High performance with fewer labels using semi-weakly supervised learning for pulmonary embolism diagnosis

Abstract This study proposes a semi-weakly supervised learning approach for pulmonary embolism (PE) detection on CT pulmonary angiography (CTPA) to alleviate the resource-intensive burden of exhaustive medical image annotation. Attention-based CNN-RNN models were trained on the RSNA pulmonary embolism CT dataset and externally validated on a pooled dataset (Aida and FUMPE). Three configurations included weak (examination-level labels only), strong (all examination and slice-level labels), and semi-weak (examination-level labels plus a limited subset of slice-level labels). The proportion of slice-level labels varying from 0 to 100%. Notably, semi-weakly supervised models using approximately one-quarter of the total slice-level labels achieved an AUC of 0.928, closely matching the strongly supervised model’s AUC of 0.932. External validation yielded AUCs of 0.999 for the semi-weak and 1.000 for the strong model. By reducing labeling requirements without sacrificing diagnostic accuracy, this method streamlines model development, accelerates the integration of models into clinical practice, and enhances patient care.