# Compete to Win: Enhancing Pseudo Labels for Barely-supervised Medical Image Segmentation

arXiv: https://arxiv.org/abs/2304.07519 · HTML: https://mlsanity.com/paper/2304.07519/

## Key facts

- Cited by 10 papers in the map (data through 14 Oct 2026).
- Builds on 36 of its 64 references that are in the map.
- First posted on arXiv 15 Apr 2023.

## Builds on (most cited first, 30 of 36)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [Swin Transformer: Hierarchical Vision Transformer using Shifted Windows](https://mlsanity.com/paper/2103.14030/) (2021)
- [Non-local Neural Networks](https://mlsanity.com/paper/1711.07971/) (2017)
- [V-Net: Fully Convolutional Neural Networks for Volumetric Medical Image Segmentation](https://mlsanity.com/paper/1606.04797/) (2016)
- [Swin-Unet: Unet-like Pure Transformer for Medical Image Segmentation](https://mlsanity.com/paper/2105.05537/) (2021)
- [Semi-Supervised Semantic Segmentation with Cross Pseudo Supervision](https://mlsanity.com/paper/2106.01226/) (2021)
- [Regularization With Stochastic Transformations and Perturbations for Deep Semi-Supervised Learning](https://mlsanity.com/paper/1606.04586/) (2016)
- [Uncertainty-aware Self-ensembling Model for Semi-supervised 3D Left Atrium Segmentation](https://mlsanity.com/paper/1907.07034/) (2019)
- [A large annotated medical image dataset for the development and evaluation of segmentation algorithms](https://mlsanity.com/paper/1902.09063/) (2019)
- [Embracing Imperfect Datasets: A Review of Deep Learning Solutions for Medical Image Segmentation](https://mlsanity.com/paper/1908.10454/) (2019)
- [FreeMatch: Self-adaptive Thresholding for Semi-supervised Learning](https://mlsanity.com/paper/2205.07246/) (2022)
- [Positive-Unlabeled Learning with Non-Negative Risk Estimator](https://mlsanity.com/paper/1703.00593/) (2017)
- [Semi-supervised Medical Image Segmentation through Dual-task Consistency](https://mlsanity.com/paper/2009.04448/) (2020)
- [ST++: Make Self-training Work Better for Semi-supervised Semantic Segmentation](https://mlsanity.com/paper/2106.05095/) (2021)
- [PseudoSeg: Designing Pseudo Labels for Semantic Segmentation](https://mlsanity.com/paper/2010.09713/) (2020)
- [DeepOrgan: Multi-level Deep Convolutional Networks for Automated Pancreas Segmentation](https://mlsanity.com/paper/1506.06448/) (2015)
- [Shape-aware Semi-supervised 3D Semantic Segmentation for Medical Images](https://mlsanity.com/paper/2007.10732/) (2020)
- [Deep Co-Training for Semi-Supervised Image Recognition](https://mlsanity.com/paper/1803.05984/) (2018)
- [Transformation Consistent Self-ensembling Model for Semi-supervised Medical Image Segmentation](https://mlsanity.com/paper/1903.00348/) (2019)
- [Dual Student: Breaking the Limits of the Teacher in Semi-supervised Learning](https://mlsanity.com/paper/1909.01804/) (2019)
- [Efficient Semi-Supervised Gross Target Volume of Nasopharyngeal Carcinoma Segmentation via Uncertainty Rectified Pyramid Consistency](https://mlsanity.com/paper/2012.07042/) (2020)
- [Semi-Supervised Medical Image Segmentation via Cross Teaching between CNN and Transformer](https://mlsanity.com/paper/2112.04894/) (2021)
- [Interlaced Sparse Self-Attention for Semantic Segmentation](https://mlsanity.com/paper/1907.12273/) (2019)
- [Semi-supervised Skin Lesion Segmentation via Transformation Consistent Self-ensembling Model](https://mlsanity.com/paper/1808.03887/) (2018)
- [Theoretical Comparisons of Positive-Unlabeled Learning against Positive-Negative Learning](https://mlsanity.com/paper/1603.03130/) (2016)
- [Semi-Supervised Multi-Organ Segmentation via Deep Multi-Planar Co-Training](https://mlsanity.com/paper/1804.02586/) (2018)
- [Every Annotation Counts: Multi-label Deep Supervision for Medical Image Segmentation](https://mlsanity.com/paper/2104.13243/) (2021)
- [Deeply-Supervised CNN for Prostate Segmentation](https://mlsanity.com/paper/1703.07523/) (2017)
- [Uncertainty guided semi-supervised segmentation of retinal layers in OCT images](https://mlsanity.com/paper/2103.02083/) (2021)

## Built on by (most cited first, 10 of 10)

- [Towards Generic Semi-Supervised Framework for Volumetric Medical Image Segmentation](https://mlsanity.com/paper/2310.11320/) (2023)
- [Semi-Supervised Semantic Segmentation Based on Pseudo-Labels: A Survey](https://mlsanity.com/paper/2403.01909/) (2024)
- [Tri-Plane Mamba: Efficiently Adapting Segment Anything Model for 3D Medical Images](https://mlsanity.com/paper/2409.08492/) (2024)
- [ProCNS: Progressive Prototype Calibration and Noise Suppression for Weakly-Supervised Medical Image Segmentation](https://mlsanity.com/paper/2401.14074/) (2024)
- [Adaptive Mix for Semi-Supervised Medical Image Segmentation](https://mlsanity.com/paper/2407.21586/) (2024)
- [BARL: Bilateral Alignment in Representation and Label Spaces for Semi-Supervised Volumetric Medical Image Segmentation](https://mlsanity.com/paper/2510.16863/) (2025)
- [Pairwise Similarity Regularization for Semi-supervised Graph Medical Image Segmentation](https://mlsanity.com/paper/2503.12800/) (2025)
- [SWDL: Stratum-Wise Difference Learning with Deep Laplacian Pyramid for Semi-Supervised 3D Intracranial Hemorrhage Segmentation](https://mlsanity.com/paper/2506.10325/) (2025)
- [Frequency Prior Guided Matching: A Data Augmentation Approach for Generalizable Semi-Supervised Polyp Segmentation](https://mlsanity.com/paper/2508.06517/) (2025)
- [Prompt-Conditioned Channel Attention for Hierarchical Feature Modulation toward Anatomy-Agnostic Segmentation](https://mlsanity.com/paper/2608.20229/) (2026)

## Abstract (arXiv)

This study investigates barely-supervised medical image segmentation where only few labeled data, i.e., single-digit cases are available. We observe the key limitation of the existing state-of-the-art semi-supervised solution cross pseudo supervision is the unsatisfactory precision of foreground classes, leading to a degenerated result under barely-supervised learning. In this paper, we propose a novel Compete-to-Win method (ComWin) to enhance the pseudo label quality. In contrast to directly using one model's predictions as pseudo labels, our key idea is that high-quality pseudo labels should be generated by comparing multiple confidence maps produced by different networks to select the most confident one (a compete-to-win strategy). To further refine pseudo labels at near-boundary areas, an enhanced version of ComWin, namely, ComWin+, is proposed by integrating a boundary-aware enhancement module. Experiments show that our method can achieve the best performance on three public medical image datasets for cardiac structure segmentation, pancreas segmentation and colon tumor segmentation, respectively. The source code is now available at https://github.com/Huiimin5/comwin.