# Progressive Test Time Energy Adaptation for Medical Image Segmentation

arXiv: https://arxiv.org/abs/2503.16616 · HTML: https://mlsanity.com/paper/2503.16616/

## Key facts

- Cited by 5 papers in the map (data through 14 Oct 2026).
- Builds on 42 of its 72 references that are in the map.
- First posted on arXiv 20 Mar 2025.

## Builds on (most cited first, 30 of 42)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [Denoising Diffusion Probabilistic Models](https://mlsanity.com/paper/2006.11239/) (2020)
- [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)
- [Explaining and Harnessing Adversarial Examples](https://mlsanity.com/paper/1412.6572/) (2014)
- [Mamba: Linear-Time Sequence Modeling with Selective State Spaces](https://mlsanity.com/paper/2312.00752/) (2023)
- [Improved Denoising Diffusion Probabilistic Models](https://mlsanity.com/paper/2102.09672/) (2021)
- [Unsupervised Domain Adaptation by Backpropagation](https://mlsanity.com/paper/1409.7495/) (2014)
- [Moment Matching for Multi-Source Domain Adaptation](https://mlsanity.com/paper/1812.01754/) (2018)
- [Swin UNETR: Swin Transformers for Semantic Segmentation of Brain Tumors in MRI Images](https://mlsanity.com/paper/2201.01266/) (2022)
- [Continual Test-Time Domain Adaptation](https://mlsanity.com/paper/2203.13591/) (2022)
- [Efficient Test-Time Model Adaptation without Forgetting](https://mlsanity.com/paper/2204.02610/) (2022)
- [Improving robustness against common corruptions by covariate shift adaptation](https://mlsanity.com/paper/2006.16971/) (2020)
- [U-Mamba: Enhancing Long-range Dependency for Biomedical Image Segmentation](https://mlsanity.com/paper/2401.04722/) (2024)
- [Your Classifier is Secretly an Energy Based Model and You Should Treat it Like One](https://mlsanity.com/paper/1912.03263/) (2019)
- [MEMO: Test Time Robustness via Adaptation and Augmentation](https://mlsanity.com/paper/2110.09506/) (2021)
- [A Survey of Unsupervised Deep Domain Adaptation](https://mlsanity.com/paper/1812.02849/) (2018)
- [Domain Adaptation for Medical Image Analysis: A Survey](https://mlsanity.com/paper/2102.09508/) (2021)
- [A Brief Review of Domain Adaptation](https://mlsanity.com/paper/2010.03978/) (2020)
- [PixelDefend: Leveraging Generative Models to Understand and Defend against Adversarial Examples](https://mlsanity.com/paper/1710.10766/) (2017)
- [Deep Learning for Segmentation using an Open Large-Scale Dataset in 2D Echocardiography](https://mlsanity.com/paper/1908.06948/) (2019)
- [nnU-Net Revisited: A Call for Rigorous Validation in 3D Medical Image Segmentation](https://mlsanity.com/paper/2404.09556/) (2024)
- [Source-Free Domain Adaptation for Semantic Segmentation](https://mlsanity.com/paper/2103.16372/) (2021)
- [MedNeXt: Transformer-driven Scaling of ConvNets for Medical Image Segmentation](https://mlsanity.com/paper/2303.09975/) (2023)
- [Mamba-UNet: UNet-Like Pure Visual Mamba for Medical Image Segmentation](https://mlsanity.com/paper/2402.05079/) (2024)
- [EcoTTA: Memory-Efficient Continual Test-time Adaptation via Self-distilled Regularization](https://mlsanity.com/paper/2303.01904/) (2023)
- [A Comprehensive Survey on Source-free Domain Adaptation](https://mlsanity.com/paper/2302.11803/) (2023)
- [Unsupervised domain adaptation for medical imaging segmentation with self-ensembling](https://mlsanity.com/paper/1811.06042/) (2018)
- [Domain Adaptation without Source Data](https://mlsanity.com/paper/2007.01524/) (2020)
- [MT3: Meta Test-Time Training for Self-Supervised Test-Time Adaption](https://mlsanity.com/paper/2103.16201/) (2021)

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

- [Extending Foundational Monocular Depth Estimators to Fisheye Cameras with Calibration Tokens](https://mlsanity.com/paper/2508.04928/) (2025)
- [ETA: Energy-based Test-time Adaptation for Depth Completion](https://mlsanity.com/paper/2508.05989/) (2025)
- [VisTa3D: A Dataset and Benchmark for Thin Object Reconstruction from Vision, Tactile, and 3D Point Clouds](https://mlsanity.com/paper/2608.20740/) (2026)
- [Test-Time Adaptation for Anomaly Segmentation via Topology-Aware Optimal Transport Chaining](https://mlsanity.com/paper/2601.20333/) (2026)
- [From Perspective to Fisheye Depth Estimation and Open-Vocabulary Segmentation](https://mlsanity.com/paper/2608.27860/) (2026)

## Abstract (arXiv)

We propose a model-agnostic, progressive test-time energy adaptation approach for medical image segmentation. Maintaining model performance across diverse medical datasets is challenging, as distribution shifts arise from inconsistent imaging protocols and patient variations. Unlike domain adaptation methods that require multiple passes through target data - impractical in clinical settings - our approach adapts pretrained models progressively as they process test data. Our method leverages a shape energy model trained on source data, which assigns an energy score at the patch level to segmentation maps: low energy represents in-distribution (accurate) shapes, while high energy signals out-of-distribution (erroneous) predictions. By minimizing this energy score at test time, we refine the segmentation model to align with the target distribution. To validate the effectiveness and adaptability, we evaluated our framework on eight public MRI (bSSFP, T1- and T2-weighted) and X-ray datasets spanning cardiac, spinal cord, and lung segmentation. We consistently outperform baselines both quantitatively and qualitatively.