# StealthMark: Harmless and Stealthy Ownership Verification for Medical Segmentation via Uncertainty-Guided Backdoors

arXiv: https://arxiv.org/abs/2601.17107 · HTML: https://mlsanity.com/paper/2601.17107/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 27 of its 52 references that are in the map.
- First posted on arXiv 23 Jan 2026.

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

- [Segment Anything](https://mlsanity.com/paper/2304.02643/) (2023)
- [Grad-CAM: Visual Explanations from Deep Networks via Gradient-based Localization](https://mlsanity.com/paper/1610.02391/) (2016)
- [A Unified Approach to Interpreting Model Predictions](https://mlsanity.com/paper/1705.07874/) (2017)
- ["Why Should I Trust You?": Explaining the Predictions of Any Classifier](https://mlsanity.com/paper/1602.04938/) (2016)
- [Axiomatic Attribution for Deep Networks](https://mlsanity.com/paper/1703.01365/) (2017)
- [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)
- [A Survey on Deep Learning in Medical Image Analysis](https://mlsanity.com/paper/1702.05747/) (2017)
- [Targeted Backdoor Attacks on Deep Learning Systems Using Data Poisoning](https://mlsanity.com/paper/1712.05526/) (2017)
- [Kvasir-SEG: A Segmented Polyp Dataset](https://mlsanity.com/paper/1911.07069/) (2019)
- [PraNet: Parallel Reverse Attention Network for Polyp Segmentation](https://mlsanity.com/paper/2006.11392/) (2020)
- [HiDDeN: Hiding Data With Deep Networks](https://mlsanity.com/paper/1807.09937/) (2018)
- [Turning Your Weakness Into a Strength: Watermarking Deep Neural Networks by Backdooring](https://mlsanity.com/paper/1802.04633/) (2018)
- [REFUGE Challenge: A Unified Framework for Evaluating Automated Methods for Glaucoma Assessment from Fundus Photographs](https://mlsanity.com/paper/1910.03667/) (2019)
- [A Benchmark for Endoluminal Scene Segmentation of Colonoscopy Images](https://mlsanity.com/paper/1612.00799/) (2016)
- [Machine Learning Models that Remember Too Much](https://mlsanity.com/paper/1709.07886/) (2017)
- [A Recipe for Watermarking Diffusion Models](https://mlsanity.com/paper/2303.10137/) (2023)
- [Untargeted Backdoor Watermark: Towards Harmless and Stealthy Dataset Copyright Protection](https://mlsanity.com/paper/2210.00875/) (2022)
- [FIBA: Frequency-Injection based Backdoor Attack in Medical Image Analysis](https://mlsanity.com/paper/2112.01148/) (2021)
- [Model Watermarking for Image Processing Networks](https://mlsanity.com/paper/2002.11088/) (2020)
- [Explanation as a Watermark: Towards Harmless and Multi-bit Model Ownership Verification via Watermarking Feature Attribution](https://mlsanity.com/paper/2405.04825/) (2024)
- [G1020: A Benchmark Retinal Fundus Image Dataset for Computer-Aided Glaucoma Detection](https://mlsanity.com/paper/2006.09158/) (2020)
- [Goal-guided Generative Prompt Injection Attack on Large Language Models](https://mlsanity.com/paper/2404.07234/) (2024)
- [Shortcut Learning in Medical Image Segmentation](https://mlsanity.com/paper/2403.06748/) (2024)
- [BAPLe: Backdoor Attacks on Medical Foundational Models using Prompt Learning](https://mlsanity.com/paper/2408.07440/) (2024)
- [Explainability Matters: Backdoor Attacks on Medical Imaging](https://mlsanity.com/paper/2101.00008/) (2020)
- [Backdoor Attack on Unpaired Medical Image-Text Foundation Models: A Pilot Study on MedCLIP](https://mlsanity.com/paper/2401.01911/) (2024)

## Abstract (arXiv)

Annotating medical data for training AI models is often costly and limited due to the shortage of specialists with relevant clinical expertise. This challenge is further compounded by privacy and ethical concerns associated with sensitive patient information. As a result, well-trained medical segmentation models on private datasets constitute valuable intellectual property requiring robust protection mechanisms. Existing model protection techniques primarily focus on classification and generative tasks, while segmentation models-crucial to medical image analysis-remain largely underexplored. In this paper, we propose a novel, stealthy, and harmless method, StealthMark, for verifying the ownership of medical segmentation models under black-box conditions. Our approach subtly modulates model uncertainty without altering the final segmentation outputs, thereby preserving the model's performance. To enable ownership verification, we incorporate model-agnostic explanation methods, e.g. LIME, to extract feature attributions from the model outputs. Under specific triggering conditions, these explanations reveal a distinct and verifiable watermark. We further design the watermark as a QR code to facilitate robust and recognizable ownership claims. We conducted extensive experiments across four medical imaging datasets and five mainstream segmentation models. The results demonstrate the effectiveness, stealthiness, and harmlessness of our method on the original model's segmentation performance. For example, when applied to the SAM model, StealthMark consistently achieved ASR above 95% across various datasets while maintaining less than a 1% drop in Dice and AUC scores, significantly outperforming backdoor-based watermarking methods and highlighting its strong potential for practical deployment. Our implementation code is made available at: https://github.com/Qinkaiyu/StealthMark.