space. SegGuidedDiff has many applications, including cross-modality translation, and the generation of paired or counterfactual data. Our code is available at https://github.com/mazurowski-lab/segmentation-guided-diffusion.

Curating datasets for object segmentation is a difficult task. With the advent of large-scale pre-trained generative models, conditional image generation has been given a significant boost in result quality and ease of use. In this paper, we present a novel method that enables the generation of general foreground-background segmentation models from simple textual descriptions, without requiring segmentation labels. We leverage and explore pre-trained latent diffusion models, to automatically generate weak segmentation masks for concepts and objects. The masks are then used to fine-tune the diffusion model on an inpainting task, which enables fine-grained removal of the object, while at the same time providing a synthetic foreground and background dataset. We demonstrate that using this method beats previous methods in both discriminative and generative performance and closes the gap with fully supervised training while requiring no pixel-wise object labels. We show results on the task of segmenting four different objects (humans, dogs, cars, birds) and a use case scenario in medical image analysis. The code is available at https://github.com/MischaD/fobadiffusion.

Purpose: This study investigated how nodule segmentation and surrounding peritumoral regions influence radionics-based lung cancer classification. Methods: Using 3D CT scans with bounding box annotated nodules, we generated 3D segmentations using four techniques: Otsu, Fuzzy C-Means (FCM), Gaussian Mixture Model (GMM), and K-Nearest Neighbors (KNN). Radiomics features were extracted using the PyRadiomics library, and multiple machine-learning-based classifiers, including Random Forest, Logistic Regression, and KNN, were employed to classify nodules as cancerous or non-cancerous. The best-performing segmentation and model were further analyzed by expanding the initial nodule segmentation into the peritumoral region (2, 4, 6, 8, 10, and 12 mm) to understand the influence of the surrounding area on classification. Additionally, we compared our results to deep learning-based feature extractors Foundation Model for Cancer Biomarkers (FMCB) and other state-of-the-art baseline models. Results: Incorporating peritumoral regions significantly enhanced performance, with the best result obtained at 8 mm expansion (AUC = 0.78). Compared to image-based deep learning models, such as FMCB (AUC = 0.71) and ResNet50-SWS++ (AUC = 0.71), our radiomics-based approach demonstrated superior classification accuracy. Conclusion: The study highlights the importance of peritumoral expansion in improving lung cancer classification using radiomics. These findings can inform the development of more robust AI-driven diagnostic tools.

In the evolving landscape of computer vision, foundation models have emerged as pivotal tools, exhibiting exceptional adaptability to a myriad of tasks. Among these, the Segment Anything Model (SAM) by Meta AI has distinguished itself in image segmentation. However, SAM, like its counterparts, encounters limitations in specific niche applications, prompting a quest for enhancement strategies that do not compromise its inherent capabilities. This paper introduces ASAM, a novel methodology that amplifies SAM's performance through adversarial tuning. We harness the potential of natural adversarial examples, inspired by their successful implementation in natural language processing. By utilizing a stable diffusion model, we augment a subset (1%) of the SA-1B dataset, generating adversarial instances that are more representative of natural variations rather than conventional imperceptible perturbations. Our approach maintains the photorealism of adversarial examples and ensures alignment with original mask annotations, thereby preserving the integrity of the segmentation task. The fine-tuned ASAM demonstrates significant improvements across a diverse range of segmentation tasks without necessitating additional data or architectural modifications. The results of our extensive evaluations confirm that ASAM establishes new benchmarks in segmentation tasks, thereby contributing to the advancement of foundational models in computer vision. Our project page is in https://asam2024.github.io/.

The Segment Anything Model (SAM) represents a state-of-the-art research advancement in natural image segmentation, achieving impressive results with input prompts such as points and bounding boxes. However, our evaluation and recent research indicate that directly applying the pretrained SAM to medical image segmentation does not yield satisfactory performance. This limitation primarily arises from significant domain gap between natural images and medical images. To bridge this gap, we introduce SAM-Med2D, the most comprehensive studies on applying SAM to medical 2D images. Specifically, we first collect and curate approximately 4.6M images and 19.7M masks from public and private datasets, constructing a large-scale medical image segmentation dataset encompassing various modalities and objects. Then, we comprehensively fine-tune SAM on this dataset and turn it into SAM-Med2D. Unlike previous methods that only adopt bounding box or point prompts as interactive segmentation approach, we adapt SAM to medical image segmentation through more comprehensive prompts involving bounding boxes, points, and masks. We additionally fine-tune the encoder and decoder of the original SAM to obtain a well-performed SAM-Med2D, leading to the most comprehensive fine-tuning strategies to date. Finally, we conducted a comprehensive evaluation and analysis to investigate the performance of SAM-Med2D in medical image segmentation across various modalities, anatomical structures, and organs. Concurrently, we validated the generalization capability of SAM-Med2D on 9 datasets from MICCAI 2023 challenge. Overall, our approach demonstrated significantly superior performance and generalization capability compared to SAM.

Unsupervised domain adaptation (UDA) for semantic segmentation aims to transfer models from a labeled source domain to an unlabeled target domain. While auxiliary self-supervised tasks-particularly contrastive learning-have improved feature discriminability, masked modeling approaches remain underexplored in this setting, largely due to architectural incompatibility and misaligned optimization objectives. We propose Masked Feature Modeling (MFM), a novel auxiliary task that performs feature masking and reconstruction directly in the feature space. Unlike existing masked modeling methods that reconstruct low-level inputs or perceptual features (e.g., HOG or visual tokens), MFM aligns its learning target with the main segmentation task, ensuring compatibility with standard architectures like DeepLab and DAFormer without modifying the inference pipeline. To facilitate effective reconstruction, we introduce a lightweight auxiliary module, Rebuilder, which is trained jointly but discarded during inference, adding zero computational overhead at test time. Crucially, MFM leverages the segmentation decoder to classify the reconstructed features, tightly coupling the auxiliary objective with the pixel-wise prediction task to avoid interference with the primary task. Extensive experiments across various architectures and UDA benchmarks demonstrate that MFM consistently enhances segmentation performance, offering a simple, efficient, and generalizable strategy for unsupervised domain-adaptive semantic segmentation.

