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

arXiv: https://arxiv.org/abs/2108.06486 · HTML: https://mlsanity.com/paper/2108.06486/

## Key facts

- Cited by 7 papers in the map (data through 14 Oct 2026).
- Builds on 13 of its 46 references that are in the map.
- First posted on arXiv 14 Aug 2021.

## Builds on (most cited first, 13 of 13)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Grad-CAM: Visual Explanations from Deep Networks via Gradient-based Localization](https://mlsanity.com/paper/1610.02391/) (2016)
- [Densely Connected Convolutional Networks](https://mlsanity.com/paper/1608.06993/) (2016)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [Cyclical Learning Rates for Training Neural Networks](https://mlsanity.com/paper/1506.01186/) (2015)
- [Score-CAM: Score-Weighted Visual Explanations for Convolutional Neural Networks](https://mlsanity.com/paper/1910.01279/) (2019)
- [CheXNet: Radiologist-Level Pneumonia Detection on Chest X-Rays with Deep Learning](https://mlsanity.com/paper/1711.05225/) (2017)
- [What Clinicians Want: Contextualizing Explainable Machine Learning for Clinical End Use](https://mlsanity.com/paper/1905.05134/) (2019)
- [Distribution-Balanced Loss for Multi-Label Classification in Long-Tailed Datasets](https://mlsanity.com/paper/2007.09654/) (2020)
- [The Emerging Trends of Multi-Label Learning](https://mlsanity.com/paper/2011.11197/) (2020)
- [Comparison of Deep Learning Approaches for Multi-Label Chest X-Ray Classification](https://mlsanity.com/paper/1803.02315/) (2018)
- [Interpreting Chest X-rays via CNNs that Exploit Hierarchical Disease Dependencies and Uncertainty Labels](https://mlsanity.com/paper/2005.12734/) (2020)
- [Transfer Learning with Deep Convolutional Neural Network (CNN) for Pneumonia Detection using Chest X-ray](https://mlsanity.com/paper/2004.06578/) (2020)

## Built on by (most cited first, 7 of 7)

- [PediCXR: An open, large-scale chest radiograph dataset for interpretation of common thoracic diseases in children](https://mlsanity.com/paper/2203.10612/) (2022)
- [An Accurate and Explainable Deep Learning System Improves Interobserver Agreement in the Interpretation of Chest Radiograph](https://mlsanity.com/paper/2208.03545/) (2022)
- [Learning to diagnose common thorax diseases on chest radiographs from radiology reports in Vietnamese](https://mlsanity.com/paper/2209.04794/) (2022)
- [Slice-level Detection of Intracranial Hemorrhage on CT Using Deep Descriptors of Adjacent Slices](https://mlsanity.com/paper/2208.03403/) (2022)
- [Improving Object Detection in Medical Image Analysis through Multiple Expert Annotators: An Empirical Investigation](https://mlsanity.com/paper/2303.16507/) (2023)
- [Evaluating the impact of an explainable machine learning system on the interobserver agreement in chest radiograph interpretation](https://mlsanity.com/paper/2304.01220/) (2023)
- [Improving Pediatric Pneumonia Diagnosis with Adult Chest X-ray Images Utilizing Contrastive Learning and Embedding Similarity](https://mlsanity.com/paper/2404.12958/) (2024)

## Abstract (arXiv)

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.