Automated infection measurement and COVID-19 diagnosis based on Chest X-ray (CXR) imaging is important for faster examination. We propose a novel approach, called DRR4Covid, to learn automated COVID-19 diagnosis and infection segmentation on CXRs from digitally reconstructed radiographs (DRRs). DRR4Covid comprises of an infection-aware DRR generator, a classification and/or segmentation network, and a domain adaptation module. The infection-aware DRR generator is able to produce DRRs with adjustable strength of radiological signs of COVID-19 infection, and generate pixel-level infection annotations that match the DRRs precisely. The domain adaptation module is introduced to reduce the domain discrepancy between DRRs and CXRs by training networks on unlabeled real CXRs and labeled DRRs together.We provide a simple but effective implementation of DRR4Covid by using a domain adaptation module based on Maximum Mean Discrepancy (MMD), and a FCN-based network with a classification header and a segmentation header. Extensive experiment results have confirmed the efficacy of our method; specifically, quantifying the performance by accuracy, AUC and F1-score, our network without using any annotations from CXRs has achieved a classification score of (0.954, 0.989, 0.953) and a segmentation score of (0.957, 0.981, 0.956) on a test set with 794 normal cases and 794 positive cases. Besides, we estimate the sensitive of X-ray images in detecting COVID-19 infection by adjusting the strength of radiological signs of COVID-19 infection in synthetic DRRs. The estimated detection limit of the proportion of infected voxels in the lungs is 19.43%, and the estimated lower bound of the contribution rate of infected voxels is 20.0% for significant radiological signs of COVID-19 infection. Our codes will be made publicly available at https://github.com/PengyiZhang/DRR4Covid.
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