Available online at www.sciencedirect.

com
Available online at www.sciencedirect.com
Available online at www.sciencedirect.com

ScienceDirect
Procedia Computer Science 00 (2020) 000–000
Procedia
Procedia Computer
Computer Science
Science 00 (2020)
176 (2020) 000–000
2212–2221 www.elsevier.com/locate/procedia
www.elsevier.com/locate/procedia

24th International Conference on Knowledge-Based and Intelligent Information & Engineering

24th International Conference on Knowledge-Based
Systems and Intelligent Information & Engineering
Systems
Machine
Machine learning
learning for
for coronavirus
coronavirus covid-19
covid-19 detection
detection
from chest x-rays
from chest x-rays
Luca Bruneseaa , Fabio Martinellibb , Francesco Mercaldoa,b,∗ c
a,b,∗, Antonella Santonec
Luca Brunese
a
, Fabio Martinelli , Francesco Mercaldo , Antonella Santone
Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
a Department of Medicine and Health Sciences “Vincenzo Tiberio”, Council
University of Molise, Campobasso,
b Institute for Informatics and Telematics, National Research of Italy (CNR), Pisa, Italy Italy
b Institute for Informatics
c Department and Telematics, National Research Council of Italy (CNR), Pisa, Italy
of Biosciences and Territory, University of Molise, Pesche (IS), Italy
c Department of Biosciences and Territory, University of Molise, Pesche (IS), Italy

Abstract
Abstract
At the end of 2019, a new form of Coronavirus, called COVID-19, has widely spread in the world. To quickly screen patients
At
withthetheend
aimofto2019,
detecta this
newnewformform
of Coronavirus,
of pulmonarycalled COVID-19,
disease, has we
in this paper widely spread
propose in the world.
a method aimed To quickly screendetect
to automatically patients
the
with the aim
COVID-19 to detect
disease this new form
by analysing of pulmonary
medical images. Wedisease, in this paper
exploit supervised we propose
machine a method
learning aimed
techniques to automatically
building detect the
a model considering
COVID-19 disease
a data-set freely by analysing
available medical
for research images.ofWe
purposes 85 exploit supervised
chest X-rays. machine learning
The experiment shows techniques building
the effectiveness a model
of the considering
proposed method
aindata-set freely available for research purposes of 85 chest X-rays. The experiment
the discrimination between the COVID-19 disease and other pulmonary diseases. shows the effectiveness of the proposed method
in the discrimination between the COVID-19 disease and other pulmonary diseases.
c 2020

© 2020 The Author(s).Published
The Authors. PublishedbybyElsevier
ElsevierB.V.
B.V.
c 2020

This is The Author(s). Published bytheElsevier B.V.
This is an
an open
open access
access article
article under
under the CC
CC BY-NC-ND
BY-NC-ND license
license (https://creativecommons.org/licenses/by-nc-nd/4.0/)
(https://creativecommons.org/licenses/by-nc-nd/4.0)
This is an
Peer-reviewopen access article
Peer-review under responsibilityunder the
of the
responsibility of KES CC BY-NC-ND
International.
scientific license
committee (https://creativecommons.org/licenses/by-nc-nd/4.0/)
of the KES International.
Peer-review under responsibility of KES International.
Keywords: Coronavirus, COVID-19, machine learning, artificial intelligence, medical images, x-ray
Keywords: Coronavirus, COVID-19, machine learning, artificial intelligence, medical images, x-ray