Training convolutional neural networks (CNNs) for segmentation of pulmonary airway, artery, and vein is challenging due to sparse supervisory signals caused by the severe class imbalance between tubular targets and background. We present a CNNs-based method for accurate airway and artery-vein segmentation in non-contrast computed tomography. It enjoys superior sensitivity to tenuous peripheral bronchioles, arterioles, and venules. The method first uses a feature recalibration module to make the best use of features learned from the neural networks. Spatial information of features is properly integrated to retain relative priority of activated regions, which benefits the subsequent channel-wise recalibration. Then, attention distillation module is introduced to reinforce representation learning of tubular objects. Fine-grained details in high-resolution attention maps are passing down from one layer to its previous layer recursively to enrich context. Anatomy prior of lung context map and distance transform map is designed and incorporated for better artery-vein differentiation capacity. Extensive experiments demonstrated considerable performance gains brought by these components. Compared with state-of-the-art methods, our method extracted much more branches while maintaining competitive overall segmentation performance. Codes and models are available at http://www.pami.sjtu.edu.cn/News/56

Patient data from real-world clinical practice often suffers from data scarcity and long-tail imbalances, leading to biased outcomes or algorithmic unfairness. This study addresses these challenges by generating lesion-containing image-segmentation pairs from lesion-free images. Previous efforts in medical imaging synthesis have struggled with separating lesion information from background, resulting in low-quality backgrounds and limited control over the synthetic output. Inspired by diffusion-based image inpainting, we propose LeFusion, a lesion-focused diffusion model. By redesigning the diffusion learning objectives to focus on lesion areas, we simplify the learning process and improve control over the output while preserving high-fidelity backgrounds by integrating forward-diffused background contexts into the reverse diffusion process. Additionally, we tackle two major challenges in lesion texture synthesis: 1) multi-peak and 2) multi-class lesions. We introduce two effective strategies: histogram-based texture control and multi-channel decomposition, enabling the controlled generation of high-quality lesions in difficult scenarios. Furthermore, we incorporate lesion mask diffusion, allowing control over lesion size, location, and boundary, thus increasing lesion diversity. Validated on 3D cardiac lesion MRI and lung nodule CT datasets, LeFusion-generated data significantly improves the performance of state-of-the-art segmentation models, including nnUNet and SwinUNETR. Code and model are available at https://github.com/M3DV/LeFusion.

Large, fine-grained image segmentation datasets, annotated at pixel-level, are difficult to obtain, particularly in medical imaging, where annotations also require expert knowledge. Weakly-supervised learning can train models by relying on weaker forms of annotation, such as scribbles. Here, we learn to segment using scribble annotations in an adversarial game. With unpaired segmentation masks, we train a multi-scale GAN to generate realistic segmentation masks at multiple resolutions, while we use scribbles to learn their correct position in the image. Central to the model's success is a novel attention gating mechanism, which we condition with adversarial signals to act as a shape prior, resulting in better object localization at multiple scales. Subject to adversarial conditioning, the segmentor learns attention maps that are semantic, suppress the noisy activations outside the objects, and reduce the vanishing gradient problem in the deeper layers of the segmentor. We evaluated our model on several medical (ACDC, LVSC, CHAOS) and non-medical (PPSS) datasets, and we report performance levels matching those achieved by models trained with fully annotated segmentation masks. We also demonstrate extensions in a variety of settings: semi-supervised learning; combining multiple scribble sources (a crowdsourcing scenario) and multi-task learning (combining scribble and mask supervision). We release expert-made scribble annotations for the ACDC dataset, and the code used for the experiments, at https://vios-s.github.io/multiscale-adversarial-attention-gates

Anomaly segmentation is a critical task for driving applications, and it is approached traditionally as a per-pixel classification problem. However, reasoning individually about each pixel without considering their contextual semantics results in high uncertainty around the objects' boundaries and numerous false positives. We propose a paradigm change by shifting from a per-pixel classification to a mask classification. Our mask-based method, Mask2Anomaly, demonstrates the feasibility of integrating an anomaly detection method in a mask-classification architecture. Mask2Anomaly includes several technical novelties that are designed to improve the detection of anomalies in masks: i) a global masked attention module to focus individually on the foreground and background regions; ii) a mask contrastive learning that maximizes the margin between an anomaly and known classes; and iii) a mask refinement solution to reduce false positives. Mask2Anomaly achieves new state-of-the-art results across a range of benchmarks, both in the per-pixel and component-level evaluations. In particular, Mask2Anomaly reduces the average false positives rate by 60% wrt the previous state-of-the-art. Github page: https://github.com/shyam671/Mask2Anomaly-Unmasking-Anomalies-in-Road-Scene-Segmentation.

Text-to-image generation has witnessed great progress, especially with the recent advancements in diffusion models. Since texts cannot provide detailed conditions like object appearance, reference images are usually leveraged for the control of objects in the generated images. However, existing methods still suffer limited accuracy when the relationship between the foreground and background is complicated. To address this issue, we develop a framework termed Mask-ControlNet by introducing an additional mask prompt. Specifically, we first employ large vision models to obtain masks to segment the objects of interest in the reference image. Then, the object images are employed as additional prompts to facilitate the diffusion model to better understand the relationship between foreground and background regions during image generation. Experiments show that the mask prompts enhance the controllability of the diffusion model to maintain higher fidelity to the reference image while achieving better image quality. Comparison with previous text-to-image generation methods demonstrates our method's superior quantitative and qualitative performance on the benchmark datasets.

Accurate vessel segmentation in X-ray angiograms is crucial for numerous clinical applications. However, the scarcity of annotated data presents a significant challenge, which has driven the adoption of self-supervised learning (SSL) methods such as masked image modeling (MIM) to leverage large-scale unlabeled data for learning transferable representations. Unfortunately, conventional MIM often fails to capture vascular anatomy because of the severe class imbalance between vessel and background pixels, leading to weak vascular representations. To address this, we introduce Vascular anatomy-aware Masked Image Modeling (VasoMIM), a novel MIM framework tailored for X-ray angiograms that explicitly integrates anatomical knowledge into the pre-training process. Specifically, it comprises two complementary components: anatomy-guided masking strategy and anatomical consistency loss. The former preferentially masks vessel-containing patches to focus the model on reconstructing vessel-relevant regions. The latter enforces consistency in vascular semantics between the original and reconstructed images, thereby improving the discriminability of vascular representations. Empirically, VasoMIM achieves state-of-the-art performance across three datasets. These findings highlight its potential to facilitate X-ray angiogram analysis.

Accurate defect segmentation is critical for industrial inspection, yet dense pixel-level annotations are rarely available. A common workaround is to convert inexpensive bounding boxes into pseudo-masks using foundation segmentation models such as the Segment Anything Model (SAM). However, these pseudo-labels are systematically noisy on industrial surfaces, often hallucinating background structure while missing sparse defects. To address this limitation, a noise-robust box-to-pixel distillation framework, Boxes2Pixels, is proposed that treats SAM as a noisy teacher rather than a source of ground-truth supervision. Bounding boxes are converted into pseudo-masks offline by SAM, and a compact student is trained with (i) a hierarchical decoder over frozen DINOv2 features for semantic stability, (ii) an auxiliary binary localization head to decouple sparse foreground discovery from class prediction, and (iii) a one-sided online self-correction mechanism that relaxes background supervision when the student is confident, targeting teacher false negatives. On a manually annotated wind turbine inspection benchmark, the proposed Boxes2Pixels improves anomaly mIoU by +6.97 and binary IoU by +9.71 over the strongest baseline trained under identical weak supervision. Moreover, online self-correction increases the binary recall by +18.56, while the model employs 80\% fewer trainable parameters. Code is available at https://github.com/CLendering/Boxes2Pixels.

