A Multi-Stage Fine-Tuning and Ensembling Strategy for Pancreatic Tumor Segmentation in Diagnostic and Therapeutic MRI

Automated segmentation of Pancreatic Ductal Adenocarcinoma (PDAC) from MRI is critical for clinical workflows but is hindered by poor tumor-tissue contrast and a scarcity of annotated data. This paper details our submission to the PANTHER challenge, addressing both diagnostic T1-weighted (Task 1) and therapeutic T2-weighted (Task 2) segmentation. Our approach is built upon the nnU-Net framework and leverages a deep, multi-stage cascaded pre-training strategy, starting from a general anatomical foundation model and sequentially fine-tuning on CT pancreatic lesion datasets and the target MRI modalities. Through extensive five-fold cross-validation, we systematically evaluated data augmentation schemes and training schedules. Our analysis revealed a critical trade-off, where aggressive data augmentation produced the highest volumetric accuracy, while default augmentations yielded superior boundary precision (achieving a state-of-the-art MASD of 5.46 mm and HD95 of 17.33 mm for Task 1). For our final submission, we exploited this finding by constructing custom, heterogeneous ensembles of specialist models, essentially creating a mix of experts. This metric-aware ensembling strategy proved highly effective, achieving a top cross-validation Tumor Dice score of 0.661 for Task 1 and 0.523 for Task 2. Our work presents a robust methodology for developing specialized, high-performance models in the context of limited data and complex medical imaging tasks (Team MIC-DKFZ).

JanusNet: Hierarchical Slice-Block Shuffle and Displacement for Semi-Supervised 3D Multi-Organ Segmentation

Limited by the scarcity of training samples and annotations, weakly supervised medical image segmentation often employs data augmentation to increase data diversity, while randomly mixing volumetric blocks has demonstrated strong performance. However, this approach disrupts the inherent anatomical continuity of 3D medical images along orthogonal axes, leading to severe structural inconsistencies and insufficient training in challenging regions, such as small-sized organs, etc. To better comply with and utilize human anatomical information, we propose JanusNet}, a data augmentation framework for 3D medical data that globally models anatomical continuity while locally focusing on hard-to-segment regions. Specifically, our Slice-Block Shuffle step performs aligned shuffling of same-index slice blocks across volumes along a random axis, while preserving the anatomical context on planes perpendicular to the perturbation axis. Concurrently, the Confidence-Guided Displacement step uses prediction reliability to replace blocks within each slice, amplifying signals from difficult areas. This dual-stage, axis-aligned framework is plug-and-play, requiring minimal code changes for most teacher-student schemes. Extensive experiments on the Synapse and AMOS datasets demonstrate that JanusNet significantly surpasses state-of-the-art methods, achieving, for instance, a 4% DSC gain on the Synapse dataset with only 20% labeled data.

ReXGroundingCT: A 3D Chest CT Dataset for Segmentation of Findings from Free-Text Reports

We present ReXGroundingCT, the first publicly available dataset to link free-text radiology findings with pixel-level segmentations in 3D chest CT scans that is manually annotated. While prior datasets have relied on structured labels or predefined categories, ReXGroundingCT captures the full expressiveness of clinical language represented in free text and grounds it to spatially localized 3D segmentation annotations in volumetric imaging. This addresses a critical gap in medical AI: the ability to connect complex, descriptive text, such as "3 mm nodule in the left lower lobe", to its precise anatomical location in three-dimensional space, a capability essential for grounded radiology report generation systems. The dataset comprises 3,142 non-contrast chest CT scans paired with standardized radiology reports from the CT-RATE dataset. Using a systematic three-stage pipeline, GPT-4 was used to extract positive lung and pleural findings, which were then manually segmented by expert annotators. A total of 8,028 findings across 16,301 entities were annotated, with quality control performed by board-certified radiologists. Approximately 79% of findings are focal abnormalities, while 21% are non-focal. The training set includes up to three representative segmentations per finding, while the validation and test sets contain exhaustive labels for each finding entity. ReXGroundingCT establishes a new benchmark for developing and evaluating sentence-level grounding and free-text medical segmentation models in chest CT. The dataset can be accessed at https://huggingface.co/datasets/rajpurkarlab/ReXGroundingCT.

M-Net: MRI Brain Tumor Sequential Segmentation Network via Mesh-Cast

MRI tumor segmentation remains a critical challenge in medical imaging, where volumetric analysis faces unique computational demands due to the complexity of 3D data. The spatially sequential arrangement of adjacent MRI slices provides valuable information that enhances segmentation continuity and accuracy, yet this characteristic remains underutilized in many existing models. The spatial correlations between adjacent MRI slices can be regarded as "temporal-like" data, similar to frame sequences in video segmentation tasks. To bridge this gap, we propose M-Net, a flexible framework specifically designed for sequential image segmentation. M-Net introduces the novel Mesh-Cast mechanism, which seamlessly integrates arbitrary sequential models into the processing of both channel and temporal information, thereby systematically capturing the inherent "temporal-like" spatial correlations between MRI slices. Additionally, we define an MRI sequential input pattern and design a Two-Phase Sequential (TPS) training strategy, which first focuses on learning common patterns across sequences before refining slice-specific feature extraction. This approach leverages temporal modeling techniques to preserve volumetric contextual information while avoiding the high computational cost of full 3D convolutions, thereby enhancing the generalizability and robustness of M-Net in sequential segmentation tasks. Experiments on the BraTS2019 and BraTS2023 datasets demonstrate that M-Net outperforms existing methods across all key metrics, establishing itself as a robust solution for temporally-aware MRI tumor segmentation.

