Pulmonary Tuberculosis Detection Using Deep Learning
Convolutional Neural Networks
Michael Norval Zenghui Wang
Department of Electrical and Mining Department of Electrical and Mining
Engineering Engineering
University of South Africa University of South Africa
Florida 1710, South Africa Florida 1710, South Africa
mnorval@gmail.com wangzengh@gmail.com
ABSTRACT
Tuberculosis (TB) is classified as one of the top ten reasons for
death from an infectious agent. This paper is to investigate the
accuracy of two methods to detect Pulmonary Tuberculosis based
on the patient chest X-ray images using Convolutional Neural
Networks (CNN). Various image preprocessing methods are
tested to find the combination that yields the highest accuracy.
Moreover, a hybrid approach using the original statistical
computer-aided detection method combined with Neural
Networks was also investigated. Simulations have been carried
out based on 406 normal images & 394 abnormal images. The
simulations show that a cropped region of interest coupled with
contrast enhancement yields excellent results. When further
enhancing the images with the hybrid method even better results
are achieved.
CCS Concepts
• Computing methodologies~Image processing
Keywords
Artificial Intelligence; Tuberculosis; Pulmonary; Lung X-Ray;
Chest; Neural Network; Rectification Linear Unit.
1. INTRODUCTION
The digital medical industry has evolved significantly in the past
decade. Most institutions are steering away from the analog way
of operations and moving to digital. Digital software driven
healthcare is in use not only by radiology departments but many
other clinical specialties and technical staff has also realized the
potential of digital medicine [3]. With patient data being digital
this would allow and open the door to computerized diagnostics
and artificial intelligence detection mechanisms. The specific
theme investigated in this research paper is to use neural networks
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ICVIP 2019, December 20–23, 2019, Shanghai, China
© 2019 Association for Computing Machinery.
ACM ISBN 978-1-4503-7682-2/19/12…$15.00
https://doi.org/10.1145/3376067.3376068
47
Yanxia Sun
Department of Electrical and
Electronic Engineering Science,
University of Johannesburg, Auckland
Park 2006, South Africa.
sunyanxia@gmail.com
to diagnose such images for the existence of tuberculosis bacteria
presence in digital x-ray data. Traditional machine learning and
vision detection techniques require expertly crafted features to be
manually created and defined. [8] With medical image diagnostics,
there are too many features for this to be a viable technique. Deep
learning Neural Networks coupled with supervised learning would
be the best approach [2]. Various visual features like the texture
and geometric features are extracted with classification being a
threshold or k-nearest approach. Convolutional Neural Network
(CNN) architectures have been proven advantageous in terms of
universality and stability [1]. With South Africa being one of the
countries with very high infection rates, it is crucial to identify the
infection as soon as possible. Utilizing an already state of the art
cell phone communications network the images can be digitized,
remotely sent to a center for diagnostics. If Neural Networks are
used to detect the disease with a Radiologist confirming the result,
the whole process would be much quicker and efficient.
Subsequently, the more data received the more the network will
learn and ultimately the accuracy will also improve significantly.
However, it is necessary to investigate and identify the methods
yielding the higher accuracy. In this paper, we investigate two
deep learning methods with DCNN for classifying TB
manifestations in chest X-Ray images. The first being various
preprocessing methods and the second the hybrid method. The
hybrid method is a combination between Computer Aided
Detection (CAD) and DCNN. Both methods show excellent
results with the hybrid method showing the highest accuracy.
The rest of this paper is structured as follows. Section II gives a
brief literature review about pulmonary tuberculosis and
convolutional neural network. The research methodology is given
in Section 3. Section 4 describes the datasets and experimental
settings. Section 5 details the evaluations of the experimental
results. Section 6 discusses the result meaning and section 7 gives
the conclusion and future work.
2. LITERATURE REVIEW
2.1 Digital Imaging and Communication in
Medicine (DICOM)
The acronym DICOM stands for Digital Imaging and
Communication in Medicine and forms a key part in digital CXR
