Source-Free Active Domain Adaptation via Influential-Points-Guided Progressive Teacher for Medical Image Segmentation

Domain adaptation in medical image segmentation enables pre-trained models to generalize to new target domains. Given limited annotated data and privacy constraints, Source-Free Active Domain Adaptation (SFADA) methods provide promising solutions by selecting a few target samples for labeling without accessing source samples. However, in a fully source-free setting, existing works have not fully explored how to select these target samples in a class-balanced manner and how to conduct robust model adaptation using both labeled and unlabeled samples. In this study, we discover that boundary samples with source-like semantics but sharp predictive discrepancies are beneficial for SFADA. We define these samples as the most influential points and propose a slice-wise framework using influential points learning to explore them. Specifically, we detect source-like samples to retain source-specific knowledge. For each target sample, an adaptive K-nearest neighbor algorithm based on local density is introduced to construct neighborhoods of source-like samples for knowledge transfer. We then propose a class-balanced Kullback-Leibler divergence for these neighborhoods, calculating it to obtain an influential score ranking. A diverse subset of the highest-ranked target samples (considered influential points) is manually annotated. Furthermore, we design a progressive teacher model to facilitate SFADA for medical image segmentation. Guided by influential points, this model independently generates and utilizes pseudo-labels to mitigate error accumulation. To further suppress noise, curriculum learning is incorporated into the model to progressively leverage reliable supervision signals from pseudo-labels. Experiments on multiple benchmarks demonstrate that our method outperforms state-of-the-art methods even with only 2.5% of the labeling budget.