# MISSFormer: An Effective Medical Image Segmentation Transformer

arXiv: https://arxiv.org/abs/2109.07162 · HTML: https://mlsanity.com/paper/2109.07162/

## Key facts

- Cited by 103 papers in the map (data through 14 Oct 2026).
- Builds on 36 of its 39 references that are in the map.
- First posted on arXiv 15 Sep 2021.

## Builds on (most cited first, 30 of 36)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [Swin Transformer: Hierarchical Vision Transformer using Shifted Windows](https://mlsanity.com/paper/2103.14030/) (2021)
- [End-to-End Object Detection with Transformers](https://mlsanity.com/paper/2005.12872/) (2020)
- [Fully Convolutional Networks for Semantic Segmentation](https://mlsanity.com/paper/1411.4038/) (2014)
- [Squeeze-and-Excitation Networks](https://mlsanity.com/paper/1709.01507/) (2017)
- [Training data-efficient image transformers & distillation through attention](https://mlsanity.com/paper/2012.12877/) (2020)
- [DeepLab: Semantic Image Segmentation with Deep Convolutional Nets, Atrous Convolution, and Fully Connected CRFs](https://mlsanity.com/paper/1606.00915/) (2016)
- [SegFormer: Simple and Efficient Design for Semantic Segmentation with Transformers](https://mlsanity.com/paper/2105.15203/) (2021)
- [Pyramid Scene Parsing Network](https://mlsanity.com/paper/1612.01105/) (2016)
- [V-Net: Fully Convolutional Neural Networks for Volumetric Medical Image Segmentation](https://mlsanity.com/paper/1606.04797/) (2016)
- [Pyramid Vision Transformer: A Versatile Backbone for Dense Prediction without Convolutions](https://mlsanity.com/paper/2102.12122/) (2021)
- [TransUNet: Transformers Make Strong Encoders for Medical Image Segmentation](https://mlsanity.com/paper/2102.04306/) (2021)
- [UNet++: A Nested U-Net Architecture for Medical Image Segmentation](https://mlsanity.com/paper/1807.10165/) (2018)
- [3D U-Net: Learning Dense Volumetric Segmentation from Sparse Annotation](https://mlsanity.com/paper/1606.06650/) (2016)
- [Rethinking Semantic Segmentation from a Sequence-to-Sequence Perspective with Transformers](https://mlsanity.com/paper/2012.15840/) (2020)
- [Swin-Unet: Unet-like Pure Transformer for Medical Image Segmentation](https://mlsanity.com/paper/2105.05537/) (2021)
- [UNETR: Transformers for 3D Medical Image Segmentation](https://mlsanity.com/paper/2103.10504/) (2021)
- [Uformer: A General U-Shaped Transformer for Image Restoration](https://mlsanity.com/paper/2106.03106/) (2021)
- [PVT v2: Improved Baselines with Pyramid Vision Transformer](https://mlsanity.com/paper/2106.13797/) (2021)
- [Twins: Revisiting the Design of Spatial Attention in Vision Transformers](https://mlsanity.com/paper/2104.13840/) (2021)
- [LeViT: a Vision Transformer in ConvNet's Clothing for Faster Inference](https://mlsanity.com/paper/2104.01136/) (2021)
- [PraNet: Parallel Reverse Attention Network for Polyp Segmentation](https://mlsanity.com/paper/2006.11392/) (2020)
- [Conditional Positional Encodings for Vision Transformers](https://mlsanity.com/paper/2102.10882/) (2021)
- [UNet 3+: A Full-Scale Connected UNet for Medical Image Segmentation](https://mlsanity.com/paper/2004.08790/) (2020)
- [TransBTS: Multimodal Brain Tumor Segmentation Using Transformer](https://mlsanity.com/paper/2103.04430/) (2021)
- [LocalViT: Analyzing Locality in Vision Transformers](https://mlsanity.com/paper/2104.05707/) (2021)
- [CoTr: Efficiently Bridging CNN and Transformer for 3D Medical Image Segmentation](https://mlsanity.com/paper/2103.03024/) (2021)

