Medical Image Segmentation

Slot attention is a powerful framework for object-centric learning, decomposing visual scenes into latent slots through iterative competitive attention. However, existing methods share two critical limitations: they decompose scenes into a flat set of slots at a single granularity, and this decomposition is based on appearance rather than semantics. Yet humans understand scenes through semantic hierarchies: separating foreground from background, recognizing object categories, and identifying individual instances. Crucially, such semantic hierarchies cannot emerge without supervision, because category names are human constructs, not visual patterns. We propose Hierarchical Slot Attention (HSA), which learns multi-granularity semantic scene decomposition from a single model. HSA decomposes scenes at three levels: holistic (foreground/background), semantic (object categories), and panoptic (individual instances). Using only 10% labeled data, combined with hierarchical alignment loss, HSA learns all three levels jointly. We further introduce grouping purity and containment to measure whether the hierarchy is encoded in representation space, not just output masks. Experiments on COCO and PASCAL VOC demonstrate that HSA outperforms the strongest flat baseline by up to \textbf{$+$41.5} ARI at holistic, \textbf{$+$14.6} at semantic, and \textbf{$+$10.4} at panoptic level on COCO, with even larger gains on Pascal VOC, while requiring a single model instead of three. Code will be made available upon acceptance.

Whole slide images (WSIs) provide rich diagnostic information for computational pathology, but their gigapixel scale, stain variation, scanner differences, tissue artifacts, and limited expert annotation make robust model training challenging. This paper presents a multi-source Masked Autoencoder (MAE) framework, named ProsMAE, for histopathology representation learning. Tiles from Prostate cANcer graDe Assessment (PANDA), CAncer MEtastases in LYmph nOdes challeNge 2017 (CAMELYON17), and BReAst Carcinoma Subtyping (BRACS) are used for ProsMAE pretraining to expose the encoder to diverse tissue morphology and acquisition conditions. The learned encoder is transferred for International Society of Urological Pathology (ISUP) grade classification through ProsCLS, using a frozen encoder and a linear classification head. ProsMAE achieved a higher mean validation quadratic weighted kappa (QWK) than the vanilla MAE frozen linear-probe baseline under the evaluated disjoint PANDA split. Repeated-split evaluation remains necessary to further establish robustness across split compositions.

LiDAR semantic segmentation is a key perception task in autonomous driving, where false predictions can affect downstream planning and safety-critical decision-making. Although adversarial attacks, and specifically adversarial examples, have been widely studied for image classification and 3D point cloud segmentation, unrestricted adversarial examples remain largely unexplored in the space of 2D range images, which are projections of 3D point clouds. The proposed method is, to the best of our knowledge, the first diffusion-based unrestricted adversarial attack against 2D range-image segmentation, using adversarial guidance from a segmentation loss. By applying guidance directly during sampling, the method produces unrestricted adversarial examples that remain close to the learned LiDAR data manifold while inducing structured segmentation errors. Experiments on the SemanticKITTI dataset using RangeNet++ and CENet segmentation networks demonstrate that the attack provides adjustable degradation across guidance strengths and transfers across segmentation architectures. Compared with norm-bounded FGSM and SegPGD baselines, the proposed attack offers a distinct effectiveness-realism trade-off, achieving controllable white-box and transfer degradation while maintaining competitive distributional and visual realism.

Semi-supervised 3D medical image segmentation reduces the need for dense voxel-level annotations by exploiting unlabeled volumes. Although existing methods such as consistency regularization, pseudo-labeling, and co-training improve prediction-level robustness, they often provide insufficient feature-space organization for anatomically complex structures, especially small organs and ambiguous boundary regions with large intra-class variations. To address this issue, we propose Variation-Conditioned Distributional Proxy Learning (VCDP), a plug-and-play training-only regularization module for semi-supervised 3D medical image segmentation. VCDP represents each class with a learnable Gaussian distribution for shared class semantics and multiple variation prototypes for fine-grained intra-class patterns. A unified variation-conditioned compatibility score is further formulated to fuse distributional similarity and soft variation aggregation, guiding voxel embeddings to align with both global organ identity and local anatomical variations. VCDP is attached to decoder features during training and removed during inference, introducing no additional inference cost. Experiments on multi-organ segmentation benchmarks show that VCDP improves most evaluated baselines, particularly for small, ambiguous, and highly variable organs. Our anonymous code is released at https://anonymous.4open.science/r/VCDP_code-41ED.

Medical image segmentation models can achieve strong benchmark performance while remaining sensitive to scanner, protocol, and institutional variation. These context shifts alter image appearance without changing the underlying lesion, allowing models to exploit nuisance cues that Dice and HD95 fail to expose. We present TRACE-Seg3D, a counterfactual context auditing framework for robust 3D medical image segmentation. TRACE-Seg3D preserves lesion-relevant evidence and systematically varies imaging context to quantify prediction stability under controlled context shifts. The framework pairs each segmentation with audit evidence for context sensitivity and anatomical plausibility, enabling case-level reliability assessment beyond overlap-based evaluation. Experiments on BraTS and UTSW glioma segmentation benchmarks demonstrate competitive in-distribution and cross-domain performance. TRACE-Seg3D also exposes context-sensitive failure modes missed by conventional metrics. These results establish counterfactual context auditing as a practical route toward transparent and reliable 3D medical image segmentation under distribution shift. Our code is available at https://github.com/danleneurocom/Counterfactual-Representation-Network.

Recent advances in semi-supervised medical image segmentation have achieved remarkable performance through prediction consistency, pseudo-label supervision, and hard-region supervision. However, these methods primarily improve supervision quality rather than explicitly enforcing semantic consistency in the learned representations of hard regions. Consequently, even under increasingly stronger prediction-level supervision, difficult regions exhibiting unstable semantic assignment often fail to establish semantically consistent representations during training, thereby limiting further segmentation improvement. To address this issue, we propose SHTA (Semantic Hard Token Correction and Center Alignment), a lightweight training-time semantic representation branch. Instead of introducing additional prediction supervision, SHTA refines intermediate semantic representations through Semantic Assignment, Hard Token Refinement, and Semantic Center Alignment, thereby improving semantic consistency in hard regions while preserving the original prediction pathway and introducing no additional inference cost. We integrate SHTA into representative semi-supervised segmentation frameworks, including GA-CPS, CPS, URPC, and MagicNet, and conduct evaluations on the Synapse and AMOS datasets. Experimental results demonstrate that SHTA delivers consistent paired improvements across frameworks, with especially clear gains in segmentation accuracy, weak-organ recovery, and semantic ambiguity reduction, while incurring only training-time overhead. The code is available at https://anonymous.4open.science/r/release_SHTA-42D5/.

Prompt-free adaptation of the Segment Anything Model (SAM) has emerged as a promising paradigm for automatic medical image segmentation. Existing methods mainly focus on prompt generation, while overlooking that prompt quality is fundamentally constrained by the expressiveness of anatomical representations. However, deterministic prototypes or semantic tokens are insufficient to jointly capture global anatomical priors, intra-structure diversity, and local structural reliability. To address this limitation, we propose the Hierarchical Probabilistic Representation (HPR) framework, which learns complementary anatomical representations through Distributional Anatomical Representation (DAR), Multi-component Anatomical Representation (MAR), and Local Reliability Representation (LRR), and integrates their predictions via Hierarchical Prediction Fusion (HPF) while remaining compatible with the original SAM decoder. Experiments on the Synapse, LA, and PROMISE12 datasets demonstrate that HPR-SAM achieves state-of-the-art performance on Synapse and the best performance under few-shot settings on LA and PROMISE12, validating the effectiveness of the proposed hierarchical probabilistic representation learning framework for prompt-free medical image segmentation. Code is available at https://anonymous.4open.science/r/HPR-SAM-E4AF.

Despite rapid advances in chest X-ray (CXR) foundation models, most radiology report generation (RRG) systems still rely on heavily downsampled inputs (e.g., 256x256) due to the fixed visual token budgets of pretrained vision encoders, suppressing subtle yet clinically important cues present in native-resolution images. However, enabling high-resolution (high-res) perception remains challenging: naive tiling causes prohibitive token inflation, while global compression suppresses subtle lesions and degrades diagnostic fidelity. Inspired by radiologists' workflow, localizing suspicious regions before detailed high-res assessment. We propose Lesion-Aware High-Resolution Patch Discovery and Fusion for Chest X-ray Reporting (LePaX), the first RRG framework that enables efficient high-res CXR perception (up to 1920x1920) without increasing the vision-token count. LePaX formulates high-res perception as a constrained spatial resolution allocation problem under a fixed token budget and introduces two key components: Learnable Spatial Resolution Allocation (LSRA), which learns a spatial utility map that adaptively allocates limited high-res capacity to diagnostically relevant regions, enabling targeted extraction of high-res patches from native CXRs; and Global-Regional Fusion (GRF), which performs token-preserving region-to-global refinement by projecting high-resolution regional evidence back onto the global feature grid through spatially aligned resolution write-back, avoiding token inflation. Experiments on multiple CXR benchmarks demonstrate that LePaX consistently improves both clinical and linguistic metrics while enabling native-resolution CXR perception with over 10x fewer visual tokens than naive high-res tiling.

