Deep neural networks (DNNs) frequently fail to generalize to out-of-distribution (OOD) medical images because of variations in scanners and acquisition protocols. Retraining DNN models to address these distribution shifts is often impractical due to the high cost of acquiring and annotating new medical datasets. To address this, we introduce VarDeepPCA, a novel lightweight variational DNN framework designed to restore/refine degraded segmentation maps by leveraging intrinsic geometric priors. Unlike existing approaches that require target-domain data or extensive pre-training, our VarDeepPCA explicitly learns a distribution of valid anatomical geometries using only small in-distribution (ID) datasets. Theoretically, our novel variational learning framework leverages a reinterpretation of the softmax mapping to implicitly perform exact distribution modeling, thereby enabling computationally efficient, sampling-free learning and inference. This also enables VarDeepPCA to provide uncertainty estimates associated with its restored segmentation maps. We empirically validate our framework across 4 distinct clinical applications, using 14 publicly available datasets, involving segmentation of the myocardium, neuroretinal rim, prostate, and fetal head. Comparisons against 15 existing methods demonstrate that VarDeepPCA consistently restores segmentation maps produced by the existing methods on OOD data to (i) significantly improve anatomical plausibility of geometries and clinical utility of the segmentations, and (ii) significantly reduce errors, without needing any more training data than that used by existing methods.

The scarcity of annotated medical imaging data has driven significant progress in semi-supervised learning to alleviate reliance on expensive expert labeling. While foundational vision models such as the Segment Anything Model (SAM) exhibit robust generalization in generic segmentation tasks, their direct application to medical images often results in suboptimal performance. To address this challenge, in this work, we propose a novel fully SAM-based semi-supervised medical image segmentation framework and develop the corresponding knowledge distillationbased learning strategy. Specifically, we first employ an efficient SAM variant as the backbone network of the semi-supervised framework and update the default prompt embedding of SAM to unleash its full potential. Then, we utilize an original SAM, which is rich in prior knowledge, as the teacher to optimize our efficient student SAM backbone through hierarchical knowledge distillation and a dynamic loss weighting strategy. Extensive experiments on various medical datasets demonstrate that our method outperforms state-of-the-art semi-supervised segmentation approaches. Especially, our model requires less than 10% of the parameter size of the original SAM, enabling substantially lower deployment and storage overhead in real-world clinical settings.

Multi-modal image segmentation faces real-world deployment challenges from incomplete/corrupted modalities degrading performance. While existing methods address training-inference modality gaps via specialized per-combination models, they introduce high deployment costs by requiring exhaustive model subsets and model-modality matching. In this work, we propose a unified modality-relax segmentation network (UniMRSeg) through hierarchical self-supervised compensation (HSSC).

This paper presents a novel approach to addressing the long-sequence problem in high-resolution medical images for Vision Transformers (ViTs). Using smaller patches as tokens can enhance ViT performance, but quadratically increases computation and memory requirements. Therefore, the common practice for applying ViTs to high-resolution images is either to: (a) employ complex sub-quadratic attention schemes or (b) use large to medium-sized patches and rely on additional mechanisms within the model to capture the spatial hierarchy of details. We propose Symmetrical Hierarchical Forest (SHF), a lightweight approach that adaptively patches the input image to increase token information density and encode hierarchical spatial structures into the input embedding. We then apply a reverse depatching scheme to the output embeddings of the transformer encoder, eliminating the need for convolution-based decoders. Unlike previous methods that modify attention mechanisms or use a complex hierarchy of interacting models, SHFcan be retrofitted to any ViT model to allow it to learn the hierarchical structure of details in high-resolution images without requiring architectural changes. Experimental results demonstrate significant gains in computational efficiency and performance: on the PAIPWSI dataset, we achieved a 3 32 speedup or a 2.95% 7.03% increase in accuracy (measured by Dice score) at a 64K2 resolution with the same computational budget, compared to state-of-the-art production models. On the 3D medical datasets BTCV and KiTS, training was 6 faster, with accuracy gains of 6.93% and 5.9%, respectively, compared to models without SHF.

In semi-supervised segmentation, capturing meaningful semantic structures from unlabeled data is essential. This is particularly challenging in histopathology image analysis, where objects are densely distributed. To address this issue, we propose a semi-supervised segmentation framework designed to robustly identify and preserve relevant topological features. Our method leverages multiple perturbed predictions obtained through stochastic dropouts and temporal training snapshots, enforcing topological consistency across these varied outputs. This consistency mechanism helps distinguish biologically meaningful structures from transient and noisy artifacts. A key challenge in this process is to accurately match the corresponding topological features across the predictions in the absence of ground truth. To overcome this, we introduce a novel matching strategy that integrates spatial overlap with global structural alignment, minimizing discrepancies among predictions. Extensive experiments demonstrate that our approach effectively reduces topological errors, resulting in more robust and accurate segmentations essential for reliable downstream analysis. Code is available at https://github.com/MelonXu/MATCH.

Rheumatoid arthritis (RA) is a common autoimmune disease that has been the focus of research in computer-aided diagnosis (CAD) and disease monitoring. In clinical settings, conventional radiography (CR) is widely used for the screening and evaluation of RA due to its low cost and accessibility. The wrist is a critical region for the diagnosis of RA. However, CAD research in this area remains limited, primarily due to the challenges in acquiring high-quality instance-level annotations.

While deep neural networks possess the capability to perform semantic segmentation, producing a single deterministic output limits reliability in safety-critical applications caused by uncertainty and annotation variability. To address this, stochastic segmentation models using Conditional Variational Autoencoders (CVAE), Bayesian networks, and diffusion have been explored. However, existing approaches suffer from limited latent expressiveness and interpretability. Furthermore, our experiments showed that models like Probabilistic U-Net rely excessively on high latent variance, leading to posterior collapse. This work propose a novel framework by integrating Gaussian Mixture Model (GMM) with Normalizing Flow (NF) in CVAE for stochastic segmentation. GMM structures the latent space into meaningful semantic clusters, while NF captures feature deformations with quantified uncertainty. Our method stabilizes latent distributions through constrained variance and mean ranges. Experiments on LIDC, Crack500, and Cityscapes datasets show that our approach outperformed state-of-the-art in curvilinear structure and medical image segmentation.

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A single biomedical image can be meaningfully segmented in multiple ways, depending on the desired application. For instance, a brain MRI can be segmented according to tissue types, vascular territories, broad anatomical regions, finegrained anatomy, or pathology, etc. Existing automatic segmentation models typically either (1) support only a single protocol - the one they were trained on - or (2) require labor-intensive manual prompting to specify the desired segmentation. We introduce Pancakes, a framework that, given a new image from a previously unseen domain, automatically generates multi-label segmentation maps for multiple plausible protocols, while maintaining semantic consistency across related images. Pancakes introduces a new problem formulation that is not currently attainable by existing foundation models. In a series of experiments on seven held-out datasets, we demonstrate that our model can significantly outperform existing foundation models in producing several plausible whole-image segmentations, that are semantically coherent across images.

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