  Lung cancer is the leading cause of cancer death and early diagnosis is
associated with a positive prognosis. Chest X-ray (CXR) provides an inexpensive
imaging mode for lung cancer diagnosis. Suspicious nodules are difficult to
distinguish from vascular and bone structures using CXR. Computer vision has
previously been proposed to assist human radiologists in this task, however,
leading studies use down-sampled images and computationally expensive methods
with unproven generalization. Instead, this study localizes lung nodules using
efficient encoder-decoder neural networks that process full resolution images
to avoid any signal loss resulting from down-sampling. Encoder-decoder networks
are trained and tested using the JSRT lung nodule dataset. The networks are
used to localize lung nodules from an independent external CXR dataset.
Sensitivity and false positive rates are measured using an automated framework
to eliminate any observer subjectivity. These experiments allow for the
determination of the optimal network depth, image resolution and pre-processing
pipeline for generalized lung nodule localization. We find that nodule
localization is influenced by subtlety, with more subtle nodules being detected
in earlier training epochs. Therefore, we propose a novel self-ensemble model
from three consecutive epochs centered on the validation optimum. This ensemble
achieved a sensitivity of 85% in 10-fold internal testing with false positives
of 8 per image. A sensitivity of 81% is achieved at a false positive rate of 6
following morphological false positive reduction. This result is comparable to
more computationally complex systems based on linear and spatial filtering, but
with a sub-second inference time that is faster than other methods. The
proposed algorithm achieved excellent generalization results against an
external dataset with sensitivity of 77% at a false positive rate of 7.6.
