SHAPE: Structure-aware Hierarchical Unsupervised Domain Adaptation with Plausibility Evaluation for Medical Image Segmentation

Domain shift remains a major obstacle to the reliable deployment of machine learning models in high-stakes environments such as healthcare. While Domain adaptation aims to mitigate these effects, existing approaches suffer from limited expressiveness of latent representations and a reliance on handcrafted, static augmentations. In this work, we address these limitations by proposing a novel deep learning architecture for Unsupervised Domain Adaptation (UDA), specifically optimized for medical image segmentation. Our framework, ADualVUOT, integrates a dual-encoder Variational Autoencoder (VAE) with Continuous Normalizing Flows (CNFs) to increase modeling flexibility and posterior expressiveness. To achieve domain alignment, we leverage Unbalanced Optimal Transport (UOT) through the Gaussian-Gromov-Wasserstein (GGW) distance, which handles structural and topological discrepancies between domains. Furthermore, we incorporate an adversarial augmentation scheme to synthesize worst-case compositions, thus enhancing model robustness. Extensive experiments on medical imaging benchmarks show significant gains over prior OT-based approaches.

Source Free Unsupervised Domain Adaptation (SFUDA) is critical for deploying deep learning models across diverse clinical settings. However, existing methods are typically designed for low-gap, specific domain shifts and cannot generalize into a unified, multi-modalities, and multi-target framework, which presents a major barrier to real-world application. To overcome this issue, we introduce Tell2Adapt, a novel SFUDA framework that harnesses the vast, generalizable knowledge of the Vision Foundation Model (VFM). Our approach ensures high-fidelity VFM prompts through Context-Aware Prompts Regularization (CAPR), which robustly translates varied text prompts into canonical instructions. This enables the generation of high-quality pseudo-labels for efficiently adapting the lightweight student model to target domain. To guarantee clinical reliability, the framework incorporates Visual Plausibility Refinement (VPR), which leverages the VFM's anatomical knowledge to re-ground the adapted model's predictions in target image's low-level visual features, effectively removing noise and false positives. We conduct one of the most extensive SFUDA evaluations to date, validating our framework across 10 domain adaptation directions and 22 anatomical targets, including brain, cardiac, polyp, and abdominal targets. Our results demonstrate that Tell2Adapt consistently outperforms existing approaches, achieving SOTA for a unified SFUDA framework in medical image segmentation. Code are avaliable at https://github.com/derekshiii/Tell2Adapt.

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.