# Improving Fairness of Automated Chest X-ray Diagnosis by Contrastive Learning

arXiv: https://arxiv.org/abs/2401.15111 · HTML: https://mlsanity.com/paper/2401.15111/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 18 of its 29 references that are in the map.
- First posted on arXiv 25 Jan 2024.

## Builds on (most cited first, 18 of 18)

- [Densely Connected Convolutional Networks](https://mlsanity.com/paper/1608.06993/) (2016)
- [Supervised Contrastive Learning](https://mlsanity.com/paper/2004.11362/) (2020)
- [A Survey on Bias and Fairness in Machine Learning](https://mlsanity.com/paper/1908.09635/) (2019)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [ChestX-ray8: Hospital-scale Chest X-ray Database and Benchmarks on Weakly-Supervised Classification and Localization of Common Thorax Diseases](https://mlsanity.com/paper/1705.02315/) (2017)
- [MIMIC-CXR-JPG, a large publicly available database of labeled chest radiographs](https://mlsanity.com/paper/1901.07042/) (2019)
- [CheXNet: Radiologist-Level Pneumonia Detection on Chest X-Rays with Deep Learning](https://mlsanity.com/paper/1711.05225/) (2017)
- [Achieving Fairness through Adversarial Learning: an Application to Recidivism Prediction](https://mlsanity.com/paper/1807.00199/) (2018)
- [Deep-COVID: Predicting COVID-19 From Chest X-Ray Images Using Deep Transfer Learning](https://mlsanity.com/paper/2004.09363/) (2020)
- [FairPrune: Achieving Fairness Through Pruning for Dermatological Disease Diagnosis](https://mlsanity.com/paper/2203.02110/) (2022)
- [Pairwise Fairness for Ranking and Regression](https://mlsanity.com/paper/1906.05330/) (2019)
- [Improving the Fairness of Chest X-ray Classifiers](https://mlsanity.com/paper/2203.12609/) (2022)
- [An Empirical Characterization of Fair Machine Learning For Clinical Risk Prediction](https://mlsanity.com/paper/2007.10306/) (2020)
- [Classification of COVID-19 in chest X-ray images using DeTraC deep convolutional neural network](https://mlsanity.com/paper/2003.13815/) (2020)
- [FairDisCo: Fairer AI in Dermatology via Disentanglement Contrastive Learning](https://mlsanity.com/paper/2208.10013/) (2022)
- [AI Fairness via Domain Adaptation](https://mlsanity.com/paper/2104.01109/) (2021)
- [Evaluate underdiagnosis and overdiagnosis bias of deep learning model on primary open-angle glaucoma diagnosis in under-served patient populations](https://mlsanity.com/paper/2301.11315/) (2023)
- [Artificial Intelligence in Tumor Subregion Analysis Based on Medical Imaging: A Review](https://mlsanity.com/paper/2103.13588/) (2021)

## Built on by (most cited first, 1 of 1)

- [FairDD: Enhancing Fairness with domain-incremental learning in dermatological disease diagnosis](https://mlsanity.com/paper/2412.16542/) (2024)

## Abstract (arXiv)

Purpose: Limited studies exploring concrete methods or approaches to tackle and enhance model fairness in the radiology domain. Our proposed AI model utilizes supervised contrastive learning to minimize bias in CXR diagnosis. Materials and Methods: In this retrospective study, we evaluated our proposed method on two datasets: the Medical Imaging and Data Resource Center (MIDRC) dataset with 77,887 CXR images from 27,796 patients collected as of April 20, 2023 for COVID-19 diagnosis, and the NIH Chest X-ray (NIH-CXR) dataset with 112,120 CXR images from 30,805 patients collected between 1992 and 2015. In the NIH-CXR dataset, thoracic abnormalities include atelectasis, cardiomegaly, effusion, infiltration, mass, nodule, pneumonia, pneumothorax, consolidation, edema, emphysema, fibrosis, pleural thickening, or hernia. Our proposed method utilizes supervised contrastive learning with carefully selected positive and negative samples to generate fair image embeddings, which are fine-tuned for subsequent tasks to reduce bias in chest X-ray (CXR) diagnosis. We evaluated the methods using the marginal AUC difference (δ mAUC). Results: The proposed model showed a significant decrease in bias across all subgroups when compared to the baseline models, as evidenced by a paired T-test (p<0.0001). The δ mAUC obtained by our method were 0.0116 (95% CI, 0.0110-0.0123), 0.2102 (95% CI, 0.2087-0.2118), and 0.1000 (95% CI, 0.0988-0.1011) for sex, race, and age on MIDRC, and 0.0090 (95% CI, 0.0082-0.0097) for sex and 0.0512 (95% CI, 0.0512-0.0532) for age on NIH-CXR, respectively. Conclusion: Employing supervised contrastive learning can mitigate bias in CXR diagnosis, addressing concerns of fairness and reliability in deep learning-based diagnostic methods.