From Specialist to Generalist: Unlocking SAM's Learning Potential on Unlabeled Medical Images

Foundation models like the Segment Anything Model (SAM) show strong generalization, yet adapting them to medical images remains difficult due to domain shift, scarce labels, and the inability of Parameter-Efficient Fine-Tuning (PEFT) to exploit unlabeled data. While conventional models like U-Net excel in semi-supervised medical learning, their potential to assist a PEFT SAM has been largely overlooked. We introduce SC-SAM, a specialist-generalist framework where U-Net provides point-based prompts and pseudo-labels to guide SAM's adaptation, while SAM serves as a powerful generalist supervisor to regularize U-Net. This reciprocal guidance forms a bidirectional co-training loop that allows both models to effectively exploit the unlabeled data. Across prostate MRI and polyp segmentation benchmarks, our method achieves state-of-the-art results, outperforming other existing semi-supervised SAM variants and even medical foundation models like MedSAM, highlighting the value of specialist-generalist cooperation for label-efficient medical image segmentation. Our code is available at https://github.com/vnlvi2k3/SC-SAM.

Domain-invariant Mixed-domain Semi-supervised Medical Image Segmentation with Clustered Maximum Mean Discrepancy Alignment

Deep learning has shown remarkable progress in medical image semantic segmentation, yet its success heavily depends on large-scale expert annotations and consistent data distributions. In practice, annotations are scarce, and images are collected from multiple scanners or centers, leading to mixed-domain settings with unknown domain labels and severe domain gaps. Existing semi-supervised or domain adaptation approaches typically assume either a single domain shift or access to explicit domain indices, which rarely hold in real-world deployment. In this paper, we propose a domain-invariant mixed-domain semi-supervised segmentation framework that jointly enhances data diversity and mitigates domain bias. A Copy-Paste Mechanism (CPM) augments the training set by transferring informative regions across domains, while a Cluster Maximum Mean Discrepancy (CMMD) block clusters unlabeled features and aligns them with labeled anchors via an MMD objective, encouraging domain-invariant representations. Integrated within a teacher-student framework, our method achieves robust and precise segmentation even with very few labeled examples and multiple unknown domain discrepancies. Experiments on Fundus and M&Ms benchmarks demonstrate that our approach consistently surpasses semi-supervised and domain adaptation methods, establishing a potential solution for mixed-domain semi-supervised medical image segmentation.