Abstract
Although the classification of chest radiographs has long been an extensively researched topic, interest increased significantly with the onset of the COVID-19 pandemic. Existing results are promising; however, the radiological similarities between COVID-19 and other types of respiratory diseases limit the success of conventional image classification approaches that focus on single instances. This study proposes a novel perspective that conceptualizes COVID-19 pneumonia as a deviation from a normative distribution of typical pneumonia patterns. Using a population- based approach, our approach utilizes distributional anomaly detection. This method diverges from traditional instance-wise approaches by focusing on sets of scans instead of individual images. Using an autoencoder to extract feature representations, we present instance-based and distribution-based assessments of the separability between COVID-positive and COVIDnegative pneumonia radiographs. The results demonstrate that the proposed distribution-based methodology outperforms conventional instance-based techniques in identifying radiographic changes associated with COVID-positive cases. This underscores its potential as an early warning system capable of detecting significant distributional shifts in radiographic data. By continuously monitoring these changes, this approach offers a mechanism for early identification of emerging health trends, potentially signaling the onset of new pandemics and enabling prompt public health responses.

Abstract
Deep learning-based models are widely used for disease classification in chest radiographs. This exam can be performed in one of two projections (posteroanterior or anteroposterior), depending on the direction that the X-ray beam travels through the body. Since projection visibly affects the way anatomical structures appear in the scans, it may introduce bias in classifiers, especially when spurious correlations between a given disease and a projection occur. This paper examines the influence of chest radiograph projection on the performance of deep learning-based classification models and proposes an approach to mitigate projection-induced bias. Results show that a DenseNet-121 model is better at classifying images from the most representative projection in the data set, suggesting that projection is taken into account by the classifier. Moreover, this model can classify chest X-ray projection better than any of the fourteen radiological findings considered, without being explicitly trained for that task, putting it at high risk for projection bias. We propose a label-conditional gradient reversal framework to make the model insensitive to projection, by forcing the extracted features to be simultaneously good for disease classification and bad for projection classification, resulting in a framework with reduced projection-induced bias.

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