Daily Papers

Transformer-based video diffusion models (VDMs) deliver state-of-the-art video generation quality but are constrained by the quadratic cost of self-attention, making long sequences and high resolutions computationally expensive. While linear attention offers sub-quadratic complexity, prior attempts fail to match the expressiveness of softmax attention without costly retraining. We introduce Attention Surgery, an efficient framework for linearizing or hybridizing attention in pretrained VDMs without training from scratch. Inspired by recent advances in language models, our method combines a novel hybrid attention mechanism-mixing softmax and linear tokens-with a lightweight distillation and fine-tuning pipeline requiring only a few GPU-days. Additionally, we incorporate a cost-aware block-rate strategy to balance expressiveness and efficiency across layers. Applied to Wan2.1 1.3B, a state-of-the-art DiT-based VDM, Attention Surgery achieves the first competitive sub-quadratic attention video diffusion models, reducing attention cost by up to 40\% in terms of FLOPs, while maintaining generation quality as measured on the standard VBench and VBench-2.0 benchmarks.

Image composition aims to seamlessly insert a user-specified object into a new scene, but existing models struggle with complex lighting (e.g., accurate shadows, water reflections) and diverse, high-resolution inputs. Modern text-to-image diffusion models (e.g., SD3.5, FLUX) already encode essential physical and resolution priors, yet lack a framework to unleash them without resorting to latent inversion, which often locks object poses into contextually inappropriate orientations, or brittle attention surgery. We propose SHINE, a training-free framework for Seamless, High-fidelity Insertion with Neutralized Errors. SHINE introduces manifold-steered anchor loss, leveraging pretrained customization adapters (e.g., IP-Adapter) to guide latents for faithful subject representation while preserving background integrity. Degradation-suppression guidance and adaptive background blending are proposed to further eliminate low-quality outputs and visible seams. To address the lack of rigorous benchmarks, we introduce ComplexCompo, featuring diverse resolutions and challenging conditions such as low lighting, strong illumination, intricate shadows, and reflective surfaces. Experiments on ComplexCompo and DreamEditBench show state-of-the-art performance on standard metrics (e.g., DINOv2) and human-aligned scores (e.g., DreamSim, ImageReward, VisionReward). Code and benchmark will be publicly available upon publication.

The surgical usage of Mixed Reality (MR) has received growing attention in areas such as surgical navigation systems, skill assessment, and robot-assisted surgeries. For such applications, pose estimation for hand and surgical instruments from an egocentric perspective is a fundamental task and has been studied extensively in the computer vision field in recent years. However, the development of this field has been impeded by a lack of datasets, especially in the surgical field, where bloody gloves and reflective metallic tools make it hard to obtain 3D pose annotations for hands and objects using conventional methods. To address this issue, we propose POV-Surgery, a large-scale, synthetic, egocentric dataset focusing on pose estimation for hands with different surgical gloves and three orthopedic surgical instruments, namely scalpel, friem, and diskplacer. Our dataset consists of 53 sequences and 88,329 frames, featuring high-resolution RGB-D video streams with activity annotations, accurate 3D and 2D annotations for hand-object pose, and 2D hand-object segmentation masks. We fine-tune the current SOTA methods on POV-Surgery and further show the generalizability when applying to real-life cases with surgical gloves and tools by extensive evaluations. The code and the dataset are publicly available at batfacewayne.github.io/POV_Surgery_io/.

Language models, while capable of generating remarkably coherent and seemingly accurate text, can occasionally produce undesirable content, including harmful or toxic outputs. In this paper, we present a new two-stage approach to detect and mitigate undesirable content generations by rectifying activations. First, we train an ensemble of layerwise classifiers to detect undesirable content using activations by minimizing a smooth surrogate of the risk-aware score. Then, for detected undesirable contents, we propose layerwise distributional steering policies that transform the attention heads. These policies are computed through principled semidefinite programming, which aims to minimally perturb the attention distribution while probabilistically guaranteeing the effectiveness of the editions. Empirical evaluations across multiple language models and datasets show that our method outperforms baselines in reducing the generation of undesirable output.

Smoke generated by surgical instruments during laparoscopic surgery can obscure the visual field, impairing surgeons' ability to perform operations accurately and safely. Thus, smoke removal task for laparoscopic images is highly desirable. Despite laparoscopic image desmoking has attracted the attention of researchers in recent years and several algorithms have emerged, the lack of publicly available high-quality benchmark datasets is the main bottleneck to hamper the development progress of this task. To advance this field, we construct a new high-quality dataset for Laparoscopic Surgery image Desmoking, named LSD3K, consisting of 3,000 paired synthetic non-homogeneous smoke images. In this paper, we provide a dataset generation pipeline, which includes modeling smoke shape using Blender, collecting ground-truth images from the Cholec80 dataset, random sampling of smoke masks and etc. Based on the proposed benchmark, we further conducted a comprehensive evaluation of the existing representative desmoking algorithms. The proposed dataset is publicly available at https://drive.google.com/file/d/1v0U5_3S4nJpaUiP898Q0pc-MfEAtnbOq/view?usp=sharing

Colonoscopy is an effective technique for detecting colorectal polyps, which are highly related to colorectal cancer. In clinical practice, segmenting polyps from colonoscopy images is of great importance since it provides valuable information for diagnosis and surgery. However, accurate polyp segmentation is a challenging task, for two major reasons: (i) the same type of polyps has a diversity of size, color and texture; and (ii) the boundary between a polyp and its surrounding mucosa is not sharp. To address these challenges, we propose a parallel reverse attention network (PraNet) for accurate polyp segmentation in colonoscopy images. Specifically, we first aggregate the features in high-level layers using a parallel partial decoder (PPD). Based on the combined feature, we then generate a global map as the initial guidance area for the following components. In addition, we mine the boundary cues using a reverse attention (RA) module, which is able to establish the relationship between areas and boundary cues. Thanks to the recurrent cooperation mechanism between areas and boundaries, our PraNet is capable of calibrating any misaligned predictions, improving the segmentation accuracy. Quantitative and qualitative evaluations on five challenging datasets across six metrics show that our PraNet improves the segmentation accuracy significantly, and presents a number of advantages in terms of generalizability, and real-time segmentation efficiency.

Accurate segmentation of thin structures is critical for microsurgical scene understanding but remains challenging due to resolution loss, low contrast, and class imbalance. We propose Microsurgery Instrument Segmentation for Robotic Assistance(MISRA), a segmentation framework that augments RGB input with luminance channels, integrates skip attention to preserve elongated features, and employs an Iterative Feedback Module(IFM) for continuity restoration across multiple passes. In addition, we introduce a dedicated microsurgical dataset with fine-grained annotations of surgical instruments including thin objects, providing a benchmark for robust evaluation Dataset available at https://huggingface.co/datasets/KIST-HARILAB/MISAW-Seg. Experiments demonstrate that MISRA achieves competitive performance, improving the mean class IoU by 5.37% over competing methods, while delivering more stable predictions at instrument contacts and overlaps. These results position MISRA as a promising step toward reliable scene parsing for computer-assisted and robotic microsurgery.

Visual Question Answering (VQA) within the surgical domain, utilizing Large Language Models (LLMs), offers a distinct opportunity to improve intra-operative decision-making and facilitate intuitive surgeon-AI interaction. However, the development of LLMs for surgical VQA is hindered by the scarcity of diverse and extensive datasets with complex reasoning tasks. Moreover, contextual fusion of the image and text modalities remains an open research challenge due to the inherent differences between these two types of information and the complexity involved in aligning them. This paper introduces PitVQA, a novel dataset specifically designed for VQA in endonasal pituitary surgery and PitVQA-Net, an adaptation of the GPT2 with a novel image-grounded text embedding for surgical VQA. PitVQA comprises 25 procedural videos and a rich collection of question-answer pairs spanning crucial surgical aspects such as phase and step recognition, context understanding, tool detection and localization, and tool-tissue interactions. PitVQA-Net consists of a novel image-grounded text embedding that projects image and text features into a shared embedding space and GPT2 Backbone with an excitation block classification head to generate contextually relevant answers within the complex domain of endonasal pituitary surgery. Our image-grounded text embedding leverages joint embedding, cross-attention and contextual representation to understand the contextual relationship between questions and surgical images. We demonstrate the effectiveness of PitVQA-Net on both the PitVQA and the publicly available EndoVis18-VQA dataset, achieving improvements in balanced accuracy of 8% and 9% over the most recent baselines, respectively. Our code and dataset is available at https://github.com/mobarakol/PitVQA.

Robotic surgical systems rely heavily on high-quality visual feedback for precise teleoperation; yet, surgical smoke from energy-based devices significantly degrades endoscopic video feeds, compromising the human-robot interface and surgical outcomes. This paper presents RGA-Net (Reciprocal Gating and Attention-fusion Network), a novel deep learning framework specifically designed for smoke removal in robotic surgery workflows. Our approach addresses the unique challenges of surgical smoke-including dense, non-homogeneous distribution and complex light scattering-through a hierarchical encoder-decoder architecture featuring two key innovations: (1) a Dual-Stream Hybrid Attention (DHA) module that combines shifted window attention with frequency-domain processing to capture both local surgical details and global illumination changes, and (2) an Axis-Decomposed Attention (ADA) module that efficiently processes multi-scale features through factorized attention mechanisms. These components are connected via reciprocal cross-gating blocks that enable bidirectional feature modulation between encoder and decoder pathways. Extensive experiments on the DesmokeData and LSD3K surgical datasets demonstrate that RGA-Net achieves superior performance in restoring visual clarity suitable for robotic surgery integration. Our method enhances the surgeon-robot interface by providing consistently clear visualization, laying a technical foundation for alleviating surgeons' cognitive burden, optimizing operation workflows, and reducing iatrogenic injury risks in minimally invasive procedures. These practical benefits could be further validated through future clinical trials involving surgeon usability assessments. The proposed framework represents a significant step toward more reliable and safer robotic surgical systems through computational vision enhancement.

The field of computer vision applied to videos of minimally invasive surgery is ever-growing. Workflow recognition pertains to the automated recognition of various aspects of a surgery: including which surgical steps are performed; and which surgical instruments are used. This information can later be used to assist clinicians when learning the surgery; during live surgery; and when writing operation notes. The Pituitary Vision (PitVis) 2023 Challenge tasks the community to step and instrument recognition in videos of endoscopic pituitary surgery. This is a unique task when compared to other minimally invasive surgeries due to the smaller working space, which limits and distorts vision; and higher frequency of instrument and step switching, which requires more precise model predictions. Participants were provided with 25-videos, with results presented at the MICCAI-2023 conference as part of the Endoscopic Vision 2023 Challenge in Vancouver, Canada, on 08-Oct-2023. There were 18-submissions from 9-teams across 6-countries, using a variety of deep learning models. A commonality between the top performing models was incorporating spatio-temporal and multi-task methods, with greater than 50% and 10% macro-F1-score improvement over purely spacial single-task models in step and instrument recognition respectively. The PitVis-2023 Challenge therefore demonstrates state-of-the-art computer vision models in minimally invasive surgery are transferable to a new dataset, with surgery specific techniques used to enhance performance, progressing the field further. Benchmark results are provided in the paper, and the dataset is publicly available at: https://doi.org/10.5522/04/26531686.

Attention mechanism has been widely believed as the key to success of vision transformers (ViTs), since it provides a flexible and powerful way to model spatial relationships. However, is the attention mechanism truly an indispensable part of ViT? Can it be replaced by some other alternatives? To demystify the role of attention mechanism, we simplify it into an extremely simple case: ZERO FLOP and ZERO parameter. Concretely, we revisit the shift operation. It does not contain any parameter or arithmetic calculation. The only operation is to exchange a small portion of the channels between neighboring features. Based on this simple operation, we construct a new backbone network, namely ShiftViT, where the attention layers in ViT are substituted by shift operations. Surprisingly, ShiftViT works quite well in several mainstream tasks, e.g., classification, detection, and segmentation. The performance is on par with or even better than the strong baseline Swin Transformer. These results suggest that the attention mechanism might not be the vital factor that makes ViT successful. It can be even replaced by a zero-parameter operation. We should pay more attentions to the remaining parts of ViT in the future work. Code is available at github.com/microsoft/SPACH.

Transformers and large language models (LLMs) have revolutionized machine learning, with attention mechanisms at the core of their success. As the landscape of attention variants expands, so too do the challenges of optimizing their performance, particularly across different hardware platforms. Current optimization strategies are often narrowly focused, requiring extensive manual intervention to accommodate changes in model configurations or hardware environments. In this paper, we introduce AttentionEngine, a comprehensive framework designed to streamline the optimization of attention mechanisms across heterogeneous hardware backends. By decomposing attention computation into modular operations with customizable components, AttentionEngine enables flexible adaptation to diverse algorithmic requirements. The framework further automates kernel optimization through a combination of programmable templates and a robust cross-platform scheduling strategy. Empirical results reveal performance gains of up to 10x on configurations beyond the reach of existing methods. AttentionEngine offers a scalable, efficient foundation for developing and deploying attention mechanisms with minimal manual tuning. Our code has been open-sourced and is available at https://github.com/microsoft/AttentionEngine.

Meningiomas are the most common type of primary brain tumor, accounting for approximately 30% of all brain tumors. A substantial number of these tumors are never surgically removed but rather monitored over time. Automatic and precise meningioma segmentation is therefore beneficial to enable reliable growth estimation and patient-specific treatment planning. In this study, we propose the inclusion of attention mechanisms over a U-Net architecture: (i) Attention-gated U-Net (AGUNet) and (ii) Dual Attention U-Net (DAUNet), using a 3D MRI volume as input. Attention has the potential to leverage the global context and identify features' relationships across the entire volume. To limit spatial resolution degradation and loss of detail inherent to encoder-decoder architectures, we studied the impact of multi-scale input and deep supervision components. The proposed architectures are trainable end-to-end and each concept can be seamlessly disabled for ablation studies. The validation studies were performed using a 5-fold cross validation over 600 T1-weighted MRI volumes from St. Olavs University Hospital, Trondheim, Norway. For the best performing architecture, an average Dice score of 81.6% was reached for an F1-score of 95.6%. With an almost perfect precision of 98%, meningiomas smaller than 3ml were occasionally missed hence reaching an overall recall of 93%. Leveraging global context from a 3D MRI volume provided the best performances, even if the native volume resolution could not be processed directly. Overall, near-perfect detection was achieved for meningiomas larger than 3ml which is relevant for clinical use. In the future, the use of multi-scale designs and refinement networks should be further investigated to improve the performance. A larger number of cases with meningiomas below 3ml might also be needed to improve the performance for the smallest tumors.

We introduce three new attention mechanisms that outperform standard multi-head attention in terms of efficiency and learning capabilities, thereby improving the performance and broader deployability of Transformer models. Our first contribution is Optimised Attention, which performs similarly to standard attention, but has 3/4 as many parameters and one matrix multiplication fewer per head. Next, we introduce Efficient Attention, which performs on par with standard attention with only 1/2 as many parameters as many parameters and two matrix multiplications fewer per head and is up to twice as fast as standard attention. Lastly, we introduce Super Attention, which surpasses standard attention by a significant margin in both vision and natural language processing tasks while having fewer parameters and matrix multiplications. In addition to providing rigorous mathematical comparisons, we evaluate the presented attention mechanisms on MNIST, CIFAR100, IMDB Movie Reviews, and Amazon Reviews datasets.

