While deep learning models become more widespread, their ability to handle unseen data and generalize for any scenario is yet to be challenged. In medical imaging, there is a high heterogeneity of distributions among images based on the equipment that generate them and their parametrization. This heterogeneity triggers a common issue in machine learning called domain shift, which represents the difference between the training data distribution and the distribution of where a model is employed. A high domain shift tends to implicate in a poor performance from models. In this work, we evaluate the extent of domain shift on three of the largest datasets of chest radiographs. We show how training and testing with different datasets (e.g. training in ChestX-ray14 and testing in CheXpert) drastically affects model performance, posing a big question over the reliability of deep learning models.
This large scale study focuses on quantifying what X-rays diagnostic prediction tasks generalize well across multiple different datasets. We present evidence that the issue of generalization is not due to a shift in the images but instead a shift in the labels. We study the cross-domain performance, agreement between models, and model representations. We find interesting discrepancies between performance and agreement where models which both achieve good performance disagree in their predictions as well as models which agree yet achieve poor performance. We also test for concept similarity by regularizing a network to group tasks across multiple datasets together and observe variation across the tasks.
The MIMIC-CXR dataset is (to date) the largest released chest x-ray dataset consisting of 473,064 chest x-rays and 206,574 radiology reports collected from 63,478 patients. We present the results of training and evaluating a collection of deep convolutional neural networks on this dataset to recognize multiple common thorax diseases. To the best of our knowledge, this is the first work that trains CNNs for this task on such a large collection of chest x-ray images, which is over four times the size of the largest previously released chest x-ray corpus (ChestX-Ray14). We describe and evaluate individual CNN models trained on frontal and lateral CXR view types. In addition, we present a novel DualNet architecture that emulates routine clinical practice by simultaneously processing both frontal and lateral CXR images obtained from a radiological exam. Our DualNet architecture shows improved performance in recognizing findings in CXR images when compared to applying separate baseline frontal and lateral classifiers.
Most deep learning models in chest X-ray prediction utilize the posteroanterior (PA) view due to the lack of other views available. PadChest is a large-scale chest X-ray dataset that has almost 200 labels and multiple views available. In this work, we use PadChest to explore multiple approaches to merging the PA and lateral views for predicting the radiological labels associated with the X-ray image. We find that different methods of merging the model utilize the lateral view differently. We also find that including the lateral view increases performance for 32 labels in the dataset, while being neutral for the others. The increase in overall performance is comparable to the one obtained by using only the PA view with twice the amount of patients in the training set.
We develop an algorithm that can detect pneumonia from chest X-rays at a level exceeding practicing radiologists. Our algorithm, CheXNet, is a 121-layer convolutional neural network trained on ChestX-ray14, currently the largest publicly available chest X-ray dataset, containing over 100,000 frontal-view X-ray images with 14 diseases. Four practicing academic radiologists annotate a test set, on which we compare the performance of CheXNet to that of radiologists. We find that CheXNet exceeds average radiologist performance on the F1 metric. We extend CheXNet to detect all 14 diseases in ChestX-ray14 and achieve state of the art results on all 14 diseases.