A REVIEW ON ADVANCEMENTS IN DEEP

LEARNING AND ARTIFICIAL INTELLIGENCE IN

MEDICAL IMAGING

Submitted By:
Ansiya A
M. Tech, Industrial Instrumentation and Control
Dept. of Electrical and Electronics Engineering
TKM College of Engineering, Kollam
TKM22EEII03
 A REVIEW ON ADVANCEMENTS IN DEEP
LEARNING AND ARTIFICIAL INTELLIGENCE IN
MEDICAL IMAGING
Abstract- This abstract presents an overview of recent advancements in the field of medical imaging,
focusing on articles from respected journals. These articles cover diverse topics such as image
segmentation, disease classification, and advanced learning techniques. They showcase innovative
approaches to address challenges in medical image analysis, including the detection of suspicious
regions in mammograms and the classification of medical conditions. The integration of technologies
like deep learning, ensemble learning, and transfer learning is evident in these studies, underscoring
their potential to revolutionize medical imaging. Techniques such as hybrid image segmentation
methods and neural networks like transformers demonstrate the multidimensional strategies
employed by researchers. These contributions hold promise for enhancing diagnostic precision and
healthcare processes. The review of these articles not only highlights the strides made in medical
imaging but also emphasizes their implications for medical research and patient care. As these
methodologies continue to progress, informed by these findings, the future of medical imaging appears
bright, offering opportunities for more accurate diagnoses and efficient medical practices.

Keywords - Medical Imaging, Image Segmentation, Disease Classification, Deep Learning, Ensemble
Learning, Transfer Learning.

I. INTRODUCTION

In recent years, the field of medical imaging has witnessed a significant surge in research efforts, aiming
to enhance the accuracy, efficiency, and reliability of various diagnostic and analytical tasks. This review
focuses on a selection of articles from well-regarded journals in the field of medical imaging. The articles
delve into innovative techniques, methodologies, and applications that have the potential to reshape the
landscape of medical image analysis. The exploration spans a wide spectrum, ranging from segmentation
and classification methodologies to the integration of advanced technologies like deep learning, ensemble
learning, and transfer learning. These contributions collectively highlight the strides made in addressing
critical challenges within medical imaging, such as the detection of suspicious regions in mammograms,
accurate disease classification, and intricate segmentation tasks. Through an in-depth examination of
these articles, this review aims to provide insights into the state-of-the-art advancements in medical
imaging and their potential implications for the broader medical and healthcare domains.

II. A Novel Hybrid Image Segmentation Method for Detection of Suspicious Regions in
Mammograms Based on Adaptive Multi-Thresholding (HCOW)

The paper introduces a hybrid thresholding method for efficient segmentation of mammograms and
reducing suspicious regions in breast cancer detection systems. The method uses Otsu multilevel
thresholding, Havrda & Charvat entropy, and the w-BSAFCM algorithm to determine an adaptive multi-
threshold value. It segmentates the pectoral muscle and breast regions to prevent information loss. Tested
on 55 mass and 210 non-mass mammograms, the method successfully locates mass regions and
significantly reduces non-mass suspicious regions.

The hybrid thresholding method improves breast cancer detection accuracy by automating the
segmentation of suspicious regions in mammograms. It uses Otsu multilevel thresholding, Havrda &
Charvat entropy, and the w-BSAFCM algorithm to create an adaptive multi-threshold value, focusing on
 pectoral muscle and breast region to prevent information loss and enhance segmentation results.

Based on adaptive multi-thresholding, the hybrid image segmentation method effectively locates mass
regions and reduces non-mass suspicious areas in mammograms, outperforming other entropy methods
in accuracy, false-positive rate, and specificity. It successfully segmented suspicious regions in 55 mass
mammograms and 210 non-mass mammograms from the mini-MIAS database, demonstrating promising
results in breast cancer detection.

The method was tested on a specific dataset, the mini-MIAS database, and may not be suitable for other
datasets or real-world scenarios. It does not provide a detailed analysis of the computational complexity
or runtime of the proposed method. It fails to provide a comprehensive analysis of the false-positive rate
and specificity of the proposed method, which are important metrics for evaluating the performance of
CAD systems.

