Heatmap-based anatomical landmark detection is still facing two unresolved challenges: 1) inability to accurately evaluate the distribution of heatmap; 2) inability to effectively exploit global spatial structure information. To address the computational inability challenge, we propose a novel position-aware and sample-aware central loss. Specifically, our central loss can absorb position information, enabling accurate evaluation of the heatmap distribution. More advanced is that our central loss is sample-aware, which can adaptively distinguish easy and hard samples and make the model more focused on hard samples while solving the challenge of extreme imbalance between landmarks and non-landmarks. To address the challenge of ignoring structure information, a Coordinated Transformer, called CoorTransformer, is proposed, which establishes long-range dependencies under the guidance of landmark coordination information, making the attention more focused on the sparse landmarks while taking advantage of global spatial structure. Furthermore, CoorTransformer can speed up convergence, effectively avoiding the defect that Transformers have difficulty converging in sparse representation learning. Using the advanced CoorTransformer and central loss, we propose a generalized detection model that can handle various scenarios, inherently exploiting the underlying relationship between landmarks and incorporating rich structural knowledge around the target landmarks. We analyzed and evaluated CoorTransformer and central loss on three challenging landmark detection tasks. The experimental results show that our CoorTransformer outperforms state-of-the-art methods, and the central loss significantly improves the performance of the model with p-values< 0.05.

提出了一种基于位置感知和样本感知的集中损失函数和Transformer模型，用于解决热图检测的分布和全局空间结构问题，并得到了在三个挑战性的任务上表现优于当前最先进的方法的实验结果。

具有位置和样本感知中央损失的协调转换器用于解剖标志物检测