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.

Segment Anything Model (SAM) fine-tuning has shown remarkable performance in medical image segmentation in a fully supervised manner, but requires precise annotations. To reduce the annotation cost and maintain satisfactory performance, in this work, we leverage the capabilities of SAM for establishing semi-supervised medical image segmentation models. Rethinking the requirements of effectiveness, efficiency, and compatibility, we propose a three-stage framework, i.e., Stitching, Fine-tuning, and Re-training (SFR). The current fine-tuning approaches mostly involve 2D slice-wise fine-tuning that disregards the contextual information between adjacent slices. Our stitching strategy mitigates the mismatch between natural and 3D medical images. The stitched images are then used for fine-tuning SAM, providing robust initialization of pseudo-labels. Afterwards, we train a 3D semi-supervised segmentation model while maintaining the same parameter size as the conventional segmenter such as V-Net. Our SFR framework is plug-and-play, and easily compatible with various popular semi-supervised methods. We also develop an extended framework SFR+ with selective fine-tuning and re-training through confidence estimation. Extensive experiments validate that our SFR and SFR+ achieve significant improvements in both moderate annotation and scarce annotation across five datasets. In particular, SFR framework improves the Dice score of Mean Teacher from 29.68% to 74.40% with only one labeled data of LA dataset. The code is available at https://github.com/ShumengLI/SFR.

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.

Despite the promising performance achieved by current semi-supervised models in segmenting individual medical targets, many of these models suffer a notable decrease in performance when tasked with the simultaneous segmentation of multiple targets. A vital factor could be attributed to the imbalanced scales among different targets: during simultaneously segmenting multiple targets, large targets dominate the loss, leading to small targets being misclassified as larger ones. To this end, we propose a novel method, which consists of a Collaborative Generalist and several Specialists, termed CGS. It is centered around the idea of employing a specialist for each target class, thus avoiding the dominance of larger targets. The generalist performs conventional multi-target segmentation, while each specialist is dedicated to distinguishing a specific target class from the remaining target classes and the background. Based on a theoretical insight, we demonstrate that CGS can achieve a more balanced training. Moreover, we develop cross-consistency losses to foster collaborative learning between the generalist and the specialists. Lastly, regarding their intrinsic relation that the target class of any specialized head should belong to the remaining classes of the other heads, we introduce an inter-head error detection module to further enhance the quality of pseudo-labels. Experimental results on three popular benchmarks showcase its superior performance compared to state-of-the-art methods. Our code is available at https://github.com/wangyou0804/CGS.

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

Recent trends in semi-supervised learning have significantly boosted the performance of 3D semi-supervised medical image segmentation. Compared with 2D images, 3D medical volumes involve information from different directions, e.g., transverse, sagittal, and coronal planes, so as to naturally provide complementary views. These complementary views and the intrinsic similarity among adjacent 3D slices inspire us to develop a novel annotation way and its corresponding semi-supervised model for effective segmentation. Specifically, we firstly propose the orthogonal annotation by only labeling two orthogonal slices in a labeled volume, which significantly relieves the burden of annotation. Then, we perform registration to obtain the initial pseudo labels for sparsely labeled volumes. Subsequently, by introducing unlabeled volumes, we propose a dual-network paradigm named Dense-Sparse Co-training (DeSCO) that exploits dense pseudo labels in early stage and sparse labels in later stage and meanwhile forces consistent output of two networks. Experimental results on three benchmark datasets validated our effectiveness in performance and efficiency in annotation. For example, with only 10 annotated slices, our method reaches a Dice up to 86.93% on KiTS19 dataset. Our code and models are available at https://github.com/HengCai-NJU/DeSCO.

It is known that annotations for 3D medical image segmentation tasks are laborious, time-consuming and expensive. Considering the similarities existing in inter-slice and inter-volume, we believe that the delineation way and the model architecture should be tightly coupled. In this paper, by introducing an extremely sparse annotation way of labeling only one slice per 3D image, we investigate a novel barely-supervised segmentation setting with only a few sparsely-labeled images along with a large amount of unlabeled images. To achieve this goal, we present a new parasitic-like network including a registration module (as host) and a semi-supervised segmentation module (as parasite) to deal with inter-slice label propagation and inter-volume segmentation prediction, respectively. Specifically, our parasitism mechanism effectively achieves the collaboration of these two modules through three stages of infection, development and eclosion, providing accurate pseudo-labels for training. Extensive results demonstrate that our framework is capable of achieving high performance on extremely sparse annotation tasks, e.g., we achieve Dice of 84.83% on LA dataset with only 16 labeled slices. The code is available athttps://github.com/ShumengLI/PLN.

Accurate image segmentation plays a crucial role in medical image analysis, yet it faces great challenges caused by various shapes, diverse sizes, and blurry boundaries. To address these difficulties, square kernel-based encoder-decoder architectures have been proposed and widely used, but their performance remains unsatisfactory. To further address these challenges, we present a novel double-branch encoder architecture. Our architecture is inspired by two observations. (1) Since the discrimination of the features learned via square convolutional kernels needs to be further improved, we propose utilizing nonsquare vertical and horizontal convolutional kernels in a double-branch encoder so that the features learned by both branches can be expected to complement each other. (2) Considering that spatial attention can help models to better focus on the target region in a large-sized image, we develop an attention loss to further emphasize the segmentation of small-sized targets. With the above two schemes, we develop a novel double-branch encoder-based segmentation framework for medical image segmentation, namely, Crosslink-Net, and validate its effectiveness on five datasets with experiments. The code is released at https://github.com/Qianyu1226/Crosslink-Net.