1. Introduction and Related Work

1. Introduction and Related Work
Coronaviruses represent an extended family of respiratory viruses that can cause mild to moderate diseases, from
theCoronaviruses
common cold represent an extended
to respiratory syndromesfamily of as
such respiratory
MERS (Middleviruses East
that can cause mild
respiratory to moderate
syndrome) diseases,
and SARS from
(Severe
the common cold to respiratory syndromes such as MERS (Middle East respiratory syndrome) and
acute respiratory syndrome) [18]. They are so called because of the crown-shaped tips that are present on their surface SARS (Severe
acute
[17]. respiratory syndrome) [18]. They are so called because of the crown-shaped tips that are present on their surface
[17].
These kind of viruses are common in many animal species (such as camels and bats) but in some cases, though rarely,
These kind
they can of viruses
evolve are common
and infect humansinand
manythenanimal
spread species
to the(such as camels
population [1].and
A newbats)coronavirus
but in some strain
cases, that
though
hasrarely,
never
they
previously been identified in humans is the one appeared at the end of 2019 i.e., the 2019 novel coronavirus has
can evolve and infect humans and then spread to the population [1]. A new coronavirus strain that never
(COVID-
previously been identified in humans is the one appeared at the end of 2019 i.e., the 2019 novel
19, acronym of COronaVIrus Disease 19) [19, 3, 28]. The first cases were found during the COVID-19 pandemic of coronavirus (COVID-
19, acronym[22],
2019-2020 of COronaVIrus
which probably Disease 19)around
started [19, 3,the
28].
endThe
of first cases were
December 2019found
in theduring
city ofthe COVID-19
Wuhan pandemic
[28], the of
capital of
2019-2020 [22], which probably started around the end of December 2019
the Chinese province of Hubei, and subsequently spread to various countries of the world. in the city of Wuhan [28], the capital of
the Chinese province of Hubei, and subsequently spread to various countries of the world.

∗ Francesco Mercaldo
∗ Francesco Mercaldo
E-mail address: [email protected]
E-mail address: [email protected]
1877-0509  c 2020 The Author(s). Published by Elsevier B.V.
1877-0509
This c 2020

is an open Thearticle
access Author(s).
underPublished by Elsevierlicense
the CC BY-NC-ND B.V. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
1877-0509
This is an © 2020
open Thearticle
access Authors. Published
under the CC by Elsevier B.V.
BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Peer-review under
This is an open responsibility
access of KES
article under International.
the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0)
Peer-review under responsibility of KES International.
Peer-review under responsibility of the scientific committee of the KES International.
10.1016/j.procs.2020.09.258
 Luca Brunese et al. / Procedia Computer Science 176 (2020) 2212–2221 2213
2 L. Brunese, F. Martinelli, F. Mercaldo, A. Santone / Procedia Computer Science 00 (2020) 000–000

In fact, as of January 28 2020, there were more than 4600 confirmed cases of contagion in many countries of the
world and 106 deaths while on February 15 these data had already risen to 49053 cases and 1381 deaths1 . As of
January 23 2020, Wuhan has been quarantined with the suspension of all public transport into and out of the city,
which measures were extended the following day to the neighboring cities of Huanggang, Ezhou, Chibi, Jingzhou and
Zhijiang. Further limitations and controls have been adopted in many areas of the world, also in Europe where several
cases have also been recorded. The country most affected in Europe is Italy, where the authorities have struggled to
contain an outbreak that has infected at least 400 people, most of them in northern Italy, near Milan. As of March
2, there have been over 1800 confirmed coronavirus cases and 30 deaths in Italy, with the third highest number of
infections per country in the world, after China and South Korea.
The COVID-19 infection caused clusters of fatal pneumonia with clinical presentation greatly resembling SARS-CoV.
In fact, patients experience flu-like symptoms such as fever, dry cough, tiredness, difficulty breathing. In more severe
cases, often found in subjects already burdened by previous pathologies, pneumonia develops, acute renal failure, up
to even death [22], but this new coronavirus presents also several unique features [28, 19]. While the diagnosis is
confirmed using polymerase chain reaction (PCR), infected patients with pneumonia may present on chest X-ray and
computed tomography (CT) images a pattern that is only moderately characteristic for the human eye as demonstrated
by researchers in [26]. The rate of transmission of COVID-19 depends on the capacity to reliably identify infected
patients with a low rate of false negatives. In addition, a low rate of false positives is required to avoid further increasing
the burden on the healthcare system by unnecessarily exposing patients to quarantine if that is not required. Along
with proper infection control, it is evident that timely detection of the disease would enable the implementation of all
the supportive care required by patients affected by COVID-19.
In late January 2020, Chinese researchers discussed the clinical and paraclinical features COVID-19 specific [19].
They reported that patients present abnormalities in chest CT images with most having bilateral involvement [19].
Bilateral multiple lobular and subsegmental areas of consolidation constitute the typical findings in chest CT images
of intensive care unit (ICU) patients on admission [19]. In comparison, non-ICU patients show bilateral ground-glass
opacity and subsegmental areas of consolidation in their chest CT images [19]. In these patients, later chest CT images
display bilateral ground-glass opacity with resolved consolidation [19].
As stated in [13, 2] COVID-19 is possibly better diagnosed using radiological imaging, for this reason in this paper
we evaluate the possibility to detect the COVID-19 disease directly from x-ray images. For this reason, in this paper
supervised machine learning is exploited to build a model starting from a set of patients COVID-19 diagnosed and
patients with other respiratory diseases exhibiting symptoms similar to COVID-19.
The remaining of the paper proceeds as follow: Section 2 presents the proposed method from COVID-19 detection
from x-rays, Section 3 describes the performance results in the evaluation of real-world chest X-rays and, in the last
section, conclusion and future works are drawn.

