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  <front>
    <journal-meta />
    <article-meta>
      <title-group>
        <article-title>Multiple Instance Learning algorithm for medical image classification</article-title>
      </title-group>
      <contrib-group>
        <aff id="aff0">
          <label>0</label>
          <institution>DIMES - Department of Computer Engineering</institution>
          ,
          <addr-line>Modelling</addr-line>
          ,
          <institution>Electronic and System University of Calabria</institution>
          ,
          <addr-line>Rende</addr-line>
          ,
          <country country="IT">Italy</country>
        </aff>
        <aff id="aff1">
          <label>1</label>
          <institution>Department of Mathematics and Computer Science, University of Calabria</institution>
          ,
          <addr-line>Rende</addr-line>
          ,
          <country country="IT">Italy</country>
        </aff>
        <aff id="aff2">
          <label>2</label>
          <institution>ICAR-CNR National Research Council</institution>
          ,
          <addr-line>Rende</addr-line>
          ,
          <country country="IT">Italy</country>
        </aff>
      </contrib-group>
      <fpage>0000</fpage>
      <lpage>0002</lpage>
      <abstract>
        <p>After an overview on most relevant methods for image classification, we focus on a recently proposed Multiple Instance Learning (MIL) approach, suitable for image processing applications and based on a mixed integer nonlinear optimization problem. In particular, the algorithm has been preliminarily applied to a set of color images, with the aim to identify images containing some specific color pattern, and successively to a medical dataset, containing photos of melanoma and common nevi. Since the results appear promising, this technique could be at the basis of computer vision systems that act as a filter mechanism to support physicians in detecting melanomas cancer.</p>
      </abstract>
      <kwd-group>
        <kwd>Image Classification</kwd>
        <kwd>Multiple Instance Learning</kwd>
        <kwd>Lagrangian Relaxation</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <sec id="sec-1">
      <title>-</title>
      <p>Nowadays, continuous development of digital technologies and ICT solutions implies
a great availability of digital images in various fields, such as scientific, medical and
industrial. Use of this information requires navigation, searching, indexing,
classification and retrieval. Image classification is aimed at classifying images according to their
visual contents: a particular application is in the medical field, where medical images
classification can support the diagnosis of some diseases.</p>
      <p>
        Interesting algorithms to evaluate image similarities have been proposed in [
        <xref ref-type="bibr" rid="ref13 ref9">9, 13</xref>
        ]: they
work by extracting first the features vectors from the image and then by using the vector
distances as a measure of similarity. Since these methods, based on object recognition
techniques, are sensitive to the noise and do not satisfactorily work when there are no
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distinct objects in the images, De Bonet and Viola [
        <xref ref-type="bibr" rid="ref8">8</xref>
        ] proposed an algorithm that works
well with natural scenes and single object test sets. Ravela et al. [
        <xref ref-type="bibr" rid="ref16">16</xref>
        ] proposed a method
to evaluate the similarity by means a correlation measure: the application of this system
involves a collection of regions of interest, but possible limitations are connected to the
difficulties in identifying such regions. A General Image Retrieval (GIR) model that
calculates the similarities between query image and the images in the image database
was proposed in [
        <xref ref-type="bibr" rid="ref11">11</xref>
        ], while R. da Silva Torres et al. [
        <xref ref-type="bibr" rid="ref19">19</xref>
        ] released an interesting
overview on content based image retrieval and its applications on digital libraries, crime
prevention, medicine, fingerprint identification and biodiversity information systems.
P.N. Shinde and A.A. Manjrekar [
        <xref ref-type="bibr" rid="ref17">17</xref>
        ] proposed different schemes to check similarity
between two images: the images are classified, re-ranked and retrieved using an
algorithm based on score histogram computation.
      </p>
      <p>
        In this paper, we face image classification by means of a Multiple Instance Learning
approach [
        <xref ref-type="bibr" rid="ref1 ref6">1, 6</xref>
        ] based on a Lagrangian relaxation technique [
        <xref ref-type="bibr" rid="ref3">3</xref>
        ]. Multiple instance
learning (MIL) is a recent paradigm of machine learning that performs well in the context of
medical images and video analysis [
        <xref ref-type="bibr" rid="ref15">15</xref>
        ]. Manual segmentation, typically needed in the
training phase, is no more necessary since the supervision is based on global labels,
unlike traditional single-instance learning algorithms. The paper is organized as
follows. In the next section, we recall the main concepts at the basis of the Multiple
Instance Learning paradigm, focusing on the binary case. In Section 3, we shortly
describe the algorithm proposed in [
        <xref ref-type="bibr" rid="ref3">3</xref>
        ], while in Section 4 we report some preliminary
numerical results performed on the classification of some artificial color images and on
a data set of dermoscopic images. Finally, some conclusions are drawn in Section 5.
