# PASS:Test-Time Prompting to Adapt Styles and Semantic Shapes in Medical Image Segmentation

arXiv: https://arxiv.org/abs/2410.01573 · HTML: https://mlsanity.com/paper/2410.01573/

## Key facts

- Cited by 12 papers in the map (data through 14 Oct 2026).
- Builds on 35 of its 51 references that are in the map.
- First posted on arXiv 2 Oct 2024.

## Builds on (most cited first, 30 of 35)

- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [Batch Normalization: Accelerating Deep Network Training by Reducing Internal Covariate Shift](https://mlsanity.com/paper/1502.03167/) (2015)
- [Layer Normalization](https://mlsanity.com/paper/1607.06450/) (2016)
- [Delving Deep into Rectifiers: Surpassing Human-Level Performance on ImageNet Classification](https://mlsanity.com/paper/1502.01852/) (2015)
- [Learning to Prompt for Vision-Language Models](https://mlsanity.com/paper/2109.01134/) (2021)
- [Pre-train, Prompt, and Predict: A Systematic Survey of Prompting Methods in Natural Language Processing](https://mlsanity.com/paper/2107.13586/) (2021)
- [Arbitrary Style Transfer in Real-time with Adaptive Instance Normalization](https://mlsanity.com/paper/1703.06868/) (2017)
- [Visual Prompt Tuning](https://mlsanity.com/paper/2203.12119/) (2022)
- [Group Normalization](https://mlsanity.com/paper/1803.08494/) (2018)
- [Exact solutions to the nonlinear dynamics of learning in deep linear neural networks](https://mlsanity.com/paper/1312.6120/) (2013)
- [Continual Test-Time Domain Adaptation](https://mlsanity.com/paper/2203.13591/) (2022)
- [PraNet: Parallel Reverse Attention Network for Polyp Segmentation](https://mlsanity.com/paper/2006.11392/) (2020)
- [Towards Stable Test-Time Adaptation in Dynamic Wild World](https://mlsanity.com/paper/2302.12400/) (2023)
- [Test-Time Prompt Tuning for Zero-Shot Generalization in Vision-Language Models](https://mlsanity.com/paper/2209.07511/) (2022)
- [Evaluating Prediction-Time Batch Normalization for Robustness under Covariate Shift](https://mlsanity.com/paper/2006.10963/) (2020)
- [Improved Texture Networks: Maximizing Quality and Diversity in Feed-forward Stylization and Texture Synthesis](https://mlsanity.com/paper/1701.02096/) (2017)
- [The Norm Must Go On: Dynamic Unsupervised Domain Adaptation by Normalization](https://mlsanity.com/paper/2112.00463/) (2021)
- [Shape-aware Meta-learning for Generalizing Prostate MRI Segmentation to Unseen Domains](https://mlsanity.com/paper/2007.02035/) (2020)
- [Test-Time Adaptable Neural Networks for Robust Medical Image Segmentation](https://mlsanity.com/paper/2004.04668/) (2020)
- [Decorate the Newcomers: Visual Domain Prompt for Continual Test Time Adaptation](https://mlsanity.com/paper/2212.04145/) (2022)
- [A Review of Single-Source Deep Unsupervised Visual Domain Adaptation](https://mlsanity.com/paper/2009.00155/) (2020)
- [Pro-tuning: Unified Prompt Tuning for Vision Tasks](https://mlsanity.com/paper/2207.14381/) (2022)
- [Source-Free Domain Adaptation for Image Segmentation](https://mlsanity.com/paper/2108.03152/) (2021)
- [On-the-Fly Test-time Adaptation for Medical Image Segmentation](https://mlsanity.com/paper/2203.05574/) (2022)
- [Each Test Image Deserves A Specific Prompt: Continual Test-Time Adaptation for 2D Medical Image Segmentation](https://mlsanity.com/paper/2311.18363/) (2023)
- [Unsupervised Domain Adaptation with Variational Approximation for Cardiac Segmentation](https://mlsanity.com/paper/2106.08752/) (2021)
- [DLTTA: Dynamic Learning Rate for Test-time Adaptation on Cross-domain Medical Images](https://mlsanity.com/paper/2205.13723/) (2022)
- [Single-domain Generalization in Medical Image Segmentation via Test-time Adaptation from Shape Dictionary](https://mlsanity.com/paper/2206.14467/) (2022)
- [UPL-SFDA: Uncertainty-aware Pseudo Label Guided Source-Free Domain Adaptation for Medical Image Segmentation](https://mlsanity.com/paper/2309.10244/) (2023)
- [Test-Time Adaptation with Shape Moments for Image Segmentation](https://mlsanity.com/paper/2205.07983/) (2022)

