# SpinalSAM-R1: A Vision-Language Multimodal Interactive System for Spine CT Segmentation

arXiv: https://arxiv.org/abs/2511.00095 · HTML: https://mlsanity.com/paper/2511.00095/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 21 of its 38 references that are in the map.
- First posted on arXiv 30 Oct 2025.

## Builds on (most cited first, 21 of 21)

- [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)
- [Segment Anything](https://mlsanity.com/paper/2304.02643/) (2023)
- [CBAM: Convolutional Block Attention Module](https://mlsanity.com/paper/1807.06521/) (2018)
- [V-Net: Fully Convolutional Neural Networks for Volumetric Medical Image Segmentation](https://mlsanity.com/paper/1606.04797/) (2016)
- [TransUNet: Transformers Make Strong Encoders for Medical Image Segmentation](https://mlsanity.com/paper/2102.04306/) (2021)
- [Swin-Unet: Unet-like Pure Transformer for Medical Image Segmentation](https://mlsanity.com/paper/2105.05537/) (2021)
- [Grounded SAM: Assembling Open-World Models for Diverse Visual Tasks](https://mlsanity.com/paper/2401.14159/) (2024)
- [Visual ChatGPT: Talking, Drawing and Editing with Visual Foundation Models](https://mlsanity.com/paper/2303.04671/) (2023)
- [UNet++: Redesigning Skip Connections to Exploit Multiscale Features in Image Segmentation](https://mlsanity.com/paper/1912.05074/) (2019)
- [LViT: Language meets Vision Transformer in Medical Image Segmentation](https://mlsanity.com/paper/2206.14718/) (2022)
- [GROUNDHOG: Grounding Large Language Models to Holistic Segmentation](https://mlsanity.com/paper/2402.16846/) (2024)
- [SAM4MLLM: Enhance Multi-Modal Large Language Model for Referring Expression Segmentation](https://mlsanity.com/paper/2409.10542/) (2024)
- [SA-Med2D-20M Dataset: Segment Anything in 2D Medical Imaging with 20 Million masks](https://mlsanity.com/paper/2311.11969/) (2023)
- [GMAI-VL-R1: Harnessing Reinforcement Learning for Multimodal Medical Reasoning](https://mlsanity.com/paper/2504.01886/) (2025)
- [MedCLIP-SAMv2: Towards Universal Text-Driven Medical Image Segmentation](https://mlsanity.com/paper/2409.19483/) (2024)
- [RobustSAM: Segment Anything Robustly on Degraded Images](https://mlsanity.com/paper/2406.09627/) (2024)
- [Domain and Content Adaptive Convolution based Multi-Source Domain Generalization for Medical Image Segmentation](https://mlsanity.com/paper/2109.05676/) (2021)
- [VividMed: Vision Language Model with Versatile Visual Grounding for Medicine](https://mlsanity.com/paper/2410.12694/) (2024)
- [A Unified Framework with Multimodal Fine-tuning for Remote Sensing Semantic Segmentation](https://mlsanity.com/paper/2410.11160/) (2024)
- [MedVisionLlama: Leveraging Pre-Trained Large Language Model Layers to Enhance Medical Image Segmentation](https://mlsanity.com/paper/2410.02458/) (2024)

## Abstract (arXiv)

The anatomical structure segmentation of the spine and adjacent structures from computed tomography (CT) images is a key step for spinal disease diagnosis and treatment. However, the segmentation of CT images is impeded by low contrast and complex vertebral boundaries. Although advanced models such as the Segment Anything Model (SAM) have shown promise in various segmentation tasks, their performance in spinal CT imaging is limited by high annotation requirements and poor domain adaptability. To address these limitations, we propose SpinalSAM-R1, a multimodal vision-language interactive system that integrates a fine-tuned SAM with DeepSeek-R1, for spine CT image segmentation. Specifically, our SpinalSAM-R1 introduces an anatomy-guided attention mechanism to improve spine segmentation performance, and a semantics-driven interaction protocol powered by DeepSeek-R1, enabling natural language-guided refinement. The SpinalSAM-R1 is fine-tuned using Low-Rank Adaptation (LoRA) for efficient adaptation. We validate our SpinalSAM-R1 on the spine anatomical structure with CT images. Experimental results suggest that our method achieves superior segmentation performance. Meanwhile, we develop a PyQt5-based interactive software, which supports point, box, and text-based prompts. The system supports 11 clinical operations with 94.3% parsing accuracy and sub-800 ms response times. The software is released on https://github.com/6jm233333/spinalsam-r1.