# MedSAM-CA: A CNN-Augmented ViT with Attention-Enhanced Multi-Scale Fusion for Medical Image Segmentation

arXiv: https://arxiv.org/abs/2506.23700 · HTML: https://mlsanity.com/paper/2506.23700/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 29 of its 49 references that are in the map.
- First posted on arXiv 30 Jun 2025.

## Builds on (most cited first, 29 of 29)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [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)
- [Segment Anything](https://mlsanity.com/paper/2304.02643/) (2023)
- [Fully Convolutional Networks for Semantic Segmentation](https://mlsanity.com/paper/1411.4038/) (2014)
- [Parameter-Efficient Transfer Learning for NLP](https://mlsanity.com/paper/1902.00751/) (2019)
- [Prefix-Tuning: Optimizing Continuous Prompts for Generation](https://mlsanity.com/paper/2101.00190/) (2021)
- [Encoder-Decoder with Atrous Separable Convolution for Semantic Image Segmentation](https://mlsanity.com/paper/1802.02611/) (2018)
- [CBAM: Convolutional Block Attention Module](https://mlsanity.com/paper/1807.06521/) (2018)
- [Masked-attention Mask Transformer for Universal Image Segmentation](https://mlsanity.com/paper/2112.01527/) (2021)
- [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)
- [Rethinking Semantic Segmentation from a Sequence-to-Sequence Perspective with Transformers](https://mlsanity.com/paper/2012.15840/) (2020)
- [Tokens-to-Token ViT: Training Vision Transformers from Scratch on ImageNet](https://mlsanity.com/paper/2101.11986/) (2021)
- [Revisiting Unreasonable Effectiveness of Data in Deep Learning Era](https://mlsanity.com/paper/1707.02968/) (2017)
- [Segmenter: Transformer for Semantic Segmentation](https://mlsanity.com/paper/2105.05633/) (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)
- [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)
- [Medical SAM Adapter: Adapting Segment Anything Model for Medical Image Segmentation](https://mlsanity.com/paper/2304.12620/) (2023)
- [Self-Supervised Pre-Training of Swin Transformers for 3D Medical Image Analysis](https://mlsanity.com/paper/2111.14791/) (2021)
- [Chameleon: Plug-and-Play Compositional Reasoning with Large Language Models](https://mlsanity.com/paper/2304.09842/) (2023)
- [AMOS: A Large-Scale Abdominal Multi-Organ Benchmark for Versatile Medical Image Segmentation](https://mlsanity.com/paper/2206.08023/) (2022)
- [Attention Gated Networks: Learning to Leverage Salient Regions in Medical Images](https://mlsanity.com/paper/1808.08114/) (2018)
- [Review of Large Vision Models and Visual Prompt Engineering](https://mlsanity.com/paper/2307.00855/) (2023)
- [One-Prompt to Segment All Medical Images](https://mlsanity.com/paper/2305.10300/) (2023)
- [Self-Prompting Large Vision Models for Few-Shot Medical Image Segmentation](https://mlsanity.com/paper/2308.07624/) (2023)
- [Training Like a Medical Resident: Context-Prior Learning Toward Universal Medical Image Segmentation](https://mlsanity.com/paper/2306.02416/) (2023)
- [Foundation Models for Biomedical Image Segmentation: A Survey](https://mlsanity.com/paper/2401.07654/) (2024)
- [I-MedSAM: Implicit Medical Image Segmentation with Segment Anything](https://mlsanity.com/paper/2311.17081/) (2023)

## Abstract (arXiv)

Medical image segmentation plays a crucial role in clinical diagnosis and treatment planning, where accurate boundary delineation is essential for precise lesion localization, organ identification, and quantitative assessment. In recent years, deep learning-based methods have significantly advanced segmentation accuracy. However, two major challenges remain. First, the performance of these methods heavily relies on large-scale annotated datasets, which are often difficult to obtain in medical scenarios due to privacy concerns and high annotation costs. Second, clinically challenging scenarios, such as low contrast in certain imaging modalities and blurry lesion boundaries caused by malignancy, still pose obstacles to precise segmentation. To address these challenges, we propose MedSAM-CA, an architecture-level fine-tuning approach that mitigates reliance on extensive manual annotations by adapting the pretrained foundation model, Medical Segment Anything (MedSAM). MedSAM-CA introduces two key components: the Convolutional Attention-Enhanced Boundary Refinement Network (CBR-Net) and the Attention-Enhanced Feature Fusion Block (Atte-FFB). CBR-Net operates in parallel with the MedSAM encoder to recover boundary information potentially overlooked by long-range attention mechanisms, leveraging hierarchical convolutional processing. Atte-FFB, embedded in the MedSAM decoder, fuses multi-level fine-grained features from skip connections in CBR-Net with global representations upsampled within the decoder to enhance boundary delineation accuracy. Experiments on publicly available datasets covering dermoscopy, CT, and MRI imaging modalities validate the effectiveness of MedSAM-CA. On dermoscopy dataset, MedSAM-CA achieves 94.43% Dice with only 2% of full training data, reaching 97.25% of full-data training performance, demonstrating strong effectiveness in low-resource clinical settings.