III. An Analysis on Ensemble Learning Optimized Medical Image Classification with Deep
Convolutional Neural Networks

The paper presents a medical image classification pipeline that uses ensemble learning techniques like
Augmenting, Stacking, and Bagging. The pipeline includes advanced preprocessing and image
augmentation methods, as well as nine deep convolutional neural network architectures. It is applied to
four medical imaging datasets with varying complexity. The results show that Stacking achieves the
largest performance gain while augmenting consistently improves capabilities by up to 4%. Cross-
validation-based Bagging also shows significant performance gains, up to +11%. The integration of
ensemble learning techniques is deemed a powerful method for improving the robustness and
performance of medical image classification pipelines. The paper utilized multiple public medical image
classification datasets to ensure increased result reliability and robustness. The datasets differed in sample
size, modality, feature type of interest, and noisiness. The four datasets used in the analysis were
CHMNIST (histology), COVID (X-ray), ISIC (dermoscopy), and DRD (ophthalmoscopy)

The paper presents a medical image classification pipeline for future research, evaluating ensemble
learning techniques like Augmenting, Stacking, and Bagging to enhance performance. Stacking achieves
the largest performance gain of up to 13% F1-score. The study includes state-of-the-art preprocessing,
image augmentation methods, and 9 deep convolutional neural network architectures. The analysis is
conducted on four popular medical imaging datasets, providing a comprehensive understanding of
ensemble learning techniques' performance impact in different scenarios.

The study found that tacking and augmenting improved capabilities by up to 13% and 4% respectively,
respectively, for single model-based pipelines. Cross-validation-based Bagging showed a significant
performance gain, close to Stacking, with an F1-score increase of up to +11%. Simple statistical pooling
functions were found to be equally or even better than more complex ones. No overfitting was observed,
and training and validation loss functions showed no significant distinction.

The Augmenting technique in medical image classification pipelines was studied using an unweighted
Mean pooling function, which restricted exploration of other simple functions. The paper lacks detailed
information on specific datasets, making it difficult to assess generalizability. The analysis focused on
deep convolutional neural network architectures, limiting understanding of ensemble learning's
performance impact. The lack of discussion on computational resources for implementing the pipeline
also poses a potential limitation for researchers with limited access to high-performance computing
resources.
IV. An Application of Transfer Learning and Ensemble Learning Techniques for Cervical
Histopathology Image Classification

The paper presents an Ensembled Transfer Learning (ETL) framework for classifying cervical histopathological
images. It uses networks like Inception-V3, Xception, VGG-16, and Resnet-50 to enhance classification
performance. A weighted voting-based Ensemble Learning strategy is introduced for improved accuracy. The
algorithm achieves high accuracy of 97.03% and 98.61% on AQP staining images and poor differentiation of
VEGF staining images. An experiment on the Herlev dataset shows 98.37% accuracy for classifying benign and
malignant cells. The authors utilized a practical histopathology image dataset of cervical cancer tissue sections,
including 307 images stained by three immunohistochemistry methods (AQP, HIF, and VEGF). They also
conducted an experiment on the publicly available Herlev dataset, which includes 917 single-cell images for
cervical cells.

The Ensembled Transfer Learning (ETL) framework for cervical histopathology image classification can
enhance the accuracy and efficiency of diagnosing cervical cancer. Using Transfer Learning approaches
like Inception-V3, Xception, VGG-16, and Resnet-50 networks, the weighted voting-based EL strategy
enhances classification performance. The high accuracy achieved in experiments demonstrates its
potential for clinical applications.

The Ensembled Transfer Learning (ETL) framework outperformed individual TL methods in achieving
high accuracy rates on AQP staining images and poorly differentiated VEGF staining images. It also
achieved 98.37% accuracy in classifying benign cells from malignant ones on the Herlev dataset, with
the poor differentiation stage achieving the best classification accuracy and precision.

