Abstract
Background/Objectives: Recent state-of-the-art advances in deep learning have significantly improved diagnostic accuracy in medical imaging, particularly in chest radiograph (CXR) analysis. Motivated by these developments, a comprehensive comparison was conducted to investigate how architectural choices affect performance of 14 deep learning models across Convolutional Neural Networks (CNNs), Transformer-based models, and Mamba-based State Space Models. Methods: These models were trained and evaluated under identical conditions on the NIH ChestX-ray14 dataset, a large-scale and widely used benchmark comprising 112,120 labeled CXR images with 14 thoracic disease categories. Results: It was found that recent hybrid architectures-particularly ConvFormer, CaFormer, and EfficientNet-deliver superior performance in both common and rare pathologies. ConvFormer achieved the highest mean AUROC of 0.841 when averaged across all 14 thoracic disease classes, closely followed by EfficientNet and CaFormer. Notably, AUROC scores of 0.94 for hernia, 0.91 for cardiomegaly, and 0.88 for edema and effusion were achieved by the proposed models, surpassing previously reported benchmarks. Conclusions: These results not only highlight the continued strength of CNNs but also demonstrate the growing potential of Transformer-based architectures in medical image analysis. This work contributes to the literature by providing a unified, state-of-the-art benchmarking of diverse deep learning models, offering valuable guidance for researchers and practitioners developing clinically robust AI systems for radiology.