DG-TTA: Out-of-Domain Medical Image Segmentation Through Augmentation, Descriptor-Driven Domain Generalization, and Test-Time Adaptation

Applying pre-trained medical deep learning segmentation models to out-of-domain images often yields predictions of insufficient quality. In this study, we propose using a robust generalizing descriptor, along with augmentation, to enable domain-generalized pre-training and test-time adaptation, thereby achieving high-quality segmentation in unseen domains. In this study, five different publicly available datasets, including 3D CT and MRI images, are used to evaluate segmentation performance in out-of-domain scenarios. The settings include abdominal, spine, and cardiac imaging. Domain-generalized pre-training on source data is used to obtain the best initial performance in the target domain. We introduce a combination of the generalizing SSC descriptor and GIN intensity augmentation for optimal generalization. Segmentation results are subsequently optimized at test time, where we propose adapting the pre-trained models for every unseen scan using a consistency scheme with the augmentation-descriptor combination. The proposed generalized pre-training and subsequent test-time adaptation improve model performance significantly in CT to MRI cross-domain prediction for abdominal (+46.2 and +28.2 Dice), spine (+72.9), and cardiac (+14.2 and +55.7 Dice) scenarios (<i>p</i> < 0.001). Our method enables the optimal, independent use of source and target data, successfully bridging domain gaps with a compact and efficient methodology.