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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.<\/jats:p>","DOI":"10.3390\/s26072100","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T15:45:42Z","timestamp":1774626342000},"page":"2100","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Decision-Aware Vision Mamba with Context-Guided Slot Mixing for Chest X-Ray Screening and Culture-Based Hierarchical Tuberculosis Classification"],"prefix":"10.3390","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8887-2513","authenticated-orcid":false,"given":"Wangsu","family":"Jeon","sequence":"first","affiliation":[{"name":"Department Computer Engineering, Kyungnam University, Changwon 51767, Republic of Korea"},{"name":"Gyungnam Intelligence Innovation Center, Kyungnam University, Changwon 51767, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3517-6175","authenticated-orcid":false,"given":"Hyeonung","family":"Jang","sequence":"additional","affiliation":[{"name":"Haewootech Co., Ltd., Busan 46742, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongchang","family":"Lee","sequence":"additional","affiliation":[{"name":"Haewootech Co., Ltd., Busan 46742, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chanho","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiwon","family":"Lyu","sequence":"additional","affiliation":[{"name":"Division of Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4478-9704","authenticated-orcid":false,"given":"Seongjun","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan 31151, Republic of Korea"},{"name":"MDAI Co., Ltd., Cheonan 31151, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2024). 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