# Single-domain Generalization in Medical Image Segmentation via Test-time Adaptation from Shape Dictionary

arXiv: https://arxiv.org/abs/2206.14467 · HTML: https://mlsanity.com/paper/2206.14467/

## Key facts

- Cited by 22 papers in the map (data through 14 Oct 2026).
- Builds on 29 of its 48 references that are in the map.
- First posted on arXiv 29 Jun 2022.

## Builds on (most cited first, 29 of 29)

- [Deeper, Broader and Artier Domain Generalization](https://mlsanity.com/paper/1710.03077/) (2017)
- [Learning to Generalize: Meta-Learning for Domain Generalization](https://mlsanity.com/paper/1710.03463/) (2017)
- [Domain Generalization via Invariant Feature Representation](https://mlsanity.com/paper/1301.2115/) (2013)
- [Generalizing to Unseen Domains via Adversarial Data Augmentation](https://mlsanity.com/paper/1805.12018/) (2018)
- [Domain Generalization by Solving Jigsaw Puzzles](https://mlsanity.com/paper/1903.06864/) (2019)
- [Self-Challenging Improves Cross-Domain Generalization](https://mlsanity.com/paper/2007.02454/) (2020)
- [Domain Generalization via Model-Agnostic Learning of Semantic Features](https://mlsanity.com/paper/1910.13580/) (2019)
- [Unified Deep Supervised Domain Adaptation and Generalization](https://mlsanity.com/paper/1709.10190/) (2017)
- [Learning to Learn Single Domain Generalization](https://mlsanity.com/paper/2003.13216/) (2020)
- [FedDG: Federated Domain Generalization on Medical Image Segmentation via Episodic Learning in Continuous Frequency Space](https://mlsanity.com/paper/2103.06030/) (2021)
- [Domain Generalization for Object Recognition with Multi-task Autoencoders](https://mlsanity.com/paper/1508.07680/) (2015)
- [Domain Randomization and Pyramid Consistency: Simulation-to-Real Generalization without Accessing Target Domain Data](https://mlsanity.com/paper/1909.00889/) (2019)
- [REFUGE Challenge: A Unified Framework for Evaluating Automated Methods for Glaucoma Assessment from Fundus Photographs](https://mlsanity.com/paper/1910.03667/) (2019)
- [Learning to Diversify for Single Domain Generalization](https://mlsanity.com/paper/2108.11726/) (2021)
- [Learning to Optimize Domain Specific Normalization for Domain Generalization](https://mlsanity.com/paper/1907.04275/) (2019)
- [Feature-Critic Networks for Heterogeneous Domain Generalization](https://mlsanity.com/paper/1901.11448/) (2019)
- [Learning to cluster in order to transfer across domains and tasks](https://mlsanity.com/paper/1711.10125/) (2017)
- [Learning to Balance Specificity and Invariance for In and Out of Domain Generalization](https://mlsanity.com/paper/2008.12839/) (2020)
- [Shape-aware Meta-learning for Generalizing Prostate MRI Segmentation to Unseen Domains](https://mlsanity.com/paper/2007.02035/) (2020)
- [MS-Net: Multi-Site Network for Improving Prostate Segmentation with Heterogeneous MRI Data](https://mlsanity.com/paper/2002.03366/) (2020)
- [Test-Time Adaptable Neural Networks for Robust Medical Image Segmentation](https://mlsanity.com/paper/2004.04668/) (2020)
- [Learning to Learn with Variational Information Bottleneck for Domain Generalization](https://mlsanity.com/paper/2007.07645/) (2020)
- [Progressive Domain Expansion Network for Single Domain Generalization](https://mlsanity.com/paper/2103.16050/) (2021)
- [Adversarially Adaptive Normalization for Single Domain Generalization](https://mlsanity.com/paper/2106.01899/) (2021)
- [DoFE: Domain-oriented Feature Embedding for Generalizable Fundus Image Segmentation on Unseen Datasets](https://mlsanity.com/paper/2010.06208/) (2020)
- [Tent: Fully Test-time Adaptation by Entropy Minimization](https://mlsanity.com/paper/2006.10726/) (2020)
- [Source-Free Domain Adaptive Fundus Image Segmentation with Denoised Pseudo-Labeling](https://mlsanity.com/paper/2109.09735/) (2021)
- [Domain Generalization via Inference-time Label-Preserving Target Projections](https://mlsanity.com/paper/2103.01134/) (2021)
- [Fast Low-rank Shared Dictionary Learning for Image Classification](https://mlsanity.com/paper/1610.08606/) (2016)

