Clore: Interactive Pathology Image Segmentation with Click-based Local Refinement

Interactive image segmentation is critical for efficient image annotation; however, existing methods often require many corrective clicks or rely on passive refinement schemes that converge slowly. We propose Uncertainty-Guided Cascade Forward Refinement (U-CFR), a novel inference-time framework that enables models to autonomously self-correct after each user interaction. U-CFR introduces a boundary-aware uncertainty score that fuses segmentation uncertainty, contour gradients, and explicit edge predictions to guide the placement of internal pseudo-clicks. These self-generated clicks target the most ambiguous boundary regions, providing strong corrective signals without additional manual input. To support this process, we design a dual-head network with a shared encoder-decoder backbone: a segmentation head ensures region consistency, while an edge head sharpens boundary alignment. In inference, U-CFR launches a cascade of refinement steps, where each stage leverages the uncertainty-driven pseudo-clicks to refine the mask progressively. Experiments on standard benchmark datasets demonstrate that the proposed U-CFR improves click efficiency, initial mask quality, and boundary accuracy. It reduces the required clicks by over 10% on challenging datasets like Berkeley and offers a more intelligent and efficient interactive annotation.

Interactive deep image segmentation enables efficient medical image annotation by iteratively refining predictions from user prompts, such as positive and negative clicks. Recent patch-based methods, including nnInteractive, achieve strong segmentation performance but remain limited in annotation workflows by high interaction latency, limited responsiveness to successive interactions, and the lack of support for reversible prompting. Furthermore, evaluation relies predominantly on simulated rather than controlled real-user interaction studies. We present SLIP, an end-to-end trainable framework for interactive 3D medical image segmentation that decouples image encoding from prompt-guided refinement. Image features are computed once and reused, while a lightweight patch memory bank maintains an interaction-aware segmentation state shared across patches. This representation enables prediction updates by propagating interaction context throughout the image, supports reversible prompting without recomputing image features, and substantially reduces interaction latency. By separating image representation from interactive reasoning, SLIP remains compatible with a wide range of image encoders. We train a single SLIP model for general interactive segmentation across diverse anatomical structures and imaging modalities. Beyond standard simulated evaluation, we conduct a controlled prospective user study comparing manual segmentation, nnInteractive, and SLIP across three clinical annotation tasks, six expert participants, and subjective usability measures, addressing the limited human validation of interactive segmentation methods. SLIP achieves SOTA interactive segmentation performance across 13 public datasets while providing lower interaction latency, greater responsiveness, support for reversible prompting, and higher user preference than existing approaches.

Interactive segmentation aims to precisely isolate target objects using sparse user guidance. However, traditional methods often suffer from heavy interaction burdens and parameter sensitivity, while deep learning approaches struggle with data dependency and iterative instability. Motivated by these limitations, we propose the Sustainable Interactive Level Set Method (SILSM). The proposed level set evolution equation incorporates interaction, regularization, and segmentation terms. Specifically, high-order regularization is employed to maintain numerical stability, and unlike traditional methods, we decouple user guidance into an independent interaction term to enable direct manual control over the zero-level set evolution. Furthermore, we develop a numerical algorithm tailored for multiple interactions, which facilitates dynamic refinement by effectively updating the segmentation results based on sequential user inputs. We theoretically demonstrate that the high-order term provides stronger regularization constraints than the conventional length term, while the interaction term ensures segmentation strictly within the user-selected region. Experimental results further demonstrate that the proposed method is robust to interactive inputs, achieves competitive performance at the first interaction, and supports stable multi-round interactions with progressively improved segmentation quality.