Hyperparameter-Free Boundary-Interior t-vMF Dice Loss for Medical Image Segmentation

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/ .

Medical image segmentation is a fundamental task for medical image processing and computer-assisted intervention, yet data imbalance and small lesion detection pose significant challenges. Dice Loss, which measures the overlap between predicted and ground truth regions, is widely used to mitigate these issues. To further emphasize its properties, we propose Polynomial Dice Loss, a polynomial extension of Dice Loss. Specifically, by leveraging the geometric characteristics of Dice Loss and formulating the loss function as a polynomial representation via Taylor expansion, we enable the adjustment of the contribution of higher-order components to the loss function. In our experiments, we evaluate the proposed method against loss functions derived from conventional Dice and Tversky coefficients. Experimental results and further analysis show that the polynomial formulation provides a simple way to control the loss shape and achieves competitive performance across multiple segmentation settings.

Medical image segmentation remains challenging in low-data regimes, where scarce annotations often yield poor generalization and ambiguous boundaries with missing fine structures. Recent self-supervised pretraining has improved transferability, but it often exhibits a texture bias. In contrast, accurate segmentation is inherently geometry-aware and depends on both topological consistency and precise boundary preservation. To address this problem, we propose a two-stage framework that couples structure-aware encoder pretraining with boundary-oriented decoding. In Stage-1, we aim to learn structure-aware representations for downstream segmentation in low-data regimes. To this end, we propose Mixed-Domain MeanFlow Pretraining, which aligns images and binary masks in a shared latent space through latent transport regression, where masks act as conditional structural guidance rather than prediction targets, making the pretraining task-agnostic. To further improve training stability under scarce supervision, we incorporate a lightweight Dispersive Loss to prevent representation collapse. In Stage-2, we fine-tune the pretrained encoder with a lightweight decoder that combines Direct Attentional Fusion for adaptive cross-scale gating and Frequency-Directional Dynamic Convolution for high-frequency boundary refinement under appearance variation. Experiments on ISIC-2016, Kvasir-SEG, and GlaS demonstrate consistent gains over state-of-the-art methods, with improved robustness in low-data settings and sharper boundary delineation.