Few-Shot Left Atrial Wall Segmentation in 3D LGE MRI via Meta-Learning

Segmenting the left atrial wall from late gadolinium enhancement magnetic resonance images (MRI) is challenging due to the wall's thin geometry, low contrast, and the scarcity of expert annotations. We propose a Model-Agnostic Meta-Learning (MAML) framework for K-shot (K = 5, 10, 20) 3D left atrial wall segmentation that is meta-trained on the wall task together with auxiliary left atrial and right atrial cavity tasks and uses a boundary-aware composite loss to emphasize thin-structure accuracy. We evaluated MAML segmentation performance on a hold-out test set and assessed robustness under an unseen synthetic shift and on a distinct local cohort. On the hold-out test set, MAML appeared to improve segmentation performance compared to the supervised fine-tuning model, achieving a Dice score (DSC) of 0.64 vs. 0.52 and HD95 of 5.70 vs. 7.60 mm at 5-shot, and approached the fully supervised reference at 20-shot (0.69 vs. 0.71 DSC). Under unseen shift, performance degraded but remained robust: at 5-shot, MAML attained 0.59 DSC and 5.99 mm HD95 on the unseen domain shift and 0.57 DSC and 6.01 mm HD95 on the local cohort, with consistent gains as K increased. These results suggest that more accurate and reliable thin-wall boundaries are achievable in low-shot adaptation, potentially enabling clinical translation with minimal additional labeling for the assessment of atrial remodeling.

Focus on Background: Exploring SAM's Potential in Few-shot Medical Image Segmentation with Background-centric Prompting

Conventional few-shot medical image segmentation (FSMIS) approaches face performance bottlenecks that hinder broader clinical applicability. Although the Segment Anything Model (SAM) exhibits strong category-agnostic segmentation capabilities, its direct application to medical images often leads to over-segmentation due to ambiguous anatomical boundaries. In this paper, we reformulate SAM-based FSMIS as a prompt localization task and propose FoB (Focus on Background), a background-centric prompt generator that provides accurate background prompts to constrain SAM's over-segmentation. Specifically, FoB bridges the gap between segmentation and prompt localization by category-agnostic generation of support background prompts and localizing them directly in the query image. To address the challenge of prompt localization for novel categories, FoB models rich contextual information to capture foreground-background spatial dependencies. Moreover, inspired by the inherent structural patterns of background prompts in medical images, FoB models this structure as a constraint to progressively refine background prompt predictions. Experiments on three diverse medical image datasets demonstrate that FoB outperforms other baselines by large margins, achieving state-of-the-art performance on FSMIS, and exhibiting strong cross-domain generalization. Our code is available at https://github.com/primebo1/FoB_SAM.

Learning Generalizable 3D Medical Image Representations from Mask-Guided Self-Supervision

Foundation models have transformed vision and language by learning general-purpose representations from large-scale unlabeled data, yet 3D medical imaging lacks analogous approaches. Existing self-supervised methods rely on low-level reconstruction or contrastive objectives that fail to capture the anatomical semantics critical for medical image analysis, limiting transfer to downstream tasks. We present MASS (MAsk-guided Self-Supervised learning), which treats in-context segmentation as the pretext task for learning general-purpose medical imaging representations. MASS's key insight is that automatically generated class-agnostic masks provide sufficient structural supervision for learning semantically rich representations. By training on thousands of diverse mask proposals spanning anatomical structures and pathological findings, MASS learns what semantically defines medical structures: the holistic combination of appearance, shape, spatial context, and anatomical relationships. We demonstrate effectiveness across data regimes: from small-scale pretraining on individual datasets (20-200 scans) to large-scale multi-modal pretraining on 5K CT, MRI, and PET volumes, all without annotations. MASS demonstrates: (i) few-shot segmentation on novel structures, (ii) matching full supervision with only 20-40\% labeled data while outperforming self-supervised baselines by over 20 in Dice score in low-data regimes, and (iii) frozen-encoder classification on unseen pathologies that matches full supervised training with thousands of samples. Mask-guided self-supervised pretraining captures broadly generalizable knowledge, opening a path toward 3D medical imaging foundation models without expert annotations. Code is available: https://github.com/Stanford-AIMI/MASS.

