A Literature Review & Research Proposal on

Recent Advancements in Applications of

Machine Learning in Image-Based Detection
& Classification of Diabetic Foot Ulcers
Ahmad Aqel, Dr. Anwarul Hasan – Qatar University
Background

 One of the main difficulties faced by diabetic patients is their compromised healing
ability.
 Diabetic wounds tend to fester and become infectious leading to severe complications
that can result in limb amputation or even death.
 Foot ulcers are one of the main wounds that fester in such manner; they are not as visible
and sometimes harder to identify for patients.
 Image processing techniques have been developed in the past to identify foot ulcers and
other infected wounds.
 In recent years, the emergence of machine learning/artificial intelligence models have
improved the accuracy and availability of such image processing techniques significantly.
Introduction

 This review looks at machine learning research work aimed at identifying or classifying
infected foot ulcers in recent years.
 The aim of this review is to find gaps in this emerging field where there is room for
improvement or un-tackled problems to address in this topic.
 There is particular interest in looking at works related to transfer learning, a newly
emerged sub-field of machine learning where highly accurate models can be trained
using relatively smaller image datasets.
 The review has investigated 20+ papers, focusing on ones related to foot ulcer/machine
learning combinations, and the most representative works of the ongoing research are
presented here.
 The review is concluded by multiple proposals for new research work utilizing
machine/transfer learning in foot ulcer detection/classification.
Image Processing vs Deep Learning
 Image Processing vs Deep Learning

 Classical image processing utilizes classical coding to enforce a set

of rules to process an image, and then use feature mapping to
outline potential “defects”, in this case the foot ulcers.
 Deep learning, an advanced neural network-based form of machine
learning, uses an existing labeled dataset to create an advanced
model for classification and/or prediction.
 Deep learning allows the machine, based on the dataset, to generate
its own set of abstract rules for solving the problem, which are later
tested on a test set to evaluate the accuracy of the model.
Image Segmentation Analysis
Image Segmentation Analysis

 Image segmentation allows a single image to be split into multiple segmented ones.
 This serves two purposes: it allows the creation of multiple images from one, thereby creating a
larger dataset to train the model on, and it allows the model to zone in on the location of the foot
ulcer/infection within an image.
 The presented paper classified the images and subsequent segmented images into “normal skin”
vs “abnormal skin”.
 This pioneering 2018 paper on the subject aimed to validate the ability of AI computer vision to
identify diabetic foot ulcers.
 The proposed model achieved accuracies as high as 96% on the test set.
 Thermogram Classification

 The presented 2020 paper approached the matter differently by

classifying diabetic foot thermograms in place of regular
images.
 It used a training set labeled as Classes 1-5 based on a thermal
index representative of the severity of an infection.
 The model was trained from scratch and obtained accuracies in
the range of 85-90%
Transfer Learning for Foot Ulcers
 Transfer Learning for Foot Ulcers

 Transfer learning is an advanced technique for training AI models.

 Deep learning models normally require large datasets to generate accurate generalizations and effective models.

 Transfer learning takes an existing pre-trained model and re-trains it for a specific task, thereby making use of the
learnings of the pre-trained model and then introducing the elements of the new model, requiring a much smaller dataset
to achieve higher accuracies.

 The presented 2020 paper is an example of a pioneering paper utilizing transfer learning for foot ulcer detection.

 The accuracies of the paper’s proposed model over the tested datasets ranged in the span of 80-95% accuracy
Transfer Learning with Feature Mapping
 Transfer Learning with Feature Mapping

 The presented paper combines multiple elements discussed in this

review.
 It utilizes feature mapping to identify the ulcers but utilizes transfer
learning as the pre-process by which the model learns how to feature
map.
 As with many studies, various models were tested with different neural
network architectures to compare results.
 This highly complex model achieved accuracies as high as 99% in
identifying the ulcer location
Transfer Learning Classification
Transfer Learning Classification

 While most works were binary in their classification (healthy vs damaged) this 2020 study further
classified the ulcers into infected, uninfected, ischemic or non-ischemic.

 This is likely the most beneficial work to date as it provides an output beyond merely the presence of an
ulcer.

 It utilized transfer learning to build the models of the classification.

 It achieved an accuracy of 90% for detecting ischemic infection and 73% for detecting non-ischemic
infections, which can be improved upon with possibly a larger dataset or better image labeling/selection.

 This work is the most similar to what will be proposed in the proposals section,
 Limitations of Existing Research

 As evident, existing bodies of work, while recent and still emerging, are relatively high in accuracy, which
can naturally be attributed to the powers of deep learning and transfer learning.

 A major concern is that these studies are all aimed at detecting clearly visible ulcers, usually infected, and
while that is a significant validation of the capability of the models, it still serves limited purpose application-
wise. Most of these infected ulcers are easy to distinguish for any untrained eye.

 This leads to the necessity of a transfer learning diabetic foot ulcer classification model that has genuine value
to the medical field, while building upon existing bodies of work.
Proposals

1 2 3
Transfer Learning Transfer Learning Transfer Learning
Classification I: Classification II: Classification III:
Healthy vs Ulcer vs Infection Types Infection/Ulcer
Infected Ulcer Severity
Transfer Learning Classification I: Healthy vs
Ulcer vs Infected Ulcer

 This model can be built to classify the foot image to healthy (no ulcer), normal ulcer and infected
ulcer.

 It will require an image dataset that can be clearly and visibly divided into these three categories.

 The purpose of this model is to allow the patient to identity the presence of an ulcer or infected ulcer
remotely, and then prompt them to act based on the output.

 The primary challenge will be identifying normal ulcers as these might be small and the foot in
general might not look that different from a healthy one.
Transfer Learning Classification II: Infection
Types

 This model will be more aimed at medical professionals. It is to assist them in identifying
the infection type of the ulcer

 The model will utilize images of categories based on infection types and will make use of
the distinguishable visual characteristics of different infection types, similar to the
ischemic vs non-ischemic paper presented.
Transfer Learning Classification III:
Infection/Ulcer Severity

 The last of the proposed models will identify the severity or progression of an infected
ulcer.

 This will be based on severity level categories (Level I, II, III,…) which can be decided
based on a medical professional’s recommendation.

 This model, like the previous one, will be aimed at medical professionals wishing to
assess the severity of an ulcer infection in a diabetic patient.
Conclusion

 Deep learning and transfer learning are powerful tools for identifying and classifying diabetic foot ulcers.

 Transfer learning is particularly powerful because it can generate high accuracies from relatively smaller
datasets.

 Existing body of work validates the first two points, but lack in its usability by patients and medical
professionals.

 The proposed models serve to utilize transfer learning to provide useful models for identifying and
classifying diabetic foot ulcers and their infections.