Out-of-distribution (OOD) detection refers to training the model on an in-distribution (ID) dataset to classify whether the input images come from unknown classes. Considerable effort has been invested in designing various OOD detection methods based on either convolutional neural networks or transformers. However, zero-shot OOD detection methods driven by CLIP, which only require class names for ID, have received less attention. This paper presents a novel method, namely CLIP saying "no" (CLIPN), which empowers the logic of saying "no" within CLIP. Our key motivation is to equip CLIP with the capability of distinguishing OOD and ID samples using positive-semantic prompts and negation-semantic prompts. Specifically, we design a novel learnable "no" prompt and a "no" text encoder to capture negation semantics within images. Subsequently, we introduce two loss functions: the image-text binary-opposite loss and the text semantic-opposite loss, which we use to teach CLIPN to associate images with "no" prompts, thereby enabling it to identify unknown samples. Furthermore, we propose two threshold-free inference algorithms to perform OOD detection by utilizing negation semantics from "no" prompts and the text encoder. Experimental results on 9 benchmark datasets (3 ID datasets and 6 OOD datasets) for the OOD detection task demonstrate that CLIPN, based on ViT-B-16, outperforms 7 well-used algorithms by at least 2.34% and 11.64% in terms of AUROC and FPR95 for zero-shot OOD detection on ImageNet-1K. Our CLIPN can serve as a solid foundation for effectively leveraging CLIP in downstream OOD tasks. The code is available on https://github.com/xmed-lab/CLIPN.

Generalizing the medical image segmentation algorithms to unseen domains is an important research topic for computer-aided diagnosis and surgery. Most existing methods require a fully labeled dataset in each source domain. Although some researchers developed a semi-supervised domain generalized method, it still requires the domain labels. This paper presents a novel confidence-aware cross pseudo supervision algorithm for semi-supervised domain generalized medical image segmentation. The main goal is to enhance the pseudo label quality for unlabeled images from unknown distributions. To achieve it, we perform the Fourier transformation to learn low-level statistic information across domains and augment the images to incorporate cross-domain information. With these augmentations as perturbations, we feed the input to a confidence-aware cross pseudo supervision network to measure the variance of pseudo labels and regularize the network to learn with more confident pseudo labels. Our method sets new records on public datasets, i.e., M&Ms and SCGM. Notably, without using domain labels, our method surpasses the prior art that even uses domain labels by 11.67% on Dice on M&Ms dataset with 2% labeled data. Code is available at https://github.com/XMed-Lab/EPL SemiDG.