## Built on by (most cited first, 30 of 103)

- [Transformers in Medical Imaging: A Survey](https://mlsanity.com/paper/2201.09873/) (2022)
- [Medical Image Segmentation Review: The success of U-Net](https://mlsanity.com/paper/2211.14830/) (2022)
- [UNETR++: Delving into Efficient and Accurate 3D Medical Image Segmentation](https://mlsanity.com/paper/2212.04497/) (2022)
- [EMCAD: Efficient Multi-scale Convolutional Attention Decoding for Medical Image Segmentation](https://mlsanity.com/paper/2405.06880/) (2024)
- [Unleashing the Potential of SAM for Medical Adaptation via Hierarchical Decoding](https://mlsanity.com/paper/2403.18271/) (2024)
- [Transformers in Medical Image Analysis: A Review](https://mlsanity.com/paper/2202.12165/) (2022)
- [D-Former: A U-shaped Dilated Transformer for 3D Medical Image Segmentation](https://mlsanity.com/paper/2201.00462/) (2022)
- [Multi-scale Hierarchical Vision Transformer with Cascaded Attention Decoding for Medical Image Segmentation](https://mlsanity.com/paper/2303.16892/) (2023)
- [SAM3D: Segment Anything Model in Volumetric Medical Images](https://mlsanity.com/paper/2309.03493/) (2023)
- [Loss Functions in the Era of Semantic Segmentation: A Survey and Outlook](https://mlsanity.com/paper/2312.05391/) (2023)
- [Transforming medical imaging with Transformers? A comparative review of key properties, current progresses, and future perspectives](https://mlsanity.com/paper/2206.01136/) (2022)
- [HUMUS-Net: Hybrid unrolled multi-scale network architecture for accelerated MRI reconstruction](https://mlsanity.com/paper/2203.08213/) (2022)
- [DAE-Former: Dual Attention-guided Efficient Transformer for Medical Image Segmentation](https://mlsanity.com/paper/2212.13504/) (2022)
- [Ladder Fine-tuning approach for SAM integrating complementary network](https://mlsanity.com/paper/2306.12737/) (2023)
- [Primus: Enforcing Attention Usage for 3D Medical Image Segmentation](https://mlsanity.com/paper/2503.01835/) (2025)
- [G-CASCADE: Efficient Cascaded Graph Convolutional Decoding for 2D Medical Image Segmentation](https://mlsanity.com/paper/2310.16175/) (2023)
- [HistoSeg : Quick attention with multi-loss function for multi-structure segmentation in digital histology images](https://mlsanity.com/paper/2209.00729/) (2022)
- [Transformers in Healthcare: A Survey](https://mlsanity.com/paper/2307.00067/) (2023)
- [PHTrans: Parallelly Aggregating Global and Local Representations for Medical Image Segmentation](https://mlsanity.com/paper/2203.04568/) (2022)
- [A survey on attention mechanisms for medical applications: are we moving towards better algorithms?](https://mlsanity.com/paper/2204.12406/) (2022)
- [BATFormer: Towards Boundary-Aware Lightweight Transformer for Efficient Medical Image Segmentation](https://mlsanity.com/paper/2206.14409/) (2022)
- [SegStitch: Multidimensional Transformer for Robust and Efficient Medical Imaging Segmentation](https://mlsanity.com/paper/2408.00496/) (2024)
- [MedSegFactory: Text-Guided Generation of Medical Image-Mask Pairs](https://mlsanity.com/paper/2504.06897/) (2025)
- [Optimizing Vision Transformers for Medical Image Segmentation](https://mlsanity.com/paper/2210.08066/) (2022)
- [DermoSegDiff: A Boundary-aware Segmentation Diffusion Model for Skin Lesion Delineation](https://mlsanity.com/paper/2308.02959/) (2023)
- [MIST: Medical Image Segmentation Transformer with Convolutional Attention Mixing (CAM) Decoder](https://mlsanity.com/paper/2310.19898/) (2023)
- [CC-SAM: SAM with Cross-feature Attention and Context for Ultrasound Image Segmentation](https://mlsanity.com/paper/2408.00181/) (2024)
- [Adapting Pre-trained Vision Transformers from 2D to 3D through Weight Inflation Improves Medical Image Segmentation](https://mlsanity.com/paper/2302.04303/) (2023)
- [BEFUnet: A Hybrid CNN-Transformer Architecture for Precise Medical Image Segmentation](https://mlsanity.com/paper/2402.08793/) (2024)
- [Dynamic Linear Transformer for 3D Biomedical Image Segmentation](https://mlsanity.com/paper/2206.00771/) (2022)

## Abstract (arXiv)

The CNN-based methods have achieved impressive results in medical image segmentation, but they failed to capture the long-range dependencies due to the inherent locality of the convolution operation. Transformer-based methods are recently popular in vision tasks because of their capacity for long-range dependencies and promising performance. However, it lacks in modeling local context. In this paper, taking medical image segmentation as an example, we present MISSFormer, an effective and powerful Medical Image Segmentation tranSFormer. MISSFormer is a hierarchical encoder-decoder network with two appealing designs: 1) A feed-forward network is redesigned with the proposed Enhanced Transformer Block, which enhances the long-range dependencies and supplements the local context, making the feature more discriminative. 2) We proposed Enhanced Transformer Context Bridge, different from previous methods of modeling only global information, the proposed context bridge with the enhanced transformer block extracts the long-range dependencies and local context of multi-scale features generated by our hierarchical transformer encoder. Driven by these two designs, the MISSFormer shows a solid capacity to capture more discriminative dependencies and context in medical image segmentation. The experiments on multi-organ and cardiac segmentation tasks demonstrate the superiority, effectiveness and robustness of our MISSFormer, the experimental results of MISSFormer trained from scratch even outperform state-of-the-art methods pre-trained on ImageNet. The core designs can be generalized to other visual segmentation tasks. The code has been released on Github: https://github.com/ZhifangDeng/MISSFormer