Kevin Kramer

Yixin Zhang, Nicholas Konz, Kevin Kramer et al.

Image segmentation foundation models (SFMs) like Segment Anything Model (SAM) have achieved impressive zero-shot and interactive segmentation across diverse domains. However, they struggle to segment objects with certain structures, particularly those with dense, tree-like morphology and low textural contrast from their surroundings. These failure modes are crucial for understanding the limitations of SFMs in real-world applications. To systematically study this issue, we introduce interpretable metrics quantifying object tree-likeness and textural separability. On carefully controlled synthetic experiments and real-world datasets, we show that SFM performance (\eg, SAM, SAM 2, HQ-SAM) noticeably correlates with these factors. We attribute these failures to SFMs misinterpreting local structure as global texture, resulting in over-segmentation or difficulty distinguishing objects from similar backgrounds. Notably, targeted fine-tuning fails to resolve this issue, indicating a fundamental limitation. Our study provides the first quantitative framework for modeling the behavior of SFMs on challenging structures, offering interpretable insights into their segmentation capabilities.

Yixin Zhang, Ryan Chamberlain, Lawrence Ngo et al.

In this study, we curated a densely annotated in-house dataset comprising 490 CTPA scans. Using this dataset, we systematically evaluated nine widely used segmentation architectures from both the CNN and Vision Transformer (ViT) families, initialized with either pretrained or random weights, under a unified testing framework as a performance audit. Our study leads to several important observations: (1) 3D U-Net with a ResNet encoder remains a highly effective architecture for PE segmentation; (2) 3D models are particularly well-suited to this task given the morphological characteristics of emboli; (3) CNN-based models generally yield superior performance compared to their ViT-based counterparts in PE segmentation; (4) classification-based pretraining, even on large PE datasets, can adversely impact segmentation performance compared to training from scratch, suggesting that PE classification and segmentation may rely on different sets of discriminative features; (5) different model architectures show a highly consistent pattern of segmentation performance when trained on the same data; and (6) while central and large emboli can be segmented with satisfactory accuracy, distal emboli remain challenging due to both task complexity and the scarcity of high-quality datasets. Besides these findings, our best-performing model achieves a mean Dice score of 0.7131 for segmentation. It detects 181 emboli with 49 false positives and 28 false negatives from 60 in-house testing scans. Its generalizability is further validated on public datasets.

Yixin Zhang, Kevin Kramer, Maciej A. Mazurowski

Automated segmentation of medical images heavily relies on the availability of precise manual annotations. However, generating these annotations is often time-consuming, expensive, and sometimes requires specialized expertise (especially for cross-sectional medical images). Therefore, it is essential to optimize the use of annotation resources to ensure efficiency and effectiveness. In this paper, we systematically address the question: "in a non-interactive annotation pipeline, how should slices from cross-sectional medical images be selected for annotation to maximize the performance of the resulting deep learning segmentation models?" We conducted experiments on 4 medical imaging segmentation tasks with varying annotation budgets, numbers of annotated cases, numbers of annotated slices per volume, slice selection techniques, and mask interpolations. We found that: 1) It is almost always preferable to annotate fewer slices per volume and more volumes given an annotation budget. 2) Selecting slices for annotation by unsupervised active learning (UAL) is not superior to selecting slices randomly or at fixed intervals, provided that each volume is allocated the same number of annotated slices. 3) Interpolating masks between annotated slices rarely enhances model performance, with exceptions of some specific configuration for 3D models.