# A 3D SAM-Based Progressive Prompting Framework for Multi-Task Segmentation of Radiotherapy-induced Normal Tissue Injuries in Limited-Data Settings

arXiv: https://arxiv.org/abs/2604.13367 · HTML: https://mlsanity.com/paper/2604.13367/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 12 of its 31 references that are in the map.
- First posted on arXiv 15 Apr 2026.

## Builds on (most cited first, 12 of 12)

- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [Swin Transformer: Hierarchical Vision Transformer using Shifted Windows](https://mlsanity.com/paper/2103.14030/) (2021)
- [Segment Anything](https://mlsanity.com/paper/2304.02643/) (2023)
- [V-Net: Fully Convolutional Neural Networks for Volumetric Medical Image Segmentation](https://mlsanity.com/paper/1606.04797/) (2016)
- [Publicly Available Clinical BERT Embeddings](https://mlsanity.com/paper/1904.03323/) (2019)
- [Swin UNETR: Swin Transformers for Semantic Segmentation of Brain Tumors in MRI Images](https://mlsanity.com/paper/2201.01266/) (2022)
- [3D MRI brain tumor segmentation using autoencoder regularization](https://mlsanity.com/paper/1810.11654/) (2018)
- [A Novel Focal Tversky loss function with improved Attention U-Net for lesion segmentation](https://mlsanity.com/paper/1810.07842/) (2018)
- [CARZero: Cross-Attention Alignment for Radiology Zero-Shot Classification](https://mlsanity.com/paper/2402.17417/) (2024)
- [XCoOp: Explainable Prompt Learning for Computer-Aided Diagnosis via Concept-guided Context Optimization](https://mlsanity.com/paper/2403.09410/) (2024)
- [Grounded Knowledge-Enhanced Medical Vision-Language Pre-training for Chest X-Ray](https://mlsanity.com/paper/2404.14750/) (2024)

## Abstract (arXiv)

Radiotherapy-induced normal tissue injury is a clinically important complication, and accurate segmentation of injury regions from medical images could facilitate disease assessment, treatment planning, and longitudinal monitoring. However, automatic segmentation of these lesions remains largely unexplored because of limited voxel-level annotations and substantial heterogeneity across injury types, lesion size, and imaging modality. To address this gap, we curate a dedicated head-and-neck radiotherapy-induced normal tissue injury dataset covering three manifestations: osteoradionecrosis (ORN), cerebral edema (CE), and cerebral radiation necrosis (CRN). We further propose a 3D SAM-based progressive prompting framework for multi-task segmentation in limited-data settings. The framework progressively incorporates three complementary prompts: text prompts for task-aware adaptation, dose-guided box prompts for coarse localization, and click prompts for iterative refinement. A small-target focus loss is introduced to improve local prediction and boundary delineation for small and sparse lesions. Experiments on ORN, CE, and CRN demonstrate that the proposed method achieves reliable segmentation performance across diverse injury types and outperforms state-of-the-art methods.