IMVS: Interactive Medical Volume Segmentation with Test-Time Adaptation - A New Method for Annotating Radiology Datasets

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Annotating large radiology datasets is bottlenecked by the manual effort of delineating structures slice-by-slice in 3D volumes. Interactive methods reduce this effort but stay interaction-inefficient: slice-wise methods (including many foundation models) ignore inter-slice continuity, while 3D and video-based methods propagate a prompt with a \emph{fixed} propagator that never adapts to the target volume, so it drifts on low-contrast or pathological structures and must be re-prompted. We present IMVS, a human-in-the-loop annotation framework that composes three components into a closed loop rather than a new segmentation primitive: a lightweight 2D Slice Mask Adapter (SMA) fine-tuned online from user scribbles, a frozen Volume Mask Tracker (VMT) that propagates corrected masks across adjacent slices, and a soft teacher--student alignment that limits forgetting. The SMA is backbone-agnostic (UNet++, DeepLabV3, TransUNet). Across 8 public CT/MRI datasets, IMVS matches strong interactive baselines in quality while sharply cutting annotation effort: $14.4\times$ faster than a proficient copy-based manual workflow ($22.3\times$ over naive manual), $4.6\times$ over slice-wise and $1.9\times$ over 3D interactive methods. MedSAM2 and ScribblePrompt stay competitive or stronger on well-delineated organs; IMVS's advantage is largest on challenging targets and on interaction efficiency. Source code and Demo Video: https://github.com/AbhilakshSinghReen/imvs.