Promptable segmentation with region exploration enables minimal-effort expert-level prostate cancer delineation

TL;DR

This paper introduces a user-guided segmentation framework for prostate cancer in MR images that combines reinforcement learning with region growing, achieving expert-level accuracy with minimal user effort and outperforming automated methods.

Contribution

The proposed method uniquely integrates reinforcement learning with region exploration driven by user prompts, reducing annotation effort while maintaining high segmentation accuracy.

Findings

Outperforms previous automated methods by nearly 9-10%.

Achieves performance comparable to manual radiologist segmentation.

Reduces annotation time by tenfold.

Abstract

Purpose: Accurate segmentation of prostate cancer on magnetic resonance (MR) images is crucial for planning image-guided interventions such as targeted biopsies, cryoablation, and radiotherapy. However, subtle and variable tumour appearances, differences in imaging protocols, and limited expert availability make consistent interpretation difficult. While automated methods aim to address this, they rely on large expertly-annotated datasets that are often inconsistent, whereas manual delineation remains labour-intensive. This work aims to bridge the gap between automated and manual segmentation through a framework driven by user-provided point prompts, enabling accurate segmentation with minimal annotation effort. Methods: The framework combines reinforcement learning (RL) with a region-growing segmentation process guided by user prompts. Starting from an initial point prompt, region-growing generates a preliminary segmentation, which is iteratively refined through RL. At each step, the RL agent observes the image and current segmentation to predict a new point, from which region growing updates the mask. A reward, balancing segmentation accuracy and voxel-wise uncertainty, encourages exploration of ambiguous regions, allowing the agent to escape local optima and perform sample-specific optimisation. Despite requiring fully supervised training, the framework bridges manual and fully automated segmentation at inference by substantially reducing user effort while outperforming current fully automated methods. Results: The framework was evaluated on two public prostate MR datasets (PROMIS and PICAI, with 566 and 1090 cases). It outperformed the previous best automated methods by 9.9% and 8.9%, respectively, with performance comparable to manual radiologist segmentation, reducing annotation time tenfold.