How SAM adapts for medical segmentation: No one-size-fits-all

Cross-method analysis of Segment Anything Model (SAM) adaptations shows no strategy is universally optimal; effectiveness depends on capability-task gap, data scale, domain discrepancy, imaging dimensionality, resources, and clinical constraints. Priorities for clinical use: sta…

• SAM generations expand from spatial prompting to sequential propagation to concept-level specification, without automatically conferring medical expertise.
• Medical adaptation strategies are organized into model adaptation and strategy selection, task knowledge organization and utilization, and application-oriented adaptation.
• Four clinical translation priorities: standardized evaluation for cross-study comparability, controlled continual adaptation under domain drift, dynamic resource scheduling, and uncertainty stratification.

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