Consistency learning with feature perturbation is a widely used strategy in semi-supervised medical image segmentation. However, many existing perturbation methods rely on dropout, and thus require a careful manual tuning of the dropout rate, which is a sensitive hyperparameter and often difficult to optimize and may lead to suboptimal regularization. To overcome this limitation, we propose VQ-Seg, the first approach to employ vector quantization (VQ) to discretize the feature space and introduce a novel and controllable Quantized Perturbation Module (QPM) that replaces dropout. Our QPM perturbs discrete representations by shuffling the spatial locations of codebook indices, enabling effective and controllable regularization. To mitigate potential information loss caused by quantization, we design a dual-branch architecture where the post-quantization feature space is shared by both image reconstruction and segmentation tasks. Moreover, we introduce a Post-VQ Feature Adapter (PFA) to incorporate guidance from a foundation model (FM), supplementing the high-level semantic information lost during quantization. Furthermore, we collect a large-scale Lung Cancer (LC) dataset comprising 828 CT scans annotated for central-type lung carcinoma. Extensive experiments on the LC dataset and other public benchmarks demonstrate the effectiveness of our method, which outperforms state-of-the-art approaches. Code available at: https://github.com/script-Yang/VQ-Seg.

Personalizing diffusion models allows users to generate new images that incorporate a given subject, allowing more control than a text prompt. These models often suffer somewhat when they end up just recreating the subject image, and ignoring the text prompt. We observe that one popular method for personalization, the IP-Adapter automatically generates masks that we definitively segment the subject from the background during inference. We propose to use this automatically generated mask on a second pass to mask the image tokens, thus restricting them to the subject, not the background, allowing the text prompt to attend to the rest of the image. For text prompts describing locations and places, this produces images that accurately depict the subject while definitively matching the prompt. We compare our method to a few other test time personalization methods, and find our method displays high prompt and source image alignment.

This paper presents MedSegFactory, a versatile medical synthesis framework that generates high-quality paired medical images and segmentation masks across modalities and tasks. It aims to serve as an unlimited data repository, supplying image-mask pairs to enhance existing segmentation tools. The core of MedSegFactory is a dual-stream diffusion model, where one stream synthesizes medical images and the other generates corresponding segmentation masks. To ensure precise alignment between image-mask pairs, we introduce Joint Cross-Attention (JCA), enabling a collaborative denoising paradigm by dynamic cross-conditioning between streams. This bidirectional interaction allows both representations to guide each other's generation, enhancing consistency between generated pairs. MedSegFactory unlocks on-demand generation of paired medical images and segmentation masks through user-defined prompts that specify the target labels, imaging modalities, anatomical regions, and pathological conditions, facilitating scalable and high-quality data generation. This new paradigm of medical image synthesis enables seamless integration into diverse medical imaging workflows, enhancing both efficiency and accuracy. Extensive experiments show that MedSegFactory generates data of superior quality and usability, achieving competitive or state-of-the-art performance in 2D and 3D segmentation tasks while addressing data scarcity and regulatory constraints.

Low-resolution image segmentation is crucial in real-world applications such as robotics, augmented reality, and large-scale scene understanding, where high-resolution data is often unavailable due to computational constraints. To address this challenge, we propose MaskAttn-UNet, a novel segmentation framework that enhances the traditional U-Net architecture via a mask attention mechanism. Our model selectively emphasizes important regions while suppressing irrelevant backgrounds, thereby improving segmentation accuracy in cluttered and complex scenes. Unlike conventional U-Net variants, MaskAttn-UNet effectively balances local feature extraction with broader contextual awareness, making it particularly well-suited for low-resolution inputs. We evaluate our approach on three benchmark datasets with input images rescaled to 128x128 and demonstrate competitive performance across semantic, instance, and panoptic segmentation tasks. Our results show that MaskAttn-UNet achieves accuracy comparable to state-of-the-art methods at significantly lower computational cost than transformer-based models, making it an efficient and scalable solution for low-resolution segmentation in resource-constrained scenarios.

We propose a minimal path method to simultaneously compute segmentation masks and extract centerlines of tubular structures with line-topology. Minimal path methods are commonly used for the segmentation of tubular structures in a wide variety of applications. Recent methods use features extracted by CNNs, and often outperform methods using hand-tuned features. However, for CNN-based methods, the samples used for training may be generated inappropriately, so that they can be very different from samples encountered during inference. We approach this discrepancy by introducing a novel iterative training scheme, which enables generating better training samples specifically tailored for the minimal path methods without changing existing annotations. In our method, segmentation masks and centerlines are not determined after one another by post-processing, but obtained using the same steps. Our method requires only very few annotated training images. Comparison with seven previous approaches on three public datasets, including satellite images and medical images, shows that our method achieves state-of-the-art results both for segmentation masks and centerlines.

We explore the capability of plain Vision Transformers (ViTs) for semantic segmentation and propose the SegVit. Previous ViT-based segmentation networks usually learn a pixel-level representation from the output of the ViT. Differently, we make use of the fundamental component -- attention mechanism, to generate masks for semantic segmentation. Specifically, we propose the Attention-to-Mask (ATM) module, in which the similarity maps between a set of learnable class tokens and the spatial feature maps are transferred to the segmentation masks. Experiments show that our proposed SegVit using the ATM module outperforms its counterparts using the plain ViT backbone on the ADE20K dataset and achieves new state-of-the-art performance on COCO-Stuff-10K and PASCAL-Context datasets. Furthermore, to reduce the computational cost of the ViT backbone, we propose query-based down-sampling (QD) and query-based up-sampling (QU) to build a Shrunk structure. With the proposed Shrunk structure, the model can save up to 40% computations while maintaining competitive performance.

Recent transformer-based architectures have shown impressive results in the field of image segmentation. Thanks to their flexibility, they obtain outstanding performance in multiple segmentation tasks, such as semantic and panoptic, under a single unified framework. To achieve such impressive performance, these architectures employ intensive operations and require substantial computational resources, which are often not available, especially on edge devices. To fill this gap, we propose Prototype-based Efficient MaskFormer (PEM), an efficient transformer-based architecture that can operate in multiple segmentation tasks. PEM proposes a novel prototype-based cross-attention which leverages the redundancy of visual features to restrict the computation and improve the efficiency without harming the performance. In addition, PEM introduces an efficient multi-scale feature pyramid network, capable of extracting features that have high semantic content in an efficient way, thanks to the combination of deformable convolutions and context-based self-modulation. We benchmark the proposed PEM architecture on two tasks, semantic and panoptic segmentation, evaluated on two different datasets, Cityscapes and ADE20K. PEM demonstrates outstanding performance on every task and dataset, outperforming task-specific architectures while being comparable and even better than computationally-expensive baselines.

