EARLY DETECTION OF TB AND OTHER LUNG DISEASES IN

CHEST RADIOGRAPHY USING IMAGE PROCESSING

TECHNIQUES

Chronic respiratory disease is a group of disorders that primarily affect the lungs and airways.
The term lung disease refers to many disorders affecting the lungs such as asthma, chronic
obstructive pulmonary (COPD) disease, tuberculosis, influenza, lung cancer, pneumonia and
other breathing problems. Chronic obstructive pulmonary disease (COPD) and tuberculosis (TB)
are two important causes of mortality and morbidity in our country and are among top 10 causes
of death.[1]. Lung diseases signs and symptoms can differ by the type of the affected disease.
Common signs are trouble in breathing, shortness of breath, feeling like you're not getting
enough air, a cough that won't go away, coughing up blood or mucus, pain or discomfort when
breathing in or out. Tuberculosis (TB) is an important case in point

M. tuberculosis is spread by aerosol droplets, the lungs are most commonly affected by the
disease 4,5. It is well known that environmental exposures, such as silica dust or cigarette smoke,
increase the risk of developing TB 6–8. Conversely, it is now becoming clearer that TB itself
may lead to chronic respiratory disease, particularly bronchiectasis and COPD 11,12. The
population attributable risk for COPD due to cigarette smoking varies from more than 70% in
some high income countries to less than 40% in low and middle income countries 13. The other
factors that cause COPD in low and middle income countries have not been established, but TB
may well play an important role 14.

BURDEN OF TB and COPD

India accounts for one fourth of the global TB burden i.e.2.2million out of 9.6millionnew cases
annually. In India, more than 40% of population if infected with M.TB.It is estimated that there
are 2.5 million prevalent cases of all forms of TB disease. It is also estimated that about 2.2lakhs
people die due to TB annually(mortality).The table below shows the estimated figures for TB
burden globally and for India provided by WHO for the year 2016.
 Incidence Prevalence Mortality
Global
India

The World Health Organization (WHO) estimates that 4.6 million people die prematurely each
year as a result of chronic respiratory disease, accounting for more than 5% of global deaths;
almost 90% of these occur in low and middle-income countries 20. The 2010 global burden of
disease report ranked COPD as the 9th leading cause of disability worldwide and this is
predicted to rise to 5th by 2020 21.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Chronic obstructive pulmonary disease (COPD) is a common lung disease. Having COPD makes
it hard to breathe. With COPD, the airways in the lungs become inflamed and thicken, and the
tissue where oxygen is exchanged is destroyed. The flow of air in and out of the lungs decreases.
When that happens, less oxygen gets into your body tissues, and it becomes harder to get rid of
the waste gas carbon dioxide. As the disease gets worse, shortness of breath makes it harder to
remain active.
There are two main forms of COPD:

 Chronic bronchitis, which involves a long-term cough with mucus

 Emphysema, which involves damage to the lungs over time

Most people with COPD have a combination of both conditions.

Causes
Smoking is the main cause of COPD. The more a person smokes, the more likely that person will
develop COPD. But some people smoke for years and never get COPD.In rare cases,
nonsmokers who lack a protein called alpha-1 antitrypsin can develop emphysema. Other risk
factors for COPD are:

 Exposure to certain gases or fumes in the workplace

 Exposure to heavy amounts of secondhand smoke and pollution

 Frequent use of a cooking fire without proper ventilation

Symptoms of COPD can be different for each person, but common symptoms are:

 Increased shortness of breath

 Frequent coughing (with and without mucus)

 Increased breathlessness

 Wheezing

 Tightness in the chest

TUBERCULOSIS

TB is a disease caused by bacteria called mycobacterium tuberculosis. It can affect almost any
part of the body, its main site of infection is the lungs because of the bacillus preference for high
oxygen environments. The pathogenesis of TB is complex, and some of its features are not fully
understood yet. Bacilli enter the lungs through the airways and end up in the alveoli where they
invoke the innate immune response. The typical symptoms associated with TB are fever, weight
loss, night sweats, and coughing.

In clinical practice, chronic respiratory diseases with focus on COPD is diagnosed by chest
radiography. TB is diagnosed using chest radiography, and sputum examination. The results of
these tests can be used as input to various computational models. The two major approaches to
diagnose TB computationally are based on either images of sputum or x-ray or the results of
various/pathological tests which are collectively called as parameters .

Standard diagnostics still rely on methods developed in the last century. They are slow and often
unreliable. Manually the detection of TB cavities is done by just looking at the X-rays/CT
images by the doctors/technicians. So by means of looking at the images by the naked eye there
is more chance for wrong prediction of the intensity of the cavities. Hence, because of this wrong
prediction of the cavities, the physicians may not prescribe correct dosage of medicine. They
may prescribe high or Low dosage of medicine. If the dosage is too high it will lead to various
harmful effects such as causing other diseases. If the dosage is too low the patient cannot easily
recover from the disease soon. So the accurate detection and classification of normally seen
abnormalities in CXR’s must be done for the accurate prescription of medicine with the correct
dosage to get rid of the diseases completely.