Pixel-level annotation remains a major bottleneck in medical image segmentation, making weak supervision an attractive yet under-constrained alternative. We propose OBBSeg, an intermediate supervision paradigm guided by Oriented Bounding Boxes (OBBs) that bridges the gap between full and weak supervision. By jointly encoding spatial extent and orientation, OBBs provide compact geometric supervision that better aligns with elongated or anisotropic lesions, reducing the ambiguity of coarse box annotations. To mitigate the inherent rectangular bias of OBBs, we introduce a Mask-to-OBB loss, a differentiable formulation that enforces geometric consistency between predicted masks and OBB regions. Furthermore, we incorporate prompt-driven semantic guidance through two complementary modules-PAFE and DBFE-which enhance foreground representation and suppress background interference. Extensive experiments on 13 datasets across 5 imaging modalities show that OBBSeg not only outperforms existing weakly supervised methods but also achieves performance comparable to fully supervised approaches, demonstrating its potential for efficient and scalable medical image segmentation. The code is available at https://github.com/StarLxc3/OBBSeg.

Survival analysis on Whole Slide Images (WSIs) is important in computational pathology for prognosis estimation and treatment planning. However, existing survival models are typically trained independently for each cancer cohort, making continual adaptation computationally expensive for gigapixel-scale WSIs. In this study, we propose MergeSurv, a merging-based continual learning framework for WSI survival analysis. A pathology vision-language foundation model is independently fine-tuned on each task, and the learned parameters are sequentially merged into a unified model without storing previous training data. We further investigate two inference strategies: One-for-All (OFA) and Voting-Expert Aggregation (VEA). Experiments on four TCGA cohorts demonstrate that MergeSurv outperforms naive fine-tuning as well as representative regularization-based and rehearsal-based continual learning methods, while effectively reducing catastrophic forgetting. The results suggest that model merging is a promising direction for scalable and privacy-preserving continual learning in computational pathology.

Accurate 3D medical segmentation is limited by anatomical variability and high computational costs. While knowledge distillation (KD) offers a route for model compression, conventional methods often fail to preserve complex structures and are overwhelmed by background noise. We propose Displacement-Preserving Relational Distillation (DPRD), which distills latent anatomical trajectories via vector based alignment to preserve the orientation and relative scale of the teacher's manifold, and prevents signal dilution by anchoring distillation in task-relevant structures. Integrated into nnU-Net, DPRD outperforms established baselines on ISLES 2022 and AMOS 2022 benchmarks. Notably, on the AMOS dataset, DPRD achieves a Dice score of 85.46%, edging out the high-capacity MedNeXt teacher while significantly reducing boundary errors. Despite utilizing only ~5% of the teacher's parameters and ~3% of its FLOPs, our approach maintains high structural consistency. This provides a robust, efficient solution for deploying high performance segmenters in resource-constrained clinical environments. Code: https://github.com/ClinicaAlpha/DPRD-3D-MedSeg

Traditional semantic segmentation models operate under a closed-set assumption and struggle to recognize unknown or unexpected objects-an essential capability for autonomous driving. As a result, such models often misclassify or overlook out-of-distribution (OOD) road anomalies, posing safety risks in open-world environments. We present a lightweight, postprocessing, road-aware anomaly segmentation framework that requires no retraining, no OOD data, and no auxiliary supervision. Our approach builds on a mask transformer-based segmentation network by exploiting query-level mask confidence and deriving a polygonal road prior to detect gap regions that may correspond to anomalies. To further suppress false positives, we introduce a CLIP-based zero-shot semantic filtering module using in-distribution prompts, with optional generalized OOD prompts. By jointly leveraging spatial priors and semantic verification, our framework produces robust and interpretable anomaly predictions. Evaluation on three public benchmarks-Fishyscapes, SMIYC, and RoadAnomaly-shows consistently strong performance. In particular, our method outperforms the training-free baseline Maskomaly on most metrics and achieves the highest AP on Fishyscapes LostAndFound. These results demonstrate the practicality and deployability of our approach for real-world autonomous driving systems.

Precise medical image segmentation is crucial for clinical diagnosis and treatment planning, yet relies heavily on expensive expert annotations. Semi-supervised medical image segmentation (SSMIS) offers a cost-effective solution but typically operates under the assumption of independent and identically distributed (i.i.d.) data, defaulting to random sampling. While statistically valid at scale, this strategy suffers from severe representation bias in low-data regimes, failing to capture the heterogeneous medical data manifold. To address this, we propose a highly data-efficient framework driven by distribution alignment. First, we introduce an offline Distribution-Aware Sample Selection strategy. By leveraging Vision Foundation Models (VFMs) and our designed Density-K-Center algorithm, we explicitly identify representative structural anchors, establishing a more representative labeled domain. Second, to bridge the remaining distribution gap, we propose the Memory-guided Copy-Paste (MCP) module. Tailored for the inherent class imbalance in medical scans, MCP leverages a semantic memory mechanism to retrieve historically consistent priors for cross-domain alignment, encouraging semantic consistency. Coupled with an easy-to-hard progressive schedule, this framework effectively mitigates early-stage pseudo-label noise. Extensive experiments on six diverse 2D and 3D datasets demonstrate strong segmentation performance, particularly in extremely low-labeled scenarios (\eg, 1/16 ratio).

The growing number of medical vision foundation models highlights the need for effective model selection. However, mainstream selection methods rely on exhaustive fine-tuning, which is computationally expensive. Most of the existing Transferability Estimation (TE) metrics are primarily designed for image-level classification. They fail to preserve spatial relationships and fine-grained boundary details, which are crucial for the segmentation task. Additionally, while image-level tasks typically process a single feature vector per input, dense prediction tasks in 3D medical imaging require voxel-wise evaluation against dense annotations. To bridge these gaps, we propose a \textit{non-parametric, topology-driven} framework that estimates transferability directly from the alignment between the sparse 1-skeleton graph of dense features and semantic labels via Minimum Spanning Trees (MST). We decouple the alignment into two complementary geometric scales: Local Boundary-Aware Topological Consistency (LBTC) to assess boundary separability, where we prove that the MST leakage rate serves as a finite-sample lower bound on the Bayes error; and Global Representation Topology Divergence (GRTD) to evaluate the overall anatomical layout. Crucially, we formally justify a counterintuitive mechanism: Although without fine-tuning, the randomly initialized segmentation decoder acts as a topology-preserving spatial projector, reducing the variance of pairwise distance estimates and stabilizing global alignment evaluation. Fused via a task-adaptive gating mechanism, these dual metrics adapt to diverse clinical complexities. Evaluated on a large-scale benchmark of 114,000 3D medical volumes across diverse anatomical tasks, our topological framework achieves state-of-the-art transferability estimation with an average weighted Kendall (outperforming by 0.36) while accelerating evaluation by 56 times.

Whole-body fluorodeoxyglucose positron emission tomography combined with computed tomography is widely used in cancer care, but manual lesion delineation is slow, subjective, and difficult to scale. We present GLOW-FDG, an open-source artificial intelligence model for whole-body cancer lesion segmentation in fluorodeoxyglucose positron emission tomography and computed tomography. The model was trained on 1,563 scans spanning multiple cancer types and evaluated on 185 external scans from independent institutions. Across breast cancer, nonmetastatic and oligometastatic lung cancer, head and neck cancer, and metastatic melanoma, GLOW-FDG consistently outperformed publicly available benchmark models in lesion detection, while reducing false positives and maintaining strong segmentation accuracy. Quantification of total tumor burden and total lesion glycolysis was robust across cohorts, and performance approached the variability observed between expert radiation oncologists. These results support GLOW-FDG as a generalizable tool for automated cancer segmentation and quantitative imaging biomarker extraction in whole-body imaging.

As hematoxylin & eosin (H&E) staining constitutes the primary entry point in routine diagnostic workflows, computer-aided diagnosis from whole-slide H&E images is of particular clinical relevance. However, substantial variability in specimen preparation, staining protocols, and scanning conditions, together with inherent uncertainty in expert pixel-level annotations, makes automated analysis of H&E-stained images challenging. In this study, we propose a semantic segmentation-based framework for image-level diagnosis, grounded in the clinically motivated assumption that each histopathological image corresponds to a single cancer type. Image-level predictions are obtained by assigning the class of the dominant pixel-level label in the segmentation output. To ensure clinical relevance, we adopt the nnU-Net architecture and train it on a publicly available dataset collected in our study with pixel-level annotations for three liver cancer types: hepatocellular cacrcinoma (HCC; 55 images from 30 patients), cholangiocellular carcinoma (CCA; 55 images from 29 patients), and colorectal metastatic adenocarcinoma (CMA; 60 images from 30 patients). Annotations were independently provided by four pathologist. We hypothesize that the combination of stain normalization and semantic segmentation mitigates domain shift and reduces sensitivity to annotation noise. Five-fold cross-validation yielded balanced accuracy of 0.975 (HCC), 0.950 (CCA), and 1.000 (CMA), comparable to results obtained with immunohosthochemical staining and superior to several deep learning models trained on patch-level annotations. The proposed framework has the potential to support pathologists in prioritizing immunohistochemical marker selection, thereby reducing diagnostic costs and turnaround time. Integration with immunohistochemical findings improve overall diagnostic reliability.

