Deep Learning Models May Spuriously Classify Covid-19 from X-ray Images Based on Confounders

Identifying who is infected with the Covid-19 virus is critical for controlling its spread. X-ray machines are widely available worldwide and can quickly provide images that can be used for diagnosis. A number of recent studies claim it may be possible to build highly accurate models, using deep learning, to detect Covid-19 from chest X-ray images. This paper explores the robustness and generalization ability of convolutional neural network models in diagnosing Covid-19 disease from frontal-view (AP/PA), raw chest X-ray images that were lung field cropped. Some concerning observations are made about high performing models that have learned to rely on confounding features related to the data source, rather than the patient's lung pathology, when differentiating between Covid-19 positive and negative labels. Specifically, these models likely made diagnoses based on confounding factors such as patient age or image processing artifacts, rather than medically relevant information.

Finding Covid-19 from Chest X-rays using Deep Learning on a Small Dataset

Testing for COVID-19 has been unable to keep up with the demand. Further, the false negative rate is projected to be as high as 30% and test results can take some time to obtain. X-ray machines are widely available and provide images for diagnosis quickly. This paper explores how useful chest X-ray images can be in diagnosing COVID-19 disease. We have obtained 122 chest X-rays of COVID-19 and over 4,000 chest X-rays of viral and bacterial pneumonia. A pretrained deep convolutional neural network has been tuned on 102 COVID-19 cases and 102 other pneumonia cases in a 10-fold cross validation. The results were all 102 COVID-19 cases were correctly classified and there were 8 false positives resulting in an AUC of 0.997. On a test set of 20 unseen COVID-19 cases all were correctly classified and more than 95% of 4171 other pneumonia examples were correctly classified. This study has flaws, most critically a lack of information about where in the disease process the COVID-19 cases were and the small data set size. More COVID-19 case images will enable a better answer to the question of how useful chest X-rays can be for diagnosing COVID-19 (so please send them).