NCT-CXR: Enhancing Pulmonary Abnormality Segmentation on Chest X-Rays Using Improved Coordinate Geometric Transformations

Medical image segmentation, especially in chest X-ray (CXR) analysis, encounters substantial problems such as class imbalance, annotation inconsistencies, and the necessity for accurate pathological region identification. This research aims to improve the precision and clinical reliability of pulmonary abnormality segmentation by developing NCT-CXR, a framework that combines anatomically constrained data augmentation with expert-guided annotation refinement. NCT-CXR applies carefully calibrated discrete-angle rotations (±5°, ±10°) and intensity-based augmentations to enrich training data while preserving spatial and anatomical integrity. To address label noise in the NIH Chest X-ray dataset, we further introduce a clinically validated annotation refinement pipeline using the OncoDocAI platform, resulting in multi-label pixel-level segmentation masks for nine thoracic conditions. YOLOv8 was selected as the segmentation backbone due to its architectural efficiency, speed, and high spatial accuracy. Experimental results show that NCT-CXR significantly improves segmentation precision, especially for pneumothorax (0.829 and 0.804 for ±5° and ±10°, respectively). Non-parametric statistical testing (Kruskal–Wallis, H = 14.874, p = 0.0019) and post hoc Nemenyi analysis (p = 0.0138 and p = 0.0056) confirm the superiority of discrete-angle augmentation over mixed strategies. These findings underscore the importance of clinically constrained augmentation and high-quality annotation in building robust segmentation models. NCT-CXR offers a practical, high-performance solution for integrating deep learning into radiological workflows.