Tell2Adapt: A Unified Framework for Source Free Unsupervised Domain Adaptation via Vision Foundation Model

Domain shift across imaging modalities and acquisition sites remains a significant barrier to the clinical deployment of segmentation models. Source-free unsupervised domain adaptation (SFUDA) addresses this by adapting a pretrained model to an unlabeled target domain without requiring access to sensitive source data. We introduce a novel SFUDA framework built on Symmetrical Flow Matching, a unified generative model that segments an input image and synthesizes a source-like image from a mask within the same learned flow. By initializing inference from a domain-agnostic Gaussian origin, the model preserves structural consistency across domains and grounds predictions in learned anatomy rather than shifted texture statistics. Our pipeline leverages this symmetry to generate reliable pseudo-labels and corresponding source-like synthetic images from unlabeled target data, creating a generative replay buffer that anchors source knowledge during a generative self-training stage that fine-tunes on a joint set of real target and synthetic source-like images. We evaluate on abdominal multi-organ and cardiac segmentation, covering cross-modality MRI<->CT shifts, and multi-site prostate segmentation. Our approach outperforms SFUDA baselines and is competitive with conventional UDA methods.

Source-free universal domain adaptation (SF-UniDA) adapts a pre-trained source model to an unlabeled target domain under both covariate and label shifts, without access to source data. However, existing SF-UniDA methods rely on inefficient techniques such as threshold tuning and clustering. Foundation models (FMs), known for their generalization and zero-shot capabilities, remain underexplored in SF-UniDA. In this paper, we propose a framework that leverages foundation models (LFM) for SF-UniDA. We use a vision-language model (VLM) to compute similarities between target samples and text labels, including those for unknown classes generated by prompting a large language model. The label shift type is determined by analyzing the coefficient of variation of a similarity-based sample-level score. Unknown samples are identified using a binary Gaussian mixture model fitted to another similarity-based metric. Under a consensus strategy, the pseudo-labels generated by the VLM are refined by the target model initialized with the pre-trained source model, integrating knowledge from both the source domain and foundation models. Finally, these refined pseudo-labels are used to train the target model. Extensive experiments across all possible label shifts and multiple benchmarks demonstrate the effectiveness and superiority of our proposed LFM framework. Our code is available at https://github.com/iamjingli/LFM.

Unsupervised Domain Adaptation (UDA) is essential for deploying medical segmentation models across diverse clinical environments. Existing methods are fundamentally limited, suffering from semantically unaware feature alignment that results in poor distributional fidelity and from pseudo-label validation that disregards global anatomical constraints, thus failing to prevent the formation of globally implausible structures. To address these issues, we propose SHAPE (Structure-aware Hierarchical Unsupervised Domain Adaptation with Plausibility Evaluation), a framework that reframes adaptation towards global anatomical plausibility. Built on a DINOv3 foundation, its Hierarchical Feature Modulation (HFM) module first generates features with both high fidelity and class-awareness. This shifts the core challenge to robustly validating pseudo-labels. To augment conventional pixel-level validation, we introduce Hypergraph Plausibility Estimation (HPE), which leverages hypergraphs to assess the global anatomical plausibility that standard graphs cannot capture. This is complemented by Structural Anomaly Pruning (SAP) to purge remaining artifacts via cross-view stability. SHAPE significantly outperforms prior methods on cardiac and abdominal cross-modality benchmarks, achieving state-of-the-art average Dice scores of 90.08% (MRI->CT) and 78.51% (CT->MRI) on cardiac data, and 87.48% (MRI->CT) and 86.89% (CT->MRI) on abdominal data. The code is available at https://github.com/BioMedIA-repo/SHAPE.