3rd International Conference on Emerging Technologies in Computer Engineering: Machine Learning and Internet of Things
(ICETCE-2020), 07-08 February 2020, (IEEE Conference Record # 48199)
Detection of Pediatric Pneumonia from Chest
X-Ray Images using CNN and Transfer
Learning
Gaurav Labhane
Indian Institute of Information
Technology Pune
labhanegaurav@gmail.com
Ritu Tiwari
ABV-Indian Institute of Information Technology and
Management, Gwalior
tiwariritu2@gmail.com
Abstract—Pneumonia is one of the most fatal diseases
caused in the lungs. The diagnosis involves a chest x-ray
which is interpreted by a radiologist. Human assisted
diagnosis has its own limitations like the availability of an
expert, cost, etc and hence an automated method for the
detection of pneumonia from x-rays is a necessity. In this
research, neural network models were developed to detect
pneumonia from the chest x-ray images. Four models
namely a basic convolutional neural network (CNN),
VGG16, VGG19, InceptionV3 were constructed using
CNN and transfer learning methodologies. The models
were then trained on a pediatric pneumonia dataset which
comprised of 2992 pneumonia and 2972 normal chest x-
rays. The results were then tested using 854 pneumonia
and 849 normal images, and an accuracy of over 97
percent was obtained from all models.
Index Terms: Pneumonia detection, Convolutional
Neural Networks, Transfer Learning, VGG16, VGG19,
InceptionV3.
I. INTRODUCTION
Medical Imaging has a huge scope for the
application of recent advancements in computation.
The Convolutional Neural Networks (CNN’s) have
been a major breakthrough for image-based analysis.
They can be effectively used for image classification
[1]. In the past decade, there have been remarkable
works in the field of medicine especially in medical
diagnostics. Deep Learning and CNN are being actively
used in various medical researches especially those
with image data. They are being used for lesion
segmentation [2], segmentation and classification of
tumor [3], image enhancement, detection of
978-1-7281-1683-9/20/$31.00 ©2020 IEEE
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Rutuja Pansare Saumil Maheshwari
Indian Institute of Information ABV-Indian Institute of Information
Technology Pune Technology and
rutujapansare.22@gmail.com ManagementGwalior
saumilmaheshwari@yahoo.co.in
Anupam Shukla
Indian Institute of Information Technology Pune
dranupamshukla@gmail.com
abnormalities and diseases, detection of nucleus, etc.
With the advent of transfer learning, newer capabilities
have been added to CNN. Transfer learning models like
VGG16, InceptionV3, etc. which are trained using
ImageNet dataset can be used to build faster and
effective models for the classification of images.
Pneumonia is amongst the leading causes of death
due to infection in children below the age of 5 years
globally. It is referred to as the infection caused in the
air sacks in the lungs. There are various causes for it
which include different viruses, bacteria, and fungi. It
can have mild to severe effects on people belonging to
any age group. Some types of pneumonia can be treated
with vaccines [4].
Chest x-ray is a simple, easy and effective way that
allows doctors to analyze inner organs or spot
abnormalities and diseases of the blood vessels, lungs,
heart, airways and bones. Pneumonia, which is caused
due to infection in lungs, can be detected from an x-ray
of the chest. In this research, automated models were
developed for the detection of pneumonia from x-ray
graphs without any human assistance.
II. RELATED WORKS
Chest x-rays are hard to interpret without an expert
radiologist. A lot of researchers are striving to make x-
ray analysis automated. In February 2018, a group of
researchers designed a system based on a deep-learning
framework to classify the images for macular
degeneration and diabetic retinopathy. It also classified
pneumonia and normal chest X-ray images [5]. The
model was trained on pediatric chest X-ray images with
5,232 images, out of which 3,883 were pneumonia and
1,349 were normal. Accuracy obtained by them was
92.8% with a93.2% sensitivity and 90.1%specificity. In
2018 RSNA Pneumonia Challenge held on Kaggle, the
winning entry worked on pneumonia detection and
localization in chest x-ray using a fully convolutional
network incorporated with features of object detection
[6].
children. It used chest radiographs for classification to
achieve a recall rate of 96.7%, and the f1-score of
92.7%[8]. Also, some researchers have solely depended
on pure CNN without transfer learning for the
classification of pneumonia images and achieved a
validation accuracy of 93.73% [9]. The summary of a
few researches on the same dataset as ours is shown in
TableI.

CheXNet is a 121-layer convolutional neural Another research proposed deep learning

network developed by researchers at Stanford that is
trained on ChestX-ray14 dataset. The deep learning
algorithms used by them have a higher accuracy than
that of an average radiologist in the identification of
pneumonia and other chest diseases from chest x-rays
[7].
architecture for the classification of pneumonia using
chest x-rays. The model used convolutional neural
networks and residual network architecture for
classifying the images. An accuracy of 78.73% was
obtained, [10] which surpassed the previously top-
scoring accuracy of 76.8%.

