# SMAFormer: Synergistic Multi-Attention Transformer for Medical Image Segmentation

arXiv: https://arxiv.org/abs/2409.00346 · HTML: https://mlsanity.com/paper/2409.00346/

## Key facts

- Cited by 14 papers in the map (data through 14 Oct 2026).
- Builds on 51 of its 67 references that are in the map.
- First posted on arXiv 31 Aug 2024.

## Builds on (most cited first, 30 of 51)

- [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)
- [MobileNetV2: Inverted Residuals and Linear Bottlenecks](https://mlsanity.com/paper/1801.04381/) (2018)
- [Gaussian Error Linear Units (GELUs)](https://mlsanity.com/paper/1606.08415/) (2016)
- [V-Net: Fully Convolutional Neural Networks for Volumetric Medical Image Segmentation](https://mlsanity.com/paper/1606.04797/) (2016)
- [TransUNet: Transformers Make Strong Encoders for Medical Image Segmentation](https://mlsanity.com/paper/2102.04306/) (2021)
- [Inception-v4, Inception-ResNet and the Impact of Residual Connections on Learning](https://mlsanity.com/paper/1602.07261/) (2016)
- [Attention U-Net: Learning Where to Look for the Pancreas](https://mlsanity.com/paper/1804.03999/) (2018)
- [Beyond a Gaussian Denoiser: Residual Learning of Deep CNN for Image Denoising](https://mlsanity.com/paper/1608.03981/) (2016)
- [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)
- [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)
- [Multi-Stage Progressive Image Restoration](https://mlsanity.com/paper/2102.02808/) (2021)
- [UNet++: Redesigning Skip Connections to Exploit Multiscale Features in Image Segmentation](https://mlsanity.com/paper/1912.05074/) (2019)
- [The Liver Tumor Segmentation Benchmark (LiTS)](https://mlsanity.com/paper/1901.04056/) (2019)
- [Self-Supervised Pre-Training of Swin Transformers for 3D Medical Image Analysis](https://mlsanity.com/paper/2111.14791/) (2021)
- [DeblurGAN: Blind Motion Deblurring Using Conditional Adversarial Networks](https://mlsanity.com/paper/1711.07064/) (2017)
- [DeblurGAN-v2: Deblurring (Orders-of-Magnitude) Faster and Better](https://mlsanity.com/paper/1908.03826/) (2019)
- [ResUNet-a: a deep learning framework for semantic segmentation of remotely sensed data](https://mlsanity.com/paper/1904.00592/) (2019)
- [Incorporating Convolution Designs into Visual Transformers](https://mlsanity.com/paper/2103.11816/) (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)
- [Deep Stacked Hierarchical Multi-patch Network for Image Deblurring](https://mlsanity.com/paper/1904.03468/) (2019)
- [nnFormer: Interleaved Transformer for Volumetric Segmentation](https://mlsanity.com/paper/2109.03201/) (2021)
- [Neighbor2Neighbor: Self-Supervised Denoising from Single Noisy Images](https://mlsanity.com/paper/2101.02824/) (2021)
- [DS-TransUNet:Dual Swin Transformer U-Net for Medical Image Segmentation](https://mlsanity.com/paper/2106.06716/) (2021)
- [LeViT-UNet: Make Faster Encoders with Transformer for Medical Image Segmentation](https://mlsanity.com/paper/2107.08623/) (2021)

## Built on by (most cited first, 14 of 14)

- [Reversible Decoupling Network for Single Image Reflection Removal](https://mlsanity.com/paper/2410.08063/) (2024)
- [Underwater Image Restoration via Polymorphic Large Kernel CNNs](https://mlsanity.com/paper/2412.18459/) (2024)
- [High-Fidelity Document Stain Removal via A Large-Scale Real-World Dataset and A Memory-Augmented Transformer](https://mlsanity.com/paper/2410.22922/) (2024)
- [Test-Time Intensity Consistency Adaptation for Shadow Detection](https://mlsanity.com/paper/2410.07695/) (2024)
- [LensNet: An End-to-End Learning Framework for Empirical Point Spread Function Modeling and Lensless Imaging Reconstruction](https://mlsanity.com/paper/2505.01755/) (2025)
- [H3DE-Net: Efficient and Accurate 3D Landmark Detection in Medical Imaging](https://mlsanity.com/paper/2502.14221/) (2025)
- [IMAN: An Adaptive Network for Robust NPC Mortality Prediction with Missing Modalities](https://mlsanity.com/paper/2410.18551/) (2024)
- [DLEN: Dual Branch of Transformer for Low-Light Image Enhancement in Dual Domains](https://mlsanity.com/paper/2501.12235/) (2025)
- [MOSAIC: A Multi-View 2.5D Organ Slice Selector with Cross-Attentional Reasoning for Anatomically-Aware CT Localization in Medical Organ Segmentation](https://mlsanity.com/paper/2505.10672/) (2025)
- [TAGE: Trustworthy Attribute Group Editing for Stable Few-shot Image Generation](https://mlsanity.com/paper/2410.17855/) (2024)
- [SFormer: SNR-guided Transformer for Underwater Image Enhancement from the Frequency Domain](https://mlsanity.com/paper/2508.18664/) (2025)
- [A Comprehensive Analysis of Churn Prediction in Telecommunications Using Machine Learning](https://mlsanity.com/paper/2509.22654/) (2025)
- [Forestpest-YOLO: A High-Performance Detection Framework for Small Forestry Pests](https://mlsanity.com/paper/2510.00547/) (2025)
- [DTEA: Dynamic Topology Weaving and Instability-Driven Entropic Attenuation for Medical Image Segmentation](https://mlsanity.com/paper/2510.11259/) (2025)

## Abstract (arXiv)

In medical image segmentation, specialized computer vision techniques, notably transformers grounded in attention mechanisms and residual networks employing skip connections, have been instrumental in advancing performance. Nonetheless, previous models often falter when segmenting small, irregularly shaped tumors. To this end, we introduce SMAFormer, an efficient, Transformer-based architecture that fuses multiple attention mechanisms for enhanced segmentation of small tumors and organs. SMAFormer can capture both local and global features for medical image segmentation. The architecture comprises two pivotal components. First, a Synergistic Multi-Attention (SMA) Transformer block is proposed, which has the benefits of Pixel Attention, Channel Attention, and Spatial Attention for feature enrichment. Second, addressing the challenge of information loss incurred during attention mechanism transitions and feature fusion, we design a Feature Fusion Modulator. This module bolsters the integration between the channel and spatial attention by mitigating reshaping-induced information attrition. To evaluate our method, we conduct extensive experiments on various medical image segmentation tasks, including multi-organ, liver tumor, and bladder tumor segmentation, achieving state-of-the-art results. Code and models are available at: https://github.com/lzeeorno/SMAFormer.