# Medical SAM Adapter: Adapting Segment Anything Model for Medical Image Segmentation

arXiv: https://arxiv.org/abs/2304.12620 · HTML: https://mlsanity.com/paper/2304.12620/

## Key facts

- Cited by 490 papers in the map (data through 14 Oct 2026).
- Builds on 40 of its 77 references that are in the map.
- First posted on arXiv 25 Apr 2023.

## Builds on (most cited first, 30 of 40)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [Denoising Diffusion Probabilistic Models](https://mlsanity.com/paper/2006.11239/) (2020)
- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [Segment Anything](https://mlsanity.com/paper/2304.02643/) (2023)
- [TransUNet: Transformers Make Strong Encoders for Medical Image Segmentation](https://mlsanity.com/paper/2102.04306/) (2021)
- [UNet++: A Nested U-Net Architecture for Medical Image Segmentation](https://mlsanity.com/paper/1807.10165/) (2018)
- [3D U-Net: Learning Dense Volumetric Segmentation from Sparse Annotation](https://mlsanity.com/paper/1606.06650/) (2016)
- [BitFit: Simple Parameter-efficient Fine-tuning for Transformer-based Masked Language-models](https://mlsanity.com/paper/2106.10199/) (2021)
- [UNETR: Transformers for 3D Medical Image Segmentation](https://mlsanity.com/paper/2103.10504/) (2021)
- [Swin UNETR: Swin Transformers for Semantic Segmentation of Brain Tumors in MRI Images](https://mlsanity.com/paper/2201.01266/) (2022)
- [AdaptFormer: Adapting Vision Transformers for Scalable Visual Recognition](https://mlsanity.com/paper/2205.13535/) (2022)
- [ConvNeXt V2: Co-designing and Scaling ConvNets with Masked Autoencoders](https://mlsanity.com/paper/2301.00808/) (2023)
- [Skin Lesion Analysis Toward Melanoma Detection: A Challenge at the 2017 International Symposium on Biomedical Imaging (ISBI), Hosted by the International Skin Imaging Collaboration (ISIC)](https://mlsanity.com/paper/1710.05006/) (2017)
- [The RSNA-ASNR-MICCAI BraTS 2021 Benchmark on Brain Tumor Segmentation and Radiogenomic Classification](https://mlsanity.com/paper/2107.02314/) (2021)
- [Attention is Not All You Need: Pure Attention Loses Rank Doubly Exponentially with Depth](https://mlsanity.com/paper/2103.03404/) (2021)
- [Transfusion: Understanding Transfer Learning for Medical Imaging](https://mlsanity.com/paper/1902.07208/) (2019)
- [AMOS: A Large-Scale Abdominal Multi-Organ Benchmark for Versatile Medical Image Segmentation](https://mlsanity.com/paper/2206.08023/) (2022)
- [SegDiff: Image Segmentation with Diffusion Probabilistic Models](https://mlsanity.com/paper/2112.00390/) (2021)
- [TransBTS: Multimodal Brain Tumor Segmentation Using Transformer](https://mlsanity.com/paper/2103.04430/) (2021)
- [REFUGE Challenge: A Unified Framework for Evaluating Automated Methods for Glaucoma Assessment from Fundus Photographs](https://mlsanity.com/paper/1910.03667/) (2019)
- [CoTr: Efficiently Bridging CNN and Transformer for 3D Medical Image Segmentation](https://mlsanity.com/paper/2103.03024/) (2021)
- [BCN20000: Dermoscopic Lesions in the Wild](https://mlsanity.com/paper/1908.02288/) (2019)
- [Diffusion Models for Implicit Image Segmentation Ensembles](https://mlsanity.com/paper/2112.03145/) (2021)
- [MedSegDiff: Medical Image Segmentation with Diffusion Probabilistic Model](https://mlsanity.com/paper/2211.00611/) (2022)
- [Reviving Iterative Training with Mask Guidance for Interactive Segmentation](https://mlsanity.com/paper/2102.06583/) (2021)
- [Segment Anything Model (SAM) for Digital Pathology: Assess Zero-shot Segmentation on Whole Slide Imaging](https://mlsanity.com/paper/2304.04155/) (2023)
- [Deep Interactive Object Selection](https://mlsanity.com/paper/1603.04042/) (2016)
- [FacT: Factor-Tuning for Lightweight Adaptation on Vision Transformer](https://mlsanity.com/paper/2212.03145/) (2022)

