# MIST: Medical Image Segmentation Transformer with Convolutional Attention Mixing (CAM) Decoder

arXiv: https://arxiv.org/abs/2310.19898 · HTML: https://mlsanity.com/paper/2310.19898/

## Key facts

- Cited by 12 papers in the map (data through 14 Oct 2026).
- Builds on 35 of its 48 references that are in the map.
- First posted on arXiv 30 Oct 2023.

## Builds on (most cited first, 30 of 35)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [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)
- [SegFormer: Simple and Efficient Design for Semantic Segmentation with Transformers](https://mlsanity.com/paper/2105.15203/) (2021)
- [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)
- [Swin-Unet: Unet-like Pure Transformer for Medical Image Segmentation](https://mlsanity.com/paper/2105.05537/) (2021)
- [CvT: Introducing Convolutions to Vision Transformers](https://mlsanity.com/paper/2103.15808/) (2021)
- [Uformer: A General U-Shaped Transformer for Image Restoration](https://mlsanity.com/paper/2106.03106/) (2021)
- [UNet++: Redesigning Skip Connections to Exploit Multiscale Features in Image Segmentation](https://mlsanity.com/paper/1912.05074/) (2019)
- [MaxViT: Multi-Axis Vision Transformer](https://mlsanity.com/paper/2204.01697/) (2022)
- [UNet 3+: A Full-Scale Connected UNet for Medical Image Segmentation](https://mlsanity.com/paper/2004.08790/) (2020)
- [Medical Transformer: Gated Axial-Attention for Medical Image Segmentation](https://mlsanity.com/paper/2102.10662/) (2021)
- [nnU-Net: Self-adapting Framework for U-Net-Based Medical Image Segmentation](https://mlsanity.com/paper/1809.10486/) (2018)
- [MISSFormer: An Effective Medical Image Segmentation Transformer](https://mlsanity.com/paper/2109.07162/) (2021)
- [Mixed Transformer U-Net For Medical Image Segmentation](https://mlsanity.com/paper/2111.04734/) (2021)
- [HiFormer: Hierarchical Multi-scale Representations Using Transformers for Medical Image Segmentation](https://mlsanity.com/paper/2207.08518/) (2022)
- [LeViT-UNet: Make Faster Encoders with Transformer for Medical Image Segmentation](https://mlsanity.com/paper/2107.08623/) (2021)
- [U-Net Transformer: Self and Cross Attention for Medical Image Segmentation](https://mlsanity.com/paper/2103.06104/) (2021)
- [TransAttUnet: Multi-level Attention-guided U-Net with Transformer for Medical Image Segmentation](https://mlsanity.com/paper/2107.05274/) (2021)
- [TransClaw U-Net: Claw U-Net with Transformers for Medical Image Segmentation](https://mlsanity.com/paper/2107.05188/) (2021)
- [Optimized U-Net for Brain Tumor Segmentation](https://mlsanity.com/paper/2110.03352/) (2021)
- [Multi-scale Hierarchical Vision Transformer with Cascaded Attention Decoding for Medical Image Segmentation](https://mlsanity.com/paper/2303.16892/) (2023)
- [Class-Aware Adversarial Transformers for Medical Image Segmentation](https://mlsanity.com/paper/2201.10737/) (2022)
- [DC-UNet: Rethinking the U-Net Architecture with Dual Channel Efficient CNN for Medical Images Segmentation](https://mlsanity.com/paper/2006.00414/) (2020)
- [TFCNs: A CNN-Transformer Hybrid Network for Medical Image Segmentation](https://mlsanity.com/paper/2207.03450/) (2022)
- [MA-Unet: An improved version of Unet based on multi-scale and attention mechanism for medical image segmentation](https://mlsanity.com/paper/2012.10952/) (2020)
- [Cats: Complementary CNN and Transformer Encoders for Segmentation](https://mlsanity.com/paper/2208.11572/) (2022)

## Built on by (most cited first, 12 of 12)

- [Cross-Modal Conditioned Reconstruction for Language-guided Medical Image Segmentation](https://mlsanity.com/paper/2404.02845/) (2024)
- [A Recent Survey of Vision Transformers for Medical Image Segmentation](https://mlsanity.com/paper/2312.00634/) (2023)
- [Eyes on the Road: State-of-the-Art Video Question Answering Models Assessment for Traffic Monitoring Tasks](https://mlsanity.com/paper/2412.01132/) (2024)
- [LHU-Net: a Lean Hybrid U-Net for Cost-efficient, High-performance Volumetric Segmentation](https://mlsanity.com/paper/2404.05102/) (2024)
- [PraNet-V2: Dual-Supervised Reverse Attention for Medical Image Segmentation](https://mlsanity.com/paper/2504.10986/) (2025)
- [Rethinking Decoder Design: Improving Biomarker Segmentation Using Depth-to-Space Restoration and Residual Linear Attention](https://mlsanity.com/paper/2506.18335/) (2025)
- [Are Vision xLSTM Embedded UNet More Reliable in Medical 3D Image Segmentation?](https://mlsanity.com/paper/2406.16993/) (2024)
- [FusionSAM: Visual Multi-Modal Learning with Segment Anything](https://mlsanity.com/paper/2408.13980/) (2024)
- [Multi-Aperture Fusion of Transformer-Convolutional Network (MFTC-Net) for 3D Medical Image Segmentation and Visualization](https://mlsanity.com/paper/2406.17080/) (2024)
- [CLFSeg: A Fuzzy-Logic based Solution for Boundary Clarity and Uncertainty Reduction in Medical Image Segmentation](https://mlsanity.com/paper/2510.24202/) (2025)
- [APRIL-MedSeg: A Modular Medical Image Segmentation Toolbox Embracing Modern Paradigms](https://mlsanity.com/paper/2606.30577/) (2026)
- [MedCAGD: Context-Aware Gated Decoder for Efficient Medical Image Segmentation](https://mlsanity.com/paper/2607.00409/) (2026)

## Abstract (arXiv)

One of the common and promising deep learning approaches used for medical image segmentation is transformers, as they can capture long-range dependencies among the pixels by utilizing self-attention. Despite being successful in medical image segmentation, transformers face limitations in capturing local contexts of pixels in multimodal dimensions. We propose a Medical Image Segmentation Transformer (MIST) incorporating a novel Convolutional Attention Mixing (CAM) decoder to address this issue. MIST has two parts: a pre-trained multi-axis vision transformer (MaxViT) is used as an encoder, and the encoded feature representation is passed through the CAM decoder for segmenting the images. In the CAM decoder, an attention-mixer combining multi-head self-attention, spatial attention, and squeeze and excitation attention modules is introduced to capture long-range dependencies in all spatial dimensions. Moreover, to enhance spatial information gain, deep and shallow convolutions are used for feature extraction and receptive field expansion, respectively. The integration of low-level and high-level features from different network stages is enabled by skip connections, allowing MIST to suppress unnecessary information. The experiments show that our MIST transformer with CAM decoder outperforms the state-of-the-art models specifically designed for medical image segmentation on the ACDC and Synapse datasets. Our results also demonstrate that adding the CAM decoder with a hierarchical transformer improves segmentation performance significantly. Our model with data and code is publicly available on GitHub.