# An Uncertainty-guided Tiered Self-training Framework for Active Source-free Domain Adaptation in Prostate Segmentation

arXiv: https://arxiv.org/abs/2407.02893 · HTML: https://mlsanity.com/paper/2407.02893/

## Key facts

- Cited by 5 papers in the map (data through 14 Oct 2026).
- Builds on 20 of its 32 references that are in the map.
- First posted on arXiv 3 Jul 2024.

## Builds on (most cited first, 20 of 20)

- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [Deep Bayesian Active Learning with Image Data](https://mlsanity.com/paper/1703.02910/) (2017)
- [Semi-Supervised Semantic Segmentation with Cross Pseudo Supervision](https://mlsanity.com/paper/2106.01226/) (2021)
- [Aleatoric uncertainty estimation with test-time augmentation for medical image segmentation with convolutional neural networks](https://mlsanity.com/paper/1807.07356/) (2018)
- [A Survey on Active Learning and Human-in-the-Loop Deep Learning for Medical Image Analysis](https://mlsanity.com/paper/1910.02923/) (2019)
- [Synergistic Image and Feature Adaptation: Towards Cross-Modality Domain Adaptation for Medical Image Segmentation](https://mlsanity.com/paper/1901.08211/) (2019)
- [MS-Net: Multi-Site Network for Improving Prostate Segmentation with Heterogeneous MRI Data](https://mlsanity.com/paper/2002.03366/) (2020)
- [Semi-supervised Left Atrium Segmentation with Mutual Consistency Training](https://mlsanity.com/paper/2103.02911/) (2021)
- [Source-Free Domain Adaptive Fundus Image Segmentation with Denoised Pseudo-Labeling](https://mlsanity.com/paper/2109.09735/) (2021)
- [Deep Symmetric Adaptation Network for Cross-modality Medical Image Segmentation](https://mlsanity.com/paper/2101.06853/) (2021)
- [Adapting Off-the-Shelf Source Segmenter for Target Medical Image Segmentation](https://mlsanity.com/paper/2106.12497/) (2021)
- [Dual-Reference Source-Free Active Domain Adaptation for Nasopharyngeal Carcinoma Tumor Segmentation across Multiple Hospitals](https://mlsanity.com/paper/2309.13401/) (2023)
- [UPL-SFDA: Uncertainty-aware Pseudo Label Guided Source-Free Domain Adaptation for Medical Image Segmentation](https://mlsanity.com/paper/2309.10244/) (2023)
- [ACT: Semi-supervised Domain-adaptive Medical Image Segmentation with Asymmetric Co-training](https://mlsanity.com/paper/2206.02288/) (2022)
- [Advancing UWF-SLO Vessel Segmentation with Source-Free Active Domain Adaptation and a Novel Multi-Center Dataset](https://mlsanity.com/paper/2406.13645/) (2024)
- [SALAD: Source-free Active Label-Agnostic Domain Adaptation for Classification, Segmentation and Detection](https://mlsanity.com/paper/2205.12840/) (2022)
- [TAAL: Test-time Augmentation for Active Learning in Medical Image Segmentation](https://mlsanity.com/paper/2301.06624/) (2023)
- [FPL+: Filtered Pseudo Label-based Unsupervised Cross-Modality Adaptation for 3D Medical Image Segmentation](https://mlsanity.com/paper/2404.04971/) (2024)
- [Semi-supervised Domain Adaptive Medical Image Segmentation through Consistency Regularized Disentangled Contrastive Learning](https://mlsanity.com/paper/2307.02798/) (2023)
- [UM-CAM: Uncertainty-weighted Multi-resolution Class Activation Maps for Weakly-supervised Fetal Brain Segmentation](https://mlsanity.com/paper/2306.11490/) (2023)

## Built on by (most cited first, 5 of 5)

- [FunOTTA: On-the-Fly Adaptation on Cross-Domain Fundus Image via Stable Test-time Training](https://mlsanity.com/paper/2407.04396/) (2024)
- [MedCAL-Bench: A Comprehensive Benchmark on Cold-Start Active Learning with Foundation Models for Medical Image Analysis](https://mlsanity.com/paper/2508.03441/) (2025)
- [Better than Average: Spatially-Aware Aggregation of Segmentation Uncertainty Improves Downstream Performance](https://mlsanity.com/paper/2603.29941/) (2026)
- [Adapting Medical Vision Foundation Models for Volumetric Medical Image Segmentation via Active Learning and Selective Semi-supervised Fine-tuning](https://mlsanity.com/paper/2509.10784/) (2025)
- [SUGFW+: An Uncertainty-guided Feature Weighting Framework for Cold Start Active Adaptation of SAM in Medical Image Segmentation](https://mlsanity.com/paper/2608.16110/) (2026)

## Abstract (arXiv)

Deep learning models have exhibited remarkable efficacy in accurately delineating the prostate for diagnosis and treatment of prostate diseases, but challenges persist in achieving robust generalization across different medical centers. Source-free Domain Adaptation (SFDA) is a promising technique to adapt deep segmentation models to address privacy and security concerns while reducing domain shifts between source and target domains. However, recent literature indicates that the performance of SFDA remains far from satisfactory due to unpredictable domain gaps. Annotating a few target domain samples is acceptable, as it can lead to significant performance improvement with a low annotation cost. Nevertheless, due to extremely limited annotation budgets, careful consideration is needed in selecting samples for annotation. Inspired by this, our goal is to develop Active Source-free Domain Adaptation (ASFDA) for medical image segmentation. Specifically, we propose a novel Uncertainty-guided Tiered Self-training (UGTST) framework, consisting of efficient active sample selection via entropy-based primary local peak filtering to aggregate global uncertainty and diversity-aware redundancy filter, coupled with a tiered self-learning strategy, achieves stable domain adaptation. Experimental results on cross-center prostate MRI segmentation datasets revealed that our method yielded marked advancements, with a mere 5% annotation, exhibiting an average Dice score enhancement of 9.78% and 7.58% in two target domains compared with state-of-the-art methods, on par with fully supervised learning. Code is available at:https://github.com/HiLab-git/UGTST