Vision Transformers (ViTs) are widely adopted in medical imaging tasks, and some existing efforts have been directed towards vision-language training for Chest X-rays (CXRs). However, we envision that there still exists a potential for improvement in vision-only training for CXRs using ViTs, by aggregating information from multiple scales, which has been proven beneficial for non-transformer networks. Hence, we have developed LT-ViT, a transformer that utilizes combined attention between image tokens and randomly initialized auxiliary tokens that represent labels. Our experiments demonstrate that LT-ViT (1) surpasses the state-of-the-art performance using pure ViTs on two publicly available CXR datasets, (2) is generalizable to other pre-training methods and therefore is agnostic to model initialization, and (3) enables model interpretability without grad-cam and its variants.
Patients undergoing chest X-rays (CXR) often endure multiple lung diseases. When evaluating a patient's condition, due to the complex pathologies, subtle texture changes of different lung lesions in images, and patient condition differences, radiologists may make uncertain even when they have experienced long-term clinical training and professional guidance, which makes much noise in extracting disease labels based on CXR reports. In this paper, we re-extract disease labels from CXR reports to make them more realistic by considering disease severity and uncertainty in classification. Our contributions are as follows: 1. We re-extracted the disease labels with severity and uncertainty by a rule-based approach with keywords discussed with clinical experts. 2. To further improve the explainability of chest X-ray diagnosis, we designed a multi-relationship graph learning method with an expert uncertainty-aware loss function. 3. Our multi-relationship graph learning method can also interpret the disease classification results. Our experimental results show that models considering disease severity and uncertainty outperform previous state-of-the-art methods.
Deep Learning methods have recently seen increased adoption in medical imaging applications. However, elevated vulnerabilities have been explored in recent Deep Learning solutions, which can hinder future adoption. Particularly, the vulnerability of Vision Transformer (ViT) to adversarial, privacy, and confidentiality attacks raise serious concerns about their reliability in medical settings. This work aims to enhance the robustness of self-ensembling ViTs for the tuberculosis chest x-ray classification task. We propose Self-Ensembling ViT with defensive Distillation and Adversarial training (SEDA). SEDA utilizes efficient CNN blocks to learn spatial features with various levels of abstraction from feature representations extracted from intermediate ViT blocks, that are largely unaffected by adversarial perturbations. Furthermore, SEDA leverages adversarial training in combination with defensive distillation for improved robustness against adversaries. Training using adversarial examples leads to better model generalizability and improves its ability to handle perturbations. Distillation using soft probabilities introduces uncertainty and variation into the output probabilities, making it more difficult for adversarial and privacy attacks. Extensive experiments performed with the proposed architecture and training paradigm on publicly available Tuberculosis x-ray dataset shows SOTA efficacy of SEDA compared to SEViT in terms of computational efficiency with 70x times lighter framework and enhanced robustness of +9%.
Medical image classification poses unique challenges due to the long-tailed distribution of diseases, the co-occurrence of diagnostic findings, and the multiple views available for each study or patient. This paper introduces our solution to the ICCV CVAMD 2023 Shared Task on CXR-LT: Multi-Label Long-Tailed Classification on Chest X-Rays. Our approach introduces CheXFusion, a transformer-based fusion module incorporating multi-view images. The fusion module, guided by self-attention and cross-attention mechanisms, efficiently aggregates multi-view features while considering label co-occurrence. Furthermore, we explore data balancing and self-training methods to optimize the model's performance. Our solution achieves state-of-the-art results with 0.372 mAP in the MIMIC-CXR test set, securing 1st place in the competition. Our success in the task underscores the significance of considering multi-view settings, class imbalance, and label co-occurrence in medical image classification. Public code is available at https://github.com/dongkyuk/CXR-LT-public-solution
Medical image classification models are frequently trained using training datasets derived from multiple data sources. While leveraging multiple data sources is crucial for achieving model generalization, it is important to acknowledge that the diverse nature of these sources inherently introduces unintended confounders and other challenges that can impact both model accuracy and transparency. A notable confounding factor in medical image classification, particularly in musculoskeletal image classification, is skeletal maturation-induced bone growth observed during adolescence. We train a deep learning model using a Covid-19 chest X-ray dataset and we showcase how this dataset can lead to spurious correlations due to unintended confounding regions. eXplanation Based Learning (XBL) is a deep learning approach that goes beyond interpretability by utilizing model explanations to interactively unlearn spurious correlations. This is achieved by integrating interactive user feedback, specifically feature annotations. In our study, we employed two non-demanding manual feedback mechanisms to implement an XBL-based approach for effectively eliminating these spurious correlations. Our results underscore the promising potential of XBL in constructing robust models even in the presence of confounding factors.
