Parhom Esmaeili

Parhom Esmaeili, Chayanin Tangwiriyasakul, Eli Gibson et al.

Interactive segmentation enables clinicians to guide annotation, but existing zero-shot models like nnInteractive fail to consistently reach expert-level performance across diverse medical imaging tasks. Because annotation campaigns produce a growing stream of task-specific labelled data, online adaptation of the segmentation model is a natural complement to zero-shot inference. We propose CLoPA, a continual adaptation strategy that tunes a small fraction of nnInteractive's parameters on the annotation cache, triggered by lightweight episode scheduling. CLoPA requires no new parameters or changes to the inference pipeline, and operates entirely within the existing annotation workflow. Across eight Medical Segmentation Decathlon tasks spanning diverse anatomical targets and imaging characteristics, CLoPA rapidly elevates performance to expert-level, even for tasks where nnInteractive previously failed, with the majority of gains realised after a single training episode. We show that the benefits of tuning different parameter groups depends on task characteristics and data regimes. Also, that for targets with complex geometries (e.g., hepatic vessels), instance normalisation and low-level feature tuning saturates, suggesting a need for deeper feature-representation alignment in the most challenging scenarios.

Parhom Esmaeili, Virginia Fernandez, Pedro Borges et al.

Interactive segmentation is a promising strategy for building robust, generalisable algorithms for volumetric medical image segmentation. However, inconsistent and clinically unrealistic evaluation hinders fair comparison and misrepresents real-world performance. We propose a clinically grounded methodology for defining evaluation tasks and metrics, and built a software framework for constructing standardised evaluation pipelines. We evaluate state-of-the-art algorithms across heterogeneous and complex tasks and observe that (i) minimising information loss when processing user interactions is critical for model robustness, (ii) adaptive-zooming mechanisms boost robustness and speed convergence, (iii) performance drops if validation prompting behaviour/budgets differ from training, (iv) 2D methods perform well with slab-like images and coarse targets, but 3D context helps with large or irregularly shaped targets, (v) performance of non-medical-domain models (e.g. SAM2) degrades with poor contrast and complex shapes.