# DG-TTA: Out-of-domain Medical Image Segmentation through Augmentation and Descriptor-driven Domain Generalization and Test-Time Adaptation

arXiv: https://arxiv.org/abs/2312.06275 · HTML: https://mlsanity.com/paper/2312.06275/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 23 of its 38 references that are in the map.
- First posted on arXiv 11 Dec 2023.

## Builds on (most cited first, 23 of 23)

- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [Masked Autoencoders Are Scalable Vision Learners](https://mlsanity.com/paper/2111.06377/) (2021)
- [Domain Randomization for Transferring Deep Neural Networks from Simulation to the Real World](https://mlsanity.com/paper/1703.06907/) (2017)
- [TotalSegmentator: robust segmentation of 104 anatomical structures in CT images](https://mlsanity.com/paper/2208.05868/) (2022)
- [AMOS: A Large-Scale Abdominal Multi-Organ Benchmark for Versatile Medical Image Segmentation](https://mlsanity.com/paper/2206.08023/) (2022)
- [SynthSeg: Segmentation of brain MRI scans of any contrast and resolution without retraining](https://mlsanity.com/paper/2107.09559/) (2021)
- [CLIP-Driven Universal Model for Organ Segmentation and Tumor Detection](https://mlsanity.com/paper/2301.00785/) (2023)
- [MIC: Masked Image Consistency for Context-Enhanced Domain Adaptation](https://mlsanity.com/paper/2212.01322/) (2022)
- [Robust and Generalizable Visual Representation Learning via Random Convolutions](https://mlsanity.com/paper/2007.13003/) (2020)
- [Causality-inspired Single-source Domain Generalization for Medical Image Segmentation](https://mlsanity.com/paper/2111.12525/) (2021)
- [Test-Time Adaptable Neural Networks for Robust Medical Image Segmentation](https://mlsanity.com/paper/2004.04668/) (2020)
- [Evaluation of Algorithms for Multi-Modality Whole Heart Segmentation: An Open-Access Grand Challenge](https://mlsanity.com/paper/1902.07880/) (2019)
- [Unsupervised domain adaptation for medical imaging segmentation with self-ensembling](https://mlsanity.com/paper/1811.06042/) (2018)
- [Source-Free Domain Adaptive Fundus Image Segmentation with Denoised Pseudo-Labeling](https://mlsanity.com/paper/2109.09735/) (2021)
- [Can we trust deep learning models diagnosis? The impact of domain shift in chest radiograph classification](https://mlsanity.com/paper/1909.01940/) (2019)
- [Source-Relaxed Domain Adaptation for Image Segmentation](https://mlsanity.com/paper/2005.03697/) (2020)
- [A Lifelong Learning Approach to Brain MR Segmentation Across Scanners and Protocols](https://mlsanity.com/paper/1805.10170/) (2018)
- [Self-Supervised Learning Across Domains](https://mlsanity.com/paper/2007.12368/) (2020)
- [Test-time Unsupervised Domain Adaptation](https://mlsanity.com/paper/2010.01926/) (2020)
- [Domain and Content Adaptive Convolution based Multi-Source Domain Generalization for Medical Image Segmentation](https://mlsanity.com/paper/2109.05676/) (2021)
- [Single-domain Generalization in Medical Image Segmentation via Test-time Adaptation from Shape Dictionary](https://mlsanity.com/paper/2206.14467/) (2022)
- [Self domain adapted network](https://mlsanity.com/paper/2007.03162/) (2020)
- [Online Reflective Learning for Robust Medical Image Segmentation](https://mlsanity.com/paper/2207.00476/) (2022)

## Built on by (most cited first, 1 of 1)

- [Why Invariance is Not Enough for Biomedical Domain Generalization and How to Fix It](https://mlsanity.com/paper/2604.02564/) (2026)

## Abstract (arXiv)

Purpose: Applying pre-trained medical deep learning segmentation models on out-of-domain images often yields predictions of insufficient quality. In this study, we propose to use a powerful generalizing descriptor along with augmentation to enable domain-generalized pre-training and test-time adaptation, achieving high-quality segmentation in unseen domains. Materials and Methods: In this retrospective study five different publicly available datasets (2012 to 2022) including 3D CT and MRI images are used to evaluate segmentation performance in out-of-domain scenarios. The settings include abdominal, spine, and cardiac imaging. The data is randomly split into training and test samples. Domain-generalized pre-training on source data is used to obtain the best initial performance in the target domain. We introduce the combination of the generalizing SSC descriptor and GIN intensity augmentation for optimal generalization. Segmentation results are subsequently optimized at test time, where we propose to adapt the pre-trained models for every unseen scan with a consistency scheme using the same augmentation-descriptor combination. The segmentation is evaluated using Dice similarity and Hausdorff distance and the significance of improvements is tested with the Wilcoxon signed-rank test. Results: The proposed generalized pre-training and subsequent test-time adaptation improves model performance significantly in CT to MRI cross-domain prediction for abdominal (+46.2% and +28.2% Dice), spine (+72.9%), and cardiac (+14.2% and +55.7% Dice) scenarios (p<0.001). Conclusion: Our method enables optimal, independent usage of medical image source and target data and bridges domain gaps successfully with a compact and efficient methodology. Open-source code available at: https://github.com/multimodallearning/DG-TTA