LITERATURE REVIEW:
The development of computer aided diagnosis and screening systems has got new momentum
due to the emergence of digital chest radiography and the possibility of digital image processing.
In recent years, several revolutionary papers have been published on computer-aided diagnosis
(CAD) in CXR’s, despite that more research is needed in this field to meet the practical
performance requirements.

B. van Ginneken and B. Ter Haar Romeny (2000) published research paper on segmentation of
lung fields in chest radiographs. In this paper author have proposed algorithms for segmentation
of lung fields in chest radiograph. Segmentation methods namely Matching, Pixel classification:
Location, Pixel classification rule-based reasoning and correction using pixel classification are
compared on performance parameters Accuracy, sensitivity, specificity are the performance
parameter used by author to compare the performance of above mentioned segmentation
schemes. Author find out rule based segmentation methods are better than pixel classification
methods. Rule based segmentation scheme developed in this paper is robust and accurate but can
still be improved in several ways, notably by adding rules to handle exceptional situations.
Research paper related to finding out abnormalities in chest x- ray using local texture analysis
published by B. van Ginneken, S. Katsuragawa, B. ter Haar Romeny, K. Doi, in 2002. In this
paper method is presented to find out abnormalities in chest radiographs which are sum into an
overall abnormality score. Main aim of method was to find out abnormal texture pattern in chest
x-ray. The scheme starts with segmentation of the lung fields, using image appearance models.
The segmentation is used to divide the lung fields from background region. [5] S. Candemir, K.
Palaniappan, and Y. Akgul (2014) published research paper related to graph cut image
segmentation algorithm with the help of energy minimization approximation”. In this paper,
author describes a methodology for adaptive parameter learning to improve the segmentation
performance using a multi-class classifier approach. Author demonstrated the performance of the
system within graph cut segmentation framework. The approaches in literature modulate the
regularization parameter using a single feature or a heuristic combination of a few features.
Author model the characteristics of the image regions with feature vectors which includes haar
feature for edge, local binary patter for texture and hessian for shape information of local
regions. Therefore this approach characterizes the image regions better than using single feature.
The simple structure of the system allows to incorporate alternative features such as Scale
Invariant Feature Transform which is one of the best performing feature descriptors among local
descriptors. [2]. Computer-aided diagnosis of tuberculosis using chest radiographs published by
Manisha RK, Palanisamy KS in 2016 .This study focus on automated approach makes use of
Chest radiography to diagnose the disease. The lung region is extracted using Graph cut lung
segmentation method for identifying the ribs and clavicles, which are needed for the diagnosis.
The Graph cut lung segmentation method provides better accuracy and then the Classification is
performed between normal and abnormal X-ray patterns. Finally, performance of the method is
analyzed.
IMPORTANT FINDINGS FROM LITERATURE SURVEY
 Chest X-rays (CXR) can be used for automatic detection of TB. The purpose of the
segmentation is to find corresponding regions within the lung fields. Segmentation of
lung fields on PA chest radiographs has received considerable attention in the literature.
 There are four important areas by which we can review the literature related to computer
analysis of chest radiographs. Those areas are Techniques related to Image pre-
processing, Algorithms related to Segmentation of the lung part, Feature extraction
methods , Image classification methods.
OBJECTIVE OF THE PROPOSED RESEARCH WORK
 To provide systematic and quantitative measurement on CXR’s images so that
physicians can diagnose the nodule/abnormalities in lungs more effectively and more
accurately.
The increasing role of software and image processing in the clinical radiology
underpins the need for greater awareness among radiologists of how software can
identify structures and lesions and yield quantitative characteristics about these objects
on the image. Some areas of radiology are using computer-aided detection methods for
lesion identification, like in finding of lung and breast nodules. The segmentation
algorithms continue to improve the regard to the quality of output and the efficiency of
these methods in radiologists work flow for the future potential of com-puter-aided
detection in radiology is substantial for the segmentation algorithms. In particular, the
contribution to the accurate longitudinal assessment of the disease progression and
response to treatment has enable optimal level.

or
 Automatic detection and classification/differentiation between normal and abnormal
CXR’s with manifestations of TB and other lung diseases, using image processing
techniques.
 In this paper a new algorithm for classification of lung diseases has been proposed.
Segmentation of image is a more effective technique to diagnose the chronic respiratory
diseases and TB in its early stage that would enhance the quality of the diagnosis speedy.
 Computer aided detection diagnosis is also known as computer aided diagnosis which is
a medical image processing for diagnosing the aid of radiology images.
The goal of CAD is not only to get the better result of the diagnostic accuracy but also the
consistent radiology image interpretation by using the computer output. CAD output is able to
help the radiologists to diagnosis and provide treatment based on the subjective judgment.
Normally, there are two types of approaches are applied in computerized schemes for CAD
which are finding the location of lesions and quantifying the features of radiography images
whether normal or abnormal patterns are included in lungs.
 Tuberculosis control efforts hampered by a mismatch in diagnostic technology: modern
optimal diagnostic tests are least available in poor areas. Lack of adequate early
diagnostics and MDR detection is a critical problem in control efforts. Our intention/goal
is to make the process easier for rural area people.

or

OBJECTIVES

 To evaluate the performance of classification of lung diseases using Algorithm.

 To compare the existing and proposed technique based on following parameters: