Reinforcement Learning for Unsupervised Domain Adaptation in Spatio-Temporal Echocardiography Segmentation

Abstract-- Domain adaptation methods aim to bridge the gap between datasets by enabling knowledge transfer across domains, reducing the need for additional expert annotations. However, many approaches struggle with reliability in the target domain, an issue particularly critical in medical image segmentation, where accuracy and anatomical validity are essential. This challenge is further exacerbated in spatio-temporal data, where the lack of temporal consistency can significantly degrade segmentation quality, and particularly in echocardiography, where the presence of artifacts and noise can further hinder segmentation performance. To address these issues, we present RL4Seg3D, an unsupervised domain adaptation framework for 2D + time echocardiography segmentation. RL4Seg3D integrates novel reward functions and a fusion scheme to enhance key landmark precision in its segmentations while processing full-sized input videos. By leveraging reinforcement learning for image segmentation, our approach improves accuracy, anatomical validity, and temporal consistency while also providing, as a beneficial side effect, a robust uncertainty estimator, which can be used at test time to further enhance segmentation performance. We demonstrate the effectiveness of our framework on over 30,000 echocardiographic videos, showing that it outperforms standard domain adaptation techniques without the need for any labels on the target domain. Obtaining such annotations is laborious, logistically challenging, and expensive, in particular for 3D images or 2D+t image sequences. This has driven the development of semi-supervised and unsupervised domain adaption methods to leverage larger datasets containing few or no annotations [1]. Reinforcement learning (RL) offers an alternative to conventional supervised training by leveraging automated reward mechanisms to iteratively improve model outputs. We recently proposed a RL-based segmentation strategy (RL4Seg) [2] framing 2D segmentation as a single-timestep RL task, in which a segmentation network acts as an agent, and is optimized through reward-driven interactions with unlabeled data.