# TRCGL-Net: A Long-Tailed Multi-Label Chest X-Ray Classification Framework with Generative Data Augmentation and Label Co-Occurrence Modeling

arXiv: https://arxiv.org/abs/2607.00975 · HTML: https://mlsanity.com/paper/2607.00975/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 17 of its 29 references that are in the map.
- First posted on arXiv 1 Jul 2026.

## Builds on (most cited first, 17 of 17)

- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [EfficientNet: Rethinking Model Scaling for Convolutional Neural Networks](https://mlsanity.com/paper/1905.11946/) (2019)
- [A ConvNet for the 2020s](https://mlsanity.com/paper/2201.03545/) (2022)
- [CheXNet: Radiologist-Level Pneumonia Detection on Chest X-Rays with Deep Learning](https://mlsanity.com/paper/1711.05225/) (2017)
- [PadChest: A large chest x-ray image dataset with multi-label annotated reports](https://mlsanity.com/paper/1901.07441/) (2019)
- [Comparison of Deep Learning Approaches for Multi-Label Chest X-Ray Classification](https://mlsanity.com/paper/1803.02315/) (2018)
- [Towards long-tailed, multi-label disease classification from chest X-ray: Overview of the CXR-LT challenge](https://mlsanity.com/paper/2310.16112/) (2023)
- [Evaluation of Deep Convolutional Generative Adversarial Networks for data augmentation of chest X-ray images](https://mlsanity.com/paper/2009.01181/) (2020)
- [DualAttNet: Synergistic Fusion of Image-level and Fine-Grained Disease Attention for Multi-Label Lesion Detection in Chest X-rays](https://mlsanity.com/paper/2306.13813/) (2023)
- [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)
- [Bag of Tricks for Long-Tailed Multi-Label Classification on Chest X-Rays](https://mlsanity.com/paper/2308.08853/) (2023)
- [Long-tailed multi-label classification with noisy label of thoracic diseases from chest X-ray](https://mlsanity.com/paper/2311.17334/) (2023)
- [LTCXNet: Advancing Chest X-Ray Analysis with Solutions for Long-Tailed Multi-Label Classification and Fairness Challenges](https://mlsanity.com/paper/2411.10746/) (2024)
- [CLARiTy: A Vision Transformer for Multi-Label Classification and Weakly-Supervised Localization of Chest X-ray Pathologies](https://mlsanity.com/paper/2512.16700/) (2025)
- [Loss Design and Architecture Selection for Long-Tailed Multi-Label Chest X-Ray Classification](https://mlsanity.com/paper/2603.02294/) (2026)

## Abstract (arXiv)

Chest X-ray multi-label classification is a core task in intelligent medical imaging diagnosis. However, real clinical data often exhibit extreme long-tailed distributions, leading to degraded performance on rare diseases in tail classes. This issue is not only driven by data scarcity but also by two intrinsic factors:1) attenuation of tail-class lesion representations under complex anatomical backgrounds, and 2) dominance of head classes in modeling label co-occurrence relationships. To address these challenges, we propose TRCGL-Net. First, a learnable text-guided conditional diffusion model is employed to generate high-quality tail-class chest X-ray image samples under disease semantic constraints, improving data diversity and realism of rare disease patterns while alleviating class imbalance and preserving pathology-consistent semantics.Second, a channel reweighting mechanism is introduced to perform feature recalibration by emphasizing disease-relevant feature channels, thereby improving feature discriminability under long-tailed distributions.A class-aware attention mechanism is further applied to generate class-specific attention maps, enabling the model to localize disease-relevant regions and focus on fine-grained lesion areas.Finally, a graph convolution network based on label co occurrence is introduced to establish an information propagation mechanism among categories. Experiments on the PadChest dataset show that the proposed method achieves a tail-class mAP of 0.4904, an overall mAP of 0.4408, and an mAUC of 0.8989, outperforming state-of-the-art methods. TRCGL-Net effectively improves recognition performance for rare diseases under long-tailed distributions and mitigates the impact of extreme class imbalance in chest X-ray multi-label classification.