A dataset of medication images with instance segmentation masks for preventing adverse drug events

Medication errors and adverse drug events (ADEs) pose significant risks to patient safety, often arising from difficulties in reliably identifying pharmaceuticals in real-world settings. AI-based pill recognition models offer a promising solution, but the lack of comprehensive datasets hinders their development. Existing pill image datasets rarely capture real-world complexities such as overlapping pills, varied lighting, and occlusions. MEDISEG addresses this gap by providing instance segmentation annotations for 32 distinct pill types across 8262 images, encompassing diverse conditions from individual pill images to cluttered dosette boxes. We trained YOLOv8 and YOLOv9 on MEDISEG to demonstrate their usability, achieving mean average precision at IoU 0.5 of 99.5 percent on the 3-Pills subset and 80.1 percent on the 32-Pills subset. We further evaluate MEDISEG under a few-shot detection protocol, demonstrating that base training on MEDISEG significantly improves recognition of unseen pill classes in occluded multi-pill scenarios compared to existing datasets. These results highlight the dataset's ability not only to support robust supervised training but also to promote transferable representations under limited supervision, making it a valuable resource for developing and benchmarking AI-driven systems for medication safety.

Unsupervised Domain Adaptation with Target-Only Margin Disparity Discrepancy

In interventional radiology, Cone-Beam Computed Tomography (CBCT) is a helpful imaging modality that provides guidance to practicians during minimally invasive procedures. CBCT differs from traditional Computed Tomography (CT) due to its limited reconstructed field of view, specific artefacts, and the intra-arterial administration of contrast medium. While CT benefits from abundant publicly available annotated datasets, interventional CBCT data remain scarce and largely unannotated, with existing datasets focused primarily on radiotherapy applications. To address this limitation, we leverage a proprietary collection of unannotated interventional CBCT scans in conjunction with annotated CT data, employing domain adaptation techniques to bridge the modality gap and enhance liver segmentation performance on CBCT. We propose a novel unsupervised domain adaptation (UDA) framework based on the formalism of Margin Disparity Discrepancy (MDD), which improves target domain performance through a reformulation of the original MDD optimization framework. Experimental results on CT and CBCT datasets for liver segmentation demonstrate that our method achieves state-of-the-art performance in UDA, as well as in the few-shot setting.

DREAM: Where Visual Understanding Meets Text-to-Image Generation

Unifying visual representation learning and text-to-image (T2I) generation within a single model remains a central challenge in multimodal learning. We introduce DREAM, a unified framework that jointly optimizes discriminative and generative objectives, while learning strong visual representations. DREAM is built on two key techniques: During training, Masking Warmup, a progressive masking schedule, begins with minimal masking to establish the contrastive alignment necessary for representation learning, then gradually transitions to full masking for stable generative training. At inference, DREAM employs Semantically Aligned Decoding to align partially masked image candidates with the target text and select the best one for further decoding, improving text-image fidelity (+6.3%) without external rerankers. Trained solely on CC12M, DREAM achieves 72.7% ImageNet linear-probing accuracy (+1.1% over CLIP) and an FID of 4.25 (+6.2% over FLUID), with consistent gains in few-shot classification, semantic segmentation, and depth estimation. These results demonstrate that discriminative and generative objectives can be synergistic, allowing unified multimodal models that excel at both visual understanding and generation.

Retrieve and Segment: Are a Few Examples Enough to Bridge the Supervision Gap in Open-Vocabulary Segmentation?