Clinical cardiac imaging pipelines currently deploy separate models for each dataset and modality, incurring redundant training costs and precluding knowledge sharing across anatomically related tasks. Consolidating semi-supervised learning, unsupervised domain adaptation, and domain generalisation into one model is therefore a practical necessity, yet naive joint training exposes a fundamental barrier: conflicting label semantics between datasets collapse LA Dice from 90.31% to 83.38%, while gradient imbalance across tasks of unequal complexity suppresses the weaker tasks throughout training. We present UniT-Diff, a unified diffusion segmentation framework that resolves these conflicts through three targeted mechanisms. An 11-channel task-specific output space physically partitions label categories, eliminating cross-task gradient sign reversal by construction. SNR-Adaptive Task Conditioning (SATC) scales the task token by the log signal-to-noise ratio of the current diffusion timestep, suppressing domain-specific bias during coarse denoising and restoring full task guidance as the signal clears. Task-Type-Aware Conditional Dropout (TTACD) permanently removes the task token for domain-generalisation inputs, routing them through a shared neutral pathway that draws on cross-dataset cardiac anatomy rather than source-vendor statistics. Under a single parameter set, UniT-Diff surpasses independently trained task-specific baselines on all three benchmarks simultaneously: +0.87% on LA, +1.77% on MMWHS, and +0.88% on MNMS.

Semi-supervised semantic segmentation (SSSS) has long turned on one question, which pseudo-labels to trust, and answered it with ever more careful confidence filtering. Foundation backbones change the regime: with a DINOv2 teacher a strict threshold already retains a measured 98%-clean pseudo-label set, so the accuracy that remains lives not in the filter but in how the embedding space is structured by class. We propose PixCon, a clean-positive pixel-contrastive framework. PixCon maintains a per-class memory bank that admits only labeled pixels the student already classifies correctly, guaranteeing a contamination-free positive set ($ρ_F=0$) by construction, unlike prior contrastive SSSS banks (ReCo, U$^2$PL) built from confidence-filtered pseudo-labels. It is a single branch over a consistency backbone, adds no inference-time parameters, and needs no bank-specific threshold. A first-order analysis of the supervised-InfoNCE gradient explains why contamination hurts: its false-positive term scales as $ρ_F/(1-ρ_F)$, which we measure (0.018 on Pascal, 0.106 on ADE20K) rather than assume. Across Pascal VOC, Cityscapes, and ADE20K, PixCon matches or improves a strong DINOv2-based UniMatch V2 baseline in a compute-matched one-switch protocol: it improves every Pascal-1/8 seed (a per-seed gain of about +0.2 mIoU) and its three-seed mean reaches 87.90, the published UniMatch V2-B figure. Because contamination is already rare under foundation-model teachers, our analysis indicates the $ρ_F=0$ guarantee acts chiefly as robustness as teachers weaken, while the accuracy gain comes from cleaner positive supervision, making clean-positive contrast a robust, low-cost default for foundation-model SSSS.

Vision Transformers (ViTs) are strong backbones for semantic segmentation, but their computational cost limits deployment. Recent token compression methods for efficient transformer-based segmentation reduce this cost by decreasing the number of tokens. However, existing evaluations primarily focus on low-to-moderate compression, leaving their behavior under aggressive compression and corrupted inputs unclear. Meanwhile, structural pruning provides an orthogonal route to efficiency by removing redundant components in the ViT architecture, but is rarely compared to token compression under a unified protocol. To bridge this gap, we benchmark representative token compression and structural pruning methods for ViT-based semantic segmentation under matched FLOPs on ADE20K and Cityscapes, together with their common-corruption variants ADE20K-C and Cityscapes-C. Our results reveal a consistent trend on both clean and corrupted inputs: token compression is highly effective at mild reductions but degrades sharply when compression becomes severe, consistent with substantial information loss from overly aggressive token reduction. In contrast, structural pruning exhibits a smoother degradation curve and is more stable at high compression. Motivated by these findings, we study a prune-then-merge pipeline that applies moderate token compression on top of a moderately pruned backbone. At comparable FLOPs, this combined strategy consistently achieves a better accuracy-robustness trade-off at high compression, offering a practical recipe for deployment-oriented ViT segmentation. Code is available at https://github.com/phatnguyencs/vit-seg-compression.

Deep learning (DL) methods dominate thyroid nodule segmentation in ultrasound (US) images, achieving high Dice scores but at the cost of millions of parameters, GPU-dependent training via backpropagation, and limited mathematical tractability. These limitations impede deployment in resource-constrained environments. In this paper, we propose MedSaab-US, a backpropagation-free segmentation framework grounded in the Green Learning paradigm. MedSaab-US extracts multi-scale spatial-frequency features by combining multi-level Discrete Wavelet Transform (DWT) with multi-scale channel-wise Saab (Subspace Approximation with Adjusted Bias) transforms at patch sizes of 5 x 5, 11 x 11, and 21 x 21 pixels. Label-Assisted Greedy (LAG) feature selection retains the most discriminative features, which are fed to an XGBoost classifier for pixel-wise prediction. The Saab transform parameters are determined analytically from data statistics, while XGBoost employs iterative greedy tree construction without requiring backpropagation. Evaluated on the TN3K dataset (2,879 training and 614 test images), MedSaab-US achieves a mean Dice coefficient of 0.4784 +/- 0.2190, precision of 0.5768, and recall of 0.5604, with a model footprint under 500K parameters and CPU-only inference in approximately 0.3 seconds per image. We present this result as an exploratory non-DL baseline for thyroid ultrasound segmentation and analyze the specific challenges posed by isoechoic nodules. An ablation study further quantifies the contribution of each pipeline component, including separate evaluations of LAG feature selection and training-set size.

Deep learning has achieved remarkable performance in medical image segmentation, yet it suffers from critical limitations: mathematical intractability, substantial parameter requirements, and lack of clinical interpretability. We propose RadiomicNet, a novel two-stream hybrid architecture that enhances standard deep learning by integrating handcrafted radiomics features directly into the segmentation learning process. The key contribution is the Radiomics Attention Gate (RAG), which leverages Gray-Level Co-occurrence Matrix (GLCM) and Local Binary Pattern (LBP) features to modulate skip-connection attention in a lightweight MobileNetV2-based encoder-decoder, providing ante-hoc interpretability without post-hoc approximations. A novel Radiomics Consistency Loss further enforces alignment between texture complexity and prediction uncertainty, reducing Expected Calibration Error (ECE) from 0.142 to 0.118. RadiomicNet achieves a Dice Similarity Coefficient (DSC) of 0.763 +/- 0.231 on the Breast Ultrasound Images (BUSI) dataset and 0.854 +/- 0.112 on Kvasir-SEG, outperforming U-KAN by 1.2% and 1.8%, respectively (p < 0.05, Wilcoxon signed-rank test), with only 3.27M parameters, 9.5x fewer than standard U-Net and 4.3x fewer than U-KAN. Gradient-based feature importance analysis reveals that GLCM dissimilarity (15.24%), GLCM energy (14.56%), and LBP entropy (11.49%) are the dominant radiomics cues, providing clinically meaningful explanations for segmentation decisions. The proposed approach demonstrates that compact, interpretable models grounded in domain knowledge can deliver state-of-the-art segmentation performance with substantially reduced computational overhead.

Due to the scarcity of expert-annotated data, Semi-Supervised Medical Image Segmentation (SSMIS) has emerged as a promising approach. Many anatomical structures in medical images exhibit significant intra-class heterogeneity, with different regions showing heterogeneous intensity patterns within the same structure. However, existing methods inadequately exploit this intensity-manifested intra-class heterogeneity, resulting in uniform structural representations and imprecise segmentation. Furthermore, the scarcity of labeled data makes it more difficult to effectively capture such complex heterogeneity. To address this, we propose Multiple Prototype Contrastive Learning (MPCL), an SSMIS framework that possesses better diversity and better precision. It consists of three novel designs: First, we provide structural representations with better diversity and propose Intensity-aligned Heterogeneous Prototype Generation (IHPG) that effectively models intra-class heterogeneity by generating multiple prototypes aligned with intensity characteristics. Second, we further enhance more diverse structural representations and build a solid foundation for more precise segmentation through Prototypical Space Optimization (PSO) that systematically optimizes a more discriminative and generalizable prototypical space. Finally, we achieve segmentation results with better precision through Dual-branch Knowledge Alignment (DKA) that efficiently promotes intra-class heterogeneity knowledge transfer from prototypical space to the segmentation network. Extensive experiments on three medical image datasets with significant intra-class heterogeneity demonstrate that MPCL significantly outperforms existing methods, especially under extremely limited labeled data.