Traditionally, algorithms that learn to segment object instances in 2D images have heavily relied on large amounts of human-annotated data. Only recently, novel approaches have emerged tackling this problem in an unsupervised fashion. Generally, these approaches first generate pseudo-masks and then train a class-agnostic detector. While such methods deliver the current state of the art, they often fail to correctly separate instances overlapping in 2D image space since only semantics are considered. To tackle this issue, we instead propose to cut the semantic masks in 3D to obtain the final 2D instances by utilizing a point cloud representation of the scene. Furthermore, we derive a Spatial Importance function, which we use to resharpen the semantics along the 3D borders of instances. Nevertheless, these pseudo-masks are still subject to mask ambiguity. To address this issue, we further propose to augment the training of a class-agnostic detector with three Spatial Confidence components aiming to isolate a clean learning signal. With these contributions, our approach outperforms competing methods across multiple standard benchmarks for unsupervised instance segmentation and object detection.

Text-to-image model personalization aims to introduce a user-provided concept to the model, allowing its synthesis in diverse contexts. However, current methods primarily focus on the case of learning a single concept from multiple images with variations in backgrounds and poses, and struggle when adapted to a different scenario. In this work, we introduce the task of textual scene decomposition: given a single image of a scene that may contain several concepts, we aim to extract a distinct text token for each concept, enabling fine-grained control over the generated scenes. To this end, we propose augmenting the input image with masks that indicate the presence of target concepts. These masks can be provided by the user or generated automatically by a pre-trained segmentation model. We then present a novel two-phase customization process that optimizes a set of dedicated textual embeddings (handles), as well as the model weights, striking a delicate balance between accurately capturing the concepts and avoiding overfitting. We employ a masked diffusion loss to enable handles to generate their assigned concepts, complemented by a novel loss on cross-attention maps to prevent entanglement. We also introduce union-sampling, a training strategy aimed to improve the ability of combining multiple concepts in generated images. We use several automatic metrics to quantitatively compare our method against several baselines, and further affirm the results using a user study. Finally, we showcase several applications of our method. Project page is available at: https://omriavrahami.com/break-a-scene/

The recent advancements in large-scale pre-training techniques have significantly enhanced the capabilities of vision foundation models, notably the Segment Anything Model (SAM), which can generate precise masks based on point and box prompts. Recent studies extend SAM to Few-shot Semantic Segmentation (FSS), focusing on prompt generation for SAM-based automatic semantic segmentation. However, these methods struggle with selecting suitable prompts, require specific hyperparameter settings for different scenarios, and experience prolonged one-shot inference times due to the overuse of SAM, resulting in low efficiency and limited automation ability. To address these issues, we propose a simple yet effective approach based on graph analysis. In particular, a Positive-Negative Alignment module dynamically selects the point prompts for generating masks, especially uncovering the potential of the background context as the negative reference. Another subsequent Point-Mask Clustering module aligns the granularity of masks and selected points as a directed graph, based on mask coverage over points. These points are then aggregated by decomposing the weakly connected components of the directed graph in an efficient manner, constructing distinct natural clusters. Finally, the positive and overshooting gating, benefiting from graph-based granularity alignment, aggregate high-confident masks and filter out the false-positive masks for final prediction, reducing the usage of additional hyperparameters and redundant mask generation. Extensive experimental analysis across standard FSS, One-shot Part Segmentation, and Cross Domain FSS datasets validate the effectiveness and efficiency of the proposed approach, surpassing state-of-the-art generalist models with a mIoU of 58.7% on COCO-20i and 35.2% on LVIS-92i. The code is available in https://andyzaq.github.io/GF-SAM/.

Vision Transformers (ViTs) have shown remarkable performance and scalability across various computer vision tasks. To apply single-scale ViTs to image segmentation, existing methods adopt a convolutional adapter to generate multi-scale features, a pixel decoder to fuse these features, and a Transformer decoder that uses the fused features to make predictions. In this paper, we show that the inductive biases introduced by these task-specific components can instead be learned by the ViT itself, given sufficiently large models and extensive pre-training. Based on these findings, we introduce the Encoder-only Mask Transformer (EoMT), which repurposes the plain ViT architecture to conduct image segmentation. With large-scale models and pre-training, EoMT obtains a segmentation accuracy similar to state-of-the-art models that use task-specific components. At the same time, EoMT is significantly faster than these methods due to its architectural simplicity, e.g., up to 4x faster with ViT-L. Across a range of model sizes, EoMT demonstrates an optimal balance between segmentation accuracy and prediction speed, suggesting that compute resources are better spent on scaling the ViT itself rather than adding architectural complexity. Code: https://www.tue-mps.org/eomt/.

Few Shot Segmentation aims to segment novel object classes given only a handful of labeled examples, enabling rapid adaptation with minimal supervision. Current literature crucially lacks a selection method that goes beyond visual similarity between the query and example images, leading to suboptimal predictions. We present MARS, a plug-and-play ranking system that leverages multimodal cues to filter and merge mask proposals robustly. Starting from a set of mask predictions for a single query image, we score, filter, and merge them to improve results. Proposals are evaluated using multimodal scores computed at local and global levels. Extensive experiments on COCO-20i, Pascal-5i, LVIS-92i, and FSS-1000 demonstrate that integrating all four scoring components is crucial for robust ranking, validating our contribution. As MARS can be effortlessly integrated with various mask proposal systems, we deploy it across a wide range of top-performer methods and achieve new state-of-the-art results on multiple existing benchmarks. Code will be available upon acceptance.

Language promptable X-ray image segmentation would enable greater flexibility for human-in-the-loop workflows in diagnostic and interventional precision medicine. Prior efforts have contributed task-specific models capable of solving problems within a narrow scope, but expanding to broader use requires additional data, annotations, and training time. Recently, language-aligned foundation models (LFMs) -- machine learning models trained on large amounts of highly variable image and text data thus enabling broad applicability -- have emerged as promising tools for automated image analysis. Existing foundation models for medical image analysis focus on scenarios and modalities where large, richly annotated datasets are available. However, the X-ray imaging modality features highly variable image appearance and applications, from diagnostic chest X-rays to interventional fluoroscopy, with varying availability of data. To pave the way toward an LFM for comprehensive and language-aligned analysis of arbitrary medical X-ray images, we introduce FluoroSAM, a language-promptable variant of the Segment Anything Model, trained from scratch on 3M synthetic X-ray images from a wide variety of human anatomies, imaging geometries, and viewing angles. These include pseudo-ground truth masks for 128 organ types and 464 tools with associated text descriptions. FluoroSAM is capable of segmenting myriad anatomical structures and tools based on natural language prompts, thanks to the novel incorporation of vector quantization (VQ) of text embeddings in the training process. We demonstrate FluoroSAM's performance quantitatively on real X-ray images and showcase on several applications how FluoroSAM is a key enabler for rich human-machine interaction in the X-ray image acquisition and analysis context. Code is available at https://github.com/arcadelab/fluorosam.