Open-vocabulary segmentation (OVS) extends the zero-shot recognition capabilities of vision-language models (VLMs) to pixel-level prediction, enabling segmentation of arbitrary categories specified by text prompts. Despite recent progress, OVS lags behind fully supervised approaches due to two challenges: the coarse image-level supervision used to train VLMs and the semantic ambiguity of natural language. We address these limitations by introducing a few-shot setting that augments textual prompts with a support set of pixel-annotated images. Building on this, we propose a retrieval-augmented test-time adapter that learns a lightweight, per-image classifier by fusing textual and visual support features. Unlike prior methods relying on late, hand-crafted fusion, our approach performs learned, per-query fusion, achieving stronger synergy between modalities. The method supports continually expanding support sets, and applies to fine-grained tasks such as personalized segmentation. Experiments show that we significantly narrow the gap between zero-shot and supervised segmentation while preserving open-vocabulary ability.

Boosting SAM for Cross-Domain Few-Shot Segmentation via Conditional Point Sparsification

Motivated by the success of the Segment Anything Model (SAM) in promptable segmentation, recent studies leverage SAM to develop training-free solutions for few-shot segmentation, which aims to predict object masks in the target image based on a few reference exemplars. These SAM-based methods typically rely on point matching between reference and target images and use the matched dense points as prompts for mask prediction. However, we observe that dense points perform poorly in Cross-Domain Few-Shot Segmentation (CD-FSS), where target images are from medical or satellite domains. We attribute this issue to large domain shifts that disrupt the point-image interactions learned by SAM, and find that point density plays a crucial role under such conditions. To address this challenge, we propose Conditional Point Sparsification (CPS), a training-free approach that adaptively guides SAM interactions for cross-domain images based on reference exemplars. Leveraging ground-truth masks, the reference images provide reliable guidance for adaptively sparsifying dense matched points, enabling more accurate segmentation results. Extensive experiments demonstrate that CPS outperforms existing training-free SAM-based methods across diverse CD-FSS datasets.

Finding NeMO: A Geometry-Aware Representation of Template Views for Few-Shot Perception

We present Neural Memory Object (NeMO), a novel object-centric representation that can be used to detect, segment and estimate the 6DoF pose of objects unseen during training using RGB images. Our method consists of an encoder that requires only a few RGB template views depicting an object to generate a sparse object-like point cloud using a learned UDF containing semantic and geometric information. Next, a decoder takes the object encoding together with a query image to generate a variety of dense predictions. Through extensive experiments, we show that our method can be used for few-shot object perception without requiring any camera-specific parameters or retraining on target data. Our proposed concept of outsourcing object information in a NeMO and using a single network for multiple perception tasks enhances interaction with novel objects, improving scalability and efficiency by enabling quick object onboarding without retraining or extensive pre-processing. We report competitive and state-of-the-art results on various datasets and perception tasks of the BOP benchmark, demonstrating the versatility of our approach. https://github.com/DLR-RM/nemo

ProGiDiff: Prompt-Guided Diffusion-Based Medical Image Segmentation

Widely adopted medical image segmentation methods, although efficient, are primarily deterministic and remain poorly amenable to natural language prompts. Thus, they lack the capability to estimate multiple proposals, human interaction, and cross-modality adaptation. Recently, text-to-image diffusion models have shown potential to bridge the gap. However, training them from scratch requires a large dataset-a limitation for medical image segmentation. Furthermore, they are often limited to binary segmentation and cannot be conditioned on a natural language prompt. To this end, we propose a novel framework called ProGiDiff that leverages existing image generation models for medical image segmentation purposes. Specifically, we propose a ControlNet-style conditioning mechanism with a custom encoder, suitable for image conditioning, to steer a pre-trained diffusion model to output segmentation masks. It naturally extends to a multi-class setting simply by prompting the target organ. Our experiment on organ segmentation from CT images demonstrates strong performance compared to previous methods and could greatly benefit from an expert-in-the-loop setting to leverage multiple proposals. Importantly, we demonstrate that the learned conditioning mechanism can be easily transferred through low-rank, few-shot adaptation to segment MR images.