Multi-loss ensemble deep learning for chest X-ray classification

Class imbalance is common in medical image classification tasks, where the number of abnormal samples is fewer than the number of normal samples. The difficulty of imbalanced classification is compounded by other issues such as the size and distribution of the dataset. Reliable training of deep neural networks continues to be a major challenge in such class-imbalanced conditions. The loss function used to train the deep neural networks highly impact the performance of both balanced and imbalanced tasks. Currently, the cross-entropy loss remains the de-facto loss function for balanced and imbalanced classification tasks. This loss, however, asserts equal learning to all classes, leading to the classification of most samples as the majority normal class. To provide a critical analysis of different loss functions and identify those suitable for class-imbalanced classification, we benchmark various state-of-the-art loss functions and propose novel loss functions to train a DL model and analyze its performance in a multiclass classification setting that classifies pediatric chest X-rays as showing normal lungs, bacterial pneumonia, or viral pneumonia manifestations. We also construct prediction-level and model-level ensembles of the models that are trained with various loss functions to improve classification performance. We performed localization studies to interpret model behavior to ensure that the individual models and their ensembles precisely learned the regions of interest showing disease manifestations to classify the chest X-rays to their respective categories.