Most recently, a methodology was proposed which Other than chest x-rays, there has been remarkable
used transfer learning and a deep residual network- work using convolutional neural networks and transfer
oriented approach for detection of pneumonia in learning.

TABLE I.SUMMARY OF RELATED WORK ON THE SAME DATASET

Comparison
Author Methods Value
Factor
Kermany, Daniel S., et al. (2018) [5] Transfer learning Accuracy 92%
Transfer learning Recall 96.7%
Liang, Gaobo, and Lixin Zheng(2019) [8] with deep residual
networks-oriented F1-score 92.7%
Validation
Stephen, Okeke, et al. (2019) [9] Pure CNN 93.73%
Accuracy

I. DATA DESCRIPTION AND

PREPROCESSING B. Data augmentation and balancing

A. Dataset
In this study, the dataset used to train, test and
evaluate the models was [11]. 5856 X-Ray images
were divided into two categories namely Pneumonia
and Normal as shown in Fig. 1. 4273 images
belonged to the Pneumonia class and 1583 images
belonged to the Normal class. The x-ray images in
this dataset were collected from patients with ages
between one and five years, from the Guangzhou
Women and Children’s Medical Center.
The original images were of high resolution and
varied sizes. To make the computation and training
faster the images were resized to 256 x 256 pixels.
The dataset collected was not balanced. The ratio
of the number of pneumonia class images to normal
class images was more than 2:1. Hence, to efficiently
train the model, the images in the normal class were
augmented and the number of images in both classes
were made almost equal. The image augmentation
methods used were as follows:
• Horizontal flip – In this method, the images
were flipped horizontally and saved.
• Zoom – The images were magnified 0.2
times of the original images.

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Fig. 1. Dataset images
After data augmentation and balancing, the dataset
was divided into three parts. 70% of the images were
put in the training set, 20% in the testing set and 10
% in the validation set. The exact distribution is
shown in Table II.
TABLE II. DATA DISTRIBUTION IN TRAINING SET,
TESTING SET, AND VALIDATION SET AFTER
AUGMENTATION AND BALANCING
Pneumonia
Training set 2992
Testing set 854
Validation set 427
Total 4273
II. MODELS AND IMPLEMENTATION
Four models were developed and trained using
the same dataset. The basic methodology used in the
models was convolutional neural networks and
transfer learning. The models proposed are as
follows:
A. Simple CNN
The neural network is made up of many smaller
units called neurons or nodes which are arranged in
the layered architecture. These nodes contain weights
that are updated using optimizing techniques like
backpropagation etc. while training the model. Every
CNN model is comprised of two parts i.e. the
convolutional or feature extraction part and the
classification part. All the components and structure
of the simple CNN model used are described as
follows and its complete architecture is shown in
Table III.
• Convolutional Layer
Convolutional Layer forms the basic
building block for a convolutional neural
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network. The convolutional layers use a filter of
a fixed size to extract various features. The
scanning of the image is done by moving the
filter as per the strides specified.6 convolutional
layers with 32,32,64,64,128,128 filters
respectively were used in the simple CNN
model. In each layer, 2D convolutional filters of
size 3x3 and a stride of 1 was used.
• Batch Normalisation
Batch normalization is used to improve the
learning rate of the model. This layer normalizes
the input. In all the models, batch normalization
was used after every convolutional layer.
• Pooling layer
Pooling is the technique used to
downsample the feature map collected from the
convolutional layer. Two types of pooling
Normal
namely max pooling and average pooling are
2972 most commonly used. In the simple CNN model,
849 max-pooling was used after every convolutional
424 layer with the pooling filter of the size of 2*2.
4245
• Activation
The activation function is used at the end of
a layer for the non-linear transformation of the
inputs. Nowadays, the most commonly used
activation function in a convolutional neural
network is Rectified Linear Unit i.e. ReLU.
ReLU was used at the end of each layer and
sigmoid activation function was used in the final
layer with two nodes.
• Dropout
Dropout is the technique used to reduce
overfitting of the model. Using dropout, some
nodes in the layer are randomly chosen to stay
inactive for some instances. In this way, it
prevents the model from getting too familiar
with the data. A dropout of 0.5 was used in dense
layers for classification here.
• Dense Layers
The output of the convolutional layer is
further flattened and given to the dense layer as
input. The role of convolutional layers is to
extract the features and the classification of
images is done by the dense layers. The simple
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 CNN architecture had two dense layers with 32 B. Transfer learning models
nodes each and a final layer with 2 nodes.
Transfer learning models were developed using
the architecture of pre-trained models like VGG16,
TABLE III.CNN MODEL ARCHITECTURE VGG19, InceptionV3 and weights obtained by
training them on the ImageNet dataset. The
Layer Output Shape Params convolutional part was used from the pre-trained
Input (256,256,3) 0 models. The output of this block was further flattened
Convolution (254, 254, 32) 864 and given to the fully connected layers which used
batch normalization, dropout, and activation as used
Batch Normalization (254, 254, 32) 128
in the simple CNN model.
Activation (254, 254, 32) 0
Max Pooling (127, 127, 32) 0 After designing the model, it was trained with
Convolution (125, 125, 32) 9216 the images from our dataset. The training was done in
Batch Normalization (125, 125, 32) 128 two ways. One, the convolutional layers of the pre-
Activation (125, 125, 32) 0 trained models were frozen to keep the initial weights
Max Pooling (62, 62, 32) 0 unchanged and other weights were updated as the
Convolution (60, 60, 64) 18432 model was trained using the dataset. Second, the
Batch Normalization (60, 60, 64) 256 weights loaded initially were modified along with
Activation (60, 60, 64) 0 others when the model was trained. Accordingly,
Max Pooling (30, 30, 64) 0
three models using VGG16, VGG19 and InceptionV3
respectively were designed and tested.
Convolution (28, 28, 64) 36864
Batch Normalization (28, 28, 64) 256
III. RESULTS
Activation (28, 28, 64) 0
Max Pooling (14, 14, 64) 0 The models developed in the research were
Convolution (12, 12, 128) 73728 trained using the chest x-ray images, on which
Batch Normalization (12, 12, 128) 512 various augmentation techniques were applied.
Activation (12, 12, 128) 0 Kaggle’s kernels were used as GPU fortraining,
Max Pooling (6, 6, 128) 0 testing and validation of the models. The model
Convolution (4, 4, 128) 147456 yielded optimum results when trained on 100 epochs.
Batch Normalization (4, 4, 128) 512 Confusion matrices were then plotted by comparing
Activation (4, 4, 128) 0 the obtained values with the ground truths. The
Max Pooling (4, 4, 128) 0 overall efficiency of the model designed was judged
Flatten (512) 0 using the evaluation metrics of accuracy, precision,
Dense (32) 16384 recall and f1 score, calculated from the confusion
matrices drawn.
Batch Normalization (32) 128
Activation (32) 0 The graphs of validation accuracy against
Dropout (32) 0 training accuracy and validation loss against training
Dense (2) 66 loss of models are shown in Fig.2, Fig.3, Fig.4. and
Sigmoid Activation (2) 0 Fig.5.