images. Where in the olden days an X-ray image was taken and
then developed on a film to form the image, DICOM is the
method where digitized image data and patient demographics can
be transmitted from a modality to a workstation or Picture
Archiving and Communication System (PACS) An X-Ray
machine can be seen in Figure 1.
2.2 Pulmonary Tuberculosis
The definition of “Pulmonary” as per the Oxford dictionary is
“Relating to the lungs”. When the tuberculosis infection becomes
active, the lungs are mostly affected, but other body parts outside
the lungs can also be affected. Three main TB types are Miliary
TB, Active TB, Latent TB. The focus of this paper is on active
TB. Active TB occurs when the bacteria multiplies and invades
different organs. Typical symptoms are cough, phlegm, chest
pain, weakness, weight loss, fever, chills, and sweating at night. A
person with active PTB may spread the disease via air. Typical
symptoms are cough, phlegm, chest pain, weakness, weight loss,
fever, chills, and sweating at night. Patient symptoms are chest
pains, night sweats, fever, fatigue, and a prolonged cough [7]. Not
every patient manifests the symptoms, some patients have little or
no symptoms [6]. From Figure 2, one can see an electron
microscope image of the Tuberculosis bacterium.
Figure 1: X-Ray Machine[11].
Figure 2. Image of an electron microscope enlargement of the
Tuberculosis bacterium [10].
2.3 Convolutional Neural Networks
Normally in multi-layer neural networks (MLNN), the inputs are
in vector form. For Medical Images, the neighboring pixels or
voxels are another source of information. When using MLNN the
vectorization process discards the voxel and neighboring pixel
information, and thus CNNs are used. When using convolutional
layers coupled with pooling and finally fully connected layers, the
spatial information in the voxels can be much better utilized, and
the structure of CNN is shown in Figure 3 [4].
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3. RESEARCH METHODOLOGY
To improve detection accuracy, it is necessary to test varying
color depth and preprocessing methods using the steps shown in
Figure 4. A fixed random generator provides more stable results
that fluctuate less. The color depth was tested and compared and
grayscale provides the same result as RGB. Following the color
depth test various image preprocessing methods are tested. The
results are shown in the evaluation section.
Figure 3. Multi-Layer neural network [4]
Figure 4. Color depth and pre processing method
Figure 5. Hybrid approach
For achieving further accuracy, a method called the hybrid
method is investigated. The preprocessed image set in Figure 4
(3rd Block output) is used and subjected to further processing
where the ROI is extracted from these images. Again a fixed
random generator is utilized for more stable accuracy results. The
method is a Hybrid approach between steps used in Computer
Aided Detection (CAD) and DCNN. The lung Region of Interest
(ROI) is extracted and fed into the DCNN as dataset. The
motivation behind this is to eliminate all unnecessary data and
only keep the image data of the lung region. This allows for
training only to happen on the relevant features. This process can
be seen in Figure 5.
4. DATASETS AND EXPERIMENTAL
SETTINGS
4.1 Datasets
Link to main Datasets used:
https://ceb.nlm.nih.gov/repositories/tuberculosis-chest-x-ray-
image-data-sets/
Shenzhen Hospital X-ray Set:
X-ray images in this data set have been collected by Shenzhen
Figure 6. X-ray Contrast Enhancement.
No.3 Hospital in Shenzhen, Guangdong province, China. The x-
rays were acquired as part of the routine care at Shenzhen It can be seen from Table 1 that the preprocessing method
Hospital. The set contains images in JPEG format. There are 336 yielding the best results is a combination of taking the ROI image
normal x-rays and 326 abnormal x-rays showing various of only the lung region and combining this with contrast
manifestations of tuberculosis. enhancement. The process is executed three times and the results
recorded as 1,2,3 in 3rd accuracy column. Highest success rate
Montgomery: here is 91.04%
X-ray images in this data set have been acquired from the
tuberculosis control program of the Department of Health and
Human Services of Montgomery County, MD, USA. This set
contains 138 posterior-anterior x-rays, of which 80 x-rays are
normal and 58 x-rays are abnormal with manifestations of
tuberculosis. All images are de-identified and available in DICOM
format. The set covers a wide range of abnormalities, including
effusions and miliary patterns. se