Segmentation of biomarkers in medical images is frequently viewed as a first step towards medical image analysis in any bioinformatics or biomedical application. Despite progress, existing methods still struggle to capture information at multiple scales and to perform upsampling effectively across different datasets. These shortcomings often result in suboptimal generalization capabilities. Recently, architectures belonging to the Nested-UNet family excel in capturing multiscale contextual information and upsample them effectively. In this work, We propose a novel Nested-UNet architecture that effectively captures multi-scale contextual information. It includes inner and outer attention units to enhance focus during upsampling, along with channel-wise feature recalibration using squeeze-and-excitation modules, leading to improved segmentation performance. Additionally, the architecture integrates an edge-aware loss to emphasize boundary accuracy by assigning greater importance to edge regions. Tested extensively on three publicly available benchmark datasets. Our method demonstrates a generalization performance superior to existing Nested-UNet methods. Code: https://github.com/saadwazir/histosegplusplus

Chest X-ray multi-label classification is a core task in intelligent medical imaging diagnosis. However, real clinical data often exhibit extreme long-tailed distributions, leading to degraded performance on rare diseases in tail classes. This issue is not only driven by data scarcity but also by two intrinsic factors:1) attenuation of tail-class lesion representations under complex anatomical backgrounds, and 2) dominance of head classes in modeling label co-occurrence relationships. To address these challenges, we propose TRCGL-Net. First, a learnable text-guided conditional diffusion model is employed to generate high-quality tail-class chest X-ray image samples under disease semantic constraints, improving data diversity and realism of rare disease patterns while alleviating class imbalance and preserving pathology-consistent semantics.Second, a channel reweighting mechanism is introduced to perform feature recalibration by emphasizing disease-relevant feature channels, thereby improving feature discriminability under long-tailed distributions.A class-aware attention mechanism is further applied to generate class-specific attention maps, enabling the model to localize disease-relevant regions and focus on fine-grained lesion areas.Finally, a graph convolution network based on label co occurrence is introduced to establish an information propagation mechanism among categories. Experiments on the PadChest dataset show that the proposed method achieves a tail-class mAP of 0.4904, an overall mAP of 0.4408, and an mAUC of 0.8989, outperforming state-of-the-art methods. TRCGL-Net effectively improves recognition performance for rare diseases under long-tailed distributions and mitigates the impact of extreme class imbalance in chest X-ray multi-label classification.

Medical image segmentation relies on the ability of encoder-decoder architectures to translate rich feature representations into accurate pixel-level predictions under challenging conditions such as low contrast, structural ambiguity, and scale variability. While recent advances in large-scale pretraining and transformer-based encoders have substantially improved feature extraction, segmentation accuracy remains constrained by decoder design, particularly in terms of cross-scale alignment, contextual integration, and boundary preservation. In this work, we revisit medical image segmentation from a decoder-centric perspective and propose a context-aware gated decoder that systematically regulates feature fusion and contextual aggregation throughout the decoding process. The proposed decoder integrates lightweight multi-scale channel recalibration, gated skip fusion with spatial competition and a global context aggregation mechanism that injects encoder-wide information into intermediate decoding stages. This design enables effective translation of strong pretrained encoder representations into spatially consistent predictions. Extensive experiments across 11 medical image segmentation benchmarks validate the effectiveness and demonstrate that the proposed approach consistently outperforms strong baselines while remaining computationally practical. Code: https://github.com/saadwazir/MedCAGD

Medical image segmentation is dominated by U-Net-style encoder-decoder architectures. Vision Transformers (ViTs) overcome the limited receptive field of convolutional networks through self-attention, enabling modeling of long-range dependencies. Early ViT-based segmentation methods typically retained U-Net-style decoders because pretrained ViT representations were insufficient to support accurate dense prediction. Recent advances in large-scale pretraining have redefined the representation capability of ViTs, reducing the reliance on U-Net-style decoder architectures in modern vision models. This prompts two questions: Is the U-Net paradigm still necessary for medical image segmentation? If not, how should an encoder-only segmentation framework be designed? Motivated by these questions, we explore key architectural choices for encoder-only medical image segmentation based on modern ViT backbones and establish a query-based encoder-only design with multi-level query modeling and learnable block fusion, realized in Encoder-only Segmentation (EoSeg). Extensive experiments across seven benchmark datasets spanning CT, MRI, histopathology, endoscopy, and dermoscopy validate the effectiveness of the proposed design across diverse medical imaging modalities, including mDice scores of 85.50% on Synapse, 91.73% on ACDC, and 93.27% on GlaS. The results demonstrate that a U-Net-style decoder is no longer necessary for medical image segmentation with modern ViT backbones and further show that EoSeg provides an effective encoder-only design. Code is available at: https://github.com/Retinal-Research/EoSeg

Robust segmentation of intraluminal thrombus is critical for risk assessment in Abdominal Aortic Aneurysm, yet it remains challenging due to heterogeneous thrombus features and low contrast with surrounding non-enhanced tissues. Domain shifts induced by different Computed Tomography Angiography (CTA) protocols further inhibit multi-center generalization of deep learning models. To address these challenges, we propose a patient-specific framework that integrates discriminative learning with anatomically informed priors. Our approach introduces two key components: (1) a patient-specific intensity normalization based on a Gaussian Mixture Model of local anatomy, and (2) an Uncertainty-Gated Anatomical Attention module that incorporates spatial priors while adaptively modulating their influence according to voxel-wise confidence. This design allows for anatomical guidance in ambiguous regions while suppressing unreliable priors. The proposed method achieves state-of-the-art performance on in-distribution test data and substantially outperforms existing alternatives in generalization to external multi-center CTA data, while remaining interpretable through an explicit separation of visual and anatomical evidence.

Volumetric medical image segmentation is essential for both preoperative diagnosis and intraoperative guidance. While recent years have witnessed rapid progress in segmentation architectures, comparatively little attention is paid to the physical voxel spacing of anatomical data. Indeed, volumetric image resampling is a ubiquitous preprocessing step before segmentation, yet its interaction with downstream segmentation has not been systematically exploited. In this work, we study the correlation between image resampling and segmentation, and propose Consispace, a semantic-aware resampling framework that achieves consistent voxel spacing in the axial direction while preserving anatomical and semantic consistency. Consispace introduces an ODE-based anatomical constraint to model inter-slice dynamics with a continuous interpolator, enabling faithful reconstruction under complex anatomical transitions beyond discrete interpolation. To further couple resampling with segmentation objectives, we leverage dense features from a pretrained vision model to build intra-slice semantic correlation maps and inject class-wise semantic consistency via feature reweighting during resampling. Both intra-slice and inter-slice constraints are integrated into an implicit neural network, supporting arbitrary-scale resampling. Extensive experiments on multiple datasets demonstrate that Consispace achieves superior reconstruction quality and perceptual fidelity, produces smoother inter-slice anatomy, and improves downstream segmentation performance when used as a preprocessing step.

Radar sensors provide reliable perception under adverse weather and lighting conditions, but their sparse, noisy, and weakly semantic measurements make dense semantic segmentation challenging. Most existing radar segmentation methods rely on grid-based encodings and pairwise interactions, which struggle to capture the higher-order relational structure formed by multiple radar returns from the same physical object. We introduce a unified higher-order structural alignment framework for multi-view radar segmentation. The proposed method refines radar feature representations using learnable hypergraphs to capture higher-order dependencies among spatially related responses. To ensure consistency across heterogeneous radar projections, we further align view-specific features using Unbalanced Optimal Transport (UOT), enabling correspondence-free alignment under varying measurement densities and partial observations. An adaptive attention mechanism then fuses complementary radar views while emphasising structurally informative responses under sparsity and noise. The resulting architecture learns structurally consistent representations across Range Angle (RA), Range Doppler (RD), and Angle Doppler (AD) views and is trained using supervised segmentation together with cross-view consistency regularisation. Experiments on the CARRADA and RADIal benchmarks demonstrate consistent improvements over strong radar-specific baselines, achieving 63.8% mIoU on CARRADA and 83.4% mIoU on RADIal, improving the previous best methods by +1.7 and +2.3 mIoU, respectively. These results highlight the importance of higher-order relational modelling for robust radar perception.

