Towards long-tailed, multi-label disease classification from chest X-ray: Overview of the CXR-LT challenge

Many real-world image recognition problems, such as diagnostic medical imaging exams, are "long-tailed" $\unicode{x2013}$ there are a few common findings followed by many more relatively rare conditions. In chest radiography, diagnosis is both a long-tailed and multi-label problem, as patients often present with multiple findings simultaneously. While researchers have begun to study the problem of long-tailed learning in medical image recognition, few have studied the interaction of label imbalance and label co-occurrence posed by long-tailed, multi-label disease classification. To engage with the research community on this emerging topic, we conducted an open challenge, CXR-LT, on long-tailed, multi-label thorax disease classification from chest X-rays (CXRs). We publicly release a large-scale benchmark dataset of over 350,000 CXRs, each labeled with at least one of 26 clinical findings following a long-tailed distribution. We synthesize common themes of top-performing solutions, providing practical recommendations for long-tailed, multi-label medical image classification. Finally, we use these insights to propose a path forward involving vision-language foundation models for few- and zero-shot disease classification.

Robust Asymmetric Loss for Multi-Label Long-Tailed Learning

In real medical data, training samples typically show long-tailed distributions with multiple labels. Class distribution of the medical data has a long-tailed shape, in which the incidence of different diseases is quite varied, and at the same time, it is not unusual for images taken from symptomatic patients to be multi-label diseases. Therefore, in this paper, we concurrently address these two issues by putting forth a robust asymmetric loss on the polynomial function. Since our loss tackles both long-tailed and multi-label classification problems simultaneously, it leads to a complex design of the loss function with a large number of hyper-parameters. Although a model can be highly fine-tuned due to a large number of hyper-parameters, it is difficult to optimize all hyper-parameters at the same time, and there might be a risk of overfitting a model. Therefore, we regularize the loss function using the Hill loss approach, which is beneficial to be less sensitive against the numerous hyper-parameters so that it reduces the risk of overfitting the model. For this reason, the proposed loss is a generic method that can be applied to most medical image classification tasks and does not make the training process more time-consuming. We demonstrate that the proposed robust asymmetric loss performs favorably against the long-tailed with multi-label medical image classification in addition to the various long-tailed single-label datasets. Notably, our method achieves Top-5 results on the CXR-LT dataset of the ICCV CVAMD 2023 competition. We opensource our implementation of the robust asymmetric loss in the public repository: https://github.com/kalelpark/RAL.

Fine-Grained Self-Supervised Learning with Jigsaw Puzzles for Medical Image Classification

Classifying fine-grained lesions is challenging due to minor and subtle differences in medical images. This is because learning features of fine-grained lesions with highly minor differences is very difficult in training deep neural networks. Therefore, in this paper, we introduce Fine-Grained Self-Supervised Learning(FG-SSL) method for classifying subtle lesions in medical images. The proposed method progressively learns the model through hierarchical block such that the cross-correlation between the fine-grained Jigsaw puzzle and regularized original images is close to the identity matrix. We also apply hierarchical block for progressive fine-grained learning, which extracts different information in each step, to supervised learning for discovering subtle differences. Our method does not require an asymmetric model, nor does a negative sampling strategy, and is not sensitive to batch size. We evaluate the proposed fine-grained self-supervised learning method on comprehensive experiments using various medical image recognition datasets. In our experiments, the proposed method performs favorably compared to existing state-of-the-art approaches on the widely-used ISIC2018, APTOS2019, and ISIC2017 datasets.