# ASTRA-Net: Anatomy-Specific Transfer and Representation Alignment for Drug-Induced Sleep Endoscopy Segmentation

arXiv: https://arxiv.org/abs/2607.21370 · HTML: https://mlsanity.com/paper/2607.21370/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 18 of its 33 references that are in the map.
- First posted on arXiv 23 Jul 2026.

## Builds on (most cited first, 18 of 18)

- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [A Simple Framework for Contrastive Learning of Visual Representations](https://mlsanity.com/paper/2002.05709/) (2020)
- [Momentum Contrast for Unsupervised Visual Representation Learning](https://mlsanity.com/paper/1911.05722/) (2019)
- [Masked Autoencoders Are Scalable Vision Learners](https://mlsanity.com/paper/2111.06377/) (2021)
- [A ConvNet for the 2020s](https://mlsanity.com/paper/2201.03545/) (2022)
- [Domain-Adversarial Training of Neural Networks](https://mlsanity.com/paper/1505.07818/) (2015)
- [TransUNet: Transformers Make Strong Encoders for Medical Image Segmentation](https://mlsanity.com/paper/2102.04306/) (2021)
- [UNet++: A Nested U-Net Architecture for Medical Image Segmentation](https://mlsanity.com/paper/1807.10165/) (2018)
- [Domain Randomization for Transferring Deep Neural Networks from Simulation to the Real World](https://mlsanity.com/paper/1703.06907/) (2017)
- [PraNet: Parallel Reverse Attention Network for Polyp Segmentation](https://mlsanity.com/paper/2006.11392/) (2020)
- [Self-Supervision with Superpixels: Training Few-shot Medical Image Segmentation without Annotation](https://mlsanity.com/paper/2007.09886/) (2020)
- [Unsupervised domain adaptation in brain lesion segmentation with adversarial networks](https://mlsanity.com/paper/1612.08894/) (2016)
- [Synergistic Image and Feature Adaptation: Towards Cross-Modality Domain Adaptation for Medical Image Segmentation](https://mlsanity.com/paper/1901.08211/) (2019)
- [Video Polyp Segmentation: A Deep Learning Perspective](https://mlsanity.com/paper/2203.14291/) (2022)
- [Progressively Normalized Self-Attention Network for Video Polyp Segmentation](https://mlsanity.com/paper/2105.08468/) (2021)
- [What Can Be Transferred: Unsupervised Domain Adaptation for Endoscopic Lesions Segmentation](https://mlsanity.com/paper/2004.11500/) (2020)
- [MAPSeg: Unified Unsupervised Domain Adaptation for Heterogeneous Medical Image Segmentation Based on 3D Masked Autoencoding and Pseudo-Labeling](https://mlsanity.com/paper/2303.09373/) (2023)
- [SimuScope: Realistic Endoscopic Synthetic Dataset Generation through Surgical Simulation and Diffusion Models](https://mlsanity.com/paper/2412.02332/) (2024)

## Abstract (arXiv)

Quantitative drug-induced sleep endoscopy (DISE) requires reliable airway boundaries at specific anatomical levels. Pixel-level DISE annotations are scarce, and manual contouring limits the scalability of quantitative assessment. To address this limitation, we developed ASTRA-Net for known-plane DISE segmentation with limited real annotations. Stage 1 aligned intermediate ConvNeXt-Base representations from 14,250 unlabeled virtual endoscopy frames derived from computed tomography and real DISE frames. Virtual images were used only for feature alignment. Stage 2 fine-tuned four independent UNet++ decoders on 401 real annotated frames. Structured zero-mask supervision constrained incompatible plane outputs and invalid frames. Six alignment configurations used maximum mean discrepancy, domain adversarial learning, or both objectives. On a hold-out evaluation set of 100 frames, the five-model MMD-only segmentation ensemble achieved a mean Dice of 0.8927, with a 95% image-level bootstrap interval of 0.8631 to 0.9160. The mean intersection over union was 0.8239. A classification- enabled variant of the same alignment configuration reached a restricted four-plane top-1 accuracy of 0.92 on the same hold-out frames. These results indicate that ASTRA-Net can support frame-level, plane-specific DISE boundary delineation when real annotations are limited.