Class incremental medical image segmentation (CIMIS) aims to preserve knowledge of previously learned classes while learning new ones without relying on old-class annotations. However, existing methods 1) either adopt one-size-fits-all strategies that treat all spatial regions and feature channels equally, which may hinder the preservation of accurate old knowledge, 2) or focus solely on aligning local prototypes with global ones for old classes while overlooking their local representations in new data, leading to knowledge degradation. To mitigate the above issues, we propose Prototype-Guided Calibration Distillation (PGCD) and Dual-Aligned Prototype Distillation (DAPD) for CIMIS in this paper. Specifically, PGCD exploits prototype-to-feature similarity to calibrate class-specific distillation intensity in different spatial regions, effectively reinforcing reliable old knowledge and suppressing misleading cues from old classes. Complementarily, DAPD aligns the local prototypes of old classes extracted from the current model with both global historical prototypes and local prototypes, further enhancing segmentation performance on old categories. Comprehensive evaluations on two widely used multi-organ segmentation benchmarks demonstrate that our method outperforms current state-of-the-art methods, highlighting its robustness and generalization capabilities.

Magnetic resonance imaging (MRI)-guided radiotherapy (MRIgRT) integrates MRI with linear accelerators (MRI-linacs), enabling real-time motion management based on temporally resolved 2D MRI (cine-MRI). Current systems rely on template matching or deformable image registration for radiotherapy target (typically the gross tumor volume) localization, which allows beam gating. Further advances in localization could support more precise and efficient delivery methods. https://trackrad2025.grand-challenge.org/ was organized to provide a common dataset to benchmark algorithms for MRIgRT target tracking in 2D+t cine-MRI. Participants propagated target segmentation masks from an initialization frame across subsequent frames. The dataset comprised sagittal cine-MRI scans of 585 cancer patients undergoing radiotherapy at 0.35 T and 1.5 T MRI-linacs at six different institutions, with expert-annotated targets in 108 sequences. Target sites included the thorax (179 cases), abdomen (266 cases), and pelvis (140 cases). A total of 477 unlabeled and 50 labeled cases were provided for training purposes, 58 cases were kept private for preliminary testing (8) and final evaluation (50). The algorithms submitted by participants were executed on the challenge platform and assessed using metrics in three categories: geometric accuracy, surrogate dose accuracy and execution speed. Rankings were derived via a Rank-Then-Mean scheme. TrackRAD2025 attracted 148 registrations from 28 countries, 100 preliminary submissions and 24 final submissions from 14 teams. The top five methods achieved mean Dice similarity coefficients >0.87 and Euclidean center distances <2.1 mm, comparable to interobserver variability. Leading top five solutions featured foundation models with (4) or without (1) finetuning. Field strength had minimal effect on performance and tracking worked better for the pelvis with reduced motion amplitude compared to the thorax and abdomen cases, which achieved equivalent performance. TrackRAD2025 established a benchmark for MRIgRT tracking on multi-institutional cine-MRI data, highlighting foundation models as promising for clinical translation.

Propagation-based methods have drawn increasing research attention in interactive medical image segmentation. However, existing propagation-based methods face two significant challenges: 1) Due tothe continuous nature of anatomical structures within the organs and tumors throughout the volume, over-propagation is likely to occur as the propagation process reaches the end of structures, leadingto a degradation in segmentation performance. 2) During the multi-round refinement process, selecting the worst-segmented slice for refinement tends to hinder the optimization of segmentation results. To overcome these challenges, we propose the Discrepancy Aware Network (DANet), which includes a Discrepancy Learning Module (DLM) and employs a confidence loss to achieve accurate segmentation. Specifically, DLM captures the temporal-contextual discrepancy between previous and current slices, enabling the model to perceive the variations of the target. Furthermore, the confidence loss is responsible for regularizing the over-confident segmentation at the image level by estimating the target foreground. Additionally, we design a straightforward slice selection strategy to optimize the refinement process. Extensive experimental results on five public medical datasets demonstrate significant improvements over state-of-the-art methods (e.g., with +1.07% improvement on the MSD-Spleen dataset).

Class incremental medical segmentation (CIMS) aims to sequentially learn new classes while preserving knowledge of previously learned categories in the absence of old-class labels. Current methods suffer from performance degradation under class imbalance and require additional segmentation heads to accommodate new categories. Inspired by recent prototype learning that leverages prototypes to achieve robust recognition of new categories under limited-data regimes, we introduce a Prototype-dRIven class increMEntal (PRIME) method. PRIME replaces the incremental segmentation heads with prototypes to mitigate class imbalance, allowing new class learning with the simple addition of new prototypes. Based on prototype learning, PRIME further involves three tailored techniques. First, prototype structure alignment imposes structural constraints on inter-prototype relations to maintain consistent relative distances in the feature space, improving the model's ability to distinguish distinct classes. Second, pixel-wise contrastive loss term groups embeddings of similar samples while separating those of different classes, enhancing segmentation accuracy across all categories. Finally, the consensus-based prototype update mechanism refines the old prototypes during the learning of new classes, preventing performance degradation on the old classes. Extensive experiments on two public multi-organ segmentation datasets demonstrate that our approach significantly outperforms state-of-the-art methods, validating the effectiveness of the proposed PRIME.

Precisely segmenting the organs at risk (OARs) in computed tomography (CT) plays an important role in radiotherapy’s treatment planning, aiding in the protection of critical tissues during irradiation. Renowned deep convolutional neural networks (DCNNs) and prevailing transformer-based architectures are widely utilized to accomplish the segmentation task, showcasing advantages in capturing local and contextual characteristics. Graph convolutional networks (GCNs) are another specialized model designed for processing the nongrid dataset, e.g., citation relationship. The DCNNs and GCNs are considered as two distinct models applicable to the grid and nongrid datasets, respectively. Motivated by the recently developed dynamic-channel GCN (DCGCN) that attempts to leverage the graph structure to enhance the feature extracted by the DCNNs, this paper proposes a novel architecture termed adaptive sparse GCN (ASGCN) to mitigate the inherent limitations in DCGCN from the aspect of node’s representation and adjacency matrix’s construction. For the node’s representation, the global average pooling used in the DCGCN is replaced by the learning mechanism to accommodate the segmentation task. For the adjacency matrix, an adaptive regularization strategy is leveraged to penalize the coefficient in the adjacency matrix, resulting in a sparse one that can better exploit the relationships between nodes. Rigorous experiments on multiple OARs’ segmentation tasks of the head and neck demonstrate that the proposed ASGCN can effectively improve the segmentation accuracy. Comparison between the proposed method and other prevalent architectures further confirms the superiority of the ASGCN.