A deep-learning pipeline for the diagnosis and discrimination of viral, non-viral and COVID-19 pneumonia from chest X-ray images

Wang, Guangyu; Liu, Xiaohong; Shen, Jun; Wang, Chengdi; Li, Zhihuan; Ye, Linsen; Wu, Xingwang; Chen, Ting; Wang, Kai; Zhang, Xuan; Zhou, Zhongguo; Yang, Jian; Sang, Ye; Deng, Ruiyun; Liang, Wenhua; Yu, Tao; Gao, Ming; Wang, Jin; Yang, Zehong; Cai, Huimin; Lu, Guangming; Zhang, Lingyan; Yang, Lei; Xu, Wenqin; Wang, Winston; Olevera, Andrea; Ziyar, Ian; Zhang, Charlotte; Li, Oulan; Liao, Weihua; Liu, Jun; Chen, Wen; Chen, Wei; Shi, Jichan; Zheng, Lianghong; Zhang, Longjiang; Yan, Zhihan; Zhou, Xiaoguang; Lin, Guiping; Cao, Guiqun; Lau, Laurance L.; Mo, Long; Liang, Yong; Roberts, Michael; Sala, Evis; Schönlieb, Carola-Bibiane; Fok, Manson; Lau, Johnson Yiu-Nam; Xu, Tao; He, Jianxing; Zhang, Kang; Li, Weimin; Lin, Tianxin

Common lung diseases are first diagnosed via chest X-rays. Here, we show that a fully automated deep-learning pipeline for chest-X-ray-image standardization, lesion visualization and disease diagnosis can identify viral pneumonia caused by Coronavirus disease 2019 (COVID-19), assess its severity, and discriminate it from other types of pneumonia. The deep-learning system was developed by using a heterogeneous multicentre dataset of 145,202 images, and tested retrospectively and prospectively with thousands of additional images across four patient cohorts and multiple countries. The system generalized across settings, discriminating between viral pneumonia, other types of pneumonia and absence of disease with areas under the receiver operating characteristic curve (AUCs) of 0.88–0.99, between severe and non-severe COVID-19 with an AUC of 0.87, and between severe or non-severe COVID-19 pneumonia and other viral and non-viral pneumonia with AUCs of 0.82–0.98. In an independent set of 440 chest X-rays, the system performed comparably to senior radiologists, and improved the performance of junior radiologists. Automated deep-learning systems for the assessment of pneumonia could facilitate early intervention and provide clinical-decision support.