CBAM-Enhanced DenseNet121 for Multi-Class Chest X-Ray Classification with Grad-CAM Explainability

Deep-learning models can achieve strong chest X-ray (CXR) classification performance without establishing whether their predictions predominantly rely on pulmonary image content. This study evaluates pulmonary attribution containment as an anatomy-related reliability property distinct from diagnostic performance. We propose DBCA-SegNet-MGAP, a multi-task anatomy-guided CNN-Transformer framework that combines complementary feature representations through bidirectional cross-backbone attention, predicts a soft lung mask, and incorporates this anatomical prior directly into classification through Mask-Guided Adaptive Global Average Pooling (MGAP). Pulmonary attribution containment is quantified using the Anatomical Local Energy Ratio (ALR) and high-intensity cumulative ALR ([email protected]). Experiments were repeated across three training seeds using the COVID-19 Radiography Database for four-class internal testing and a locked Shenzhen-to-Montgomery protocol for zero-shot external tuberculosis testing. On COVID-19, the proposed model achieved a weighted F1 of $0.9615 \pm 0.0015$ and macro ROC-AUC of $0.9906 \pm 0.0007$. In an architecture-matched dual-bridge comparison, replacing conventional GAP with MGAP increased ALR from $0.3878 \pm 0.0098$ to $0.7086 \pm 0.0104$ and [email protected] from $0.5265 \pm 0.0101$ to $0.9905 \pm 0.0018$, while weighted F1 remained essentially unchanged ($0.9618 \pm 0.0015$ vs. $0.9615 \pm 0.0015$). Under locked external transfer to Montgomery, ROC-AUC remained $0.9080 \pm 0.0043$ and pulmonary ALR remained $0.6466 \pm 0.0081$, whereas weighted F1 decreased to $0.7528 \pm 0.0080$ and ECE increased to $0.1683 \pm 0.0055$. These findings show that diagnostic discrimination, calibration, and pulmonary attribution containment are distinct model properties and support their joint evaluation under internal testing and external domain shift.

Chest radiography is a widely used imaging modality for thoracic disease diagnosis, yet its conventional interpretation remains time-consuming and heavily dependent on expert knowledge. While deep learning has improved diagnostic efficiency through automated feature extraction, challenges such as class imbalance and the localization of multiple co-existing pathologies remain unsolved. In this paper, inspired by the strength of Convolutional Block Attention Module (CBAM) in feature refinement and the capability of CNN blocks in feature extraction, we propose a strategy to integrate CBAM into traditional CNN blocks to enhance performance in multi-label classification tasks. Our method achieves a mean AUC of 0.8695 on ChestXray14 dataset, outperforming several state-of-the-art baselines.Our source code is available at: https://github.com/NNNguyenDuyyy/FETC_CBAM_Enhanced_CNN.git

Chest X-ray imaging remains the primary diagnostic tool for pulmonary and cardiac disorders worldwide, yet its accuracy is hampered by radiologist shortages and inter-observer variability. This study presents a systematic comparative evaluation of seven deep learning architectures for multi-class chest disease classification: ConvNeXt-Tiny, DenseNet121, DenseNet201, ResNet50, ViT-B/16, EfficientNetV2-M, and MobileNetV2. A balanced dataset of 18,080 chest X-ray images spanning five disease categories (Cardiomegaly, COVID-19, Normal, Pneumonia, and Tuberculosis) was constructed from three public repositories and partitioned at the patient level to prevent data leakage. All models were trained under identical conditions using ImageNet-pretrained weights, standardized preprocessing, and consistent hyperparameters. All seven architectures exceeded 90% test accuracy. ConvNeXt-Tiny achieved the highest performance (92.31% accuracy, 95.70% AUROC), while MobileNetV2 emerged as the most parameter-efficient model (3.5M parameters, 90.42% accuracy, 94.10% AUROC), completing training in 48 minutes. Tuberculosis and COVID-19 classification was near-perfect (AUROC >= 99.97%) across all architectures, while Normal, Cardiomegaly, and Pneumonia presented greater challenges due to overlapping radiographic features. Grad-CAM visualizations confirmed clinically consistent attention patterns across disease categories. These findings demonstrate that high-accuracy multi-disease chest X-ray classification is achievable without excessive computational resources, with important implications for AI-assisted diagnosis in both resource-rich and resource-constrained healthcare settings.