Pulmonary Embolism (PE) is a life-threatening condition for which accurate and timely detection is critical to patient care. However, our systematic study of PE segmentation algorithms reveals concerning limitations in the current state of research. Challenges such as small and inconsistent datasets, a lack of reproducible baselines, and limited comparative evaluation across models are hindering progress in the field. In this study, we curated a densely annotated dataset comprising 490 CTPA scans, each from a unique patient (430 for training and 60 for testing). We evaluated nine widely used segmentation architectures, including both CNN- and ViT-based models, in 2D and 3D configurations, using mean Dice Similarity Coefficient (mDSC) and Average Symmetric Surface Distance (ASSD) as evaluation metrics. Furthermore, the highest-performing model was evaluated on a public dataset without fine-tuning and achieved reasonable generalization performance. Our results show that: (1) a 3D U-Net with ResNet encoding blocks remains a highly effective architecture for PE segmentation; (2) 3D models consistently outperform their 2D counterparts; (3) across all architectures, when trained and evaluated on the same datasets, model error patterns are highly consistent; and (4) distal emboli remain particularly challenging due to both task complexity and the scarcity of high-quality datasets, highlighting the need for datasets with more comprehensive and consistent distal PE coverage. To promote research reproducibility, the architecture and pretrained weights of our best-performing model are publicly available at https://github.com/mazurowski-lab/PulmonaryEmbolismSegmentation

We tackle the challenge of open-vocabulary segmentation, where we need to identify objects from a wide range of categories in different environments, using text prompts as our input. To overcome this challenge, existing methods often use multi-modal models like CLIP, which combine image and text features in a shared embedding space to bridge the gap between limited and extensive vocabulary recognition, resulting in a two-stage approach: In the first stage, a mask generator takes an input image to generate mask proposals, and the in the second stage the target mask is picked based on the query. However, the expected target mask may not exist in the generated mask proposals, which leads to an unexpected output mask. In our work, we propose a novel approach named Prompt-guided Mask Proposal (PMP) where the mask generator takes the input text prompts and generates masks guided by these prompts. Compared with mask proposals generated without input prompts, masks generated by PMP are better aligned with the input prompts. To realize PMP, we designed a cross-attention mechanism between text tokens and query tokens which is capable of generating prompt-guided mask proposals after each decoding. We combined our PMP with several existing works employing a query-based segmentation backbone and the experiments on five benchmark datasets demonstrate the effectiveness of this approach, showcasing significant improvements over the current two-stage models (1% ~ 3% absolute performance gain in terms of mIOU). The steady improvement in performance across these benchmarks indicates the effective generalization of our proposed lightweight prompt-aware method.

Open-vocabulary segmentation poses significant challenges, as it requires segmenting and recognizing objects across an open set of categories in unconstrained environments. Building on the success of powerful vision-language (ViL) foundation models, such as CLIP, recent efforts sought to harness their zero-short capabilities to recognize unseen categories. Despite notable performance improvements, these models still encounter the critical issue of generating precise mask proposals for unseen categories and scenarios, resulting in inferior segmentation performance eventually. To address this challenge, we introduce a novel approach, FrozenSeg, designed to integrate spatial knowledge from a localization foundation model (e.g., SAM) and semantic knowledge extracted from a ViL model (e.g., CLIP), in a synergistic framework. Taking the ViL model's visual encoder as the feature backbone, we inject the space-aware feature into the learnable queries and CLIP features within the transformer decoder. In addition, we devise a mask proposal ensemble strategy for further improving the recall rate and mask quality. To fully exploit pre-trained knowledge while minimizing training overhead, we freeze both foundation models, focusing optimization efforts solely on a lightweight transformer decoder for mask proposal generation-the performance bottleneck. Extensive experiments demonstrate that FrozenSeg advances state-of-the-art results across various segmentation benchmarks, trained exclusively on COCO panoptic data, and tested in a zero-shot manner. Code is available at https://github.com/chenxi52/FrozenSeg.

Segment Anything Model (SAM) is a foundation model for interactive segmentation, and it has catalyzed major advances in generative AI, computational photography, and medical imaging. This model takes in an arbitrary user input and provides segmentation masks of the corresponding objects. It is our goal to develop a version of SAM that is appropriate for use in a photography app. The original SAM model has a few challenges in this setting. First, original SAM a 600 million parameter based on ViT-H, and its high computational cost and large model size that are not suitable for todays mobile hardware. We address this by proposing the SqueezeSAM model architecture, which is 50x faster and 100x smaller than SAM. Next, when a user takes a photo on their phone, it might not occur to them to click on the image and get a mask. Our solution is to use salient object detection to generate the first few clicks. This produces an initial segmentation mask that the user can interactively edit. Finally, when a user clicks on an object, they typically expect all related pieces of the object to be segmented. For instance, if a user clicks on a person t-shirt in a photo, they expect the whole person to be segmented, but SAM typically segments just the t-shirt. We address this with a new data augmentation scheme, and the end result is that if the user clicks on a person holding a basketball, the person and the basketball are all segmented together.

Chest X-rays (CXRs) are commonly utilized as a low-dose modality for lung screening. Nonetheless, the efficacy of CXRs is somewhat impeded, given that approximately 75% of the lung area overlaps with bone, which in turn hampers the detection and diagnosis of diseases. As a remedial measure, bone suppression techniques have been introduced. The current dual-energy subtraction imaging technique in the clinic requires costly equipment and subjects being exposed to high radiation. To circumvent these issues, deep learning-based image generation algorithms have been proposed. However, existing methods fall short in terms of producing high-quality images and capturing texture details, particularly with pulmonary vessels. To address these issues, this paper proposes a new bone suppression framework, termed BS-Diff, that comprises a conditional diffusion model equipped with a U-Net architecture and a simple enhancement module to incorporate an autoencoder. Our proposed network cannot only generate soft tissue images with a high bone suppression rate but also possesses the capability to capture fine image details. Additionally, we compiled the largest dataset since 2010, including data from 120 patients with high-definition, high-resolution paired CXRs and soft tissue images collected by our affiliated hospital. Extensive experiments, comparative analyses, ablation studies, and clinical evaluations indicate that the proposed BS-Diff outperforms several bone-suppression models across multiple metrics. Our code can be accessed at https://github.com/Benny0323/BS-Diff.

Open-vocabulary 3D instance segmentation transcends traditional closed-vocabulary methods by enabling the identification of both previously seen and unseen objects in real-world scenarios. It leverages a dual-modality approach, utilizing both 3D point clouds and 2D multi-view images to generate class-agnostic object mask proposals. Previous efforts predominantly focused on enhancing 3D mask proposal models; consequently, the information that could come from 2D association to 3D was not fully exploited. This bias towards 3D data, while effective for familiar indoor objects, limits the system's adaptability to new and varied object types, where 2D models offer greater utility. Addressing this gap, we introduce Zero-Shot Dual-Path Integration Framework that equally values the contributions of both 3D and 2D modalities. Our framework comprises three components: 3D pathway, 2D pathway, and Dual-Path Integration. 3D pathway generates spatially accurate class-agnostic mask proposals of common indoor objects from 3D point cloud data using a pre-trained 3D model, while 2D pathway utilizes pre-trained open-vocabulary instance segmentation model to identify a diverse array of object proposals from multi-view RGB-D images. In Dual-Path Integration, our Conditional Integration process, which operates in two stages, filters and merges the proposals from both pathways adaptively. This process harmonizes output proposals to enhance segmentation capabilities. Our framework, utilizing pre-trained models in a zero-shot manner, is model-agnostic and demonstrates superior performance on both seen and unseen data, as evidenced by comprehensive evaluations on the ScanNet200 and qualitative results on ARKitScenes datasets.