## Built on by (most cited first, 12 of 12)

- [Prompt-based Adaptation in Large-scale Vision Models: A Survey](https://mlsanity.com/paper/2510.13219/) (2025)
- [FB-Diff: Fourier Basis-guided Diffusion for Temporal Interpolation of 4D Medical Imaging](https://mlsanity.com/paper/2507.04547/) (2025)
- [Navigating Distribution Shifts in Medical Image Analysis: A Survey](https://mlsanity.com/paper/2411.05824/) (2024)
- [Test-time Adaptation for Foundation Medical Segmentation Model without Parametric Updates](https://mlsanity.com/paper/2504.02008/) (2025)
- [A Large Scale Benchmark for Test Time Adaptation Methods in Medical Image Segmentation](https://mlsanity.com/paper/2512.02497/) (2025)
- [Temporal Differential Fields for 4D Motion Modeling via Image-to-Video Synthesis](https://mlsanity.com/paper/2505.17333/) (2025)
- [Test-Time Domain Generalization via Universe Learning: A Multi-Graph Matching Approach for Medical Image Segmentation](https://mlsanity.com/paper/2503.13012/) (2025)
- [A3-TTA: Adaptive Anchor Alignment Test-Time Adaptation for Image Segmentation](https://mlsanity.com/paper/2602.03292/) (2026)
- [Multi-Scale Global-Instance Prompt Tuning for Continual Test-time Adaptation in Medical Image Segmentation](https://mlsanity.com/paper/2602.05937/) (2026)
- [DP-TTA: Test-time Adaptation for Transient Electromagnetic Signal Denoising via Dictionary-driven Prior Regularization](https://mlsanity.com/paper/2510.13160/) (2025)
- [VISTA: Variance-Gated Inter-Sequence Test-Time Adaptation for Multi-Sequence MRI Segmentation](https://mlsanity.com/paper/2605.17433/) (2026)
- [Test-Time Adaptation for ECG Classification via SQI-Gated Self-Training and Beat-Rhythm Consistency](https://mlsanity.com/paper/2608.23347/) (2026)

## Abstract (arXiv)

Test-time adaptation (TTA) has emerged as a promising paradigm to handle the domain shifts at test time for medical images from different institutions without using extra training data. However, existing TTA solutions for segmentation tasks suffer from (1) dependency on modifying the source training stage and access to source priors or (2) lack of emphasis on shape-related semantic knowledge that is crucial for segmentation tasks.Recent research on visual prompt learning achieves source-relaxed adaptation by extended parameter space but still neglects the full utilization of semantic features, thus motivating our work on knowledge-enriched deep prompt learning. Beyond the general concern of image style shifts, we reveal that shape variability is another crucial factor causing the performance drop. To address this issue, we propose a TTA framework called PASS (Prompting to Adapt Styles and Semantic shapes), which jointly learns two types of prompts: the input-space prompt to reformulate the style of the test image to fit into the pretrained model and the semantic-aware prompts to bridge high-level shape discrepancy across domains. Instead of naively imposing a fixed prompt, we introduce an input decorator to generate the self-regulating visual prompt conditioned on the input data. To retrieve the knowledge representations and customize target-specific shape prompts for each test sample, we propose a cross-attention prompt modulator, which performs interaction between target representations and an enriched shape prompt bank. Extensive experiments demonstrate the superior performance of PASS over state-of-the-art methods on multiple medical image segmentation datasets. The code is available at https://github.com/EndoluminalSurgicalVision-IMR/PASS.