Arash Tavangar, Larissa K. Chiu, Hamidreza Khodashenas +2eess.IV cs.CV
Manual annotation remains a major bottleneck in ultrasound (US) bone segmentation, where experts typically iteratively refine rough brush masks rather than delineating precise contours in a single pass. We present ExiL, a mask-conditioned progressive learning framework that models annotation as a structured refinement trajectory. ExiL combines a synthetic expert-like brush simulator based on signed distance fields with a lightweight 7.8M-parameter U-Net that learns to complete and refine imperfect masks from US images. During deployment, an expert mode updates the model directly from accepted refinements, enabling continual adaptation to expert behavior. Evaluated using UltraBones100k cadaver data for quantitative segmentation and a prospective volunteer dataset for annotation-efficiency analysis, ExiL reduced single-expert average annotation time from 60 to 20 seconds per frame (66.7\%) and improved mean Dice by approximately 0.045 over non-progressive training, while achieving 0.87 Dice and 2.7 px boundary error in the best trajectory-aware setting. With 10--50 ms inference, ExiL enables real-time, self-improving annotation for US-guided orthopedic workflows in practical clinical labeling.
Multi-organ ultrasound segmentation remains challenging when anatomically adjacent structures must be delineated jointly, as localized boundary errors can persist even when Dice scores are high. To address these challenges, we propose Boundary-Adaptive Prompting for Multi-Organ Segmentation (BAP-MOS), a closed-loop adaptive prompting framework. BAP-MOS formulates prompt selection as an organ-specific multi-armed bandit problem over box, point, and combined prompts. An outer Tree-structured Parzen Estimator (TPE) loop selects the prompt-selection parameter vector, while an inner UCB-Tuned loop adapts per-organ prompt preferences during fine-tuning using a bounded Dice--MSD--HD95 validation-probe reward. The framework further introduces an organ-scaled negative prompt ring to adapt sparse prompt geometry across anatomical scales, while keeping the image and prompt encoders frozen and updating only the mask decoder. We evaluate BAP-MOS on pooled prostate-region TRUS cohorts against U-Net, nnU-Net, MedSAM, fixed-prompt SAM/MedSAM, and adaptive policy variants. On this benchmark, BAP-MOS achieves Dice 0.982, HD95 0.482, and MSD 0.204, reducing HD95 by approximately 48% and MSD by 45% relative to the strongest conventional baseline. To verify the generalization ability of the framework, we tested it on the external PFUS1 pelvic-floor ultrasound corpus using MedSAM and its adaptive strategy variants, and the results were good. These results support adaptive prompt allocation as an effective mechanism for improving boundary-sensitive multi-organ ultrasound segmentation without modifying the foundation-model backbone. Source Code is available at: https://github.com/SatvikPraveen/BAP-MOS
Continual learning in clinical imaging faces a dual challenge: a model must assimilate knowledge from new anatomical domains while retaining representations learned from prior tasks, a problem known as catastrophic forgetting. Existing mitigation strategies, including regularization and knowledge distillation, treat all spatial regions equally, ignoring the fact that prediction uncertainty is strongly correlated with the propensity for forgetting. We introduce UCBound-Net, a continual segmentation framework that exploits Monte Carlo (MC) Dropout uncertainty as a spatial proxy for forgetting risk. Our method contributes three synergistic components: (i) uncertainty-weighted boundary distillation, which amplifies the knowledge transfer signal at high-entropy regions of the frozen teacher; (ii) uncertainty-calibration regularization, which explicitly penalizes overconfident erroneous predictions; and (iii) uncertainty-guided exemplar selection, a memory buffer that preferentially stores samples whose boundary regions exhibit the highest predictive entropy. Evaluated on a sequential domain-incremental benchmark comprising breast ultrasound (BUSI, Task 1) followed by thyroid ultrasound (TN3K, Task 2), UCBound-Net reduces forgetting relative to naive fine-tuning, achieving a backward transfer (BWT) of -0.098 compared with -0.173, while obtaining an average Dice Similarity Coefficient (DSC) of 0.755 across both tasks. The proposed framework outperforms baseline methods without requiring task-boundary supervision. An ablation study further demonstrates that each component contributes independently to forgetting mitigation, providing a practical pathway toward uncertainty-aware continual learning for clinical image segmentation.
Ultrasound imaging has become increasingly widespread in clinical practice due to its portability, low cost and real-time capability, making ultrasound image segmentation important. However, ultrasound images differ substantially from CT, MRI, and other medical imaging modalities, as they are often affected by speckle noise, low contrast, acoustic shadows and ambiguous boundaries. Existing ultrasound segmentation methods are still mainly limited to task-specific models or visual-prompt-based foundation models, which are either tailored to particular tasks or require expert-provided visual prompts, making them inconvenient for flexible clinical use. To address these challenges, we propose UltraSAM3, a concept-driven foundation model for universal ultrasound image segmentation. Unlike conventional models, UltraSAM3 enables text-based target specification by adapting SAM3 to ultrasound-specific image--mask--concept triplets. The model is trained on a large-scale ultrasound segmentation corpus covering 37 public datasets and 13 anatomical categories, allowing it to align ultrasound visual patterns with clinically meaningful concepts across diverse organs and lesions. To further improve usability under realistic clinical interaction, we propose an instruction-guided agent that parses complex natural language queries into concise ultrasound concept prompts for UltraSAM3. Extensive experiments demonstrate that UltraSAM3 consistently outperforms representative concept- and text-driven biomedical segmentation models on multi-organ ultrasound benchmarks, external datasets, and visual-prompt-enhanced settings. Moreover, the agent improves segmentation robustness for complex user instructions. These results indicate that ultrasound-specific concept adaptation is effective for building generalizable and interactive ultrasound segmentation foundation models.
