Training segmentation models for medical images continues to be challenging due to the limited availability and acquisition expense of data annotations. Segment Anything Model (SAM) is a foundation model trained on over 1 billion annotations, predominantly for natural images, that is intended to be able to segment the user-defined object of interest in an interactive manner. Despite its impressive performance on natural images, it is unclear how the model is affected when shifting to medical image domains. Here, we perform an extensive evaluation of SAM's ability to segment medical images on a collection of 11 medical imaging datasets from various modalities and anatomies. In our experiments, we generated point prompts using a standard method that simulates interactive segmentation. Experimental results show that SAM's performance based on single prompts highly varies depending on the task and the dataset, i.e., from 0.1135 for a spine MRI dataset to 0.8650 for a hip x-ray dataset, evaluated by IoU. Performance appears to be high for tasks including well-circumscribed objects with unambiguous prompts and poorer in many other scenarios such as segmentation of tumors. When multiple prompts are provided, performance improves only slightly overall, but more so for datasets where the object is not contiguous. An additional comparison to RITM showed a much better performance of SAM for one prompt but a similar performance of the two methods for a larger number of prompts. We conclude that SAM shows impressive performance for some datasets given the zero-shot learning setup but poor to moderate performance for multiple other datasets. While SAM as a model and as a learning paradigm might be impactful in the medical imaging domain, extensive research is needed to identify the proper ways of adapting it in this domain.

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