Unsupervised domain adaptation (UDA) methods have shown their promising performance in the cross-modality medical image segmentation tasks. These typical methods usually utilize a translation network to transform images from the source domain to target domain or train the pixel-level classifier merely using translated source images and original target images. However, when there exists a large domain shift between source and target domains, we argue that this asymmetric structure, to some extent, could not fully eliminate the domain gap. In this paper, we present a novel deep symmetric architecture of UDA for medical image segmentation, which consists of a segmentation sub-network, and two symmetric source and target domain translation sub-networks. To be specific, based on two translation sub-networks, we introduce a bidirectional alignment scheme via a shared encoder and two private decoders to simultaneously align features 1) from source to target domain and 2) from target to source domain, which is able to effectively mitigate the discrepancy between domains. Furthermore, for the segmentation sub-network, we train a pixel-level classifier using not only original target images and translated source images, but also original source images and translated target images, which could sufficiently leverage the semantic information from the images with different styles. Extensive experiments demonstrate that our method has remarkable advantages compared to the state-of-the-art methods in three segmentation tasks, such as cross-modality cardiac, BraTS, and abdominal multi-organ segmentation.

In semi-supervised medical image segmentation, most previous works draw on the common assumption that higher entropy means higher uncertainty. In this paper, we investigate a novel method of estimating uncertainty. We observe that, when assigned different misclassification costs in a certain degree, if the segmentation result of a pixel becomes inconsistent, this pixel shows a relative uncertainty in its segmentation. Therefore, we present a new semi-supervised segmentation model, namely, conservative-radical network (CoraNet in short) based on our uncertainty estimation and separate self-training strategy. In particular, our CoraNet model consists of three major components: a conservative-radical module (CRM), a certain region segmentation network (C-SN), and an uncertain region segmentation network (UC-SN) that could be alternatively trained in an end-to-end manner. We have extensively evaluated our method on various segmentation tasks with publicly available benchmark datasets, including CT pancreas, MR endocardium, and MR multi-structures segmentation on the ACDC dataset. Compared with the current state of the art, our CoraNet has demonstrated superior performance. In addition, we have also analyzed its connection with and difference from conventional methods of uncertainty estimation in semi-supervised medical image segmentation.

Along with the prosperity of the Mobile Internet, a large amount of stream data has emerged. Stream data cannot be completely stored in memory because of its massive volume and continuous arrival. Moreover, it should be accessed only once and handled in time due to the high cost of multiple accesses. Therefore, the intrinsic nature of stream data calls facilitates the development of a summary in the main memory to enable fast incremental learning and to allow working in limited time and memory. Sampling techniques are one of the commonly used methods for constructing data stream summaries. Given that the traditional random sampling algorithm deviates from the real data distribution and does not consider the true distribution of the stream data attributes, we propose a novel sampling algorithm based on feature-selected and -preserved algorithm. We first use matrix approximation to select important features in stream data. Then, the feature-preserved sampling algorithm is used to generate high-quality representative samples over a sliding window. The sampling quality of our algorithm could guarantee a high degree of consistency between the distribution of attribute values in the population (the entire data) and that in the sample. Experiments on real datasets show that the proposed algorithm can select a representative sample with high efficiency.

Due to the unpredictable location, fuzzy texture and diverse shape, accurate segmentation of the kidney tumor in CT images is an important yet challenging task. To this end, we in this paper present a cascaded trainable segmentation model termed as Crossbar-Net. Our method combines two novel schemes: (1) we originally proposed the crossbar patches, which consists of two orthogonal non-squared patches (i.e., the vertical patch and horizontal patch). The crossbar patches are able to capture both the global and local appearance information of the kidney tumors from both the vertical and horizontal directions simultaneously. (2) With the obtained crossbar patches, we iteratively train two sub-models (i.e., horizontal sub-model and vertical sub-model) in a cascaded training manner. During the training, the trained sub-models are encouraged to become more focus on the difficult parts of the tumor automatically (i.e., mis-segmented regions). Specifically, the vertical (horizontal) sub-model is required to help segment the mis-segmented regions for the horizontal (vertical) sub-model. Thus, the two sub-models could complement each other to achieve the self-improvement until convergence. In the experiment, we evaluate our method on a real CT kidney tumor dataset which is collected from 94 different patients including 3,500 CT slices. Compared with the state-of-the-art segmentation methods, the results demonstrate the superior performance of our method on the Dice similarity coefficient, true positive fraction, centroid distance and Hausdorff distance. Moreover, to exploit the generalization to other segmentation tasks, we also extend our Crossbar-Net to two related segmentation tasks: (1) cardiac segmentation in MR images and (2) breast mass segmentation in X-ray images, showing the promising results for these two tasks. Our implementation is released at https: //github.com/Qianyu1226/Crossbar-Net.