This framework uses four base learners, requiring a sophisticated computer for implementation. The
current immunohistochemistry dataset lacks patient-level labels, limiting basic studies. The authors are
collecting more data and working on addressing this limitation. The algorithm's performance is evaluated
on a small dataset, but expanding to a larger dataset could provide a more comprehensive evaluation.

V. Automated Classification of Breast Cancer Stroma Maturity from Histological Images

The paper presents a method to automatically classify breast cancer stromal regions based on their
maturity, achieving an accuracy of 84%. The method uses multiscale basic image features, local binary
patterns, and a random decision trees classifier. The study demonstrates the effectiveness of texture-based
image analysis in distinguishing stromal morphology and suggests it could improve pre-operative
imaging for prognosis and treatment outcomes. The method also discusses the use of derivative-of-
Gaussian filtering with local binary patterns. The paper uses histological images of 55 invasive breast
carcinoma patients, analyzing 169 regions of interest. The data was divided into training and test sets,
with ground truth labels created by a pathologist. The classification performance was evaluated by
comparing the classifier's output with ground truth labels and comparing single- and multi-scale
approaches.

The paper introduces an automated classification method for breast cancer stroma maturity, achieving
84% accuracy using multiscale basic image features and local binary patterns. This method, which uses
a random decision trees classifier, is promising for clinical applications, potentially improving pre-
operative imaging for prognosis and treatment outcomes. It can be applied to emerging imaging
modalities like MR diffusion and ultrasound elastography.

The study analyzed 169 regions of interest in breast cancer stroma, revealing a multiscale approach with
an 84% classification accuracy. The study evaluated the performance of single- and multi-scale random
decision tree classifiers on 52 ROIs, identifying mature and immature stroma.
 The paper discusses the binary classification problem of stroma maturity, which simplifies the biological
process of stromal changes. It suggests expanding this to a multiple-class problem for a more
comprehensive understanding. The evaluation of stromal regions was limited to small areas, suggesting
future work should evaluate the entire tumor stroma. The paper also acknowledges the need for further
investigation into optimal image size and stromal features.

VI. Automatic Detection Approach for Bioresorbable Vascular Scaffolds Using a U-Shaped
Convolutional Neural Network

The paper introduces a new automatic detection method for bioresorbable vascular scaffolds (BVSs) using a U-
shaped convolutional neural network, aiding doctors in disease diagnosis and decision-making. The method
involves data preprocessing and network training, with vascular stenting experts tagging BVC OCT images. The
paper uses a dataset of OCT images of bioresorbable vascular scaffolds (BVSs) for training and testing an
automatic detection method. Vascular stenting experts tag the images, and the labelled data is shown to experts for
optimization. The masked images are used for training and restoring labelling information.

The paper presents a novel automatic detection method for bioresorbable vascular scaffolds (BVSs) using
a U-shaped convolutional neural network. This method aids doctors in diagnosing diseases and making
important decisions. The method improves the U-shaped network structure for better training biomedical
OCT images, enhancing its performance and prediction speed. The method offers a comprehensive
pipeline for data preparation, training, and testing.

The study validates an automatic detection method for bioresorbable vascular scaffolds (BVSs) using a
U-shaped convolutional neural network. The model accurately predicts BVS information in OCT images,
aiding doctors in disease diagnosis. However, the predicted size may be smaller due to insufficient
training samples. The method offers a systematic approach for better performance in biomedical OCT
image analysis.

The paper discusses the challenges of labeling bioresorbable vascular scaffolds (BVS) in OCT images
due to insufficient training samples and obstacles. It suggests larger input images for better results but
also acknowledges the time-consuming nature of this method. The study also lacks comparison with
existing methods for BVS detection.

