IPLC+: SAM-Guided Iterative Pseudo Label Correction for Source-Free Domain Adaptation in Medical Image Segmentation

Domain Adaptation (DA) is important for a segmentation model to deal with domain shift in a new target domain. Due to the privacy concern of medical data and the expensive annotation process, Source-Free Domain Adaptation (SFDA) is appealing without access to source data and labels of target domain images for the adaptation. However, existing SFDA methods have limited performance due to insufficient supervision and unreliable pseudo labels. In this paper, we propose an enhanced Iterative Pseudo Label Correction (IPLC+) SFDA framework guided by Segment Anything Model (SAM) for medical image segmentation. Specifically, with a pre-trained source model and SAM, we propose a Reliable SAM Pseudo-label Generator (RSPG) to obtain high-quality and reliable pseudo labels in the target domain based on multiple prompts randomly sampled from the model's prediction. To provide more efficient constraints during adaptation, we introduce self-training pseudo labels weighted by the uncertainty, and propose regularization using mean curvature minimization based on shape-prior knowledge for smoother segmentation. We also propose an Iterative Correction Learning (ICL) strategy to iteratively refine pseudo labels using SAM with updated prompts and combine supervisions to optimize the model sufficiently. Experiments on two public multi-site datasets for prostate and heart segmentation show that our method effectively outperformed ten state-of-the-art SFDA methods, improved the quality of pseudo labels, and even achieved better results than fully supervised learning in the target domain in some cases. The code is available at https://github.com/HiLab-git/IPLC.