Transformer-based methods have demonstrated impressive results in medical image restoration, attributed to the multi-head self-attention (MSA) mechanism in the spatial dimension. However, the majority of existing Transformers conduct attention within fixed and coarsely partitioned regions (e.g. the entire image or fixed patches), resulting in interference from irrelevant regions and fragmentation of continuous image content. To overcome these challenges, we introduce a novel Region Attention Transformer (RAT) that utilizes a region-based multi-head self-attention mechanism (R-MSA). The R-MSA dynamically partitions the input image into non-overlapping semantic regions using the robust Segment Anything Model (SAM) and then performs self-attention within these regions. This region partitioning is more flexible and interpretable, ensuring that only pixels from similar semantic regions complement each other, thereby eliminating interference from irrelevant regions. Moreover, we introduce a focal region loss to guide our model to adaptively focus on recovering high-difficulty regions. Extensive experiments demonstrate the effectiveness of RAT in various medical image restoration tasks, including PET image synthesis, CT image denoising, and pathological image super-resolution. Code is available at https://github.com/Yaziwel/Region-Attention-Transformer-for-Medical-Image-Restoration.git{https://github.com/RAT}.

Attention is a powerful and ubiquitous mechanism for allowing neural models to focus on particular salient pieces of information by taking their weighted average when making predictions. In particular, multi-headed attention is a driving force behind many recent state-of-the-art NLP models such as Transformer-based MT models and BERT. These models apply multiple attention mechanisms in parallel, with each attention "head" potentially focusing on different parts of the input, which makes it possible to express sophisticated functions beyond the simple weighted average. In this paper we make the surprising observation that even if models have been trained using multiple heads, in practice, a large percentage of attention heads can be removed at test time without significantly impacting performance. In fact, some layers can even be reduced to a single head. We further examine greedy algorithms for pruning down models, and the potential speed, memory efficiency, and accuracy improvements obtainable therefrom. Finally, we analyze the results with respect to which parts of the model are more reliant on having multiple heads, and provide precursory evidence that training dynamics play a role in the gains provided by multi-head attention.

Integration of Vision-Language Models (VLMs) in surgical intelligence is hindered by hallucinations, domain knowledge gaps, and limited understanding of task interdependencies within surgical scenes, undermining clinical reliability. While recent VLMs demonstrate strong general reasoning and thinking capabilities, they still lack the domain expertise and task-awareness required for precise surgical scene interpretation. Although Chain-of-Thought (CoT) can structure reasoning more effectively, current approaches rely on self-generated CoT steps, which often exacerbate inherent domain gaps and hallucinations. To overcome this, we present SurgRAW, a CoT-driven multi-agent framework that delivers transparent, interpretable insights for most tasks in robotic-assisted surgery. By employing specialized CoT prompts across five tasks: instrument recognition, action recognition, action prediction, patient data extraction, and outcome assessment, SurgRAW mitigates hallucinations through structured, domain-aware reasoning. Retrieval-Augmented Generation (RAG) is also integrated to external medical knowledge to bridge domain gaps and improve response reliability. Most importantly, a hierarchical agentic system ensures that CoT-embedded VLM agents collaborate effectively while understanding task interdependencies, with a panel discussion mechanism promotes logical consistency. To evaluate our method, we introduce SurgCoTBench, the first reasoning-based dataset with structured frame-level annotations. With comprehensive experiments, we demonstrate the effectiveness of proposed SurgRAW with 29.32% accuracy improvement over baseline VLMs on 12 robotic procedures, achieving the state-of-the-art performance and advancing explainable, trustworthy, and autonomous surgical assistance.

Recent advancements in surgical computer vision have been driven by vision-only models, which lack language semantics, relying on manually annotated videos to predict fixed object categories. This limits their generalizability to unseen surgical procedures and tasks. We propose leveraging surgical video lectures from e-learning platforms to provide effective vision and language supervisory signals for multi-modal representation learning, bypassing manual annotations. We address surgery-specific linguistic challenges using multiple automatic speech recognition systems for text transcriptions. We introduce SurgVLP - Surgical Vision Language Pre-training - a novel method for multi-modal representation learning. SurgVLP employs a new contrastive learning objective, aligning video clip embeddings with corresponding multiple text embeddings in a joint latent space. We demonstrate the representational capability of this space through several vision-and-language surgical tasks and vision-only tasks specific to surgery. Unlike current fully supervised approaches, SurgVLP adapts to different surgical procedures and tasks without specific fine-tuning, achieving zero-shot adaptation to tasks such as surgical tool, phase, and triplet recognition without manual annotation. These results highlight the transferability and versatility of the learned multi-modal representations in surgical video analysis. The code is available at https://github.com/CAMMA-public/SurgVLP

This work introduces the first framework for reconstructing surgical dialogue from unstructured real-world recordings, which is crucial for characterizing teaching tasks. In surgical training, the formative verbal feedback that trainers provide to trainees during live surgeries is crucial for ensuring safety, correcting behavior immediately, and facilitating long-term skill acquisition. However, analyzing and quantifying this feedback is challenging due to its unstructured and specialized nature. Automated systems are essential to manage these complexities at scale, allowing for the creation of structured datasets that enhance feedback analysis and improve surgical education. Our framework integrates voice activity detection, speaker diarization, and automated speech recaognition, with a novel enhancement that 1) removes hallucinations (non-existent utterances generated during speech recognition fueled by noise in the operating room) and 2) separates speech from trainers and trainees using few-shot voice samples. These aspects are vital for reconstructing accurate surgical dialogues and understanding the roles of operating room participants. Using data from 33 real-world surgeries, we demonstrated the system's capability to reconstruct surgical teaching dialogues and detect feedback instances effectively (F1 score of 0.79+/-0.07). Moreover, our hallucination removal step improves feedback detection performance by ~14%. Evaluation on downstream clinically relevant tasks of predicting Behavioral Adjustment of trainees and classifying Technical feedback, showed performances comparable to manual annotations with F1 scores of 0.82+/0.03 and 0.81+/0.03 respectively. These results highlight the effectiveness of our framework in supporting clinically relevant tasks and improving over manual methods.

Recent Artificial Intelligence (AI) models have matched or exceeded human experts in several benchmarks of biomedical task performance, but have lagged behind on surgical image-analysis benchmarks. Since surgery requires integrating disparate tasks -- including multimodal data integration, human interaction, and physical effects -- generally-capable AI models could be particularly attractive as a collaborative tool if performance could be improved. On the one hand, the canonical approach of scaling architecture size and training data is attractive, especially since there are millions of hours of surgical video data generated per year. On the other hand, preparing surgical data for AI training requires significantly higher levels of professional expertise, and training on that data requires expensive computational resources. These trade-offs paint an uncertain picture of whether and to-what-extent modern AI could aid surgical practice. In this paper, we explore this question through a case study of surgical tool detection using state-of-the-art AI methods available in 2026. We demonstrate that even with multi-billion parameter models and extensive training, current Vision Language Models fall short in the seemingly simple task of tool detection in neurosurgery. Additionally, we show scaling experiments indicating that increasing model size and training time only leads to diminishing improvements in relevant performance metrics. Thus, our experiments suggest that current models could still face significant obstacles in surgical use cases. Moreover, some obstacles cannot be simply ``scaled away'' with additional compute and persist across diverse model architectures, raising the question of whether data and label availability are the only limiting factors. We discuss the main contributors to these constraints and advance potential solutions.

Surgical workflow recognition has numerous potential medical applications, such as the automatic indexing of surgical video databases and the optimization of real-time operating room scheduling, among others. As a result, phase recognition has been studied in the context of several kinds of surgeries, such as cataract, neurological, and laparoscopic surgeries. In the literature, two types of features are typically used to perform this task: visual features and tool usage signals. However, the visual features used are mostly handcrafted. Furthermore, the tool usage signals are usually collected via a manual annotation process or by using additional equipment. In this paper, we propose a novel method for phase recognition that uses a convolutional neural network (CNN) to automatically learn features from cholecystectomy videos and that relies uniquely on visual information. In previous studies, it has been shown that the tool signals can provide valuable information in performing the phase recognition task. Thus, we present a novel CNN architecture, called EndoNet, that is designed to carry out the phase recognition and tool presence detection tasks in a multi-task manner. To the best of our knowledge, this is the first work proposing to use a CNN for multiple recognition tasks on laparoscopic videos. Extensive experimental comparisons to other methods show that EndoNet yields state-of-the-art results for both tasks.

In medical image segmentation, specialized computer vision techniques, notably transformers grounded in attention mechanisms and residual networks employing skip connections, have been instrumental in advancing performance. Nonetheless, previous models often falter when segmenting small, irregularly shaped tumors. To this end, we introduce SMAFormer, an efficient, Transformer-based architecture that fuses multiple attention mechanisms for enhanced segmentation of small tumors and organs. SMAFormer can capture both local and global features for medical image segmentation. The architecture comprises two pivotal components. First, a Synergistic Multi-Attention (SMA) Transformer block is proposed, which has the benefits of Pixel Attention, Channel Attention, and Spatial Attention for feature enrichment. Second, addressing the challenge of information loss incurred during attention mechanism transitions and feature fusion, we design a Feature Fusion Modulator. This module bolsters the integration between the channel and spatial attention by mitigating reshaping-induced information attrition. To evaluate our method, we conduct extensive experiments on various medical image segmentation tasks, including multi-organ, liver tumor, and bladder tumor segmentation, achieving state-of-the-art results. Code and models are available at: https://github.com/CXH-Research/SMAFormer.

Several recent studies have demonstrated that attention-based networks, such as Vision Transformer (ViT), can outperform Convolutional Neural Networks (CNNs) on several computer vision tasks without using convolutional layers. This naturally leads to the following questions: Can a self-attention layer of ViT express any convolution operation? In this work, we prove that a single ViT layer with image patches as the input can perform any convolution operation constructively, where the multi-head attention mechanism and the relative positional encoding play essential roles. We further provide a lower bound on the number of heads for Vision Transformers to express CNNs. Corresponding with our analysis, experimental results show that the construction in our proof can help inject convolutional bias into Transformers and significantly improve the performance of ViT in low data regimes.

Human attention modelling has proven, in recent years, to be particularly useful not only for understanding the cognitive processes underlying visual exploration, but also for providing support to artificial intelligence models that aim to solve problems in various domains, including image and video processing, vision-and-language applications, and language modelling. This survey offers a reasoned overview of recent efforts to integrate human attention mechanisms into contemporary deep learning models and discusses future research directions and challenges. For a comprehensive overview on the ongoing research refer to our dedicated repository available at https://github.com/aimagelab/awesome-human-visual-attention.

Intra-operative recognition of surgical phases holds significant potential for enhancing real-time contextual awareness in the operating room. However, we argue that online recognition, while beneficial, primarily lends itself to post-operative video analysis due to its limited direct impact on the actual surgical decisions and actions during ongoing procedures. In contrast, we contend that the prediction and anticipation of surgical phases are inherently more valuable for intra-operative assistance, as they can meaningfully influence a surgeon's immediate and long-term planning by providing foresight into future steps. To address this gap, we propose a dual approach that simultaneously recognises the current surgical phase and predicts upcoming ones, thus offering comprehensive intra-operative assistance and guidance on the expected remaining workflow. Our novel method, Surgical Phase Recognition and Anticipation (SuPRA), leverages past and current information for accurate intra-operative phase recognition while using future segments for phase prediction. This unified approach challenges conventional frameworks that treat these objectives separately. We have validated SuPRA on two reputed datasets, Cholec80 and AutoLaparo21, where it demonstrated state-of-the-art performance with recognition accuracies of 91.8% and 79.3%, respectively. Additionally, we introduce and evaluate our model using new segment-level evaluation metrics, namely Edit and F1 Overlap scores, for a more temporal assessment of segment classification. In conclusion, SuPRA presents a new multi-task approach that paves the way for improved intra-operative assistance through surgical phase recognition and prediction of future events.

Attention mechanisms are a central property of cognitive systems allowing them to selectively deploy cognitive resources in a flexible manner. Attention has been long studied in the neurosciences and there are numerous phenomenological models that try to capture its core properties. Recently attentional mechanisms have become a dominating architectural choice of machine learning and are the central innovation of Transformers. The dominant intuition and formalism underlying their development has drawn on ideas of keys and queries in database management systems. In this work, we propose an alternative Bayesian foundation for attentional mechanisms and show how this unifies different attentional architectures in machine learning. This formulation allows to to identify commonality across different attention ML architectures as well as suggest a bridge to those developed in neuroscience. We hope this work will guide more sophisticated intuitions into the key properties of attention architectures and suggest new ones.

An attentional mechanism has lately been used to improve neural machine translation (NMT) by selectively focusing on parts of the source sentence during translation. However, there has been little work exploring useful architectures for attention-based NMT. This paper examines two simple and effective classes of attentional mechanism: a global approach which always attends to all source words and a local one that only looks at a subset of source words at a time. We demonstrate the effectiveness of both approaches over the WMT translation tasks between English and German in both directions. With local attention, we achieve a significant gain of 5.0 BLEU points over non-attentional systems which already incorporate known techniques such as dropout. Our ensemble model using different attention architectures has established a new state-of-the-art result in the WMT'15 English to German translation task with 25.9 BLEU points, an improvement of 1.0 BLEU points over the existing best system backed by NMT and an n-gram reranker.

Automated detection and segmentation of surgical devices, such as catheters or wires, in X-ray fluoroscopic images have the potential to enhance image guidance in minimally invasive heart surgeries. In this paper, we present a convolutional neural network model that integrates a resnet architecture with multiple prediction heads to achieve real-time, accurate localization of electrodes on catheters and catheter segmentation in an end-to-end deep learning framework. We also propose a multi-task learning strategy in which our model is trained to perform both accurate electrode detection and catheter segmentation simultaneously. A key challenge with this approach is achieving optimal performance for both tasks. To address this, we introduce a novel multi-level dynamic resource prioritization method. This method dynamically adjusts sample and task weights during training to effectively prioritize more challenging tasks, where task difficulty is inversely proportional to performance and evolves throughout the training process. Experiments on both public and private datasets have demonstrated that the accuracy of our method surpasses the existing state-of-the-art methods in both single segmentation task and in the detection and segmentation multi-task. Our approach achieves a good trade-off between accuracy and efficiency, making it well-suited for real-time surgical guidance applications.

Surgical future prediction, driven by real-time AI analysis of surgical video, is critical for operating room safety and efficiency. It provides actionable insights into upcoming events, their timing, and risks-enabling better resource allocation, timely instrument readiness, and early warnings for complications (e.g., bleeding, bile duct injury). Despite this need, current surgical AI research focuses on understanding what is happening rather than predicting future events. Existing methods target specific tasks in isolation, lacking unified approaches that span both short-term (action triplets, events) and long-term horizons (remaining surgery duration, phase transitions). These methods rely on coarse-grained supervision while fine-grained surgical action triplets and steps remain underexplored. Furthermore, methods based only on future feature prediction struggle to generalize across different surgical contexts and procedures. We address these limits by reframing surgical future prediction as state-change learning. Rather than forecasting raw observations, our approach classifies state transitions between current and future timesteps. We introduce SurgFUTR, implementing this through a teacher-student architecture. Video clips are compressed into state representations via Sinkhorn-Knopp clustering; the teacher network learns from both current and future clips, while the student network predicts future states from current videos alone, guided by our Action Dynamics (ActDyn) module. We establish SFPBench with five prediction tasks spanning short-term (triplets, events) and long-term (remaining surgery duration, phase and step transitions) horizons. Experiments across four datasets and three procedures show consistent improvements. Cross-procedure transfer validates generalizability.

