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However, some challenges are associated with these datasets, including variability in data distribution, data scarcity, and transfer learning issues when using models pre-trained from generic images. This work studies the effect of these challenges at the intra- and inter-domain level in few-shot learning scenarios with severe data imbalance. For this, we propose a methodology based on Siamese neural networks in which a series of techniques are integrated to mitigate the effects of data scarcity and distribution imbalance. Specifically, different initialization and data augmentation methods are analyzed, and four adaptations to Siamese networks of solutions to deal with imbalanced data are introduced, including data balancing and weighted loss, both separately and combined, and with a different balance of pairing ratios. Moreover, we also assess the inference process considering four classifiers, namely Histogram, <jats:italic>k<\/jats:italic>NN, SVM, and Random Forest. Evaluation is performed on three chest X-ray datasets with annotated cases of both positive and negative COVID-19 diagnoses. The accuracy of each technique proposed for the Siamese architecture is analyzed separately. The results are compared to those obtained using equivalent methods on a state-of-the-art CNN, achieving an average F1 improvement of up to 3.6%, and up to 5.6% of F1 for intra-domain cases. We conclude that the introduced techniques offer promising improvements over the baseline in almost all cases and that the technique selection may vary depending on the amount of data available and the level of imbalance.<\/jats:p>","DOI":"10.1007\/s10044-024-01285-w","type":"journal-article","created":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T17:02:16Z","timestamp":1718125336000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Few-shot learning for COVID-19 chest X-ray classification with imbalanced data: an inter vs. intra domain study"],"prefix":"10.1007","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5799-6270","authenticated-orcid":false,"given":"Alejandro","family":"Gal\u00e1n-Cuenca","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3148-6886","authenticated-orcid":false,"given":"Antonio Javier","family":"Gallego","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6245-5145","authenticated-orcid":false,"given":"Marcelo","family":"Saval-Calvo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9445-5529","authenticated-orcid":false,"given":"Antonio","family":"Pertusa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,6,11]]},"reference":[{"key":"1285_CR1","doi-asserted-by":"publisher","DOI":"10.1016\/j.media.2022.102444","volume":"79","author":"X Chen","year":"2022","unstructured":"Chen X, Wang X, Zhang K, Fung K-M, Thai TC, Moore K, Mannel RS, Liu H, Zheng B, Qiu Y (2022) Recent advances and clinical applications of deep learning in medical image analysis. 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