Adrien Meyer

Aditya Murali, Farahdiba Zarin, Adrien Meyer et al.

Surgical image segmentation is highly challenging, primarily due to scarcity of annotated data. Generalist prompted segmentation models like the Segment-Anything Model (SAM) can help tackle this task, but because they require image-specific visual prompts for effective performance, their use is limited to improving data annotation efficiency. Recent approaches extend SAM to automatic segmentation by using a few labeled reference images to predict point prompts; however, they rely on feature matching pipelines that lack robustness to out-of-domain data like surgical images. To tackle this problem, we introduce CycleSAM, an improved visual prompt learning approach that employs a data-efficient training phase and enforces a series of soft constraints to produce high-quality feature similarity maps. CycleSAM label-efficiently addresses domain gap by leveraging surgery-specific self-supervised feature extractors, then adapts the resulting features through a short parameter-efficient training stage, enabling it to produce informative similarity maps. CycleSAM further filters the similarity maps with a series of consistency constraints before robustly sampling diverse point prompts for each object instance. In our experiments on four diverse surgical datasets, we find that CycleSAM outperforms existing few-shot SAM approaches by a factor of 2-4x in both 1-shot and 5-shot settings, while also achieving strong performance gains over traditional linear probing, parameter-efficient adaptation, and pseudo-labeling methods.

Adrien Meyer, Didier Mutter, Nicolas Padoy

Detecting anatomical landmarks in medical imaging is essential for diagnosis and intervention guidance. However, object detection models rely on costly bounding box annotations, limiting scalability. Weakly Semi-Supervised Object Detection (WSSOD) with point annotations proposes annotating each instance with a single point, minimizing annotation time while preserving localization signals. A Point-to-Box teacher model, trained on a small box-labeled subset, converts these point annotations into pseudo-box labels to train a student detector. Yet, medical imagery presents unique challenges, including overlapping anatomy, variable object sizes, and elusive structures, which hinder accurate bounding box inference. To overcome these challenges, we introduce DExTeR (DETR with Experts), a transformer-based Point-to-Box regressor tailored for medical imaging. Built upon Point-DETR, DExTeR encodes single-point annotations as object queries, refining feature extraction with the proposed class-guided deformable attention, which guides attention sampling using point coordinates and class labels to capture class-specific characteristics. To improve discrimination in complex structures, it introduces CLICK-MoE (CLass, Instance, and Common Knowledge Mixture of Experts), decoupling class and instance representations to reduce confusion among adjacent or overlapping instances. Finally, we implement a multi-point training strategy which promotes prediction consistency across different point placements, improving robustness to annotation variability. DExTeR achieves state-of-the-art performance across three datasets spanning different medical domains (endoscopy, chest X-rays, and endoscopic ultrasound) highlighting its potential to reduce annotation costs while maintaining high detection accuracy.

Adrien Meyer, Aditya Murali, Farahdiba Zarin et al.

Purpose: Automated ultrasound image analysis is challenging due to anatomical complexity and limited annotated data. To tackle this, we take a data-centric approach, assembling the largest public ultrasound segmentation dataset and training a versatile visual foundation model tailored for ultrasound. Methods: We compile US-43d, a large-scale collection of 43 open-access ultrasound datasets with over 280,000 images and segmentation masks for more than 50 anatomical structures. We then introduce UltraSam, an adaptation of the Segment Anything Model (SAM) that is trained on US-43d and supports both point- and box-prompts. Finally, we introduce a new use case for SAM-style models by using UltraSam as a model initialization that can be fine-tuned for various downstream analysis tasks, demonstrating UltraSam's foundational capabilities. Results: UltraSam achieves vastly improved performance over existing SAM-style models for prompt-based segmentation on three diverse public datasets. Moreover, an UltraSam-initialized Vision Transformer surpasses ImageNet-, SAM-, and MedSAM-initialized models in various downstream segmentation and classification tasks, highlighting UltraSam's effectiveness as a foundation model. Conclusion: We compile US-43d, a large-scale unified ultrasound dataset, and introduce UltraSam, a powerful multi-purpose SAM-style model for ultrasound images. We release our code and pretrained models at https://github.com/CAMMA-public/UltraSam and invite the community to further this effort by contributing high-quality datasets.

Adrien Meyer, Lorenzo Arboit, Giuseppe Massimiani et al.

Purpose: The Segment Anything Model (SAM) promises to ease the annotation bottleneck in medical segmentation, but overlapping anatomy and blurred boundaries make its point prompts ambiguous, leading to cycles of manual refinement to achieve precise masks. Better prompting strategies are needed. Methods: We propose a structured prompting strategy using 4 points as a compact instance-level shape description. We study two 4-point variants: extreme points and the proposed major/minor axis endpoints, inspired by ultrasound measurement practice. SAM cannot fully exploit such structured prompts because it treats all points identically and lacks geometry-aware reasoning. To address this, we introduce S4M (4-points to Segment Anything), which augments SAM to interpret 4 points as relational cues rather than isolated clicks. S4M expands the prompt space with role-specific embeddings and adds an auxiliary "Canvas" pretext task that sketches coarse masks directly from prompts, fostering geometry-aware reasoning. Results: Across eight datasets in ultrasound and surgical endoscopy, S4M improves segmentation by +3.42 mIoU over a strong SAM baseline at equal prompt budget. An annotation study with three clinicians further shows that major/minor prompts enable faster annotation. Conclusion: S4M increases performance, reduces annotation effort, and aligns prompting with clinical practice, enabling more scalable dataset development in medical imaging.