# Few-Shot Medical Image Segmentation via a Region-enhanced Prototypical Transformer

arXiv: https://arxiv.org/abs/2309.04825 · HTML: https://mlsanity.com/paper/2309.04825/

## Key facts

- Cited by 28 papers in the map (data through 14 Oct 2026).
- Builds on 16 of its 24 references that are in the map.
- First posted on arXiv 9 Sep 2023.

## Builds on (most cited first, 16 of 16)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Microsoft COCO: Common Objects in Context](https://mlsanity.com/paper/1405.0312/) (2014)
- [Prototypical Networks for Few-shot Learning](https://mlsanity.com/paper/1703.05175/) (2017)
- [PANet: Few-Shot Image Semantic Segmentation with Prototype Alignment](https://mlsanity.com/paper/1908.06391/) (2019)
- [CHAOS Challenge -- Combined (CT-MR) Healthy Abdominal Organ Segmentation](https://mlsanity.com/paper/2001.06535/) (2020)
- [Boundary loss for highly unbalanced segmentation](https://mlsanity.com/paper/1812.07032/) (2018)
- [Multivariate mixture model for myocardium segmentation combining multi-source images](https://mlsanity.com/paper/1612.08820/) (2016)
- [Self-Supervision with Superpixels: Training Few-shot Medical Image Segmentation without Annotation](https://mlsanity.com/paper/2007.09886/) (2020)
- ['Squeeze & Excite' Guided Few-Shot Segmentation of Volumetric Images](https://mlsanity.com/paper/1902.01314/) (2019)
- [Feature-Proxy Transformer for Few-Shot Segmentation](https://mlsanity.com/paper/2210.06908/) (2022)
- [Few-shot Medical Image Segmentation using a Global Correlation Network with Discriminative Embedding](https://mlsanity.com/paper/2012.05440/) (2020)
- [Anomaly Detection-Inspired Few-Shot Medical Image Segmentation Through Self-Supervision With Supervoxels](https://mlsanity.com/paper/2203.02048/) (2022)
- [Few-shot Medical Image Segmentation with Cycle-resemblance Attention](https://mlsanity.com/paper/2212.03967/) (2022)
- [Q-Net: Query-Informed Few-Shot Medical Image Segmentation](https://mlsanity.com/paper/2208.11451/) (2022)
- [Prototype Refinement Network for Few-Shot Segmentation](https://mlsanity.com/paper/2002.03579/) (2020)
- [PoissonSeg: Semi-Supervised Few-Shot Medical Image Segmentation via Poisson Learning](https://mlsanity.com/paper/2108.11694/) (2021)

