Multi-Scale Global-Instance Prompt Tuning for Continual Test-time Adaptation in Medical Image Segmentation

Distribution shift is a common challenge in medical images obtained from different clinical centers, significantly hindering the deployment of pre-trained semantic segmentation models in real-world applications across multiple domains. Continual Test-Time Adaptation(CTTA) has emerged as a promising approach to address cross-domain shifts during continually evolving target domains. Most existing CTTA methods rely on incrementally updating model parameters, which inevitably suffer from error accumulation and catastrophic forgetting, especially in long-term adaptation. Recent prompt-tuning-based works have shown potential to mitigate the two issues above by updating only visual prompts. While these approaches have demonstrated promising performance, several limitations remain:1)lacking multi-scale prompt diversity, 2)inadequate incorporation of instance-specific knowledge, and 3)risk of privacy leakage. To overcome these limitations, we propose Multi-scale Global-Instance Prompt Tuning(MGIPT), to enhance scale diversity of prompts and capture both global- and instance-level knowledge for robust CTTA. Specifically, MGIPT consists of an Adaptive-scale Instance Prompt(AIP) and a Multi-scale Global-level Prompt(MGP). AIP dynamically learns lightweight and instance-specific prompts to mitigate error accumulation with adaptive optimal-scale selection mechanism. MGP captures domain-level knowledge across different scales to ensure robust adaptation with anti-forgetting capabilities. These complementary components are combined through a weighted ensemble approach, enabling effective dual-level adaptation that integrates both global and local information. Extensive experiments on medical image segmentation benchmarks demonstrate that our MGIPT outperforms state-of-the-art methods, achieving robust adaptation across continually changing target domains.

An Intuitionistic Fuzzy Logic Driven UNet architecture: Application to Brain Image segmentation

Accurate segmentation of MRI brain images is essential for image analysis, diagnosis of neuro-logical disorders and medical image computing. In the deep learning approach, the convolutional neural networks (CNNs), especially UNet, are widely applied in medical image segmentation. However, it is difficult to deal with uncertainty due to the partial volume effect in brain images. To overcome this limitation, we propose an enhanced framework, named UNet with intuitionistic fuzzy logic (IF-UNet), which incorporates intuitionistic fuzzy logic into UNet. The model processes input data in terms of membership, nonmembership, and hesitation degrees, allowing it to better address tissue ambiguity resulting from partial volume effects and boundary uncertainties. The proposed architecture is evaluated on the Internet Brain Segmentation Repository (IBSR) dataset, and its performance is computed using accuracy, Dice coefficient, and intersection over union (IoU). Experimental results confirm that IF-UNet improves segmentation quality with handling uncertainty in brain images.

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.

SRA-Seg: Synthetic to Real Alignment for Semi-Supervised Medical Image Segmentation

Synthetic data, an appealing alternative to extensive expert-annotated data for medical image segmentation, consistently fails to improve segmentation performance despite its visual realism. The reason being that synthetic and real medical images exist in different semantic feature spaces, creating a domain gap that current semi-supervised learning methods cannot bridge. We propose SRA-Seg, a framework explicitly designed to align synthetic and real feature distributions for medical image segmentation. SRA-Seg introduces a similarity-alignment (SA) loss using frozen DINOv2 embeddings to pull synthetic representations toward their nearest real counterparts in semantic space. We employ soft edge blending to create smooth anatomical transitions and continuous labels, eliminating the hard boundaries from traditional copy-paste augmentation. The framework generates pseudo-labels for synthetic images via an EMA teacher model and applies soft-segmentation losses that respect uncertainty in mixed regions. Our experiments demonstrate strong results: using only 10% labeled real data and 90% synthetic unlabeled data, SRA-Seg achieves 89.34% Dice on ACDC and 84.42% on FIVES, significantly outperforming existing semi-supervised methods and matching the performance of methods using real unlabeled data.

Contour Refinement using Discrete Diffusion in Low Data Regime

Boundary detection of irregular and translucent objects is an important problem with applications in medical imaging, environmental monitoring and manufacturing, where many of these applications are plagued with scarce labeled data and low in situ computational resources. While recent image segmentation studies focus on segmentation mask alignment with ground-truth, the task of boundary detection remains understudied, especially in the low data regime. In this work, we present a lightweight discrete diffusion contour refinement pipeline for robust boundary detection in the low data regime. We use a Convolutional Neural Network(CNN) architecture with self-attention layers as the core of our pipeline, and condition on a segmentation mask, iteratively denoising a sparse contour representation. We introduce multiple novel adaptations for improved low-data efficacy and inference efficiency, including using a simplified diffusion process, a customized model architecture, and minimal post processing to produce a dense, isolated contour given a dataset of size <500 training images. Our method outperforms several SOTA baselines on the medical imaging dataset KVASIR, is competitive on HAM10K and our custom wildfire dataset, Smoke, while improving inference framerate by 3.5X.

