# Multi-Scale Global-Instance Prompt Tuning for Continual Test-time Adaptation in Medical Image Segmentation

arXiv: https://arxiv.org/abs/2602.05937 · HTML: https://mlsanity.com/paper/2602.05937/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 28 of its 38 references that are in the map.
- First posted on arXiv 5 Feb 2026.

## Builds on (most cited first, 28 of 28)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Pre-train, Prompt, and Predict: A Systematic Survey of Prompting Methods in Natural Language Processing](https://mlsanity.com/paper/2107.13586/) (2021)
- [Visual Prompt Tuning](https://mlsanity.com/paper/2203.12119/) (2022)
- [Kvasir-SEG: A Segmented Polyp Dataset](https://mlsanity.com/paper/1911.07069/) (2019)
- [FDA: Fourier Domain Adaptation for Semantic Segmentation](https://mlsanity.com/paper/2004.05498/) (2020)
- [Continual Test-Time Domain Adaptation](https://mlsanity.com/paper/2203.13591/) (2022)
- [Structure-measure: A New Way to Evaluate Foreground Maps](https://mlsanity.com/paper/1708.00786/) (2017)
- [Res2Net: A New Multi-scale Backbone Architecture](https://mlsanity.com/paper/1904.01169/) (2019)
- [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)
- [Enhanced-alignment Measure for Binary Foreground Map Evaluation](https://mlsanity.com/paper/1805.10421/) (2018)
- [Revisiting Batch Normalization For Practical Domain Adaptation](https://mlsanity.com/paper/1603.04779/) (2016)
- [REFUGE Challenge: A Unified Framework for Evaluating Automated Methods for Glaucoma Assessment from Fundus Photographs](https://mlsanity.com/paper/1910.03667/) (2019)
- [The Norm Must Go On: Dynamic Unsupervised Domain Adaptation by Normalization](https://mlsanity.com/paper/2112.00463/) (2021)
- [Decorate the Newcomers: Visual Domain Prompt for Continual Test Time Adaptation](https://mlsanity.com/paper/2212.04145/) (2022)
- [Unsupervised domain adaptation for medical imaging segmentation with self-ensembling](https://mlsanity.com/paper/1811.06042/) (2018)
- [SITA: Single Image Test-time Adaptation](https://mlsanity.com/paper/2112.02355/) (2021)
- [Beyond Model Adaptation at Test Time: A Survey](https://mlsanity.com/paper/2411.03687/) (2024)
- [ViDA: Homeostatic Visual Domain Adapter for Continual Test Time Adaptation](https://mlsanity.com/paper/2306.04344/) (2023)
- [NeoUNet: Towards accurate colon polyp segmentation and neoplasm detection](https://mlsanity.com/paper/2107.05023/) (2021)
- [ReLayNet: Retinal Layer and Fluid Segmentation of Macular Optical Coherence Tomography using Fully Convolutional Network](https://mlsanity.com/paper/1704.02161/) (2017)
- [Each Test Image Deserves A Specific Prompt: Continual Test-Time Adaptation for 2D Medical Image Segmentation](https://mlsanity.com/paper/2311.18363/) (2023)
- [DLTTA: Dynamic Learning Rate for Test-time Adaptation on Cross-domain Medical Images](https://mlsanity.com/paper/2205.13723/) (2022)
- [Label Shift Adapter for Test-Time Adaptation under Covariate and Label Shifts](https://mlsanity.com/paper/2308.08810/) (2023)
- [DomainAdaptor: A Novel Approach to Test-time Adaptation](https://mlsanity.com/paper/2308.10297/) (2023)
- [ProSFDA: Prompt Learning based Source-free Domain Adaptation for Medical Image Segmentation](https://mlsanity.com/paper/2211.11514/) (2022)
- [PASS:Test-Time Prompting to Adapt Styles and Semantic Shapes in Medical Image Segmentation](https://mlsanity.com/paper/2410.01573/) (2024)
- [Decomposing the Neurons: Activation Sparsity via Mixture of Experts for Continual Test Time Adaptation](https://mlsanity.com/paper/2405.16486/) (2024)

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

- [Memory-Supported Synergistic Adaptation for Training-Free Test-Time Medical Image Segmentation](https://mlsanity.com/paper/2607.17693/) (2026)

## Abstract (arXiv)

Distribution shift is a common challenge in medical images obtained from different clinical centers, significantly hindering the deployment of pre-trained semantic segmentation models in real-world applications across multiple domains. Continual Test-Time Adaptation(CTTA) has emerged as a promising approach to address cross-domain shifts during continually evolving target domains. Most existing CTTA methods rely on incrementally updating model parameters, which inevitably suffer from error accumulation and catastrophic forgetting, especially in long-term adaptation. Recent prompt-tuning-based works have shown potential to mitigate the two issues above by updating only visual prompts. While these approaches have demonstrated promising performance, several limitations remain:1)lacking multi-scale prompt diversity, 2)inadequate incorporation of instance-specific knowledge, and 3)risk of privacy leakage. To overcome these limitations, we propose Multi-scale Global-Instance Prompt Tuning(MGIPT), to enhance scale diversity of prompts and capture both global- and instance-level knowledge for robust CTTA. Specifically, MGIPT consists of an Adaptive-scale Instance Prompt(AIP) and a Multi-scale Global-level Prompt(MGP). AIP dynamically learns lightweight and instance-specific prompts to mitigate error accumulation with adaptive optimal-scale selection mechanism. MGP captures domain-level knowledge across different scales to ensure robust adaptation with anti-forgetting capabilities. These complementary components are combined through a weighted ensemble approach, enabling effective dual-level adaptation that integrates both global and local information. Extensive experiments on medical image segmentation benchmarks demonstrate that our MGIPT outperforms state-of-the-art methods, achieving robust adaptation across continually changing target domains.