# Going to Extremes: Weakly Supervised Medical Image Segmentation

arXiv: https://arxiv.org/abs/2009.11988 · HTML: https://mlsanity.com/paper/2009.11988/

## Key facts

- Cited by 38 papers in the map (data through 14 Oct 2026).
- First posted on arXiv 25 Sep 2020.

## Built on by (most cited first, 30 of 38)

- [ScribblePrompt: Fast and Flexible Interactive Segmentation for Any Biomedical Image](https://mlsanity.com/paper/2312.07381/) (2023)
- [MIDeepSeg: Minimally Interactive Segmentation of Unseen Objects from Medical Images Using Deep Learning](https://mlsanity.com/paper/2104.12166/) (2021)
- [MONAI Label: A framework for AI-assisted Interactive Labeling of 3D Medical Images](https://mlsanity.com/paper/2203.12362/) (2022)
- [Deep Interactive Segmentation of Medical Images: A Systematic Review and Taxonomy](https://mlsanity.com/paper/2311.13964/) (2023)
- [A Survey on Deep Learning for Skin Lesion Segmentation](https://mlsanity.com/paper/2206.00356/) (2022)
- [Inter Extreme Points Geodesics for End-to-End Weakly Supervised Image Segmentation](https://mlsanity.com/paper/2107.00583/) (2021)
- [PA-Seg: Learning from Point Annotations for 3D Medical Image Segmentation using Contextual Regularization and Cross Knowledge Distillation](https://mlsanity.com/paper/2208.05669/) (2022)
- [Label-Efficient Deep Learning in Medical Image Analysis: Challenges and Future Directions](https://mlsanity.com/paper/2303.12484/) (2023)
- [Scribble2D5: Weakly-Supervised Volumetric Image Segmentation via Scribble Annotations](https://mlsanity.com/paper/2205.06779/) (2022)
- [mathrmSAMMed: A medical image annotation framework based on large vision model](https://mlsanity.com/paper/2307.05617/) (2023)
- [MultiverSeg: Scalable Interactive Segmentation of Biomedical Imaging Datasets with In-Context Guidance](https://mlsanity.com/paper/2412.15058/) (2024)
- [Non-Iterative Scribble-Supervised Learning with Pacing Pseudo-Masks for Medical Image Segmentation](https://mlsanity.com/paper/2210.10956/) (2022)
- [Acquiring Weak Annotations for Tumor Localization in Temporal and Volumetric Data](https://mlsanity.com/paper/2310.15098/) (2023)
- [Multimodal Interactive Lung Lesion Segmentation: A Framework for Annotating PET/CT Images based on Physiological and Anatomical Cues](https://mlsanity.com/paper/2301.09914/) (2023)
- [Weakly Supervised Intracranial Hemorrhage Segmentation using Head-Wise Gradient-Infused Self-Attention Maps from a Swin Transformer in Categorical Learning](https://mlsanity.com/paper/2304.04902/) (2023)
- [SimPLe: Similarity-Aware Propagation Learning for Weakly-Supervised Breast Cancer Segmentation in DCE-MRI](https://mlsanity.com/paper/2306.16714/) (2023)
- [Data efficient deep learning for medical image analysis: A survey](https://mlsanity.com/paper/2310.06557/) (2023)
- [SimTxtSeg: Weakly-Supervised Medical Image Segmentation with Simple Text Cues](https://mlsanity.com/paper/2406.19364/) (2024)
- [Annotation by Clicks: A Point-Supervised Contrastive Variance Method for Medical Semantic Segmentation](https://mlsanity.com/paper/2212.08774/) (2022)
- [Beyond Pixel-Wise Supervision for Medical Image Segmentation: From Traditional Models to Foundation Models](https://mlsanity.com/paper/2404.13239/) (2024)
- [Guiding Users to Where to Give Color Hints for Efficient Interactive Sketch Colorization via Unsupervised Region Prioritization](https://mlsanity.com/paper/2210.14270/) (2022)
- [From Few to More: Scribble-based Medical Image Segmentation via Masked Context Modeling and Continuous Pseudo Labels](https://mlsanity.com/paper/2408.12814/) (2024)
- [Leveraging point annotations in segmentation learning with boundary loss](https://mlsanity.com/paper/2311.03537/) (2023)
- [Enhancing Weakly Supervised 3D Medical Image Segmentation through Probabilistic-aware Learning](https://mlsanity.com/paper/2403.02566/) (2024)
- [DenseMP: Unsupervised Dense Pre-training for Few-shot Medical Image Segmentation](https://mlsanity.com/paper/2307.09604/) (2023)
- [Volumetric Medical Image Segmentation via Scribble Annotations and Shape Priors](https://mlsanity.com/paper/2310.08084/) (2023)
- [Morphology-Enhanced CAM-Guided SAM for weakly supervised Breast Lesion Segmentation](https://mlsanity.com/paper/2311.11176/) (2023)
- [S4M: 4-points to Segment Anything](https://mlsanity.com/paper/2503.05534/) (2025)
- [AdLER: Adversarial Training with Label Error Rectification for One-Shot Medical Image Segmentation](https://mlsanity.com/paper/2309.00971/) (2023)
- [Semi-supervised ViT knowledge distillation network with style transfer normalization for colorectal liver metastases survival prediction](https://mlsanity.com/paper/2311.10305/) (2023)

## Abstract (arXiv)

Medical image annotation is a major hurdle for developing precise and robust machine learning models. Annotation is expensive, time-consuming, and often requires expert knowledge, particularly in the medical field. Here, we suggest using minimal user interaction in the form of extreme point clicks to train a segmentation model which, in effect, can be used to speed up medical image annotation. An initial segmentation is generated based on the extreme points utilizing the random walker algorithm. This initial segmentation is then used as a noisy supervision signal to train a fully convolutional network that can segment the organ of interest, based on the provided user clicks. Through experimentation on several medical imaging datasets, we show that the predictions of the network can be refined using several rounds of training with the prediction from the same weakly annotated data. Further improvements are shown utilizing the clicked points within a custom-designed loss and attention mechanism. Our approach has the potential to speed up the process of generating new training datasets for the development of new machine learning and deep learning-based models for, but not exclusively, medical image analysis.