RPG-SAM: Reliability-Weighted Prototypes and Geometric Adaptive Threshold Selection for Training-Free One-Shot Polyp Segmentation

Few-shot medical image segmentation (FSMIS) has achieved notable progress, yet most existing methods mainly rely on semantic correspondences from scarce annotations while under-utilizing a key property of medical imagery: anatomical targets exhibit repeatable high-frequency morphology (e.g., boundary geometry and spatial layout) across patients and acquisitions. We propose RAP, a training-free framework that retrieves, adapts, and prompts Segment Anything Model 2 (SAM2) for FSMIS. First, RAP retrieves morphologically compatible supports from an archive using DINOv3 features to reduce brittleness in single-support choice. Second, it adapts the retrieved support mask to the query by fitting boundary-aware structural cues, yielding an anatomy-consistent pre-mask under domain shifts. Third, RAP converts the pre-mask into prompts by sampling positive points via Voronoi partitioning and negative points via sector-based sampling, and feeds them into SAM2 for final refinement without any fine-tuning. Extensive experiments on multiple medical segmentation benchmarks show that RAP consistently surpasses prior FSMIS baselines and achieves state-of-the-art performance. Overall, RAP demonstrates that explicit structural fitting combined with retrieval-augmented prompting offers a simple and effective route to robust training-free few-shot medical segmentation.

Automated polyp segmentation is critical for early colorectal cancer detection and its prevention, yet remains challenging due to weak boundaries, large appearance variations, and limited annotated data. Lightweight segmentation models such as U-Net, U-Net++, and PraNet offer practical efficiency for clinical deployment but struggle to capture the rich semantic and structural cues required for accurate delineation of complex polyp regions. In contrast, large Vision Foundation Models (VFMs), including SAM, OneFormer, Mask2Former, and DINOv2, exhibit strong generalization but transfer poorly to polyp segmentation due to domain mismatch, insufficient boundary sensitivity, and high computational cost. To bridge this gap, we propose LiteBounD, a Lightweight Boundary-guided Distillation framework that transfers complementary semantic and structural priors from multiple VFMs into compact segmentation backbones. LiteBounD introduces (i) a dual-path distillation mechanism that disentangles semantic and boundary-aware representations, (ii) a frequency-aware alignment strategy that supervises low-frequency global semantics and high-frequency boundary details separately, and (iii) a boundary-aware decoder that fuses multi-scale encoder features with distilled semantically rich boundary information for precise segmentation. Extensive experiments on both seen (Kvasir-SEG, CVC-ClinicDB) and unseen (ColonDB, CVC-300, ETIS) datasets demonstrate that LiteBounD consistently outperforms its lightweight baselines by a significant margin and achieves performance competitive with state-of-the-art methods, while maintaining the efficiency required for real-time clinical use. Our code is available at https://github.com/lostinrepo/LiteBounD.

Medical image segmentation remains difficult to scale because high-performing methods typically rely on dense expert annotations and task-specific training. We introduce GazeRefine, a training-free framework that uses gaze as an inference-time prompt for zero-shot medical image segmentation. Sparse, duration-weighted fixations are converted into foreground and background priors that initialize semantic prototypes in frozen DINOv3 feature space. These prototypes are iteratively refined through foreground-background discrimination, feature-space affinity propagation, and anchoring to the initial gaze guidance, allowing segmentation to extend beyond directly fixated regions while limiting semantic drift. GazeRefine requires no segmentation masks, fine-tuning, adapters, prompt encoders, or gradient updates. We evaluate the method on gaze-annotated polyp segmentation and prostate MRI segmentation. The results show strong performance on colonoscopy images and competitive performance on prostate MRI, supporting gaze-guided prototype refinement as a promising approach for segmentation-label-efficient, human-in-the-loop medical image segmentation. Our tools and code can be found in the following repository: https://github.com/MohammedOussamaBEN/GazeRefine.git