# Loss Design and Architecture Selection for Long-Tailed Multi-Label Chest X-Ray Classification

arXiv: https://arxiv.org/abs/2603.02294 · HTML: https://mlsanity.com/paper/2603.02294/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 14 of its 20 references that are in the map.
- First posted on arXiv 2 Mar 2026.

## Builds on (most cited first, 14 of 14)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Densely Connected Convolutional Networks](https://mlsanity.com/paper/1608.06993/) (2016)
- [A ConvNet for the 2020s](https://mlsanity.com/paper/2201.03545/) (2022)
- [Sharpness-Aware Minimization for Efficiently Improving Generalization](https://mlsanity.com/paper/2010.01412/) (2020)
- [Class-Balanced Loss Based on Effective Number of Samples](https://mlsanity.com/paper/1901.05555/) (2019)
- [EfficientNetV2: Smaller Models and Faster Training](https://mlsanity.com/paper/2104.00298/) (2021)
- [Learning Imbalanced Datasets with Label-Distribution-Aware Margin Loss](https://mlsanity.com/paper/1906.07413/) (2019)
- [Decoupling Representation and Classifier for Long-Tailed Recognition](https://mlsanity.com/paper/1910.09217/) (2019)
- [Asymmetric Loss For Multi-Label Classification](https://mlsanity.com/paper/2009.14119/) (2020)
- [PadChest: A large chest x-ray image dataset with multi-label annotated reports](https://mlsanity.com/paper/1901.07441/) (2019)
- [Long-Tailed Recognition via Weight Balancing](https://mlsanity.com/paper/2203.14197/) (2022)
- [CXR-LT 2024: A MICCAI challenge on long-tailed, multi-label, and zero-shot disease classification from chest X-ray](https://mlsanity.com/paper/2506.07984/) (2025)
- [Handling Supervision Scarcity in Chest X-ray Classification: Long-Tailed and Zero-Shot Learning](https://mlsanity.com/paper/2602.13430/) (2026)
- [Overview of the CXR-LT 2026 Challenge: Multi-Center Long-Tailed and Zero Shot Chest X-ray Classification](https://mlsanity.com/paper/2602.22092/) (2026)

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

- [TRCGL-Net: A Long-Tailed Multi-Label Chest X-Ray Classification Framework with Generative Data Augmentation and Label Co-Occurrence Modeling](https://mlsanity.com/paper/2607.00975/) (2026)

## Abstract (arXiv)

Long-tailed class distributions pose a significant challenge for multi-label chest X-ray (CXR) classification, where rare but clinically important findings are severely underrepresented. In this work, we present a systematic empirical evaluation of loss functions, CNN backbone architectures and post-training strategies on the CXR-LT 2026 benchmark, comprising approximately 143K images with 30 disease labels from PadChest. Our experiments demonstrate that LDAM with deferred re-weighting (LDAM-DRW) consistently outperforms standard BCE and asymmetric losses for rare class recognition. Amongst the architectures evaluated, ConvNeXt-Large achieves the best single-model performance with 0.5220 mAP and 0.3765 F1 on our development set, whilst classifier re-training and test-time augmentation further improve ranking metrics. On the official test leaderboard, our submission achieved 0.3950 mAP, ranking 5th amongst all 68 participating teams with total of 1528 submissions. We provide a candid analysis of the development-to-test performance gap and discuss practical insights for handling class imbalance in clinical imaging settings. Code is available at https://github.com/Nikhil-Rao20/Long_Tail.