Learning to Automatically Diagnose Multiple Diseases in Pediatric Chest Radiographs Using Deep Convolutional Neural Networks

TL;DR

This study develops a deep learning model to automatically diagnose multiple lung diseases in pediatric chest X-rays, overcoming data scarcity and class imbalance, achieving promising accuracy and outperforming previous methods.

Contribution

The paper introduces a novel distribution-balanced loss function for training D-CNNs on pediatric CXR data with class imbalance, and provides a large annotated dataset for multi-disease detection.

Findings

Achieved AUC of 0.709 on test set for multi-disease classification.

Outperformed previous state-of-the-art methods on most target diseases.

Validated effectiveness of the proposed loss function through ablation studies.

Abstract

Chest radiograph (CXR) interpretation in pediatric patients is error-prone and requires a high level of understanding of radiologic expertise. Recently, deep convolutional neural networks (D-CNNs) have shown remarkable performance in interpreting CXR in adults. However, there is a lack of evidence indicating that D-CNNs can recognize accurately multiple lung pathologies from pediatric CXR scans. In particular, the development of diagnostic models for the detection of pediatric chest diseases faces significant challenges such as (i) lack of physician-annotated datasets and (ii) class imbalance problems. In this paper, we retrospectively collect a large dataset of 5,017 pediatric CXR scans, for which each is manually labeled by an experienced radiologist for the presence of 10 common pathologies. A D-CNN model is then trained on 3,550 annotated scans to classify multiple pediatric lung pathologies automatically. To address the high-class imbalance issue, we propose to modify and apply "Distribution-Balanced loss" for training D-CNNs which reshapes the standard Binary-Cross Entropy loss (BCE) to efficiently learn harder samples by down-weighting the loss assigned to the majority classes. On an independent test set of 777 studies, the proposed approach yields an area under the receiver operating characteristic (AUC) of 0.709 (95% CI, 0.690-0.729). The sensitivity, specificity, and F1-score at the cutoff value are 0.722 (0.694-0.750), 0.579 (0.563-0.595), and 0.389 (0.373-0.405), respectively. These results significantly outperform previous state-of-the-art methods on most of the target diseases. Moreover, our ablation studies validate the effectiveness of the proposed loss function compared to other standard losses, e.g., BCE and Focal Loss, for this learning task. Overall, we demonstrate the potential of D-CNNs in interpreting pediatric CXRs.