X-Ray image enhancement, along with many other medical image processing applications, requires the segmentation of images into bone, soft tissue, and open beam regions. We apply a machine learning approach to this problem, presenting an end-to-end solution which results in robust and efficient inference. Since medical institutions frequently do not have the resources to process and label the large quantity of X-Ray images usually needed for neural network training, we design an end-to-end solution for small datasets, while achieving state-of-the-art results. Our implementation produces an overall accuracy of 92 , F1 score of 0.92, and an AUC of 0.98, surpassing classical image processing techniques, such as clustering and entropy based methods, while improving upon the output of existing neural networks used for segmentation in non-medical contexts. The code used for this project is available online.
@cite_7: The chest X-ray is one of the most commonly accessible radiological examinations for screening and diagnosis of many lung diseases. A tremendous number of X-ray imaging studies accompanied by radiological reports are accumulated and stored in many modern hospitals Picture Archiving and Communication Systems (PACS). On the other side, it is still an open question how this type of hospital-size knowledge database containing invaluable imaging informatics (i.e., loosely labeled) can be used to facilitate the data-hungry deep learning paradigms in building truly large-scale high precision computer-aided diagnosis (CAD) systems. In this paper, we present a new chest X-ray database, namely ChestX-ray8, which comprises 108,948 frontal-view X-ray images of 32,717 unique patients with the text-mined eight disease image labels (where each image can have multi-labels), from the associated radiological reports using natural language processing. Importantly, we demonstrate that these commonly occurring thoracic diseases can be detected and even spatially-located via a unified weakly-supervised multi-label image classification and disease localization framework, which is validated using our proposed dataset. Although the initial quantitative results are promising as reported, deep convolutional neural network based reading chest X-rays (i.e., recognizing and locating the common disease patterns trained with only image-level labels) remains a strenuous task for fully-automated high precision CAD systems.
@cite_29: 
@cite_42: We develop an algorithm that can detect pneumonia from chest X-rays at a level exceeding practicing radiologists. Our algorithm, CheXNet, is a 121-layer convolutional neural network trained on ChestX-ray14, currently the largest publicly available chest X-ray dataset, containing over 100,000 frontal-view X-ray images with 14 diseases. Four practicing academic radiologists annotate a test set, on which we compare the performance of CheXNet to that of radiologists. We find that CheXNet exceeds average radiologist performance on the F1 metric. We extend CheXNet to detect all 14 diseases in ChestX-ray14 and achieve state of the art results on all 14 diseases.
@cite_21: 
@cite_9: Chest X-rays is one of the most commonly available and affordable radiological examinations in clinical practice. While detecting thoracic diseases on chest X-rays is still a challenging task for machine intelligence, due to 1) the highly varied appearance of lesion areas on X-rays from patients of different thoracic disease and 2) the shortage of accurate pixel-level annotations by radiologists for model training. Existing machine learning methods are unable to deal with the challenge that thoracic diseases usually happen in localized disease-specific areas. In this article, we propose a weakly supervised deep learning framework equipped with squeeze-and-excitation blocks, multi-map transfer and max-min pooling for classifying common thoracic diseases as well as localizing suspicious lesion regions on chest X-rays. The comprehensive experiments and discussions are performed on the ChestX-ray14 dataset. Both numerical and visual results have demonstrated the effectiveness of proposed model and its better performance against the state-of-the-art pipelines.
