Atle Bjornerud

Sheng He, Rina Bao, Jingpeng Li et al.

Background: The segment-anything model (SAM), introduced in April 2023, shows promise as a benchmark model and a universal solution to segment various natural images. It comes without previously-required re-training or fine-tuning specific to each new dataset. Purpose: To test SAM's accuracy in various medical image segmentation tasks and investigate potential factors that may affect its accuracy in medical images. Methods: SAM was tested on 12 public medical image segmentation datasets involving 7,451 subjects. The accuracy was measured by the Dice overlap between the algorithm-segmented and ground-truth masks. SAM was compared with five state-of-the-art algorithms specifically designed for medical image segmentation tasks. Associations of SAM's accuracy with six factors were computed, independently and jointly, including segmentation difficulties as measured by segmentation ability score and by Dice overlap in U-Net, image dimension, size of the target region, image modality, and contrast. Results: The Dice overlaps from SAM were significantly lower than the five medical-image-based algorithms in all 12 medical image segmentation datasets, by a margin of 0.1-0.5 and even 0.6-0.7 Dice. SAM-Semantic was significantly associated with medical image segmentation difficulty and the image modality, and SAM-Point and SAM-Box were significantly associated with image segmentation difficulty, image dimension, target region size, and target-vs-background contrast. All these 3 variations of SAM were more accurate in 2D medical images, larger target region sizes, easier cases with a higher Segmentation Ability score and higher U-Net Dice, and higher foreground-background contrast.

Rina Bao, Erfan Darzi, Sheng He et al.

Foundation models refer to artificial intelligence (AI) models that are trained on massive amounts of data and demonstrate broad generalizability across various tasks with high accuracy. These models offer versatile, one-for-many or one-for-all solutions, eliminating the need for developing task-specific AI models. Examples of such foundation models include the Chat Generative Pre-trained Transformer (ChatGPT) and the Segment Anything Model (SAM). These models have been trained on millions to billions of samples and have shown wide-ranging and accurate applications in numerous tasks such as text processing (using ChatGPT) and natural image segmentation (using SAM). In medical image segmentation - finding target regions in medical images - there is a growing need for these one-for-many or one-for-all foundation models. Such models could obviate the need to develop thousands of task-specific AI models, which is currently standard practice in the field. They can also be adapted to tasks with datasets too small for effective training. We discuss two paths to achieve foundation models for medical image segmentation and comment on progress, challenges, and opportunities. One path is to adapt or fine-tune existing models, originally developed for natural images, for use with medical images. The second path entails building models from scratch, exclusively training on medical images.