Existing methods for adapting 2D foundation models such as SAM to 3D volumes either process slices independently---ignoring inter-slice context---or require substantial architectural changes and retraining. In this paper, we present \textbf{SAM+D}, a parameter-efficient framework that lifts SAM-family models by one spatial dimension---enabling 3D volumetric segmentation from 2D SAM and, for the first time via parameter-efficient fine-tuning, end-to-end 4D (3D+T) spatiotemporal segmentation from video-based SAM2---while keeping the vast majority of pre-trained parameters frozen. SAM+D introduces two lightweight, model-agnostic modules into frozen transformer blocks: (1)\textbf{Depth-Routed LoRA (DRLoRA)} experts with learned routing for spatially adaptive low-rank updates, and (2)\textbf{Depth Shift Modules (DSM)} for cross-slice feature exchange at zero additional parameter cost. Together, they provide volume-level context while tuning only ∼2.8% of parameters for SAM and ∼3.7% for SAM2. We evaluate SAM+D in two distinct settings, each lifting the base model by one spatial dimension: 3D segmentation, where SAM(2D→3D) is evaluated on four CT benchmarks (KiTS, Pancreas, LiTS, Colon), and 4D segmentation, where SAM2 (2D+T→3D+T) is evaluated on a cell tracking challenge (CTC) dataset (Fluo-N3DH-SIM+). In both settings SAM+D achieves competitive or superior results under the single-point prompt setting while using fewer trainable parameters than existing methods, demonstrating that SAM+D generalizes across SAM-family architectures, target dimensionalities (3D, 4D), and domains spanning medical imaging and bio-scene understanding. Code is publicly available at https://github.com/JerrySongCST/SAM-Plus-D.
Efficient surgical segmentation empowers clinical diagnosis, intraoperative monitoring, and downstream robotic pipelines for reconstruction and simulation. Although prompt-driven foundation models like Segment Anything Model 3 (SAM3) achieve strong segmentation performance on natural images, surgical data exhibits domain gaps against its pre-training data, resulting in degraded segmentation accuracy. Furthermore, existing medical SAM methods require full-parameter fine-tuning, incurring heavy computational consumption and low efficiency. To address these limitations, this work proposes a parameter-efficient Low-Rank Adaptation (LoRA) adaptation of SAM3 for surgical concept segmentation. We inject low-rank adapters into the prompt encoder, detector and tracker while fully freezing the vision backbone, which only optimizes 0.98% of the total model parameters and supports training on a single consumer GPU. Comprehensive experiments demonstrate that our method consistently outperforms zero-shot SAM3 and other mainstream baselines, and the generated segmentation results can be directly deployed to support downstream robotic surgical scene reconstruction and physical simulation pipelines.
Four-dimensional computed tomography (4DCT) captures the full respiratory cycle of thoracic anatomy, yet current Internal Target Volume contouring workflows process each phase in isolation, discarding temporal coherence and leaving contours vulnerable to phase-specific artifacts. We present a lightweight framework that applies parameter-efficient fine-tuning to the Segment Anything Model 3 (SAM 3) via low-rank adaptation (LoRA) to align its text-prompted segmentation with the medical domain using only seven annotated 3D CT volumes. Furthermore, the framework incorporates a hard negative mining strategy to improve boundary discrimination in low-contrast thoracic regions. At inference, phase-wise predictions are refined through phase-coherent temporal filtering and spatial connectivity analysis. Since respiratory motion is continuous and periodic, genuine anatomy appears in contiguous blocks of phases, whereas transient artifacts appear sporadically and are thus effectively suppressed. Experiments on pulmonary and cardiac structures yield median Dice scores of 0.968 and 0.910 with 95th-percentile Hausdorff distances of 0.998 mm and 2.931 mm, respectively. The proposed framework effectively eliminates the severe false-positive predictions inherent in the zero-shot inference of the unadapted SAM 3. With only seven annotated volumes, the framework retains over 95% of full-data accuracy, and the entire pipeline is trainable on a single consumer-grade GPU, demonstrating a scalable, data-efficient solution for adaptive radiotherapy.
Large segmentation foundation models such as the Segment Anything Model (SAM) have reshaped promptable segmentation in natural images, and recent efforts have extended these models to medical images and volumetric settings. However, directly transferring a 3D SAM-style model to lesion segmentation remains challenging due to (i) weak spatial representational capacity for small, irregular targets in intermediate features, and (ii) extreme foreground-background imbalance in 3D volumes.We propose SGP-SAM, a self-gated prompting framework for efficient and effective transfer to 3D lesion segmentation. Our key component, the Self-Gated Prompting Module (SGPM), performs conditional multi-scale spatial enhancement: a lightweight multi-channel gating unit predicts whether the current features require additional multi-scale fusion, and only then activates a Multi-Scale Feature Fusion Block to enrich spatial context. To further address small-lesion learning, we design a Zoom Loss that up-weights lesion-focused supervision by combining Dice and a voxel-balanced focal term.Experiments on MSD Liver Tumor and MSD Brain Tumor (enhancing tumor) show consistent gains over strong transfer baselines based on SAM-Med3D. On MSD Liver Tumor, SGP-SAM improves mDice by 7.3% over fine-tuning.