Decision-Aware Vision Mamba with Context-Guided Slot Mixing for Chest X-Ray Screening and Culture-Based Hierarchical Tuberculosis Classification.

Distinguishing Active from Inactive Tuberculosis (TB) on Chest X-rays presents a clinical challenge due to overlapping radiological signs. This study introduces Vision Mamba CGSM, a deep learning framework integrating a State Space Model (SSM) backbone with a Context-Guided Slot Mixing (CGSM) module. The SSM captures global anatomical context, while the CGSM module isolates subtle pathological features by applying localized spatial attention. We validated the model using a hierarchical diagnostic scheme covering Normal, Pneumonia, Active TB, and Inactive TB. Experimental evaluations demonstrate an accuracy of 92.96% and a Youden Index of 79.55% on the independent test set. In the specific binary classification of Active vs. Inactive TB, the model recorded a specificity of 97.04%, outperforming standard baseline architectures including ResNet152 and ViT-B. Additional validations on external datasets confirm the consistent generalization of the proposed feature extraction mechanism.