# Decoding with Structured Awareness: Integrating Directional, Frequency-Spatial, and Structural Attention for Medical Image Segmentation

arXiv: https://arxiv.org/abs/2512.05494 · HTML: https://mlsanity.com/paper/2512.05494/

## Key facts

- Cited by 9 papers in the map (data through 14 Oct 2026).
- Builds on 15 of its 32 references that are in the map.
- First posted on arXiv 5 Dec 2025.

## Builds on (most cited first, 15 of 15)

- [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)
- [Very Deep Convolutional Networks for Large-Scale Image Recognition](https://mlsanity.com/paper/1409.1556/) (2014)
- [Swin Transformer: Hierarchical Vision Transformer using Shifted Windows](https://mlsanity.com/paper/2103.14030/) (2021)
- [Fully Convolutional Networks for Semantic Segmentation](https://mlsanity.com/paper/1411.4038/) (2014)
- [Going Deeper with Convolutions](https://mlsanity.com/paper/1409.4842/) (2014)
- [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)
- [SegNet: A Deep Convolutional Encoder-Decoder Architecture for Image Segmentation](https://mlsanity.com/paper/1511.00561/) (2015)
- [NDC-Scene: Boost Monocular 3D Semantic Scene Completion in Normalized Device Coordinates Space](https://mlsanity.com/paper/2309.14616/) (2023)
- [FineCIR: Explicit Parsing of Fine-Grained Modification Semantics for Composed Image Retrieval](https://mlsanity.com/paper/2503.21309/) (2025)
- [OFFSET: Segmentation-based Focus Shift Revision for Composed Image Retrieval](https://mlsanity.com/paper/2507.05631/) (2025)
- [HUD: Hierarchical Uncertainty-Aware Disambiguation Network for Composed Video Retrieval](https://mlsanity.com/paper/2512.02792/) (2025)
- [Swift Sampler: Efficient Learning of Sampler by 10 Parameters](https://mlsanity.com/paper/2410.05578/) (2024)
- [C3-OWD: A Curriculum Cross-modal Contrastive Learning Framework for Open-World Detection](https://mlsanity.com/paper/2509.23316/) (2025)

## Built on by (most cited first, 9 of 9)

- [Air-Know: Arbiter-Calibrated Knowledge-Internalizing Robust Network for Composed Image Retrieval](https://mlsanity.com/paper/2604.19386/) (2026)
- [ConeSep: Cone-based Robust Noise-Unlearning Compositional Network for Composed Image Retrieval](https://mlsanity.com/paper/2604.20358/) (2026)
- [MIS-HCC: Hierarchical Channel Clustering for Efficient Medical Image Segmentation](https://mlsanity.com/paper/2607.17329/) (2026)
- [CP-WSP: A Declarative CP-SAT Framework for Configurable Multi-Constraint Workforce Scheduling](https://mlsanity.com/paper/2607.05177/) (2026)
- [Polygon-mamba: Retinal vessel segmentation using polygon scanning mamba and space-frequency collaborative attention](https://mlsanity.com/paper/2605.10581/) (2026)
- [PESD-TSF: A Period-Aware and Explicit Structured Decomposition Framework for Long-Term Time Series Forecasting](https://mlsanity.com/paper/2605.16449/) (2026)
- [MHMamba: Multi-Head Mamba for 3D Brain Tumor Segmentation](https://mlsanity.com/paper/2605.16464/) (2026)
- [Rethinking Air-Ground Collaboration: A Progressive Cross-Task Benchmark and Socialized Learning Framework](https://mlsanity.com/paper/2606.18841/) (2026)
- [MedXplore: Towards Reliable and Unbiased Generalized Category Discovery in Medical Imaging](https://mlsanity.com/paper/2607.27620/) (2026)

## Abstract (arXiv)

To address the limitations of Transformer decoders in capturing edge details, recognizing local textures and modeling spatial continuity, this paper proposes a novel decoder framework specifically designed for medical image segmentation, comprising three core modules. First, the Adaptive Cross-Fusion Attention (ACFA) module integrates channel feature enhancement with spatial attention mechanisms and introduces learnable guidance in three directions (planar, horizontal, and vertical) to enhance responsiveness to key regions and structural orientations. Second, the Triple Feature Fusion Attention (TFFA) module fuses features from Spatial, Fourier and Wavelet domains, achieving joint frequency-spatial representation that strengthens global dependency and structural modeling while preserving local information such as edges and textures, making it particularly effective in complex and blurred boundary scenarios. Finally, the Structural-aware Multi-scale Masking Module (SMMM) optimizes the skip connections between encoder and decoder by leveraging multi-scale context and structural saliency filtering, effectively reducing feature redundancy and improving semantic interaction quality. Working synergistically, these modules not only address the shortcomings of traditional decoders but also significantly enhance performance in high-precision tasks such as tumor segmentation and organ boundary extraction, improving both segmentation accuracy and model generalization. Experimental results demonstrate that this framework provides an efficient and practical solution for medical image segmentation.