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. 2021 Sep 1;11:15523. doi: 10.1038/s41598-021-93967-2

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© The Author(s) 2021

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Sample CXRs of true and false positives, and true and false negatives for (A) general abnormalities, (B) TB, and (C) COVID-19. Each image has the class activation map presented as red outlines that indicate the areas the DLS is focusing on for identifying abnormalities, and yellow outlines representing regions of interest indicated by radiologists. Text descriptions for each CXR are below the respective image. Note that the general abnormality false negative example is shown with abnormal class activation maps. However, the DLS predictive score on the case was lower than the selected threshold; hence the image was classified as “normal”. Note that the TB false positive image was saved in the system with inverted colors that were inconsistent with what was specified in the DICOM header tag, and presented to the model that way.