# Dual Cross-Attention for Medical Image Segmentation

arXiv: https://arxiv.org/abs/2303.17696 · HTML: https://mlsanity.com/paper/2303.17696/

## Key facts

- Cited by 15 papers in the map (data through 14 Oct 2026).
- Builds on 69 of its 85 references that are in the map.
- First posted on arXiv 30 Mar 2023.

## Builds on (most cited first, 30 of 69)

- [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)
- [Adam: A Method for Stochastic Optimization](https://mlsanity.com/paper/1412.6980/) (2014)
- [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)
- [Batch Normalization: Accelerating Deep Network Training by Reducing Internal Covariate Shift](https://mlsanity.com/paper/1502.03167/) (2015)
- [Layer Normalization](https://mlsanity.com/paper/1607.06450/) (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)
- [Gaussian Error Linear Units (GELUs)](https://mlsanity.com/paper/1606.08415/) (2016)
- [SegFormer: Simple and Efficient Design for Semantic Segmentation with Transformers](https://mlsanity.com/paper/2105.15203/) (2021)
- [Xception: Deep Learning with Depthwise Separable Convolutions](https://mlsanity.com/paper/1610.02357/) (2016)
- [Non-local Neural Networks](https://mlsanity.com/paper/1711.07971/) (2017)
- [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)
- [MLP-Mixer: An all-MLP Architecture for Vision](https://mlsanity.com/paper/2105.01601/) (2021)
- [Rethinking Semantic Segmentation from a Sequence-to-Sequence Perspective with Transformers](https://mlsanity.com/paper/2012.15840/) (2020)
- [VisualBERT: A Simple and Performant Baseline for Vision and Language](https://mlsanity.com/paper/1908.03557/) (2019)
- [Swin-Unet: Unet-like Pure Transformer for Medical Image Segmentation](https://mlsanity.com/paper/2105.05537/) (2021)
- [Tokens-to-Token ViT: Training Vision Transformers from Scratch on ImageNet](https://mlsanity.com/paper/2101.11986/) (2021)
- [Dual Attention Network for Scene Segmentation](https://mlsanity.com/paper/1809.02983/) (2018)
- [Deep Networks with Stochastic Depth](https://mlsanity.com/paper/1603.09382/) (2016)
- [CvT: Introducing Convolutions to Vision Transformers](https://mlsanity.com/paper/2103.15808/) (2021)
- [Pre-Trained Image Processing Transformer](https://mlsanity.com/paper/2012.00364/) (2020)
- [Segmenter: Transformer for Semantic Segmentation](https://mlsanity.com/paper/2105.05633/) (2021)

## Built on by (most cited first, 15 of 15)

- [A Recent Survey of Vision Transformers for Medical Image Segmentation](https://mlsanity.com/paper/2312.00634/) (2023)
- [DCFormer: Efficient 3D Vision-Language Modeling with Decomposed Convolutions](https://mlsanity.com/paper/2502.05091/) (2025)
- [Deep Learning-based Bathymetry Retrieval without In-situ Depths using Remote Sensing Imagery and SfM-MVS DSMs with Data Gaps](https://mlsanity.com/paper/2504.11416/) (2025)
- [Trustworthy Multi-phase Liver Tumor Segmentation via Evidence-based Uncertainty](https://mlsanity.com/paper/2305.05344/) (2023)
- [Swin UNETR++: Advancing Transformer-Based Dense Dose Prediction Towards Fully Automated Radiation Oncology Treatments](https://mlsanity.com/paper/2311.06572/) (2023)
- [Multi-label Classification with Panoptic Context Aggregation Networks](https://mlsanity.com/paper/2512.23486/) (2025)
- [Contextual Embedding Learning to Enhance 2D Networks for Volumetric Image Segmentation](https://mlsanity.com/paper/2404.01723/) (2024)
- [MDFI-Net: Multiscale Differential Feature Interaction Network for Accurate Retinal Vessel Segmentation](https://mlsanity.com/paper/2410.15444/) (2024)
- [ViTaL: A Multimodality Dataset and Benchmark for Multi-pathological Ovarian Tumor Recognition](https://mlsanity.com/paper/2507.04383/) (2025)
- [FMD-TransUNet: Abdominal Multi-Organ Segmentation Based on Frequency Domain Multi-Axis Representation Learning and Dual Attention Mechanisms](https://mlsanity.com/paper/2509.16044/) (2025)
- [Enhanced Fracture Diagnosis Based on Critical Regional and Scale Aware in YOLO](https://mlsanity.com/paper/2509.23408/) (2025)
- [DTEA: Dynamic Topology Weaving and Instability-Driven Entropic Attenuation for Medical Image Segmentation](https://mlsanity.com/paper/2510.11259/) (2025)
- [SYNAPSE-Net: A Unified Framework with Lesion-Aware Hierarchical Gating for Robust Segmentation of Heterogeneous Brain Lesions](https://mlsanity.com/paper/2510.26961/) (2025)
- [UniFLM: United Segmentation and Measurement on Fetal Limb Ultrasonic Image](https://mlsanity.com/paper/2608.27240/) (2026)
- [MoSSGate: Memory-Modulated State-Space Gating for Skin Lesion Segmentation](https://mlsanity.com/paper/2609.20181/) (2026)

## Abstract (arXiv)

We propose Dual Cross-Attention (DCA), a simple yet effective attention module that is able to enhance skip-connections in U-Net-based architectures for medical image segmentation. DCA addresses the semantic gap between encoder and decoder features by sequentially capturing channel and spatial dependencies across multi-scale encoder features. First, the Channel Cross-Attention (CCA) extracts global channel-wise dependencies by utilizing cross-attention across channel tokens of multi-scale encoder features. Then, the Spatial Cross-Attention (SCA) module performs cross-attention to capture spatial dependencies across spatial tokens. Finally, these fine-grained encoder features are up-sampled and connected to their corresponding decoder parts to form the skip-connection scheme. Our proposed DCA module can be integrated into any encoder-decoder architecture with skip-connections such as U-Net and its variants. We test our DCA module by integrating it into six U-Net-based architectures such as U-Net, V-Net, R2Unet, ResUnet++, DoubleUnet and MultiResUnet. Our DCA module shows Dice Score improvements up to 2.05% on GlaS, 2.74% on MoNuSeg, 1.37% on CVC-ClinicDB, 1.12% on Kvasir-Seg and 1.44% on Synapse datasets. Our codes are available at: https://github.com/gorkemcanates/Dual-Cross-Attention