2019 International Conference on Information and Communications Technology (ICOIACT)
Tuberculosis Detection In Chest X-Ray Images
Using Optimized Gray Level Co-Occurrence Matrix
Features
Imam Junaedi Erni Yudaningtyas
Department of Electrical Engineering Department of Electrical Engineering
Brawijaya University Brawijaya University
Malang, Indonesia Malang, Indonesia
imam.junaedi90@yahoo.com erni@ub.ac.id
Abstract— Tuberculosis (TB) is a deadly infectious disease
caused by Mycobacterium Tuberculosis (MTB). Chest X-ray
(CXR) image has been the main tool for detecting lung TB
historically. CXR images are analyzed by radiologists to
determine whether or not there are signs of TB in the lungs. The
results of the analysis by radiologists in analyzing CXR images
are influenced by the subjectivity of radiologists, such as
experience from radiologists, conditions of observation, fatigue,
and others. The subjectivity factor of the radiologist can be
overcome by the computer aided diagnosis system. This paper
proposed a TB detection system on CXR images using optimized
Gray Level Co-Occurrence Matrix (GLCM) features as the
input. GLCM is optimized using the Principal Component
Analysis (PCA) and then classified using the Support Vector
Machine (SVM). In this paper, CXR images were classified as
normal, primary TB (PTB) and secondary TB (STB). The
results of this paper indicate that the classification system with
optimized GLCM as input has better performance than the
classification system with regular GLCM as input. The
classification system with optimized GLCM as input in the 8-
fold cross validation test has an accuracy of 100% for the
normal class, 98.72% for the PTB class and 98.72% for the STB
class.
Keywords— computer aided diagnosis, tuberculosis (TB),
gray level co-occurrence matrix (GLCM), principal component
analysis (PCA), support vector machine (SVM)
I. INTRODUCTION
TB is a deadly infectious disease caused by MTB [1]. The
World Health Organization (WHO) reported that in 2017
Indonesia was included in the list of 20 high TB burden
countries with a total of 446,732 cases. WHO estimates that
there are 107,000 deaths of TB patients in Indonesia in 2017
[2]. Historically, CXR is the main tool for detecting TB [3].
CXR has a fairly high sensitivity to TB detection, especially
when used to detect pulmonary abnormalities associated with
TB in cases of patients who do not have visible symptoms of
TB. CXR images are analyzed by radiologists to determine
whether or not there are abnormalities in the lungs. The results
of analysis by radiologists in analyzing CXR images are
influenced by the subjectivity of radiologists, such as
experience from radiologists, conditions of observation,
fatigue, etc [4]. The subjectivity factor of the radiologist can
be overcome by the TB detection system on computerized
CXR images. The TB detection system in computerized CXR
images can also be used as a second opinion in giving a
diagnosis.
Detection of TB in CXR images has been investigated in
recent years. Many methods are used to extract feature and
XXX-X-XXXX-XXXX-X/XX/$XX.00 ©20XX IEEE
978-1-7281-1655-6/19/$31.00 ©2019 IEEE
Rahmadwati
Department of Electrical Engineering
Brawijaya University
Malang, Indonesia
rahma@ub.ac.id
classification in detecting TB. The feature extraction methods
used include Histogram of Gradient (HOG) [5], Gray Level
Co-occurrence Matrix [6], Haar Wavelet Transform (HWT)
[7], and Local Binary Pattern (LBP) [8]. GLCM is known as
a mathematical method for detecting lung abnormalities and
provides an opportunity for doctors to localize abnormal tissue
types, both tumors and pulmonary edema (fluid buildup in the
lung airbag) [9]. Ten GLCM features can detect TB with an
accuracy of 75%, specificity of 75% and sensitivity of 75% in
Pawar and Ganorkar’s research [6]. Pawar’s TB detection
system can be improved by applying optimization features to
the GLCM to improve system performance.
PCA is used in this research to optimize GLCM features.
PCA can optimize the GLCM features by reducing the GLCM
texture features and provide a better classification in the
classification system of the sub-Antarctic vegetation
community [10]. PCA is also able to reduce GLCM features
in electroencephalogram (EEG) spectrogram analysis from
eighty to five components [11].
Classification methods that can be used are Euclidian
Distance [6], SVM [5], K-nearest Neighbor (K-NN) [12], and
Convolutional Neural Network (CNN) [13]. SVM is a
supervised machine learning that can be used for
classification. SVM has a fairly high level of accuracy. SVM
is widely applied in the field of bioinformatics, such as for TB
detection [5], detection of brain tumors [14], and medical
image classification [15]. SVM can detect TB in CXR images
with an accuracy rate of 88%, sensitivity of 88% and
specificity of 88% [5]. The classification output of the SVM
classification can be improved by using the optimized GLCM
features as the input.
In this paper, a computer aided diagnosis system was
designed to detect TB in CXR images using Matlab 2018a and
Weka 3.8 software. CXR images are processed through
several stages, namely preprocessing, segmentation, and
classification. The optimized GLCM features used as input for
the classification process. The classification method in this
research is SVM. This research aims to reduce the subjectivity
factor in the process of detecting TB in CXR
II. RESEARCH METHOD
This research proposed a TB detection system in CXR
images using optimized GLCM by PCA as input and
classified by multilevel SVM classification. In this research,
CXR images were obtained from Shenzhen chest X-ray set,
Guangdong Medical College [16]. CXR data used consisted
of 46 normal images, 24 PTB images, and 8 STB images.
CXR images are processed through several stages, namely
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 2019 International Conference on Information and Communications Technology (ICOIACT)