VII. Breast Cancer Image Classification via Multi-Network Features and Dual-Network
Orthogonal Low-Rank Learning.

The study developed a classification framework for breast cancer histological images using multi-
network features, dual-network orthogonal low-rank learning, and an ensemble support vector machine.
The framework achieved a classification accuracy of 97.70% on the ICIAR 2018 Challenge dataset,
demonstrating the effectiveness of these techniques in breast cancer classification. The paper utilizes the
ICIAR 2018 grand challenge dataset, consisting of 400 HE-stained breast histology microscopy images
with a resolution of 2048 x 1536 pixels and digitized with 200x magnification. The images are labelled
with benign, in situ carcinoma, invasive carcinoma, and normal classes, annotated by two expert
pathologists.

The study developed a classification framework for breast cancer using histology images, combining
deep learning and machine learning methodologies. The framework achieved a high classification
accuracy of 97.70% on the ICIAR 2018 Challenge dataset, outperforming state-of-the-art methods. The
approach used multi-network features from four pre-trained DCNNs, introduced a dual-network
orthogonal low-rank learning method for feature selection, and trained an ensemble support vector
 machine.

The proposed classification framework achieved a high accuracy of 97.70% on the ICIAR 2018
Challenge dataset of histology images of breast cancer. The method outperformed state-of-the-art
methods and was improved by combining deep learning with machine learning methodologies, multi-
network feature extraction, and dual-network orthogonal low-rank learning. Pre-trained DCNNs, DOLL,
and an ensemble support vector machine further enhanced the classification performance.

The paper lacks a detailed discussion of the proposed method's limitations and potential challenges, and
its evaluation is limited to the public ICIAR 2018 Challenge dataset of histology images of breast cancer.
It also lacks a comparison with other state-of-the-art methods in terms of computational efficiency, which
is crucial for real-time applications. Additionally, the paper does not discuss the interpretability of the
classification results, which is essential for medical applications.

VIII. Medical Image Segmentation Using Transformer Networks

The paper introduces a transformer network architecture for medical image segmentation, based on self-
attention between neighboring image patches. This architecture outperforms fully-convolutional
networks (FCNs) in accuracy, especially when labelled training data is limited. Pretraining strategies on
large unlabeled images improve the network's performance, particularly in accurately segmenting
intricate structures, contributing to the field's advancements. The paper presents experimental results on
two datasets: the brain cortical plate dataset and the hippocampus dataset. The authors used these datasets
to compare the segmentation performance of the proposed method with competing FCNs.

The proposed transformer network architecture achieves more accurate segmentations than FCNs,
particularly in terms of distance metrics such as HD95 and ASSD . The proposed network can be trained
using only tens of labeled images, making it advantageous in scenarios with limited labeled training data.

The results presented in Table 2 show that the proposed convolution-free network achieved segmentation
performance levels that are superior to the competing FCNs in terms of DSC, HD95, and ASSD. The
proposed network outperformed UNet, a popular FCN architecture, on both the brain cortical plate and
hippocampus datasets.

IX. Multimorbidity Content-Based Medical Image Retrieval and Disease Recognition Using Multi-
Label Proxy Metric Learning

The paper proposes a novel multi-label proxy metric learning method for content-based image retrieval
and classification in the context of multimorbidity medical images. This method allows for the encoding
of complex relationships between diseases in the feature space. The efficacy of the proposed method is
demonstrated experimentally on two multimorbidity radiology datasets.

The proposed method outperforms state-of-the-art image retrieval systems and baseline approaches,
improving the accuracy and interpretability of computer-aided diagnosis systems. Experimental results
show that the proposed method outperforms existing content-based image retrieval systems and baseline
approaches.

The method uses brute force nearest neighbor search, which may not scale well for large databases and
become a computational bottleneck. Future research should explore efficient approximate nearest
neighbor search methods. The proxies used in the method are approximations of the true feature space
distribution, which may limit the benefits of fine-grained neighborhood metric learning methods. Hybrid
 proxy and pairwise methods can achieve some benefits while maintaining training efficiency.
Unbalanced data, common in the medical domain, may affect the method. The paper suggests using self-
supervised and semi-supervised methods to improve model performance without manual annotation cost.

