Chest X-Ray Classification

Deep learning models can identify racial identity with high accuracy from chest X-ray (CXR) recordings. Thus, there is widespread concern about the potential for racial shortcut learning, where a model inadvertently learns to systematically bias its diagnostic predictions as a function of racial identity. Such racial biases threaten healthcare equity and model reliability, as models may systematically misdiagnose certain demographic groups. Since racial shortcuts are diffuse - non-localized and distributed throughout the whole CXR recording - image preprocessing methods may influence racial shortcut learning, yet the potential of such methods for reducing biases remains underexplored. Here, we investigate the effects of image preprocessing methods including lung masking, lung cropping, and Contrast Limited Adaptive Histogram Equalization (CLAHE). These approaches aim to suppress spurious cues encoding racial information while preserving diagnostic accuracy. Our experiments reveal that simple bounding box-based lung cropping can be an effective strategy for reducing racial shortcut learning while maintaining diagnostic model performance, bypassing frequently postulated fairness-accuracy trade-offs.

Long-tailed class distributions pose a significant challenge for multi-label chest X-ray (CXR) classification, where rare but clinically important findings are severely underrepresented. In this work, we present a systematic empirical evaluation of loss functions, CNN backbone architectures and post-training strategies on the CXR-LT 2026 benchmark, comprising approximately 143K images with 30 disease labels from PadChest. Our experiments demonstrate that LDAM with deferred re-weighting (LDAM-DRW) consistently outperforms standard BCE and asymmetric losses for rare class recognition. Amongst the architectures evaluated, ConvNeXt-Large achieves the best single-model performance with 0.5220 mAP and 0.3765 F1 on our development set, whilst classifier re-training and test-time augmentation further improve ranking metrics. On the official test leaderboard, our submission achieved 0.3950 mAP, ranking 5th amongst all 68 participating teams with total of 1528 submissions. We provide a candid analysis of the development-to-test performance gap and discuss practical insights for handling class imbalance in clinical imaging settings. Code is available at https://github.com/Nikhil-Rao20/Long_Tail.

One of the common issues in clinical decision-making is the presence of uncertainty, which often arises due to ambiguity in radiology reports, which often reflect genuine diagnostic uncertainty or limitations of automated label extraction in various complex cases. Especially the case of multilabel datasets such as CheXpert, MIMIC-CXR, etc., which contain labels such as positive, negative, and uncertain. In clinical decision-making, the uncertain label plays a tricky role as the model should not be forced to provide a confident prediction in the absence of sufficient evidence. The ability of the model to say it does not understand whenever it is not confident is crucial, especially in the cases of clinical decision-making involving high risks. Here, we propose AdURA-Net, a geometry-driven adaptive uncertainty-aware framework for reliable thoracic disease classification. The key highlights of the proposed model are: a) Adaptive dilated convolution and multiscale deformable alignment coupled with the backbone Densenet architecture capturing the anatomical complexities of the medical images, and b) Dual Head Loss, which combines masked binary cross entropy with logit and a Dirichlet evidential learning objective.

Chest X-ray (CXR) interpretation is hindered by the long-tailed distribution of pathologies and the open-world nature of clinical environments. Existing benchmarks often rely on closed-set classes from single institutions, failing to capture the prevalence of rare diseases or the appearance of novel findings. To address this, we present the CXR-LT 2026 challenge. This third iteration of the benchmark introduces a multi-center dataset comprising over 145,000 images from PadChest and NIH Chest X-ray datasets. The challenge defines two core tasks: (1) Robust Multi-Label Classification on 30 known classes and (2) Open-World Generalization to 6 unseen (out-of-distribution) rare disease classes. We report the results of the top-performing teams, evaluating them via mean Average Precision (mAP), AUROC, and F1-score. The winning solutions achieved an mAP of 0.5854 on Task 1 and 0.4315 on Task 2, demonstrating that large-scale vision-language pre-training significantly mitigates the performance drop typically associated with zero-shot diagnosis.