The limited availability of labeled chest X-ray datasets is a significant bottleneck in the development of medical imaging methods. Self-supervised learning (SSL) can mitigate this problem by training models on unlabeled data. Furthermore, self-supervised pretraining has yielded promising results in visual recognition of natural images but has not been given much consideration in medical image analysis. In this work, we propose a self-supervised method, DINO-CXR, which is a novel adaptation of a self-supervised method, DINO, based on a vision transformer for chest X-ray classification. A comparative analysis is performed to show the effectiveness of the proposed method for both pneumonia and COVID-19 detection. Through a quantitative analysis, it is also shown that the proposed method outperforms state-of-the-art methods in terms of accuracy and achieves comparable results in terms of AUC and F-1 score while requiring significantly less labeled data.
Deep learning models for image classification are often trained at a resolution of 224 x 224 pixels for historical and efficiency reasons. However, chest X-rays are acquired at a much higher resolution to display subtle pathologies. This study investigates the effect of training resolution on chest X-ray classification performance, using the chest X-ray 14 dataset. The results show that training with a higher image resolution, specifically 1024 x 1024 pixels, results in the best overall classification performance with a mean AUC of 84.2 % compared to 82.7 % when trained with 256 x 256 pixel images. Additionally, comparison of bounding boxes and GradCAM saliency maps suggest that low resolutions, such as 256 x 256 pixels, are insufficient for identifying small pathologies and force the model to use spurious discriminating features. Our code is publicly available at https://gitlab.lrz.de/IP/cxr-resolution
Chest X-ray (CXR) images are commonly compressed to a lower resolution and bit depth to reduce their size, potentially altering subtle diagnostic features. Radiologists use windowing operations to enhance image contrast, but the impact of such operations on CXR classification performance is unclear. In this study, we show that windowing can improve CXR classification performance, and propose WindowNet, a model that learns optimal window settings. We first investigate the impact of bit-depth on classification performance and find that a higher bit-depth (12-bit) leads to improved performance. We then evaluate different windowing settings and show that training with a distinct window generally improves pathology-wise classification performance. Finally, we propose and evaluate WindowNet, a model that learns optimal window settings, and show that it significantly improves performance compared to the baseline model without windowing.
This study aimed to develop an algorithm to automatically extract annotations for chest X-ray classification models from German thoracic radiology reports. An automatic label extraction model was designed based on the CheXpert architecture, and a web-based annotation interface was created for iterative improvements. Results showed that automated label extraction can reduce time spent on manual labeling and improve overall modeling performance. The model trained on automatically extracted labels performed competitively to manually labeled data and strongly outperformed the model trained on publicly available data.
Eye tracking research is important in computer vision because it can help us understand how humans interact with the visual world. Specifically for high-risk applications, such as in medical imaging, eye tracking can help us to comprehend how radiologists and other medical professionals search, analyze, and interpret images for diagnostic and clinical purposes. Hence, the application of eye tracking techniques in disease classification has become increasingly popular in recent years. Contemporary works usually transform gaze information collected by eye tracking devices into visual attention maps (VAMs) to supervise the learning process. However, this is a time-consuming preprocessing step, which stops us from applying eye tracking to radiologists' daily work. To solve this problem, we propose a novel gaze-guided graph neural network (GNN), GazeGNN, to leverage raw eye-gaze data without being converted into VAMs. In GazeGNN, to directly integrate eye gaze into image classification, we create a unified representation graph that models both images and gaze pattern information. With this benefit, we develop a real-time, real-world, end-to-end disease classification algorithm for the first time in the literature. This achievement demonstrates the practicality and feasibility of integrating real-time eye tracking techniques into the daily work of radiologists. To our best knowledge, GazeGNN is the first work that adopts GNN to integrate image and eye-gaze data. Our experiments on the public chest X-ray dataset show that our proposed method exhibits the best classification performance compared to existing methods. The code is available at https://github.com/ukaukaaaa/GazeGNN.
The chest X-ray (CXR) is commonly employed to diagnose thoracic illnesses, but the challenge of achieving accurate automatic diagnosis through this method persists due to the complex relationship between pathology. In recent years, various deep learning-based approaches have been suggested to tackle this problem but confounding factors such as image resolution or noise problems often damage model performance. In this paper, we focus on the chest X-ray classification task and proposed an interpretable instrumental variable (IV) learning framework, to eliminate the spurious association and obtain accurate causal representation. Specifically, we first construct a structural causal model (SCM) for our task and learn the confounders and the preliminary representations of IV, we then leverage electronic health record (EHR) as auxiliary information and we fuse the above feature with our transformer-based semantic fusion module, so the IV has the medical semantic. Meanwhile, the reliability of IV is further guaranteed via the constraints of mutual information between related causal variables. Finally, our approach's performance is demonstrated using the MIMIC-CXR, NIH ChestX-ray 14, and CheXpert datasets, and we achieve competitive results.
