Leveraging Large-Scale Public Data for Artificial Intelligence-Driven Chest X-Ray Analysis and Diagnosis

Background: Chest X-ray (CXR) imaging is crucial for diagnosing thoracic abnormalities; however, the rising demand burdens radiologists, particularly in resource-limited settings. Method: We used large-scale, diverse public CXR datasets with noisy labels to train general-purpose deep learning models (ResNet, DenseNet, EfficientNet, and DLAD-10) for multi-label classification of thoracic conditions. Uncertainty quantification was incorporated to assess model reliability. Performance was evaluated on both internal and external validation sets, with analyses of data scale, diversity, and fine-tuning effects. Result: EfficientNet achieved the highest overall area under the receiver operating characteristic curve (0.8944) with improved sensitivity and F1-score. Moreover, as training data volume increased-particularly using multi-source datasets-both diagnostic performance and generalizability were enhanced. Although larger datasets reduced predictive uncertainty, conditions such as tuberculosis remained challenging due to limited high-quality samples. Conclusions: General-purpose deep learning models can achieve robust CXR diagnostic performance when trained on large-scale, diverse public datasets despite noisy labels. However, further targeted strategies are needed for underrepresented conditions.