As the COVID-19 pandemic continues to ravage the world, the use of chest X-ray (CXR) images as a complementary screening strategy to reverse transcription-polymerase chain reaction (RT-PCR) testing continues to grow owing to its routine clinical application to respiratory diseases. We performed extensive convolutional neural network (CNN) fine-tuning experiments and identified that models pretrained on larger out-of-domain datasets show an improved performance. This suggests that a priori knowledge of models from out-of-field training should also apply to X-ray images. With appropriate hyperparameters selection, we found that higher resolution images carry more clinical information, and the use of mixup in training improved the performance of the model. The experimental showed that our proposed transfer learning present state-of-the-art results. Furthermore, we evaluated the performance of our model with a small amount of downstream training data and found that the model still performed well in COVID-19 identification. We also explored the mechanism of model detection using a gradient-weighted class activation mapping (Grad-CAM) method for CXR imaging to interpret the detection of radiology images. The results helped us understand how the model detects COVID-19, which can be used to discover new visual features and assist radiologists in screening.
Keywords: COVID-19; Grad-CAM; X-ray images; convolutional neural network; transfer learning.