State-of-the-art models for medical image segmentation achieve excellent accuracy, but require substantial computational resources, limiting deployment in typical resource-constrained clinical settings. We present SegMate, an efficient 2.5D framework that achieves state-of-the-art accuracy, while considerably reducing computational requirements. Our efficient design is the result of meticulously integrating asymmetric architectures, attention mechanisms, multi-scale feature fusion, slice-based positional conditioning, and multi-task optimization. We demonstrate the efficiency-accuracy trade-off of our framework across three modern backbones (EfficientNetV2-M, MambaOut-Tiny, FastViT-T12). We perform experiments on three datasets: TotalSegmentator, SegTHOR and AMOS22. Compared with the vanilla models, SegMate reduces computation (GFLOPs) by up to 2.5x and memory footprint (VRAM) by up to 2.1x, while generally registering performance gains of around 1%. On TotalSegmentator, we achieve a Dice score of 93.51% with only 295 MB peak GPU memory. Zero-shot cross-dataset evaluations on SegTHOR and AMOS22 demonstrate strong generalization, with Dice scores of up to 86.85% and 89.35%, respectively. SegMate variants in this study empower single GPU setups to process up to 10,000 volumes per hour with just 74 J per volume using batch inference, enabling population-scale CT processing on commodity hardware. We release our open-source code at https://github.com/andreibunea99/SegMate.

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