# Anatomy-Structured Hierarchical MIL for Weakly-Supervised Thoracic Disease Detection in Chest X-rays

arXiv: https://arxiv.org/abs/2609.33520 · HTML: https://mlsanity.com/paper/2609.33520/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 17 of its 26 references that are in the map.
- First posted on arXiv 27 Sep 2026.

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

- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [DINOv2: Learning Robust Visual Features without Supervision](https://mlsanity.com/paper/2304.07193/) (2023)
- [End-to-End Object Detection with Transformers](https://mlsanity.com/paper/2005.12872/) (2020)
- [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)
- [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)
- [RadGraph: Extracting Clinical Entities and Relations from Radiology Reports](https://mlsanity.com/paper/2106.14463/) (2021)
- [Exploring scalable medical image encoders beyond text supervision](https://mlsanity.com/paper/2401.10815/) (2024)
- [Chest ImaGenome Dataset for Clinical Reasoning](https://mlsanity.com/paper/2108.00316/) (2021)
- [Deep Learning for Chest X-ray Analysis: A Survey](https://mlsanity.com/paper/2103.08700/) (2021)
- [Accurate Fine-Grained Segmentation of Human Anatomy in Radiographs via Volumetric Pseudo-Labeling](https://mlsanity.com/paper/2306.03934/) (2023)
- [Anatomy-Guided Weakly-Supervised Abnormality Localization in Chest X-rays](https://mlsanity.com/paper/2206.12704/) (2022)
- [Weakly supervised one-stage vision and language disease detection using large scale pneumonia and pneumothorax studies](https://mlsanity.com/paper/2007.15778/) (2020)
- [Anatomy-Driven Pathology Detection on Chest X-rays](https://mlsanity.com/paper/2309.02578/) (2023)
- [ThoraX-PriorNet: A Novel Attention-Based Architecture Using Anatomical Prior Probability Maps for Thoracic Disease Classification](https://mlsanity.com/paper/2210.02998/) (2022)
- [Weakly Supervised Object Detection in Chest X-Rays with Differentiable ROI Proposal Networks and Soft ROI Pooling](https://mlsanity.com/paper/2402.11985/) (2024)

## Abstract (arXiv)

Weakly-supervised thoracic disease detection in chest X-rays (CXR) is challenging due to subtle appearances and complex anatomical overlap, motivating anatomy-aware modeling for improved localization. However, prior anatomy-aware methods typically rely on coarse region proxies or static spatial priors, which may restrict dynamic instance discovery and limit precise localization of small abnormalities. We propose Anatomy-Structured Hierarchical Multiple Instance Learning (ASH-MIL), a framework that introduces parallel anatomy-structured observation branches (cardiac, pulmonary, and agnostic) combined with hierarchical MIL aggregation. Anatomical priors are injected as soft spatial biases into decoder cross-attention, enabling anatomically grounded evidence maps without disease bounding-box supervision. Instance localization is derived directly from MIL-weighted cross-attention maps without bounding box supervision. Experiments on CXR8 and cross-domain MIMIC-CXR held-out sets demonstrate consistent improvements over prior weakly-supervised and anatomy-aware approaches, particularly under stricter localization criteria. Our code is available at https://github.com/jn-kim/ash-mil.