# CBAM-Enhanced DenseNet121 for Multi-Class Chest X-Ray Classification with Grad-CAM Explainability

arXiv: https://arxiv.org/abs/2604.12305 · HTML: https://mlsanity.com/paper/2604.12305/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 10 of its 16 references that are in the map.
- First posted on arXiv 14 Apr 2026.

## Builds on (most cited first, 10 of 10)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Grad-CAM: Visual Explanations from Deep Networks via Gradient-based Localization](https://mlsanity.com/paper/1610.02391/) (2016)
- [Densely Connected Convolutional Networks](https://mlsanity.com/paper/1608.06993/) (2016)
- [CBAM: Convolutional Block Attention Module](https://mlsanity.com/paper/1807.06521/) (2018)
- [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)
- [CheXNet: Radiologist-Level Pneumonia Detection on Chest X-Rays with Deep Learning](https://mlsanity.com/paper/1711.05225/) (2017)
- [Attention Gated Networks: Learning to Leverage Salient Regions in Medical Images](https://mlsanity.com/paper/1808.08114/) (2018)
- [Learning to diagnose from scratch by exploiting dependencies among labels](https://mlsanity.com/paper/1710.10501/) (2017)
- [Deep image mining for diabetic retinopathy screening](https://mlsanity.com/paper/1610.07086/) (2016)

## Abstract (arXiv)

Pneumonia remains a leading cause of childhood mortality worldwide, with a heavy burden in low-resource settings such as Bangladesh where radiologist availability is limited. Most existing deep learning approaches treat pneumonia detection as a binary problem, overlooking the clinically critical distinction between bacterial and viral aetiology. This paper proposes CBAM-DenseNet121, a transfer-learning framework that integrates the Convolutional Block Attention Module (CBAM) into DenseNet121 for three-class chest X-ray classification: Normal, Bacterial Pneumonia, and Viral Pneumonia. We also conduct a systematic binary-task baseline study revealing that EfficientNetB3 (73.88%) underperforms even the custom CNN baseline (78.53%) -- a practically important negative finding for medical imaging model selection. To ensure statistical reliability, all experiments were repeated three times with independent random seeds (42, 7, 123), and results are reported as mean +/- standard deviation. CBAM-DenseNet121 achieves 84.29% +/- 1.14% test accuracy with per-class AUC scores of 0.9565 +/- 0.0010, 0.9610 +/- 0.0014, and 0.9187 +/- 0.0037 for bacterial pneumonia, normal, and viral pneumonia respectively. Grad-CAM visualizations confirm that the model attends to anatomically plausible pulmonary regions for each class, supporting interpretable deployment in resource-constrained clinical environments.