# Enhancing SAM with Efficient Prompting and Preference Optimization for Semi-supervised Medical Image Segmentation

arXiv: https://arxiv.org/abs/2503.04639 · HTML: https://mlsanity.com/paper/2503.04639/

## Key facts

- Cited by 12 papers in the map (data through 14 Oct 2026).
- Builds on 48 of its 64 references that are in the map.
- First posted on arXiv 6 Mar 2025.

## Builds on (most cited first, 30 of 48)

- [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)
- [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)
- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [Training language models to follow instructions with human feedback](https://mlsanity.com/paper/2203.02155/) (2022)
- [LLaMA: Open and Efficient Foundation Language Models](https://mlsanity.com/paper/2302.13971/) (2023)
- [Segment Anything](https://mlsanity.com/paper/2304.02643/) (2023)
- [Direct Preference Optimization: Your Language Model is Secretly a Reward Model](https://mlsanity.com/paper/2305.18290/) (2023)
- [Visual Instruction Tuning](https://mlsanity.com/paper/2304.08485/) (2023)
- [BLIP-2: Bootstrapping Language-Image Pre-training with Frozen Image Encoders and Large Language Models](https://mlsanity.com/paper/2301.12597/) (2023)
- [Flamingo: a Visual Language Model for Few-Shot Learning](https://mlsanity.com/paper/2204.14198/) (2022)
- [MiniGPT-4: Enhancing Vision-Language Understanding with Advanced Large Language Models](https://mlsanity.com/paper/2304.10592/) (2023)
- [V-Net: Fully Convolutional Neural Networks for Volumetric Medical Image Segmentation](https://mlsanity.com/paper/1606.04797/) (2016)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [A Survey on Deep Learning in Medical Image Analysis](https://mlsanity.com/paper/1702.05747/) (2017)
- [MedCLIP: Contrastive Learning from Unpaired Medical Images and Text](https://mlsanity.com/paper/2210.10163/) (2022)
- [BiomedCLIP: a multimodal biomedical foundation model pretrained from fifteen million scientific image-text pairs](https://mlsanity.com/paper/2303.00915/) (2023)
- [Aligning Text-to-Image Models using Human Feedback](https://mlsanity.com/paper/2302.12192/) (2023)
- [Fine-Grained Human Feedback Gives Better Rewards for Language Model Training](https://mlsanity.com/paper/2306.01693/) (2023)
- [Med-Flamingo: a Multimodal Medical Few-shot Learner](https://mlsanity.com/paper/2307.15189/) (2023)
- [AMOS: A Large-Scale Abdominal Multi-Organ Benchmark for Versatile Medical Image Segmentation](https://mlsanity.com/paper/2206.08023/) (2022)
- [PMC-VQA: Visual Instruction Tuning for Medical Visual Question Answering](https://mlsanity.com/paper/2305.10415/) (2023)
- [Human Preference Score: Better Aligning Text-to-Image Models with Human Preference](https://mlsanity.com/paper/2303.14420/) (2023)
- [Segment Anything in Medical Images](https://mlsanity.com/paper/2304.12306/) (2023)
- [PMC-CLIP: Contrastive Language-Image Pre-training using Biomedical Documents](https://mlsanity.com/paper/2303.07240/) (2023)
- [Can AI help in screening Viral and COVID-19 pneumonia?](https://mlsanity.com/paper/2003.13145/) (2020)
- [Towards Generalist Foundation Model for Radiology by Leveraging Web-scale 2D&3D Medical Data](https://mlsanity.com/paper/2308.02463/) (2023)
- [A Survey on Active Learning and Human-in-the-Loop Deep Learning for Medical Image Analysis](https://mlsanity.com/paper/1910.02923/) (2019)

## Built on by (most cited first, 12 of 12)

- [MedSAM-Agent: Empowering Interactive Medical Image Segmentation with Multi-turn Agentic Reinforcement Learning](https://mlsanity.com/paper/2602.03320/) (2026)
- [SSS: Semi-Supervised SAM-2 with Efficient Prompting for Medical Imaging Segmentation](https://mlsanity.com/paper/2506.08949/) (2025)
- [MATCH: Multi-faceted Adaptive Topo-Consistency for Semi-Supervised Histopathology Segmentation](https://mlsanity.com/paper/2510.01532/) (2025)
- [ReSAM: Refine, Requery, and Reinforce: Self-Prompting Point-Supervised Segmentation for Remote Sensing Images](https://mlsanity.com/paper/2511.21606/) (2025)
- [Model Agnostic Preference Optimization for Medical Image Segmentation](https://mlsanity.com/paper/2512.15009/) (2025)
- [Beyond Manual Annotation: A Human-AI Collaborative Framework for Medical Image Segmentation Using Only "Better or Worse" Expert Feedback](https://mlsanity.com/paper/2507.05815/) (2025)
- [Multi-Sequence Parotid Gland Lesion Segmentation via Expert Text-Guided Segment Anything Model](https://mlsanity.com/paper/2508.09645/) (2025)
- [Region-Normalized DPO for Medical Image Segmentation under Noisy Judges](https://mlsanity.com/paper/2601.23222/) (2026)
- [Prefer-DAS: Learning from Local Preferences and Sparse Prompts for Domain Adaptive Segmentation of Electron Microscopy](https://mlsanity.com/paper/2602.19423/) (2026)
- [ARIADNE: A Perception-Reasoning Synergy Framework for Trustworthy Coronary Angiography Analysis](https://mlsanity.com/paper/2603.19169/) (2026)
- [Enhancing MedSAM with a Lightweight Box Predictor for Medical Image Segmentation](https://mlsanity.com/paper/2606.04705/) (2026)
- [Preference-Guided Adaptation for Open-Vocabulary Semantic Segmentation via Prompt Disagreement](https://mlsanity.com/paper/2609.34528/) (2026)

## Abstract (arXiv)

Foundational models such as the Segment Anything Model (SAM) are gaining traction in medical imaging segmentation, supporting multiple downstream tasks. However, such models are supervised in nature, still relying on large annotated datasets or prompts supplied by experts. Conventional techniques such as active learning to alleviate such limitations are limited in scope and still necessitate continuous human involvement and complex domain knowledge for label refinement or establishing reward ground truth. To address these challenges, we propose an enhanced Segment Anything Model (SAM) framework that utilizes annotation-efficient prompts generated in a fully unsupervised fashion, while still capturing essential semantic, location, and shape information through contrastive language-image pretraining and visual question answering. We adopt the direct preference optimization technique to design an optimal policy that enables the model to generate high-fidelity segmentations with simple ratings or rankings provided by a virtual annotator simulating the human annotation process. State-of-the-art performance of our framework in tasks such as lung segmentation, breast tumor segmentation, and organ segmentation across various modalities, including X-ray, ultrasound, and abdominal CT, justifies its effectiveness in low-annotation data scenarios.