Debiasing pipeline improves deep learning model generalization for X-ray based lung nodule detection

Lung cancer is the leading cause of cancer death worldwide and a good prognosis depends on early diagnosis. Unfortunately, screening programs for the early diagnosis of lung cancer are uncommon. This is in-part due to the at-risk groups being located in rural areas far from medical facilities. Reaching these populations would require a scaled approach that combines mobility, low cost, speed, accuracy, and privacy. We can resolve these issues by combining the chest X-ray imaging mode with a federated deep-learning approach, provided that the federated model is trained on homogenous data to ensure that no single data source can adversely bias the model at any point in time. In this study we show that an image pre-processing pipeline that homogenizes and debiases chest X-ray images can improve both internal classification and external generalization, paving the way for a low-cost and accessible deep learning-based clinical system for lung cancer screening. An evolutionary pruning mechanism is used to train a nodule detection deep learning model on the most informative images from a publicly available lung nodule X-ray dataset. Histogram equalization is used to remove systematic differences in image brightness and contrast. Model training is performed using all combinations of lung field segmentation, close cropping, and rib suppression operators. We show that this pre-processing pipeline results in deep learning models that successfully generalize an independent lung nodule dataset using ablation studies to assess the contribution of each operator in this pipeline. In stripping chest X-ray images of known confounding variables by lung field segmentation, along with suppression of signal noise from the bone structure we can train a highly accurate deep learning lung nodule detection algorithm with outstanding generalization accuracy of 89% to nodule samples in unseen data.