# Exploring Transfer Learning in Medical Image Segmentation using Vision-Language Models

arXiv: https://arxiv.org/abs/2308.07706 · HTML: https://mlsanity.com/paper/2308.07706/

## Key facts

- Cited by 28 papers in the map (data through 14 Oct 2026).
- Placed in Medical vision-language models, one of 16 directions in Multimodal LLMs / vision-language models.
- Builds on 52 of its 82 references that are in the map.
- First posted on arXiv 15 Aug 2023.

## Placed in

- Multimodal LLMs / vision-language models / [Medical vision-language models](https://mlsanity.com/mllm/medical-vision-language-models/)

## Builds on (most cited first, 30 of 52)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Adam: A Method for Stochastic Optimization](https://mlsanity.com/paper/1412.6980/) (2014)
- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [Microsoft COCO: Common Objects in Context](https://mlsanity.com/paper/1405.0312/) (2014)
- [BLIP: Bootstrapping Language-Image Pre-training for Unified Vision-Language Understanding and Generation](https://mlsanity.com/paper/2201.12086/) (2022)
- [LAION-5B: An open large-scale dataset for training next generation image-text models](https://mlsanity.com/paper/2210.08402/) (2022)
- [Scaling Up Visual and Vision-Language Representation Learning With Noisy Text Supervision](https://mlsanity.com/paper/2102.05918/) (2021)
- [Encoder-Decoder with Atrous Separable Convolution for Semantic Image Segmentation](https://mlsanity.com/paper/1802.02611/) (2018)
- [V-Net: Fully Convolutional Neural Networks for Volumetric Medical Image Segmentation](https://mlsanity.com/paper/1606.04797/) (2016)
- [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)
- [Attention U-Net: Learning Where to Look for the Pancreas](https://mlsanity.com/paper/1804.03999/) (2018)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [Flickr30k Entities: Collecting Region-to-Phrase Correspondences for Richer Image-to-Sentence Models](https://mlsanity.com/paper/1505.04870/) (2015)
- [Grounded Language-Image Pre-training](https://mlsanity.com/paper/2112.03857/) (2021)
- [Domain-Specific Language Model Pretraining for Biomedical Natural Language Processing](https://mlsanity.com/paper/2007.15779/) (2020)
- [UNETR: Transformers for 3D Medical Image Segmentation](https://mlsanity.com/paper/2103.10504/) (2021)
- [OFA: Unifying Architectures, Tasks, and Modalities Through a Simple Sequence-to-Sequence Learning Framework](https://mlsanity.com/paper/2202.03052/) (2022)
- [FLAVA: A Foundational Language And Vision Alignment Model](https://mlsanity.com/paper/2112.04482/) (2021)
- [Contrastive Learning of Medical Visual Representations from Paired Images and Text](https://mlsanity.com/paper/2010.00747/) (2020)
- [MIMIC-CXR-JPG, a large publicly available database of labeled chest radiographs](https://mlsanity.com/paper/1901.07042/) (2019)
- [Kvasir-SEG: A Segmented Polyp Dataset](https://mlsanity.com/paper/1911.07069/) (2019)
- [LiT: Zero-Shot Transfer with Locked-image text Tuning](https://mlsanity.com/paper/2111.07991/) (2021)
- [MedCLIP: Contrastive Learning from Unpaired Medical Images and Text](https://mlsanity.com/paper/2210.10163/) (2022)
- [DenseCLIP: Language-Guided Dense Prediction with Context-Aware Prompting](https://mlsanity.com/paper/2112.01518/) (2021)
- [BiomedCLIP: a multimodal biomedical foundation model pretrained from fifteen million scientific image-text pairs](https://mlsanity.com/paper/2303.00915/) (2023)
- [Image Segmentation Using Text and Image Prompts](https://mlsanity.com/paper/2112.10003/) (2021)
- [Supervision Exists Everywhere: A Data Efficient Contrastive Language-Image Pre-training Paradigm](https://mlsanity.com/paper/2110.05208/) (2021)

