Concatenate, Fine-tuning, Re-training: A SAM-enabled Framework for Semi-supervised 3D Medical Image Segmentation

Segment Anything Model (SAM) fine-tuning has shown remarkable performance in medical image segmentation in a fully supervised manner, but requires precise annotations. To reduce the annotation cost and maintain satisfactory performance, in this work, we leverage the capabilities of SAM for establishing semi-supervised medical image segmentation models. Rethinking the requirements of effectiveness, efficiency, and compatibility, we propose a three-stage framework, i.e., Concatenate, Fine-tuning, and Re-training (CFR). The current fine-tuning approaches mostly involve 2D slice-wise fine-tuning that disregards the contextual information between adjacent slices. Our concatenation strategy mitigates the mismatch between natural and 3D medical images. The concatenated images are then used for fine-tuning SAM, providing robust initialization pseudo-labels. Afterwards, we train a 3D semi-supervised segmentation model while maintaining the same parameter size as the conventional segmenter such as V-Net. Our CFR framework is plug-and-play, and easily compatible with various popular semi-supervised methods. Extensive experiments validate that our CFR achieves significant improvements in both moderate annotation and scarce annotation across four datasets. In particular, CFR framework improves the Dice score of Mean Teacher from 29.68% to 74.40% with only one labeled data of LA dataset.