SAM-driven cross prompting with adaptive sampling consistency for semi-supervised medical image segmentation

• An innovative SAM-driven cross prompting scheme that seamlessly integrates into the semi-supervised framework and effectively utilizes unlabeled data for SAM fine-tuning. • A novel prototype-guided grid sampling strategy to ensure the quality of prompts for unlabeled data. • A novel prompt consistency regularization strategy to reduce SAM’s sensitivity to varying prompts, enhancing segmentation quality under noisy prompts for unlabeled data. • A state-of-the-art segmentation performance on five public datasets with various medical imaging modalities. Semi-supervised learning (SSL) has achieved notable progress in medical image segmentation. To achieve effective SSL, a model needs to be able to efficiently learn from limited labeled data and effectively exploit knowledge from abundant unlabeled data. Recent developments in visual foundation models, such as the Segment Anything Model (SAM), have demonstrated remarkable adaptability with improved sample efficiency. To seamlessly harness foundation models in SSL, we propose a SAM-driven cross prompting framework with adaptive sampling and prompt consistency for semi-supervised medical image segmentation, named CPAC-SAM. Our method employs SAM’s unique prompt design and innovates a cross prompting strategy within a dual-branch framework to automatically generate prompts and supervision across two decoder branches, enabling effective learning from both scarce labeled and valuable unlabeled data. To ensure the quality of prompts for unlabeled data and provide meaningful supervision in the cross prompting scheme, we propose an innovative prototype-guided grid sampling strategy with adaptive intervals to simultaneously improve the reliability of the prompt selection area and ensure both adequate prompt density and complete target coverage. We further design a novel prompt consistency regularization to reduce SAM’s prompt sensitivity and to enhance the output invariance under different prompts. We validate our method on five medical image segmentation tasks, encompassing both 2D and 3D scenarios. The extensive experiments with different labeled-data ratios and modalities demonstrate the superiority of our proposed method over the state-of-the-art SSL methods, with more than 4.1% and 3.8% Dice improvement on the breast cancer segmentation task and left atrium segmentation task, respectively. Our code is available at: https://github.com/JuzhengMiao/CPAC-SAM .