The Attention mechanism is the main component of the Transformer architecture, and since its introduction, it has led to significant advancements in Deep Learning that span many domains and multiple tasks. The Attention Mechanism was utilized in Computer Vision as the Vision Transformer ViT, and its usage has expanded into many tasks in the vision domain, such as classification, segmentation, object detection, and image generation. While this mechanism is very expressive and capable, it comes with the drawback of being computationally expensive and requiring datasets of considerable size for effective optimization. To address these shortcomings, many designs have been proposed in the literature to reduce the computational burden and alleviate the data size requirements. Examples of such attempts in the vision domain are the MLP-Mixer, the Conv-Mixer, the Perciver-IO, and many more. This paper introduces a new computational block as an alternative to the standard ViT block that reduces the compute burdens by replacing the normal Attention layers with a Network in Network structure that enhances the static approach of the MLP Mixer with a dynamic system of learning an element-wise gating function by a token mixing process. Extensive experimentation shows that the proposed design provides better performance than the baseline architectures on multiple datasets applied in the image classification task of the vision domain.

Surgical scene segmentation is critical in computer-assisted surgery and is vital for enhancing surgical quality and patient outcomes. Recently, referring surgical segmentation is emerging, given its advantage of providing surgeons with an interactive experience to segment the target object. However, existing methods are limited by low efficiency and short-term tracking, hindering their applicability in complex real-world surgical scenarios. In this paper, we introduce ReSurgSAM2, a two-stage surgical referring segmentation framework that leverages Segment Anything Model 2 to perform text-referred target detection, followed by tracking with reliable initial frame identification and diversity-driven long-term memory. For the detection stage, we propose a cross-modal spatial-temporal Mamba to generate precise detection and segmentation results. Based on these results, our credible initial frame selection strategy identifies the reliable frame for the subsequent tracking. Upon selecting the initial frame, our method transitions to the tracking stage, where it incorporates a diversity-driven memory mechanism that maintains a credible and diverse memory bank, ensuring consistent long-term tracking. Extensive experiments demonstrate that ReSurgSAM2 achieves substantial improvements in accuracy and efficiency compared to existing methods, operating in real-time at 61.2 FPS. Our code and datasets will be available at https://github.com/jinlab-imvr/ReSurgSAM2.

Surgical scene perception via videos are critical for advancing robotic surgery, telesurgery, and AI-assisted surgery, particularly in ophthalmology. However, the scarcity of diverse and richly annotated video datasets has hindered the development of intelligent systems for surgical workflow analysis. Existing datasets for surgical workflow analysis, which typically face challenges such as small scale, a lack of diversity in surgery and phase categories, and the absence of time-localized annotations, limit the requirements for action understanding and model generalization validation in complex and diverse real-world surgical scenarios. To address this gap, we introduce OphNet, a large-scale, expert-annotated video benchmark for ophthalmic surgical workflow understanding. OphNet features: 1) A diverse collection of 2,278 surgical videos spanning 66 types of cataract, glaucoma, and corneal surgeries, with detailed annotations for 102 unique surgical phases and 150 granular operations; 2) It offers sequential and hierarchical annotations for each surgery, phase, and operation, enabling comprehensive understanding and improved interpretability; 3) Moreover, OphNet provides time-localized annotations, facilitating temporal localization and prediction tasks within surgical workflows. With approximately 205 hours of surgical videos, OphNet is about 20 times larger than the largest existing surgical workflow analysis benchmark. Our dataset and code have been made available at: https://github.com/minghu0830/OphNet-benchmark.

Attention Model has now become an important concept in neural networks that has been researched within diverse application domains. This survey provides a structured and comprehensive overview of the developments in modeling attention. In particular, we propose a taxonomy which groups existing techniques into coherent categories. We review salient neural architectures in which attention has been incorporated, and discuss applications in which modeling attention has shown a significant impact. We also describe how attention has been used to improve the interpretability of neural networks. Finally, we discuss some future research directions in attention. We hope this survey will provide a succinct introduction to attention models and guide practitioners while developing approaches for their applications.

In recent years, the landscape of computer-assisted interventions and post-operative surgical video analysis has been dramatically reshaped by deep-learning techniques, resulting in significant advancements in surgeons' skills, operation room management, and overall surgical outcomes. However, the progression of deep-learning-powered surgical technologies is profoundly reliant on large-scale datasets and annotations. Particularly, surgical scene understanding and phase recognition stand as pivotal pillars within the realm of computer-assisted surgery and post-operative assessment of cataract surgery videos. In this context, we present the largest cataract surgery video dataset that addresses diverse requisites for constructing computerized surgical workflow analysis and detecting post-operative irregularities in cataract surgery. We validate the quality of annotations by benchmarking the performance of several state-of-the-art neural network architectures for phase recognition and surgical scene segmentation. Besides, we initiate the research on domain adaptation for instrument segmentation in cataract surgery by evaluating cross-domain instrument segmentation performance in cataract surgery videos. The dataset and annotations will be publicly available upon acceptance of the paper.

While deep learning and deep reinforcement learning (RL) systems have demonstrated impressive results in domains such as image classification, game playing, and robotic control, data efficiency remains a major challenge. Multi-task learning has emerged as a promising approach for sharing structure across multiple tasks to enable more efficient learning. However, the multi-task setting presents a number of optimization challenges, making it difficult to realize large efficiency gains compared to learning tasks independently. The reasons why multi-task learning is so challenging compared to single-task learning are not fully understood. In this work, we identify a set of three conditions of the multi-task optimization landscape that cause detrimental gradient interference, and develop a simple yet general approach for avoiding such interference between task gradients. We propose a form of gradient surgery that projects a task's gradient onto the normal plane of the gradient of any other task that has a conflicting gradient. On a series of challenging multi-task supervised and multi-task RL problems, this approach leads to substantial gains in efficiency and performance. Further, it is model-agnostic and can be combined with previously-proposed multi-task architectures for enhanced performance.

To mitigate the computational complexity in the self-attention mechanism on long sequences, linear attention utilizes computation tricks to achieve linear complexity, while state space models (SSMs) popularize a favorable practice of using non-data-dependent memory pattern, i.e., emphasize the near and neglect the distant, to processing sequences. Recent studies have shown the priorities by combining them as one. However, the efficiency of linear attention remains only at the theoretical level in a causal setting, and SSMs require various designed constraints to operate effectively on specific data. Therefore, in order to unveil the true power of the hybrid design, the following two issues need to be addressed: (1) hardware-efficient implementation for linear attention and (2) stabilization of SSMs. To achieve this, we leverage the thought of tiling and hierarchy to propose CHELA (short-long Convolutions with Hardware-Efficient Linear Attention), which replaces SSMs with short-long convolutions and implements linear attention in a divide-and-conquer manner. This approach enjoys global abstraction and data-dependent selection from stable SSM and linear attention while maintaining real linear complexity. Our comprehensive experiments on the Long Range Arena benchmark and language modeling tasks demonstrate the effectiveness of the proposed method.

We present Lightning Attention, the first linear attention implementation that maintains a constant training speed for various sequence lengths under fixed memory consumption. Due to the issue with cumulative summation operations (cumsum), previous linear attention implementations cannot achieve their theoretical advantage in a casual setting. However, this issue can be effectively solved by utilizing different attention calculation strategies to compute the different parts of attention. Specifically, we split the attention calculation into intra-blocks and inter-blocks and use conventional attention computation for intra-blocks and linear attention kernel tricks for inter-blocks. This eliminates the need for cumsum in the linear attention calculation. Furthermore, a tiling technique is adopted through both forward and backward procedures to take full advantage of the GPU hardware. To enhance accuracy while preserving efficacy, we introduce TransNormerLLM (TNL), a new architecture that is tailored to our lightning attention. We conduct rigorous testing on standard and self-collected datasets with varying model sizes and sequence lengths. TNL is notably more efficient than other language models. In addition, benchmark results indicate that TNL performs on par with state-of-the-art LLMs utilizing conventional transformer structures. The source code is released at github.com/OpenNLPLab/TransnormerLLM.

In recent years, medical information technology has made it possible for electronic health record (EHR) to store fairly complete clinical data. This has brought health care into the era of "big data". However, medical data are often sparse and strongly correlated, which means that medical problems cannot be solved effectively. With the rapid development of deep learning in recent years, it has provided opportunities for the use of big data in healthcare. In this paper, we propose a temporal-saptial correlation attention network (TSCAN) to handle some clinical characteristic prediction problems, such as predicting death, predicting length of stay, detecting physiologic decline, and classifying phenotypes. Based on the design of the attention mechanism model, our approach can effectively remove irrelevant items in clinical data and irrelevant nodes in time according to different tasks, so as to obtain more accurate prediction results. Our method can also find key clinical indicators of important outcomes that can be used to improve treatment options. Our experiments use information from the Medical Information Mart for Intensive Care (MIMIC-IV) database, which is open to the public. Finally, we have achieved significant performance benefits of 2.0\% (metric) compared to other SOTA prediction methods. We achieved a staggering 90.7\% on mortality rate, 45.1\% on length of stay. The source code can be find: https://github.com/yuyuheintju/TSCAN.

Vision transformer (ViT) expands the success of transformer models from sequential data to images. The model decomposes an image into many smaller patches and arranges them into a sequence. Multi-head self-attentions are then applied to the sequence to learn the attention between patches. Despite many successful interpretations of transformers on sequential data, little effort has been devoted to the interpretation of ViTs, and many questions remain unanswered. For example, among the numerous attention heads, which one is more important? How strong are individual patches attending to their spatial neighbors in different heads? What attention patterns have individual heads learned? In this work, we answer these questions through a visual analytics approach. Specifically, we first identify what heads are more important in ViTs by introducing multiple pruning-based metrics. Then, we profile the spatial distribution of attention strengths between patches inside individual heads, as well as the trend of attention strengths across attention layers. Third, using an autoencoder-based learning solution, we summarize all possible attention patterns that individual heads could learn. Examining the attention strengths and patterns of the important heads, we answer why they are important. Through concrete case studies with experienced deep learning experts on multiple ViTs, we validate the effectiveness of our solution that deepens the understanding of ViTs from head importance, head attention strength, and head attention pattern.

Magnetic resonance imaging (MRI) is a crucial tool to identify brain abnormalities in a wide range of neurological disorders. In focal epilepsy MRI is used to identify structural cerebral abnormalities. For covert lesions, machine learning and artificial intelligence algorithms may improve lesion detection if abnormalities are not evident on visual inspection. The success of this approach depends on the volume and quality of training data. Herein, we release an open-source dataset of preprocessed MRI scans from 442 individuals with drug-refractory focal epilepsy who had neurosurgical resections, and detailed demographic information. The MRI scan data includes the preoperative 3D T1 and where available 3D FLAIR, as well as a manually inspected complete surface reconstruction and volumetric parcellations. Demographic information includes age, sex, age of onset of epilepsy, location of surgery, histopathology of resected specimen, occurrence and frequency of focal seizures with and without impairment of awareness, focal to bilateral tonic-clonic seizures, number of anti-seizure medications (ASMs) at time of surgery, and a total of 1764 patient years of post-surgical follow up. Crucially, we also include resection masks delineated from post-surgical imaging. To demonstrate the veracity of our data, we successfully replicated previous studies showing long-term outcomes of seizure freedom in the range of around 50%. Our imaging data replicates findings of group level atrophy in patients compared to controls. Resection locations in the cohort were predominantly in the temporal and frontal lobes. We envisage our dataset, shared openly with the community, will catalyse the development and application of computational methods in clinical neurology.

While the Transformer architecture has become the de-facto standard for natural language processing tasks, its applications to computer vision remain limited. In vision, attention is either applied in conjunction with convolutional networks, or used to replace certain components of convolutional networks while keeping their overall structure in place. We show that this reliance on CNNs is not necessary and a pure transformer applied directly to sequences of image patches can perform very well on image classification tasks. When pre-trained on large amounts of data and transferred to multiple mid-sized or small image recognition benchmarks (ImageNet, CIFAR-100, VTAB, etc.), Vision Transformer (ViT) attains excellent results compared to state-of-the-art convolutional networks while requiring substantially fewer computational resources to train.

Convolutional neural networks have allowed remarkable advances in single image super-resolution (SISR) over the last decade. Among recent advances in SISR, attention mechanisms are crucial for high-performance SR models. However, the attention mechanism remains unclear on why and how it works in SISR. In this work, we attempt to quantify and visualize attention mechanisms in SISR and show that not all attention modules are equally beneficial. We then propose attention in attention network (A^2N) for more efficient and accurate SISR. Specifically, A^2N consists of a non-attention branch and a coupling attention branch. A dynamic attention module is proposed to generate weights for these two branches to suppress unwanted attention adjustments dynamically, where the weights change adaptively according to the input features. This allows attention modules to specialize to beneficial examples without otherwise penalties and thus greatly improve the capacity of the attention network with few parameters overhead. Experimental results demonstrate that our final model A^2N could achieve superior trade-off performances comparing with state-of-the-art networks of similar sizes. Codes are available at https://github.com/haoyuc/A2N.

We propose a novel attention mechanism, named Cog Attention, that enables attention weights to be negative for enhanced expressiveness, which stems from two key factors: (1) Cog Attention can shift the token deletion and copying function from a static OV matrix to dynamic QK inner products, with the OV matrix now focusing more on refinement or modification. The attention head can simultaneously delete, copy, or retain tokens by assigning them negative, positive, or minimal attention weights, respectively. As a result, a single attention head becomes more flexible and expressive. (2) Cog Attention improves the model's robustness against representational collapse, which can occur when earlier tokens are over-squashed into later positions, leading to homogeneous representations. Negative weights reduce effective information paths from earlier to later tokens, helping to mitigate this issue. We develop Transformer-like models which use Cog Attention as attention modules, including decoder-only models for language modeling and U-ViT diffusion models for image generation. Experiments show that models using Cog Attention exhibit superior performance compared to those employing traditional softmax attention modules. Our approach suggests a promising research direction for rethinking and breaking the entrenched constraints of traditional softmax attention, such as the requirement for non-negative weights.

Neuroimage processing tasks like segmentation, reconstruction, and registration are central to the study of neuroscience. Robust deep learning strategies and architectures used to solve these tasks are often similar. Yet, when presented with a new task or a dataset with different visual characteristics, practitioners most often need to train a new model, or fine-tune an existing one. This is a time-consuming process that poses a substantial barrier for the thousands of neuroscientists and clinical researchers who often lack the resources or machine-learning expertise to train deep learning models. In practice, this leads to a lack of adoption of deep learning, and neuroscience tools being dominated by classical frameworks. We introduce Neuralizer, a single model that generalizes to previously unseen neuroimaging tasks and modalities without the need for re-training or fine-tuning. Tasks do not have to be known a priori, and generalization happens in a single forward pass during inference. The model can solve processing tasks across multiple image modalities, acquisition methods, and datasets, and generalize to tasks and modalities it has not been trained on. Our experiments on coronal slices show that when few annotated subjects are available, our multi-task network outperforms task-specific baselines without training on the task.

