Numerous unsupervised domain adaptation (UDA) algorithms exist, but for clinical practice, selecting the best-suited one along with proper hyperparameters often remains unclear, as the unlabeled deployment (target) domain prevents direct evaluation. We propose a label-free criterion that jointly selects the algorithm and hyperparameters for UDA. Given a pool of candidate models from multiple algorithms trained with different hyperparameters, our approach scores each candidate against an agreement reference, and selects the one with the highest score. The agreement reference is constructed in two levels without using target labels. First, we leverage multiple label-free selection signals, using each to nominate a model within every algorithm. Second, the nominated models are aggregated across algorithms to form a reference prediction for each unlabeled target sample. The candidate whose predictions agree most with this reference is then selected for deployment. Experimental results on four brain MRI and four chest X-ray datasets across seven clinically relevant transfer scenarios show that our method achieves better selection performance than other methods and remains effective across different algorithm pools. Our approach takes a step towards practical, label-free algorithm selection for clinical deployment of UDA.
Deploying unsupervised domain adaptation (UDA) in clinical practice requires choosing which algorithm to use and which of its trained models to ship. However, the deployment (target) domain is unlabeled, so models cannot be evaluated directly on it, leaving it unclear which to select. We address this by evaluating the complete UDA pipeline, considering both adaptation and label-free selection together. Our study covers eleven clinically relevant cross-domain scenarios from nine medical imaging datasets, with ten UDA algorithms and 13 label-free selection methods (validators), evaluating over 80,000 trained models in total. By this, we find that a capable adapted model usually exists, but identifying it without target labels is difficult: the validator-selected models leave a large and structural target performance gap to the best available one, with no evaluated validator consistently reliable. Towards closing it, we explore two strategies, ensembling and a small target-labeling budget; both narrow this gap but do not close it entirely. Overall, deployable UDA depends on the complete pipeline; addressing the less explored selection step could bring much of current UDA closer to clinical use.