A Large Scale Benchmark for Test Time Adaptation Methods in Medical Image Segmentation
This work addresses the problem of domain shift in medical image segmentation for researchers and clinicians by providing a standardized benchmark, though it is incremental as it builds on existing adaptation methods.
The authors tackled the lack of comprehensive evaluation for test time adaptation methods in medical image segmentation by creating MedSeg-TTA, a benchmark that tested 20 methods across 7 imaging modalities, finding no single paradigm performs best in all conditions, with methods showing varying stability and advantages depending on shifts and metrics.
Test time Adaptation is a promising approach for mitigating domain shift in medical image segmentation; however, current evaluations remain limited in terms of modality coverage, task diversity, and methodological consistency. We present MedSeg-TTA, a comprehensive benchmark that examines twenty representative adaptation methods across seven imaging modalities, including MRI, CT, ultrasound, pathology, dermoscopy, OCT, and chest X-ray, under fully unified data preprocessing, backbone configuration, and test time protocols. The benchmark encompasses four significant adaptation paradigms: Input-level Transformation, Feature-level Alignment, Output-level Regularization, and Prior Estimation, enabling the first systematic cross-modality comparison of their reliability and applicability. The results show that no single paradigm performs best in all conditions. Input-level methods are more stable under mild appearance shifts. Feature-level and Output-level methods offer greater advantages in boundary-related metrics, whereas prior-based methods exhibit strong modality dependence. Several methods degrade significantly under large inter-center and inter-device shifts, which highlights the importance of principled method selection for clinical deployment. MedSeg-TTA provides standardized datasets, validated implementations, and a public leaderboard, establishing a rigorous foundation for future research on robust, clinically reliable test-time adaptation. All source codes and open-source datasets are available at https://github.com/wenjing-gg/MedSeg-TTA.