4.2 Settings
The software used for the simulation is Matlab. The Image
Processing and Neural Network Toolboxes of this product are Figure 7. X-Ray Histogram Equalization.
used. The settings of the simulations are
 All data is shuffled as to never have a repeat sequence of the
same data
 A mini batch of 80 is used
 30 Epochs specified as a maximum
 10% of all data is used for verification
 A fixed random generator for the initial weight selection is
used. This ensures that all simulations start with the same
random weight values selected. Subsequently the results do not
deviate. This method is used in all simulations.
5. EVALUATION
The evaluation is to investigate the detection success rate of two Figure 8: X-Ray Adaptive Histogram Equalization.
different methods. The following methods are evaluated: image
preprocessing and secondly the hybrid approach.

5.1 Various Pre Processing Techniques

The input data is enhanced and then the simulation is executed.
Figure 6 shows contrast enhancement. Figure 7 and Figure 8
shows histogram equalization. Figure 9 showed the final adjusted
and cropped image used in the dataset. In the following
simulations, various preprocessing is applied to the input set of
images. Histogram Equalization, contrast enhancement, reducing
of the color channel, sharpening and taking the cropped ROI.
Figure 9: X-Ray Image, Adjusted and Cropped.
Table 1. Image preprocessing results
Pre Processing Image res & color Accuracy
Histogram Equalization 64x64x1 1. 78,46%
2. 76.92%
3. 80.00%

49
Contrast Enhance 64x64x1 1. 75.38% 6. DISCUSSION
And Color channel reduce 2. 81.54% Diseases like TB has a very high mortality rate on the African
3. 80.00% continent and worldwide. It is essential to identify it as quick and
Contrast Enhance and 64x64x1 1. 78.46% accurately as possible. Detection accuracy can save lives. The two
Histogram Equalization 2. 70.77% tested methods show how to improve the detection accuracy by
setting the experiments. More preprocessing techniques like PCA
3. 73.85%
whitening must be investigated in future. If coupled with the
Sharpening 64x64x1 1. 78.46% hybrid method better results can be achieved.
2. 83.08%
3. 82.29% 7. CONCLUSION AND FUTURE WORK
Cropped ROI 64x64x1 1. 83.58% The results yield solid evidence that preprocessing of images
shows a higher accuracy than no preprocessing. Subsequently
2. 83.58%
extracting only the ROI from these images yields even better
3. 80.60% results with a maximum accuracy of 92.54% the main advantage
Cropped ROI & Contrast 64x64x1 1. 89.55% of the hybrid method is significantly better accuracy by reducing
Enhance 2. 91.04% overfitting.
3. 89.55% In the future, we would be to obtain more clinical data and thus
vastly improve the accuracy of the detection. In order to obtain the
5.2 Hybrid Method data, collaboration can be done with some sort of organization like
This method is a mixture between the normal computer-aided a state TB hospital. Over time more data will be processed and the
detection and neural network. The preprocessing and system will keep on learning and improve its accuracy. This
Segmentation part of CAD [5] is used and then fed into a Neural ‘system’ or rather portal can then be expanded to other institutions
Network. Images are extracted so that only the lung ROI remains. as well as assisting with the diagnosing of Tuberculosis.
Figure 6 shows the result of the operation. The results are higher
than the data enhancement method. The advantage of only using 8. ACKNOWLEDGEMENT
the ROI for training is that irrelevant data and features are This research is supported partially by South African National
eliminated from the dataset and overfitting is reduced. Figure 10 Research Foundation Grants (No. 112108 and 112142), and South
shows an extracted ROI. Figure 11 shows the extracted ROI African National Research Foundation Incentive Grant (No.
when the patient has a partial lung left. 95687 and 114911), Eskom Tertiary Education Support
Programme Grants, Research grant from URC of University of
Johannesburg.

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