  Source-free domain adaptation (SFDA) aims to adapt models trained on a
labeled source domain to an unlabeled target domain without the access to
source data. In medical imaging scenarios, the practical significance of SFDA
methods has been emphasized due to privacy concerns. Recent State-of-the-art
SFDA methods primarily rely on self-training based on pseudo-labels (PLs).
Unfortunately, PLs suffer from accuracy deterioration caused by domain shift,
and thus limit the effectiveness of the adaptation process. To address this
issue, we propose a Chebyshev confidence guided SFDA framework to accurately
assess the reliability of PLs and generate self-improving PLs for
self-training. The Chebyshev confidence is estimated by calculating probability
lower bound of the PL confidence, given the prediction and the corresponding
uncertainty. Leveraging the Chebyshev confidence, we introduce two
confidence-guided denoising methods: direct denoising and prototypical
denoising. Additionally, we propose a novel teacher-student joint training
scheme (TJTS) that incorporates a confidence weighting module to improve PLs
iteratively. The TJTS, in collaboration with the denoising methods, effectively
prevents the propagation of noise and enhances the accuracy of PLs. Extensive
experiments in diverse domain scenarios validate the effectiveness of our
proposed framework and establish its superiority over state-of-the-art SFDA
methods. Our paper contributes to the field of SFDA by providing a novel
approach for precisely estimating the reliability of pseudo-labels and a
framework for obtaining high-quality PLs, resulting in improved adaptation
performance.