Multi-task learning (MTL) compresses the information from multiple tasks into a unified backbone to improve computational efficiency and generalization. Recent work directly merges multiple independently trained models to perform MTL instead of collecting their raw data for joint training, greatly expanding the application scenarios of MTL. However, by visualizing the representation distribution of existing model merging schemes, we find that the merged model often suffers from the dilemma of representation bias. That is, there is a significant discrepancy in the representation distribution between the merged and individual models, resulting in poor performance of merged MTL. In this paper, we propose a representation surgery solution called "Surgery" to reduce representation bias in the merged model. Specifically, Surgery is a lightweight task-specific module that takes the representation of the merged model as input and attempts to output the biases contained in the representation from the merged model. We then designed an unsupervised optimization objective that updates the Surgery module by minimizing the distance between the merged model's representation and the individual model's representation. Extensive experiments demonstrate significant MTL performance improvements when our Surgery module is applied to state-of-the-art (SOTA) model merging schemes.

Visual search is important in our daily life. The efficient allocation of visual attention is critical to effectively complete visual search tasks. Prior research has predominantly modelled the spatial allocation of visual attention in images at the pixel level, e.g. using a saliency map. However, emerging evidence shows that visual attention is guided by objects rather than pixel intensities. This paper introduces the Object-level Attention Transformer (OAT), which predicts human scanpaths as they search for a target object within a cluttered scene of distractors. OAT uses an encoder-decoder architecture. The encoder captures information about the position and appearance of the objects within an image and about the target. The decoder predicts the gaze scanpath as a sequence of object fixations, by integrating output features from both the encoder and decoder. We also propose a new positional encoding that better reflects spatial relationships between objects. We evaluated OAT on the Amazon book cover dataset and a new dataset for visual search that we collected. OAT's predicted gaze scanpaths align more closely with human gaze patterns, compared to predictions by algorithms based on spatial attention on both established metrics and a novel behavioural-based metric. Our results demonstrate the generalization ability of OAT, as it accurately predicts human scanpaths for unseen layouts and target objects.

Conversation agents powered by large language models are revolutionizing the way we interact with visual data. Recently, large vision-language models (LVLMs) have been extensively studied for both images and videos. However, these studies typically focus on common scenarios. In this work, we introduce an LVLM specifically designed for surgical scenarios. We integrate visual representations of surgical images and videos into the language feature space. Consequently, we establish a LVLM model, Surgical-LLaVA, fine-tuned on instruction following data of surgical scenarios. Our experiments demonstrate that Surgical-LLaVA exhibits impressive multi-modal chat abilities in surgical contexts, occasionally displaying multi-modal behaviors on unseen instructions. We conduct a quantitative evaluation of visual question-answering datasets for surgical scenarios. The results show superior performance compared to previous works, indicating the potential of our model to tackle more complex surgery scenarios.

Attention-based mechanisms are widely used in machine learning, most prominently in transformers. However, hyperparameters such as the rank of the attention matrices and the number of heads are scaled nearly the same way in all realizations of this architecture, without theoretical justification. In this work we show that there are dramatic trade-offs between the rank and number of heads of the attention mechanism. Specifically, we present a simple and natural target function that can be represented using a single full-rank attention head for any context length, but that cannot be approximated by low-rank attention unless the number of heads is exponential in the embedding dimension, even for short context lengths. Moreover, we prove that, for short context lengths, adding depth allows the target to be approximated by low-rank attention. For long contexts, we conjecture that full-rank attention is necessary. Finally, we present experiments with off-the-shelf transformers that validate our theoretical findings.

Cortical visual prostheses aim to restore sight by electrically stimulating neurons in early visual cortex (V1). With the emergence of high-density and flexible neural interfaces, electrode placement within three-dimensional cortex has become a critical surgical planning problem. Existing strategies emphasize visual field coverage and anatomical heuristics but do not directly optimize predicted perceptual outcomes under safety constraints. We present a percept-aware framework for surgical planning of cortical visual prostheses that formulates electrode placement as a constrained optimization problem in anatomical space. Electrode coordinates are treated as learnable parameters and optimized end-to-end using a differentiable forward model of prosthetic vision. The objective minimizes task-level perceptual error while incorporating vascular avoidance and gray matter feasibility constraints. Evaluated on simulated reading and natural image tasks using realistic folded cortical geometry (FreeSurfer fsaverage), percept-aware optimization consistently improves reconstruction fidelity relative to coverage-based placement strategies. Importantly, vascular safety constraints eliminate margin violations while preserving perceptual performance. The framework further enables co-optimization of multi-electrode thread configurations under fixed insertion budgets. These results demonstrate how differentiable percept models can inform anatomically grounded, safety-aware computer-assisted planning for cortical neural interfaces and provide a foundation for optimizing next-generation visual prostheses.

Vision Transformers (ViT) have shown their competitive advantages performance-wise compared to convolutional neural networks (CNNs) though they often come with high computational costs. To this end, previous methods explore different attention patterns by limiting a fixed number of spatially nearby tokens to accelerate the ViT's multi-head self-attention (MHSA) operations. However, such structured attention patterns limit the token-to-token connections to their spatial relevance, which disregards learned semantic connections from a full attention mask. In this work, we propose a novel approach to learn instance-dependent attention patterns, by devising a lightweight connectivity predictor module to estimate the connectivity score of each pair of tokens. Intuitively, two tokens have high connectivity scores if the features are considered relevant either spatially or semantically. As each token only attends to a small number of other tokens, the binarized connectivity masks are often very sparse by nature and therefore provide the opportunity to accelerate the network via sparse computations. Equipped with the learned unstructured attention pattern, sparse attention ViT (Sparsifiner) produces a superior Pareto-optimal trade-off between FLOPs and top-1 accuracy on ImageNet compared to token sparsity. Our method reduces 48% to 69% FLOPs of MHSA while the accuracy drop is within 0.4%. We also show that combining attention and token sparsity reduces ViT FLOPs by over 60%.

Surgical practice involves complex visual interpretation, procedural skills, and advanced medical knowledge, making surgical vision-language pretraining (VLP) particularly challenging due to this complexity and the limited availability of annotated data. To address the gap, we propose OphCLIP, a hierarchical retrieval-augmented vision-language pretraining framework specifically designed for ophthalmic surgical workflow understanding. OphCLIP leverages the OphVL dataset we constructed, a large-scale and comprehensive collection of over 375K hierarchically structured video-text pairs with tens of thousands of different combinations of attributes (surgeries, phases/operations/actions, instruments, medications, as well as more advanced aspects like the causes of eye diseases, surgical objectives, and postoperative recovery recommendations, etc). These hierarchical video-text correspondences enable OphCLIP to learn both fine-grained and long-term visual representations by aligning short video clips with detailed narrative descriptions and full videos with structured titles, capturing intricate surgical details and high-level procedural insights, respectively. Our OphCLIP also designs a retrieval-augmented pretraining framework to leverage the underexplored large-scale silent surgical procedure videos, automatically retrieving semantically relevant content to enhance the representation learning of narrative videos. Evaluation across 11 datasets for phase recognition and multi-instrument identification shows OphCLIP's robust generalization and superior performance.

In this paper, we propose a novel text promptable surgical instrument segmentation approach to overcome challenges associated with diversity and differentiation of surgical instruments in minimally invasive surgeries. We redefine the task as text promptable, thereby enabling a more nuanced comprehension of surgical instruments and adaptability to new instrument types. Inspired by recent advancements in vision-language models, we leverage pretrained image and text encoders as our model backbone and design a text promptable mask decoder consisting of attention- and convolution-based prompting schemes for surgical instrument segmentation prediction. Our model leverages multiple text prompts for each surgical instrument through a new mixture of prompts mechanism, resulting in enhanced segmentation performance. Additionally, we introduce a hard instrument area reinforcement module to improve image feature comprehension and segmentation precision. Extensive experiments on EndoVis2017 and EndoVis2018 datasets demonstrate our model's superior performance and promising generalization capability. To our knowledge, this is the first implementation of a promptable approach to surgical instrument segmentation, offering significant potential for practical application in the field of robotic-assisted surgery.

In this work, we upgrade the multi-head attention mechanism, the core of the Transformer model, to improve efficiency while maintaining or surpassing the previous accuracy level. We show that multi-head attention can be expressed in the summation form. Drawing on the insight that not all attention heads hold equal significance, we propose Mixture-of-Head attention (MoH), a new architecture that treats attention heads as experts in the Mixture-of-Experts (MoE) mechanism. MoH has two significant advantages: First, MoH enables each token to select the appropriate attention heads, enhancing inference efficiency without compromising accuracy or increasing the number of parameters. Second, MoH replaces the standard summation in multi-head attention with a weighted summation, introducing flexibility to the attention mechanism and unlocking extra performance potential. Extensive experiments on ViT, DiT, and LLMs demonstrate that MoH outperforms multi-head attention by using only 50%-90% of the attention heads. Moreover, we demonstrate that pre-trained multi-head attention models, such as LLaMA3-8B, can be further continue-tuned into our MoH models. Notably, MoH-LLaMA3-8B achieves an average accuracy of 64.0% across 14 benchmarks, outperforming LLaMA3-8B by 2.4% by utilizing only 75% of the attention heads. We believe the proposed MoH is a promising alternative to multi-head attention and provides a strong foundation for developing advanced and efficient attention-based models.

Even though convolutional neural networks (CNNs) are driving progress in medical image segmentation, standard models still have some drawbacks. First, the use of multi-scale approaches, i.e., encoder-decoder architectures, leads to a redundant use of information, where similar low-level features are extracted multiple times at multiple scales. Second, long-range feature dependencies are not efficiently modeled, resulting in non-optimal discriminative feature representations associated with each semantic class. In this paper we attempt to overcome these limitations with the proposed architecture, by capturing richer contextual dependencies based on the use of guided self-attention mechanisms. This approach is able to integrate local features with their corresponding global dependencies, as well as highlight interdependent channel maps in an adaptive manner. Further, the additional loss between different modules guides the attention mechanisms to neglect irrelevant information and focus on more discriminant regions of the image by emphasizing relevant feature associations. We evaluate the proposed model in the context of semantic segmentation on three different datasets: abdominal organs, cardiovascular structures and brain tumors. A series of ablation experiments support the importance of these attention modules in the proposed architecture. In addition, compared to other state-of-the-art segmentation networks our model yields better segmentation performance, increasing the accuracy of the predictions while reducing the standard deviation. This demonstrates the efficiency of our approach to generate precise and reliable automatic segmentations of medical images. Our code is made publicly available at https://github.com/sinAshish/Multi-Scale-Attention

Large multimodal models (LMMs) "see" images by leveraging the attention mechanism between text and visual tokens in the transformer decoder. Ideally, these models should focus on key visual information relevant to the text token. However, recent findings indicate that LMMs have an extraordinary tendency to consistently allocate high attention weights to specific visual tokens, even when these tokens are irrelevant to the corresponding text. In this study, we investigate the property behind the appearance of these irrelevant visual tokens and examine their characteristics. Our findings show that this behavior arises due to the massive activation of certain hidden state dimensions, which resembles the attention sink found in language models. Hence, we refer to this phenomenon as the visual attention sink. In particular, our analysis reveals that removing the irrelevant visual sink tokens does not impact model performance, despite receiving high attention weights. Consequently, we recycle the attention to these tokens as surplus resources, redistributing the attention budget to enhance focus on the image. To achieve this, we introduce Visual Attention Redistribution (VAR), a method that redistributes attention in image-centric heads, which we identify as innately focusing on visual information. VAR can be seamlessly applied across different LMMs to improve performance on a wide range of tasks, including general vision-language tasks, visual hallucination tasks, and vision-centric tasks, all without the need for additional training, models, or inference steps. Experimental results demonstrate that VAR enables LMMs to process visual information more effectively by adjusting their internal attention mechanisms, offering a new direction to enhancing the multimodal capabilities of LMMs.

Quantification of real-time informal feedback delivered by an experienced surgeon to a trainee during surgery is important for skill improvements in surgical training. Such feedback in the live operating room is inherently multimodal, consisting of verbal conversations (e.g., questions and answers) as well as non-verbal elements (e.g., through visual cues like pointing to anatomic elements). In this work, we leverage a clinically-validated five-category classification of surgical feedback: "Anatomic", "Technical", "Procedural", "Praise" and "Visual Aid". We then develop a multi-label machine learning model to classify these five categories of surgical feedback from inputs of text, audio, and video modalities. The ultimate goal of our work is to help automate the annotation of real-time contextual surgical feedback at scale. Our automated classification of surgical feedback achieves AUCs ranging from 71.5 to 77.6 with the fusion improving performance by 3.1%. We also show that high-quality manual transcriptions of feedback audio from experts improve AUCs to between 76.5 and 96.2, which demonstrates a clear path toward future improvements. Empirically, we find that the Staged training strategy, with first pre-training each modality separately and then training them jointly, is more effective than training different modalities altogether. We also present intuitive findings on the importance of modalities for different feedback categories. This work offers an important first look at the feasibility of automated classification of real-world live surgical feedback based on text, audio, and video modalities.

In some medical imaging tasks and other settings where only small parts of the image are informative for the classification task, traditional CNNs can sometimes struggle to generalise. Manually annotated Regions of Interest (ROI) are sometimes used to isolate the most informative parts of the image. However, these are expensive to collect and may vary significantly across annotators. To overcome these issues, we propose a framework that employs saliency maps to obtain soft spatial attention masks that modulate the image features at different scales. We refer to our method as Adversarial Counterfactual Attention (ACAT). ACAT increases the baseline classification accuracy of lesions in brain CT scans from 71.39% to 72.55% and of COVID-19 related findings in lung CT scans from 67.71% to 70.84% and exceeds the performance of competing methods. We investigate the best way to generate the saliency maps employed in our architecture and propose a way to obtain them from adversarially generated counterfactual images. They are able to isolate the area of interest in brain and lung CT scans without using any manual annotations. In the task of localising the lesion location out of 6 possible regions, they obtain a score of 65.05% on brain CT scans, improving the score of 61.29% obtained with the best competing method.

The multi-task learning (MTL) paradigm aims to simultaneously learn multiple tasks within a single model capturing higher-level, more general hidden patterns that are shared by the tasks. In deep learning, a significant challenge in the backpropagation training process is the design of advanced optimisers to improve the convergence speed and stability of the gradient descent learning rule. In particular, in multi-task deep learning (MTDL) the multitude of tasks may generate potentially conflicting gradients that would hinder the concurrent convergence of the diverse loss functions. This challenge arises when the gradients of the task objectives have either different magnitudes or opposite directions, causing one or a few to dominate or to interfere with each other, thus degrading the training process. Gradient surgery methods address the problem explicitly dealing with conflicting gradients by adjusting the overall gradient trajectory. This work introduces a novel gradient surgery method, the Similarity-Aware Momentum Gradient Surgery (SAM-GS), which provides an effective and scalable approach based on a gradient magnitude similarity measure to guide the optimisation process. The SAM-GS surgery adopts gradient equalisation and modulation of the first-order momentum. A series of experimental tests have shown the effectiveness of SAM-GS on synthetic problems and MTL benchmarks. Gradient magnitude similarity plays a crucial role in regularising gradient aggregation in MTDL for the optimisation of the learning process.

We introduce Adaptive Filter Attention (AFA), a novel attention mechanism that incorporates a learnable dynamics model directly into the computation of attention weights. Rather than comparing queries and keys directly, we model the input sequence as discrete observations of a linear stochastic differential equation (SDE). By imposing a linear dynamics model with simultaneously diagonalizable state matrices and noise covariances, we can make use of a closed-form solution to the differential Lyapunov equation to efficiently propagate pairwise uncertainties through the dynamics. Attention naturally arises as the maximum likelihood solution for this linear SDE, with attention weights corresponding to robust residual-based reweightings of the propagated pairwise precisions. Imposing an additional constraint on the state matrix's eigenvalues leads to a simplified variant with the same computational and memory complexity as standard attention. In the limit of vanishing dynamics and process noise, and using a small-angle approximation, we recover ordinary dot-product attention.