Modern Referring Image Segmentation (RIS) systems generate multiple candidate masks per expression but rely on a simple heuristic--typically the argmax detection score--to select the final output. We identify query selection as a failure-case bottleneck: although heuristic selection succeeds on 82-93% of samples, the residual 7-18% of failures dominate the error budget, leaving a best-query selection gap of 3-11% mIoU. We introduce Venice-H1, a lightweight, backbone-decoupled post-hoc re-ranking module that encodes each candidate through multi-scale grid signatures--compact spatial descriptors pooled onto 4x4, 8x8, and 16x16 grids--and feeds them to a Transformer-based re-ranker with a Failure Gate (ROCAUC 0.78-0.82) that intervenes only when the default choice is likely suboptimal. Instantiated on DeRIS-L and DeRIS-B, Venice-H1 achieves delta_fail of +1.40 and +0.89 mIoU with strictly positive 95% CIs on all 16/16 (split, backbone) pairs and harmful-switch rates below 0.53%. Zero-shot transfer to medical referring segmentation (MS-CXR, M3D-RefSeg-2D) yields +1.16 and +0.51 mIoU without RIS-backbone fine-tuning. The module adds approximately 11.3M parameters and under 1 ms latency.

Segment anything model (SAM) has revolutionized natural image segmentation, but its performance on medical images is limited. This work presents MedSAM, the first attempt at extending the success of SAM to medical images, with the goal of creating a universal tool for the segmentation of various medical targets. Specifically, we first curate a large-scale medical image dataset, encompassing over 200,000 masks across 11 different modalities. Then, we develop a simple fine-tuning method to adapt SAM to general medical image segmentation. Comprehensive experiments on 21 3D segmentation tasks and 9 2D segmentation tasks demonstrate that MedSAM outperforms the default SAM model with an average Dice Similarity Coefficient (DSC) of 22.5% and 17.6% on 3D and 2D segmentation tasks, respectively. The code and trained model are publicly available at https://github.com/bowang-lab/MedSAM.

Weakly-supervised semantic segmentation (WSS) ensures high-quality segmentation with limited data and excels when employed as input seed masks for large-scale vision models such as Segment Anything. However, WSS faces challenges related to minor classes since those are overlooked in images with adjacent multiple classes, a limitation originating from the overfitting of traditional expansion methods like Random Walk. We first address this by employing unsupervised and weakly-supervised feature maps instead of conventional methodologies, allowing for hierarchical mask enhancement. This method distinctly categorizes higher-level classes and subsequently separates their associated lower-level classes, ensuring all classes are correctly restored in the mask without losing minor ones. Our approach, validated through extensive experimentation, significantly improves WSS across five benchmarks (VOC: 79.8\%, COCO: 53.9\%, Context: 49.0\%, ADE: 32.9\%, Stuff: 37.4\%), reducing the gap with fully supervised methods by over 84\% on the VOC validation set. Code is available at https://github.com/shjo-april/DHR.

We introduce Medal S, a medical segmentation foundation model that supports native-resolution spatial and textual prompts within an end-to-end trainable framework. Unlike text-only methods lacking spatial awareness, Medal S achieves channel-wise alignment between volumetric prompts and text embeddings, mitigating inaccuracies from resolution mismatches. By preserving full 3D context, it efficiently processes multiple native-resolution masks in parallel, enhancing multi-class segmentation performance. A lightweight 3D convolutional module enables precise voxel-space refinement guided by both prompt types, supporting up to 243 classes across CT, MRI, PET, ultrasound, and microscopy modalities in the BiomedSegFM dataset. Medal S offers two prompting modes: a text-only mode, where model predictions serve as spatial prompts for self-refinement without human input, and a hybrid mode, incorporating manual annotations for enhanced flexibility. For 24-class segmentation, parallel spatial prompting reduces inference time by more than 90% compared to sequential prompting. We propose dynamic resampling to address target-patch ratio imbalance, extending SAT and nnU-Net for data augmentation. Furthermore, we develop optimized text preprocessing, a two-stage inference strategy, and post-processing techniques to improve memory efficiency, precision, and inference speed. On the five-modality average on the validation set, Medal S outperforms SAT with a DSC of 75.44 (vs. 69.83), NSD of 77.34 (vs. 71.06), F1 of 38.24 (vs. 24.88), and DSC TP of 65.46 (vs. 46.97). Medal S achieves excellent performance by harmonizing spatial precision with semantic textual guidance, demonstrating superior efficiency and accuracy in multi-class medical segmentation tasks compared to sequential prompt-based approaches. Medal S will be publicly available at https://github.com/yinghemedical/Medal-S.

Collecting pixel-level labels for medical datasets can be a laborious and expensive process, and enhancing segmentation performance with a scarcity of labeled data is a crucial challenge. This work introduces AugPaint, a data augmentation framework that utilizes inpainting to generate image-label pairs from limited labeled data. AugPaint leverages latent diffusion models, known for their ability to generate high-quality in-domain images with low overhead, and adapts the sampling process for the inpainting task without need for retraining. Specifically, given a pair of image and label mask, we crop the area labeled with the foreground and condition on it during reversed denoising process for every noise level. Masked background area would gradually be filled in, and all generated images are paired with the label mask. This approach ensures the accuracy of match between synthetic images and label masks, setting it apart from existing dataset generation methods. The generated images serve as valuable supervision for training downstream segmentation models, effectively addressing the challenge of limited annotations. We conducted extensive evaluations of our data augmentation method on four public medical image segmentation datasets, including CT, MRI, and skin imaging. Results across all datasets demonstrate that AugPaint outperforms state-of-the-art label-efficient methodologies, significantly improving segmentation performance.

Masked AutoEncoders (MAE) have emerged as a robust self-supervised framework, offering remarkable performance across a wide range of downstream tasks. To increase the difficulty of the pretext task and learn richer visual representations, existing works have focused on replacing standard random masking with more sophisticated strategies, such as adversarial-guided and teacher-guided masking. However, these strategies depend on the input data thus commonly increasing the model complexity and requiring additional calculations to generate the mask patterns. This raises the question: Can we enhance MAE performance beyond random masking without relying on input data or incurring additional computational costs? In this work, we introduce a simple yet effective data-independent method, termed ColorMAE, which generates different binary mask patterns by filtering random noise. Drawing inspiration from color noise in image processing, we explore four types of filters to yield mask patterns with different spatial and semantic priors. ColorMAE requires no additional learnable parameters or computational overhead in the network, yet it significantly enhances the learned representations. We provide a comprehensive empirical evaluation, demonstrating our strategy's superiority in downstream tasks compared to random masking. Notably, we report an improvement of 2.72 in mIoU in semantic segmentation tasks relative to baseline MAE implementations.

