Organizations: College of Automation, Nanjing University of Posts and Telecommunications, Nanjing 210003, China · Department of Electrical and Computer Engineering, National University of Singapore, Singapore 117583 · State Key Laboratory Cultivation Base of Research, Prevention and Treatment for Oral Diseases, the Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing 210029, China
Reliable pelvic bone segmentation (PBS) from CT is essential for robot-assisted pelvic trauma surgery, yet deploying a source-trained model to a new hospital suffers from severe performance degradation due to cross-center domain shifts. While test-time adaptation (TTA) enables online model adaptation without accessing source data, existing methods show limited effectiveness for PBS, facing challenges including boundary degradation, anatomical inconsistency under domain shifts, and voxel-level class imbalance. To address these challenges, we propose a novel closed-loop dynamic Reliability-Guided TTA framework (ReGA) for PBS. Specifically, we introduce a pseudo-label reliability criterion termed Segmentation Inference Consistency Evaluation (SICE), which jointly measures region overlap and boundary deviation via dropout-based ensemble predictions. Based on SICE, a trust-weighted refinement module adaptively updates features to mitigate boundary errors in pseudo-labels. Furthermore, a confidence-weighted region-level contrastive learning strategy is proposed to enforce anatomical consistency. Finally, ReGA follows the teacher-student (TS) scheme to alleviate voxel-level class imbalance. Experiments on three heterogeneous 3D pelvic CT datasets demonstrate that ReGA consistently outperforms state-of-the-art TTA methods, enabling effective adaptation of the source-trained PBS model to unseen clinical domains. The code is available at https://github.com/Ren-ling/ReGA.
Test-time adaptation (TTA) aims to mitigate distribution shifts by adapting models with unlabeled target data at inference time. While TTA with vision-language models (VLMs) has shown promising results in classification, extending it to medical image segmentation remains challenging. In this setting, the adaptation gains from optimizing on VLM-generated predictions are often outweighed by the degradation to the VLM's strong pretrained features caused by noisy, update-driven learning, resulting in limited and unstable improvements. We therefore propose Memory-Supported Synergistic Adaptation (MSSA), a novel training-free TTA framework for medical image segmentation. Without updating model parameters, MSSA dynamically selects reliable image-text predictions to construct an online memory, uses them as text-guided semantic priors, and couples them with cross-image structural alignment for robust adaptation. Specifically, MSSA consists of (i) a noise-aware memory construction module that filters and stabilizes cross-modal predictions, and (ii) a relevance-driven prototype alignment module that aligns the target sample with structurally consistent memory samples and their reliable predictions to improve adaptation. Extensive experiments on multiple medical segmentation benchmarks demonstrate that MSSA consistently improves VLM-based segmentation models and outperforms existing fine-tuning-based TTA methods by a clear margin, with gains of up to 12.2% DSC and 11.7% mIoU. Project page: https://lingrayy.github.io/MSSA/ .
Test-Time Domain Adaptation (TTDA) aims to adapt Deep Neural Networks to distribution shifts using only streaming, unlabeled test data in real time. Current methods for semantic segmentation tasks suffer from critical limitations. Entropy minimization techniques require costly backpropagation, risking catastrophic forgetting and producing noisy segmentation boundaries. Memory-bank methods, while backpropagation-free, exhibit slow adaptation, requiring numerous samples to converge and struggle to handle continuous domain shifts. We introduce TestMate, a novel, real-time, and backpropagation-free TTDA framework that overcomes these issues. TestMate leverages generalization capability of a lightweight Visual Foundation Model to guide the adaptation. We use a zero-shot instance segmentation YOLOv8-seg based model to generate unlabeled mask proposals for objects and their parts at multiple scales in real time. These proposals are fused with the primary model via a heuristic, size-ordered competitive scheme, where small, high-confidence regions dominate and refine predictions in surrounding larger, less certain areas. This paremeter-free mechanism enables immediate adaptation from the first frame, inherently avoids catastrophic forgetting and effectively preserves fine object details and boundaries, even for small objects. TestMate can be used as a standalone, efficient refinement module or seamlessly integrated into existing TTDA methods to significantly boost their performance. We demonstrate state-of-the-art results across two benchmark datasets, proving TestMate's effectiveness in three distinct adaptation tasks: TTDA, Source-Free Domain Adaptation (SFDA), and online-TTDA. Code is available.
Dimitrios Fotiou, Vasileios Mygdalis, Ioannis Pitas
Test-time adaptation (TTA) can mitigate domain shift without source data, but it is highly brittle under adversarially contaminated test streams, where corrupted inputs also destabilize online updates. We study robust test-time adaptation (RTTA) in the adversarial-stream setting, which remains comparatively underexplored relative to standard TTA, and propose SAFER (Stochastic Augmentation Framework for Enhanced Robustness), a training-free reliability-guided augmentation wrapper for RTTA. SAFER preserves the wrapped TTA objective while replacing brittle single-view predictions with a reliability-guided pooled predictor. For each test sample, SAFER generates stochastic augmentations and aggregates their predictions through correlation-weighted pooling with outlier detection. We further study an adaptive-mixing extension that improves clean-performance retention by adjusting original-versus-augmentation weighting using feature disagreement signals. We evaluate on PACS, VLCS, and OfficeHome under PGD attacks at various attack rates. Across benchmarks, SAFER improves resilience of TTA methods to adversarial attacks while maintaining competitive clean performance.