Inference-Time Orthogonal Seeding Enables Geometry-Aligned 3D Organ Segmentation for Slice-Propagation Methods
Authors: Md Rakibul Haque, Tushar Kataria, Shireen Y. Elhabian
Organizations: Kahlert School of Computing, University of Utah, Salt Lake City, USA · Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, USA
Dense voxel-level annotation remains a major bottleneck in 3D medical image segmentation. Single-slice propagation methods such as Sli2Vol reduce this burden by propagating one annotated seed slice through a volume using label-free registration. However, axial-only propagation accumulates errors with distance from the seed, especially in surface-distance metrics, because it ignores coronal and sagittal evidence and therefore underuses the 3D information available in CT/MRI volumes. To better leverage volumetric geometry, we study how key training and inference choices affect slice-propagation models, including single-axis versus multi-axis label-free registration, single-seed versus multi-seed propagation, and orthogonal seed configurations. Instead of propagating from a single axial seed, we use three orthogonal seeds---one axial, one coronal, and one sagittal---and fuse their propagated labels with a simple label-free rule. Our results show that the training paradigm has limited impact: an axially trained network applied to off-axis seeds captures nearly all the improvement, while explicit three-axis training adds little. Instead, performance is driven by inference-time seed geometry, especially orthogonality rather than the number of annotated slices, as a budget-matched three-axial control provides no benefit and can even degrade performance. On a multi-organ CT cohort, orthogonal seeding with the axial Sli2Vol backbone improves Dice by 21.9%, Normalized Surface Dice by 25.5%, and reduces Average Hausdorff Distance by 53.5% over the single-axis baseline.
Medical image segmentation models typically rely on large amounts of densely annotated volumetric data, limiting their scalability across tasks and imaging modalities. This work addresses the challenge of predicting entire 3D anatomical structures from extreme annotation sparsity. An annotation-efficient student-teacher framework is proposed for automatic 3D medical segmentation that requires only a set of point prompts on a single 2D slice per volume, as input. A foundation model serves as an offline teacher, utilizing the provided point prompts from the selected slice to full-volume pseudo-annotations alongside their corresponding spatial confidence scores prior to student training. To mitigate the error propagation of noisy pseudo-annotations, a task-specific 3D student network is trained using a confidence-aware optimization strategy. By leveraging the teacher's pre-computed confidence scores, this strategy explicitly excludes statically uncertain regions of the pseudo-annotations from the loss calculation, while simultaneously emphasizing regions with higher confidence. Evaluated on 3D cardiac MRI datasets, our framework outperforms state-of-the-art semi-supervised methods, improving segmentation performance by up to 43.6%. Furthermore, it drastically reduces the manual annotation burden to just a few positive point prompts per volume, while improving surface boundary precision by up to 14.7% over the teacher and successfully recovering up to 34.1% of the performance gap toward the fully supervised upper bound.
Volumetric segmentation of optical coherence tomography (OCT) images is essential for diagnosing ocular diseases but requires labor-intensive voxel-wise annotations. While semi-supervised learning (SSL) can reduce annotation costs, most existing methods process data slice by slice and fail to exploit the inherent 3D spatial context. We propose PC-Seg, a progressive cross-view consistency framework that learns high-accuracy 3D segmentation models from sparse 2D annotations. Unlike conventional multi-view approaches, PC-Seg uses a single 2D model to learn cross-view consistency from standard B-scans and orthogonal slices, thereby generating reliable volumetric pseudo-labels. These pseudo-labels are then distilled into a 3D model, followed by a co-training stage in which the 2D and 3D models mutually refine each other through ensemble pseudo-labeling. Experiments on the MSHC and Duke DME datasets demonstrate that PC-Seg achieves accuracy comparable to fully supervised learning while using labels for only about 0.7% of the training data, outperforming state-of-the-art semi-supervised and retinal layer segmentation methods. Our code is publicly available at https://github.com/gsisaoki/pc-seg-official.
The release of public 3D medical image segmentation (MIS) datasets accelerates clinical research but simultaneously heightens risks of unauthorized AI model training. While Unlearnable Examples (UE) offer protection by injecting imperceptible perturbations to prevent effective model learning, existing methods primarily target 2D scenarios. They neglect the volumetric spatial correlations and inter-slice anatomical consistency inherent in 3D medical volumes, which serve as critical learning priors for 3D segmentation networks. To bridge this gap, we propose VoxShield, a UE framework that explicitly targets the volumetric inductive biases of 3D networks. Our core insight is that by systematically dismantling the cross-slice continuity that 3D architectures rely on, we can fundamentally impair their spatial aggregation process. Specifically, we introduce an Inter-Slice Frequency Consistency Disruption mechanism that maximizes the spectral divergence between adjacent slices, injecting structural incoherence along the z-axis. Complementing this structural attack, a Semantic Prediction Disruption module is incorporated. By maximizing the ℓ1 divergence between clean and perturbed logits, it forces the injected noise to penetrate the entire network and corrupt the final semantic mapping. Experiments on BraTS19 and FLARE21 demonstrate that VoxShield successfully degrades 3D segmentation performance, reducing the DSC from 80.0% to near 0.0% and from 88.6% to 6.8%, respectively. All protections are achieved with minimal perturbation (ε=4/255) to preserve high visual fidelity. The code is available at https://github.com/KK266299/VoxShield.