2. The Method

In this section the proposed method for COVID-19 detection from x-rays is discussed.
The proposed method relies in supervised machine learning [24, 11, 8] and it is composed by two main phases:
training, depicted in Figure 1 and testing, shown in Figure 2.
The training phase is aimed to build a model for discriminating between x-rays images COVID-19 related and
images related to other pathologies.
As shows from Figure 1, from the Picture archiving and communication system (PACS) chest X-rays are obtained.
As required by supervised classification, we need a label (i.e., a diagnosis): for this reason the proposed method
requires the domain experts (i.e., radiologists) to assign to each training chest X-rays a label (i.e, COVID-19 or other).
In particular in the other category following pulmonary diseases are considered: Streptococcus, SARS, ARDS (Acute
respiratory distress syndrome) and Pneumocystis [14].
To obtain numerical values from medical images, we consider a set of color layout descriptor (CLD) features.
CDL features are designed to capture the spatial distribution of color in an image [20]. The feature extraction process

1 https://www.worldometers.info/coronavirus/
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L. Brunese, F. Martinelli, F. Mercaldo, A. Santone / Procedia Computer Science 00 (2020) 000–000 3

Fig. 1: The training phase.

consists of two parts: grid based representative color selection and discrete cosine transform with quantization [9].
Clearly, color is the most basic quality of the visual contents, therefore it is possible to use colors to describe and
represent an image. The MPEG-7 standard has tested the most efficient procedure to describe the color and has
selected those that have provided more satisfactory results [23]. This standard proposes different methods to obtain
these descriptors, and one method defined to describe the color is the CLD, that permit to describe the color relation
between sequences or group of images [12], for this reason this standard is chosen in this paper to extract meaningful
numeric features from x-ray images.
MPEG-7 visual descriptors include the color, texture and shape descriptor for efficient content-based image re-
trieval [21].
Basically, an x-ray image is divided into 64 equal blocks and we compute the average color for each block, and
then features are calculated from the averages [23]: this is resulting in 64 different features (one feature for each block
in which we divide the x-ray image). We apply a feature selection algorithm i.e., the CfsSubsetEval [16] one: the final
feature set is composed from a total of 33 CLD features that are included in this study.
The feature set is obtained from each chest X-ray and, with the associated label, it represents the input for the
supervised machine learning algorithm, that will output the model.
Once generated the model, in the testing phase we evaluate the performance of the model built in the training phase.
As shows from Figure 2, in this phase we obtain the numerical features from a set of chest X-ray not considered
in the previous phase: this represents the input for the model that will generate the prediction i.e., whether the input
chest X-ray is related to the COVID-19 or to the other category. Subsequently, the output of the model is validated by
the radiologist.

3. Experimental Analysis

The effectiveness of the proposed feature set in discriminating between COVID-19 and other disease is organised
in descriptive statistics i.e., boxplot analysis and the evaluation of the model obtained as output from the machine
learning classifier.
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Fig. 2: The testing phase.

3.1. The Data-set

Real world x-ray images are considered in this work and are available for research purposes 2 .
In details, the data-set consists in x-ray images belonging to the pathologies shown in Table 1

Table 1: The considered pathologies.

COVID-19 Streptococcus SARS ARDS Pneumocystis

63 6 11 4 2

Figure 3 shows the detail about the patient age with regard to the COVID-19 patients.
As shown from Figure 3, the majority of patients are in the 51-55 years range. Moreover, the age classes with a
number of patients equal to 7 are following: 0-39, 39-43, 55-59 and 63-67.
Figure 6 shows an example of chest X-rays belonging to the analysed data-set.
The medical images are obtained from different institutions, as shown in Table 2:
As shows from Table 2, the medical images are obtaining from different institutions: from China (where COVID-19
disease started to manifest) from Italy (the European area in which it was found to be most widespread), but also from
Australia and USA.
Figure 4 shows the sex distribution in the X-rays.
Unfortunately, we do not have the detail about the sex for all the patients involved in the experiment. Anyway, the
majority of X-ray is related to men with regard to the COVID-19 disease, while for the other pathologies the majority
is female.

