Current interactive segmentation approaches, inspired by the success of META's Segment Anything model, have achieved notable advancements, however, they come with substantial limitations that hinder their practical application in 3D radiological scenarios. These include unrealistic human interaction requirements, such as slice-by-slice operations for 2D models on 3D data, a lack of iterative interactive refinement, and insufficient evaluation experiments. These shortcomings prevent accurate assessment of model performance and lead to inconsistent outcomes across studies. The RadioActive benchmark overcomes these challenges by offering a comprehensive and reproducible evaluation of interactive segmentation methods in realistic, clinically relevant scenarios. It includes diverse datasets, target structures, and interactive segmentation methods, and provides a flexible, extendable codebase that allows seamless integration of new models and prompting strategies. We also introduce advanced prompting techniques to enable 2D models on 3D data by reducing the needed number of interaction steps, enabling a fair comparison. We show that surprisingly the performance of slice-wise prompted approaches can match native 3D methods, despite the domain gap. Our findings challenge the current literature and highlight that models not specifically trained on medical data can outperform the current specialized medical methods. By open-sourcing RadioActive, we invite the research community to integrate their models and prompting techniques, ensuring continuous and transparent evaluation of interactive segmentation models in 3D medical imaging.

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