X. Optimal Feature Selection-Based Medical Image Classification Using Deep Learning Model in
Internet of Medical Things

The paper introduces Optimal Deep Learning (DL) as an improved classifier for lung cancer, brain
images, and Alzheimer's disease classification. It uses preprocessing, feature selection, and classification
to create an optimal model. The Opposition-based Crow Search (OCS) algorithm enhances the DL's
performance by selecting optimal features from pre-processed images, specifically multi-texture and
grey-level features. The model achieves high accuracy, sensitivity, and specificity, with results of
95.22%, 86.45%, and 100% respectively.

The current research work considered four datasets for image classification analysis and the main aim is
to achieve maximum accuracy in disease prediction. The three datasets considered were brain, lung,
breast cancer and Alzheimer’s disease. From these datasets, the stages of each patient’s image were
classified as Benign and Malignant at an early stage by the proposed classification technique.

The Optimal Deep Learning classifier and the OCS algorithm improve the classification of medical
images, leading to enhanced accuracy, sensitivity, and specificity. The proposed model achieves a
maximum performance in terms of accuracy, sensitivity, and specificity, with results of 95.22%, 86.45%,
and 100% respectively for the applied set of images.

XI. A Curvature-Enhanced Random Walker Segmentation Method for Detailed Capture of 3D Cell
Surface Membranes

The paper focuses on the segmentation of Dictyostelium cells undergoing macropinocytosis, a process
of vesicular uptake of nutrients from extracellular fluid. The authors introduce a new random walker-
based method with a curvature-based enhancement to capture cell surface protrusions and invaginations.
They also introduce an automated seeding method for microscopy data, enabling the segmentation of
large time series with minimal experimenter input. The method was tested on both real and synthetic 3D
image volumes of Dictyostelium cells undergoing macropinocytosis captured on an iSPIM microscope.
The training data from Fluo-C3DH-A549-SIM are also used for comparison purposes.

The inclusion of the curvature enhancement term improves the segmentation of fine protrusions and deep
invaginations on the cell surface. The proposed method performs better than other state-of-the-art
segmentation methods in 3D images of Dictyostelium cells and performs competitively against CNN-
based methods in two Cell Tracking Challenge datasets.

The curvature-enhanced random walker (CERW) method outperforms other methods in protrusions and
evaluation measures, except for the Hausdorff measure where CNN performs best, and generally
outperforms CNN even with extensive training data. But the curvature enhancement decreases the
accuracy of the segmentation in areas other than filopodia detection.
XII. CONCLUSION

The articles reviewed here showcase the continuous evolution and innovation within the realm of medical
imaging. The amalgamation of cutting-edge technologies, including deep learning, ensemble learning,
and transfer learning, has propelled the field forward, enabling remarkable achievements in image
segmentation, disease classification, and retrieval. The adoption of hybrid methodologies, such as the
combination of adaptive multi-thresholding and deep learning, signifies the holistic approach researchers
are adopting to tackle the complexity of medical image analysis. Additionally, the utilization of advanced
neural networks, like transformer networks, in image segmentation illustrates the ongoing exploration of
novel paradigms to address long-standing challenges. The reviewed articles collectively underline the
transformative potential of these advancements in not only enhancing diagnostic accuracy but also
streamlining healthcare processes and decision-making. As the trajectory of medical imaging continues
to progress, informed by the insights gleaned from these studies, the prospects for improved patient care
and medical research remain promising.