## Built on by (most cited first, 28 of 28)

- [A Comprehensive Survey of Foundation Models in Medicine](https://mlsanity.com/paper/2406.10729/) (2024)
- [CLIP in Medical Imaging: A Survey](https://mlsanity.com/paper/2312.07353/) (2023)
- [MedCLIP-SAMv2: Towards Universal Text-Driven Medical Image Segmentation](https://mlsanity.com/paper/2409.19483/) (2024)
- [Medical Vision Language Pretraining: A survey](https://mlsanity.com/paper/2312.06224/) (2023)
- [VLSM-Adapter: Finetuning Vision-Language Segmentation Efficiently with Lightweight Blocks](https://mlsanity.com/paper/2405.06196/) (2024)
- [Synthetic Boost: Leveraging Synthetic Data for Enhanced Vision-Language Segmentation in Echocardiography](https://mlsanity.com/paper/2309.12829/) (2023)
- [Potential of Multimodal Large Language Models for Data Mining of Medical Images and Free-text Reports](https://mlsanity.com/paper/2407.05758/) (2024)
- [Language-guided Medical Image Segmentation with Target-informed Multi-level Contrastive Alignments](https://mlsanity.com/paper/2412.13533/) (2024)
- [STPNet: Scale-aware Text Prompt Network for Medical Image Segmentation](https://mlsanity.com/paper/2504.01561/) (2025)
- [Adapting Vision-Language Foundation Model for Next Generation Medical Ultrasound Image Analysis](https://mlsanity.com/paper/2506.08849/) (2025)
- [Uncertainty-Aware Vision-Language Segmentation for Medical Imaging](https://mlsanity.com/paper/2602.14498/) (2026)
- [MedCLIPSeg: Probabilistic Vision-Language Adaptation for Data-Efficient and Generalizable Medical Image Segmentation](https://mlsanity.com/paper/2602.20423/) (2026)
- [TuneVLSeg: Prompt Tuning Benchmark for Vision-Language Segmentation Models](https://mlsanity.com/paper/2410.05239/) (2024)
- [Few-shot Structure-Informed Machinery Part Segmentation with Foundation Models and Graph Neural Networks](https://mlsanity.com/paper/2501.10080/) (2025)
- [Adversarial Robustness Analysis of Vision-Language Models in Medical Image Segmentation](https://mlsanity.com/paper/2505.02971/) (2025)
- [Improvise, Adapt, Overcome -- Telescopic Adapters for Efficient Fine-tuning of Vision Language Models in Medical Imaging](https://mlsanity.com/paper/2512.13855/) (2025)
- [VLSM-Ensemble: Ensembling CLIP-based Vision-Language Models for Enhanced Medical Image Segmentation](https://mlsanity.com/paper/2509.05154/) (2025)
- [A Text-Image Fusion Method with Data Augmentation Capabilities for Referring Medical Image Segmentation](https://mlsanity.com/paper/2510.12482/) (2025)
- [MedPEFT-CL: Dual-Phase Parameter-Efficient Continual Learning with Medical Semantic Adapter and Bidirectional Memory Consolidation](https://mlsanity.com/paper/2511.17668/) (2025)
- [Evidential learning driven Breast Tumor Segmentation with Stage-divided Vision-Language Interaction](https://mlsanity.com/paper/2603.11206/) (2026)
- [Localization-Infused Vision-Language Semantic Fusion for Text-Guided Medical Image Segmentation](https://mlsanity.com/paper/2607.16327/) (2026)
- [AKGNet: Attribute Knowledge-Guided Unsupervised Lung-Infected Area Segmentation](https://mlsanity.com/paper/2404.11008/) (2024)
- [TAGS: 3D Tumor-Adaptive Guidance for SAM](https://mlsanity.com/paper/2505.17096/) (2025)
- [Adapting Foundation Vision-Language Models to Medical Diagnosis via Query-Driven Expert Bridging](https://mlsanity.com/paper/2505.21698/) (2025)
- [BiCLIP: Bidirectional and Consistent Language-Image Processing for Robust Medical Image Segmentation](https://mlsanity.com/paper/2603.00156/) (2026)
- [MedCRP-CL: Continual Medical Image Segmentation via Bayesian Nonparametric Semantic Modality Discovery](https://mlsanity.com/paper/2605.20297/) (2026)
- [CoMLP: Cooperatively-Gated MLPs for Fine-Grained Cross-Modal Information Fusion in Medical Image Segmentation](https://mlsanity.com/paper/2609.04781/) (2026)
- [Preference-Guided Adaptation for Open-Vocabulary Semantic Segmentation via Prompt Disagreement](https://mlsanity.com/paper/2609.34528/) (2026)

## Abstract (arXiv)

Medical image segmentation allows quantifying target structure size and shape, aiding in disease diagnosis, prognosis, surgery planning, and comprehension.Building upon recent advancements in foundation Vision-Language Models (VLMs) from natural image-text pairs, several studies have proposed adapting them to Vision-Language Segmentation Models (VLSMs) that allow using language text as an additional input to segmentation models. Introducing auxiliary information via text with human-in-the-loop prompting during inference opens up unique opportunities, such as open vocabulary segmentation and potentially more robust segmentation models against out-of-distribution data. Although transfer learning from natural to medical images has been explored for image-only segmentation models, the joint representation of vision-language in segmentation problems remains underexplored. This study introduces the first systematic study on transferring VLSMs to 2D medical images, using carefully curated 11 datasets encompassing diverse modalities and insightful language prompts and experiments. Our findings demonstrate that although VLSMs show competitive performance compared to image-only models for segmentation after finetuning in limited medical image datasets, not all VLSMs utilize the additional information from language prompts, with image features playing a dominant role. While VLSMs exhibit enhanced performance in handling pooled datasets with diverse modalities and show potential robustness to domain shifts compared to conventional segmentation models, our results suggest that novel approaches are required to enable VLSMs to leverage the various auxiliary information available through language prompts. The code and datasets are available at https://github.com/naamiinepal/medvlsm.