# Test-time Adaptation of Pelvic Bone Segmentation Models via Dynamic Reliability-Guided

arXiv: https://arxiv.org/abs/2608.00510 · HTML: https://mlsanity.com/paper/2608.00510/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 14 of its 25 references that are in the map.
- First posted on arXiv 1 Aug 2026.

## Builds on (most cited first, 14 of 14)

- [Dropout as a Bayesian Approximation: Representing Model Uncertainty in Deep Learning](https://mlsanity.com/paper/1506.02142/) (2015)
- [Do We Really Need to Access the Source Data? Source Hypothesis Transfer for Unsupervised Domain Adaptation](https://mlsanity.com/paper/2002.08546/) (2020)
- [Continual Test-Time Domain Adaptation](https://mlsanity.com/paper/2203.13591/) (2022)
- [A large annotated medical image dataset for the development and evaluation of segmentation algorithms](https://mlsanity.com/paper/1902.09063/) (2019)
- [The KiTS19 Challenge Data: 300 Kidney Tumor Cases with Clinical Context, CT Semantic Segmentations, and Surgical Outcomes](https://mlsanity.com/paper/1904.00445/) (2019)
- [Guiding Pseudo-labels with Uncertainty Estimation for Source-free Unsupervised Domain Adaptation](https://mlsanity.com/paper/2303.03770/) (2023)
- [Deep Learning to Segment Pelvic Bones: Large-scale CT Datasets and Baseline Models](https://mlsanity.com/paper/2012.08721/) (2020)
- [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)
- [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)
- [Source-Free Domain Adaptation for Medical Image Segmentation via Prototype-Anchored Feature Alignment and Contrastive Learning](https://mlsanity.com/paper/2307.09769/) (2023)
- [FPL+: Filtered Pseudo Label-based Unsupervised Cross-Modality Adaptation for 3D Medical Image Segmentation](https://mlsanity.com/paper/2404.04971/) (2024)
- [Medical Image Segmentation with InTEnt: Integrated Entropy Weighting for Single Image Test-Time Adaptation](https://mlsanity.com/paper/2402.09604/) (2024)
- [AETTA: Label-Free Accuracy Estimation for Test-Time Adaptation](https://mlsanity.com/paper/2404.01351/) (2024)

## Abstract (arXiv)

Reliable pelvic bone segmentation (PBS) from CT is essential for robot-assisted pelvic trauma surgery, yet deploying a source-trained model to a new hospital suffers from severe performance degradation due to cross-center domain shifts. While test-time adaptation (TTA) enables online model adaptation without accessing source data, existing methods show limited effectiveness for PBS, facing challenges including boundary degradation, anatomical inconsistency under domain shifts, and voxel-level class imbalance. To address these challenges, we propose a novel closed-loop dynamic Reliability-Guided TTA framework (ReGA) for PBS. Specifically, we introduce a pseudo-label reliability criterion termed Segmentation Inference Consistency Evaluation (SICE), which jointly measures region overlap and boundary deviation via dropout-based ensemble predictions. Based on SICE, a trust-weighted refinement module adaptively updates features to mitigate boundary errors in pseudo-labels. Furthermore, a confidence-weighted region-level contrastive learning strategy is proposed to enforce anatomical consistency. Finally, ReGA follows the teacher-student (TS) scheme to alleviate voxel-level class imbalance. Experiments on three heterogeneous 3D pelvic CT datasets demonstrate that ReGA consistently outperforms state-of-the-art TTA methods, enabling effective adaptation of the source-trained PBS model to unseen clinical domains. The code is available at https://github.com/Ren-ling/ReGA.