REFERENCES
[1] G. Toz and P. Erdoğmuş, "A Novel Hybrid Image Segmentation Method for Detection of Suspicious
Regions in Mammograms Based on Adaptive Multi-Thresholding (HCOW)," in IEEE Access, vol. 9,
pp. 85377-85391, 2021, doi: 10.1109/ACCESS.2021.3089077.
[2] D. Müller, I. Soto-Rey and F. Kramer, "An Analysis on Ensemble Learning Optimized Medical
Image Classification With Deep Convolutional Neural Networks," in IEEE Access, vol. 10, pp.
66467-66480, 2022, doi: 10.1109/ACCESS.2022.3182399.
[3] D. Xue et al., "An Application of Transfer Learning and Ensemble Learning Techniques for Cervical
Histopathology Image Classification," in IEEE Access, vol. 8, pp. 104603-104618, 2020, doi:
10.1109/ACCESS.2020.2999816.
[4] S. Reis et al., "Automated Classification of Breast Cancer Stroma Maturity From Histological
Images," in IEEE Transactions on Biomedical Engineering, vol. 64, no. 10, pp. 2344-2352, Oct.
2017, doi: 10.1109/TBME.2017.2665602.
[5] W. Zhou et al., "Automatic Detection Approach for Bioresorbable Vascular Scaffolds Using a U-
Shaped Convolutional Neural Network," in IEEE Access, vol. 7, pp. 94424-94430, 2019, doi:
10.1109/ACCESS.2019.2926523.
[6] Y. Wang et al., "Breast Cancer Image Classification via Multi-Network Features and Dual-Network
Orthogonal Low-Rank Learning," in IEEE Access, vol. 8, pp. 27779-27792, 2020, doi:
10.1109/ACCESS.2020.2964276.
[7] D. Karimi, H. Dou and A. Gholipour, "Medical Image Segmentation Using Transformer Networks,"
in IEEE Access, vol. 10, pp. 29322-29332, 2022, doi: 10.1109/ACCESS.2022.3156894.
[8] Y. Xing, B. J. Meyer, M. Harandi, T. Drummond and Z. Ge, "Multimorbidity Content-Based Medical
Image Retrieval and Disease Recognition Using Multi-Label Proxy Metric Learning," in IEEE
Access, vol. 11, pp. 50165-50179, 2023, doi: 10.1109/ACCESS.2023.3278376.
[9] R. J. S. Raj, S. J. Shobana, I. V. Pustokhina, D. A. Pustokhin, D. Gupta and K. Shankar, "Optimal
Feature Selection-Based Medical Image Classification Using Deep Learning Model in Internet of
Medical Things," in IEEE Access, vol. 8, pp. 58006-58017, 2020, doi:
10.1109/ACCESS.2020.2981337.
[10] J. E. Lutton, S. Collier and T. Bretschneider, "A Curvature-Enhanced Random Walker Segmentation
Method for Detailed Capture of 3D Cell Surface Membranes," in IEEE Transactions on Medical
Imaging, vol. 40, no. 2, pp. 514-526, Feb. 2021, doi: 10.1109/TMI.2020.3031029.
No. Title Journal Name SCI Year of
IF Publication
1 A Novel Hybrid Image Segmentation IEEE Access 3.476 2021
Method for Detection of Suspicious
Regions in Mammograms Based on
Adaptive Multi-Thresholding (HCOW)

2 An Analysis on Ensemble Learning IEEE Access 3.476 2022

Optimized Medical Image Classification
with Deep Convolutional Neural
Networks
3 An Application of Transfer Learning and IEEE Access 3.476 2020
Ensemble Learning Techniques for
Cervical Histopathology Image
Classification

4 Automated Classification of Breast IEEE Transactions on 4.756 2017

Cancer Stroma Maturity from Biomedical Engineering
Histological Images

5 Automatic Detection Approach for IEEE Access 3.476 2019

Bioresorbable Vascular Scaffolds Using a
U-Shaped Convolutional Neural Network

6 Breast Cancer Image Classification via IEEE Access 3.476 2019

Multi-Network Features and Dual-
Network Orthogonal Low-Rank Learning.

7 Medical Image Segmentation Using IEEE Access 3.476 2022

Transformer Networks

8 Multimorbidity Content-Based Medical IEEE Access 3.476 2023

Image Retrieval and Disease Recognition
Using Multi-Label Proxy Metric Learning

9 Optimal Feature Selection-Based Medical IEEE Access 3.476 2020

Image Classification Using Deep
Learning Model in Internet of Medical
Things

10 A Curvature-Enhanced Random Walker IEEE Transactions on 4.756 2021

Segmentation Method for Detailed Biomedical Engineering
Capture of 3D Cell Surface Membranes