Geographic atrophy (GA) secondary to age-related macular degeneration (AMD) requires precise monitoring of relevant structural biomarkers to assess disease stage, progression, and treatment response. This paper presents a fully automated, deep learning-based framework for the high-precision, pixel-wise segmentation of key biomarkers in optical coherence tomography (OCT) imaging: retinal pigment epithelium (RPE) loss, ellipsoid zone (EZ) loss, and EZ thinning. The proposed pipeline uses three specialized semantic segmentation models to delineate RPE loss, EZ boundaries (including interruptions), and Bruch's membrane. To ensure robustness and generalizability, the models were developed on a diverse dataset of 298 SD-OCT volumes representing the full phenotypic spectrum of AMD (GA:222, intermediate AMD: 40, neovascular AMD: 17, healthy: 19) and validated on an independent external dataset (n=43). The comprehensive evaluation was further strengthened using additional datasets to assess repeatability, inter-reader reliability, the impact of B-scan density on measurement accuracy, and subgroup performance stratified by lesion size. Results demonstrated high segmentation accuracy (Dice RPE loss: 0.88, Dice EZ loss: 0.87, Pearson's r > 0.99). Total EZ thickness measurements exhibited a sub-pixel average deviation of 2.15 $μm$, and segmentation reliability was confirmed by a strong reproducibility score (ICC > 0.98). By accurately and consistently quantifying outer photoreceptor degeneration and RPE loss, this fully automated framework provides a highly reliable tool for GA assessment in both clinical trials and routine real-world ophthalmic care.

The Segment Anything Model with Concepts (SAM3) heralds a new paradigm for open-vocabulary segmentation through natural language interaction, offering significant potential for medical image analysis. However, effectively adapting such a powerful vision-language model to the diverse and nuanced domain of medical imaging remains a key challenge. Naive fine-tuning is parameter-inefficient, while standard Mixture-of-Experts (MoE) methods introduce prohibitive computational overhead, limiting their clinical applicability. To address this, we propose Dual-Adaptive SAM3 (DA-SAM3), a novel framework that achieves both high segmentation accuracy and extreme parameter efficiency via a dual-adaptive specialization mechanism. Our first adaptation is task-aware: a Dynamic Expert Router (DER) that sparsely activates the most relevant experts by jointly reasoning about the visual input and the textual concept prompt, mimicking a clinical consultation process. Our second adaptation is parameter-aware: a Decomposed Parameterized Experts (DPE) design that represents each expert as a shared frozen base (inherited from the pretrained SAM3) and a lightweight trainable low-rank delta, reducing MoE parameter overhead by over 80%. Extensive experiments on multiple public medical segmentation benchmarks demonstrate that Dual-Adaptive SAM3 not only matches or exceeds the accuracy of fully fine-tuned SAM3 and standard MoE baselines, but also achieves a notable 5% gain over current state-of-the-art methods, with interpretable results validating its effectiveness. The code is available at: https://github.com/Reconsider80/DA-SAM3.

LiDAR semantic segmentation often degrades under real-world deployment due to evolving sensing conditions, while collecting new annotations for retraining is impractical. Test-time adaptation (TTA) updates model parameters online using pseudo-label supervision, but directly applying standard TTA strategies to LiDAR data is challenging. Because pseudo-label reliability is spatially heteroscedastic under range-dependent sparsity and occlusion, uniform updates on globally shared parameters can inject unstable gradients and destabilize adaptation. We propose a geometry-constrained test-time prompt tuning framework for LiDAR semantic segmentation. Our method estimates per-location sensing reliability from depth-consistent beam terminations and neighborhood support, and uses it to reweight spatial supervision. Adaptation is confined to lightweight prompt adapters inserted into a frozen backbone, with spatial gating to prevent unreliable regions from perturbing globally shared representations. A temporally smoothed prototype alignment strategy further stabilizes online updates by accumulating reliable semantic evidence over time. Experiments on standard LiDAR benchmarks demonstrate improved adaptation stability and segmentation performance under deployment variations without additional annotations.

Prototype-based medical image classifiers present three clinical limitations: they treat findings as independent, silently amplify unsafe physician feedback, and require full retraining whenever a new finding is needed. We present GRAPE (Graph-Augmented Prototype Explanations), a unified architecture that addresses all three challenges. First, a Graph Attention Task Head models anatomical concept co-occurrence, boosting macro-F1 by +13.8,pp over the prototype baseline on TBX11K. Second, a Concept-Mismatch Safety Check - the first such mechanism in prototype-based medical classifiers - warns when the model's dominant finding inside a doctor-drawn region conflicts with the claimed label, catching 85% of erroneous annotations versus 51% for MC-Dropout with no extra inference cost. Third, Open-Vocabulary Prototype Anchoring aligns visual prototypes to clinical text, allowing a new finding to be added from a single labeled image without modifying any other component. On NIH ChestX-ray14, one Effusion example recovers full-supervision localization accuracy; on TBX11K, prototype maps achieve 2.6x better lesion localization than end-to-end baselines. All three capabilities add only +1~ms latency at interactive batch size. The project page is https://github.com/KurbanIntelligenceLab/GRAPE.

We present APRIL-MedSeg, a YAML-driven modular framework for 2D medical image segmentation. It provides a unified and extensible ecosystem that decomposes segmentation networks into reusable components. Also, the framework integrates a broad spectrum of advanced paradigms, including semi-supervised learning, domain adaptation, knowledge distillation, weakly supervised learning, and text-guided segmentation as well as foundation model support. A registry-based configuration system with inheritance enables flexible and reproducible experiment management, supporting seamless switching across models, datasets, and training strategies. In addition, the framework provides a unified interface for medical datasets, augmentation pipelines, deployment utilities and model ensembling. Overall, APRIL-MedSeg is designed as a general-purpose research and development platform that bridges algorithmic innovation and practical deployment, while also serving as a structured ecosystem for systematically organizing and reproducing advances in medical image segmentation. The code is available at https://github.com/juntaoJianggavin/APRIL-MedSeg under an Apache 2.0 license.

Segment Anything Model (SAM) has revolutionized promptable image segmentation with strong zero-shot generalization. However, its performance degrades substantially under real-world imaging artifacts such as noise, blur, and compression. Existing methods restore features globally without focusing on segmentation-relevant regions and neglect SAM's iterative refinement mechanism, leading to suboptimal performance in interactive settings. We propose Prompt-Guided Feature Enhancement SAM (PGE-SAM), a framework that explicitly leverages user prompts and prior mask predictions to spatially guide the feature restoration process toward regions of interest through a Prompt Guidance Generator. To recover fine-grained details lost under degradation, we introduce Multi-Scale Features Interaction to incorporate low-level encoder features, along with a Foreground Reconstruction Loss that restricts feature-level supervision to the segmentation target. Furthermore, we present DM-Seg, a benchmark for interactive segmentation on degraded medical images, spanning multiple imaging modalities with both general and modality-specific degradations at varying severity levels. Extensive experiments demonstrate that PGE-SAM achieves SOTA robustness on both medical and natural image domains across multiple degradation levels, while maintaining generalization to clean images and adding less than one-fifth of the parameters of prior methods.

RECIST diameter measurements are widely used for tumor response assessment, but they provide only a limited 2D description of lesion extent. We present LETT-NeXt, a lightweight RECIST-guided model that predicts 3D lesion masks from CT volumes and RECIST markers for the CVPR 2026 Foundation Models for Pan-cancer Segmentation in CT Images competition. LETT-NeXt extracts a RECIST-centered regional crop, encodes the RECIST line and endpoints as two prompt channels, and concatenates them with the CT input. A compact MedNeXt-v2 encoder--decoder predicts the lesion mask, followed by prompt-aware component selection and adaptive AutoZoom inference. On the public validation set, LETT-NeXt achieved a Dice Similarity Coefficient (DSC) of 79.4 $\pm$ 10.1 and a Normalized Surface Dice (NSD) of 72.3 $\pm$ 16.2. On the hidden test set, it achieved a DSC of 73.9 and an NSD of 67.3, corresponding to a challenge score of 70.6%. On the public validation mirror, LETT-NeXt completed CPU inference in 6.9 $\pm$ 3.0 s per case with a peak memory use of 3.6 GB. Code is available at github.com/Ahus-AIM/lett-next.

Visual Object Tracking (VOT) and Moving Object Segmentation (MOS) are two fundamental tasks in computer vision that involve both spatial and temporal object dynamics. Existing methods rely predominantly on visual cues and thus often falter in real-world scenarios where object motions are inherently complex and nonlinear. To address this limitation, we propose SUMO, a zero-shot, training-free, unified framework integrating nonlinear dynamics with vision-based segmentation for accurate and consistent VOT and MOS. Specifically, we develop a nonlinear State Space Model (SSM) inspired by robotics principles to capture the complex object dynamics. Building on this model, we propose a Selective Unscented Filter (SUF) for accurate state estimation, which features a joint scoring mechanism and dynamically fuses multi-source predictions to identify the most plausible object state over time. Furthermore, we apply a memory selection mechanism to evaluate the reliability of memory frames. Our extensive experimental results show that SUMO achieves state-of-the-art performance on both VOT and MOS tasks.

