# SAM-Driven Weakly Supervised Nodule Segmentation with Uncertainty-Aware Cross Teaching

arXiv: https://arxiv.org/abs/2407.13553 · HTML: https://mlsanity.com/paper/2407.13553/

## Key facts

- Cited by 7 papers in the map (data through 14 Oct 2026).
- Builds on 18 of its 26 references that are in the map.
- First posted on arXiv 18 Jul 2024.

## Builds on (most cited first, 18 of 18)

- [PyTorch: An Imperative Style, High-Performance Deep Learning Library](https://mlsanity.com/paper/1912.01703/) (2019)
- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [Segment Anything](https://mlsanity.com/paper/2304.02643/) (2023)
- [Co-teaching: Robust Training of Deep Neural Networks with Extremely Noisy Labels](https://mlsanity.com/paper/1804.06872/) (2018)
- [Semi-Supervised Semantic Segmentation with Cross Pseudo Supervision](https://mlsanity.com/paper/2106.01226/) (2021)
- [Uncertainty-aware Self-ensembling Model for Semi-supervised 3D Left Atrium Segmentation](https://mlsanity.com/paper/1907.07034/) (2019)
- [ScribbleSup: Scribble-Supervised Convolutional Networks for Semantic Segmentation](https://mlsanity.com/paper/1604.05144/) (2016)
- [BoxSup: Exploiting Bounding Boxes to Supervise Convolutional Networks for Semantic Segmentation](https://mlsanity.com/paper/1503.01640/) (2015)
- [Weakly- and Semi-Supervised Learning of a DCNN for Semantic Image Segmentation](https://mlsanity.com/paper/1502.02734/) (2015)
- [Efficient Semi-Supervised Gross Target Volume of Nasopharyngeal Carcinoma Segmentation via Uncertainty Rectified Pyramid Consistency](https://mlsanity.com/paper/2012.07042/) (2020)
- [Scribble-Supervised Medical Image Segmentation via Dual-Branch Network and Dynamically Mixed Pseudo Labels Supervision](https://mlsanity.com/paper/2203.02106/) (2022)
- [Gated CRF Loss for Weakly Supervised Semantic Image Segmentation](https://mlsanity.com/paper/1906.04651/) (2019)
- [Mumford-Shah Loss Functional for Image Segmentation with Deep Learning](https://mlsanity.com/paper/1904.02872/) (2019)
- [Accurate Weakly-Supervised Deep Lesion Segmentation using Large-Scale Clinical Annotations: Slice-Propagated 3D Mask Generation from 2D RECIST](https://mlsanity.com/paper/1807.01172/) (2018)
- [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)
- [Unsupervised Total Variation Loss for Semi-supervised Deep Learning of Semantic Segmentation](https://mlsanity.com/paper/1605.01368/) (2016)
- [Teach me to segment with mixed supervision: Confident students become masters](https://mlsanity.com/paper/2012.08051/) (2020)
- [RECIST Weakly Supervised Lesion Segmentation via Label-Space Co-Training](https://mlsanity.com/paper/2303.00205/) (2023)

## Built on by (most cited first, 7 of 7)

- [MedSynapse-V: Bridging Visual Perception and Clinical Intuition via Latent Memory Evolution](https://mlsanity.com/paper/2604.26283/) (2026)
- [Divide, Conquer and Unite: Hierarchical Style-Recalibrated Prototype Alignment for Federated Medical Segmentation](https://mlsanity.com/paper/2511.10945/) (2025)
- [ActiveSSF: An Active-Learning-Guided Self-Supervised Framework for Long-Tailed Megakaryocyte Classification](https://mlsanity.com/paper/2502.08200/) (2025)
- [pFedSAM: Personalized Federated Learning of Segment Anything Model for Medical Image Segmentation](https://mlsanity.com/paper/2509.15638/) (2025)
- [Weakly Supervised Segmentation Framework for Thyroid Nodule Based on High-confidence Labels and High-rationality Losses](https://mlsanity.com/paper/2502.19707/) (2025)
- [Boxes2Pixels: Learning Defect Segmentation from Noisy SAM Masks](https://mlsanity.com/paper/2604.11162/) (2026)
- [Shift-Dependent Asymmetry: Orthogonal Inverse Low-Rank Adaptation for Federated Medical Segmentation](https://mlsanity.com/paper/2606.08687/) (2026)

## Abstract (arXiv)

Automated nodule segmentation is essential for computer-assisted diagnosis in ultrasound images. Nevertheless, most existing methods depend on precise pixel-level annotations by medical professionals, a process that is both costly and labor-intensive. Recently, segmentation foundation models like SAM have shown impressive generalizability on natural images, suggesting their potential as pseudo-labelers. However, accurate prompts remain crucial for their success in medical images. In this work, we devise a novel weakly supervised framework that effectively utilizes the segmentation foundation model to generate pseudo-labels from aspect ration annotations for automatic nodule segmentation. Specifically, we develop three types of bounding box prompts based on scalable shape priors, followed by an adaptive pseudo-label selection module to fully exploit the prediction capabilities of the foundation model for nodules. We also present a SAM-driven uncertainty-aware cross-teaching strategy. This approach integrates SAM-based uncertainty estimation and label-space perturbations into cross-teaching to mitigate the impact of pseudo-label inaccuracies on model training. Extensive experiments on two clinically collected ultrasound datasets demonstrate the superior performance of our proposed method.