# SAM2-SGP: Enhancing SAM2 for Medical Image Segmentation via Support-Set Guided Prompting

arXiv: https://arxiv.org/abs/2506.19658 · HTML: https://mlsanity.com/paper/2506.19658/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 32 of its 42 references that are in the map.
- First posted on arXiv 24 Jun 2025.

## Builds on (most cited first, 30 of 32)

- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [Segment Anything](https://mlsanity.com/paper/2304.02643/) (2023)
- [DINOv2: Learning Robust Visual Features without Supervision](https://mlsanity.com/paper/2304.07193/) (2023)
- [On the Opportunities and Risks of Foundation Models](https://mlsanity.com/paper/2108.07258/) (2021)
- [SAM 2: Segment Anything in Images and Videos](https://mlsanity.com/paper/2408.00714/) (2024)
- [Masked-attention Mask Transformer for Universal Image Segmentation](https://mlsanity.com/paper/2112.01527/) (2021)
- [UNETR: Transformers for 3D Medical Image Segmentation](https://mlsanity.com/paper/2103.10504/) (2021)
- [Swin UNETR: Swin Transformers for Semantic Segmentation of Brain Tumors in MRI Images](https://mlsanity.com/paper/2201.01266/) (2022)
- [Medical SAM Adapter: Adapting Segment Anything Model for Medical Image Segmentation](https://mlsanity.com/paper/2304.12620/) (2023)
- [AMOS: A Large-Scale Abdominal Multi-Organ Benchmark for Versatile Medical Image Segmentation](https://mlsanity.com/paper/2206.08023/) (2022)
- [Mask3D: Mask Transformer for 3D Semantic Instance Segmentation](https://mlsanity.com/paper/2210.03105/) (2022)
- [Hiera: A Hierarchical Vision Transformer without the Bells-and-Whistles](https://mlsanity.com/paper/2306.00989/) (2023)
- [Deep Learning for Segmentation using an Open Large-Scale Dataset in 2D Echocardiography](https://mlsanity.com/paper/1908.06948/) (2019)
- [REFUGE Challenge: A Unified Framework for Evaluating Automated Methods for Glaucoma Assessment from Fundus Photographs](https://mlsanity.com/paper/1910.03667/) (2019)
- [SAM3D: Segment Anything in 3D Scenes](https://mlsanity.com/paper/2306.03908/) (2023)
- [Medical SAM 2: Segment medical images as video via Segment Anything Model 2](https://mlsanity.com/paper/2408.00874/) (2024)
- [UniverSeg: Universal Medical Image Segmentation](https://mlsanity.com/paper/2304.06131/) (2023)
- [MA-SAM: Modality-agnostic SAM Adaptation for 3D Medical Image Segmentation](https://mlsanity.com/paper/2309.08842/) (2023)
- [VRP-SAM: SAM with Visual Reference Prompt](https://mlsanity.com/paper/2402.17726/) (2024)
- [AutoSAM: Adapting SAM to Medical Images by Overloading the Prompt Encoder](https://mlsanity.com/paper/2306.06370/) (2023)
- [3DSAM-adapter: Holistic adaptation of SAM from 2D to 3D for promptable tumor segmentation](https://mlsanity.com/paper/2306.13465/) (2023)
- [Dense Cross-Query-and-Support Attention Weighted Mask Aggregation for Few-Shot Segmentation](https://mlsanity.com/paper/2207.08549/) (2022)
- [Unleashing the Potential of SAM for Medical Adaptation via Hierarchical Decoding](https://mlsanity.com/paper/2403.18271/) (2024)
- [A Survey on Segment Anything Model (SAM): Vision Foundation Model Meets Prompt Engineering](https://mlsanity.com/paper/2306.06211/) (2023)
- [Segment Anything in Medical Images and Videos: Benchmark and Deployment](https://mlsanity.com/paper/2408.03322/) (2024)
- [Retrieval-augmented Few-shot Medical Image Segmentation with Foundation Models](https://mlsanity.com/paper/2408.08813/) (2024)
- [Interactive 3D Medical Image Segmentation with SAM 2](https://mlsanity.com/paper/2408.02635/) (2024)
- [Biomedical SAM 2: Segment Anything in Biomedical Images and Videos](https://mlsanity.com/paper/2408.03286/) (2024)
- [RevSAM2: Prompt SAM2 for Medical Image Segmentation via Reverse-Propagation without Fine-tuning](https://mlsanity.com/paper/2409.04298/) (2024)
- [SwinCross: Cross-modal Swin Transformer for Head-and-Neck Tumor Segmentation in PET/CT Images](https://mlsanity.com/paper/2302.03861/) (2023)

## Built on by (most cited first, 1 of 1)

- [Towards Better Ultrasound Video Segmentation Foundation Model: An Empirical study on SAM2 Finetuning from Data Perspective](https://mlsanity.com/paper/2511.05731/) (2025)

## Abstract (arXiv)

Although new vision foundation models such as Segment Anything Model 2 (SAM2) have significantly enhanced zero-shot image segmentation capabilities, reliance on human-provided prompts poses significant challenges in adapting SAM2 to medical image segmentation tasks. Moreover, SAM2's performance in medical image segmentation was limited by the domain shift issue, since it was originally trained on natural images and videos. To address these challenges, we proposed SAM2 with support-set guided prompting (SAM2-SGP), a framework that eliminated the need for manual prompts. The proposed model leveraged the memory mechanism of SAM2 to generate pseudo-masks using image-mask pairs from a support set via a Pseudo-mask Generation (PMG) module. We further introduced a novel Pseudo-mask Attention (PMA) module, which used these pseudo-masks to automatically generate bounding boxes and enhance localized feature extraction by guiding attention to relevant areas. Furthermore, a low-rank adaptation (LoRA) strategy was adopted to mitigate the domain shift issue. The proposed framework was evaluated on both 2D and 3D datasets across multiple medical imaging modalities, including fundus photography, X-ray, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and ultrasound. The results demonstrated a significant performance improvement over state-of-the-art models, such as nnUNet and SwinUNet, as well as foundation models, such as SAM2 and MedSAM2, underscoring the effectiveness of the proposed approach. Our code is publicly available at https://github.com/astlian9/SAM_Support.