# ZScribbleSeg: Zen and the Art of Scribble Supervised Medical Image Segmentation

arXiv: https://arxiv.org/abs/2301.04882 · HTML: https://mlsanity.com/paper/2301.04882/

## Key facts

- Cited by 8 papers in the map (data through 14 Oct 2026).
- Builds on 38 of its 59 references that are in the map.
- First posted on arXiv 12 Jan 2023.

## Builds on (most cited first, 30 of 38)

- [mixup: Beyond Empirical Risk Minimization](https://mlsanity.com/paper/1710.09412/) (2017)
- [DeepLab: Semantic Image Segmentation with Deep Convolutional Nets, Atrous Convolution, and Fully Connected CRFs](https://mlsanity.com/paper/1606.00915/) (2016)
- [CutMix: Regularization Strategy to Train Strong Classifiers with Localizable Features](https://mlsanity.com/paper/1905.04899/) (2019)
- [Learning Deep Features for Discriminative Localization](https://mlsanity.com/paper/1512.04150/) (2015)
- [Improved Regularization of Convolutional Neural Networks with Cutout](https://mlsanity.com/paper/1708.04552/) (2017)
- [Temporal Ensembling for Semi-Supervised Learning](https://mlsanity.com/paper/1610.02242/) (2016)
- [Semi-Supervised Semantic Segmentation with Cross-Consistency Training](https://mlsanity.com/paper/2003.09005/) (2020)
- [ScribbleSup: Scribble-Supervised Convolutional Networks for Semantic Segmentation](https://mlsanity.com/paper/1604.05144/) (2016)
- [Self-supervised Equivariant Attention Mechanism for Weakly Supervised Semantic Segmentation](https://mlsanity.com/paper/2004.04581/) (2020)
- [What's the Point: Semantic Segmentation with Point Supervision](https://mlsanity.com/paper/1506.02106/) (2015)
- [A Probabilistic U-Net for Segmentation of Ambiguous Images](https://mlsanity.com/paper/1806.05034/) (2018)
- [Puzzle Mix: Exploiting Saliency and Local Statistics for Optimal Mixup](https://mlsanity.com/paper/2009.06962/) (2020)
- [Embracing Imperfect Datasets: A Review of Deep Learning Solutions for Medical Image Segmentation](https://mlsanity.com/paper/1908.10454/) (2019)
- [Simple Does It: Weakly Supervised Instance and Semantic Segmentation](https://mlsanity.com/paper/1603.07485/) (2016)
- [Positive-Unlabeled Learning with Non-Negative Risk Estimator](https://mlsanity.com/paper/1703.00593/) (2017)
- [Conditional Random Fields as Recurrent Neural Networks](https://mlsanity.com/paper/1502.03240/) (2015)
- [Weakly- and Semi-Supervised Learning of a DCNN for Semantic Image Segmentation](https://mlsanity.com/paper/1502.02734/) (2015)
- [Multivariate mixture model for myocardium segmentation combining multi-source images](https://mlsanity.com/paper/1612.08820/) (2016)
- [Co-Mixup: Saliency Guided Joint Mixup with Supermodular Diversity](https://mlsanity.com/paper/2102.03065/) (2021)
- [On Regularized Losses for Weakly-supervised CNN Segmentation](https://mlsanity.com/paper/1803.09569/) (2018)
- [Mixture Proportion Estimation via Kernel Embedding of Distributions](https://mlsanity.com/paper/1603.02501/) (2016)
- [CycleMix: A Holistic Strategy for Medical Image Segmentation from Scribble Supervision](https://mlsanity.com/paper/2203.01475/) (2022)
- [Scribble-Supervised Medical Image Segmentation via Dual-Branch Network and Dynamically Mixed Pseudo Labels Supervision](https://mlsanity.com/paper/2203.02106/) (2022)
- [FocalMix: Semi-Supervised Learning for 3D Medical Image Detection](https://mlsanity.com/paper/2003.09108/) (2020)
- [Mixture Proportion Estimation and PU Learning: A Modern Approach](https://mlsanity.com/paper/2111.00980/) (2021)
- [Learning to Segment Medical Images with Scribble-Supervision Alone](https://mlsanity.com/paper/1807.04668/) (2018)
- [Affinity Attention Graph Neural Network for Weakly Supervised Semantic Segmentation](https://mlsanity.com/paper/2106.04054/) (2021)
- [Semi-Supervised and Task-Driven Data Augmentation](https://mlsanity.com/paper/1902.05396/) (2019)
- [Gated CRF Loss for Weakly Supervised Semantic Image Segmentation](https://mlsanity.com/paper/1906.04651/) (2019)
- [Fully Convolutional Multi-Class Multiple Instance Learning](https://mlsanity.com/paper/1412.7144/) (2014)

## Built on by (most cited first, 8 of 8)

- [Segment Anything Model for Medical Image Segmentation: Current Applications and Future Directions](https://mlsanity.com/paper/2401.03495/) (2024)
- [Beyond Pixel-Wise Supervision for Medical Image Segmentation: From Traditional Models to Foundation Models](https://mlsanity.com/paper/2404.13239/) (2024)
- [ProCNS: Progressive Prototype Calibration and Noise Suppression for Weakly-Supervised Medical Image Segmentation](https://mlsanity.com/paper/2401.14074/) (2024)
- [ModelMix: A New Model-Mixup Strategy to Minimize Vicinal Risk across Tasks for Few-scribble based Cardiac Segmentation](https://mlsanity.com/paper/2406.13237/) (2024)
- [Volumetric Medical Image Segmentation via Scribble Annotations and Shape Priors](https://mlsanity.com/paper/2310.08084/) (2023)
- [Revisiting 3D Medical Scribble Supervision: Benchmarking Beyond Cardiac Segmentation](https://mlsanity.com/paper/2403.12834/) (2024)
- [MedCL: Learning Consistent Anatomy Distribution for Scribble-supervised Medical Image Segmentation](https://mlsanity.com/paper/2503.22890/) (2025)
- [Size Aware Cross-shape Scribble Supervision for Medical Image Segmentation](https://mlsanity.com/paper/2408.13639/) (2024)

## Abstract (arXiv)

Curating a large scale fully-annotated dataset can be both labour-intensive and expertise-demanding, especially for medical images. To alleviate this problem, we propose to utilize solely scribble annotations for weakly supervised segmentation. Existing solutions mainly leverage selective losses computed solely on annotated areas and generate pseudo gold standard segmentation by propagating labels to adjacent areas. However, these methods could suffer from the inaccurate and sometimes unrealistic pseudo segmentation due to the insufficient supervision and incomplete shape features. Different from previous efforts, we first investigate the principle of ''good scribble annotations'', which leads to efficient scribble forms via supervision maximization and randomness simulation. Furthermore, we introduce regularization terms to encode the spatial relationship and shape prior, where a new formulation is developed to estimate the mixture ratios of label classes. These ratios are critical in identifying the unlabeled pixels for each class and correcting erroneous predictions, thus the accurate estimation lays the foundation for the incorporation of spatial prior. Finally, we integrate the efficient scribble supervision with the prior into a unified framework, denoted as ZScribbleSeg, and apply the method to multiple scenarios. Leveraging only scribble annotations, ZScribbleSeg set new state-of-the-arts on four segmentation tasks using ACDC, MSCMRseg, MyoPS and PPSS datasets.