Computer-aided diagnosis (CAD) has significantly advanced automated chest X-ray diagnosis but remains isolated from clinical workflows and lacks reliable decision support and interpretability. Human-AI collaboration seeks to enhance the reliability of diagnostic models by integrating the behaviors of controllable radiologists. However, the absence of interactive tools seamlessly embedded within diagnostic routines impedes collaboration, while the semantic gap between radiologists' decision-making patterns and model representations further limits clinical adoption. To overcome these limitations, we propose a visual cognition-guided collaborative network (VCC-Net) to achieve the cooperative diagnostic paradigm. VCC-Net centers on visual cognition (VC) and employs clinically compatible interfaces, such as eye-tracking or the mouse, to capture radiologists' visual search traces and attention patterns during diagnosis. VCC-Net employs VC as a spatial cognition guide, learning hierarchical visual search strategies to localize diagnostically key regions. A cognition-graph co-editing module subsequently integrates radiologist VC with model inference to construct a disease-aware graph. The module captures dependencies among anatomical regions and aligns model representations with VC-driven features, mitigating radiologist bias and facilitating complementary, transparent decision-making. Experiments on the public datasets SIIM-ACR, EGD-CXR, and self-constructed TB-Mouse dataset achieved classification accuracies of 88.40%, 85.05%, and 92.41%, respectively. The attention maps produced by VCC-Net exhibit strong concordance with radiologists' gaze distributions, demonstrating a mutual reinforcement of radiologist and model inference. The code is available at https://github.com/IPMI-NWU/VCC-Net.

The significant advancements in computational power cre- ate a vast opportunity for using Artificial Intelligence in different ap- plications of healthcare and medical science. A Hybrid FL-Enabled Ensemble Approach For Lung Disease Diagnosis Leveraging a Combination of SWIN Transformer and CNN is the combination of cutting-edge technology of AI and Federated Learning. Since, medi- cal specialists and hospitals will have shared data space, based on that data, with the help of Artificial Intelligence and integration of federated learning, we can introduce a secure and distributed system for medical data processing and create an efficient and reliable system. The proposed hybrid model enables the detection of COVID-19 and Pneumonia based on x-ray reports. We will use advanced and the latest available tech- nology offered by Tensorflow and Keras along with Microsoft-developed Vision Transformer, that can help to fight against the pandemic that the world has to fight together as a united. We focused on using the latest available CNN models (DenseNet201, Inception V3, VGG 19) and the Transformer model SWIN Transformer in order to prepare our hy- brid model that can provide a reliable solution as a helping hand for the physician in the medical field. In this research, we will discuss how the Federated learning-based Hybrid AI model can improve the accuracy of disease diagnosis and severity prediction of a patient using the real-time continual learning approach and how the integration of federated learn- ing can ensure hybrid model security and keep the authenticity of the information.

Clinical deployment of chest radiograph classifiers requires models that can be updated as new datasets become available without retraining on previously observed data or degrading validated performance. We study a task-incremental continual learning setting for chest radiograph classification under task-unknown inference, where heterogeneous chest X-ray datasets arrive sequentially and task identity is unavailable at deployment time. We propose CARL-CXR, a continual adapter-based routing framework that maintains a fixed high-capacity backbone while incrementally introducing lightweight task-specific adapters and classifier heads. A latent task selector operates on adapter-conditioned features to dynamically route each input to the most relevant task pathway, leveraging compact task prototypes and feature-level experience replay to preserve task identity across sequential updates without storing raw images. Experiments on MIMIC-CXR and CheXpert two large-scale datasets with distinct patient populations, imaging devices, and annotation pipelines demonstrate that CARL-CXR achieves minimal catastrophic forgetting (0.012 AUROC drop), representing a 6X and 11X reduction over established continual learning baselines LwF and EWC respectively, while maintaining competitive diagnostic performance (AUROC 0.74). Under task unknown deployment, CARL-CXR outperforms joint training by 12.5 points in routing accuracy (75.0% vs. 62.5%): unlike LwF and EWC, which require explicit task identifiers at inference and provide no routing mechanism.

