Rethinking domain generalization in medical image segmentation: One image as one domain

Abstract

Domain shifts in medical image segmentation, particularly when data comes from different centers, pose significant challenges. Intra-center variability, such as differences in scanner models or imaging protocols, can cause domain shifts as large as, or even larger than, those between centers. To address this, we propose the "one image as one domain" (OIOD) hypothesis, which treats each image as a unique domain, enabling flexible and robust domain generalization. Based on this hypothesis, we develop a unified disentanglement-based domain generalization (UniDDG) framework, which simultaneously handles both multi-source and single-source domain generalization without requiring explicit domain labels. This approach simplifies training with a fixed architecture, independent of the number of source domains, reducing complexity and enhancing scalability. We decouple each input image into content representation and style code, then exchange and combine these within the batch for segmentation, reconstruction, and further disentanglement. By maintaining distinct style codes for each image, our model ensures thorough decoupling of content representations and style codes, improving domain invariance of the content representations. Additionally, we enhance generalization with expansion mask attention (EMA) for boundary preservation and style augmentation (SA) to simulate diverse image styles, improving robustness to domain shifts. Extensive experiments show that our method achieves Dice scores of 84.43% and 88.91% for multi-source to single-center and single-center generalization in optic disc and optic cup segmentation, respectively, and 86.96% and 88.56% for prostate segmentation, outperforming current state-of-the-art domain generalization methods, offering superior performance and adaptability across clinical settings.