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RetiGen: Framework leveraging domain generalization and test-time adaptation for multi-view retinal diagnostics.

Gongyu Zhang1, Ze Chen2, Jiayu Huo3

  • 1School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom; School of Life Course & Population Sciences, King's College London, London, United Kingdom.

Computers in Biology and Medicine
|September 11, 2025
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Summary

RetiGen integrates domain generalization and test-time adaptation for ophthalmic imaging, significantly improving diagnostic accuracy across different datasets. This novel approach enhances machine learning model robustness and addresses domain shift challenges.

Keywords:
Deep learningDomain generalizationMedical image analysisMulti-view imagingRetinal diagnosticsTest-time adaptation

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Area of Science:

  • Ophthalmic imaging
  • Medical machine learning
  • Computer vision

Background:

  • Domain generalization (DG) and test-time adaptation (TTA) improve medical imaging model accuracy across different domains.
  • Existing methods often address DG or TTA separately, not leveraging their combined strengths.
  • Domain shift remains a significant challenge, hindering the performance of AI in diagnostics.

Purpose of the Study:

  • To introduce RetiGen, a novel test-time optimization framework that integrates DG and TTA in an end-to-end fashion.
  • To enhance the robustness and accuracy of machine learning models in the ophthalmic imaging domain, specifically using multi-view color fundus photographs.
  • To address the persistent issue of domain shift in medical imaging analysis.

Main Methods:

  • RetiGen is a test-time optimization framework designed for integration with existing domain generalization approaches.
  • It utilizes unlabeled multi-view color fundus photographs, leveraging information from multiple viewing angles.
  • The framework integrates class balancing, test-time adaptation, and a multi-view optimization strategy to combat domain shift.

Main Results:

  • RetiGen significantly enhances the generalizability and accuracy of ophthalmic imaging models.
  • On the MFIDDR dataset, RetiGen improved AUC from 0.751 to 0.872 (0.121 improvement).
  • On the DRTiD dataset, RetiGen improved AUC from 0.794 to 0.879 (0.085 improvement), outperforming state-of-the-art methods.

Conclusions:

  • RetiGen effectively addresses domain shift by combining DG and TTA in an end-to-end framework.
  • The proposed method demonstrates superior performance compared to existing state-of-the-art techniques in both DG and TTA.
  • RetiGen offers a promising solution for improving diagnostic accuracy in ophthalmic imaging and other medical domains.