RepViT-CXR: A Channel Replication Strategy for Vision Transformers in Chest X-ray Tuberculosis and Pneumonia Classification

Abstract: Chest X-ray (CXR) imaging remains one of the most widely used diagnostic tools for detecting pulmonary diseases such as tuberculosis (TB) and pneumonia. Recent advances in deep learning, particularly Vision Transformers (ViTs), have shown strong potential for automated medical image analysis. However, most ViT architectures are pretrained on natural images and require three-channel inputs, while CXR scans are inherently grayscale. To address this gap, we propose RepViT-CXR, a channel replication strategy that adapts single-channel CXR images into a ViT-compatible format without introducing additional information loss. We evaluate RepViT-CXR on three benchmark datasets. On the TB-CXR dataset,our method achieved an accuracy of 99.9% and an AUC of 99.9%, surpassing prior state-of-the-art methods such as Topo-CXR (99.3% accuracy, 99.8% AUC). For the Pediatric Pneumonia dataset, RepViT-CXR obtained 99.0% accuracy, with 99.2% recall, 99.3% precision, and an AUC of 99.0%, outperforming strong baselines including DCNN and VGG16. On the Shenzhen TB dataset, our approach achieved 91.1% accuracy and an AUC of 91.2%, marking a performance improvement over previously reported CNN-based methods. These results demonstrate that a simple yet effective channel replication strategy allows ViTs to fully leverage their representational power on grayscale medical imaging tasks. RepViT-CXR establishes a new state of the art for TB and pneumonia detection from chest X-rays, showing strong potential for deployment in real-world clinical screening systems.