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 Fig. 2.Graph of (a) Validation accuracy against Training Accuracy (b) Validation loss against Training loss for Basic CNN model.

Fig. 3. Graph of (a) Validation accuracy against Training Accuracy (b) Validation loss against Training loss for Basic VGG16
model which is trained by freezing the convolutional layers.

Fig. 4.Graph of (a) Validation accuracy against Training Accuracy (b) Validation loss against Training loss for Basic VGG19 model which is
trained by freezing the convolutional layers.

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 Fig. 5. Graph of (a) Validation accuracy against Training Accuracy (b) Validation loss against Training loss for Basic VGG19 model which is
trained by not freezing the convolutional layers.

While training with 100 epochs, the best model was models developed are shown in Fig.6. Further, the
saved where training accuracy is closest to the recall, precision, f1-score and testing accuracy of the
validation accuracy in order to obtain the most models were calculated to detect pneumonia from the
efficient results. A confusion matrix was then plotted chest x-ray images. The results were compared with
where the testing set was tested using the best model some of the previous researches on the same dataset,
saved. The confusion matrices obtained from all the as shown in Table IV.

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 Fig. 6.Confusion matrices of:(a) Simple CNN (b) VGG16 (c) VGG19 (d) InceptionV3.

TABLE IV.RESULTS SUMMARY OF ALL MODELS AND MODEL COMPARISON

Sr. Testing
Model / Author Name Accuracy Recall F1-score Precision
No images
1 Kermany, Daniel S., et al.(2018) [5] 624 92.8 % --- --- ---
2 Liang, Gaobo, and Lixin Zheng.(2019) [8] 624 90.5% 96.7% 0.92 ---
93.79%(Val
3 Stephen, Okeke, et al(2019) [9] 2314 idation --- --- ---
Accuracy)
Our Methods
Basic CNN 97 % 0.97 0.97 0.98
4 VGG16 1703 98 % 0.96 0.98 0.99
VGG19 97 % 0.95 0.97 0.99
InceptionV3 98 % 0.98 0.98 0.99

IV. DISCUSSION AND CONCLUSION

The models proposed in this research for the
detection of pediatric pneumonia on the frontal chest
x-ray images using CNN and Transfer learning
approaches have significant results. Most recently,
there have been several researcheson the samedataset.
However, our models have outperformed the results
from previous researches to attain state-of-the art.
Neural Networks were used to develop models for
efficient extraction of features from an x-ray image
and predict the presence or absence of pneumonia.
Also, in this research, the testing data was increased
by data augmentation techniques and thus, the
models were tested on a greater number of images as
compared to a few other approaches.
With advancements of computer applications in
the medical sector, pediatric pneumonia can be
effectively detected using chest radiographs with the
help of technologies like CNN and deep learning. In
this research, methodologies were developed using
which pediatric pneumonia can be predicted with
higher accuracy. Automated diagnosis in medical
field is the key area that will benefit directly from our
research.

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