Chest X-Ray (CXR) images are commonly used for clinical screening and diagnosis. Automatically writing reports for these images can considerably lighten the workload of radiologists for summarizing descriptive findings and conclusive impressions. The complex structures between and within sections of the reports pose a great challenge to the automatic report generation. Specifically, the section Impression is a diagnostic summarization over the section Findings; and the appearance of normality dominates each section over that of abnormality. Existing studies rarely explore and consider this fundamental structure information. In this work, we propose a novel framework which exploits the structure information between and within report sections for generating CXR imaging reports. First, we propose a two-stage strategy that explicitly models the relationship between Findings and Impression. Second, we design a novel cooperative multi-agent system that implicitly captures the imbalanced distribution between abnormality and normality. Experiments on two CXR report datasets show that our method achieves state-of-the-art performance in terms of various evaluation metrics. Our results expose that the proposed approach is able to generate high-quality medical reports through integrating the structure information. Findings: The cardiac silhouette is enlarged and has a globular appearance. Mild bibasilar dependent atelectasis. No pneumothorax or large pleural effusion. No acute bone abnormality. Impression: Cardiomegaly with globular appearance of the cardiac silhouette. Considerations would include pericardial effusion or dilated cardiomyopathy.

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Chest X-ray (CXR) is one of the most commonly prescribed medical imaging procedures, often with over 2-10x more scans than other imaging modalities such as MRI, CT scan, and PET scans. These voluminous CXR scans place significant workloads on radiologists and medical practitioners. Organ segmentation is a crucial step to obtain effective computer-aided detection on CXR. In this work, we propose Structure Correcting Adversarial Network (SCAN) to segment lung fields and the heart in CXR images. SCAN incorporates a critic network to impose on the convolutional segmentation network the structural regularities emerging from human physiology. During training, the critic network learns to discriminate between the ground truth organ annotations from the masks synthesized by the segmentation network. Through this adversarial process the critic network learns the higher order structures and guides the segmentation model to achieve realistic segmentation outcomes. Extensive experiments show that our method produces highly accurate and natural segmentation. Using only very limited training data available, our model reaches human-level performance without relying on any existing trained model or dataset. Our method also generalizes well to CXR images from a different patient population and disease profiles, surpassing the current state-of-the-art.

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The cardiothoracic ratio (CTR), a clinical metric of heart size in chest X-rays (CXRs), is a key indicator of cardiomegaly. Manual measurement of CTR is time-consuming and can be affected by human subjectivity, making it desirable to design computer-aided systems that assist clinicians in the diagnosis process. Automatic CTR estimation through chest organ segmentation, however, requires large amounts of pixel-level annotated data, which is often unavailable. To alleviate this problem, we propose an unsupervised domain adaptation framework based on adversarial networks. The framework learns domain invariant feature representations from openly available data sources to produce accurate chest organ segmentation for unlabeled datasets. Specifically, we propose a model that enforces our intuition that prediction masks should be domain independent. Hence, we introduce a discriminator that distinguishes segmentation predictions from ground truth masks. We evaluate our system's prediction based on the assessment of radiologists and demonstrate the clinical practicability for the diagnosis of cardiomegaly. We finally illustrate on the JSRT dataset that the semi-supervised performance of our model is also very promising.