# Following the Diagnostic Trace: Visual Cognition-guided Cooperative Network for Chest X-Ray Diagnosis

arXiv: https://arxiv.org/abs/2602.21657 · HTML: https://mlsanity.com/paper/2602.21657/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 22 of its 43 references that are in the map.
- First posted on arXiv 25 Feb 2026.

## Builds on (most cited first, 22 of 22)

- [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)
- [Swin Transformer: Hierarchical Vision Transformer using Shifted Windows](https://mlsanity.com/paper/2103.14030/) (2021)
- [Grad-CAM: Visual Explanations from Deep Networks via Gradient-based Localization](https://mlsanity.com/paper/1610.02391/) (2016)
- [Learning Deep Features for Discriminative Localization](https://mlsanity.com/paper/1512.04150/) (2015)
- [Shortcut Learning in Deep Neural Networks](https://mlsanity.com/paper/2004.07780/) (2020)
- [DeepGCNs: Can GCNs Go as Deep as CNNs?](https://mlsanity.com/paper/1904.03751/) (2019)
- [CoTr: Efficiently Bridging CNN and Transformer for 3D Medical Image Segmentation](https://mlsanity.com/paper/2103.03024/) (2021)
- [Vision GNN: An Image is Worth Graph of Nodes](https://mlsanity.com/paper/2206.00272/) (2022)
- [CA-Net: Comprehensive Attention Convolutional Neural Networks for Explainable Medical Image Segmentation](https://mlsanity.com/paper/2009.10549/) (2020)
- [Attention Based Glaucoma Detection: A Large-scale Database and CNN Model](https://mlsanity.com/paper/1903.10831/) (2019)
- [Creation and Validation of a Chest X-Ray Dataset with Eye-tracking and Report Dictation for AI Development](https://mlsanity.com/paper/2009.07386/) (2020)
- [DeepGaze IIE: Calibrated prediction in and out-of-domain for state-of-the-art saliency modeling](https://mlsanity.com/paper/2105.12441/) (2021)
- [EML-NET:An Expandable Multi-Layer NETwork for Saliency Prediction](https://mlsanity.com/paper/1805.01047/) (2018)
- [Follow My Eye: Using Gaze to Supervise Computer-Aided Diagnosis](https://mlsanity.com/paper/2204.02976/) (2022)
- [Global-Local Transformer for Brain Age Estimation](https://mlsanity.com/paper/2109.01663/) (2021)
- [Aligning Eyes between Humans and Deep Neural Network through Interactive Attention Alignment](https://mlsanity.com/paper/2202.02838/) (2022)
- [GazeGNN: A Gaze-Guided Graph Neural Network for Chest X-ray Classification](https://mlsanity.com/paper/2305.18221/) (2023)
- [Diagnose Like a Radiologist: Hybrid Neuro-Probabilistic Reasoning for Attribute-Based Medical Image Diagnosis](https://mlsanity.com/paper/2208.09282/) (2022)
- [Eye-gaze-guided Vision Transformer for Rectifying Shortcut Learning](https://mlsanity.com/paper/2205.12466/) (2022)
- [RadioTransformer: A Cascaded Global-Focal Transformer for Visual Attention-guided Disease Classification](https://mlsanity.com/paper/2202.11781/) (2022)
- [Gaze-directed Vision GNN for Mitigating Shortcut Learning in Medical Image](https://mlsanity.com/paper/2406.14050/) (2024)

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

- [CheXpercept: A Benchmark for Evaluating Expert-Level Lesion Perception in Chest X-rays](https://mlsanity.com/paper/2606.21020/) (2026)

## Abstract (arXiv)

Computer-aided diagnosis (CAD) has significantly advanced automated chest X-ray diagnosis but remains isolated from clinical workflows and lacks reliable decision support and interpretability. Human-AI collaboration seeks to enhance the reliability of diagnostic models by integrating the behaviors of controllable radiologists. However, the absence of interactive tools seamlessly embedded within diagnostic routines impedes collaboration, while the semantic gap between radiologists' decision-making patterns and model representations further limits clinical adoption. To overcome these limitations, we propose a visual cognition-guided collaborative network (VCC-Net) to achieve the cooperative diagnostic paradigm. VCC-Net centers on visual cognition (VC) and employs clinically compatible interfaces, such as eye-tracking or the mouse, to capture radiologists' visual search traces and attention patterns during diagnosis. VCC-Net employs VC as a spatial cognition guide, learning hierarchical visual search strategies to localize diagnostically key regions. A cognition-graph co-editing module subsequently integrates radiologist VC with model inference to construct a disease-aware graph. The module captures dependencies among anatomical regions and aligns model representations with VC-driven features, mitigating radiologist bias and facilitating complementary, transparent decision-making. Experiments on the public datasets SIIM-ACR, EGD-CXR, and self-constructed TB-Mouse dataset achieved classification accuracies of 88.40%, 85.05%, and 92.41%, respectively. The attention maps produced by VCC-Net exhibit strong concordance with radiologists' gaze distributions, demonstrating a mutual reinforcement of radiologist and model inference. The code is available at https://github.com/IPMI-NWU/VCC-Net.