# Prompt-Guided Interactive Segmentation of Interstitial Lung Disease in Thoracic CT

arXiv: https://arxiv.org/abs/2608.28453 · HTML: https://mlsanity.com/paper/2608.28453/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 14 of its 33 references that are in the map.
- First posted on arXiv 28 Aug 2026.

## Builds on (most cited first, 14 of 14)

- [Segment Anything](https://mlsanity.com/paper/2304.02643/) (2023)
- [SAM 2: Segment Anything in Images and Videos](https://mlsanity.com/paper/2408.00714/) (2024)
- [TotalSegmentator: robust segmentation of 104 anatomical structures in CT images](https://mlsanity.com/paper/2208.05868/) (2022)
- [Segment Anything Model for Medical Image Analysis: an Experimental Study](https://mlsanity.com/paper/2304.10517/) (2023)
- [nnU-Net Revisited: A Call for Rigorous Validation in 3D Medical Image Segmentation](https://mlsanity.com/paper/2404.09556/) (2024)
- [Metrics reloaded: Recommendations for image analysis validation](https://mlsanity.com/paper/2206.01653/) (2022)
- [MedSAM2: Segment Anything in 3D Medical Images and Videos](https://mlsanity.com/paper/2504.03600/) (2025)
- [ScribblePrompt: Fast and Flexible Interactive Segmentation for Any Biomedical Image](https://mlsanity.com/paper/2312.07381/) (2023)
- [nnInteractive: Redefining 3D Promptable Segmentation](https://mlsanity.com/paper/2503.08373/) (2025)
- [RadSAM: Segmenting 3D radiological images with a 2D promptable model](https://mlsanity.com/paper/2504.20837/) (2025)
- [Semantic Segmentation of Pathological Lung Tissue with Dilated Fully Convolutional Networks](https://mlsanity.com/paper/1803.06167/) (2018)
- [RadioActive: 3D Radiological Interactive Segmentation Benchmark](https://mlsanity.com/paper/2411.07885/) (2024)
- [StructSAM: Structure- and Spectrum-Preserving Token Merging for Segment Anything Models](https://mlsanity.com/paper/2603.07307/) (2026)
- [Unmasking Interstitial Lung Diseases: Leveraging Masked Autoencoders for Diagnosis](https://mlsanity.com/paper/2508.04429/) (2025)

## Abstract (arXiv)

Accurate segmentation of interstitial lung disease (ILD) patterns is essential for quantitative disease assessment and longitudinal monitoring. However, existing approaches remain limited by relying on dense annotations and producing static predictions that cannot be refined, motivating interactive approaches. While promptable models show promise in interactive segmentation, their adaptation to ILDs remains largely unexplored. To address this gap, we investigate prompt-guided foundation models for ILD refinement and present, to the best of our knowledge, the first adaptation of MedSAM2 for interactive 3D ILD segmentation on thoracic CT. We investigate three fine-tuning strategies and multiple clinically motivated prompts: bounding-boxes (BBox), point, lasso, and scribble. On a dataset spanning seven ILD patterns and healthy lung tissue, full model fine-tuning performed best, improving the average Dice score by 4.7 percentage points over MedSAM2.While BBox prompts achieve the strongest performance, non-native MedSAM2 interactions such as lasso and scribble prompts also prove effective. Finally, we present and evaluate a proof-of-concept end-to-end workflow in which MedSAM2 is initialized from an automatic segmentation prior and subsequently refined using radiologist prompts. Model weights and plug-ins made available at: https://github.com/AIHNlab/ILD-SemiSegTool.