Few-Shot Medical Image Segmentation (FSMIS) offers a powerful solution to data scarcity but struggles to generalize across different imaging modalities. This performance collapse stems primarily from the drastic texture discrepancies between domains, which mislead models trained on source-specific intensity distributions. While existing methods attempt to align frequency or local texture features, they often fail to decouple semantic structure from domain-specific appearance. To address this, we identify a critical invariance: despite distinct imaging physics, the position and geometric shape of organs remain robustly consistent across modalities. Therefore, we propose a novel framework that harnesses Position and Shape Priors (PSP) for cross-domain FSMIS. Specifically, PSP first introduces a Position Coordinate Embedding (PCE) module to inject relative spatial coordinates for rapid organ localization. Subsequently, a Shape Prototype Modulation (SPM) module constructs domain-invariant structural prototypes via explicit shape priors, effectively filtering out texture noise. Furthermore, the Hybrid-Prototype Prediction (HPP) module adaptively calibrates the support prototype to the query feature distribution, mitigating feature misalignment. Extensive experiments on two public medical imaging datasets demonstrate that PSP significantly outperforms state-of-the-art methods.

Language-guided Medical Image Segmentation (LMIS) has shown great potential to improve the delineation of anatomical structures and lesions by integrating clinical textual information. Existing methods generally rely on either implicit interaction between textual and visual features or auxiliary coarse-grained supervision for cross-modal alignment. However, these methods lack explicit and fine-grained constraints to ensure semantic consistency, causing a mismatch between language and the segmentation outputs. To address this issue, we propose Text-as-Illumination Retinex Network (TIRNet), a novel Retinex-inspired framework that treats text embeddings as semantic illumination for feature modulation, thereby improving semantic consistency in LMIS. TIRNet introduces two key blocks integrated at each decoder stage: (1) the Retinex-inspired Text Modulation Block (RTMB), which employs positive and negative illumination maps to enhance text-relevant foreground features and suppress background interference; and (2) the Consistent Detail Compensation Block (CDCB), which selectively recovers high-frequency details via a consistency-gated mechanism conditioned on illumination reliability. Furthermore, we propose a Multi-Scale Illumination Supervision Loss (MSIS-Loss), comprising a Region-Grounded Contrastive Loss (RGC-Loss) that enforces cross-modal similarity to be concentrated in text-relevant foreground regions and suppressed in background regions, and a Background Suppression Loss (BS-Loss) that provides pixel-level supervision for negative illumination maps, jointly ensuring a precise cross-modal alignment at each decoder stage. Extensive experiments on the MosMedData+ and QaTa-COV19 datasets demonstrate that TIRNet achieves state-of-the-art performance in LMIS. The code is available at: https://github.com/anaanaa/TIRNet.

Accurate assessment of tumor proportion score (TPS) in non-small cell lung cancer (NSCLC) is critical for treatment planning and prognosis. Key challenges include the tedious manual work required to annotate each slide, combined with the limited number of experts certified for this task. Multiple instance learning (MIL) has proven to be an effective approach for predicting TPS scores at the slide level; however, existing methods struggle with non-expressive (zero class) images. Our approach involves two models: (1) an embedding-extraction and multiclass-classification network that captures the histopathological features of individual patches, and (2) a MIL model that aggregates these embeddings to predict zero-inflated beta (ZIBeta) parameters representing the overall TPS probability distribution for the entire slide. Using only slide-level TPS scores as labels, we demonstrate how this end-to-end framework can leverage a novel distribution-based architecture to improve prediction accuracy and explainability. ZIBeta modeling significantly outperforms baseline linear and ridge regression while capturing expected accuracy through distribution concentration.

Deep neural networks (DNNs) have shown outstanding performance in visual recognition tasks within vision sensor networks; however, they are still vulnerable to adversarial manipulations and imperceptible perturbations that can lead to erroneous predictions. To address that, this paper presents AEGIS, a semantic aware and uncertainty guided adversarial detection framework designed for robust image classification in vision sensors pipelines. At its core, a SemantiGAN module functions as a multi class semantic discriminator, identifying and filtering visually inconsistent adversarial inputs before they propagate further in the pipeline. For inputs that pass this stage, a stochastic augmentation process generates test time variations, from which handcrafted instability metrics FlipScore, Prediction Inconsistency, Layerwise Cosine Similarity (early and mid layers), and Entropy are computed. These features are aggregated into a compact five dimensional vector and processed by an Evidential Deep Learning (EDL) classifier, which models output evidence using a Dirichlet distribution to yield both class predictions and calibrated uncertainty estimates. Evaluations on the Tiny ImageNet dataset across six categories clean, FGSM, PGD, patch based, functional, and geometric attacks demonstrate the effectiveness of AEGIS. The proposed framework achieves an AUROC of 92.1%, an AUPRC of 90.2%, and an accuracy of 90.7%, outperforming conventional softmax-based detectors in terms of detection performance, robustness, interpretability, and uncertainty calibration.

Skin lesion segmentation is a key task in computer-aided dermatological diagnosis, where accuracy directly impacts downstream analysis and disease classification. However, dermoscopic images are challenging due to blurred boundaries, low contrast, large shape variations, and artifacts such as hair and shadows. Recently, diffusion models have shown strong performance in medical image segmentation thanks to their progressive denoising and distribution modeling capabilities. Nevertheless, existing diffusion-based methods still suffer from limited cross-level feature interaction and insufficient boundary detail recovery. To address these issues, we propose MLFFM-SegDiff, a multi-level feature fusion diffusion model for skin lesion segmentation. Built on a diffusion framework, the method introduces a dual-path U-Net encoder, a Multi-Level Feature Fusion Module (MLFFM), and a boundary-sensitive loss function. The dual-path encoder enhances interaction between noisy mask features and dermoscopic image features. MLFFM improves skip connections via attention, scale alignment, and adaptive cross-level fusion. These designs enable the decoder to jointly leverage shallow boundary cues and deep semantic representations, improving mask reconstruction quality. Experiments on ISIC2018, PH2, and HAM10000 demonstrate that MLFFM-SegDiff outperforms representative methods including DermoSegDiff, U-Net, and SwinUNETR across Accuracy, F1-score, Jaccard index, Recall, and Dice. In particular, it achieves an average Jaccard index of 0.8546 and Dice coefficient of 0.9207. These results validate the effectiveness of the proposed multi-level feature fusion strategy for improving lesion segmentation performance. The code will be released at https://github.com/Qacket/MLFFM-SegDiff.git after publication.

Transforming foundation segmentation models from human-prompted tools into auto-promptable annotators is critical for scalable medical data annotation. Current methods commonly depend on external feature matchers or auxiliary networks to automate geometric prompting, but introducing architectural overhead and limiting performance scalability. Although SAM3 natively supports concept segmentation via reusable text prompts, its direct use in medical imaging is hindered by a lack of fine-grained clinical knowledge and the ambiguity of human-written descriptions. In this work, we propose Mask to Concept (M2C), an efficient framework that adapts SAM3 for medical few-shot annotation without external modules, parameter retraining, or manual text engineering. Using only a few labeled images, M2C enables SAM3 to automatically search for transferable visual concepts entirely within its frozen architecture: it initializes a learnable concept embedding, uses it to prompt segmentation, and updates the embedding by gradients of minimizing the concept segmentation error. We further introduce a Hybrid Uncertainty Estimation (HUE) module that calculates the prediction entropy and maps concept predictions back to the box prompts, measuring concept-geometry prompting inconsistency. Highly uncertain samples are flagged actively for human correction, and the corrected masks are then fed back to M2C to continuously search for more precise concept embeddings, forming a self-enhancing annotation loop with minimal expert effort. Experiments on medical segmentation benchmarks show that our method achieves SOTA few-shot segmentation performance and outstanding annotation efficiency, offering a practical and efficient pathway toward scalable medical image labeling. Codes are at https://github.com/Huster-Hq/M2C.

Intracranial aneurysms are often asymptomatic until rupture, which carries high mortality. Rupture risk assessment and treatment planning depend on both aneurysm morphology and anatomical location, yet existing automated methods remain limited to binary detection without fine-grained anatomical classification or multi-class segmentation. We present a multi-task framework that simultaneously performs multi-label classification, multi-class aneurysm segmentation, and multi-class vessel segmentation across 13 anatomical locations and four imaging modalities (CTA, MRA, T2, T1-post). Our two-stage approach combines a fast 2D tri-axial Region of Interest (ROI) extraction method with a 3D multi-task nnU-Net backbone. A dual-decoder design mitigates the extreme volume imbalance between aneurysm and vessel classes, while cross-attention pooling and modality-specific auxiliary heads improve feature learning across heterogeneous inputs. Our two-fold ensemble achieved 2nd place in the RSNA 2025 Intracranial Aneurysm Detection challenge. Code, model weights, and a 3D Slicer plugin are publicly available.

