Quality-Guided Semi-Supervised Learning for Medical Image Segmentation

In the era of information explosion, efficiently leveraging large-scale unlabeled data while minimizing the reliance on high-quality pixel-level annotations remains a critical challenge in the field of medical imaging. Semi-supervised learning (SSL) enhances the utilization of unlabeled data by facilitating knowledge transfer, significantly improving the performance of fully supervised models and emerging as a highly promising research direction in medical image analysis. Inspired by the ability of Vision Foundation Models (e.g., SAM-2) to provide rich prior knowledge, we propose SSS (Semi-Supervised SAM-2), a novel approach that leverages SAM-2's robust feature extraction capabilities to uncover latent knowledge in unlabeled medical images, thus effectively enhancing feature support for fully supervised medical image segmentation. Specifically, building upon the single-stream "weak-to-strong" consistency regularization framework, this paper introduces a Discriminative Feature Enhancement (DFE) mechanism to further explore the feature discrepancies introduced by various data augmentation strategies across multiple views. By leveraging feature similarity and dissimilarity across multi-scale augmentation techniques, the method reconstructs and models the features, thereby effectively optimizing the salient regions. Furthermore, a prompt generator is developed that integrates Physical Constraints with a Sliding Window (PCSW) mechanism to generate input prompts for unlabeled data, fulfilling SAM-2's requirement for additional prompts. Extensive experiments demonstrate the superiority of the proposed method for semi-supervised medical image segmentation on two multi-label datasets, i.e., ACDC and BHSD. Notably, SSS achieves an average Dice score of 53.15 on BHSD, surpassing the previous state-of-the-art method by +3.65 Dice. Code will be available at https://github.com/AIGeeksGroup/SSS.

Semi-supervised learning (SSL) is an effective solution for medical image segmentation with limited annotations. Existing SSL methods mainly rely on pseudo-labels generated by teacher-student supervision or cross-network consistency. However, these methods lack an explicit structural reference for judging pseudo-label quality. Low-quality pseudo-labels may lead to unreliable training, error accumulation and confirmation bias when processing unlabeled data with substantial appearance variations. To address this issue, we proposed OFD-Net, a teacher-free single-network framework for reliable semi-supervised medical image segmentation. OFD-Net employs an Orthogonal Feature Disentanglement Module (OFDM) to capture OFD features for reliable SSL by disentangling unlabeled data into background and foreground representations with a reliable structural distribution, thereby effectively reducing error accumulation and alleviating confirmation bias among unlabeled data. Specifically, OFD-Net explicitly employs a Disentanglement Guidance Module (DGM) to inject the resulting structural priors of foreground-background into the decoder by deformable convolution processing, and outputs predictions with clearer foreground representations. Based on DGM and the OFDM, we further develop a reliability-aware pseudo-label learning mechanism that evaluates unlabeled supervision according to the structural consistency between the main prediction and the disentangled foreground-background responses, and then down-weights unreliable regions during training. Extensive experiments on four public medical image segmentation benchmarks, namely ISIC-2016, Kvasir-SEG, Synapse, and ACDC, validate the effectiveness of OFD-Net. These results confirm that orthogonal foreground-background disentanglement enables OFD-Net to establish an efficient and reliable training paradigm within a teacher-free single-network framework.

In practical settings, medical image segmentation models are often developed with limited annotated data rather than fully labeled datasets. Training frequently begins in ultra-low labeled regimes where only a small number of volumes are annotated. In such scenarios, practitioners must simultaneously decide which cases to annotate and how to best use the remaining unlabeled data. Although active learning (AL) and semi-supervised learning (SSL) both target annotation scarcity, they are typically designed and optimized independently, resulting in objective mismatch and unstable training during early-stage "cold start" conditions. We propose RegAL, a unified active semi-supervised framework governed by a shared topology-aware Pareto optimization that couples sample acquisition with unlabeled data utilization. RegAL evaluates images along three complementary axes, voxel-wise uncertainty, feature diversity, and a novel topological consistency metric, to select anatomically informative edge cases for annotation. On the other hand, the same criteria are used to identify geometrically stable atlas candidates for diffeomorphic registration-guided augmentation to train a self-supervised Mean Teacher segmentation network. Across BraTS 2021, dHCP, and ProstateX, RegAL remains stable with few labeled volumes and consistently outperforms state-of-the-art AL, SSL, and active semi-supervised baselines across Dice and boundary-distance (ASD, HD95) metrics under extreme annotation scarcity.