David Hagerman, Roman Naeem, Fredrik Kahlcs.CV cs.LG
Many high-performing volumetric segmentation models maintain dense multi-scale feature maps, leading to high activation memory and inference cost. We present BATS (Boundary-Aware Token Selection), a 3D medical image segmentation architecture that concentrates fine-resolution processing near predicted class boundaries. A dense boundary predictor identifies where additional resolution is needed, while a fine-first context cascade constructs an input-dependent mixed-resolution hierarchy. Homogeneous regions are represented coarsely, with finer tokens retained around boundaries, thin structures, and small targets. The sparse hierarchy is refined and rasterised into a dense segmentation. BATS predicts boundary relevance independently at every resolution level, preventing an erroneous coarse-scale decision from suppressing fine-scale evidence. Parent cluster attention further injects hierarchical ancestor tokens into local attention neighbourhoods, providing cross-scale context without dense multi-scale feature maps or cross-scale neighbour search. We evaluate BATS on five public CT and MRI datasets using the standardised nnU-Net Revisited protocol. BATS achieves the highest LiTS Dice among the compared methods and averages within 0.37 Dice points of the strongest dense baseline, MedNeXt-L, across the five datasets. Relative to MedNeXt-L, it reduces peak allocated GPU memory by more than 53% on KiTS, LiTS, and BraTS. Inference is up to 30% faster on KiTS and LiTS, which retain fewer tokens, but slower on the more token-dense BraTS. Mixed-resolution processing therefore provides consistent memory savings, while runtime and accuracy gains depend on dataset boundary density.
Diffusion models have demonstrated superior fidelity for medical image-to-image translation, but their extension to high-resolution 3D volumes is severely constrained by prohibitive computational cost and GPU memory requirements. Existing memory-efficient strategies often compromise global volumetric consistency or fine anatomical detail. In this work, we propose the Pixel Puzzling Diffusion Model (PPDM), a simple and effective framework for memory- and speed-efficient 3D medical image translation. PPDM introduces a reversible pixel puzzle-unpuzzle operator that trades spatial resolution for channel dimensionality, substantially reducing activation memory while preserving global context. To further improve efficiency and stability, we adopt a direct bridge diffusion formulation that starts from the conditional input rather than pure noise, enabling the model to focus on task-relevant residuals. In addition, a puzzle-gradient loss is incorporated to enforce spatial coherence and suppress grid-like artifacts introduced by spatial rearrangement. We evaluate PPDM on multiple challenging 3D medical image translation tasks, including low-count PET denoising, joint PET denoising and attenuation correction, and cross-modal MRI translation. Across all tasks, PPDM consistently matches or outperforms full 3D diffusion models while reducing training GPU memory usage by up to an order of magnitude and significantly accelerating inference, and it outperforms existing memory-efficient diffusion approaches based on latent compression or frequency decomposition. These results demonstrate that PPDM provides a practical and scalable solution for high-fidelity 3D diffusion-based medical image translation under limited computational resources.