# CC-SAM: SAM with Cross-feature Attention and Context for Ultrasound Image Segmentation

arXiv: https://arxiv.org/abs/2408.00181 · HTML: https://mlsanity.com/paper/2408.00181/

## Key facts

- Cited by 12 papers in the map (data through 14 Oct 2026).
- Builds on 36 of its 58 references that are in the map.
- First posted on arXiv 31 Jul 2024.

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

- [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)
- [Segment Anything](https://mlsanity.com/paper/2304.02643/) (2023)
- [Densely Connected Convolutional Networks](https://mlsanity.com/paper/1608.06993/) (2016)
- [Parameter-Efficient Transfer Learning for NLP](https://mlsanity.com/paper/1902.00751/) (2019)
- [Grounding DINO: Marrying DINO with Grounded Pre-Training for Open-Set Object Detection](https://mlsanity.com/paper/2303.05499/) (2023)
- [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)
- [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)
- [CLIP-Adapter: Better Vision-Language Models with Feature Adapters](https://mlsanity.com/paper/2110.04544/) (2021)
- [UNETR: Transformers for 3D Medical Image Segmentation](https://mlsanity.com/paper/2103.10504/) (2021)
- [Deep Variational Information Bottleneck](https://mlsanity.com/paper/1612.00410/) (2016)
- [LLaMA-Adapter V2: Parameter-Efficient Visual Instruction Model](https://mlsanity.com/paper/2304.15010/) (2023)
- [Medical SAM Adapter: Adapting Segment Anything Model for Medical Image Segmentation](https://mlsanity.com/paper/2304.12620/) (2023)
- [AdapterHub: A Framework for Adapting Transformers](https://mlsanity.com/paper/2007.07779/) (2020)
- [Med-BERT: pre-trained contextualized embeddings on large-scale structured electronic health records for disease prediction](https://mlsanity.com/paper/2005.12833/) (2020)
- [VL-Adapter: Parameter-Efficient Transfer Learning for Vision-and-Language Tasks](https://mlsanity.com/paper/2112.06825/) (2021)
- [Customized Segment Anything Model for Medical Image Segmentation](https://mlsanity.com/paper/2304.13785/) (2023)
- [TransFuse: Fusing Transformers and CNNs for Medical Image Segmentation](https://mlsanity.com/paper/2102.08005/) (2021)
- [Deep Learning for Segmentation using an Open Large-Scale Dataset in 2D Echocardiography](https://mlsanity.com/paper/1908.06948/) (2019)
- [CE-Net: Context Encoder Network for 2D Medical Image Segmentation](https://mlsanity.com/paper/1903.02740/) (2019)
- [ST-Adapter: Parameter-Efficient Image-to-Video Transfer Learning](https://mlsanity.com/paper/2206.13559/) (2022)
- [UNeXt: MLP-based Rapid Medical Image Segmentation Network](https://mlsanity.com/paper/2203.04967/) (2022)
- [MISSFormer: An Effective Medical Image Segmentation Transformer](https://mlsanity.com/paper/2109.07162/) (2021)
- [CA-Net: Comprehensive Attention Convolutional Neural Networks for Explainable Medical Image Segmentation](https://mlsanity.com/paper/2009.10549/) (2020)
- [SMART Frame Selection for Action Recognition](https://mlsanity.com/paper/2012.10671/) (2020)
- [SAM.MD: Zero-shot medical image segmentation capabilities of the Segment Anything Model](https://mlsanity.com/paper/2304.05396/) (2023)
- [AAU-net: An Adaptive Attention U-net for Breast Lesions Segmentation in Ultrasound Images](https://mlsanity.com/paper/2204.12077/) (2022)

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

- [TextSAM-EUS: Text Prompt Learning for SAM to Accurately Segment Pancreatic Tumor in Endoscopic Ultrasound](https://mlsanity.com/paper/2507.18082/) (2025)
- [UniUltra: Interactive Parameter-Efficient SAM2 for Universal Ultrasound Segmentation](https://mlsanity.com/paper/2511.15771/) (2025)
- [Grounding DINO-US-SAM: Text-Prompted Multi-Organ Segmentation in Ultrasound with LoRA-Tuned Vision-Language Models](https://mlsanity.com/paper/2506.23903/) (2025)
- [Distribution-Based Masked Medical Vision-Language Model Using Structured Reports](https://mlsanity.com/paper/2507.21794/) (2025)
- [BOTM: Echocardiography Segmentation via Bi-directional Optimal Token Matching](https://mlsanity.com/paper/2505.18052/) (2025)
- [Prototype-Enhanced Confidence Modeling for Cross-Modal Medical Image-Report Retrieval](https://mlsanity.com/paper/2508.03494/) (2025)
- [Multi-Sequence Parotid Gland Lesion Segmentation via Expert Text-Guided Segment Anything Model](https://mlsanity.com/paper/2508.09645/) (2025)
- [EMA-SAM: Exponential Moving-average for SAM-based PTMC Segmentation](https://mlsanity.com/paper/2510.18213/) (2025)
- [Revisiting Sharpness-Aware Minimization: A More Faithful and Effective Implementation](https://mlsanity.com/paper/2603.10048/) (2026)
- [An Edge-aware Prompt-enhanced SAM for Ultrasound Image Segmentation](https://mlsanity.com/paper/2607.07240/) (2026)
- [FreqDINO++: A Frequency-Guided Multi-Task Routing Vision Foundation Model for Universal Ultrasound Analysis](https://mlsanity.com/paper/2609.20340/) (2026)
- [ThyCLIPNet: A BiomedCLIP-Guided Lightweight Attention-Enhanced DeepLabV3+ Framework for Robust Thyroid Nodule Segmentation](https://mlsanity.com/paper/2610.04743/) (2026)

## Abstract (arXiv)

The Segment Anything Model (SAM) has achieved remarkable successes in the realm of natural image segmentation, but its deployment in the medical imaging sphere has encountered challenges. Specifically, the model struggles with medical images that feature low contrast, faint boundaries, intricate morphologies, and small-sized objects. To address these challenges and enhance SAM's performance in the medical domain, we introduce a comprehensive modification. Firstly, we incorporate a frozen Convolutional Neural Network (CNN) branch as an image encoder, which synergizes with SAM's original Vision Transformer (ViT) encoder through a novel variational attention fusion module. This integration bolsters the model's capability to capture local spatial information, which is often paramount in medical imagery. Moreover, to further optimize SAM for medical imaging, we introduce feature and position adapters within the ViT branch, refining the encoder's representations. We see that compared to current prompting strategies to fine-tune SAM for ultrasound medical segmentation, the use of text descriptions that serve as text prompts for SAM helps significantly improve the performance. Leveraging ChatGPT's natural language understanding capabilities, we generate prompts that offer contextual information and guidance to SAM, enabling it to better understand the nuances of ultrasound medical images and improve its segmentation accuracy. Our method, in its entirety, represents a significant stride towards making universal image segmentation models more adaptable and efficient in the medical domain.