Content-based 3D Image Retrieval and a ColBERT-inspired Re-ranking for Tumor Flagging and Staging

The increasing volume of medical images poses challenges for radiologists in retrieving relevant cases. Content-based image retrieval (CBIR) systems offer potential for efficient access to similar cases, yet lack standardized evaluation and comprehensive studies. Building on prior studies for tumor characterization via CBIR, this study advances CBIR research for volumetric medical images through three key contributions: (1) a framework eliminating reliance on pre-segmented data and organ-specific datasets, aligning with large and unstructured image archiving systems, i.e. PACS in clinical practice; (2) introduction of C-MIR, a novel volumetric re-ranking method adapting ColBERT's contextualized late interaction mechanism for 3D medical imaging; (3) comprehensive evaluation across four tumor sites using three feature extractors and three database configurations. Our evaluations highlight the significant advantages of C-MIR. We demonstrate the successful adaptation of the late interaction principle to volumetric medical images, enabling effective context-aware re-ranking. A key finding is C-MIR's ability to effectively localize the region of interest, eliminating the need for pre-segmentation of datasets and offering a computationally efficient alternative to systems relying on expensive data enrichment steps. C-MIR demonstrates promising improvements in tumor flagging, achieving improved performance, particularly for colon and lung tumors (p<0.05). C-MIR also shows potential for improving tumor staging, warranting further exploration of its capabilities. Ultimately, our work seeks to bridge the gap between advanced retrieval techniques and their practical applications in healthcare, paving the way for improved diagnostic processes.

RAPS-3D: Efficient interactive segmentation for 3D radiological imaging

Promptable segmentation, introduced by the Segment Anything Model (SAM), is a promising approach for medical imaging, as it enables clinicians to guide and refine model predictions interactively. However, SAM's architecture is designed for 2D images and does not extend naturally to 3D volumetric data such as CT or MRI scans. Adapting 2D models to 3D typically involves autoregressive strategies, where predictions are propagated slice by slice, resulting in increased inference complexity. Processing large 3D volumes also requires significant computational resources, often leading existing 3D methods to also adopt complex strategies like sliding-window inference to manage memory usage, at the cost of longer inference times and greater implementation complexity. In this paper, we present a simplified 3D promptable segmentation method, inspired by SegVol, designed to reduce inference time and eliminate prompt management complexities associated with sliding windows while achieving state-of-the-art performance.

SWDL: Stratum-Wise Difference Learning with Deep Laplacian Pyramid for Semi-Supervised 3D Intracranial Hemorrhage Segmentation

Recent advances in medical imaging have established deep learning-based segmentation as the predominant approach, though it typically requires large amounts of manually annotated data. However, obtaining annotations for intracranial hemorrhage (ICH) remains particularly challenging due to the tedious and costly labeling process. Semi-supervised learning (SSL) has emerged as a promising solution to address the scarcity of labeled data, especially in volumetric medical image segmentation. Unlike conventional SSL methods that primarily focus on high-confidence pseudo-labels or consistency regularization, we propose SWDL-Net, a novel SSL framework that exploits the complementary advantages of Laplacian pyramid and deep convolutional upsampling. The Laplacian pyramid excels at edge sharpening, while deep convolutions enhance detail precision through flexible feature mapping. Our framework achieves superior segmentation of lesion details and boundaries through a difference learning mechanism that effectively integrates these complementary approaches. Extensive experiments on a 271-case ICH dataset and public benchmarks demonstrate that SWDL-Net outperforms current state-of-the-art methods in scenarios with only 2% labeled data. Additional evaluations on the publicly available Brain Hemorrhage Segmentation Dataset (BHSD) with 5% labeled data further confirm the superiority of our approach. Code and data have been released at https://github.com/SIAT-CT-LAB/SWDL.

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.

TK-Mamba: Marrying KAN with Mamba for Text-Driven 3D Medical Image Segmentation

3D medical image segmentation is vital for clinical diagnosis and treatment but is challenged by high-dimensional data and complex spatial dependencies. Traditional single-modality networks, such as CNNs and Transformers, are often limited by computational inefficiency and constrained contextual modeling in 3D settings. We introduce a novel multimodal framework that leverages Mamba and Kolmogorov-Arnold Networks (KAN) as an efficient backbone for long-sequence modeling. Our approach features three key innovations: First, an EGSC (Enhanced Gated Spatial Convolution) module captures spatial information when unfolding 3D images into 1D sequences. Second, we extend Group-Rational KAN (GR-KAN), a Kolmogorov-Arnold Networks variant with rational basis functions, into 3D-Group-Rational KAN (3D-GR-KAN) for 3D medical imaging - its first application in this domain - enabling superior feature representation tailored to volumetric data. Third, a dual-branch text-driven strategy leverages CLIP's text embeddings: one branch swaps one-hot labels for semantic vectors to preserve inter-organ semantic relationships, while the other aligns images with detailed organ descriptions to enhance semantic alignment. Experiments on the Medical Segmentation Decathlon (MSD) and KiTS23 datasets show our method achieving state-of-the-art performance, surpassing existing approaches in accuracy and efficiency. This work highlights the power of combining advanced sequence modeling, extended network architectures, and vision-language synergy to push forward 3D medical image segmentation, delivering a scalable solution for clinical use. The source code is openly available at https://github.com/yhy-whu/TK-Mamba.