# T-Gated Adapter: A Lightweight Temporal Adapter for Vision-Language Medical Segmentation

arXiv: https://arxiv.org/abs/2604.08167 · HTML: https://mlsanity.com/paper/2604.08167/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 15 of its 22 references that are in the map.
- First posted on arXiv 9 Apr 2026.

## Builds on (most cited first, 15 of 15)

- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [Segment Anything](https://mlsanity.com/paper/2304.02643/) (2023)
- [Scaling Up Visual and Vision-Language Representation Learning With Noisy Text Supervision](https://mlsanity.com/paper/2102.05918/) (2021)
- [3D U-Net: Learning Dense Volumetric Segmentation from Sparse Annotation](https://mlsanity.com/paper/1606.06650/) (2016)
- [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)
- [Image Segmentation Using Text and Image Prompts](https://mlsanity.com/paper/2112.10003/) (2021)
- [Medical SAM Adapter: Adapting Segment Anything Model for Medical Image Segmentation](https://mlsanity.com/paper/2304.12620/) (2023)
- [Domain Adaptation for Medical Image Analysis: A Survey](https://mlsanity.com/paper/2102.09508/) (2021)
- [AMOS: A Large-Scale Abdominal Multi-Organ Benchmark for Versatile Medical Image Segmentation](https://mlsanity.com/paper/2206.08023/) (2022)
- [Embracing Imperfect Datasets: A Review of Deep Learning Solutions for Medical Image Segmentation](https://mlsanity.com/paper/1908.10454/) (2019)
- [3DSAM-adapter: Holistic adaptation of SAM from 2D to 3D for promptable tumor segmentation](https://mlsanity.com/paper/2306.13465/) (2023)
- [Combining Fully Convolutional and Recurrent Neural Networks for 3D Biomedical Image Segmentation](https://mlsanity.com/paper/1609.01006/) (2016)
- [RadCLIP: Enhancing Radiologic Image Analysis through Contrastive Language-Image Pre-training](https://mlsanity.com/paper/2403.09948/) (2024)

## Abstract (arXiv)

Medical image segmentation traditionally relies on fully supervised 3D architectures that demand a large amount of dense, voxel-level annotations from clinical experts which is a prohibitively expensive process. Vision Language Models (VLMs) offer a powerful alternative by leveraging broad visual semantic representations learned from billions of images. However, when applied independently to 2D slices of a 3D scan, these models often produce noisy and anatomically implausible segmentations that violate the inherent continuity of anatomical structures. We propose a temporal adapter that addresses this by injecting adjacent-slice context directly into the model's visual token representations. The adapter comprises a temporal transformer attending across a fixed context window at the token level, a spatial context block refining within-slice representations, and an adaptive gate balancing temporal and single-slice features. Training on 30 labeled volumes from the FLARE22 dataset, our method achieves a mean Dice of 0.704 across 13 abdominal organs with a gain of +0.206 over the baseline VLM trained with no temporal context. Zero-shot evaluation on BTCV and AMOS22 datasets yields consistent improvements of +0.210 and +0.230, with the average cross-domain performance drop reducing from 38.0% to 24.9%. Furthermore, in a cross-modality evaluation on AMOS22 MRI with neither model receiving any MRI supervision, our method achieves a mean Dice of 0.366, outperforming a fully supervised 3D baseline (DynUNet, 0.224) trained exclusively on CT, suggesting that CLIP's visual semantic representations generalize more gracefully across imaging modalities than convolutional features.