Automated multi-label chest X-rays (CXR) image classification has achieved substantial progress in clinical diagnosis via utilizing sophisticated deep learning approaches. However, most deep models have high computational demands, which makes them less feasible for compact devices with low computational requirements. To overcome this problem, we propose a knowledge distillation (KD) strategy to create the compact deep learning model for the real-time multi-label CXR image classification. We study different alternatives of CNNs and Transforms as the teacher to distill the knowledge to a smaller student. Then, we employed explainable artificial intelligence (XAI) to provide the visual explanation for the model decision improved by the KD. Our results on three benchmark CXR datasets show that our KD strategy provides the improved performance on the compact student model, thus being the feasible choice for many limited hardware platforms. For instance, when using DenseNet161 as the teacher network, EEEA-Net-C2 achieved an AUC of 83.7%, 87.1%, and 88.7% on the ChestX-ray14, CheXpert, and PadChest datasets, respectively, with fewer parameters of 4.7 million and computational cost of 0.3 billion FLOPS.
This study explores the use of the Dirichlet Variational Autoencoder (DirVAE) for learning disentangled latent representations of chest X-ray (CXR) images. Our working hypothesis is that distributional sparsity, as facilitated by the Dirichlet prior, will encourage disentangled feature learning for the complex task of multi-label classification of CXR images. The DirVAE is trained using CXR images from the CheXpert database, and the predictive capacity of multi-modal latent representations learned by DirVAE models is investigated through implementation of an auxiliary multi-label classification task, with a view to enforce separation of latent factors according to class-specific features. The predictive performance and explainability of the latent space learned using the DirVAE were quantitatively and qualitatively assessed, respectively, and compared with a standard Gaussian prior-VAE (GVAE). We introduce a new approach for explainable multi-label classification in which we conduct gradient-guided latent traversals for each class of interest. Study findings indicate that the DirVAE is able to disentangle latent factors into class-specific visual features, a property not afforded by the GVAE, and achieve a marginal increase in predictive performance relative to GVAE. We generate visual examples to show that our explainability method, when applied to the trained DirVAE, is able to highlight regions in CXR images that are clinically relevant to the class(es) of interest and additionally, can identify cases where classification relies on spurious feature correlations.
Federated learning (FL) is a promising paradigm to collaboratively train a global chest x-ray (CXR) classification model using distributed datasets while preserving patient privacy. A significant, yet relatively underexplored, challenge in FL is class-heterogeneity, where clients have different sets of classes. We propose surgical aggregation, a FL method that uses selective aggregation to collaboratively train a global model using distributed, class-heterogeneous datasets. Unlike other methods, our method does not rely on the assumption that clients share the same classes as other clients, know the classes of other clients, or have access to a fully annotated dataset. We evaluate surgical aggregation using class-heterogeneous CXR datasets across IID and non-IID settings. Our results show that our method outperforms current methods and has better generalizability.
Vulnerability to adversarial attacks is a well-known weakness of Deep Neural Networks. While most of the studies focus on natural images with standardized benchmarks like ImageNet and CIFAR, little research has considered real world applications, in particular in the medical domain. Our research shows that, contrary to previous claims, robustness of chest x-ray classification is much harder to evaluate and leads to very different assessments based on the dataset, the architecture and robustness metric. We argue that previous studies did not take into account the peculiarity of medical diagnosis, like the co-occurrence of diseases, the disagreement of labellers (domain experts), the threat model of the attacks and the risk implications for each successful attack. In this paper, we discuss the methodological foundations, review the pitfalls and best practices, and suggest new methodological considerations for evaluating the robustness of chest xray classification models. Our evaluation on 3 datasets, 7 models, and 18 diseases is the largest evaluation of robustness of chest x-ray classification models.
