Weakly-Supervised Lung Nodule Segmentation via Training-Free Guidance of 3D Rectified Flow

Low dose Computed Tomography (CT) is the standard imaging modality for lung cancer screening. On CT scans, lung cancer typically manifests as pulmonary nodules, whose manual identification is time-consuming and prone to observer variability, image quality limitations, and suboptimal reading conditions. Moreover, subtle temporal changes are often difficult to quantify reliably in CT scans from the same patient across follow-up examinations. Deep learning-based approaches for the automatic detection and segmentation of lung nodules have demonstrated improved accuracy and efficiency. However, most existing approaches provide only coarse region-of-interest localisation, rely on prior lesion annotations or human supervision, or treat detection and segmentation as separate tasks. In this work, we present NoduleFlow, a framework for lung nodule detection, classification, and segmentation directly from series of CT volumes. Our proposal consists of four interconnected modules and operates in an automated manner at inference time, without requiring prior lesion annotations, manual initialisation, or region-of-interest pre-selection. We further investigate whether nodule localization benefits from the propagation of candidate regions across follow-up scans through inter-scan registration fields, as opposed to conventional independent per-scan analysis. The generalisability of the framework is systematically evaluated across four independent datasets. The results underscore the potential of automated pipelines for lung nodule analysis in screening and diagnostic settings.

Medical experts often manually segment images to obtain diagnostic statistics and discard the resulting annotations. We aim to train segmentation models to alleviate this burden, but constrained to the retained summary statistics (e.g., the area of the annotated region). Empirical results suggest that statistics alone are insufficient for this task, but adding weak information in the form of a few pixels within the area of interest significantly improves performance. We use a novel loss function that combines terms for image reconstruction quality, matching to summary statistics, and overlap between the predicted foreground and the weak supervisory signal. Experiments on standard image, ultrasound (breast cancer), and Computed Tomography (CT) scan (kidney tumors) data demonstrate the utility and potential of the approach.

We present Rewis3d, a framework that leverages recent advances in feed-forward 3D reconstruction to significantly improve weakly supervised semantic segmentation on 2D images. Obtaining dense, pixel-level annotations remains a costly bottleneck for training segmentation models. Alleviating this issue, sparse annotations offer an efficient weakly-supervised alternative. However, they still incur a performance gap. To address this, we introduce a novel approach that leverages 3D scene reconstruction as an auxiliary supervisory signal. Our key insight is that 3D geometric structure recovered from 2D videos provides strong cues that can propagate sparse annotations across entire scenes. Specifically, a dual student-teacher architecture enforces semantic consistency between 2D images and reconstructed 3D point clouds, using state-of-the-art feed-forward reconstruction to generate reliable geometric supervision. Extensive experiments demonstrate that Rewis3d achieves state-of-the-art performance in sparse supervision, outperforming existing approaches by 2-7% without requiring additional labels or inference overhead.