GazeRefine: Expert Gaze as a Test-Time Prompt for Training-Free Medical Image Segmentation

Medical image segmentation remains difficult to scale because high-performing methods typically rely on dense expert annotations and task-specific training. We introduce GazeRefine, a training-free framework that uses gaze as an inference-time prompt for zero-shot medical image segmentation. Sparse, duration-weighted fixations are converted into foreground and background priors that initialize semantic prototypes in frozen DINOv3 feature space. These prototypes are iteratively refined through foreground-background discrimination, feature-space affinity propagation, and anchoring to the initial gaze guidance, allowing segmentation to extend beyond directly fixated regions while limiting semantic drift. GazeRefine requires no segmentation masks, fine-tuning, adapters, prompt encoders, or gradient updates. We evaluate the method on gaze-annotated polyp segmentation and prostate MRI segmentation. The results show strong performance on colonoscopy images and competitive performance on prostate MRI, supporting gaze-guided prototype refinement as a promising approach for segmentation-label-efficient, human-in-the-loop medical image segmentation. Our tools and code can be found in the following repository: https://github.com/MohammedOussamaBEN/GazeRefine.git

GLINT: Sparsely Gated Vision-Language Alignment for Fine-Grained Radiology Representations

Vision-language models (VLMs) for radiology have emerged as a scalable paradigm by leveraging image-report pairs naturally produced in clinical workflows. However, this pairing reveals a mismatch in scale: each finding occupies only a small region of the image, yet supervision is provided only at the global image-report level. This poses a central challenge: prior approaches spread weight densely across all patches rather than concentrating on the sparse subset relevant to a given query. To address this, we present GLINT (Gated Language-Image alignmeNT), a framework that explicitly models this sparse correspondence. On the alignment side, we introduce Sparsely Gated Alignment, a novel architecture in which a sigmoid gate over a separate gate embedding space activates only the patches relevant to each textual query, enforcing explicit sparsity. On the representation side, we add Dense Feature Regularization, which anchors the trainable encoder's intermediate features to a frozen self-supervised learning (SSL) teacher, preserving the fine-grained patch features that the gate relies on. The same recipe applies to both 2D chest X-ray (CXR) and 3D chest computed tomography (CT), built with DINOv3 and V-JEPA 2.1, respectively. GLINT enables zero-shot classification, grounding, and segmentation from free-text queries, and to our knowledge is the first to demonstrate zero-shot segmentation on 3D CT volumes without mask supervision. Notably, the most pronounced gains arise on zero-shot grounding and segmentation, where sparse, query-specific localization is required, consistent with our design intent. In downstream evaluation, GLINT outperforms both SSL encoders and medical VLMs on classification, report generation, and segmentation.