Improved UNet with Attention for Medical Image Segmentation

Medical image segmentation is crucial for medical image processing and the development of computer-aided diagnostics. In recent years, deep Convolutional Neural Networks (CNNs) have been widely adopted for medical image segmentation and have achieved significant success. UNet, which is based on CNNs, is the mainstream method used for medical image segmentation. However, its performance suffers owing to its inability to capture long-range dependencies. Transformers were initially designed for Natural Language Processing (NLP), and sequence-to-sequence applications have demonstrated the ability to capture long-range dependencies. However, their abilities to acquire local information are limited. Hybrid architectures of CNNs and Transformer, such as TransUNet, have been proposed to benefit from Transformer's long-range dependencies and CNNs' low-level details. Nevertheless, automatic medical image segmentation remains a challenging task due to factors such as blurred boundaries, the low-contrast tissue environment, and in the context of ultrasound, issues like speckle noise and attenuation. In this paper, we propose a new model that combines the strengths of both CNNs and Transformer, with network architectural improvements designed to enrich the feature representation captured by the skip connections and the decoder. To this end, we devised a new attention module called Three-Level Attention (TLA). This module is composed of an Attention Gate (AG), channel attention, and spatial normalization mechanism. The AG preserves structural information, whereas channel attention helps to model the interdependencies between channels. Spatial normalization employs the spatial coefficient of the Transformer to improve spatial attention akin to TransNorm. To further improve the skip connection and reduce the semantic gap, skip connections between the encoder and decoder were redesigned in a manner similar to that of the UNet++ dense connection. Moreover, deep supervision using a side-output channel was introduced, analogous to BASNet, which was originally used for saliency predictions. Two datasets from different modalities, a CT scan dataset and an ultrasound dataset, were used to evaluate the proposed UNet architecture. The experimental results showed that our model consistently improved the prediction performance of the UNet across different datasets.