# Axial-Centric Cross-Plane Attention for 3D Medical Image Classification

arXiv: https://arxiv.org/abs/2602.21636 · HTML: https://mlsanity.com/paper/2602.21636/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 13 of its 29 references that are in the map.
- First posted on arXiv 25 Feb 2026.

## Builds on (most cited first, 13 of 13)

- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [Grad-CAM: Visual Explanations from Deep Networks via Gradient-based Localization](https://mlsanity.com/paper/1610.02391/) (2016)
- [MedMNIST v2 -- A large-scale lightweight benchmark for 2D and 3D biomedical image classification](https://mlsanity.com/paper/2110.14795/) (2021)
- [MedMNIST Classification Decathlon: A Lightweight AutoML Benchmark for Medical Image Analysis](https://mlsanity.com/paper/2010.14925/) (2020)
- [Polyp-SAM: Transfer SAM for Polyp Segmentation](https://mlsanity.com/paper/2305.00293/) (2023)
- [Multi-view analysis of unregistered medical images using cross-view transformers](https://mlsanity.com/paper/2103.11390/) (2021)
- [Evaluating General Purpose Vision Foundation Models for Medical Image Analysis: An Experimental Study of DINOv2 on Radiology Benchmarks](https://mlsanity.com/paper/2312.02366/) (2023)
- [MedDINOv3: How to adapt vision foundation models for medical image segmentation?](https://mlsanity.com/paper/2509.02379/) (2025)
- [Residual-based Language Models are Free Boosters for Biomedical Imaging](https://mlsanity.com/paper/2403.17343/) (2024)
- [Does DINOv3 Set a New Medical Vision Standard? Benchmarking 2D and 3D Classification, Segmentation, and Registration](https://mlsanity.com/paper/2509.06467/) (2025)
- [XFMamba: Cross-Fusion Mamba for Multi-View Medical Image Classification](https://mlsanity.com/paper/2503.02619/) (2025)
- [BSDA: Bayesian Random Semantic Data Augmentation for Medical Image Classification](https://mlsanity.com/paper/2403.06138/) (2024)
- [RICAU-Net: Residual-block Inspired Coordinate Attention U-Net for Segmentation of Small and Sparse Calcium Lesions in Cardiac CT](https://mlsanity.com/paper/2409.06993/) (2024)

## Abstract (arXiv)

Abridged: Clinicians commonly interpret 3D medical images by examining multiple anatomical planes rather than relying on volumetric views. In clinical CT workflows, the axial plane often serves as the primary diagnostic reference, while the auxiliary planes provide complementary spatial context. However, many existing 3D deep learning approaches either process volumetric data holistically or assign equal importance to all planes, failing to reflect this asymmetric, axial-centric interpretation strategy. To address this, we propose an axial-centric cross-plane attention architecture for 3D medical image classification that models asymmetric dependencies between anatomical planes. The architecture employs large-scale axial CT images pretrained MedDINOv3 as a frozen feature extractor for axial, coronal, and sagittal planes. RICA blocks and intra-plane transformer encoders capture plane-specific positional and contextual information, while axial-centric cross-plane transformer encoders selectively condition axial representations on complementary auxiliary representations. Experiments on six datasets from the MedMNIST3D benchmark show that the proposed method consistently outperforms existing 3D and multi-plane models in ACC and AUC. A lightweight variant, AC-Tiny, achieves competitive performance with substantially fewer trainable parameters, suggesting that architectural design contributes more to performance gains than increased model scale. Ablation studies further validate the importance of axial-centric querying, QKV allocation, directional cross-plane fusion, residual-free cross-attention, and classification head design. Slice-level Grad-CAM visualizations demonstrate that the model identifies diagnostically relevant regions across all planes. These findings highlight the value of aligning architectural design with clinical interpretation workflows for robust 3D medical image analysis.