无需源数据，主动筛选关键目标样本提升医学图像分割泛化能力

Deep learning (DL) methods are challenged to demonstrate robust performance across different segmentation datasets due to domain shifts, but active domain adaptation techniques enhance their generalization performance by querying a few samples from target domains for adaptation training. However in clinical practice, target domains often include private classes of new anatomical structures or pathologies that are not presented in the source data, and existing methods implement closed-set segmentation where source and target domains have the same segmentation classes. Additionally, source data are often inaccessible during adaptation due to strict data privacy regulations. To address these limitations, we propose an Active Source-free Open-set Domain Adaptation (ASFOSDA) method which is the first work to implement active learning for adapting DL models in open-set medical image segmentation without the access to source data. This method employs an active open-set query strategy to select the most informative target samples for training models based on Class-aware Decomposed Uncertainty (CDU) and Class-agnostic Prototype Discrepancy (CPD). CDU measures sample aleatoric uncertainty and model epistemic uncertainty by employing test time augmentation in stochastic processes. CPD measures cross-domain and self-domain discrepancy for selecting diverse samples. Subsequently, to boost the adaptation performance by enhancing training samples, a Target-refined Self-training strategy is proposed to generate high-quality pseudo labels for unselected samples, thus combining them with labeled samples for a semi-supervised training. We evaluated our method on cross-domain open-set volumetric medical image segmentation tasks, and it outperformed state-of-the-art adaptation methods.