@cite_32: Chest X-Rays (CXRs) are widely used for diagnosing abnormalities in the heart and lung area. Automatically detecting these abnormalities with high accuracy could greatly enhance real world diagnosis processes. Lack of standard publicly available dataset and benchmark studies, however, makes it difficult to compare various detection methods. In order to overcome these difficulties, we have used a publicly available Indiana CXR, JSRT and Shenzhen dataset and studied the performance of known deep convolutional network (DCN) architectures on different abnormalities. We find that the same DCN architecture doesn't perform well across all abnormalities. Shallow features or earlier layers consistently provide higher detection accuracy compared to deep features. We have also found ensemble models to improve classification significantly compared to single model. Combining these insight, we report the highest accuracy on chest X-Ray abnormality detection on these datasets. We find that for cardiomegaly detection, the deep learning method improves the accuracy by a staggering 17 percentage point compared to rule based methods. We applied the techniques to the problem of tuberculosis detection on a different dataset and achieved the highest accuracy. Our localization experiments using these trained classifiers show that for spatially spread out abnormalities like cardiomegaly and pulmonary edema, the network can localize the abnormalities successfully most of the time. One remarkable result of the cardiomegaly localization is that the heart and its surrounding region is most responsible for cardiomegaly detection, in contrast to the rule based models where the ratio of heart and lung area is used as the measure. We believe that through deep learning based classification and localization, we will discover many more interesting features in medical image diagnosis that are not considered traditionally.
@cite_40: Deep learning with convolutional neural networks can accurately classify tuberculosis at chest radiography with an area under the curve of 0.99.
@cite_23: As the most common examination tool in medical practice, chest radiography has important clinical value in the diagnosis of disease. Thus, the automatic detection of chest disease based on chest radiography has become one of the hot topics in medical imaging research. Based on the clinical applications, the study conducts a comprehensive survey on computer-aided detection (CAD) systems, and especially focuses on the artificial intelligence technology applied in chest radiography. The paper presents several common chest X-ray datasets and briefly introduces general image preprocessing procedures, such as contrast enhancement and segmentation, and bone suppression techniques that are applied to chest radiography. Then, the CAD system in the detection of specific disease (pulmonary nodules, tuberculosis, and interstitial lung diseases) and multiple diseases is described, focusing on the basic principles of the algorithm, the data used in the study, the evaluation measures, and the results. Finally, the paper summarizes the CAD system in chest radiography based on artificial intelligence and discusses the existing problems and trends.
@cite_10: The field of medical diagnostics contains a wealth of challenges which closely resemble classical machine learning problems; practical constraints, however, complicate the translation of these endpoints naively into classical architectures. Many tasks in radiology, for example, are largely problems of multi-label classification wherein medical images are interpreted to indicate multiple present or suspected pathologies. Clinical settings drive the necessity for high accuracy simultaneously across a multitude of pathological outcomes and greatly limit the utility of tools which consider only a subset. This issue is exacerbated by a general scarcity of training data and maximizes the need to extract clinically relevant features from available samples -- ideally without the use of pre-trained models which may carry forward undesirable biases from tangentially related tasks. We present and evaluate a partial solution to these constraints in using LSTMs to leverage interdependencies among target labels in predicting 14 pathologic patterns from chest x-rays and establish state of the art results on the largest publicly available chest x-ray dataset from the NIH without pre-training. Furthermore, we propose and discuss alternative evaluation metrics and their relevance in clinical practice.
@cite_20: 
The growth of machine learning applications in the healthcare sector has been considerable in recent years. Indeed, due to the large amount of information encoded in X-Ray images, focused research into their analysis has been significant. Aiding this advancement of research has been an increase in availability of X-Ray image datasets, each tailored to different applications @cite_7 @cite_21 @cite_20 @cite_29 . Using such datasets, many machine learning approaches for the detection of anomalies, such as pneumonia @cite_42 , pulmonary tuberculosis @cite_40 , and thoracic diseased @cite_9 have been developed, as well as a variety of diseases based on chest X-Rays @cite_10 . Islam @cite_32 and Qin @cite_23 provide comparisons of a range of neural networks applied to detecting anomalies in chest X-Rays. These detection technologies usually perform image segmentation to localise the position of the anomaly, or of a certain bone structure (most commonly the rib cage), and are carefully tuned to these applications. Additionally, due to their architectures, many of the networks presented in the above literature would not be suitable for performing a pixel-level segmentation over the entirety of the image.