Ranking-Guided Semi-Supervised Domain Adaptation for Severity Classification

In mixed domain semi-supervised medical image segmentation (MiDSS), achieving superior performance under domain shift and limited annotations is challenging. This scenario presents two primary issues: (1) distributional differences between labeled and unlabeled data hinder effective knowledge transfer, and (2) inefficient learning from unlabeled data causes severe confirmation bias. In this paper, we propose the bidirectional correlation maps domain adaptation (BCMDA) framework to overcome these issues. On the one hand, we employ knowledge transfer via virtual domain bridging (KTVDB) to facilitate cross-domain learning. First, to construct a distribution-aligned virtual domain, we leverage bidirectional correlation maps between labeled and unlabeled data to synthesize both labeled and unlabeled images, which are then mixed with the original images to generate virtual images using two strategies, a fixed ratio and a progressive dynamic MixUp. Next, dual bidirectional CutMix is used to enable initial knowledge transfer within the fixed virtual domain and gradual knowledge transfer from the dynamically transitioning labeled domain to the real unlabeled domains. On the other hand, to alleviate confirmation bias, we adopt prototypical alignment and pseudo label correction (PAPLC), which utilizes learnable prototype cosine similarity classifiers for bidirectional prototype alignment between the virtual and real domains, yielding smoother and more compact feature representations. Finally, we use prototypical pseudo label correction to generate more reliable pseudo labels. Empirical evaluations on three public multi-domain datasets demonstrate the superiority of our method, particularly showing excellent performance even with very limited labeled samples. Code available at https://github.com/pascalcpp/BCMDA.

Distribution shift in medical imaging remains a central bottleneck for the clinical translation of medical AI. Failure to address it can lead to severe performance degradation in unseen environments and exacerbate health inequities. Existing methods for domain adaptation are inherently limited by exhausting predefined possibilities through simulated shifts or pseudo-supervision. Such strategies struggle in the open-ended and unpredictable real world, where distribution shifts are effectively infinite. To address this challenge, we introduce an empirical law called Rank Stability of Positive Regions'', which states that the relative rank of predicted probabilities for positive voxels remains stable under distribution shift. Guided by this principle, we propose CRISP, a parameter-free and model-agnostic framework requiring no target-domain information. CRISP is the first framework to make segmentation based on rank rather than probabilities. CRISP simulates model behavior under distribution shift via latent feature perturbation, where voxel probability rankings exhibit two stable patterns: regions that consistently retain high probabilities (destined positives according to the principle) and those that remain low-probability (can be safely classified as negatives). Based on these patterns, we construct high-precision (HP) and high-recall (HR) priors and recursively refine them under perturbation. We then design an iterative training framework, making HP and HR progressively squeeze'' to the final segmentation. Extensive evaluations on multi-center cardiac MRI and CT-based lung vessel segmentation demonstrate CRISP's superior robustness, significantly outperforming state-of-the-art methods with striking HD95 reductions of up to 0.14 (7.0% improvement), 1.90 (13.1% improvement), and 8.39 (38.9% improvement) pixels across multi-center, demographic, and modality shifts, respectively.

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.