Operating rooms (ORs) demand precise coordination among surgeons, nurses, and equipment in a fast-paced, occlusion-heavy environment, necessitating advanced perception models to enhance safety and efficiency. Existing datasets either provide partial egocentric views or sparse exocentric multi-view context, but do not explore the comprehensive combination of both. We introduce EgoExOR, the first OR dataset and accompanying benchmark to fuse first-person and third-person perspectives. Spanning 94 minutes (84,553 frames at 15 FPS) of two emulated spine procedures, Ultrasound-Guided Needle Insertion and Minimally Invasive Spine Surgery, EgoExOR integrates egocentric data (RGB, gaze, hand tracking, audio) from wearable glasses, exocentric RGB and depth from RGB-D cameras, and ultrasound imagery. Its detailed scene graph annotations, covering 36 entities and 22 relations (568,235 triplets), enable robust modeling of clinical interactions, supporting tasks like action recognition and human-centric perception. We evaluate the surgical scene graph generation performance of two adapted state-of-the-art models and offer a new baseline that explicitly leverages EgoExOR's multimodal and multi-perspective signals. This new dataset and benchmark set a new foundation for OR perception, offering a rich, multimodal resource for next-generation clinical perception.

Convolutional Neural Networks (CNNs) have advanced existing medical systems for automatic disease diagnosis. However, there are still concerns about the reliability of deep medical diagnosis systems against the potential threats of adversarial attacks since inaccurate diagnosis could lead to disastrous consequences in the safety realm. In this study, we propose a highly robust yet efficient CNN-Transformer hybrid model which is equipped with the locality of CNNs as well as the global connectivity of vision Transformers. To mitigate the high quadratic complexity of the self-attention mechanism while jointly attending to information in various representation subspaces, we construct our attention mechanism by means of an efficient convolution operation. Moreover, to alleviate the fragility of our Transformer model against adversarial attacks, we attempt to learn smoother decision boundaries. To this end, we augment the shape information of an image in the high-level feature space by permuting the feature mean and variance within mini-batches. With less computational complexity, our proposed hybrid model demonstrates its high robustness and generalization ability compared to the state-of-the-art studies on a large-scale collection of standardized MedMNIST-2D datasets.

Multi-head attentive neural architectures have achieved state-of-the-art results on a variety of natural language processing tasks. Evidence has shown that they are overparameterized; attention heads can be pruned without significant performance loss. In this work, we instead "reallocate" them -- the model learns to activate different heads on different inputs. Drawing connections between multi-head attention and mixture of experts, we propose the mixture of attentive experts model (MAE). MAE is trained using a block coordinate descent algorithm that alternates between updating (1) the responsibilities of the experts and (2) their parameters. Experiments on machine translation and language modeling show that MAE outperforms strong baselines on both tasks. Particularly, on the WMT14 English to German translation dataset, MAE improves over "transformer-base" by 0.8 BLEU, with a comparable number of parameters. Our analysis shows that our model learns to specialize different experts to different inputs.

Vision transformer has emerged as a new paradigm in computer vision, showing excellent performance while accompanied by expensive computational cost. Image token pruning is one of the main approaches for ViT compression, due to the facts that the complexity is quadratic with respect to the token number, and many tokens containing only background regions do not truly contribute to the final prediction. Existing works either rely on additional modules to score the importance of individual tokens, or implement a fixed ratio pruning strategy for different input instances. In this work, we propose an adaptive sparse token pruning framework with a minimal cost. Specifically, we firstly propose an inexpensive attention head importance weighted class attention scoring mechanism. Then, learnable parameters are inserted as thresholds to distinguish informative tokens from unimportant ones. By comparing token attention scores and thresholds, we can discard useless tokens hierarchically and thus accelerate inference. The learnable thresholds are optimized in budget-aware training to balance accuracy and complexity, performing the corresponding pruning configurations for different input instances. Extensive experiments demonstrate the effectiveness of our approach. Our method improves the throughput of DeiT-S by 50% and brings only 0.2% drop in top-1 accuracy, which achieves a better trade-off between accuracy and latency than the previous methods.

Multi-head self-attention (MHSA) is a key component of Transformers, a widely popular architecture in both language and vision. Multiple heads intuitively enable different parallel processes over the same input. Yet, they also obscure the attribution of each input patch to the output of a model. We propose a novel 1-head Transformer Attention Bottleneck (TAB) layer, inserted after the traditional MHSA architecture, to serve as an attention bottleneck for interpretability and intervention. Unlike standard self-attention, TAB constrains the total attention over all patches to in [0, 1]. That is, when the total attention is 0, no visual information is propagated further into the network and the vision-language model (VLM) would default to a generic, image-independent response. To demonstrate the advantages of TAB, we train VLMs with TAB to perform image difference captioning. Over three datasets, our models perform similarly to baseline VLMs in captioning but the bottleneck is superior in localizing changes and in identifying when no changes occur. TAB is the first architecture to enable users to intervene by editing attention, which often produces expected outputs by VLMs.

Transformers have shown superior performance on various vision tasks. Their large receptive field endows Transformer models with higher representation power than their CNN counterparts. Nevertheless, simply enlarging the receptive field also raises several concerns. On the one hand, using dense attention in ViT leads to excessive memory and computational cost, and features can be influenced by irrelevant parts that are beyond the region of interests. On the other hand, the handcrafted attention adopted in PVT or Swin Transformer is data agnostic and may limit the ability to model long-range relations. To solve this dilemma, we propose a novel deformable multi-head attention module, where the positions of key and value pairs in self-attention are adaptively allocated in a data-dependent way. This flexible scheme enables the proposed deformable attention to dynamically focus on relevant regions while maintains the representation power of global attention. On this basis, we present Deformable Attention Transformer (DAT), a general vision backbone efficient and effective for visual recognition. We further build an enhanced version DAT++. Extensive experiments show that our DAT++ achieves state-of-the-art results on various visual recognition benchmarks, with 85.9% ImageNet accuracy, 54.5 and 47.0 MS-COCO instance segmentation mAP, and 51.5 ADE20K semantic segmentation mIoU.

Attention mechanisms are ubiquitous components in neural architectures applied to natural language processing. In addition to yielding gains in predictive accuracy, attention weights are often claimed to confer interpretability, purportedly useful both for providing insights to practitioners and for explaining why a model makes its decisions to stakeholders. We call the latter use of attention mechanisms into question by demonstrating a simple method for training models to produce deceptive attention masks. Our method diminishes the total weight assigned to designated impermissible tokens, even when the models can be shown to nevertheless rely on these features to drive predictions. Across multiple models and tasks, our approach manipulates attention weights while paying surprisingly little cost in accuracy. Through a human study, we show that our manipulated attention-based explanations deceive people into thinking that predictions from a model biased against gender minorities do not rely on the gender. Consequently, our results cast doubt on attention's reliability as a tool for auditing algorithms in the context of fairness and accountability.

While Attention has come to be an important mechanism in deep learning, there remains limited intuition for why it works so well. Here, we show that Transformer Attention can be closely related under certain data conditions to Kanerva's Sparse Distributed Memory (SDM), a biologically plausible associative memory model. We confirm that these conditions are satisfied in pre-trained GPT2 Transformer models. We discuss the implications of the Attention-SDM map and provide new computational and biological interpretations of Attention.

Research on autonomous surgery has largely focused on simple task automation in controlled environments. However, real-world surgical applications demand dexterous manipulation over extended durations and generalization to the inherent variability of human tissue. These challenges remain difficult to address using existing logic-based or conventional end-to-end learning approaches. To address this gap, we propose a hierarchical framework for performing dexterous, long-horizon surgical steps. Our approach utilizes a high-level policy for task planning and a low-level policy for generating robot trajectories. The high-level planner plans in language space, generating task-level or corrective instructions that guide the robot through the long-horizon steps and correct for the low-level policy's errors. We validate our framework through ex vivo experiments on cholecystectomy, a commonly-practiced minimally invasive procedure, and conduct ablation studies to evaluate key components of the system. Our method achieves a 100\% success rate across eight unseen ex vivo gallbladders, operating fully autonomously without human intervention. This work demonstrates step-level autonomy in a surgical procedure, marking a milestone toward clinical deployment of autonomous surgical systems.

We propose a novel attention gate (AG) model for medical imaging that automatically learns to focus on target structures of varying shapes and sizes. Models trained with AGs implicitly learn to suppress irrelevant regions in an input image while highlighting salient features useful for a specific task. This enables us to eliminate the necessity of using explicit external tissue/organ localisation modules of cascaded convolutional neural networks (CNNs). AGs can be easily integrated into standard CNN architectures such as the U-Net model with minimal computational overhead while increasing the model sensitivity and prediction accuracy. The proposed Attention U-Net architecture is evaluated on two large CT abdominal datasets for multi-class image segmentation. Experimental results show that AGs consistently improve the prediction performance of U-Net across different datasets and training sizes while preserving computational efficiency. The code for the proposed architecture is publicly available.

Transformers have become the de facto standard for a wide range of tasks, from image classification to physics simulations. Despite their impressive performance, the quadratic complexity of standard Transformers in both memory and time with respect to the input length makes them impractical for processing high-resolution inputs. Therefore, several variants have been proposed, the most successful relying on patchification, downsampling, or coarsening techniques, often at the cost of losing the finest-scale details. In this work, we take a different approach. Inspired by state-of-the-art techniques in n-body numerical simulations, we cast attention as an interaction problem between grid points. We introduce the Multipole Attention Neural Operator (MANO), which computes attention in a distance-based multiscale fashion. MANO maintains, in each attention head, a global receptive field and achieves linear time and memory complexity with respect to the number of grid points. Empirical results on image classification and Darcy flows demonstrate that MANO rivals state-of-the-art models such as ViT and Swin Transformer, while reducing runtime and peak memory usage by orders of magnitude. We open source our code for reproducibility at https://github.com/AlexColagrande/MANO.

Although attention mechanisms have been applied to a variety of deep learning models and have been shown to improve the prediction performance, it has been reported to be vulnerable to perturbations to the mechanism. To overcome the vulnerability to perturbations in the mechanism, we are inspired by adversarial training (AT), which is a powerful regularization technique for enhancing the robustness of the models. In this paper, we propose a general training technique for natural language processing tasks, including AT for attention (Attention AT) and more interpretable AT for attention (Attention iAT). The proposed techniques improved the prediction performance and the model interpretability by exploiting the mechanisms with AT. In particular, Attention iAT boosts those advantages by introducing adversarial perturbation, which enhances the difference in the attention of the sentences. Evaluation experiments with ten open datasets revealed that AT for attention mechanisms, especially Attention iAT, demonstrated (1) the best performance in nine out of ten tasks and (2) more interpretable attention (i.e., the resulting attention correlated more strongly with gradient-based word importance) for all tasks. Additionally, the proposed techniques are (3) much less dependent on perturbation size in AT. Our code is available at https://github.com/shunk031/attention-meets-perturbation

Automatic diabetic retinopathy (DR) lesions segmentation makes great sense of assisting ophthalmologists in diagnosis. Although many researches have been conducted on this task, most prior works paid too much attention to the designs of networks instead of considering the pathological association for lesions. Through investigating the pathogenic causes of DR lesions in advance, we found that certain lesions are closed to specific vessels and present relative patterns to each other. Motivated by the observation, we propose a relation transformer block (RTB) to incorporate attention mechanisms at two main levels: a self-attention transformer exploits global dependencies among lesion features, while a cross-attention transformer allows interactions between lesion and vessel features by integrating valuable vascular information to alleviate ambiguity in lesion detection caused by complex fundus structures. In addition, to capture the small lesion patterns first, we propose a global transformer block (GTB) which preserves detailed information in deep network. By integrating the above blocks of dual-branches, our network segments the four kinds of lesions simultaneously. Comprehensive experiments on IDRiD and DDR datasets well demonstrate the superiority of our approach, which achieves competitive performance compared to state-of-the-arts.

Transformer-based Large Language Models (LLMs) are the state-of-the-art for natural language tasks. Recent work has attempted to decode, by reverse engineering the role of linear layers, the internal mechanisms by which LLMs arrive at their final predictions for text completion tasks. Yet little is known about the specific role of attention heads in producing the final token prediction. We propose Attention Lens, a tool that enables researchers to translate the outputs of attention heads into vocabulary tokens via learned attention-head-specific transformations called lenses. Preliminary findings from our trained lenses indicate that attention heads play highly specialized roles in language models. The code for Attention Lens is available at github.com/msakarvadia/AttentionLens.

In this paper, we introduce a novel Multi-Modal Contrastive Pre-training Framework that synergistically combines X-rays, electrocardiograms (ECGs), and radiology/cardiology reports. Our approach leverages transformers to encode these diverse modalities into a unified representation space, aiming to enhance diagnostic accuracy and facilitate comprehensive patient assessments. We utilize LoRA-Peft to significantly reduce trainable parameters in the LLM and incorporate recent linear attention dropping strategy in the Vision Transformer(ViT) for smoother attention. Furthermore, we provide novel multimodal attention explanations and retrieval for our model. To the best of our knowledge, we are the first to propose an integrated model that combines X-ray, ECG, and Radiology/Cardiology Report with this approach. By utilizing contrastive loss, MoRE effectively aligns modality-specific features into a coherent embedding, which supports various downstream tasks such as zero-shot classification and multimodal retrieval. Employing our proposed methodology, we achieve state-of-the-art (SOTA) on the Mimic-IV, CheXpert, Edema Severity, and PtbXl downstream datasets, surpassing existing multimodal approaches. Our proposed framework shows significant improvements in capturing intricate inter-modal relationships and its robustness in medical diagnosis that establishes a framework for future research in multimodal learning in the healthcare sector.

Recent advances in robot-assisted surgery have resulted in progressively more precise, efficient, and minimally invasive procedures, sparking a new era of robotic surgical intervention. This enables doctors, in collaborative interaction with robots, to perform traditional or minimally invasive surgeries with improved outcomes through smaller incisions. Recent efforts are working toward making robotic surgery more autonomous which has the potential to reduce variability of surgical outcomes and reduce complication rates. Deep reinforcement learning methodologies offer scalable solutions for surgical automation, but their effectiveness relies on extensive data acquisition due to the absence of prior knowledge in successfully accomplishing tasks. Due to the intensive nature of simulated data collection, previous works have focused on making existing algorithms more efficient. In this work, we focus on making the simulator more efficient, making training data much more accessible than previously possible. We introduce Surgical Gym, an open-source high performance platform for surgical robot learning where both the physics simulation and reinforcement learning occur directly on the GPU. We demonstrate between 100-5000x faster training times compared with previous surgical learning platforms. The code is available at: https://github.com/SamuelSchmidgall/SurgicalGym.

Large Language Models (LLMs) have been demonstrated effective for code generation. Due to the complexity and opacity of LLMs, little is known about how these models generate code. To deepen our understanding, we investigate whether LLMs attend to the same parts of a natural language description as human programmers during code generation. An analysis of five LLMs on a popular benchmark, HumanEval, revealed a consistent misalignment between LLMs' and programmers' attention. Furthermore, we found that there is no correlation between the code generation accuracy of LLMs and their alignment with human programmers. Through a quantitative experiment and a user study, we confirmed that, among twelve different attention computation methods, attention computed by the perturbation-based method is most aligned with human attention and is constantly favored by human programmers. Our findings highlight the need for human-aligned LLMs for better interpretability and programmer trust.