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

- [Partition-A-Medical-Image: Extracting Multiple Representative Sub-regions for Few-shot Medical Image Segmentation](https://mlsanity.com/paper/2309.11172/) (2023)
- [SynPo: Boosting Training-Free Few-Shot Medical Segmentation via High-Quality Negative Prompts](https://mlsanity.com/paper/2506.15153/) (2025)
- [MAUP: Training-free Multi-center Adaptive Uncertainty-aware Prompting for Cross-domain Few-shot Medical Image Segmentation](https://mlsanity.com/paper/2508.03511/) (2025)
- [RevSAM2: Prompt SAM2 for Medical Image Segmentation via Reverse-Propagation without Fine-tuning](https://mlsanity.com/paper/2409.04298/) (2024)
- [RobustEMD: Domain Robust Matching for Cross-domain Few-shot Medical Image Segmentation](https://mlsanity.com/paper/2410.01110/) (2024)
- [Rethinking Few-Shot Medical Image Segmentation by SAM2: A Training-Free Framework with Augmentative Prompting and Dynamic Matching](https://mlsanity.com/paper/2503.04826/) (2025)
- [ProCNS: Progressive Prototype Calibration and Noise Suppression for Weakly-Supervised Medical Image Segmentation](https://mlsanity.com/paper/2401.14074/) (2024)
- [Concentrate on Weakness: Mining Hard Prototypes for Few-Shot Medical Image Segmentation](https://mlsanity.com/paper/2505.21897/) (2025)
- [SPENet: Self-guided Prototype Enhancement Network for Few-shot Medical Image Segmentation](https://mlsanity.com/paper/2509.02993/) (2025)
- [Atlas is Your Perfect Context: One-Shot Customization for Generalizable Foundational Medical Image Segmentation](https://mlsanity.com/paper/2512.18176/) (2025)
- [Few-Shot 3D Volumetric Segmentation with Multi-Surrogate Fusion](https://mlsanity.com/paper/2408.14427/) (2024)
- [Tied Prototype Model for Few-Shot Medical Image Segmentation](https://mlsanity.com/paper/2506.22101/) (2025)
- [Contrastive Graph Modeling for Cross-Domain Few-Shot Medical Image Segmentation](https://mlsanity.com/paper/2512.21683/) (2025)
- [Focus on Background: Exploring SAM's Potential in Few-shot Medical Image Segmentation with Background-centric Prompting](https://mlsanity.com/paper/2603.21287/) (2026)
- [DyABD: The Abdominal Muscle Segmentation in Dynamic MRI Benchmark](https://mlsanity.com/paper/2604.23187/) (2026)
- [Prototypical Few-Shot Medical Image Semantic Segmentation with Background Fusion](https://mlsanity.com/paper/2412.02983/) (2024)
- [LMS-Net: A Learned Mumford-Shah Network For Few-Shot Medical Image Segmentation](https://mlsanity.com/paper/2502.05473/) (2025)
- [Efficient Masked Attention Transformer for Few-Shot Classification and Segmentation](https://mlsanity.com/paper/2507.23642/) (2025)
- [AGENet: Adaptive Edge-aware Geodesic Distance Learning for Few-Shot Medical Image Segmentation](https://mlsanity.com/paper/2511.11662/) (2025)
- [RAP: Retrieve, Adapt, and Prompt-Fit for Training-Free Few-Shot Medical Image Segmentation](https://mlsanity.com/paper/2603.27705/) (2026)
- [SD-FSMIS: Adapting Stable Diffusion for Few-Shot Medical Image Segmentation](https://mlsanity.com/paper/2604.03134/) (2026)
- [DINO-MVR: Multi-View Readout of Frozen DINOv3 for Annotation-Efficient Medical Segmentation](https://mlsanity.com/paper/2605.07221/) (2026)
- [Geometry-aware Prototype Learning for Cross-domain Few-shot Medical Image Segmentation](https://mlsanity.com/paper/2605.10885/) (2026)
- [Beyond Euclidean Prototypes: Spectral Disentanglement and Geodesic Matching for Few-Shot Medical Image Segmentation](https://mlsanity.com/paper/2605.17904/) (2026)
- [Attention-Based Prototype Calibration for Multi-Rater Few-Shot Medical Image Segmentation](https://mlsanity.com/paper/2606.16325/) (2026)
- [PSP: Harnessing Position and Shape Priors for Cross-Domain Few-Shot Medical Image Segmentation](https://mlsanity.com/paper/2606.28799/) (2026)
- [H2AL: Hyperbolic Hierarchy-aware Aggregative Learning for Registration-based Few-shot Medical Image Segmentation](https://mlsanity.com/paper/2608.07340/) (2026)
- [From Few-Shot Segmentation to Clinician-in-the-Loop Medical Image Analysis](https://mlsanity.com/paper/2609.10001/) (2026)

## Abstract (arXiv)

Automated segmentation of large volumes of medical images is often plagued by the limited availability of fully annotated data and the diversity of organ surface properties resulting from the use of different acquisition protocols for different patients. In this paper, we introduce a more promising few-shot learning-based method named Region-enhanced Prototypical Transformer (RPT) to mitigate the effects of large intra-class diversity/bias. First, a subdivision strategy is introduced to produce a collection of regional prototypes from the foreground of the support prototype. Second, a self-selection mechanism is proposed to incorporate into the Bias-alleviated Transformer (BaT) block to suppress or remove interferences present in the query prototype and regional support prototypes. By stacking BaT blocks, the proposed RPT can iteratively optimize the generated regional prototypes and finally produce rectified and more accurate global prototypes for Few-Shot Medical Image Segmentation (FSMS). Extensive experiments are conducted on three publicly available medical image datasets, and the obtained results show consistent improvements compared to state-of-the-art FSMS methods. The source code is available at: https://github.com/YazhouZhu19/RPT.