PPBoost: Progressive Prompt Boosting for Text-Driven Medical Image Segmentation

TL;DR

PPBoost is a novel framework that transforms weak text prompts into strong, spatially precise visual prompts for medical image segmentation, improving accuracy without requiring labeled data.

Contribution

It introduces a zero-shot method that converts text signals into high-quality visual prompts, enhancing segmentation performance across diverse medical imaging modalities.

Findings

Consistently improves Dice and NSSD metrics over baselines

Outperforms few-shot segmentation models without labeled data

Generalizes to multiple segmentation model backbones

Abstract

Text-prompted foundation models for medical image segmentation offer an intuitive way to delineate anatomical structures from natural language queries, but their predictions often lack spatial precision and degrade under domain shift. In contrast, visual-prompted models achieve strong segmentation performance across diverse modalities by leveraging spatial cues of precise bounding-box (bbox) prompts to guide the segmentation of target lesions. However, it is costly and challenging to obtain the precise visual prompts in clinical practice. We propose PPBoost (Progressive Prompt-Boosting), a framework that bridges these limitations by transforming weak text-derived signals into strong, spatially grounded visual prompts, operating under a strict zero-shot regime with no image- or pixel-level segmentation labels. PPBoost first uses a vision-language model to produce initial pseudo-bboxes conditioned on the textual object descriptions and applies an uncertainty-aware criterion to filter unreliable predictions. The retained image-bboxes pairs are then leveraged to train a pseudo-labeled detector, producing the high-quality bboxes for the query images. During inference, PPBoost further refines the generated bboxes by appropriately expanding them to tightly cover the target anatomical structures. The enhanced spatially-grounding bbox prompts guide existing segmentation models to generate final dense masks, effectively amplifying weak text cues into strong spatial guidance. Across three datasets spanning diverse modalities and anatomies, PPBoost consistently improves Dice and Normalized Surface Distance over text- and visual-prompted baselines and, notably, surpasses few-shot segmentation models without using labeled data. PPBoost can generalize to multiple typical visual segmentation model backbones.