Vision Transformers (ViTs) have gained significant popularity in recent years and have proliferated into many applications. However, their behavior under different learning paradigms is not well explored. We compare ViTs trained through different methods of supervision, and show that they learn a diverse range of behaviors in terms of their attention, representations, and downstream performance. We also discover ViT behaviors that are consistent across supervision, including the emergence of Offset Local Attention Heads. These are self-attention heads that attend to a token adjacent to the current token with a fixed directional offset, a phenomenon that to the best of our knowledge has not been highlighted in any prior work. Our analysis shows that ViTs are highly flexible and learn to process local and global information in different orders depending on their training method. We find that contrastive self-supervised methods learn features that are competitive with explicitly supervised features, and they can even be superior for part-level tasks. We also find that the representations of reconstruction-based models show non-trivial similarity to contrastive self-supervised models. Project website (https://www.cs.umd.edu/~sakshams/vit_analysis) and code (https://www.github.com/mwalmer-umd/vit_analysis) are publicly available.

Effectively utilizing multi-sensory data is important for robots to generalize across diverse tasks. However, the heterogeneous nature of these modalities makes fusion challenging. Existing methods propose strategies to obtain comprehensively fused features but often ignore the fact that each modality requires different levels of attention at different manipulation stages. To address this, we propose a force-guided attention fusion module that adaptively adjusts the weights of visual and tactile features without human labeling. We also introduce a self-supervised future force prediction auxiliary task to reinforce the tactile modality, improve data imbalance, and encourage proper adjustment. Our method achieves an average success rate of 93% across three fine-grained, contactrich tasks in real-world experiments. Further analysis shows that our policy appropriately adjusts attention to each modality at different manipulation stages. The videos can be viewed at https://adaptac-dex.github.io/.

In this paper, we present a novel approach for incorporating external knowledge in Recurrent Neural Networks (RNNs). We propose the integration of lexicon features into the self-attention mechanism of RNN-based architectures. This form of conditioning on the attention distribution, enforces the contribution of the most salient words for the task at hand. We introduce three methods, namely attentional concatenation, feature-based gating and affine transformation. Experiments on six benchmark datasets show the effectiveness of our methods. Attentional feature-based gating yields consistent performance improvement across tasks. Our approach is implemented as a simple add-on module for RNN-based models with minimal computational overhead and can be adapted to any deep neural architecture.

Surgical robot automation has attracted increasing research interest over the past decade, expecting its potential to benefit surgeons, nurses and patients. Recently, the learning paradigm of embodied intelligence has demonstrated promising ability to learn good control policies for various complex tasks, where embodied AI simulators play an essential role to facilitate relevant research. However, existing open-sourced simulators for surgical robot are still not sufficiently supporting human interactions through physical input devices, which further limits effective investigations on how the human demonstrations would affect policy learning. In this work, we study human-in-the-loop embodied intelligence with a new interactive simulation platform for surgical robot learning. Specifically, we establish our platform based on our previously released SurRoL simulator with several new features co-developed to allow high-quality human interaction via an input device. We showcase the improvement of our simulation environment with the designed new features, and validate effectiveness of incorporating human factors in embodied intelligence through the use of human demonstrations and reinforcement learning as a representative example. Promising results are obtained in terms of learning efficiency. Lastly, five new surgical robot training tasks are developed and released, with which we hope to pave the way for future research on surgical embodied intelligence. Our learning platform is publicly released and will be continuously updated in the website: https://med-air.github.io/SurRoL.

Humans do not passively observe the visual world -- we actively look in order to act. Motivated by this principle, we introduce EyeRobot, a robotic system with gaze behavior that emerges from the need to complete real-world tasks. We develop a mechanical eyeball that can freely rotate to observe its surroundings and train a gaze policy to control it using reinforcement learning. We accomplish this by first collecting teleoperated demonstrations paired with a 360 camera. This data is imported into a simulation environment that supports rendering arbitrary eyeball viewpoints, allowing episode rollouts of eye gaze on top of robot demonstrations. We then introduce a BC-RL loop to train the hand and eye jointly: the hand (BC) agent is trained from rendered eye observations, and the eye (RL) agent is rewarded when the hand produces correct action predictions. In this way, hand-eye coordination emerges as the eye looks towards regions which allow the hand to complete the task. EyeRobot implements a foveal-inspired policy architecture allowing high resolution with a small compute budget, which we find also leads to the emergence of more stable fixation as well as improved ability to track objects and ignore distractors. We evaluate EyeRobot on five panoramic workspace manipulation tasks requiring manipulation in an arc surrounding the robot arm. Our experiments suggest EyeRobot exhibits hand-eye coordination behaviors which effectively facilitate manipulation over large workspaces with a single camera. See project site for videos: https://www.eyerobot.net/

Understanding the workflow of surgical procedures in complex operating rooms requires a deep understanding of the interactions between clinicians and their environment. Surgical activity recognition (SAR) is a key computer vision task that detects activities or phases from multi-view camera recordings. Existing SAR models often fail to account for fine-grained clinician movements and multi-view knowledge, or they require calibrated multi-view camera setups and advanced point-cloud processing to obtain better results. In this work, we propose a novel calibration-free multi-view multi-modal pretraining framework called Multiview Pretraining for Video-Pose Surgical Activity Recognition PreViPS, which aligns 2D pose and vision embeddings across camera views. Our model follows CLIP-style dual-encoder architecture: one encoder processes visual features, while the other encodes human pose embeddings. To handle the continuous 2D human pose coordinates, we introduce a tokenized discrete representation to convert the continuous 2D pose coordinates into discrete pose embeddings, thereby enabling efficient integration within the dual-encoder framework. To bridge the gap between these two modalities, we propose several pretraining objectives using cross- and in-modality geometric constraints within the embedding space and incorporating masked pose token prediction strategy to enhance representation learning. Extensive experiments and ablation studies demonstrate improvements over the strong baselines, while data-efficiency experiments on two distinct operating room datasets further highlight the effectiveness of our approach. We highlight the benefits of our approach for surgical activity recognition in both multi-view and single-view settings, showcasing its practical applicability in complex surgical environments. Code will be made available at: https://github.com/CAMMA-public/PreViPS.

In ophthalmic surgery, developing an AI system capable of interpreting surgical videos and predicting subsequent operations requires numerous ophthalmic surgical videos with high-quality annotations, which are difficult to collect due to privacy concerns and labor consumption. Text-guided video generation (T2V) emerges as a promising solution to overcome this issue by generating ophthalmic surgical videos based on surgeon instructions. In this paper, we present Ophora, a pioneering model that can generate ophthalmic surgical videos following natural language instructions. To construct Ophora, we first propose a Comprehensive Data Curation pipeline to convert narrative ophthalmic surgical videos into a large-scale, high-quality dataset comprising over 160K video-instruction pairs, Ophora-160K. Then, we propose a Progressive Video-Instruction Tuning scheme to transfer rich spatial-temporal knowledge from a T2V model pre-trained on natural video-text datasets for privacy-preserved ophthalmic surgical video generation based on Ophora-160K. Experiments on video quality evaluation via quantitative analysis and ophthalmologist feedback demonstrate that Ophora can generate realistic and reliable ophthalmic surgical videos based on surgeon instructions. We also validate the capability of Ophora for empowering downstream tasks of ophthalmic surgical workflow understanding. Code is available at https://github.com/mar-cry/Ophora.

Building AI models with trustworthiness is important especially in regulated areas such as healthcare. In tackling COVID-19, previous work uses convolutional neural networks as the backbone architecture, which has shown to be prone to over-caution and overconfidence in making decisions, rendering them less trustworthy -- a crucial flaw in the context of medical imaging. In this study, we propose a feature learning approach using Vision Transformers, which use an attention-based mechanism, and examine the representation learning capability of Transformers as a new backbone architecture for medical imaging. Through the task of classifying COVID-19 chest radiographs, we investigate into whether generalization capabilities benefit solely from Vision Transformers' architectural advances. Quantitative and qualitative evaluations are conducted on the trustworthiness of the models, through the use of "trust score" computation and a visual explainability technique. We conclude that the attention-based feature learning approach is promising in building trustworthy deep learning models for healthcare.

The field of surgical computer vision has undergone considerable breakthroughs in recent years with the rising popularity of deep neural network-based methods. However, standard fully-supervised approaches for training such models require vast amounts of annotated data, imposing a prohibitively high cost; especially in the clinical domain. Self-Supervised Learning (SSL) methods, which have begun to gain traction in the general computer vision community, represent a potential solution to these annotation costs, allowing to learn useful representations from only unlabeled data. Still, the effectiveness of SSL methods in more complex and impactful domains, such as medicine and surgery, remains limited and unexplored. In this work, we address this critical need by investigating four state-of-the-art SSL methods (MoCo v2, SimCLR, DINO, SwAV) in the context of surgical computer vision. We present an extensive analysis of the performance of these methods on the Cholec80 dataset for two fundamental and popular tasks in surgical context understanding, phase recognition and tool presence detection. We examine their parameterization, then their behavior with respect to training data quantities in semi-supervised settings. Correct transfer of these methods to surgery, as described and conducted in this work, leads to substantial performance gains over generic uses of SSL - up to 7.4% on phase recognition and 20% on tool presence detection - as well as state-of-the-art semi-supervised phase recognition approaches by up to 14%. Further results obtained on a highly diverse selection of surgical datasets exhibit strong generalization properties. The code is available at https://github.com/CAMMA-public/SelfSupSurg.

Medical image analysis continues to hold interesting challenges given the subtle characteristics of certain diseases and the significant overlap in appearance between diseases. In this work, we explore the concept of self-attention for tackling such subtleties in and between diseases. To this end, we introduce MEDUSA, a multi-scale encoder-decoder self-attention mechanism tailored for medical image analysis. While self-attention deep convolutional neural network architectures in existing literature center around the notion of multiple isolated lightweight attention mechanisms with limited individual capacities being incorporated at different points in the network architecture, MEDUSA takes a significant departure from this notion by possessing a single, unified self-attention mechanism with significantly higher capacity with multiple attention heads feeding into different scales in the network architecture. To the best of the authors' knowledge, this is the first "single body, multi-scale heads" realization of self-attention and enables explicit global context amongst selective attention at different levels of representational abstractions while still enabling differing local attention context at individual levels of abstractions. With MEDUSA, we obtain state-of-the-art performance on multiple challenging medical image analysis benchmarks including COVIDx, RSNA RICORD, and RSNA Pneumonia Challenge when compared to previous work. Our MEDUSA model is publicly available.

Adaptive learning systems optimize content delivery based on performance metrics but ignore the dynamic attention fluctuations that characterize neurodivergent learners. We present AttentionGuard, a framework that detects engagement-attention states from privacy-preserving behavioral signals and adapts interface elements accordingly. Our approach models four attention states derived from ADHD phenomenology and implements five novel UI adaptation patterns including bi-directional scaffolding that responds to both understimulation and overstimulation. We validate our detection model on the OULAD dataset, achieving 87.3% classification accuracy, and demonstrate correlation with clinical ADHD profiles through cross-validation on the HYPERAKTIV dataset. A Wizard-of-Oz study with 11 adults showing ADHD characteristics found significantly reduced cognitive load in the adaptive condition (NASA-TLX: 47.2 vs 62.8, Cohen's d=1.21, p=0.008) and improved comprehension (78.4% vs 61.2%, p=0.009). Concordance analysis showed 84% agreement between wizard decisions and automated classifier predictions, supporting deployment feasibility. The system is presented as an interactive demo where observers can inspect detected attention states, observe real-time UI adaptations, and compare automated decisions with human-in-the-loop overrides. We contribute empirically validated UI patterns for attention-adaptive interfaces and evidence that behavioral attention detection can meaningfully support neurodivergent learning experiences.

The quadratic computation complexity of self-attention has been a persistent challenge when applying Transformer models to vision tasks. Linear attention, on the other hand, offers a much more efficient alternative with its linear complexity by approximating the Softmax operation through carefully designed mapping functions. However, current linear attention approaches either suffer from significant performance degradation or introduce additional computation overhead from the mapping functions. In this paper, we propose a novel Focused Linear Attention module to achieve both high efficiency and expressiveness. Specifically, we first analyze the factors contributing to the performance degradation of linear attention from two perspectives: the focus ability and feature diversity. To overcome these limitations, we introduce a simple yet effective mapping function and an efficient rank restoration module to enhance the expressiveness of self-attention while maintaining low computation complexity. Extensive experiments show that our linear attention module is applicable to a variety of advanced vision Transformers, and achieves consistently improved performances on multiple benchmarks. Code is available at https://github.com/LeapLabTHU/FLatten-Transformer.

Unneeded elements in the attention's context degrade performance. We introduce Selective Attention, a simple parameter-free change to the standard attention mechanism which reduces attention to unneeded elements. Selective attention improves language modeling performance in a variety of model sizes and context lengths. For example, a range of transformers trained with the language modeling objective on C4 with selective attention perform equivalently to standard transformers with ~2X more heads and parameters in their attention modules. Selective attention also allows decreasing the size of the attention's context buffer, leading to meaningful reductions in the memory and compute requirements during inference. For example, transformers with 100M parameters trained on C4 with context sizes of 512, 1,024, and 2,048 need 16X, 25X, and 47X less memory for their attention module, respectively, when equipped with selective attention, as those without selective attention, with the same validation perplexity.

We present a very simple algorithm for attention that requires O(1) memory with respect to sequence length and an extension to self-attention that requires O(log n) memory. This is in contrast with the frequently stated belief that self-attention requires O(n^2) memory. While the time complexity is still O(n^2), device memory rather than compute capability is often the limiting factor on modern accelerators. Thus, reducing the memory requirements of attention allows processing of longer sequences than might otherwise be feasible. We provide a practical implementation for accelerators that requires O(n) memory, is numerically stable, and is within a few percent of the runtime of the standard implementation of attention. We also demonstrate how to differentiate the function while remaining memory-efficient. For sequence length 16384, the memory overhead of self-attention is reduced by 59X for inference and by 32X for differentiation.