While traditional image restoration focuses on perceptual quality, Task-Driven Image Restoration (TDIR) aims to maximize the performance of downstream high-level vision tasks. Recent approaches leveraging generative priors have shown promise for TDIR; however, they typically suffer from computational inefficiency and potential semantic alteration by indiscriminately updating all latent tokens. In this paper, we posit that not all visual information is equally important for machine perception. Through an analysis of the latent token space, we observe that task-relevant cues are unevenly distributed across the token sequence, exhibiting index-wise specialization. This suggests that selectively refining a subset of tokens can be sufficient for task-driven objectives. Leveraging this insight, we propose TaskTok, a novel framework that selectively restores only task-relevant tokens via a learnable token switch and a lightweight token refinement module. Extensive experiments across image classification, semantic segmentation, and object detection demonstrate that TaskTok significantly enhances task performance with high computational efficiency. The source code is available at https://github.com/jimmy9704/TaskTok

Small object segmentation in medical imaging is primarily hindered by class imbalance and inherent boundary complexity. Consequently, conventional global networks frequently fail to detect sparse targets or suffer from severe edge degradation. To overcome these limitations, we propose the Detection-guided Cropping Segmentation Network (DCSNet), an end-to-end framework that transforms global dense prediction into a localized refinement process. This framework integrates two core components, namely Detection-guided Hierarchical Cropping (DGHC) and Multiscale Feature Aggregation (MSFA). The DGHC module leverages region proposals to dynamically extract object-centric features, effdataectively filtering out massive background interference to mitigate class imbalance. Subsequently, the MSFA module operates strictly within these purified regions, synergizing a Transformer encoder with a pixel-adaptive fusion strategy. This mechanism dynamically aggregates multiscale features to capture both semantic context and fine-grained details for sharp boundary delineation. Extensive experiments across three diverse medical datasets demonstrate that DCSNet significantly outperforms existing state-of-the-art methods, yielding substantial improvements in boundary precision and offering a highly robust solution for clinical micro-lesion segmentation.

Resource-constrained visual Internet of Things (IoT) systems, such as edge cameras, unmanned sensing platforms, industrial inspection nodes, and remote monitoring sensors, often need to transmit task-relevant visual evidence over low-rate wireless links to an edge/cloud service. Existing image communication methods usually compress or transmit complete global representations, leaving limited room to exploit receiver-side generative restoration. This paper proposes a semantic-aware generative image transmission framework for edge-assisted visual IoT. The image captured by an IoT visual sensor is encoded into a discrete token grid by a VQ encoder. At the IoT transmitter or nearby gateway, token recoverability, estimated from prediction entropy and local structure complexity, is fused with semantic importance obtained from instance segmentation and category-aware scoring. A spatial dispersal sampler then selects the tokens to be transmitted under a bitrate budget. The transmitter sends only the quantization indices of kept tokens and a binary mask map, while the edge/cloud receiver recovers masked tokens through MaskGIT with Halton sequence scheduling. Experiments on Kodak and VisDrone scenes under AWGN and Rayleigh channels show that the proposed method provides a flexible bitrate-quality tradeoff for narrowband visual IoT links. At 0.074 bpp, it uses 44.6% of the transmitted bits of the 0.167-bpp DeepJSCC/WITT reference while achieving 29.9 dB PSNR. A pseudo-GT downstream detection study on Kodak further shows that semantic-aware masking preserves task-relevant objects better than random masking at both 30% and 50% mask ratios.

Accurate lesion segmentation in PET/CT is critical for oncology, yet remains challenging because physiologic tracer uptake and artifacts can mimic malignant signal. We present RADIANT-PET, a reasoning-augmented framework that couples a high-sensitivity voxel-level segmentation model with lesion-level large language model (LLM) adjudication. Candidate uptake regions are generated with a deliberately permissive segmentation stage, then converted into structured textual descriptions that summarize uptake intensity, morphology, and regional and global anatomical context. An LLM classifies each candidate as true lesion vs. false positive, optionally leveraging the radiology report as additional clinical context. To strengthen lesion-level reasoning, we further optimize a local LLM via reinforcement learning using Group Relative Policy Optimization, rewarding correct lesion classification and anatomically concordant site assignment. Across AutoPET and an OSU test cohort, RADIANT-PET consistently outperforms strong image-only baselines, with the largest improvements observed when radiology reports are provided. Overall, these results demonstrate that LLM-based lesion-level reasoning adds a novel reasoning layer beyond conventional segmentation, suppressing physiologic false positives and aligning voxel-level predictions with clinical interpretation. The project repository is available at: https://github.com/jwang-580/RADIANT-PET.

AI-driven image-to-image synthesis is rapidly advancing, with growing applications in medical imaging. Multi-modal image analysis plays a crucial role in optimizing examination quality, yet acquiring multiple imaging modalities in clinical settings remains resource-intensive and time-consuming, especially for 3D imaging. To address this challenge, we propose a novel image-to-image translation model based on Brownian Bridge Diffusion Models (BBDM), which synthesizes magnetic resonance imaging (MRI) sequences from 2D axial slices. Our approach integrates a variational encoder-guided diffusion mechanism, leveraging probabilistic image distributions to enhance synthesis quality. Evaluated on the BraTS 2021 dataset, our Probabilistic-BBDM (Prob-BBDM) achieves superior performance across multiple translation tasks, reaching up to 88.46% SSIM and 26.09 dB PSNR, with consistent improvements over baselines. Notably, our diffusion process requires only 4 steps, making it computationally efficient while maintaining high-quality synthesis. To further validate generalizability, we test Prob-BBDM on an external third-party dataset, demonstrating consistent performance across domains. Additionally, we assess the clinical utility of the synthesized slices by using them as input to a pre-trained segmentation model. Tumor segmentation yields a Dice score of 88.71% and an HD95 of 3.49 mm, confirming that the synthesized slices preserve critical diagnostic information. These results highlight the potential of Prob-BBDM for high-quality, efficient, and generalizable MRI synthesis, offering a promising step toward improved medical image translation.

Food images often contain several visible ingredients, so assigning one dish label to an entire image hides important visual structure. This work studies ingredient-level semantic segmentation on FoodSeg103, where the model predicts an ingredient class for each pixel. Two SegFormer variants were fine-tuned and evaluated under a controlled setup: SegFormer-B0 as the smaller baseline model and SegFormer-B1 as the larger final model. Both models use ImageNet-pretrained MiT backbones with newly initialized 104-class output layers. On the held-out FoodSeg103 test split of 2,135 images, B0 achieved 0.7709 pixel accuracy and 0.2521 mean IoU, while B1 achieved 0.7929 pixel accuracy and 0.3204 mean IoU. B1 improved every saved test metric, including a +0.0683 absolute gain in mean IoU. The system also converts predicted masks into visible ingredient-area percentages, giving a simple visual composition summary of the predicted meal. This summary can serve as a first-pass nutrition-awareness cue by providing a visual alternative to detailed food tracking similar to plate-based meal guidance, but it is not a direct estimate of calories, macronutrients, food mass, volume, density, or true portion size.

Medical image segmentation is a fundamental task for medical image processing and computer-assisted intervention, yet data imbalance and small lesion detection pose significant challenges. Dice Loss, which measures the overlap between predicted and ground truth regions, is widely used to mitigate these issues. To further emphasize its properties, we propose Polynomial Dice Loss, a polynomial extension of Dice Loss. Specifically, by leveraging the geometric characteristics of Dice Loss and formulating the loss function as a polynomial representation via Taylor expansion, we enable the adjustment of the contribution of higher-order components to the loss function. In our experiments, we evaluate the proposed method against loss functions derived from conventional Dice and Tversky coefficients. Experimental results and further analysis show that the polynomial formulation provides a simple way to control the loss shape and achieves competitive performance across multiple segmentation settings.

Deep learning-based medical image segmentation models are trained using annotations that exhibit systematic bias and variability across raters. While probabilistic multi-rater approaches can emulate annotator-specific delineations, annotator characteristics are typically encoded implicitly in deep latent feature space, making direct analysis of their influence on predictive distributions less straightforward. We propose a logit-space probabilistic segmentation framework based on stochastic variational Gaussian Process that explicitly decomposes predictions into an image-dependent reference logit distribution and annotator specific perturbations parameterised by bias and variance. This formulation enables more explicit analysis on how intra- and inter-rater variability propagate to predictive distributions. We evaluate the method on a multi-annotator medical image dataset, which shows that explicitly modelling annotator specific perturbations improves uncertainty calibration while maintaining comparable segmentation accuracy, compared with state-of-the-art multi-rater probabilistic segmentation method. The learned bias and variance parameters quantitatively reflect annotator-specific behaviour. Furthermore, controlled perturbation experiments over bias and variance demonstrate how changes in annotator parameters systematically influence predictive performance. The code used in this paper is made publicly available at https://github.com/QiLi111/GPS-Var.

