Human-Inspired Asymmetric Collaboration for Dual-Student Semi-Supervised Medical Image Segmentation

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.

Registration-based Few-shot medical image segmentation (RFMIS) aims to generate pseudo-labels for unlabeled images by warping a labeled image through registration. However, existing methods primarily perform pixel-level optimization and inference in Euclidean space, treating anatomical structures as flat and disjoint. This neglect of inherent hierarchies degrades pseudo-label quality and weakens the discrimination of ambiguous regions, limiting the segmentation performance. To overcome this challenge, we propose a Hyperbolic Hierarchy-aware Aggregative Learning framework for RFMIS, termed H2AL, that enhances both deformation plausibility and anatomical discrimination for dual-task learning. Specifically, we introduce a Hyperbolic Hierarchy-aware Infusion (H2I) module, which leverages the hierarchical modeling capability of hyperbolic space to learn precise hierarchy-aware representations via transformation-guided supervised hyperbolic contrastive learning, and injects such hierarchical priors into Euclidean space through a gated infusion block while preserving semantic richness. Furthermore, we propose an end-to-end joint optimization algorithm by gradient aggregation, where the gradients from the registration and segmentation decoders, embedding semantic and hierarchical cues, are aggregated to update the shared encoder to promote collaborative learning across tasks. Extensive experiments on two anatomical regions, with five experimental settings, demonstrate the effectiveness and efficiency of our method in both registration and segmentation. The code is publicly available at https://github.com/JiamingCai469/H2AL.

Data augmentation is a standard component of modern semantic segmentation pipelines, but most augmentation techniques allocate transformations uniformly across training samples or adapt to a single difficulty signal such as loss. This ignores the fact that segmentation difficulty is multi-factorial, since ambiguous predictions, persistent optimization errors, rare classes, and complex object boundaries can each make a sample informative in different ways. This paper introduces Difficulty-Aware Sample Allocation (DASA), an architecture-agnostic framework that assigns stronger augmentation to samples estimated to be more difficult. DASA combines prediction ambiguity, training loss, class rarity, and boundary complexity into a normalized difficulty score, then maps that score to sample-specific augmentation strength during iterative training. Experiments on Oxford-IIIT Pet and binary Pascal VOC segmentation with U-Net, DeepLabV3, and SegFormer-B0 show that DASA improves over standard training and is competitive with or stronger than single-signal adaptive baselines. On Oxford-IIIT Pet, DASA improves DeepLabV3 from 0.633 to 0.740 mIoU. On binary Pascal VOC, DASA obtains the best foreground IoU for all three evaluated architectures. These results attest to the value of multi-factor difficulty estimation as a practical mechanism for directing augmentation where it is most useful.