In this era of pandemic, the future of healthcare industry has never been more exciting. Artificial intelligence and machine learning (AI & ML) present opportunities to develop solutions that cater for very specific needs within the industry. Deep learning in healthcare had become incredibly powerful for supporting clinics and in transforming patient care in general. Deep learning is increasingly being applied for the detection of clinically important features in the images beyond what can be perceived by the naked human eye. Chest X-ray images are one of the most common clinical method for diagnosing a number of diseases such as pneumonia, lung cancer and many other abnormalities like lesions and fractures. Proper diagnosis of a disease from X-ray images is often challenging task for even expert radiologists and there is a growing need for computerized support systems due to the large amount of information encoded in X-Ray images. The goal of this paper is to develop a lightweight solution to detect 14 different chest conditions from an X ray image. Given an X-ray image as input, our classifier outputs a label vector indicating which of 14 disease classes does the image fall into. Along with the image features, we are also going to use non-image features available in the data such as X-ray view type, age, gender etc. The original study conducted Stanford ML Group is our base line. Original study focuses on predicting 5 diseases. Our aim is to improve upon previous work, expand prediction to 14 diseases and provide insight for future chest radiography research.
A chest X-ray is one of the most widely available radiological examinations for diagnosing and detecting various lung illnesses. The National Institutes of Health (NIH) provides an extensive database, ChestX-ray8 and ChestXray14, to help establish a deep learning community for analysing and predicting lung diseases. ChestX-ray14 consists of 112,120 frontal-view X-ray images of 30,805 distinct patients with text-mined fourteen disease image labels, where each image has multiple labels and has been utilised in numerous research in the past. To our current knowledge, no previous study has investigated outliers and multi-label impact for a single X-ray image during the preprocessing stage. The effect of outliers is mitigated in this paper by our proposed auto-outlier fusion technique. The image label is regenerated by concentrating on a particular factor in one image. The final cleaned dataset will be used to compare the mechanisms of multi-head self-attention and multi-head attention with generalised max-pooling.
Chest X-Ray imaging is one of the most common radiological tools for detection of various pathologies related to the chest area and lung function. In a clinical setting, automated assessment of chest radiographs has the potential of assisting physicians in their decision making process and optimize clinical workflows, for example by prioritizing emergency patients. Most work analyzing the potential of machine learning models to classify chest X-ray images focuses on vision methods processing and predicting pathologies for one image at a time. However, many patients undergo such a procedure multiple times during course of a treatment or during a single hospital stay. The patient history, that is previous images and especially the corresponding diagnosis contain useful information that can aid a classification system in its prediction. In this study, we analyze how information about diagnosis can improve CNN-based image classification models by constructing a novel dataset from the well studied CheXpert dataset of chest X-rays. We show that a model trained on additional patient history information outperforms a model trained without the information by a significant margin. We provide code to replicate the dataset creation and model training.
Medical image datasets and their annotations are not growing as fast as their equivalents in the general domain. This makes translation from the newest, more data-intensive methods that have made a large impact on the vision field increasingly more difficult and less efficient. In this paper, we propose a new probabilistic latent variable model for disease classification in chest X-ray images. Specifically we consider chest X-ray datasets that contain global disease labels, and for a smaller subset contain object level expert annotations in the form of eye gaze patterns and disease bounding boxes. We propose a two-stage optimization algorithm which is able to handle these different label granularities through a single training pipeline in a two-stage manner. In our pipeline global dataset features are learned in the lower level layers of the model. The specific details and nuances in the fine-grained expert object-level annotations are learned in the final layers of the model using a knowledge distillation method inspired by conditional variational inference. Subsequently, model weights are frozen to guide this learning process and prevent overfitting on the smaller richly annotated data subsets. The proposed method yields consistent classification improvement across different backbones on the common benchmark datasets Chest X-ray14 and MIMIC-CXR. This shows how two-stage learning of labels from coarse to fine-grained, in particular with object level annotations, is an effective method for more optimal annotation usage.
Deep learning approaches achieve state-of-the-art performance for classifying radiology images, but rely on large labelled datasets that require resource-intensive annotation by specialists. Both semi-supervised learning and active learning can be utilised to mitigate this annotation burden. However, there is limited work on combining the advantages of semi-supervised and active learning approaches for multi-label medical image classification. Here, we introduce a novel Consistency-based Semi-supervised Evidential Active Learning framework (CSEAL). Specifically, we leverage predictive uncertainty based on theories of evidence and subjective logic to develop an end-to-end integrated approach that combines consistency-based semi-supervised learning with uncertainty-based active learning. We apply our approach to enhance four leading consistency-based semi-supervised learning methods: Pseudo-labelling, Virtual Adversarial Training, Mean Teacher and NoTeacher. Extensive evaluations on multi-label Chest X-Ray classification tasks demonstrate that CSEAL achieves substantive performance improvements over two leading semi-supervised active learning baselines. Further, a class-wise breakdown of results shows that our approach can substantially improve accuracy on rarer abnormalities with fewer labelled samples.