Following the Diagnostic Trace: Visual Cognition-guided Cooperative Network for Chest X-Ray Diagnosis

TL;DR

This paper introduces VCC-Net, a visual cognition-guided collaborative network that enhances chest X-ray diagnosis by integrating radiologists' visual search patterns with model inference for improved accuracy and interpretability.

Contribution

VCC-Net uniquely combines visual cognition data with model inference through a cognition-graph, enabling more transparent and collaborative diagnostic decision-making in chest X-ray analysis.

Findings

Achieved high classification accuracies on multiple datasets.

Produced attention maps aligned with radiologists' gaze.

Enhanced interpretability and collaboration between AI and radiologists.

Abstract

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.