In computational pathology, automatic nuclei instance segmentation plays an essential role in whole slide image analysis. While many computerized approaches have been proposed for this task, supervised deep learning (DL) methods have shown superior segmentation performances compared to classical machine learning and image processing techniques. However, these models need fully annotated datasets for training which is challenging to acquire, especially in the medical domain. In this work, we release one of the biggest fully manually annotated datasets of nuclei in Hematoxylin and Eosin (H&E)-stained histological images, called NuInsSeg. This dataset contains 665 image patches with more than 30,000 manually segmented nuclei from 31 human and mouse organs. Moreover, for the first time, we provide additional ambiguous area masks for the entire dataset. These vague areas represent the parts of the images where precise and deterministic manual annotations are impossible, even for human experts. The dataset and detailed step-by-step instructions to generate related segmentation masks are publicly available at https://www.kaggle.com/datasets/ipateam/nuinsseg and https://github.com/masih4/NuInsSeg, respectively.

The interactive segmentation task consists in the creation of object segmentation masks based on user interactions. The most common way to guide a model towards producing a correct segmentation consists in clicks on the object and background. The recently published Segment Anything Model (SAM) supports a generalized version of the interactive segmentation problem and has been trained on an object segmentation dataset which contains 1.1B masks. Though being trained extensively and with the explicit purpose of serving as a foundation model, we show significant limitations of SAM when being applied for interactive segmentation on novel domains or object types. On the used datasets, SAM displays a failure rate FR_{30}@90 of up to 72.6 %. Since we still want such foundation models to be immediately applicable, we present a framework that can adapt SAM during immediate usage. For this we will leverage the user interactions and masks, which are constructed during the interactive segmentation process. We use this information to generate pseudo-labels, which we use to compute a loss function and optimize a part of the SAM model. The presented method causes a relative reduction of up to 48.1 % in the FR_{20}@85 and 46.6 % in the FR_{30}@90 metrics.

Collective insights from a group of experts have always proven to outperform an individual's best diagnostic for clinical tasks. For the task of medical image segmentation, existing research on AI-based alternatives focuses more on developing models that can imitate the best individual rather than harnessing the power of expert groups. In this paper, we introduce a single diffusion model-based approach that produces multiple plausible outputs by learning a distribution over group insights. Our proposed model generates a distribution of segmentation masks by leveraging the inherent stochastic sampling process of diffusion using only minimal additional learning. We demonstrate on three different medical image modalities- CT, ultrasound, and MRI that our model is capable of producing several possible variants while capturing the frequencies of their occurrences. Comprehensive results show that our proposed approach outperforms existing state-of-the-art ambiguous segmentation networks in terms of accuracy while preserving naturally occurring variation. We also propose a new metric to evaluate the diversity as well as the accuracy of segmentation predictions that aligns with the interest of clinical practice of collective insights.

Multi-modal large language models (MLLMs) have achieved remarkable success in image- and region-level remote sensing (RS) image understanding tasks, such as image captioning, visual question answering, and visual grounding. However, existing RS MLLMs lack the pixel-level dialogue capability, which involves responding to user instructions with segmentation masks for specific instances. In this paper, we propose GeoPix, a RS MLLM that extends image understanding capabilities to the pixel level. This is achieved by equipping the MLLM with a mask predictor, which transforms visual features from the vision encoder into masks conditioned on the LLM's segmentation token embeddings. To facilitate the segmentation of multi-scale objects in RS imagery, a class-wise learnable memory module is integrated into the mask predictor to capture and store class-wise geo-context at the instance level across the entire dataset. In addition, to address the absence of large-scale datasets for training pixel-level RS MLLMs, we construct the GeoPixInstruct dataset, comprising 65,463 images and 140,412 instances, with each instance annotated with text descriptions, bounding boxes, and masks. Furthermore, we develop a two-stage training strategy to balance the distinct requirements of text generation and masks prediction in multi-modal multi-task optimization. Extensive experiments verify the effectiveness and superiority of GeoPix in pixel-level segmentation tasks, while also maintaining competitive performance in image- and region-level benchmarks.

The goal of this paper is to interactively refine the automatic segmentation on challenging structures that fall behind human performance, either due to the scarcity of available annotations or the difficulty nature of the problem itself, for example, on segmenting cancer or small organs. Specifically, we propose a novel Transformer-based architecture for Interactive Segmentation (TIS), that treats the refinement task as a procedure for grouping pixels with similar features to those clicks given by the end users. Our proposed architecture is composed of Transformer Decoder variants, which naturally fulfills feature comparison with the attention mechanisms. In contrast to existing approaches, our proposed TIS is not limited to binary segmentations, and allows the user to edit masks for arbitrary number of categories. To validate the proposed approach, we conduct extensive experiments on three challenging datasets and demonstrate superior performance over the existing state-of-the-art methods. The project page is: https://wtliu7.github.io/tis/.

Producing quality segmentation masks for images is a fundamental problem in computer vision. Recent research has explored large-scale supervised training to enable zero-shot segmentation on virtually any image style and unsupervised training to enable segmentation without dense annotations. However, constructing a model capable of segmenting anything in a zero-shot manner without any annotations is still challenging. In this paper, we propose to utilize the self-attention layers in stable diffusion models to achieve this goal because the pre-trained stable diffusion model has learned inherent concepts of objects within its attention layers. Specifically, we introduce a simple yet effective iterative merging process based on measuring KL divergence among attention maps to merge them into valid segmentation masks. The proposed method does not require any training or language dependency to extract quality segmentation for any images. On COCO-Stuff-27, our method surpasses the prior unsupervised zero-shot SOTA method by an absolute 26% in pixel accuracy and 17% in mean IoU. The project page is at https://sites.google.com/view/diffseg/home.

With the rapid growth of artificial intelligence (AI) in healthcare, there has been a significant increase in the generation and storage of sensitive medical data. This abundance of data, in turn, has propelled the advancement of medical AI technologies. However, concerns about unauthorized data exploitation, such as training commercial AI models, often deter researchers from making their invaluable datasets publicly available. In response to the need to protect this hard-to-collect data while still encouraging medical institutions to share it, one promising solution is to introduce imperceptible noise into the data. This method aims to safeguard the data against unauthorized training by inducing degradation in model generalization. Although existing methods have shown commendable data protection capabilities in general domains, they tend to fall short when applied to biomedical data, mainly due to their failure to account for the sparse nature of medical images. To address this problem, we propose the Sparsity-Aware Local Masking (SALM) method, a novel approach that selectively perturbs significant pixel regions rather than the entire image as previous strategies have done. This simple-yet-effective approach significantly reduces the perturbation search space by concentrating on local regions, thereby improving both the efficiency and effectiveness of data protection for biomedical datasets characterized by sparse features. Besides, we have demonstrated that SALM maintains the essential characteristics of the data, ensuring its clinical utility remains uncompromised. Our extensive experiments across various datasets and model architectures demonstrate that SALM effectively prevents unauthorized training of deep-learning models and outperforms previous state-of-the-art data protection methods.

