# Beyond Conventional Transformers: The Medical X-ray Attention (MXA) Block for Improved Multi-Label Diagnosis Using Knowledge Distillation

arXiv: https://arxiv.org/abs/2504.02277 · HTML: https://mlsanity.com/paper/2504.02277/

## Key facts

- Cited by 2 papers in the map (data through 14 Oct 2026).
- Builds on 25 of its 47 references that are in the map.
- First posted on arXiv 3 Apr 2025.

## Builds on (most cited first, 25 of 25)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [Swin Transformer: Hierarchical Vision Transformer using Shifted Windows](https://mlsanity.com/paper/2103.14030/) (2021)
- [Distilling the Knowledge in a Neural Network](https://mlsanity.com/paper/1503.02531/) (2015)
- [Densely Connected Convolutional Networks](https://mlsanity.com/paper/1608.06993/) (2016)
- [EfficientNet: Rethinking Model Scaling for Convolutional Neural Networks](https://mlsanity.com/paper/1905.11946/) (2019)
- [Training data-efficient image transformers & distillation through attention](https://mlsanity.com/paper/2012.12877/) (2020)
- [Fast R-CNN](https://mlsanity.com/paper/1504.08083/) (2015)
- [CBAM: Convolutional Block Attention Module](https://mlsanity.com/paper/1807.06521/) (2018)
- [TransUNet: Transformers Make Strong Encoders for Medical Image Segmentation](https://mlsanity.com/paper/2102.04306/) (2021)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [ShuffleNet: An Extremely Efficient Convolutional Neural Network for Mobile Devices](https://mlsanity.com/paper/1707.01083/) (2017)
- [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)
- [Segmenter: Transformer for Semantic Segmentation](https://mlsanity.com/paper/2105.05633/) (2021)
- [Network In Network](https://mlsanity.com/paper/1312.4400/) (2013)
- [CheXNet: Radiologist-Level Pneumonia Detection on Chest X-Rays with Deep Learning](https://mlsanity.com/paper/1711.05225/) (2017)
- [Hidden Stratification Causes Clinically Meaningful Failures in Machine Learning for Medical Imaging](https://mlsanity.com/paper/1909.12475/) (2019)
- [CNN-RNN: A Unified Framework for Multi-label Image Classification](https://mlsanity.com/paper/1604.04573/) (2016)
- [EfficientViT: Memory Efficient Vision Transformer with Cascaded Group Attention](https://mlsanity.com/paper/2305.07027/) (2023)
- [CheXclusion: Fairness gaps in deep chest X-ray classifiers](https://mlsanity.com/paper/2003.00827/) (2020)
- [Large-scale Robust Deep AUC Maximization: A New Surrogate Loss and Empirical Studies on Medical Image Classification](https://mlsanity.com/paper/2012.03173/) (2020)
- [On the limits of cross-domain generalization in automated X-ray prediction](https://mlsanity.com/paper/2002.02497/) (2020)
- [Survey of Social Bias in Vision-Language Models](https://mlsanity.com/paper/2309.14381/) (2023)

## Built on by (most cited first, 2 of 2)

- [Radiology Report Generation with Layer-Wise Anatomical Attention](https://mlsanity.com/paper/2512.16841/) (2025)
- [PulmoSight-XAI: An Explainable Multi-View Attention Ensemble with Gradient Boosting Meta-Learning for Multi-Label Chest X-Ray Classification](https://mlsanity.com/paper/2607.04478/) (2026)

## Abstract (arXiv)

Medical imaging, particularly X-ray analysis, often involves detecting multiple conditions simultaneously within a single scan, making multi-label classification crucial for real-world clinical applications. We present the Medical X-ray Attention (MXA) block, a novel attention mechanism tailored specifically to address the unique challenges of X-ray abnormality detection. The MXA block enhances traditional Multi-Head Self Attention (MHSA) by integrating a specialized module that efficiently captures both detailed local information and broader global context. To the best of our knowledge, this is the first work to propose a task-specific attention mechanism for diagnosing chest X-rays, as well as to attempt multi-label classification using an Efficient Vision Transformer (EfficientViT). By embedding the MXA block within the EfficientViT architecture and employing knowledge distillation, our proposed model significantly improves performance on the CheXpert dataset, a widely used benchmark for multi-label chest X-ray abnormality detection. Our approach achieves an area under the curve (AUC) of 0.85, an absolute improvement of 0.19 compared to our baseline model's AUC of 0.66, corresponding to a substantial approximate 233% relative improvement over random guessing (AUC = 0.5).