2 https://github.com/ieee8023/covid-chestxray-dataset
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Fig. 3: Patient age: on the x axis the number of exams, while on the y axis the number of patients belonging to the age clusters we defined.

Table 2: Institutions involved the study.

Hospital Country
Ospedale Santo Spirito, Rome Italy
Riccione Italy
Myongji Hospital, Goyang Korea
Jönköping Sweden
Melbourne Australia
Royal Brisbane and Women’s Hospital, Brisbane Australia
Sichuan Provincial People’s Hospital, Chengdu China
Tongji Medical College, Wuhan, Hubei Province China
Taoyuan General Hospital, Taoyuan Taiwan
Snohomish County, Washington USA

Fig. 4: Patient sex: on the x axis the number of patients in the data-set afflicted by COVID-19 and other diseases, while on the y axis with M we
indicate the male patients, while with F we indicate the f emale ones.

Figure 5 shows the details about the status (dead or alive) or the patient involved in the experiment. This data is
updated to March 2020.
With regard to COVID-19 disease all the patients for whom we have this label are alive. Relating to other patholo-
gies, 2 patients resulting alive, while 6 are dead.
 Luca Brunese et al. / Procedia Computer Science 176 (2020) 2212–2221 2217
6 L. Brunese, F. Martinelli, F. Mercaldo, A. Santone / Procedia Computer Science 00 (2020) 000–000

Fig. 5: Alive and dead patients: on the x axis the number of patients in the data-set with by COVID-19 and other diseases, while on the y axis with
Alive we indicate the alive patients, while with dead we indicate the dead ones.

Fig. 6: Example of chest X-rays.

3.2. Descriptive statistics

In this section, we present the boxplot analysis. For reason space, we present plots related only to four color layout
descriptor features but similar consideration can be made also for the remaining features.
Figure 7 shows the boxplot for the third feature.

Fig. 7: Color layout descriptor feature 3 boxplot.

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As emerges from the boxplot, the COVID-19 distribution for the color layout descriptor feature 3 is partially
overlapped with the distribution of the other pulmonary pathologies. Symptomatic that this feature can exhibit a
medium discrimination effectiveness between other respiratory diseases and the COVID-19 disease.
Figure 8 shows the boxplots for the color layout descriptor feature 6.

Fig. 8: Color layout descriptor feature 6 boxplot.

In this case, the two distributions range in different numeric values: in fact, there is just a slightly overlapping
between the two distributions. For this reason it is reasonable that this feature can exhibit a more discriminative power
if compared to feature 3.
The next boxplot in Figure 9 we discuss is the one related to the color layout descriptor feature 10 features.

Fig. 9: Color layout descriptor feature 10 boxplot.

The distributions, similarly to the previous color layout descriptor feature we analysed, does not exhibits overlapped
areas. Coherently with the previous features, also in this boxplot, the numerical values for the COVID-19 distribution
are greater if compared to the ones related to the other numeric values.
The last boxplot we discuss is the one depicted in Figure 10, related to the color layout descriptor feature 15.

Fig. 10: Color layout descriptor feature 15 boxplot.

This boxplot seems to exhibit a less discriminative power if compared to the previous ones. In fact, the area
overlapped between the two boxplots is extended, and there is also a little area belonging to the COVID-19 distribution
that is not overlapped.

3.3. Experimental Analysis

In the follow we explain the settings of the experiment to generate the COVID-19 detection model.
 Luca Brunese et al. / Procedia Computer Science 176 (2020) 2212–2221 2219
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With regard to the model building, for training the model, we defined T detection as a set of labeled messages
{(Mdetection , ldetection )}, where each Mdetection is the label associated to a ldetection ∈ { COVID-19, other}. For each Mdetection
we built a feature vector F ∈ Ry , where y is the number of the features used in training phase (y = 33).
For the learning phase, we consider a k-fold cross-validation: the data-set is randomly partitioned into k subsets.
A single subset is retained as the validation data-set for testing the model, while the remaining k − 1 subsets of the
original data-set are used as training data. We repeated the process for k = 10 times; each one of the k subsets has
been used once as the validation data-set. To obtain a single estimate, we computed the average of the k results from
the folds.
We evaluated the effectiveness of the built model with the following procedure:

1. build a training set T⊂D;

2. build a testing set T  = D÷T;
3. run the training phase on T;
4. apply the learned classifier to each element of T  .