Camouflaged object segmentation presents unique challenges compared to traditional segmentation tasks, primarily due to the high similarity in patterns and colors between camouflaged objects and their backgrounds. Effective solutions to this problem have significant implications in critical areas such as pest control, defect detection, and lesion segmentation in medical imaging. Prior research has predominantly emphasized supervised or unsupervised pre-training methods, leaving zero-shot approaches significantly underdeveloped. Existing zero-shot techniques commonly utilize the Segment Anything Model (SAM) in automatic mode or rely on vision-language models to generate cues for segmentation; however, their performances remain unsatisfactory, due to the similarity of the camouflaged object and the background. This work studies how to avoid training by integrating large pre-trained models like SAM-2 and Owl-v2 with temporal information into a modular pipeline. Evaluated on the MoCA-Mask dataset, our approach achieves outstanding performance improvements, significantly outperforming existing zero-shot methods by raising the F-measure (F_beta^w) from 0.296 to 0.628. Our approach also surpasses supervised methods, increasing the F-measure from 0.476 to 0.628. Additionally, evaluation on the MoCA-Filter dataset demonstrates an increase in the success rate from 0.628 to 0.697 when compared with FlowSAM, a supervised transfer method. A thorough ablation study further validates the individual contributions of each component. Besides our main contributions, we also highlight inconsistencies in previous work regarding metrics and settings. Code can be found in https://github.com/weathon/vcos.

To investigate whether the pleurae, airways and vessels surrounding a nodule on non-contrast computed tomography (CT) can discriminate benign and malignant pulmonary nodules. The LIDC-IDRI dataset, one of the largest publicly available CT database, was exploited for study. A total of 1556 nodules from 694 patients were involved in statistical analysis, where nodules with average scorings <3 and >3 were respectively denoted as benign and malignant. Besides, 339 nodules from 113 patients with diagnosis ground-truth were independently evaluated. Computer algorithms were developed to segment pulmonary structures and quantify the distances to pleural surface, airways and vessels, as well as the counting number and normalized volume of airways and vessels near a nodule. Odds ratio (OR) and Chi-square (\chi^2) testing were performed to demonstrate the correlation between features of surrounding structures and nodule malignancy. A non-parametric receiver operating characteristic (ROC) analysis was conducted in logistic regression to evaluate discrimination ability of each structure. For benign and malignant groups, the average distances from nodules to pleural surface, airways and vessels are respectively (6.56, 5.19), (37.08, 26.43) and (1.42, 1.07) mm. The correlation between nodules and the counting number of airways and vessels that contact or project towards nodules are respectively (OR=22.96, \chi^2=105.04) and (OR=7.06, \chi^2=290.11). The correlation between nodules and the volume of airways and vessels are (OR=9.19, \chi^2=159.02) and (OR=2.29, \chi^2=55.89). The areas-under-curves (AUCs) for pleurae, airways and vessels are respectively 0.5202, 0.6943 and 0.6529. Our results show that malignant nodules are often surrounded by more pulmonary structures compared with benign ones, suggesting that features of these structures could be viewed as lung cancer biomarkers.

We tackle open-world semantic segmentation, which aims at learning to segment arbitrary visual concepts in images, by using only image-text pairs without dense annotations. Existing open-world segmentation methods have shown impressive advances by employing contrastive learning (CL) to learn diverse visual concepts and transferring the learned image-level understanding to the segmentation task. However, these CL-based methods suffer from a train-test discrepancy, since it only considers image-text alignment during training, whereas segmentation requires region-text alignment during testing. In this paper, we proposed a novel Text-grounded Contrastive Learning (TCL) framework that enables a model to directly learn region-text alignment. Our method generates a segmentation mask for a given text, extracts text-grounded image embedding from the masked region, and aligns it with text embedding via TCL. By learning region-text alignment directly, our framework encourages a model to directly improve the quality of generated segmentation masks. In addition, for a rigorous and fair comparison, we present a unified evaluation protocol with widely used 8 semantic segmentation datasets. TCL achieves state-of-the-art zero-shot segmentation performances with large margins in all datasets. Code is available at https://github.com/kakaobrain/tcl.

AI models for lung cancer screening are limited by data scarcity, impacting generalizability and clinical applicability. Generative models address this issue but are constrained by training data variability. We introduce SYN-LUNGS, a framework for generating high-quality 3D CT images with detailed annotations. SYN-LUNGS integrates XCAT3 phantoms for digital twin generation, X-Lesions for nodule simulation (varying size, location, and appearance), and DukeSim for CT image formation with vendor and parameter variability. The dataset includes 3,072 nodule images from 1,044 simulated CT scans, with 512 lesions and 174 digital twins. Models trained on clinical + simulated data outperform clinical only models, achieving 10% improvement in detection, 2-9% in segmentation and classification, and enhanced synthesis. By incorporating anatomy-informed simulations, SYN-LUNGS provides a scalable approach for AI model development, particularly in rare disease representation and improving model reliability.

Current methods for 3D semantic segmentation propose training models with limited annotations to address the difficulty of annotating large, irregular, and unordered 3D point cloud data. They usually focus on the 3D domain only, without leveraging the complementary nature of 2D and 3D data. Besides, some methods extend original labels or generate pseudo labels to guide the training, but they often fail to fully use these labels or address the noise within them. Meanwhile, the emergence of comprehensive and adaptable foundation models has offered effective solutions for segmenting 2D data. Leveraging this advancement, we present a novel approach that maximizes the utility of sparsely available 3D annotations by incorporating segmentation masks generated by 2D foundation models. We further propagate the 2D segmentation masks into the 3D space by establishing geometric correspondences between 3D scenes and 2D views. We extend the highly sparse annotations to encompass the areas delineated by 3D masks, thereby substantially augmenting the pool of available labels. Furthermore, we apply confidence- and uncertainty-based consistency regularization on augmentations of the 3D point cloud and select the reliable pseudo labels, which are further spread on the 3D masks to generate more labels. This innovative strategy bridges the gap between limited 3D annotations and the powerful capabilities of 2D foundation models, ultimately improving the performance of 3D weakly supervised segmentation.

Interactive segmentation has recently attracted attention for specialized tasks where expert input is required to further enhance the segmentation performance. In this work, we propose a novel interactive segmentation framework, where user clicks are dynamically adapted in size based on the current segmentation mask. The clicked regions form a weight map and are fed to a deep neural network as a novel weighted loss function. To evaluate our loss function, an interactive U-Net (IU-Net) model which applies both foreground and background user clicks as the main method of interaction is employed. We train and validate on the BCV dataset, while testing on spleen and colon cancer CT images from the MSD dataset to improve the overall segmentation accuracy in comparison to the standard U-Net using our weighted loss function. Applying dynamic user click sizes increases the overall accuracy by 5.60% and 10.39% respectively by utilizing only a single user interaction.