Pixel-level annotation for chest X-ray (CXR) lesion segmentation is expensive, making active learning (AL) essential. However, existing AL strategies fail to account for the spatial distribution of selected samples, resulting in inconsistent performance across focal (e.g., aortic calcification) and diffuse (e.g., nodules) pathologies. In this paper, we propose SPARCL (Spatially Adaptive Regional Coverage for Active Learning) to dynamically balance predictive uncertainty with cumulative spatial coverage. By employing a concave coverage function, SPARCL imposes diminishing returns on previously annotated regions, naturally directing the annotation budget toward under-labeled areas. Furthermore, an entropy gate reverts the algorithm to standard uncertainty sampling when spatial variation is absent. This coverage objective is monotone submodular, guaranteeing near-optimal greedy batch selection. To address how aggregate metrics like Dice obscure regional failures, we further introduce two metrics---Spatial Inconsistency (SI) and Performance Coverage (PC)---to quantify anatomical fairness across AL rounds. Evaluated on an in-house calcification cohort and public CXR benchmarks, SPARCL reaches 95% of fully supervised performance using only 24% of the data, compared to 29% for the best baseline. Ultimately, SPARCL ensures robust spatial reliability, surfacing regional gains that aggregate metrics miss.

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