CLARiTy: A Vision Transformer for Multi-Label Classification and Weakly-Supervised Localization of Chest X-ray Pathologies

The interpretation of chest X-rays (CXRs) poses significant challenges, particularly in achieving accurate multi-label pathology classification and spatial localization. These tasks demand different levels of annotation granularity but are frequently constrained by the scarcity of region-level (dense) annotations. We introduce CLARiTy (Class Localizing and Attention Refining Image Transformer), a vision transformer-based model for joint multi-label classification and weakly-supervised localization of thoracic pathologies. CLARiTy employs multiple class-specific tokens to generate discriminative attention maps, and a SegmentCAM module for foreground segmentation and background suppression using explicit anatomical priors. Trained on image-level labels from the NIH ChestX-ray14 dataset, it leverages distillation from a ConvNeXtV2 teacher for efficiency. Evaluated on the official NIH split, the CLARiTy-S-16-512 (a configuration of CLARiTy), achieves competitive classification performance across 14 pathologies, and state-of-the-art weakly-supervised localization performance on 8 pathologies, outperforming prior methods by 50.7%. In particular, pronounced gains occur for small pathologies like nodules and masses. The lower-resolution variant of CLARiTy, CLARiTy-S-16-224, offers high efficiency while decisively surpassing baselines, thereby having the potential for use in low-resource settings. An ablation study confirms contributions of SegmentCAM, DINO pretraining, orthogonal class token loss, and attention pooling. CLARiTy advances beyond CNN-ViT hybrids by harnessing ViT self-attention for global context and class-specific localization, refined through convolutional background suppression for precise, noise-reduced heatmaps.