The recent advent of in-context learning (ICL) capabilities in large pre-trained models has yielded significant advancements in the generalization of segmentation models. By supplying domain-specific image-mask pairs, the ICL model can be effectively guided to produce optimal segmentation outcomes, eliminating the necessity for model fine-tuning or interactive prompting. However, current existing ICL-based segmentation models exhibit significant limitations when applied to medical segmentation datasets with substantial diversity. To address this issue, we propose a dual similarity checkup approach to guarantee the effectiveness of selected in-context samples so that their guidance can be maximally leveraged during inference. We first employ large pre-trained vision models for extracting strong semantic representations from input images and constructing a feature embedding memory bank for semantic similarity checkup during inference. Assuring the similarity in the input semantic space, we then minimize the discrepancy in the mask appearance distribution between the support set and the estimated mask appearance prior through similarity-weighted sampling and augmentation. We validate our proposed dual similarity checkup approach on eight publicly available medical segmentation datasets, and extensive experimental results demonstrate that our proposed method significantly improves the performance metrics of existing ICL-based segmentation models, particularly when applied to medical image datasets characterized by substantial diversity.

Ultrasound based estimation of fetal biometry is extensively used to diagnose prenatal abnormalities and to monitor fetal growth, for which accurate segmentation of the fetal anatomy is a crucial prerequisite. Although deep neural network-based models have achieved encouraging results on this task, inevitable distribution shifts in ultrasound images can still result in severe performance drop in real world deployment scenarios. In this article, we propose a complete ultrasound fetal examination system to deal with this troublesome problem by repairing and screening the anatomically implausible results. Our system consists of three main components: A routine segmentation network, a fetal anatomical key points guided repair network, and a shape-coding based selective screener. Guided by the anatomical key points, our repair network has stronger cross-domain repair capabilities, which can substantially improve the outputs of the segmentation network. By quantifying the distance between an arbitrary segmentation mask to its corresponding anatomical shape class, the proposed shape-coding based selective screener can then effectively reject the entire implausible results that cannot be fully repaired. Extensive experiments demonstrate that our proposed framework has strong anatomical guarantee and outperforms other methods in three different cross-domain scenarios.