Large pretrained visual foundation models exhibit impressive general capabilities. However, the extensive prior knowledge inherent in these models can sometimes be a double-edged sword when adapting them to downstream tasks in specific domains. In the context of semi-supervised medical image segmentation with domain shift, foundation models like MedSAM tend to make overconfident predictions, some of which are incorrect. The error accumulation hinders the effective utilization of unlabeled data and limits further improvements. In this paper, we introduce a Synergistic training framework for Foundation and Conventional models (SynFoC) to address the issue. We observe that a conventional model trained from scratch has the ability to correct the high-confidence mispredictions of the foundation model, while the foundation model can supervise it with high-quality pseudo-labels in the early training stages. Furthermore, to enhance the collaborative training effectiveness of both models and promote reliable convergence towards optimization, the consensus-divergence consistency regularization is proposed. We demonstrate the superiority of our method across four public multi-domain datasets. In particular, our method improves the Dice score by 10.31% on the Prostate dataset. Our code is available at https://github.com/MQinghe/SynFoC.

Both limited annotation and domain shift are prevalent challenges in medical image segmentation. Traditional semi-supervised segmentation and unsupervised domain adaptation methods address one of these issues separately. However, the coexistence of limited annotation and domain shift is quite common, which motivates us to introduce a novel and challenging scenario: Mixed Domain Semi-supervised medical image Segmentation (MiDSS), where limited labeled data from a single domain and a large amount of unlabeled data from multiple domains. To tackle this issue, we propose the UST-RUN framework, which fully leverages intermediate domain information to facilitate knowledge transfer. We employ Unified Copy-paste (UCP) to construct intermediate domains, and propose a Symmetric GuiDance training strategy (SymGD) to supervise unlabeled data by merging pseudo-labels from intermediate samples. Subsequently, we introduce a Training Process aware Random Amplitude MixUp (TP-RAM) to progressively incorporate style-transition components into intermediate samples. To generate more diverse intermediate samples, we further select reliable samples with high-quality pseudo-labels, which are then mixed with other unlabeled data. Additionally, we generate sophisticated intermediate samples with high-quality pseudo-labels for unreliable samples, ensuring effective knowledge transfer for them. Extensive experiments on four public datasets demonstrate the superiority of UST-RUN. Notably, UST-RUN achieves a 12.94% improvement in Dice score on the Prostate dataset. Our code is available at https://github.com/MQinghe/UST-RUN.

Both limited annotation and domain shift are preva-lent challenges in medical image segmentation. Traditional semi-supervised segmentation and unsupervised do-main adaptation methods address one of these issues sepa-rately. However, the coexistence of limited annotation and domain shift is quite common, which motivates us to in-troduce a novel and challenging scenario: Mixed Domain Semi-supervised medical image Segmentation (MiDSS). In this scenario, we handle data from multiple medical cen-ters, with limited annotations available for a single do-main and a large amount of unlabeled data from multi-ple domains. We found that the key to solving the prob-lem lies in how to generate reliable pseudo labels for the unlabeled data in the presence of domain shift with la-beled data. To tackle this issue, we employ Unified Copy-Paste (UCP) between images to construct intermediate do-mains, facilitating the knowledge transfer from the do-main of labeled data to the domains of unlabeled data. To fully utilize the information within the intermediate do-main, we propose a symmetric Guidance training strategy (SymGD), which additionally offers direct guidance to un-labeled data by merging pseudo labels from intermediate samples. Subsequently, we introduce a Training Process aware Random Amplitude MixUp (TP-RAM) to progres-sively incorporate style-transition components into inter-mediate samples. Compared with existing state-of-the-art approaches, our method achieves a notable 13.57% im-provement in Dice score on Prostate dataset, as demon-strated on three public datasets. Our code is available at https://github.com/MQinghe/MiDSS