An Efficient Mixture of Deep and Machine Learning Models for COVID-19 and Tuberculosis Detection Using X-Ray Images in Resource Limited Settings

Al-Timemy, Ali H.; Khushaba, Rami N.; Mosa, Zahraa M.; Escudero, Javier

Clinicians in the frontline need to assess quickly whether a patient with symptoms indeed has COVID-19 or not. The difficulty of this task is exacerbated in low resource settings that may not have access to biotechnology tests. Furthermore, Tuberculosis (TB) remains a major health problem in several low- and middle-income countries and its common symptoms include fever, cough and tiredness, similarly to COVID-19. In order to help in the detection of COVID-19, we propose the extraction of deep features (DF) from chest X-ray images, a technology available in most hospitals, and their subsequent classification using machine learning methods that do not require large computational resources. We compiled a five-class dataset of X-ray chest images including a balanced number of COVID-19, viral pneumonia, bacterial pneumonia, TB, and healthy cases. We compared the performance of pipelines combining 14 individual state-of-the-art pre-trained deep networks for DF extraction with traditional machine learning classifiers. A pipeline consisting of ResNet-50 for DF computation and ensemble of subspace discriminant classifier was the best performer in the classification of the five classes, achieving a detection accuracy of 91.6+ 2.6% (accuracy + 95% Confidence Interval). Furthermore, the same pipeline achieved accuracies of 98.6+1.4% and 99.9+0.5% in simpler three-class and two-class classification problems focused on distinguishing COVID-19, TB and healthy cases; and COVID-19 and healthy images, respectively. The pipeline was computationally efficient requiring just 0.19 second to extract DF per X-ray image and 2 minutes for training a traditional classifier with more than 2000 images on a CPU machine. The results suggest the potential benefits of using our pipeline in the detection of COVID-19, particularly in resource-limited settings and it can run with limited computational resources.