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

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

Fully Kolmogorov-Arnold Deep Model in Medical Image Segmentation

Deeply stacked KANs are practically impossible due to high training difficulties and substantial memory requirements. Consequently, existing studies can only incorporate few KAN layers, hindering the comprehensive exploration of KANs. This study overcomes these limitations and introduces the first fully KA-based deep model, demonstrating that KA-based layers can entirely replace traditional architectures in deep learning and achieve superior learning capacity. Specifically, (1) the proposed Share-activation KAN (SaKAN) reformulates Sprecher's variant of Kolmogorov-Arnold representation theorem, which achieves better optimization due to its simplified parameterization and denser training samples, to ease training difficulty, (2) this paper indicates that spline gradients contribute negligibly to training while consuming huge GPU memory, thus proposes the Grad-Free Spline to significantly reduce memory usage and computational overhead. (3) Building on these two innovations, our ALL U-KAN is the first representative implementation of fully KA-based deep model, where the proposed KA and KAonv layers completely replace FC and Conv layers. Extensive evaluations on three medical image segmentation tasks confirm the superiority of the full KA-based architecture compared to partial KA-based and traditional architectures, achieving all higher segmentation accuracy. Compared to directly deeply stacked KAN, ALL U-KAN achieves 10 times reduction in parameter count and reduces memory consumption by more than 20 times, unlocking the new explorations into deep KAN architectures.

Towards Segmenting the Invisible: An End-to-End Registration and Segmentation Framework for Weakly Supervised Tumour Analysis

Liver tumour ablation presents a significant clinical challenge: whilst tumours are clearly visible on pre-operative MRI, they are often effectively invisible on intra-operative CT due to minimal contrast between pathological and healthy tissue. This work investigates the feasibility of cross-modality weak supervision for scenarios where pathology is visible in one modality (MRI) but absent in another (CT). We present a hybrid registration-segmentation framework that combines MSCGUNet for inter-modal image registration with a UNet-based segmentation module, enabling registration-assisted pseudo-label generation for CT images. Our evaluation on the CHAOS dataset demonstrates that the pipeline can successfully register and segment healthy liver anatomy, achieving a Dice score of 0.72. However, when applied to clinical data containing tumours, performance degrades substantially (Dice score of 0.16), revealing the fundamental limitations of current registration methods when the target pathology lacks corresponding visual features in the target modality. We analyse the "domain gap" and "feature absence" problems, demonstrating that whilst spatial propagation of labels via registration is feasible for visible structures, segmenting truly invisible pathology remains an open challenge. Our findings highlight that registration-based label transfer cannot compensate for the absence of discriminative features in the target modality, providing important insights for future research in cross-modality medical image analysis. Code an weights are available at: https://github.com/BudhaTronix/Weakly-Supervised-Tumour-Detection

A labeled dataset of simulated phlebotomy procedures for medical AI: polygon annotations for object detection and human-object interaction

This data article presents a dataset of 11,884 labeled images documenting a simulated blood extraction (phlebotomy) procedure performed on a training arm. Images were extracted from high-definition videos recorded under controlled conditions and curated to reduce redundancy using Structural Similarity Index Measure (SSIM) filtering. An automated face-anonymization step was applied to all videos prior to frame selection. Each image contains polygon annotations for five medically relevant classes: syringe, rubber band, disinfectant wipe, gloves, and training arm. The annotations were exported in a segmentation format compatible with modern object detection frameworks (e.g., YOLOv8), ensuring broad usability. This dataset is partitioned into training (70%), validation (15%), and test (15%) subsets and is designed to advance research in medical training automation and human-object interaction. It enables multiple applications, including phlebotomy tool detection, procedural step recognition, workflow analysis, conformance checking, and the development of educational systems that provide structured feedback to medical trainees. The data and accompanying label files are publicly available on Zenodo.

Med-MMFL: A Multimodal Federated Learning Benchmark in Healthcare

Federated learning (FL) enables collaborative model training across decentralized medical institutions while preserving data privacy. However, medical FL benchmarks remain scarce, with existing efforts focusing mainly on unimodal or bimodal modalities and a limited range of medical tasks. This gap underscores the need for standardized evaluation to advance systematic understanding in medical MultiModal FL (MMFL). To this end, we introduce Med-MMFL, the first comprehensive MMFL benchmark for the medical domain, encompassing diverse modalities, tasks, and federation scenarios. Our benchmark evaluates six representative state-of-the-art FL algorithms, covering different aggregation strategies, loss formulations, and regularization techniques. It spans datasets with 2 to 4 modalities, comprising a total of 10 unique medical modalities, including text, pathology images, ECG, X-ray, radiology reports, and multiple MRI sequences. Experiments are conducted across naturally federated, synthetic IID, and synthetic non-IID settings to simulate real-world heterogeneity. We assess segmentation, classification, modality alignment (retrieval), and VQA tasks. To support reproducibility and fair comparison of future multimodal federated learning (MMFL) methods under realistic medical settings, we release the complete benchmark implementation, including data processing and partitioning pipelines, at https://github.com/bhattarailab/Med-MMFL-Benchmark .