FlexICL: A Flexible Visual In-context Learning Framework for Elbow and Wrist Ultrasound Segmentation
Bibliographic record
Abstract
Elbow and wrist fractures are the most common fractures in pediatric populations. Automatic segmentation of musculoskeletal structures in ultrasound (US) can improve diagnostic accuracy and treatment planning. Fractures appear as cortical defects but require expert interpretation. Deep learning (DL) can provide real-time feedback and highlight key structures, helping lightly trained users perform exams more confidently. However, pixel-wise expert annotations for training remain time-consuming and costly. To address this challenge, we propose FlexICL, a novel and flexible in-context learning (ICL) framework for segmenting bony regions in US images. We apply it to an intra-video segmentation setting, where experts annotate only a small subset of frames, and the model segments unseen frames. We systematically investigate various image concatenation techniques and training strategies for visual ICL and introduce novel concatenation methods that significantly enhance model performance with limited labeled data. By integrating multiple augmentation strategies, FlexICL achieves robust segmentation performance across four wrist and elbow US datasets while requiring only 5% of the training images. It outperforms state-of-the-art visual ICL models like Painter, MAE-VQGAN, and conventional segmentation models like U-Net and TransUNet by 1-27% Dice coefficient on 1,252 US sweeps. These initial results highlight the potential of FlexICL as an efficient and scalable solution for US image segmentation well suited for medical imaging use cases where labeled data is scarce.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".