MedSAM-U: Uncertainty-Guided Auto Multi-Prompt Adaptation for Reliable MedSAM

The Medical Segment Anything Model (MedSAM) has demonstrated strong performance in medical image segmentation, attracting increasing attention in the medical imaging domain. However, as with many prompt-based segmentation models, its performance is highly sensitive to the type and location of input prompts. This sensitivity often leads to suboptimal segmentation outcomes and necessitates labor-intensive manual prompt tuning, which hampers both efficiency and robustness. To address this challenge, this paper proposes MedSAM-U, an uncertainty-guided framework designed to automatically refine prompt inputs and enhance segmentation reliability. Specifically, a Multi-Prompt Adapter is integrated into MedSAM, resulting in MPA-MedSAM, which enables the model to effectively accommodate diverse multi-prompt inputs. An uncertainty estimation module is then introduced to evaluate the reliability of the prompts and their initial segmentation results. Based on this, a novel uncertainty-guided prompt adaptation strategy is applied to automatically generate refined prompts and more accurate segmentation outputs. The proposed MedSAM-U framework is evaluated across multiple medical imaging modalities. Experimental results on five diverse datasets demonstrate that MedSAM-U achieves consistent performance improvements ranging from 1.7% to 20.5% over the baseline MedSAM, confirming its effectiveness and practicality for robust and efficient medical image segmentation.