Text-Promptable Propagation for Referring Medical Image Sequence Segmentation

Referring Medical Image Sequence Segmentation (Ref-MISS) is a novel and challenging task that aims to segment anatomical structures in medical image sequences (e.g. endoscopy, ultrasound, CT, and MRI) based on natural language descriptions. This task holds significant clinical potential and offers a user-friendly advancement in medical imaging interpretation. Existing 2D and 3D segmentation models struggle to explicitly track objects of interest across medical image sequences, and lack support for interactive, text-driven guidance. To address these limitations, we propose Text-Promptable Propagation (TPP), a model designed for referring medical image sequence segmentation. TPP captures the intrinsic relationships among sequential images along with their associated textual descriptions. Specifically, it enables the recognition of referred objects through cross-modal referring interaction, and maintains continuous tracking across the sequence via Transformer-based triple propagation, using text embeddings as queries. To support this task, we curate a large-scale benchmark, Ref-MISS-Bench, which covers 4 imaging modalities and 20 different organs and lesions. Experimental results on this benchmark demonstrate that TPP consistently outperforms state-of-the-art methods in both medical segmentation and referring video object segmentation.