# HiFormer: Hierarchical Multi-scale Representations Using Transformers for Medical Image Segmentation

arXiv: https://arxiv.org/abs/2207.08518 · HTML: https://mlsanity.com/paper/2207.08518/

## Key facts

- Cited by 95 papers in the map (data through 14 Oct 2026).
- Builds on 53 of its 64 references that are in the map.
- First posted on arXiv 18 Jul 2022.

## Builds on (most cited first, 30 of 53)

- [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)
- [Grad-CAM: Visual Explanations from Deep Networks via Gradient-based Localization](https://mlsanity.com/paper/1610.02391/) (2016)
- [Densely Connected Convolutional Networks](https://mlsanity.com/paper/1608.06993/) (2016)
- [Feature Pyramid Networks for Object Detection](https://mlsanity.com/paper/1612.03144/) (2016)
- [Fully Convolutional Networks for Semantic Segmentation](https://mlsanity.com/paper/1411.4038/) (2014)
- [Training data-efficient image transformers & distillation through attention](https://mlsanity.com/paper/2012.12877/) (2020)
- [Deformable DETR: Deformable Transformers for End-to-End Object Detection](https://mlsanity.com/paper/2010.04159/) (2020)
- [DeepLab: Semantic Image Segmentation with Deep Convolutional Nets, Atrous Convolution, and Fully Connected CRFs](https://mlsanity.com/paper/1606.00915/) (2016)
- [Encoder-Decoder with Atrous Separable Convolution for Semantic Image Segmentation](https://mlsanity.com/paper/1802.02611/) (2018)
- [Pyramid Scene Parsing Network](https://mlsanity.com/paper/1612.01105/) (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)
- [Group Normalization](https://mlsanity.com/paper/1803.08494/) (2018)
- [SegNet: A Deep Convolutional Encoder-Decoder Architecture for Image Segmentation](https://mlsanity.com/paper/1511.00561/) (2015)
- [Swin-Unet: Unet-like Pure Transformer for Medical Image Segmentation](https://mlsanity.com/paper/2105.05537/) (2021)
- [Multi-Scale Context Aggregation by Dilated Convolutions](https://mlsanity.com/paper/1511.07122/) (2015)
- [Tokens-to-Token ViT: Training Vision Transformers from Scratch on ImageNet](https://mlsanity.com/paper/2101.11986/) (2021)
- [UNETR: Transformers for 3D Medical Image Segmentation](https://mlsanity.com/paper/2103.10504/) (2021)
- [Stacked Hourglass Networks for Human Pose Estimation](https://mlsanity.com/paper/1603.06937/) (2016)
- [Segmenter: Transformer for Semantic Segmentation](https://mlsanity.com/paper/2105.05633/) (2021)
- [CrossViT: Cross-Attention Multi-Scale Vision Transformer for Image Classification](https://mlsanity.com/paper/2103.14899/) (2021)
- [Skin Lesion Analysis Toward Melanoma Detection 2018: A Challenge Hosted by the International Skin Imaging Collaboration (ISIC)](https://mlsanity.com/paper/1902.03368/) (2019)
- [Panoptic Feature Pyramid Networks](https://mlsanity.com/paper/1901.02446/) (2019)
- [Semantic Image Segmentation with Deep Convolutional Nets and Fully Connected CRFs](https://mlsanity.com/paper/1412.7062/) (2014)
- [Skin Lesion Analysis Toward Melanoma Detection: A Challenge at the 2017 International Symposium on Biomedical Imaging (ISBI), Hosted by the International Skin Imaging Collaboration (ISIC)](https://mlsanity.com/paper/1710.05006/) (2017)