## Built on by (most cited first, 22 of 22)

- [A Comprehensive Survey on Test-Time Adaptation under Distribution Shifts](https://mlsanity.com/paper/2303.15361/) (2023)
- [MA-SAM: Modality-agnostic SAM Adaptation for 3D Medical Image Segmentation](https://mlsanity.com/paper/2309.08842/) (2023)
- [Domain Generalization for Medical Image Analysis: A Review](https://mlsanity.com/paper/2310.08598/) (2023)
- [From Denoising Training to Test-Time Adaptation: Enhancing Domain Generalization for Medical Image Segmentation](https://mlsanity.com/paper/2310.20271/) (2023)
- [CIRCLe: Color Invariant Representation Learning for Unbiased Classification of Skin Lesions](https://mlsanity.com/paper/2208.13528/) (2022)
- [Genuine Knowledge from Practice: Diffusion Test-Time Adaptation for Video Adverse Weather Removal](https://mlsanity.com/paper/2403.07684/) (2024)
- [PASS:Test-Time Prompting to Adapt Styles and Semantic Shapes in Medical Image Segmentation](https://mlsanity.com/paper/2410.01573/) (2024)
- [Medical Image Segmentation with InTEnt: Integrated Entropy Weighting for Single Image Test-Time Adaptation](https://mlsanity.com/paper/2402.09604/) (2024)
- [Domain Generalization of 3D Object Detection by Density-Resampling](https://mlsanity.com/paper/2311.10845/) (2023)
- [Improved post-hoc probability calibration for out-of-domain MRI segmentation](https://mlsanity.com/paper/2208.02870/) (2022)
- [Navigating Distribution Shifts in Medical Image Analysis: A Survey](https://mlsanity.com/paper/2411.05824/) (2024)
- [Mixture-of-Shape-Experts (MoSE): End-to-End Shape Dictionary Framework to Prompt SAM for Generalizable Medical Segmentation](https://mlsanity.com/paper/2504.09601/) (2025)
- [Evaluating Synthetic Data Generation for Domain Generalization in Fetal Brain MRI Segmentation](https://mlsanity.com/paper/2411.06842/) (2024)
- [Pay Attention to the Atlas: Atlas-Guided Test-Time Adaptation Method for Robust 3D Medical Image Segmentation](https://mlsanity.com/paper/2307.00676/) (2023)
- [Test-Time Domain Generalization via Universe Learning: A Multi-Graph Matching Approach for Medical Image Segmentation](https://mlsanity.com/paper/2503.13012/) (2025)
- [DG-TTA: Out-of-domain Medical Image Segmentation through Augmentation and Descriptor-driven Domain Generalization and Test-Time Adaptation](https://mlsanity.com/paper/2312.06275/) (2023)
- [Domain Generalization of Pathological Image Segmentation by Patch-Level and WSI-Level Contrastive Learning](https://mlsanity.com/paper/2508.07539/) (2025)
- [SPEGC: Continual Test-Time Adaptation via Semantic-Prompt-Enhanced Graph Clustering for Medical Image Segmentation](https://mlsanity.com/paper/2603.11492/) (2026)
- [Gradient-Map-Guided Adaptive Domain Generalization for Cross Modality MRI Segmentation](https://mlsanity.com/paper/2311.09737/) (2023)
- [Semantic-aware Random Convolution and Source Matching for Domain Generalization in Medical Image Segmentation](https://mlsanity.com/paper/2512.01510/) (2025)
- [Contour-Guided Query-Based Feature Fusion for Boundary-Aware and Generalizable Cardiac Ultrasound Segmentation](https://mlsanity.com/paper/2603.28110/) (2026)
- [Concept Alignment Contrast and Long-Short Prompt Memory for Test-Time Adaptation of SAM3 in Medical Image Segmentation](https://mlsanity.com/paper/2606.22963/) (2026)

## Abstract (arXiv)

Domain generalization typically requires data from multiple source domains for model learning. However, such strong assumption may not always hold in practice, especially in medical field where the data sharing is highly concerned and sometimes prohibitive due to privacy issue. This paper studies the important yet challenging single domain generalization problem, in which a model is learned under the worst-case scenario with only one source domain to directly generalize to different unseen target domains. We present a novel approach to address this problem in medical image segmentation, which extracts and integrates the semantic shape prior information of segmentation that are invariant across domains and can be well-captured even from single domain data to facilitate segmentation under distribution shifts. Besides, a test-time adaptation strategy with dual-consistency regularization is further devised to promote dynamic incorporation of these shape priors under each unseen domain to improve model generalizability. Extensive experiments on two medical image segmentation tasks demonstrate the consistent improvements of our method across various unseen domains, as well as its superiority over state-of-the-art approaches in addressing domain generalization under the worst-case scenario.