# Concentrate on Weakness: Mining Hard Prototypes for Few-Shot Medical Image Segmentation

arXiv: https://arxiv.org/abs/2505.21897 · HTML: https://mlsanity.com/paper/2505.21897/

## Key facts

- Cited by 3 papers in the map (data through 14 Oct 2026).
- Builds on 27 of its 52 references that are in the map.
- First posted on arXiv 28 May 2025.

## Builds on (most cited first, 27 of 27)

- [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)
- [ImageNet Large Scale Visual Recognition Challenge](https://mlsanity.com/paper/1409.0575/) (2014)
- [Model-Agnostic Meta-Learning for Fast Adaptation of Deep Networks](https://mlsanity.com/paper/1703.03400/) (2017)
- [Fully Convolutional Networks for Semantic Segmentation](https://mlsanity.com/paper/1411.4038/) (2014)
- [Prototypical Networks for Few-shot Learning](https://mlsanity.com/paper/1703.05175/) (2017)
- [Matching Networks for One Shot Learning](https://mlsanity.com/paper/1606.04080/) (2016)
- [Swin-Unet: Unet-like Pure Transformer for Medical Image Segmentation](https://mlsanity.com/paper/2105.05537/) (2021)
- [Learning to Compare: Relation Network for Few-Shot Learning](https://mlsanity.com/paper/1711.06025/) (2017)
- [PANet: Few-Shot Image Semantic Segmentation with Prototype Alignment](https://mlsanity.com/paper/1908.06391/) (2019)
- [One-Shot Learning for Semantic Segmentation](https://mlsanity.com/paper/1709.03410/) (2017)
- [Few-Shot Learning with Graph Neural Networks](https://mlsanity.com/paper/1711.04043/) (2017)
- [CHAOS Challenge -- Combined (CT-MR) Healthy Abdominal Organ Segmentation](https://mlsanity.com/paper/2001.06535/) (2020)
- [Prototype Mixture Models for Few-shot Semantic Segmentation](https://mlsanity.com/paper/2008.03898/) (2020)
- [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)
- [DeepIGeoS: A Deep Interactive Geodesic Framework for Medical Image Segmentation](https://mlsanity.com/paper/1707.00652/) (2017)
- [CA-Net: Comprehensive Attention Convolutional Neural Networks for Explainable Medical Image Segmentation](https://mlsanity.com/paper/2009.10549/) (2020)
- [Multi-organ Segmentation over Partially Labeled Datasets with Multi-scale Feature Abstraction](https://mlsanity.com/paper/2001.00208/) (2020)
- ['Squeeze & Excite' Guided Few-Shot Segmentation of Volumetric Images](https://mlsanity.com/paper/1902.01314/) (2019)
- [HyperDense-Net: A hyper-densely connected CNN for multi-modal image segmentation](https://mlsanity.com/paper/1804.02967/) (2018)
- [Anomaly Detection-Inspired Few-Shot Medical Image Segmentation Through Self-Supervision With Supervoxels](https://mlsanity.com/paper/2203.02048/) (2022)
- [A Robust Volumetric Transformer for Accurate 3D Tumor Segmentation](https://mlsanity.com/paper/2111.13300/) (2021)
- [Few-Shot Medical Image Segmentation via a Region-enhanced Prototypical Transformer](https://mlsanity.com/paper/2309.04825/) (2023)
- [Q-Net: Query-Informed Few-Shot Medical Image Segmentation](https://mlsanity.com/paper/2208.11451/) (2022)
- [Few Shot Medical Image Segmentation with Cross Attention Transformer](https://mlsanity.com/paper/2303.13867/) (2023)
- [Few-Shot 3D Volumetric Segmentation with Multi-Surrogate Fusion](https://mlsanity.com/paper/2408.14427/) (2024)

## Built on by (most cited first, 3 of 3)

- [Focus on Background: Exploring SAM's Potential in Few-shot Medical Image Segmentation with Background-centric Prompting](https://mlsanity.com/paper/2603.21287/) (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)

## Abstract (arXiv)

Few-Shot Medical Image Segmentation (FSMIS) has been widely used to train a model that can perform segmentation from only a few annotated images. However, most existing prototype-based FSMIS methods generate multiple prototypes from the support image solely by random sampling or local averaging, which can cause particularly severe boundary blurring due to the tendency for normal features accounting for the majority of features of a specific category. Consequently, we propose to focus more attention to those weaker features that are crucial for clear segmentation boundary. Specifically, we design a Support Self-Prediction (SSP) module to identify such weak features by comparing true support mask with one predicted by global support prototype. Then, a Hard Prototypes Generation (HPG) module is employed to generate multiple hard prototypes based on these weak features. Subsequently, a Multiple Similarity Maps Fusion (MSMF) module is devised to generate final segmenting mask in a dual-path fashion to mitigate the imbalance between foreground and background in medical images. Furthermore, we introduce a boundary loss to further constraint the edge of segmentation. Extensive experiments on three publicly available medical image datasets demonstrate that our method achieves state-of-the-art performance. Code is available at https://github.com/jcjiang99/CoW.