# Robust and Interpretable COVID-19 Diagnosis on Chest X-ray Images using Adversarial Training

arXiv: https://arxiv.org/abs/2311.14227 · HTML: https://mlsanity.com/paper/2311.14227/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 28 of its 56 references that are in the map.
- First posted on arXiv 23 Nov 2023.

## Builds on (most cited first, 28 of 28)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Very Deep Convolutional Networks for Large-Scale Image Recognition](https://mlsanity.com/paper/1409.1556/) (2014)
- [Explaining and Harnessing Adversarial Examples](https://mlsanity.com/paper/1412.6572/) (2014)
- [Grad-CAM: Visual Explanations from Deep Networks via Gradient-based Localization](https://mlsanity.com/paper/1610.02391/) (2016)
- [EfficientNet: Rethinking Model Scaling for Convolutional Neural Networks](https://mlsanity.com/paper/1905.11946/) (2019)
- [Rethinking the Inception Architecture for Computer Vision](https://mlsanity.com/paper/1512.00567/) (2015)
- [Intriguing properties of neural networks](https://mlsanity.com/paper/1312.6199/) (2013)
- [Axiomatic Attribution for Deep Networks](https://mlsanity.com/paper/1703.01365/) (2017)
- [Xception: Deep Learning with Depthwise Separable Convolutions](https://mlsanity.com/paper/1610.02357/) (2016)
- [Identity Mappings in Deep Residual Networks](https://mlsanity.com/paper/1603.05027/) (2016)
- [Inception-v4, Inception-ResNet and the Impact of Residual Connections on Learning](https://mlsanity.com/paper/1602.07261/) (2016)
- [EfficientNetV2: Smaller Models and Faster Training](https://mlsanity.com/paper/2104.00298/) (2021)
- [SmoothGrad: removing noise by adding noise](https://mlsanity.com/paper/1706.03825/) (2017)
- [Adversarial Examples Are Not Bugs, They Are Features](https://mlsanity.com/paper/1905.02175/) (2019)
- [Robustness May Be at Odds with Accuracy](https://mlsanity.com/paper/1805.12152/) (2018)
- [COVID-Net: A Tailored Deep Convolutional Neural Network Design for Detection of COVID-19 Cases from Chest X-Ray Images](https://mlsanity.com/paper/2003.09871/) (2020)
- [Covid-19: Automatic detection from X-Ray images utilizing Transfer Learning with Convolutional Neural Networks](https://mlsanity.com/paper/2003.11617/) (2020)
- [Interpreting Adversarially Trained Convolutional Neural Networks](https://mlsanity.com/paper/1905.09797/) (2019)
- [CoroNet: A deep neural network for detection and diagnosis of COVID-19 from chest x-ray images](https://mlsanity.com/paper/2004.04931/) (2020)
- [Deep Learning COVID-19 Features on CXR using Limited Training Data Sets](https://mlsanity.com/paper/2004.05758/) (2020)
- [Deep-COVID: Predicting COVID-19 From Chest X-Ray Images Using Deep Transfer Learning](https://mlsanity.com/paper/2004.09363/) (2020)
- [COVIDX-Net: A Framework of Deep Learning Classifiers to Diagnose COVID-19 in X-Ray Images](https://mlsanity.com/paper/2003.11055/) (2020)
- [Automatic Detection of Coronavirus Disease (COVID-19) in X-ray and CT Images: A Machine Learning-Based Approach](https://mlsanity.com/paper/2004.10641/) (2020)
- [Deep Learning for Screening COVID-19 using Chest X-Ray Images](https://mlsanity.com/paper/2004.10507/) (2020)
- [Improving performance of CNN to predict likelihood of COVID-19 using chest X-ray images with preprocessing algorithms](https://mlsanity.com/paper/2006.12229/) (2020)
- [Improving Interpretability in Medical Imaging Diagnosis using Adversarial Training](https://mlsanity.com/paper/2012.01166/) (2020)
- [Now You See It, Now You Dont: Adversarial Vulnerabilities in Computational Pathology](https://mlsanity.com/paper/2106.08153/) (2021)
- [Efficient and Visualizable Convolutional Neural Networks for COVID-19 Classification Using Chest CT](https://mlsanity.com/paper/2012.11860/) (2020)

## Abstract (arXiv)

The novel 2019 Coronavirus disease (COVID-19) global pandemic is a defining health crisis. Recent efforts have been increasingly directed towards achieving quick and accurate detection of COVID-19 across symptomatic patients to mitigate the intensity and spread of the disease. Artificial intelligence (AI) algorithms applied to chest X-ray (CXR) images have emerged as promising diagnostic tools, and previous work has demonstrated impressive classification performances. However, such methods have faced criticisms from physicians due to their black-box reasoning process and unpredictable nature. In contrast to professional radiologist diagnosis, AI systems often lack generalizability, explainability, and robustness in the clinical decision making process. In our work, we address these issues by first proposing an extensive baseline study, training and evaluating 21 convolutional neural network (CNN) models on a diverse set of 33,000+ CXR images to classify between healthy, COVID-19, and non-COVID-19 pneumonia CXRs. Our resulting models achieved a 3-way classification accuracy, recall, and precision of up to 97.03%, 97.97%, and 99.95%, respectively. Next, we investigate the effectiveness of adversarial training on model robustness and explainability via Gradient-weighted Class Activation Mapping (Grad-CAM) heatmaps. We find that adversarially trained models not only significantly outperform their standard counterparts on classifying perturbed images, but also yield saliency maps that 1) better specify clinically relevant features, 2) are robust against extraneous artifacts, and 3) agree considerably more with expert radiologist findings.