Each classification was performed using 90% of the data-set as training data-set and 10% as testing data-set employ-
ing the full feature set exploiting the K-nearest neighbours classifier (k-NN) classification algorithm implementation
available in the Waikato Environment for Knowledge Analysis3 (Weka) software, a suite for machine learning exper-
iments. In the k-NN classification, the output is a class membership. An object is classified by a plurality vote of its
neighbors, with the object being assigned to the class most common among its k nearest neighbors. We experimented
with k=4.
Five metrics are considered to evaluate the performance of the classifiers: FP-Rate, Precision, Recall, F-Measure
and Roc Area.
The FP-Rate (i.e., false positive rate) is calculated as the ratio between the number of negative events wrongly
categorized as positive (false positives) and the total number of actual negative events:
fp
FP Rate = f p+tn

where fp indicates the number of false positives and tn indicates the number of true negatives.
The precision has been computed as the proportion of the examples that truly belong to class X among all those
which were assigned to the class. It is the ratio of the number of relevant records retrieved to the total number of
irrelevant and relevant records retrieved:
tp
Precision = tp+ f p

where tp indicates the number of true positives and fp indicates the number of false positives.
The recall has been computed as the proportion of examples that were assigned to class X, among all the examples
that truly belong to the class, i.e., how much part of the class was captured. It is the ratio of the number of relevant
records retrieved to the total number of relevant records:
tp
Recall = tp+ f n

where tp indicates the number of true positives and fn indicates the number of false negatives.
The F-Measure is a measure of a test’s accuracy. This score can be interpreted as a weighted average of the
precision and recall:

Precision∗Recall
F-Measure = 2 ∗ Precision+Recall

The ROC area is created by considering the true positive rate against the false positive rate.

3 https://www.cs.waikato.ac.nz/ml/weka/
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L. Brunese, F. Martinelli, F. Mercaldo, A. Santone / Procedia Computer Science 00 (2020) 000–000 9

Table 3 shows the classification results.

Table 3: Classification results.

Class FP Rate Precision Recall F-Measure ROC Area

COVID-19 0.087 0.968 0.984 0.976 0.989
other 0.016 0.955 0.913 0.933 0.989
average 0.068 0.965 0.965 0.964 0,989

As shows by classification results shows in Table 3, an average precision and an average recall equal to 0.965
are obtained. In particular, for the COVID-19 detection a precision equal to 0.968 and a recall of 0.964 are reached,
demonstrating the ability of supervised machine learning for the discrimination between COVID-19 and other pul-
monary pathologies.
To better understand the ability prediction of the proposed model, Table 4 shows the confusion matrix.

Table 4: Confusion matrix.

a b ←classified as
61 1 a = COVID-19
2 21 b = other

Confusion matrix in Table 4 shows that only 3 X-rays in total are misclassified, in particular, 1 COVID-19 x-
ray image is erroneously classified as belonging to the other pulmonary disease category, while 2 x-ray images are
classified as belonging to the COVID-19 category, while radiologists marked these medical images with the other
pulmonary disease category.

4. Conclusion and Future Work

Considering the rate of spread of COVID-19, automatic techniques are needed for the detection of this disease.
In this paper, a machine learning method is proposed for the detection of COVID-19 disease. The evaluation demon-
strated the effectiveness of the proposed method, by obtaining an average precision and recall equal to 0.965 in the
discrimination between the COVID-19 and other pulmonary diseases with similar symptoms.
As future work, we plan to validate the proposed method considering also a set of healthy chest X-rays. Moreover,
we will investigate whether deep learning [5, 25] and formal verification techniques [15, 27] can obtain better perfor-
mances in the COVID-19 as demonstrated in similar contexts, from cancer detection to malware detection [7, 4, 10, 6].

ACKNOWLEDGEMENTS

This work has been partially supported by MIUR - SecureOpenNets and EU SPARTA contract 830892, Cyber-
SANE projects, and the EU project CyberSure 734815.

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