Zero-Shot Gaze-based Volumetric Medical Image Segmentation

Accurate segmentation of anatomical structures in volumetric medical images is crucial for clinical applications, including disease monitoring and cancer treatment planning. Contemporary interactive segmentation models, such as Segment Anything Model 2 (SAM-2) and its medical variant (MedSAM-2), rely on manually provided prompts like bounding boxes and mouse clicks. In this study, we introduce eye gaze as a novel informational modality for interactive segmentation, marking the application of eye-tracking for 3D medical image segmentation. We evaluate the performance of using gaze-based prompts with SAM-2 and MedSAM-2 using both synthetic and real gaze data. Compared to bounding boxes, gaze-based prompts offer a time-efficient interaction approach with slightly lower segmentation quality. Our findings highlight the potential of using gaze as a complementary input modality for interactive 3D medical image segmentation.

Towards user-centered interactive medical image segmentation in VR with an assistive AI agent

Crucial in disease analysis and surgical planning, manual segmentation of volumetric medical scans (e.g. MRI, CT) is laborious, error-prone, and challenging to master, while fully automatic algorithms can benefit from user feedback. Therefore, with the complementary power of the latest radiological AI foundation models and virtual reality (VR)'s intuitive data interaction, we propose SAMIRA, a novel conversational AI agent that assists users with localizing, segmenting, and visualizing 3D medical concepts in VR. Through speech-based interaction, the agent helps users understand radiological features, locate clinical targets, and generate segmentation masks that can be refined with just a few point prompts. The system also supports true-to-scale 3D visualization of segmented pathology to enhance patient-specific anatomical understanding. Furthermore, to determine the optimal interaction paradigm under near-far attention-switching for refining segmentation masks in an immersive, human-in-the-loop workflow, we compare VR controller pointing, head pointing, and eye tracking as input modes. With a user study, evaluations demonstrated a high usability score (SUS=90.0 $\pm$ 9.0), low overall task load, as well as strong support for the proposed VR system's guidance, training potential, and integration of AI in radiological segmentation tasks.

Accelerating Volumetric Medical Image Annotation via Short-Long Memory SAM 2

Manual annotation of volumetric medical images, such as magnetic resonance imaging (MRI) and computed tomography (CT), is a labor-intensive and time-consuming process. Recent advancements in foundation models for video object segmentation, such as Segment Anything Model 2 (SAM 2), offer a potential opportunity to significantly speed up the annotation process by manually annotating one or a few slices and then propagating target masks across the entire volume. However, the performance of SAM 2 in this context varies. Our experiments show that relying on a single memory bank and attention module is prone to error propagation, particularly at boundary regions where the target is present in the previous slice but absent in the current one. To address this problem, we propose Short-Long Memory SAM 2 (SLM-SAM 2), a novel architecture that integrates distinct short-term and long-term memory banks with separate attention modules to improve segmentation accuracy. We evaluate SLM-SAM 2 on three public datasets covering organs, bones, and muscles across MRI and CT modalities. We show that the proposed method markedly outperforms the default SAM 2, achieving average Dice Similarity Coefficient improvement of 0.14 and 0.11 in the scenarios when 5 volumes and 1 volume are available for the initial adaptation, respectively. SLM-SAM 2 also exhibits stronger resistance to over-propagation, making a notable step toward more accurate automated annotation of medical images for segmentation model development.

Automated segmenta-on of pediatric neuroblastoma on multi-modal MRI: Results of the SPPIN challenge at MICCAI 2023