This report presents our solution for the ICRA 2026 GOOSE 2D Fine-Grained Semantic Segmentation Challenge, which requires parsing unstructured outdoor scenes from four camera platforms into 56 fine-grained categories. Our approach pairs foundation vision encoders (including DINOv3, SigLIP2, and InternImage) with a Mask2Former decoder, and trains them with a strong recipe including long training schedules, exponential moving average, a larger crop size, and multi-scale plus flip test-time augmentation. The three encoders, chosen for their complementary pretraining objectives, are combined into a pretraining-diverse ensemble through per-class validation-IoU weighting. Evaluated on the official GOOSE test set, our submission achieves 75.40% composite mIoU and wins the second place of the challenge. Our study further shows that the encoder's pretraining recipe, rather than its parameter count or the decoder design, is the dominant factor for accuracy on this benchmark.

Real-time weld-pool perception is critical for closed-loop control in laser wire-feed welding, where sensing, computation, and actuator response introduce unavoidable delay. This paper presents a physics-guided spatiotemporal state space network for lookahead weld-pool segmentation. The model uses historical coaxial grayscale images, welding process parameters, and aligned wire-state electrical signals to predict the future semantic layout of three physically meaningful regions: keyhole, wire, and molten pool. It combines a visual encoder, process- and sensor-conditioned feature normalization, patch-level temporal state space modeling, horizon-conditioned latent prediction, dense future feature prediction, and a motion-aware mask decoder. Auxiliary signed-distance-function supervision, temporal consistency, feature distillation, and fine-grained keyhole losses further constrain the predicted geometry and local motion. Experiments on a 43-sequence laser welding dataset show that the proposed WeldMamba reaches 74.63% mIoU at a 500 ms lookahead. Ablation studies further show that temporal history, patch-level state space modeling, and keyhole motion awareness are the main contributors to robust future segmentation.

Concept segmentation models like Segment Anything Model 3 (SAM3) show strong generalization on natural images, yet their performance degrades in medical imaging due to the domain gap caused by different imaging principles and styles. Test-Time Adaptation (TTA) is essential for improving the testing performance by updating the model on the fly without annotations. However, existing vision-language TTA methods are mainly driven by image-level uncertainty minimization, which does not necessarily reflect region-level semantic correctness in medical segmentation. Moreover, they often lack mechanisms to maintain stability in continual one-pass adaptation, leading to limited performance when reliable dense supervision is missing for segmentation. To address these issues, we propose Concept Alignment Contrast and LongShort Prompt Memory for Test-Time Adaptation (CM-TTA) of SAM3 for medical images. First, for a test sample with multiple augmentations, we introduce a novel Concept Alignment Contrast (CAC) metric, which leverages textual-visual semantic consistency to robustly evaluate prediction quality to select the best augmented view as the supervision. Second, to balance rapid and stable adaptation, we design a Long-Short Prompt Memory (LSPM) module. The short memory dynamically fuses recent prompts based on CAC scores for agile local adaptation, while the long memory maintains a stable global prompt to generate enhanced pseudo-labels. Finally, a Densely Supervised Prompt Update (DSPU) strategy is proposed to optimize the prompt embeddings with enhanced pseudo labels as dense supervision. Extensive experiments on prostate and skin lesion segmentation demonstrate that our CM-TTA framework significantly outperforms existing methods for TTA of SAM3. The code is available at https://github.com/SherlockZYB/CM-TTA.

In this paper, we present a framework dubbed \textbf{BEV-Denoise} that estimates and removes intrinsic noise from learned Bird's-Eye-View (BEV) features to achieve accurate BEV semantic segmentation. Inspired by the noise estimation capability of Denoising Diffusion Probabilistic Models (DDPM), we design a UNet-based noise estimation module that learns to estimate the noise from the learned BEV features. The estimated noise is then subtracted from the BEV features and fed to BEV map decoders for the final prediction results. To facilitate supervision for the noise estimation module, we follow a sequential learning paradigm called Task Decomposition (TD) where a pre-trained BEV map autoencoder is employed to train a view transformation (VT) encoder. We share three key insights learned from our intensive experiments that are critical for improved performance. We apply our framework to four existing models, encompassing the three major VT paradigms. Experimental results on a large-scale real-world dataset, nuScenes, demonstrate the effectiveness of our framework.

Modern Referring Image Segmentation (RIS) systems generate multiple candidate masks per expression but rely on a simple heuristic--typically the argmax detection score--to select the final output. We identify query selection as a failure-case bottleneck: although heuristic selection succeeds on 82-93% of samples, the residual 7-18% of failures dominate the error budget, leaving a best-query selection gap of 3-11% mIoU. We introduce Venice-H1, a lightweight, backbone-decoupled post-hoc re-ranking module that encodes each candidate through multi-scale grid signatures--compact spatial descriptors pooled onto 4x4, 8x8, and 16x16 grids--and feeds them to a Transformer-based re-ranker with a Failure Gate (ROCAUC 0.78-0.82) that intervenes only when the default choice is likely suboptimal. Instantiated on DeRIS-L and DeRIS-B, Venice-H1 achieves delta_fail of +1.40 and +0.89 mIoU with strictly positive 95% CIs on all 16/16 (split, backbone) pairs and harmful-switch rates below 0.53%. Zero-shot transfer to medical referring segmentation (MS-CXR, M3D-RefSeg-2D) yields +1.16 and +0.51 mIoU without RIS-backbone fine-tuning. The module adds approximately 11.3M parameters and under 1 ms latency.

Lesion segmentation in breast ultrasound involves two related challenges. In images with lesions, speckle noise, low tissue contrast, and posterior acoustic shadowing cause boundary leakage and incomplete contour delineation. In images without lesions, those same artifacts generate false-positive activations in regions resembling solid lesion tissue. This study addresses both failure modes through a single modification to the training objective. Rather than weighting every boundary pixel equally, the proposed loss scales contour penalties by per-pixel predictive entropy and the ground-truth boundary map, concentrating gradient emphasis on lesion margin locations where the network remains uncertain. The loss was evaluated on the BUSI dataset through a controlled ablation against two baselines: a model without boundary supervision and a model with uniformly weighted boundary binary cross-entropy. Across 97 lesion-containing test images, mean Dice scores were statistically indistinguishable between the proposed method and the no-boundary baseline (0.7624 versus 0.7616, paired Wilcoxon p = 0.27), confirming that lesion segmentation quality is preserved. The primary effect appears in specificity. False-positive activations on 20 no-lesion test images fell from 14 of 20 and 19 of 20 for the two baselines to 5 of 20 with the proposed approach (McNemar p = 0.012 and 0.0005). Non-overlapping Wilson 95% confidence intervals confirm the difference is both statistically significant and practically substantial. A post-hoc spatial temperature scaling step further reduced expected calibration error from 0.0201 to 0.0095 without altering segmentation masks. Entropy-guided boundary supervision and spatial calibration thus function as complementary training-level and inference-level refinements that improve specificity and probability reliability within a U-Net framework.

Cell segmentation is critical for computational pathology and biomedical discovery. While recent Vision Foundation Models (VFMs) have demonstrated remarkable universal feature representations, unlocking their full potential for cellular imaging is currently bottlenecked by resource-intensive adaptation paradigms. Existing methods typically rely on fine-tuning heavy visual encoders, leading to extensive computational overhead and a dependency on large-scale annotations. To address this, we propose the EffiCell-Seg framework for highly efficient cell segmentation without re-training the visual encoder. Our core insight is that pretrained VFMs intrinsically encode complementary structural priors: global saliency for localizing potential cells, and local morphological patterns for delineating cellular structures. To harness these priors, we devise a Cell Structure Prompt Encoder (CSP-Encoder) that synthesizes semantic-aware saliency and principal morphological features from frozen VFM representations into explicit structural prior maps. Moreover, we propose a Synergistic Mask Decoder (SM-Decoder) that enforces contextual consistency by jointly predicting geometric distance fields and semantic maps via mutual cross-guidance. Extensive experiments demonstrate that EffiCell-Seg outperforms state-of-the-art methods across diverse cell imaging modalities while requiring only ~5M trainable parameters, over 130x fewer than fully fine-tuned VFM counterparts. The code is available at https://github.com/xq141839/EffiCell-Seg.

Medical image segmentation is widely used for disease detection but relies on sensitive data, raising privacy concerns as trained models can leak information. Differential privacy, typically implemented via Differential Private Stochastic Gradient Descent (DPSGD), provides a solution, though at the cost of reduced utility. Recent DPSGD variants, including Automatic clipping (Auto-S), Normalised SGD with perturbation (NSGD), and Per-sample adaptive clipping (PSAC), have shown promise in image classification, but their behavior in medical segmentation remains underexplored. We evaluate these methods across binary and multi-class tasks and analyze gradient alignment, showing that prior assumptions, particularly for PSAC, do not consistently hold. We further demonstrate that combining clipping strategies with morphological refinement improves segmentation quality under privacy constraints. Finally, we propose an adaptive DP-Morph variant that captures class-specific structures and enhances performance in multi-class settings.