Recent advances in deep learning-based medical image segmentation studies achieve nearly human-level performance when in fully supervised condition. However, acquiring pixel-level expert annotations is extremely expensive and laborious in medical imaging fields. Unsupervised domain adaptation can alleviate this problem, which makes it possible to use annotated data in one imaging modality to train a network that can successfully perform segmentation on target imaging modality with no labels. In this work, we propose a self-training based unsupervised domain adaptation framework for 3D medical image segmentation named COSMOS and validate it with automatic segmentation of Vestibular Schwannoma (VS) and cochlea on high-resolution T2 Magnetic Resonance Images (MRI). Our target-aware contrast conversion network translates source domain annotated T1 MRI to pseudo T2 MRI to enable segmentation training on target domain, while preserving important anatomical features of interest in the converted images. Iterative self-training is followed to incorporate unlabeled data to training and incrementally improve the quality of pseudo-labels, thereby leading to improved performance of segmentation. COSMOS won the 1\textsuperscript{st} place in the Cross-Modality Domain Adaptation (crossMoDA) challenge held in conjunction with the 24th International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI 2021). It achieves mean Dice score and Average Symmetric Surface Distance of 0.871(0.063) and 0.437(0.270) for VS, and 0.842(0.020) and 0.152(0.030) for cochlea.
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