OOOE: Only-One-Object-Exists Assumption to Find Very Small Objects in Chest Radiographs

The accurate localization of inserted medical tubes and parts of human anatomy is a common problem when analyzing chest radiographs and something deep neural networks could potentially automate. However, many foreign objects like tubes and various anatomical structures are small in comparison to the entire chest X-ray, which leads to severely unbalanced data and makes training deep neural networks difficult. In this paper, we present a simple yet effective `Only-One-Object-Exists' (OOOE) assumption to improve the deep network's ability to localize small landmarks in chest radiographs. The OOOE enables us to recast the localization problem as a classification problem and we can replace commonly used continuous regression techniques with a multi-class discrete objective. We validate our approach using a large scale proprietary dataset of over 100K radiographs as well as publicly available RANZCR-CLiP Kaggle Challenge dataset and show that our method consistently outperforms commonly used regression-based detection models as well as commonly used pixel-wise classification methods. Additionally, we find that the method using the OOOE assumption generalizes to multiple detection problems in chest X-rays and the resulting model shows state-of-the-art performance on detecting various tube tips inserted to the patient as well as patient anatomy.

Did You Get What You Paid For? Rethinking Annotation Cost of Deep Learning Based Computer Aided Detection in Chest Radiographs

As deep networks require large amounts of accurately labeled training data, a strategy to collect sufficiently large and accurate annotations is as important as innovations in recognition methods. This is especially true for building Computer Aided Detection (CAD) systems for chest X-rays where domain expertise of radiologists is required to annotate the presence and location of abnormalities on X-ray images. However, there lacks concrete evidence that provides guidance on how much resource to allocate for data annotation such that the resulting CAD system reaches desired performance. Without this knowledge, practitioners often fall back to the strategy of collecting as much detail as possible on as much data as possible which is cost inefficient. In this work, we investigate how the cost of data annotation ultimately impacts the CAD model performance on classification and segmentation of chest abnormalities in frontal-view X-ray images. We define the cost of annotation with respect to the following three dimensions: quantity, quality and granularity of labels. Throughout this study, we isolate the impact of each dimension on the resulting CAD model performance on detecting 10 chest abnormalities in X-rays. On a large scale training data with over 120K X-ray images with gold-standard annotations, we find that cost-efficient annotations provide great value when collected in large amounts and lead to competitive performance when compared to models trained with only gold-standard annotations. We also find that combining large amounts of cost efficient annotations with only small amounts of expensive labels leads to competitive CAD models at a much lower cost.