nnSAM: Plug-and-play Segment Anything Model Improves nnUNet Performance

Automatic segmentation of medical images is crucial in modern clinical workflows. The Segment Anything Model (SAM) has emerged as a versatile tool for image segmentation without specific domain training, but it requires human prompts and may have limitations in specific domains. Traditional models like nnUNet perform automatic segmentation during inference and are effective in specific domains but need extensive domain-specific training. To combine the strengths of foundational and domain-specific models, we propose nnSAM, integrating SAM's robust feature extraction with nnUNet's automatic configuration to enhance segmentation accuracy on small datasets. Our nnSAM model optimizes two main approaches: leveraging SAM's feature extraction and nnUNet's domain-specific adaptation, and incorporating a boundary shape supervision loss function based on level set functions and curvature calculations to learn anatomical shape priors from limited data. We evaluated nnSAM on four segmentation tasks: brain white matter, liver, lung, and heart segmentation. Our method outperformed others, achieving the highest DICE score of 82.77% and the lowest ASD of 1.14 mm in brain white matter segmentation with 20 training samples, compared to nnUNet's DICE score of 79.25% and ASD of 1.36 mm. A sample size study highlighted nnSAM's advantage with fewer training samples. Our results demonstrate significant improvements in segmentation performance with nnSAM, showcasing its potential for small-sample learning in medical image segmentation.