Surgery plays an important role within the treatment for neuroblastoma, a common pediatric cancer. This requires careful planning, often via magnetic resonance imaging (MRI)-based anatomical 3D models. However, creating these models is often time-consuming and user dependent. We organized the Surgical Planning in Pediatric Neuroblastoma (SPPIN) challenge, to stimulate developments on this topic, and set a benchmark for fully automatic segmentation of neuroblastoma on multi-model MRI. The challenge started with a training phase, where teams received 78 sets of MRI scans from 34 patients, consisting of both diagnostic and post-chemotherapy MRI scans. The final test phase, consisting of 18 MRI sets from 9 patients, determined the ranking of the teams. Ranking was based on the Dice similarity coefficient (Dice score), the 95th percentile of the Hausdorff distance (HD95) and the volumetric similarity (VS). The SPPIN challenge was hosted at MICCAI 2023. The final leaderboard consisted of 9 teams. The highest-ranking team achieved a median Dice score 0.82, a median HD95 of 7.69 mm and a VS of 0.91, utilizing a large, pretrained network called STU-Net. A significant difference for the segmentation results between diagnostic and post-chemotherapy MRI scans was observed (Dice = 0.89 vs Dice = 0.59, P = 0.01) for the highest-ranking team. SPPIN is the first medical segmentation challenge in extracranial pediatric oncology. The highest-ranking team used a large pre-trained network, suggesting that pretraining can be of use in small, heterogenous datasets. Although the results of the highest-ranking team were high for most patients, segmentation especially in small, pre-treated tumors were insufficient. Therefore, more reliable segmentation methods are needed to create clinically applicable models to aid surgical planning in pediatric neuroblastoma.

TextDiffSeg: Text-guided Latent Diffusion Model for 3d Medical Images Segmentation

Diffusion Probabilistic Models (DPMs) have demonstrated significant potential in 3D medical image segmentation tasks. However, their high computational cost and inability to fully capture global 3D contextual information limit their practical applications. To address these challenges, we propose a novel text-guided diffusion model framework, TextDiffSeg. This method leverages a conditional diffusion framework that integrates 3D volumetric data with natural language descriptions, enabling cross-modal embedding and establishing a shared semantic space between visual and textual modalities. By enhancing the model's ability to recognize complex anatomical structures, TextDiffSeg incorporates innovative label embedding techniques and cross-modal attention mechanisms, effectively reducing computational complexity while preserving global 3D contextual integrity. Experimental results demonstrate that TextDiffSeg consistently outperforms existing methods in segmentation tasks involving kidney and pancreas tumors, as well as multi-organ segmentation scenarios. Ablation studies further validate the effectiveness of key components, highlighting the synergistic interaction between text fusion, image feature extractor, and label encoder. TextDiffSeg provides an efficient and accurate solution for 3D medical image segmentation, showcasing its broad applicability in clinical diagnosis and treatment planning.

Multi-Modal Brain Tumor Segmentation via 3D Multi-Scale Self-attention and Cross-attention

Due to the success of CNN-based and Transformer-based models in various computer vision tasks, recent works study the applicability of CNN-Transformer hybrid architecture models in 3D multi-modality medical segmentation tasks. Introducing Transformer brings long-range dependent information modeling ability in 3D medical images to hybrid models via the self-attention mechanism. However, these models usually employ fixed receptive fields of 3D volumetric features within each self-attention layer, ignoring the multi-scale volumetric lesion features. To address this issue, we propose a CNN-Transformer hybrid 3D medical image segmentation model, named TMA-TransBTS, based on an encoder-decoder structure. TMA-TransBTS realizes simultaneous extraction of multi-scale 3D features and modeling of long-distance dependencies by multi-scale division and aggregation of 3D tokens in a self-attention layer. Furthermore, TMA-TransBTS proposes a 3D multi-scale cross-attention module to establish a link between the encoder and the decoder for extracting rich volume representations by exploiting the mutual attention mechanism of cross-attention and multi-scale aggregation of 3D tokens. Extensive experimental results on three public 3D medical segmentation datasets show that TMA-TransBTS achieves higher averaged segmentation results than previous state-of-the-art CNN-based 3D methods and CNN-Transform hybrid 3D methods for the segmentation of 3D multi-modality brain tumors.

