Is attention all you need in medical image analysis? A review
Giorgos Papanastasiou Nikolaos Dikaios Jiahao Huang Chengjia Wang Guang Yang
Medical imaging is a key component in clinical diagnosis, treatment planning
and clinical trial design, accounting for almost 90% of all healthcare data.
CNNs achieved performance gains in medical image analysis (MIA) over the last
years. CNNs can efficiently model local pixel interactions and be trained on
small-scale MI data. The main disadvantage of typical CNN models is that they
ignore global pixel relationships within images, which limits their
generalisation ability to understand out-of-distribution data with different
'global' information. The recent progress of Artificial Intelligence gave rise
to Transformers, which can learn global relationships from data. However, full
Transformer models need to be trained on large-scale data and involve
tremendous computational complexity. Attention and Transformer compartments
(Transf/Attention) which can well maintain properties for modelling global
relationships, have been proposed as lighter alternatives of full Transformers.
Recently, there is an increasing trend to co-pollinate complementary
local-global properties from CNN and Transf/Attention architectures, which led
to a new era of hybrid models. The past years have witnessed substantial growth
in hybrid CNN-Transf/Attention models across diverse MIA problems. In this
systematic review, we survey existing hybrid CNN-Transf/Attention models,
review and unravel key architectural designs, analyse breakthroughs, and
evaluate current and future opportunities as well as challenges. We also
introduced a comprehensive analysis framework on generalisation opportunities
of scientific and clinical impact, based on which new data-driven domain
generalisation and adaptation methods can be stimulated.