Medical ultrasound (US) image segmentation faces significant challenges due to speckle noise, low-contrast boundaries, acoustic shadowing, and acquisition variation across operators and clinical centers. Although encoder-decoder and transformer-based networks have achieved strong performance, many methods recover boundary details through dense decoders or larger backbones, which may still produce over-smoothed contours or unstable predictions under external distribution shifts. In this article, we propose Risk-routed Implicit Boundary Refinement (RIBR), a compact segmentation framework that uses implicit neural representation as a risk-routed residual correction rather than an unconstrained full-mask predictor. RIBR combines boundary-refinement implicit residuals, risk-routed residual control, and geometry- and speckle-aware boundary regularization to refine uncertain contours while suppressing non-boundary oscillations. Evaluation on nine US datasets covering lymph nodes, breast lesions, thyroid nodules, and prostate shows that RIBR achieves the best overall macro-average and consistently reduces boundary error across grouped and organ-specific comparisons under a compact parameter budget. These findings suggest that controlled implicit residual learning is a practical strategy for resource-constrained and boundary-sensitive US segmentation. Source code is available at https://github.com/jinggqu/ribr.
Deep learning (DL) methods dominate thyroid nodule segmentation in ultrasound (US) images, achieving high Dice scores but at the cost of millions of parameters, GPU-dependent training via backpropagation, and limited mathematical tractability. These limitations impede deployment in resource-constrained environments. In this paper, we propose MedSaab-US, a backpropagation-free segmentation framework grounded in the Green Learning paradigm. MedSaab-US extracts multi-scale spatial-frequency features by combining multi-level Discrete Wavelet Transform (DWT) with multi-scale channel-wise Saab (Subspace Approximation with Adjusted Bias) transforms at patch sizes of 5 x 5, 11 x 11, and 21 x 21 pixels. Label-Assisted Greedy (LAG) feature selection retains the most discriminative features, which are fed to an XGBoost classifier for pixel-wise prediction. The Saab transform parameters are determined analytically from data statistics, while XGBoost employs iterative greedy tree construction without requiring backpropagation. Evaluated on the TN3K dataset (2,879 training and 614 test images), MedSaab-US achieves a mean Dice coefficient of 0.4784 +/- 0.2190, precision of 0.5768, and recall of 0.5604, with a model footprint under 500K parameters and CPU-only inference in approximately 0.3 seconds per image. We present this result as an exploratory non-DL baseline for thyroid ultrasound segmentation and analyze the specific challenges posed by isoechoic nodules. An ablation study further quantifies the contribution of each pipeline component, including separate evaluations of LAG feature selection and training-set size.
Ultrasound imaging is the most widely adopted medical modality globally due to its low cost and portability, yet artificial intelligence (AI) deployment remains constrained by reliance on GPU-accelerated models, creating a structural paradox where the cost of "intelligence" exceeds that of the imaging device itself. Here, we present the systematic adaptation and extensive evaluation of UltraSeg, an ultra-lightweight architecture originally developed for colonoscopic polyp segmentation, now engineered for point-of-care ultrasound (POCUS) across ten public datasets spanning six anatomical sites (breast, thyroid, kidney, carotid, fetal, and small-animal tumor). We systematically validate both variants in ultrasound domains: UltraSeg-130K (0.13M parameters) achieves 89.7 FPS on single-core CPUs and 34.8 FPS on a refurbished mobile device, while UltraSeg-500K (0.5M parameters) delivers 44.6 FPS on CPU and 16.1 FPS on mobile device. UltraSeg-500K matches or exceeds the Dice performance of the 31M-parameter UNet and approaches 105M-parameter TransUNet in average performance, with superior zero-shot cross-dataset generalization on external validation sets (UDIAT, DDTI). By enabling clinical-grade segmentation without GPU dependency, this work brings AI costs in line with ultrasound accessibility, making advanced diagnostics available in resource-limited settings.
Fetal ventriculomegaly is assessed by measuring the atrial width of the lateral ventricle in prenatal ultrasound. Accurate segmentation is essential for this measurement, but acoustic shadowing, speckle noise, and poor contrast make it difficult. We developed MVSegNet, a lightweight encoder-decoder network combining multi-scale feature extraction and boundary-aware refinement. The model was trained and evaluated on 584 expert-annotated transventricular ultrasound frames using a 70/15/15 split. Performance was compared against six segmentation baselines using overlap, boundary, and measurement metrics. MVSegNet achieved a Dice score of 80.79%, IoU of 68.47%, Hausdorff distance of 4.07 mm, and atrial width mean absolute error of 3.40 mm. The model contains 2.31 million parameters and runs at 165.6 frames per second on an NVIDIA T4 GPU. MVSegNet outperformed all evaluated baselines on boundary and measurement metrics while maintaining low computational cost, supporting its use in automated fetal ultrasound analysis.