The Segment Anything Model (SAM) has recently emerged as a groundbreaking foundation model for prompt-driven image segmentation tasks. However, both the original SAM and its medical variants require slice-by-slice manual prompting of target structures, which directly increase the burden for applications. Despite attempts of auto-prompting to turn SAM into a fully automatic manner, it still exhibits subpar performance and lacks of reliability especially in the field of medical imaging. In this paper, we propose UR-SAM, an uncertainty rectified SAM framework to enhance the reliability for auto-prompting medical image segmentation. Building upon a localization framework for automatic prompt generation, our method incorporates a prompt augmentation module to obtain a series of input prompts for SAM for uncertainty estimation and an uncertainty-based rectification module to further utilize the distribution of estimated uncertainty to improve the segmentation performance. Extensive experiments on two public 3D medical datasets covering the segmentation of 35 organs demonstrate that without supplementary training or fine-tuning, our method further improves the segmentation performance with up to 10.7 % and 13.8 % in dice similarity coefficient, demonstrating efficiency and broad capabilities for medical image segmentation without manual prompting.
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