Improved Chest Anomaly Localization without Pixel-level Annotation via Image Translation Network Application in Pseudo-paired Registration Domain

Image translation based on a generative adversarial network (GAN-IT) is a promising method for the precise localization of abnormal regions in chest X-ray images (AL-CXR) even without pixel-level annotation. However, heterogeneous unpaired datasets undermine existing methods to extract key features and distinguish normal from abnormal cases, resulting in inaccurate and unstable AL-CXR. To address this problem, we propose an improved two-stage GAN-IT involving registration and data augmentation. For the first stage, we introduce an advanced deep-learning-based registration technique that virtually and reasonably converts unpaired data into paired data for learning registration maps, by sequentially utilizing linear-based global and uniform coordinate transformation and AI-based non-linear coordinate fine-tuning. This approach enables the independent and complex coordinate transformation of each detailed location of the lung while recognizing the entire lung structure, thereby achieving higher registration performance with resolving inherent artifacts caused by unpaired conditions. For the second stage, we apply data augmentation to diversify anomaly locations by swapping the left and right lung regions on the uniform registered frames, further improving the performance by alleviating imbalance in data distribution showing left and right lung lesions. The proposed method is model agnostic and shows consistent AL-CXR performance improvement in representative AI models. Therefore, we believe GAN-IT for AL-CXR can be clinically implemented by using our basis framework, even if learning data are scarce or difficult for the pixel-level disease annotation.