Machine-Learning Based Detection of Coronary Artery Calcification Using Synthetic Chest X-Rays
This provides a scalable method for CAC detection that could improve cardiovascular screening, though it's incremental as it builds on existing synthetic data approaches.
The researchers tackled the problem of detecting coronary artery calcification (CAC) from chest X-rays by using synthetic images from CT scans as training data, achieving a mean AUC of 0.754 which matches or exceeds previous studies.
Coronary artery calcification (CAC) is a strong predictor of cardiovascular events, with CT-based Agatston scoring widely regarded as the clinical gold standard. However, CT is costly and impractical for large-scale screening, while chest X-rays (CXRs) are inexpensive but lack reliable ground truth labels, constraining deep learning development. Digitally reconstructed radiographs (DRRs) offer a scalable alternative by projecting CT volumes into CXR-like images while inheriting precise labels. In this work, we provide the first systematic evaluation of DRRs as a surrogate training domain for CAC detection. Using 667 CT scans from the COCA dataset, we generate synthetic DRRs and assess model capacity, super-resolution fidelity enhancement, preprocessing, and training strategies. Lightweight CNNs trained from scratch outperform large pretrained networks; pairing super-resolution with contrast enhancement yields significant gains; and curriculum learning stabilises training under weak supervision. Our best configuration achieves a mean AUC of 0.754, comparable to or exceeding prior CXR-based studies. These results establish DRRs as a scalable, label-rich foundation for CAC detection, while laying the foundation for future transfer learning and domain adaptation to real CXRs.