Modern deep learning systems are typically deployed as open-loop function approximators: they map inputs to outputs in a single pass, without regulating how much computation or explanatory effort is spent on a given case. In safety-critical settings, this is brittle: easy and ambiguous inputs receive identical processing, and uncertainty is only read off retrospectively from raw probabilities. We introduce the Surgical Cognitive Interpreter (SCI), a lightweight closed-loop metacognitive control layer that wraps an existing stochastic model and turns prediction into an iterative process. SCI monitors a scalar interpretive state SP(t), here instantiated as a normalized entropy-based confidence signal, and adaptively decides whether to stop, continue sampling, or abstain. The goal is not to improve accuracy per se, but to regulate interpretive error ΔSP and expose a safety signal that tracks when the underlying model is likely to fail. We instantiate SCI around Monte Carlo dropout classifiers in three domains: vision (MNIST digits), medical time series (MIT-BIH arrhythmia), and industrial condition monitoring (rolling-element bearings). In all cases, the controller allocates more inference steps to misclassified inputs than to correct ones (up to about 3-4x on MNIST and bearings, and 1.4x on MIT-BIH). The resulting ΔSP acts as a usable safety signal for detecting misclassifications (AUROC 0.63 on MNIST, 0.70 on MIT-BIH, 0.86 on bearings). Code and reproducibility: https://github.com/vishal-1344/sci

Multimodal large language models (MLLMs) recently showed strong capacity in integrating data among multiple modalities, empowered by a generalizable attention architecture. Advanced methods predominantly focus on language-centric tuning while less exploring multimodal tokens mixed through attention, posing challenges in high-level tasks that require fine-grained cognition and emotion understanding. In this work, we identify the attention deficit disorder problem in multimodal learning, caused by inconsistent cross-modal attention and layer-by-layer decayed attention activation. To address this, we propose a novel attention mechanism, termed MOdular Duplex Attention (MODA), simultaneously conducting the inner-modal refinement and inter-modal interaction. MODA employs a correct-after-align strategy to effectively decouple modality alignment from cross-layer token mixing. In the alignment phase, tokens are mapped to duplex modality spaces based on the basis vectors, enabling the interaction between visual and language modality. Further, the correctness of attention scores is ensured through adaptive masked attention, which enhances the model's flexibility by allowing customizable masking patterns for different modalities. Extensive experiments on 21 benchmark datasets verify the effectiveness of MODA in perception, cognition, and emotion tasks. Source code and demo are available in https://zzcheng.top/MODA.

The rapid increase in the number of Computed Tomography (CT) scan examinations has created an urgent need for automated tools, such as organ segmentation, anomaly classification, and report generation, to assist radiologists with their growing workload. Multi-label classification of Three-Dimensional (3D) CT scans is a challenging task due to the volumetric nature of the data and the variety of anomalies to be detected. Existing deep learning methods based on Convolutional Neural Networks (CNNs) struggle to capture long-range dependencies effectively, while Vision Transformers require extensive pre-training, posing challenges for practical use. Additionally, these existing methods do not explicitly model the radiologist's navigational behavior while scrolling through CT scan slices, which requires both global context understanding and local detail awareness. In this study, we present CT-Scroll, a novel global-local attention model specifically designed to emulate the scrolling behavior of radiologists during the analysis of 3D CT scans. Our approach is evaluated on two public datasets, demonstrating its efficacy through comprehensive experiments and an ablation study that highlights the contribution of each model component.

A major goal of neuroscience is to understand brain computations during visual processing in naturalistic settings. A dominant approach is to use image-computable deep neural networks trained with different task objectives as a basis for linear encoding models. However, in addition to requiring tuning a large number of parameters, the linear encoding approach ignores the structure of the feature maps both in the brain and the models. Recently proposed alternatives have focused on decomposing the linear mapping to spatial and feature components but focus on finding static receptive fields for units that are applicable only in early visual areas. In this work, we employ the attention mechanism used in the transformer architecture to study how retinotopic visual features can be dynamically routed to category-selective areas in high-level visual processing. We show that this computational motif is significantly more powerful than alternative methods in predicting brain activity during natural scene viewing, across different feature basis models and modalities. We also show that this approach is inherently more interpretable, without the need to create importance maps, by interpreting the attention routing signal for different high-level categorical areas. Our approach proposes a mechanistic model of how visual information from retinotopic maps can be routed based on the relevance of the input content to different category-selective regions.

This paper presents the Holistic and Multi-Granular Surgical Scene Understanding of Prostatectomies (GraSP) dataset, a curated benchmark that models surgical scene understanding as a hierarchy of complementary tasks with varying levels of granularity. Our approach encompasses long-term tasks, such as surgical phase and step recognition, and short-term tasks, including surgical instrument segmentation and atomic visual actions detection. To exploit our proposed benchmark, we introduce the Transformers for Actions, Phases, Steps, and Instrument Segmentation (TAPIS) model, a general architecture that combines a global video feature extractor with localized region proposals from an instrument segmentation model to tackle the multi-granularity of our benchmark. Through extensive experimentation in ours and alternative benchmarks, we demonstrate TAPIS's versatility and state-of-the-art performance across different tasks. This work represents a foundational step forward in Endoscopic Vision, offering a novel framework for future research towards holistic surgical scene understanding.

Attending to what is relevant is fundamental to both the mammalian brain and modern machine learning models such as Transformers. Yet, determining relevance remains a core challenge, traditionally offloaded to learning algorithms like backpropagation. Inspired by recent cellular neurobiological evidence linking neocortical pyramidal cells to distinct mental states, this work shows how models (e.g., Transformers) can emulate high-level perceptual processing and awake thought (imagination) states to pre-select relevant information before applying attention. Triadic neuronal-level modulation loops among questions (Q), clues (keys, K), and hypotheses (values, V) enable diverse, deep, parallel reasoning chains at the representation level and allow a rapid shift from initial biases to refined understanding. This leads to orders-of-magnitude faster learning with significantly reduced computational demand (e.g., fewer heads, layers, and tokens), at an approximate cost of O(N), where N is the number of input tokens. Results span reinforcement learning (e.g., CarRacing in a high-dimensional visual setup), computer vision, and natural language question answering.

Medical image segmentation is a cornerstone of modern clinical diagnostics. While Vision Transformers that leverage shifted window-based self-attention have established new benchmarks in this field, they are often hampered by a critical limitation: their localized attention mechanism struggles to effectively fuse local details with global context. This deficiency is particularly detrimental to challenging tasks such as the segmentation of microtumors and miniature organs, where both fine-grained boundary definition and broad contextual understanding are paramount. To address this gap, we propose HBFormer, a novel Hybrid-Bridge Transformer architecture. The 'Hybrid' design of HBFormer synergizes a classic U-shaped encoder-decoder framework with a powerful Swin Transformer backbone for robust hierarchical feature extraction. The core innovation lies in its 'Bridge' mechanism, a sophisticated nexus for multi-scale feature integration. This bridge is architecturally embodied by our novel Multi-Scale Feature Fusion (MFF) decoder. Departing from conventional symmetric designs, the MFF decoder is engineered to fuse multi-scale features from the encoder with global contextual information. It achieves this through a synergistic combination of channel and spatial attention modules, which are constructed from a series of dilated and depth-wise convolutions. These components work in concert to create a powerful feature bridge that explicitly captures long-range dependencies and refines object boundaries with exceptional precision. Comprehensive experiments on challenging medical image segmentation datasets, including multi-organ, liver tumor, and bladder tumor benchmarks, demonstrate that HBFormer achieves state-of-the-art results, showcasing its outstanding capabilities in microtumor and miniature organ segmentation. Code and models are available at: https://github.com/lzeeorno/HBFormer.

Motivated by the factorization inherent in the original fast multipole method and the improved fast Gauss transform we introduce a factorable form of attention that operates efficiently in high dimensions. This approach reduces the computational and memory complexity of the attention mechanism in transformers from O(N^2) to O(N). In comparison to previous attempts, our work presents a linearly scaled attention mechanism that maintains the full representation of the attention matrix without compromising on sparsification and incorporates the all-to-all relationship between tokens. We explore the properties of our new attention metric and conduct tests in various standard settings. Results indicate that our attention mechanism has a robust performance and holds significant promise for diverse applications where self-attention is used.

Vision-language pre-training (VLP) offers unique advantages for surgery by aligning language with surgical videos, enabling workflow understanding and transfer across tasks without relying on expert-labeled datasets. However, progress in surgical VLP remains constrained by the limited scale, procedural diversity, semantic quality, and hierarchical structure of existing datasets. In this work, we present SurgLaVi, the largest and most diverse surgical vision-language dataset to date, comprising nearly 240k clip-caption pairs from more than 200 procedures, and comprising hierarchical levels at phase-, step-, and task-level. At the core of SurgLaVi lies a fully automated pipeline that systematically generates fine-grained transcriptions of surgical videos and segments them into coherent procedural units. To ensure high-quality annotations, it applies dual-modality filtering to remove irrelevant and noisy samples. Within this framework, the resulting captions are enriched with contextual detail, producing annotations that are both semantically rich and easy to interpret. To ensure accessibility, we release SurgLaVi-eta, an open-source derivative of 113k clip-caption pairs constructed entirely from public data, which is over four times larger than existing surgical VLP datasets. To demonstrate the value of SurgLaVi datasets, we introduce SurgCLIP, a CLIP-style video-text contrastive framework with dual encoders, as a representative base model. SurgCLIP achieves consistent improvements across phase, step, action, and tool recognition, surpassing prior state-of-the-art methods, often by large margins. These results validate that large-scale, semantically rich, and hierarchically structured datasets directly translate into stronger and more generalizable representations, establishing SurgLaVi as a key resource for developing surgical foundation models.

Vision Transformers (ViTs) have recently taken computer vision by storm. However, the softmax attention underlying ViTs comes with a quadratic complexity in time and memory, hindering the application of ViTs to high-resolution images. We revisit the attention design and propose a linear attention method to address the limitation, which doesn't sacrifice ViT's core advantage of capturing global representation like existing methods (e.g. local window attention of Swin). We further investigate the key difference between linear attention and softmax attention. Our empirical results suggest that linear attention lacks a fundamental property of concentrating the distribution of the attention matrix. Inspired by this observation, we introduce a local concentration module to enhance linear attention. By incorporating enhanced linear global attention and local window attention, we propose a new ViT architecture, dubbed L^2ViT. Notably, L^2ViT can effectively capture both global interactions and local representations while enjoying linear computational complexity. Extensive experiments demonstrate the strong performance of L^2ViT. On image classification, L^2ViT achieves 84.4% Top-1 accuracy on ImageNet-1K without any extra training data or label. By further pre-training on ImageNet-22k, it attains 87.0% when fine-tuned with resolution 384^2. For downstream tasks, L^2ViT delivers favorable performance as a backbone on object detection as well as semantic segmentation.

Purpose: General consensus amongst researchers and industry points to a lack of large, representative annotated datasets as the biggest obstacle to progress in the field of surgical data science. Self-supervised learning represents a solution to part of this problem, removing the reliance on annotations. However, the robustness of current self-supervised learning methods to domain shifts remains unclear, limiting our understanding of its utility for leveraging diverse sources of surgical data. Methods: In this work, we employ self-supervised learning to flexibly leverage diverse surgical datasets, thereby learning taskagnostic representations that can be used for various surgical downstream tasks. Based on this approach, to elucidate the impact of pre-training on downstream task performance, we explore 22 different pre-training dataset combinations by modulating three variables: source hospital, type of surgical procedure, and pre-training scale (number of videos). We then finetune the resulting model initializations on three diverse downstream tasks: namely, phase recognition and critical view of safety in laparoscopic cholecystectomy and phase recognition in laparoscopic hysterectomy. Results: Controlled experimentation highlights sizable boosts in performance across various tasks, datasets, and labeling budgets. However, this performance is intricately linked to the composition of the pre-training dataset, robustly proven through several study stages. Conclusion: The composition of pre-training datasets can severely affect the effectiveness of SSL methods for various downstream tasks and should critically inform future data collection efforts to scale the application of SSL methodologies. Keywords: Self-Supervised Learning, Transfer Learning, Surgical Computer Vision, Endoscopic Videos, Critical View of Safety, Phase Recognition

Surgical intelligence has the potential to improve the safety and consistency of surgical care, yet most existing surgical AI frameworks remain task-specific and struggle to generalize across procedures and institutions. Although multimodal foundation models, particularly multimodal large language models, have demonstrated strong cross-task capabilities across various medical domains, their advancement in surgery remains constrained by the lack of large-scale, systematically curated multimodal data. To address this challenge, we introduce SurgΣ, a spectrum of large-scale multimodal data and foundation models for surgical intelligence. At the core of this framework lies SurgΣ-DB, a large-scale multimodal data foundation designed to support diverse surgical tasks. SurgΣ-DB consolidates heterogeneous surgical data sources (including open-source datasets, curated in-house clinical collections and web-source data) into a unified schema, aiming to improve label consistency and data standardization across heterogeneous datasets. SurgΣ-DB spans 6 clinical specialties and diverse surgical types, providing rich image- and video-level annotations across 18 practical surgical tasks covering understanding, reasoning, planning, and generation, at an unprecedented scale (over 5.98M conversations). Beyond conventional multimodal conversations, SurgΣ-DB incorporates hierarchical reasoning annotations, providing richer semantic cues to support deeper contextual understanding in complex surgical scenarios. We further provide empirical evidence through recently developed surgical foundation models built upon SurgΣ-DB, illustrating the practical benefits of large-scale multimodal annotations, unified semantic design, and structured reasoning annotations for improving cross-task generalization and interpretability.

Transformer attention is typically implemented using softmax normalization, which enforces attention weights with unit sum normalization. While effective in many settings, this constraint can limit flexibility in controlling attention magnitudes and may contribute to overly concentrated or unstable attention patterns during training. Prior work has explored modifications such as attention sinks or gating mechanisms, but these approaches provide only limited or indirect control over attention reweighting. We propose Affine-Scaled Attention, a simple extension to standard attention that introduces input-dependent scaling and a corresponding bias term applied to softmax-normalized attention weights. This design relaxes the strict normalization constraint while maintaining aggregation of value representations, allowing the model to adjust both the relative distribution and the scale of attention in a controlled manner. We empirically evaluate Affine-Scaled Attention in large-scale language model pretraining across multiple model sizes. Experimental results show consistent improvements in training stability, optimization behavior, and downstream task performance compared to standard softmax attention and attention sink baselines. These findings suggest that modest reweighting of attention outputs provides a practical and effective way to improve attention behavior in Transformer models.

Multi-head attention layers, as used in the Transformer neural sequence model, are a powerful alternative to RNNs for moving information across and between sequences. While training these layers is generally fast and simple, due to parallelizability across the length of the sequence, incremental inference (where such paralleization is impossible) is often slow, due to the memory-bandwidth cost of repeatedly loading the large "keys" and "values" tensors. We propose a variant called multi-query attention, where the keys and values are shared across all of the different attention "heads", greatly reducing the size of these tensors and hence the memory bandwidth requirements of incremental decoding. We verify experimentally that the resulting models can indeed be much faster to decode, and incur only minor quality degradation from the baseline.

Convolutional networks, transformers, hybrid models, and Mamba-based architectures have demonstrated strong performance across various medical image classification tasks. However, these methods were primarily designed to classify clean images using labeled data. In contrast, real-world clinical data often involve image corruptions that are unique to multi-center studies and stem from variations in imaging equipment across manufacturers. In this paper, we introduce the Medical Vision Transformer (MedViTV2), a novel architecture incorporating Kolmogorov-Arnold Network (KAN) layers into the transformer architecture for the first time, aiming for generalized medical image classification. We have developed an efficient KAN block to reduce computational load while enhancing the accuracy of the original MedViT. Additionally, to counteract the fragility of our MedViT when scaled up, we propose an enhanced Dilated Neighborhood Attention (DiNA), an adaptation of the efficient fused dot-product attention kernel capable of capturing global context and expanding receptive fields to scale the model effectively and addressing feature collapse issues. Moreover, a hierarchical hybrid strategy is introduced to stack our Local Feature Perception and Global Feature Perception blocks in an efficient manner, which balances local and global feature perceptions to boost performance. Extensive experiments on 17 medical image classification datasets and 12 corrupted medical image datasets demonstrate that MedViTV2 achieved state-of-the-art results in 27 out of 29 experiments with reduced computational complexity. MedViTV2 is 44\% more computationally efficient than the previous version and significantly enhances accuracy, achieving improvements of 4.6\% on MedMNIST, 5.8\% on NonMNIST, and 13.4\% on the MedMNIST-C benchmark.