## Built on by (most cited first, 30 of 490)

- [SAM 2: Segment Anything in Images and Videos](https://mlsanity.com/paper/2408.00714/) (2024)
- [Medical SAM 2: Segment medical images as video via Segment Anything Model 2](https://mlsanity.com/paper/2408.00874/) (2024)
- [On the Challenges and Perspectives of Foundation Models for Medical Image Analysis](https://mlsanity.com/paper/2306.05705/) (2023)
- [SAM-Med2D](https://mlsanity.com/paper/2308.16184/) (2023)
- [Foundational Models Defining a New Era in Vision: A Survey and Outlook](https://mlsanity.com/paper/2307.13721/) (2023)
- [SAM-Med3D: Towards General-purpose Segmentation Models for Volumetric Medical Images](https://mlsanity.com/paper/2310.15161/) (2023)
- [Segment Anything Model for Medical Image Segmentation: Current Applications and Future Directions](https://mlsanity.com/paper/2401.03495/) (2024)
- [MedSAM2: Segment Anything in 3D Medical Images and Videos](https://mlsanity.com/paper/2504.03600/) (2025)
- [MA-SAM: Modality-agnostic SAM Adaptation for 3D Medical Image Segmentation](https://mlsanity.com/paper/2309.08842/) (2023)
- [Review of Large Vision Models and Visual Prompt Engineering](https://mlsanity.com/paper/2307.00855/) (2023)
- [Foundation Model for Advancing Healthcare: Challenges, Opportunities, and Future Directions](https://mlsanity.com/paper/2404.03264/) (2024)
- [Foundational Models in Medical Imaging: A Comprehensive Survey and Future Vision](https://mlsanity.com/paper/2310.18689/) (2023)
- [Open-Vocabulary SAM: Segment and Recognize Twenty-thousand Classes Interactively](https://mlsanity.com/paper/2401.02955/) (2024)
- [MedAgent-Pro: Towards Evidence-based Multi-modal Medical Diagnosis via Reasoning Agentic Workflow](https://mlsanity.com/paper/2503.18968/) (2025)
- [AutoSAM: Adapting SAM to Medical Images by Overloading the Prompt Encoder](https://mlsanity.com/paper/2306.06370/) (2023)
- [3DSAM-adapter: Holistic adaptation of SAM from 2D to 3D for promptable tumor segmentation](https://mlsanity.com/paper/2306.13465/) (2023)
- [Convolution Meets LoRA: Parameter Efficient Finetuning for Segment Anything Model](https://mlsanity.com/paper/2401.17868/) (2024)
- [A Comprehensive Survey on Segment Anything Model for Vision and Beyond](https://mlsanity.com/paper/2305.08196/) (2023)
- [VISTA3D: A Unified Segmentation Foundation Model For 3D Medical Imaging](https://mlsanity.com/paper/2406.05285/) (2024)
- [SAM2-Adapter: Evaluating & Adapting Segment Anything 2 in Downstream Tasks: Camouflage, Shadow, Medical Image Segmentation, and More](https://mlsanity.com/paper/2408.04579/) (2024)
- [Parameter-Efficient Fine-Tuning for Medical Image Analysis: The Missed Opportunity](https://mlsanity.com/paper/2305.08252/) (2023)
- [Adapting Segment Anything Model for Change Detection in HR Remote Sensing Images](https://mlsanity.com/paper/2309.01429/) (2023)
- [A Comprehensive Survey of Foundation Models in Medicine](https://mlsanity.com/paper/2406.10729/) (2024)
- [SA-Med2D-20M Dataset: Segment Anything in 2D Medical Imaging with 20 Million masks](https://mlsanity.com/paper/2311.11969/) (2023)
- [How to Efficiently Adapt Large Segmentation Model(SAM) to Medical Images](https://mlsanity.com/paper/2306.13731/) (2023)
- [ScribblePrompt: Fast and Flexible Interactive Segmentation for Any Biomedical Image](https://mlsanity.com/paper/2312.07381/) (2023)
- [Unleashing the Potential of SAM for Medical Adaptation via Hierarchical Decoding](https://mlsanity.com/paper/2403.18271/) (2024)
- [Surgical SAM 2: Real-time Segment Anything in Surgical Video by Efficient Frame Pruning](https://mlsanity.com/paper/2408.07931/) (2024)
- [Annotation-free Audio-Visual Segmentation](https://mlsanity.com/paper/2305.11019/) (2023)
- [Are Natural Domain Foundation Models Useful for Medical Image Classification?](https://mlsanity.com/paper/2310.19522/) (2023)

## Abstract (arXiv)

The Segment Anything Model (SAM) has recently gained popularity in the field of image segmentation due to its impressive capabilities in various segmentation tasks and its prompt-based interface. However, recent studies and individual experiments have shown that SAM underperforms in medical image segmentation, since the lack of the medical specific knowledge. This raises the question of how to enhance SAM's segmentation capability for medical images. In this paper, instead of fine-tuning the SAM model, we propose the Medical SAM Adapter (Med-SA), which incorporates domain-specific medical knowledge into the segmentation model using a light yet effective adaptation technique. In Med-SA, we propose Space-Depth Transpose (SD-Trans) to adapt 2D SAM to 3D medical images and Hyper-Prompting Adapter (HyP-Adpt) to achieve prompt-conditioned adaptation. We conduct comprehensive evaluation experiments on 17 medical image segmentation tasks across various image modalities. Med-SA outperforms several state-of-the-art (SOTA) medical image segmentation methods, while updating only 2% of the parameters. Our code is released at https://github.com/KidsWithTokens/Medical-SAM-Adapter.