## Built on by (most cited first, 30 of 95)

- [Customized Segment Anything Model for Medical Image Segmentation](https://mlsanity.com/paper/2304.13785/) (2023)
- [Diffusion Models for Medical Image Analysis: A Comprehensive Survey](https://mlsanity.com/paper/2211.07804/) (2022)
- [Medical Image Segmentation Review: The success of U-Net](https://mlsanity.com/paper/2211.14830/) (2022)
- [TransDeepLab: Convolution-Free Transformer-based DeepLab v3+ for Medical Image Segmentation](https://mlsanity.com/paper/2208.00713/) (2022)
- [TransNorm: Transformer Provides a Strong Spatial Normalization Mechanism for a Deep Segmentation Model](https://mlsanity.com/paper/2207.13415/) (2022)
- [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)
- [Directional Connectivity-based Segmentation of Medical Images](https://mlsanity.com/paper/2304.00145/) (2023)
- [Beyond Self-Attention: Deformable Large Kernel Attention for Medical Image Segmentation](https://mlsanity.com/paper/2309.00121/) (2023)
- [DAE-Former: Dual Attention-guided Efficient Transformer for Medical Image Segmentation](https://mlsanity.com/paper/2212.13504/) (2022)
- [Modality-agnostic Domain Generalizable Medical Image Segmentation by Multi-Frequency in Multi-Scale Attention](https://mlsanity.com/paper/2405.06284/) (2024)
- [Attention Swin U-Net: Cross-Contextual Attention Mechanism for Skin Lesion Segmentation](https://mlsanity.com/paper/2210.16898/) (2022)
- [Self-Sampling Meta SAM: Enhancing Few-shot Medical Image Segmentation with Meta-Learning](https://mlsanity.com/paper/2308.16466/) (2023)
- [SelfReg-UNet: Self-Regularized UNet for Medical Image Segmentation](https://mlsanity.com/paper/2406.14896/) (2024)
- [MIST: Medical Image Segmentation Transformer with Convolutional Attention Mixing (CAM) Decoder](https://mlsanity.com/paper/2310.19898/) (2023)
- [CSWin-UNet: Transformer UNet with Cross-Shaped Windows for Medical Image Segmentation](https://mlsanity.com/paper/2407.18070/) (2024)
- [MetaSeg: MetaFormer-based Global Contexts-aware Network for Efficient Semantic Segmentation](https://mlsanity.com/paper/2408.07576/) (2024)
- [Enhancing Medical Image Segmentation with TransCeption: A Multi-Scale Feature Fusion Approach](https://mlsanity.com/paper/2301.10847/) (2023)
- [Laplacian-Former: Overcoming the Limitations of Vision Transformers in Local Texture Detection](https://mlsanity.com/paper/2309.00108/) (2023)
- [SynergyNet: Bridging the Gap between Discrete and Continuous Representations for Precise Medical Image Segmentation](https://mlsanity.com/paper/2310.17764/) (2023)
- [Vision Transformers in Medical Imaging: A Review](https://mlsanity.com/paper/2211.10043/) (2022)
- [Dilated-UNet: A Fast and Accurate Medical Image Segmentation Approach using a Dilated Transformer and U-Net Architecture](https://mlsanity.com/paper/2304.11450/) (2023)
- [SimuScope: Realistic Endoscopic Synthetic Dataset Generation through Surgical Simulation and Diffusion Models](https://mlsanity.com/paper/2412.02332/) (2024)
- [BRAU-Net++: U-Shaped Hybrid CNN-Transformer Network for Medical Image Segmentation](https://mlsanity.com/paper/2401.00722/) (2024)
- [MSVM-UNet: Multi-Scale Vision Mamba UNet for Medical Image Segmentation](https://mlsanity.com/paper/2408.13735/) (2024)
- [RWKV-UNet: Improving UNet with Long-Range Cooperation for Effective Medical Image Segmentation](https://mlsanity.com/paper/2501.08458/) (2025)
- [Weakly Supervised Intracranial Hemorrhage Segmentation using Head-Wise Gradient-Infused Self-Attention Maps from a Swin Transformer in Categorical Learning](https://mlsanity.com/paper/2304.04902/) (2023)
- [SPIRONet: Spatial-Frequency Learning and Graph-based Channel Interaction Network for Vessel Segmentation](https://mlsanity.com/paper/2406.19749/) (2024)
- [TransUKAN:Computing-Efficient Hybrid KAN-Transformer for Enhanced Medical Image Segmentation](https://mlsanity.com/paper/2409.14676/) (2024)
- [EViT-Unet: U-Net Like Efficient Vision Transformer for Medical Image Segmentation on Mobile and Edge Devices](https://mlsanity.com/paper/2410.15036/) (2024)

## Abstract (arXiv)

Convolutional neural networks (CNNs) have been the consensus for medical image segmentation tasks. However, they suffer from the limitation in modeling long-range dependencies and spatial correlations due to the nature of convolution operation. Although transformers were first developed to address this issue, they fail to capture low-level features. In contrast, it is demonstrated that both local and global features are crucial for dense prediction, such as segmenting in challenging contexts. In this paper, we propose HiFormer, a novel method that efficiently bridges a CNN and a transformer for medical image segmentation. Specifically, we design two multi-scale feature representations using the seminal Swin Transformer module and a CNN-based encoder. To secure a fine fusion of global and local features obtained from the two aforementioned representations, we propose a Double-Level Fusion (DLF) module in the skip connection of the encoder-decoder structure. Extensive experiments on various medical image segmentation datasets demonstrate the effectiveness of HiFormer over other CNN-based, transformer-based, and hybrid methods in terms of computational complexity, and quantitative and qualitative results. Our code is publicly available at: https://github.com/amirhossein-kz/HiFormer