Accurate and efficient classification of thoracic diseases in chest X-ray (CXR) images is crucial for timely diagnosis and treatment. However, the presence of multiple pathologies with overlapping visual characteristics poses significant challenges for automated classification systems. In this study, we propose two novel hierarchical multi-label classification techniques, namely the loss-based and logit-based methods, to address these challenges by leveraging the hierarchical relationships among different thoracic pathologies. The loss-based technique integrates hierarchical information directly into the optimization process, while the logit-based method adjusts the predicted probabilities of each class based on its parent class in the disease taxonomy. We evaluate the performance of both techniques using three large-scale CXR datasets: CheXpert (224,316 CXRs), PADCHEST (160,000 CXRs), and NIH (112,120 CXRs). The experimental results demonstrate significant improvements in accuracy, AUC, and F1 scores compared to the baseline method across various pathologies. The logit-based and loss-based methods improve accuracy by 12\% and 11\%, AUC by 13\% and 10\%, and F1 scores by 24\% and 12\%, respectively compared to the baseline. These results represent a substantial improvement over the baseline method. Furthermore, we conduct a comprehensive statistical analysis to validate the robustness and reliability of the proposed techniques. The integration of domain-specific hierarchical knowledge not only enhances the classification performance but also provides a more interpretable output for clinical decision support. Our findings highlight the potential of hierarchical multi-label classification in advancing computer-aided diagnosis systems for chest radiography.

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