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Objectives: With the popularization of chest computed tomography (CT) screening, there are more sub-centimeter (≤ 1 cm) pulmonary nodules (SCPNs) requiring further diagnostic workup. This area represents an important opportunity to optimize the SCPN management algorithm avoiding "one-size fits all" approach. One critical problem is how to learn the discriminative multi-view characteristics and the unique context of each SCPN. Methods: Here, we propose a multi-view coupled self-attention module (MVCS) to capture the global spatial context of the CT image through modeling the association order of space and dimension. Compared with existing self-attention methods, MVCS uses less memory consumption and computational complexity, unearths dimension correlations that previous methods have not found, and is easy to integrate with other frameworks. Results: In total, a public dataset LUNA16 from LIDC-IDRI, 1319 SCPNs from 1069 patients presenting to a major referral center, and 160 SCPNs from 137 patients from three other major centers were analyzed to pre-train, train, and validate the model. Experimental results showed that performance outperforms the state-of-the-art models in terms of accuracy and stability and is comparable to that of human experts in classifying precancerous lesions and invasive adenocarcinoma. We also provide a fusion MVCS network (MVCSN) by combining the CT image with the clinical characteristics and radiographic features of patients. Conclusion: This tool may ultimately aid in expediting resection of the malignant SCPNs and avoid over-diagnosis of the benign ones, resulting in improved management outcomes. Clinical relevance statement: In the diagnosis of sub-centimeter lung adenocarcinoma, fusion MVCSN can help doctors improve work efficiency and guide their treatment decisions to a certain extent. Key Points: • Advances in computed tomography (CT) not only increase the number of nodules detected, but also the nodules that are identified are smaller, such as sub-centimeter pulmonary nodules (SCPNs). • We propose a multi-view coupled self-attention module (MVCS), which could model spatial and dimensional correlations sequentially for learning global spatial contexts, which is better than other attention mechanisms. • MVCS uses fewer huge memory consumption and computational complexity than the existing self-attention methods when dealing with 3D medical image data. Additionally, it reaches promising accuracy for SCPNs' malignancy evaluation and has lower training cost than other models. [ABSTRACT FROM AUTHOR]

Automated medical image segmentation plays an important role in many clinical applications, which however is a very challenging task, due to complex background texture, lack of clear boundary and significant shape and texture variation between images. Many researchers proposed an encoder–decoder architecture with skip connections to combine low-level feature maps from the encoder path with high-level feature maps from the decoder path for automatically segmenting medical images. The skip connections have been shown to be effective in recovering fine-grained details of the target objects and may facilitate the gradient back-propagation. However, not all the feature maps transmitted by those connections contribute positively to the network performance. In this paper, to adaptively select useful information to pass through those skip connections, we propose a novel 3D network with self-supervised function, named selective information passing network. We evaluate our proposed model on the MICCAI Prostate MR Image Segmentation 2012 Grant Challenge dataset, TCIA Pancreas CT-82 and MICCAI 2017 Liver Tumor Segmentation Challenge dataset. The experimental results across these datasets show that our model achieved improved segmentation results and outperformed other state-of-the-art methods. The source code of this work is available at https://github.com/ahukui/SIPNet. [ABSTRACT FROM AUTHOR]