The study of the attention mechanism has sparked interest in many fields, such as language modeling and machine translation. Although its patterns have been exploited to perform different tasks, from neural network understanding to textual alignment, no previous work has analysed the encoder-decoder attention behavior in speech translation (ST) nor used it to improve ST on a specific task. In this paper, we fill this gap by proposing an attention-based policy (EDAtt) for simultaneous ST (SimulST) that is motivated by an analysis of the existing attention relations between audio input and textual output. Its goal is to leverage the encoder-decoder attention scores to guide inference in real time. Results on en->{de, es} show that the EDAtt policy achieves overall better results compared to the SimulST state of the art, especially in terms of computational-aware latency.

The Segment Anything Model (SAM) has achieved remarkable successes in the realm of natural image segmentation, but its deployment in the medical imaging sphere has encountered challenges. Specifically, the model struggles with medical images that feature low contrast, faint boundaries, intricate morphologies, and small-sized objects. To address these challenges and enhance SAM's performance in the medical domain, we introduce a comprehensive modification. Firstly, we incorporate a frozen Convolutional Neural Network (CNN) branch as an image encoder, which synergizes with SAM's original Vision Transformer (ViT) encoder through a novel variational attention fusion module. This integration bolsters the model's capability to capture local spatial information, which is often paramount in medical imagery. Moreover, to further optimize SAM for medical imaging, we introduce feature and position adapters within the ViT branch, refining the encoder's representations. We see that compared to current prompting strategies to fine-tune SAM for ultrasound medical segmentation, the use of text descriptions that serve as text prompts for SAM helps significantly improve the performance. Leveraging ChatGPT's natural language understanding capabilities, we generate prompts that offer contextual information and guidance to SAM, enabling it to better understand the nuances of ultrasound medical images and improve its segmentation accuracy. Our method, in its entirety, represents a significant stride towards making universal image segmentation models more adaptable and efficient in the medical domain.

Endoscopic Submucosal Dissection (ESD) is a minimally invasive procedure initially developed for early gastric cancer treatment and has expanded to address diverse gastrointestinal lesions. While computer-assisted surgery (CAS) systems enhance ESD precision and safety, their efficacy hinges on accurate real-time surgical phase recognition, a task complicated by ESD's inherent complexity, including heterogeneous lesion characteristics and dynamic tissue interactions. Existing video-based phase recognition algorithms, constrained by inefficient temporal context modeling, exhibit limited performance in capturing fine-grained phase transitions and long-range dependencies. To overcome these limitations, we propose SPRMamba, a novel framework integrating a Mamba-based architecture with a Scaled Residual TranMamba (SRTM) block to synergize long-term temporal modeling and localized detail extraction. SPRMamba further introduces the Hierarchical Sampling Strategy to optimize computational efficiency, enabling real-time processing critical for clinical deployment. Evaluated on the ESD385 dataset and the cholecystectomy benchmark Cholec80, SPRMamba achieves state-of-the-art performance (87.64% accuracy on ESD385, +1.0% over prior methods), demonstrating robust generalizability across surgical workflows. This advancement bridges the gap between computational efficiency and temporal sensitivity, offering a transformative tool for intraoperative guidance and skill assessment in ESD surgery. The code is accessible at https://github.com/Zxnyyyyy/SPRMamba.

Recent advances in training-free attention control methods have enabled flexible and efficient text-guided editing capabilities for existing generation models. However, current approaches struggle to simultaneously deliver strong editing strength while preserving consistency with the source. This limitation becomes particularly critical in multi-round and video editing, where visual errors can accumulate over time. Moreover, most existing methods enforce global consistency, which limits their ability to modify individual attributes such as texture while preserving others, thereby hindering fine-grained editing. Recently, the architectural shift from U-Net to MM-DiT has brought significant improvements in generative performance and introduced a novel mechanism for integrating text and vision modalities. These advancements pave the way for overcoming challenges that previous methods failed to resolve. Through an in-depth analysis of MM-DiT, we identify three key insights into its attention mechanisms. Building on these, we propose ConsistEdit, a novel attention control method specifically tailored for MM-DiT. ConsistEdit incorporates vision-only attention control, mask-guided pre-attention fusion, and differentiated manipulation of the query, key, and value tokens to produce consistent, prompt-aligned edits. Extensive experiments demonstrate that ConsistEdit achieves state-of-the-art performance across a wide range of image and video editing tasks, including both structure-consistent and structure-inconsistent scenarios. Unlike prior methods, it is the first approach to perform editing across all inference steps and attention layers without handcraft, significantly enhancing reliability and consistency, which enables robust multi-round and multi-region editing. Furthermore, it supports progressive adjustment of structural consistency, enabling finer control.

Effectively representing medical images, especially retinal images, presents a considerable challenge due to variations in appearance, size, and contextual information of pathological signs called lesions. Precise discrimination of these lesions is crucial for diagnosing vision-threatening issues such as diabetic retinopathy. While visual attention-based neural networks have been introduced to learn spatial context and channel correlations from retinal images, they often fall short in capturing localized lesion context. Addressing this limitation, we propose a novel attention mechanism called Guided Context Gating, an unique approach that integrates Context Formulation, Channel Correlation, and Guided Gating to learn global context, spatial correlations, and localized lesion context. Our qualitative evaluation against existing attention mechanisms emphasize the superiority of Guided Context Gating in terms of explainability. Notably, experiments on the Zenodo-DR-7 dataset reveal a substantial 2.63% accuracy boost over advanced attention mechanisms & an impressive 6.53% improvement over the state-of-the-art Vision Transformer for assessing the severity grade of retinopathy, even with imbalanced and limited training samples for each class.

Linear attention is an efficient attention mechanism that has recently emerged as a promising alternative to conventional softmax attention. With its ability to process tokens in linear computational complexities, linear attention, in theory, can handle sequences of unlimited length without sacrificing speed, i.e., maintaining a constant training speed for various sequence lengths with a fixed memory consumption. However, due to the issue with cumulative summation (cumsum), current linear attention algorithms cannot demonstrate their theoretical advantage in a causal setting. In this paper, we present Lightning Attention-2, the first linear attention implementation that enables linear attention to realize its theoretical computational benefits. To achieve this, we leverage the thought of tiling, separately handling the intra-block and inter-block components in linear attention calculation. Specifically, we utilize the conventional attention computation mechanism for the intra-blocks and apply linear attention kernel tricks for the inter-blocks. A tiling technique is adopted through both forward and backward procedures to take full advantage of the GPU hardware. We implement our algorithm in Triton to make it IO-aware and hardware-friendly. Various experiments are conducted on different model sizes and sequence lengths. Lightning Attention-2 retains consistent training and inference speed regardless of input sequence length and is significantly faster than other attention mechanisms. The source code is available at https://github.com/OpenNLPLab/lightning-attention.

Recent work in mechanistic interpretability has shown that behaviors in language models can be successfully reverse-engineered through circuit analysis. A common criticism, however, is that each circuit is task-specific, and thus such analysis cannot contribute to understanding the models at a higher level. In this work, we present evidence that insights (both low-level findings about specific heads and higher-level findings about general algorithms) can indeed generalize across tasks. Specifically, we study the circuit discovered in Wang et al. (2022) for the Indirect Object Identification (IOI) task and 1.) show that it reproduces on a larger GPT2 model, and 2.) that it is mostly reused to solve a seemingly different task: Colored Objects (Ippolito & Callison-Burch, 2023). We provide evidence that the process underlying both tasks is functionally very similar, and contains about a 78% overlap in in-circuit attention heads. We further present a proof-of-concept intervention experiment, in which we adjust four attention heads in middle layers in order to 'repair' the Colored Objects circuit and make it behave like the IOI circuit. In doing so, we boost accuracy from 49.6% to 93.7% on the Colored Objects task and explain most sources of error. The intervention affects downstream attention heads in specific ways predicted by their interactions in the IOI circuit, indicating that this subcircuit behavior is invariant to the different task inputs. Overall, our results provide evidence that it may yet be possible to explain large language models' behavior in terms of a relatively small number of interpretable task-general algorithmic building blocks and computational components.

Linear attention transformers have become a strong alternative to softmax attention due to their efficiency. However, linear attention tends to be less expressive and results in reduced accuracy compared to softmax attention. To bridge the accuracy gap between softmax attention and linear attention, we manipulate Mamba-2, a very strong linear attention variant. We first simplify Mamba-2 down to its most fundamental and important components, evaluating which specific choices make it most accurate. From this simplified Mamba variant (Mamba-2S), we improve the A-mask and increase the order of the hidden state, resulting in a method, which we call 2Mamba, that is nearly as accurate as softmax attention, yet much more memory efficient for long context lengths. We also investigate elements to Mamba-2 that help surpass softmax attention accuracy. Code is provided for all our experiments

In recent years, the long-range attention mechanism of vision transformers has driven significant performance breakthroughs across various computer vision tasks. However, the traditional self-attention mechanism, which processes both informative and non-informative tokens, suffers from inefficiency and inaccuracies. While sparse attention mechanisms have been introduced to mitigate these issues by pruning tokens involved in attention, they often lack context-awareness and intelligence. These mechanisms frequently apply a uniform token selection strategy across different inputs for batch training or optimize efficiency only for the inference stage. To overcome these challenges, we propose a novel algorithm: Select and Pack Attention (SPA). SPA dynamically selects informative tokens using a low-cost gating layer supervised by selection labels and packs these tokens into new batches, enabling a variable number of tokens to be used in parallelized GPU batch training and inference. Extensive experiments across diverse datasets and computer vision tasks demonstrate that SPA delivers superior performance and efficiency, including a 0.6 mAP improvement in object detection and a 16.4% reduction in computational costs.

Text-guided image editing has seen rapid progress in natural image domains, but its adaptation to medical imaging remains limited and lacks standardized evaluation. Clinically, such editing holds promise for simulating surgical outcomes, creating personalized teaching materials, and enhancing patient communication. To bridge this gap, we introduce MedEBench, a comprehensive benchmark for evaluating text-guided medical image editing. It consists of 1,182 clinically sourced image-prompt triplets spanning 70 tasks across 13 anatomical regions. MedEBench offers three key contributions: (1) a clinically relevant evaluation framework covering Editing Accuracy, Contextual Preservation, and Visual Quality, supported by detailed descriptions of expected change and ROI (Region of Interest) masks; (2) a systematic comparison of seven state-of-the-art models, revealing common failure patterns; and (3) a failure analysis protocol based on attention grounding, using IoU between attention maps and ROIs to identify mislocalization. MedEBench provides a solid foundation for developing and evaluating reliable, clinically meaningful medical image editing systems.

The strong capabilities of recent Large Language Models (LLMs) have made them highly effective for zero-shot re-ranking task. Attention-based re-ranking methods, which derive relevance scores directly from attention weights, offer an efficient and interpretable alternative to generation-based re-ranking methods. However, they still face two major limitations. First, attention signals are highly concentrated a small subset of tokens within a few documents, making others indistinguishable. Second, attention often overemphasizes phrases lexically similar to the query, yielding biased rankings that irrelevant documents with mere lexical resemblance are regarded as relevant. In this paper, we propose ReAttn, a post-hoc re-weighting strategy for attention-based re-ranking methods. It first compute the cross-document IDF weighting to down-weight attention on query-overlapping tokens that frequently appear across the candidate documents, reducing lexical bias and emphasizing distinctive terms. It then employs entropy-based regularization to mitigate over-concentrated attention, encouraging a more balanced distribution across informative tokens. Both adjustments operate directly on existing attention weights without additional training or supervision. Extensive experiments demonstrate the effectiveness of our method.

Very recently, a variety of vision transformer architectures for dense prediction tasks have been proposed and they show that the design of spatial attention is critical to their success in these tasks. In this work, we revisit the design of the spatial attention and demonstrate that a carefully-devised yet simple spatial attention mechanism performs favourably against the state-of-the-art schemes. As a result, we propose two vision transformer architectures, namely, Twins-PCPVT and Twins-SVT. Our proposed architectures are highly-efficient and easy to implement, only involving matrix multiplications that are highly optimized in modern deep learning frameworks. More importantly, the proposed architectures achieve excellent performance on a wide range of visual tasks, including image level classification as well as dense detection and segmentation. The simplicity and strong performance suggest that our proposed architectures may serve as stronger backbones for many vision tasks. Our code is released at https://github.com/Meituan-AutoML/Twins .

Large Language Model (LLM)-powered multi-agent systems (MAS) have rapidly advanced collaborative reasoning, tool use, and role-specialized coordination in complex tasks. However, reliability-critical deployment remains hindered by a systemic failure mode: hierarchical compliance under instruction conflicts (system-user, peer-peer), where agents misprioritize system-level rules in the presence of competing demands. Moreover, widely used macro-level metrics (e.g., pass@k) obscure these micro-level violations and offer little actionable guidance for remedy. In this work, we present a full-stack, three-stage framework: (1) Diagnose - Contextualized Role Adherence Score (CRAS), a query-wise, context-aware scoring metric that decomposes role adherence into four measurable dimensions; (2) Localize - attention drift analysis revealing that instruction conflicts are resolved by attention heads that are largely concentrated in middle layers; (3) Align - Surgical Alignment of Instruction Layers (SAIL), which installs LoRA only on the localized focal layers and optimizes a token-weighted DPO-style preference objective that credits tokens by their focal attentional contribution. Across standard benchmarks and MAS frameworks, our surgical approach improves instruction hierarchy compliance (e.g., +5.60% with AutoGen on MedQA) without full-model finetuning.

Surgical tool detection is a fundamental task for understanding egocentric open surgery videos. However, detecting surgical tools presents significant challenges due to their highly imbalanced class distribution, similar shapes and similar textures, and heavy occlusion. The lack of a comprehensive large-scale dataset compounds these challenges. In this paper, we introduce EgoSurgery-Tool, an extension of the existing EgoSurgery-Phase dataset, which contains real open surgery videos captured using an egocentric camera attached to the surgeon's head, along with phase annotations. EgoSurgery-Tool has been densely annotated with surgical tools and comprises over 49K surgical tool bounding boxes across 15 categories, constituting a large-scale surgical tool detection dataset. EgoSurgery-Tool also provides annotations for hand detection with over 46K hand-bounding boxes, capturing hand-object interactions that are crucial for understanding activities in egocentric open surgery. EgoSurgery-Tool is superior to existing datasets due to its larger scale, greater variety of surgical tools, more annotations, and denser scenes. We conduct a comprehensive analysis of EgoSurgery-Tool using nine popular object detectors to assess their effectiveness in both surgical tool and hand detection. The dataset will be released at https://github.com/Fujiry0/EgoSurgery.

Recent approaches to multi-task learning (MTL) have focused on modelling connections between tasks at the decoder level. This leads to a tight coupling between tasks, which need retraining if a new task is inserted or removed. We argue that MTL is a stepping stone towards universal feature learning (UFL), which is the ability to learn generic features that can be applied to new tasks without retraining. We propose Medusa to realize this goal, designing task heads with dual attention mechanisms. The shared feature attention masks relevant backbone features for each task, allowing it to learn a generic representation. Meanwhile, a novel Multi-Scale Attention head allows the network to better combine per-task features from different scales when making the final prediction. We show the effectiveness of Medusa in UFL (+13.18% improvement), while maintaining MTL performance and being 25% more efficient than previous approaches.