Joint enhancement of automatic chest X-ray diagnosis and radiological gaze prediction with multi-stage cooperative learning

Purpose: As visual inspection is an inherent process during radiological screening, the associated eye gaze data can provide valuable insights into relevant clinical decisions. As deep learning has become the state-of-the-art for computer-assisted diagnosis, integrating human behavior, such as eye gaze data, into these systems is instrumental to help align machine predictions with clinical diagnostic criteria, thus enhancing the quality of automatic radiological diagnosis. Methods: We propose a novel deep learning framework for joint disease diagnosis and prediction of corresponding clinical visual attention maps for chest X-ray scans. Specifically, we introduce a new dual-encoder multi-task UNet, which leverages both a DenseNet201 backbone and a Residual and Squeeze-and-Excitation block-based encoder to extract diverse features for visual attention map prediction, and a multi-scale feature-fusion classifier to perform disease classification. To tackle the issue of asynchronous training schedules of individual tasks in multi-task learning, we proposed a multi-stage cooperative learning strategy, with contrastive learning for feature encoder pretraining to boost performance. Results: Our proposed method is shown to significantly outperform existing techniques for chest X-ray diagnosis (AUC=0.93) and the quality of visual attention map prediction (Correlation coefficient=0.58). Conclusion: Benefiting from the proposed multi-task multi-stage cooperative learning, our technique demonstrates the benefit of integrating clinicians' eye gaze into clinical AI systems to boost performance and potentially explainability.