Chest X-ray (CXR) plays a pivotal role in clinical diagnosis, and a variety of task-specific and foundation models have been developed for automatic CXR interpretation. However, these models often struggle to adapt to new diagnostic tasks and complex reasoning scenarios. Recently, LLM-based agent models have emerged as a promising paradigm for CXR analysis, enhancing model's capability through tool coordination, multi-step reasoning, and team collaboration, etc. However, existing agents often rely on a single diagnostic pipeline and lack mechanisms for assessing tools' reliability, limiting their adaptability and credibility. To this end, we propose CXRAgent, a director-orchestrated, multi-stage agent for CXR interpretation, where a central director coordinates the following stages: (1) Tool Invocation: The agent strategically orchestrates a set of CXR-analysis tools, with outputs normalized and verified by the Evidence-driven Validator (EDV), which grounds diagnostic outputs with visual evidence to support reliable downstream diagnosis; (2) Diagnostic Planning: Guided by task requirements and intermediate findings, the agent formulates a targeted diagnostic plan. It then assembles an expert team accordingly, defining member roles and coordinating their interactions to enable adaptive and collaborative reasoning; (3) Collaborative Decision-making: The agent integrates insights from the expert team with accumulated contextual memories, synthesizing them into an evidence-backed diagnostic conclusion. Experiments on various CXR interpretation tasks show that CXRAgent delivers strong performance, providing visual evidence and generalizes well to clinical tasks of different complexity. Code and data are valuable at this link.

Public datasets of Chest X-Rays (CXRs) have long been a popular benchmark for developing machine learning (ML) computer vision models in healthcare. However, the reported strong average-case performance of these models do not necessarily reflect their actual utility when used in heterogeneous clinical settings, potentially masking weaker performance in medically significant scenarios. In this work we use clinical context to provide a more holistic evaluation of models for CXR diagnosis. In particular, we use discharge summaries, recorded prior to each CXR, to derive a ``pre-CXR'' probability of each CXR label, as a proxy for existing contextual knowledge available to clinicians when interpreting CXRs. We use this measure to probe model performance along two dimensions: First, using a stratified analysis, we show that models tend to have lower performance (as measured by AUROC and other metrics) among individuals with higher pre-CXR probability. Second, by controlling for pre-CXR probability via matching and re-weighting, we demonstrate that performance degrades when the correlation is broken between prior context and the current CXR label, suggesting that model performance is highly sensitive to the underlying distribution of clinical context. Specifically, cases with high pre-test probabilities present a fundamentally more difficult visual classification task, highlighting a gap in clinical utility when models are applied to high-risk cohorts.

Chest X-ray (CXR) AI models are increasingly proposed for triage, screening, and rule-out, where the operating point is fixed to miss few abnormalities. Most evaluations instead report threshold-free discrimination on a few public benchmarks, leaving clinically usable performance and generalisability to unseen institutional cohorts poorly characterised. We retrospectively evaluated 10 published CXR classification models on 12 datasets from six countries: seven public benchmarks and five institutional cohorts from China, Japan, and Germany. Models spanned convolutional networks, vision-language models, a question-answering foundation model, and a repurposed encoder. Only image-level classification was assessed; segmentation, detection, and report generation were out of scope. Source labels were harmonised to a common vocabulary. The primary outcome was specificity at 95% sensitivity; PPV at 95% sensitivity and AUROC were secondary outcomes. Estimates weighted each diagnostic task equally, with 95% CIs. MAVL and MedKLIP had the highest overall specificity at 95% sensitivity (0.37 [95% CI 0.31-0.44] and 0.37 [0.30-0.44]) and kept that ranking on tasks evaluable for every model. Their PPV was 0.18 (0.13-0.24) and 0.19 (0.13-0.25): most flagged examinations would be false positives. Specificity was lower on institutional cohorts than on public benchmarks for most models, by 0.13 for MAVL, 0.15 for DenseNet, and 0.09 for MedKLIP. No model was best for every finding, country, lesion extent, or prevalence stratum; specificity fell from 0.34 for diffuse to 0.15 for focal findings. At 95% sensitivity, the best current models clear only about a third of truly negative examinations, and public-benchmark performance overstates what they achieve on unseen institutional data. Operating-point-aware evaluation and external validation on institutional cohorts should precede deployment.