preprocessing, segmentation, feature extraction, feature

optimization, and classification as shown as a block diagram
in Fig. 1.
Start

CXR Image

Preprocessing

Segmentation

Fig. 2. Preprocessing result

GLCM Feature Extraction
B. Segmentation
The segmentation process is the process of separating the
Feature Optimization Using PCA
region of interest (ROI) from the background image. The
segmentation process separates the lung fields from the rest of
SVM Classification the CXR images. The segmentation process in this research
uses morphological filters, binary segmentation methods and
the selection of two largest binary large objects to obtain
masks. Mask is used to separate background images with ROI
Secondary
Normal Classification
TB
on CXR images. The segmentation result of Fig. 2 is shown in
Fig. 3.

Primary TB

End

Fig. 1. Block diagram of TB detection system in CXR images

A. Preprocessing
Preprocessing is the initial process in processing CXR
images in this research. Preprocessing includes the process of
reducing image size (resize), sharpening image features and
reducing noise. The preprocessing process is done using
Matlab 2018a.
The initial stage of preprocessing is the reduction of image
size. CXR images are reduced in size to 512x512 pixels to
speed up CXR image processing. After the CXR image is
reduced in size, the next step is to sharpen the features on the
CXR image. The CXR feature is sharpened by adapthisteq
function in Matlab 2018a. Adaphisteq on Matlab 2018a serves
to improve the contrast quality of the image by transforming
contrast values using the Contrast Limited Adaptive
Histogram Equalization (CLAHE) method. CLAHE can
improve image contrast quality by considering the presence of
noise in the image. The final step is noise reduction in CXR
images. Noise on CXR images is reduced by using a Gaussian
filter. Gaussian filter can reduce noise and smoothened CXR
images to facilitate edge detection in the segmentation
process. The preprocessing result is shown in Fig. 2.
Fig. 3. Segmentation result
C. Feature Extraction
The feature extracted in this research is the GCLM feature.
The GLCM features in this research are twelve features,
namely contrast, correlation, energy, homogeneity, mean,
standard deviation, entropy, root mean square (RMS),
variance, smoothness, kurtosis, and skewness.
1) Contrast
Contrast is a measure of the intensity of gray level
variations between reference pixels against neighboring
pixels. The contrast will be zero for plain images.
Contrast is given by (1),
=∑ ∑( − ) = [, ] (1)
where, the matrix P [i, j] is a GLCM matrix of images
with gray values i and j.
2) Correlation
Correlation is a measure of the relation of a reference
pixel to its neighbor in an image. The mean is denoted as

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 2019 International Conference on Information and Communications Technology (ICOIACT)

, and the standard deviation is denoted as , . 9) Variance

Correlation is given by (2), Variance is the square root of the standard deviation
(σ). Variance is given by (9),
(, )
=∑ ∑ (2)
=√ (9)

3) Energy 10) Smoothness

Energy is a measure of local uniformity at the gray Smoothness describes the relative smoothness of the
level. Energy will be worth one on a plain image. Energy image intensity. Smoothness is a statistical method for
is given by (3), selecting image blocks that have less noise. Smoothness
is given by (10),
=∑ ∑ [, ] (3)
ℎ =1− (10)
4) Homogeneity
Homogeneity is a measure of the distribution of pixel
11) Kurtosis
elements in the co-occurrence matrix to the GLCM
Kurtosis (K) is a measure of the extent of normal
diagonal. Homogeneity is given by (4),
distribution. Kurtosis is given by (11),

(, )
=∑ ∑
[, ]
(4) = ∑ ∑ −3 (11)
| |

5) Mean 12) Skewness

Mean (μ) is the average value of pixels in an
image. Mean is given by (5),
= ∑ ∑ (, )
where, p (i, j) is the pixel value at point (i, j) of an image
of size M x N.
6) Standard Deviation
The standard deviation (σ) is an estimate of the
deviation of the square of the average gray pixel of the
mean value. The standard deviation describes dispersing
within the local area. Standard deviation is given by (6),
= ∑ ∑ ( ( , )− ) (6)
7) Entropy
Entropy is a measure of randomness from gray level
distribution. Entropy is used as a measure of the
distribution of variations within a region. Entropy is given
by (7),
Skewness (S) is a measure of the degree of
asymmetric distribution of a pixel around the mean.
Skewness is given by,
(5)
(, )
= ∑ ∑ (12)
D. Feature Optimization
Twelve GLCM features from the image extraction process
are optimized using PCA. PCA purpose is to reduce the
dimensions of the GLCM feature. Weka 3.8 is used for the
feature optimization process. The initial process of PCA is the
calculation of the mean used for the process of forming a
correlation matrix. Twelve GLCM features are converted into
a correlation matrix. Continually eigenvalue and eigenvector
are calculated, followed by the formation of a new GLCM
feature. The new GLCM feature is used as input to the SVM
classification system.
The result of GLCM optimization by PCA is shown in Fig.
4.

