SRA-Seg: Synthetic to Real Alignment for Semi-Supervised Medical Image Segmentation

Synthetic data, an appealing alternative to extensive expert-annotated data for medical image segmentation, consistently fails to improve segmentation performance despite its visual realism. The reason being that synthetic and real medical images exist in different semantic feature spaces, creating a domain gap that current semi-supervised learning methods cannot bridge. We propose SRA-Seg, a framework explicitly designed to align synthetic and real feature distributions for medical image segmentation. SRA-Seg introduces a similarity-alignment (SA) loss using frozen DINOv2 embeddings to pull synthetic representations toward their nearest real counterparts in semantic space. We employ soft edge blending to create smooth anatomical transitions and continuous labels, eliminating the hard boundaries from traditional copy-paste augmentation. The framework generates pseudo-labels for synthetic images via an EMA teacher model and applies soft-segmentation losses that respect uncertainty in mixed regions. Our experiments demonstrate strong results: using only 10% labeled real data and 90% synthetic unlabeled data, SRA-Seg achieves 89.34% Dice on ACDC and 84.42% on FIVES, significantly outperforming existing semi-supervised methods and matching the performance of methods using real unlabeled data.