A Comprehensive Analysis of Mamba for 3D Volumetric Medical Image Segmentation

Mamba, with its selective State Space Models (SSMs), offers a more computationally efficient solution than Transformers for long-range dependency modeling. However, there is still a debate about its effectiveness in high-resolution 3D medical image segmentation. In this study, we present a comprehensive investigation into Mamba's capabilities in 3D medical image segmentation by tackling three pivotal questions: Can Mamba replace Transformers? Can it elevate multi-scale representation learning? Is complex scanning necessary to unlock its full potential? We evaluate Mamba's performance across three large public benchmarks-AMOS, TotalSegmentator, and BraTS. Our findings reveal that UlikeMamba, a U-shape Mamba-based network, consistently surpasses UlikeTrans, a U-shape Transformer-based network, particularly when enhanced with custom-designed 3D depthwise convolutions, boosting accuracy and computational efficiency. Further, our proposed multi-scale Mamba block demonstrates superior performance in capturing both fine-grained details and global context, especially in complex segmentation tasks, surpassing Transformer-based counterparts. We also critically assess complex scanning strategies, finding that simpler methods often suffice, while our Tri-scan approach delivers notable advantages in the most challenging scenarios. By integrating these advancements, we introduce a new network for 3D medical image segmentation, positioning Mamba as a transformative force that outperforms leading models such as nnUNet, CoTr, and U-Mamba, offering competitive accuracy with superior computational efficiency. This study provides key insights into Mamba's unique advantages, paving the way for more efficient and accurate approaches to 3D medical imaging.

Zero-shot Domain Generalization of Foundational Models for 3D Medical Image Segmentation: An Experimental Study

Domain shift, caused by variations in imaging modalities and acquisition protocols, limits model generalization in medical image segmentation. While foundation models (FMs) trained on diverse large-scale data hold promise for zero-shot generalization, their application to volumetric medical data remains underexplored. In this study, we examine their ability towards domain generalization (DG), by conducting a comprehensive experimental study encompassing 6 medical segmentation FMs and 12 public datasets spanning multiple modalities and anatomies. Our findings reveal the potential of promptable FMs in bridging the domain gap via smart prompting techniques. Additionally, by probing into multiple facets of zero-shot DG, we offer valuable insights into the viability of FMs for DG and identify promising avenues for future research.

DBF-UNet: A Two-Stage Framework for Carotid Artery Segmentation with Pseudo-Label Generation

Medical image analysis faces significant challenges due to limited annotation data, particularly in three-dimensional carotid artery segmentation tasks, where existing datasets exhibit spatially discontinuous slice annotations with only a small portion of expert-labeled slices in complete 3D volumetric data. To address this challenge, we propose a two-stage segmentation framework. First, we construct continuous vessel centerlines by interpolating between annotated slice centroids and propagate labels along these centerlines to generate interpolated annotations for unlabeled slices. The slices with expert annotations are used for fine-tuning SAM-Med2D, while the interpolated labels on unlabeled slices serve as prompts to guide segmentation during inference. In the second stage, we propose a novel Dense Bidirectional Feature Fusion UNet (DBF-UNet). This lightweight architecture achieves precise segmentation of complete 3D vascular structures. The network incorporates bidirectional feature fusion in the encoder and integrates multi-scale feature aggregation with dense connectivity for effective feature reuse. Experimental validation on public datasets demonstrates that our proposed method effectively addresses the sparse annotation challenge in carotid artery segmentation while achieving superior performance compared to existing approaches. The source code is available at https://github.com/Haoxuanli-Thu/DBF-UNet.

3D Convolutional Neural Networks for Improved Detection of Intracranial bleeding in CT Imaging

Background: Intracranial bleeding (IB) is a life-threatening condition caused by traumatic brain injuries, including epidural, subdural, subarachnoid, and intraparenchymal hemorrhages. Rapid and accurate detection is crucial to prevent severe complications. Traditional imaging can be slow and prone to variability, especially in high-pressure scenarios. Artificial Intelligence (AI) provides a solution by quickly analyzing medical images, identifying subtle hemorrhages, and flagging urgent cases. By enhancing diagnostic speed and accuracy, AI improves workflows and patient care. This article explores AI's role in transforming IB detection in emergency settings. Methods: A U-shaped 3D Convolutional Neural Network (CNN) automates IB detection and classification in volumetric CT scans. Advanced preprocessing, including CLAHE and intensity normalization, enhances image quality. The architecture preserves spatial and contextual details for precise segmentation. A dataset of 2,912 annotated CT scans was used for training and evaluation. Results: The model achieved high performance across major bleed types, with precision, recall, and accuracy exceeding 90 percent in most cases 96 percent precision for epidural hemorrhages and 94 percent accuracy for subarachnoid hemorrhages. Its ability to classify and localize hemorrhages highlights its clinical reliability. Conclusion: This U-shaped 3D CNN offers a scalable solution for automating IB detection, reducing diagnostic delays, and improving emergency care outcomes. Future work will expand dataset diversity, optimize real-time processing, and integrate multimodal data for enhanced clinical applicability.