= −∑ ∑ [, ] [, ] (7)

8) RMS
RMS is an RMS calculation of each input row or
column along the vector of the input dimension. RMS is
given by (8),

= ∑ ∑ ( − Ī) (8)

where, is the pixel intensity of the ith and jth elements

in the two-dimensional image with the size M x N and the
value of Ī is the average intensity of all pixel values in the
image.
Fig. 4. Feature optimization result
E. Classification
The classification process is the process of determining
CXR images classified as normal, PTB or STB. Weka 3.8 is

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 2019 International Conference on Information and Communications Technology (ICOIACT)
used for the classification process. The classification method
used in this research is multiclass SVM. The type of multiclass
SVM used in the research is C-SVC (support vector class). C-
SVC is an SVM type that seeks the best hyperplane to separate
different classes by maximizing the distance between sample
points to the hyperplane to minimize misclassification errors.
Function on C-SVC to minimize misclassification errors is
given by (13),
Ф( , ) = ∑ (13)
where, w is weight vector, ξi is slack variable, Ф is cost
function, and C is the regulation parameter. The value of
parameter C in this research is 1.
SVM classifier in this research has two types of inputs,
namely the GLCM feature without optimization and the
GLCM feature optimized by using the PCA.
III. RESULT AND ANALYSIS
The parameters for measuring the performance of the system
are accuracy, sensitivity, and specificity. Each parameter
calculated for each classification class. Accuracy is the
amount of data that is properly classified by the system.
Sensitivity is a measure of how well a classification system
classifies data points in the positive class. Specificity is a
measure of how well a classification system classifies data
points in the negative class. Accuracy, sensitivity, and
specificity are given by (14), (15), and (16),
= (14)
= (15)
= (16)
where, TP (True Positive) is an outcome where the system
correctly predicts the positive class, TN (True Negative) is an
outcome where the system correctly predicts the negative
class, FP (False Positive) is an outcome where the system
incorrectly predicts the positive class, and FN (False
Negative) is an outcome where the system incorrectly
predicts the negative class.
The SVM classification system in this research is validated
using the cross-validation method. Cross-validation methods
used in this research are 2-fold, 4-fold, 6-fold, 8-fold, and 10-
fold. Validation results from SVM with GLCM input without
optimization will be compared with SVM with GLCM input
that has been optimized using PCA.
Fig. 5 shows the accuracy, sensitivity, and specificity of
the SVM with GLCM input without optimization. SVM with
GLCM input without optimization have highest performance
at 6-fold cross-validation with 62.82% accuracy, 86.96%
sensitivity and 28.13% specificity for normal class; 67.95%
accuracy, 29.17% sensitivity and 85.19% specificity for PTB
class; and 89.74% accuracy, 0% sensitivity and 100%
specificity for STB class.
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Fig. 5. Graph of SVM (GLCM without optimization) performance
Fig. 6 shows the accuracy, sensitivity, and specificity of
the SVM with GLCM input that has been optimized using
PCA. SVM with GLCM input optimized by PCA have the
highest value on 8-fold cross-validation with 100% accuracy,
100% sensitivity and 100% specificity for normal class;
98.72% accuracy, 100% sensitivity and 98.15% specificity for
PTB class; and 98.72% accuracy, 87.50% sensitivity and
100% specificity for STB class.
Fig. 6. Graph of SVM (optimized GLCM by PCA) performance
The SVM classification system with GLCM input without
optimization is not able to classify PTB and STB classes
properly. The performance of the SVM classification system
with GLCM input optimized by PCA is better than the SVM
classification system with GLCM input without optimization.
PCA is able to optimize the GLCM feature in the SVM
classification system to improve the performance of the CXR
image classification system.
IV. CONCLUSION
TB detection system in the CXR images has been
developed to reduce the subjectivity factor in the process of
detecting TB in CXR. SVM classification system with GLCM
input optimized by PCA is better than SVM classification with
GLCM input without optimization. PCA can optimize the
GLCM feature in the SVM classification system to improve
the performance of the CXR image classification system.
SVM with GLCM input optimized by PCA have the highest
value on 8-fold cross-validation with 100% accuracy for the
normal class; 98.72% accuracy for PTB class; and 98.72%
accuracy for STB class.
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