# How to Train Your CheXDragon: Training Chest X-Ray Models for Transfer to Novel Tasks and Healthcare Systems

arXiv: https://arxiv.org/abs/2305.08017 · HTML: https://mlsanity.com/paper/2305.08017/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 19 of its 31 references that are in the map.
- First posted on arXiv 13 May 2023.

## Builds on (most cited first, 19 of 19)

- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [Densely Connected Convolutional Networks](https://mlsanity.com/paper/1608.06993/) (2016)
- [Don't Stop Pretraining: Adapt Language Models to Domains and Tasks](https://mlsanity.com/paper/2004.10964/) (2020)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [Big Self-Supervised Models are Strong Semi-Supervised Learners](https://mlsanity.com/paper/2006.10029/) (2020)
- [Publicly Available Clinical BERT Embeddings](https://mlsanity.com/paper/1904.03323/) (2019)
- [Fine-Tuning can Distort Pretrained Features and Underperform Out-of-Distribution](https://mlsanity.com/paper/2202.10054/) (2022)
- [Contrastive Learning of Medical Visual Representations from Paired Images and Text](https://mlsanity.com/paper/2010.00747/) (2020)
- [CheXNet: Radiologist-Level Pneumonia Detection on Chest X-Rays with Deep Learning](https://mlsanity.com/paper/1711.05225/) (2017)
- [Big Self-Supervised Models Advance Medical Image Classification](https://mlsanity.com/paper/2101.05224/) (2021)
- [PadChest: A large chest x-ray image dataset with multi-label annotated reports](https://mlsanity.com/paper/1901.07441/) (2019)
- [Data Determines Distributional Robustness in Contrastive Language Image Pre-training (CLIP)](https://mlsanity.com/paper/2205.01397/) (2022)
- [Quality Not Quantity: On the Interaction between Dataset Design and Robustness of CLIP](https://mlsanity.com/paper/2208.05516/) (2022)
- [Self-supervised learning methods and applications in medical imaging analysis: A survey](https://mlsanity.com/paper/2109.08685/) (2021)
- [MoCo-CXR: MoCo Pretraining Improves Representation and Transferability of Chest X-ray Models](https://mlsanity.com/paper/2010.05352/) (2020)
- [CheXtransfer: Performance and Parameter Efficiency of ImageNet Models for Chest X-Ray Interpretation](https://mlsanity.com/paper/2101.06871/) (2021)
- [MedAug: Contrastive learning leveraging patient metadata improves representations for chest X-ray interpretation](https://mlsanity.com/paper/2102.10663/) (2021)
- [Robust and Efficient Medical Imaging with Self-Supervision](https://mlsanity.com/paper/2205.09723/) (2022)
- [Downstream Datasets Make Surprisingly Good Pretraining Corpora](https://mlsanity.com/paper/2209.14389/) (2022)

## Abstract (arXiv)

Self-supervised learning (SSL) enables label efficient training for machine learning models. This is essential for domains such as medical imaging, where labels are costly and time-consuming to curate. However, the most effective supervised or SSL strategy for transferring models to different healthcare systems or novel tasks is not well understood. In this work, we systematically experiment with a variety of supervised and self-supervised pretraining strategies using multimodal datasets of medical images (chest X-rays) and text (radiology reports). We then evaluate their performance on data from two external institutions with diverse sets of tasks. In addition, we experiment with different transfer learning strategies to effectively adapt these pretrained models to new tasks and healthcare systems. Our empirical results suggest that multimodal SSL gives substantial gains over unimodal SSL in performance across new healthcare systems and tasks, comparable to models pretrained with full supervision. We demonstrate additional performance gains with models further adapted to the new dataset and task, using multimodal domain-adaptive pretraining (DAPT), linear probing then finetuning (LP-FT), and both methods combined. We offer suggestions for alternative models to use in scenarios where not all of these additions are feasible. Our results provide guidance for improving the generalization of medical image interpretation models to new healthcare systems and novel tasks.