2
      </p>
    </sec>
    <sec id="sec-2">
      <title>Multiple Instance Learning</title>
      <p>
        The objective of the Multiple Instance Learning (MIL) is to discriminate among sets of
points: the sets to be classified are called bags, while the points inside the bags are
named instances. In the image classification, an image is represented by a bag, whereas
the sub-regions forming the images are the instances. In a MIL problem, during the
learning phase only the labels of the bags are known, whereas the labels of the instances
are unknown. This is different from a classical supervised classification approach,
where the label of each point is known. In this work, we focus on the binary MIL
classification, whose objective is to discriminate between positive and negative images.
Two different approaches are mainly possible: one is in the instance-space and the other
one is in the bag-space. In the instance-space, the learning process looks only at the
characteristics of each individual instance, without considering the more global
characteristics of the entire bag. Vice-versa, in the bag-space case, the learning phase is
more global, because each bag is treated as a whole entity: the classification consists in
separating directly the positive bags from the negative ones. There exists also a
compromise between these two approaches. It consists in representing each bag by means
of some of its instances containing maximal similarities and it is referred as the
embedding-space approach [
        <xref ref-type="bibr" rid="ref6">6</xref>
        ]. An important issue in binary MIL problems is to specify what
a positive bag is. The standard assumption is that a bag is negative if all its instances
are negative and positive whenever at least one instance is positive: as a consequence,
under such an assumption, only the labels of the instances inside the positive bags are
to be predicted. An extensive survey on classification of medical images by means of
MIL techniques is reported in [
        <xref ref-type="bibr" rid="ref15">15</xref>
        ]. The proposed classification method, described in
the next section, is a heuristic optimization algorithm [
        <xref ref-type="bibr" rid="ref3">3</xref>
        ] based on the SVM (Support
Vector Machine) type model introduced in [
        <xref ref-type="bibr" rid="ref2">2</xref>
        ].We recall that optimization techniques,
aimed at obtaining separation surfaces, play a relevant role in every machine learning
problem and in literature various mathematical programming models have been
proposed to face a binary MIL classification problem, such as [
        <xref ref-type="bibr" rid="ref12 ref5">5, 12</xref>
        ].
3
      </p>
    </sec>
    <sec id="sec-3">
      <title>The Classification Algorithm</title>
      <p>points (the instances) inside the bags.</p>
      <p>
        In this section we describe the heuristics optimization MIL algorithm proposed in [
        <xref ref-type="bibr" rid="ref3">3</xref>
        ],
which is suitable for image classification. This method is based on the SVM type model
introduced by Andrews et al. in [
        <xref ref-type="bibr" rid="ref2">2</xref>
        ]. In particular, let  + and  − the index sets
corresponding to
      </p>
      <p>positive bags and  negative ones. The two sets are therefore defined
respectively as:  + = { 1+, … ,  + } and  − = { 1−, … ,  −}. Let p be the total number of
1, … ,</p>
      <p>and it is equal to -1 for each negative bag  − = 1, … ,  .</p>
      <p>The  ℎ instance,  = (1, … , ) is represented by a vector   ∈ ℝ and its class label

 ∈ {−1,1} is supposed to be unknown. Differently from the class label of the
instances, the class label of each bag is known: it is equal to +1 for each positive bag  + =
We hypothesize to work under the MIL standard assumption: we suppose that a bag is
positive if it contains at least a positive instance, while it is negative if it contains only
negative instances. The objective is to determine a hyperplane:
(, ) ≜</p>
      <p>{ ℝ  |   +  = 0 }
separating the two classes of bags, where  ∈ ℝ  is the normal to the hyperplane and
 ∈ ℝ</p>
      <p>
        is the bias. Since a negative bag is defined containing only negative instances,
only the class label   ∈ {−1,1} of the instances inside the positive bags are actually
unknown. If in addition we want to minimize a measure of the classification error of all
the instances inside the bags, the optimization model [
        <xref ref-type="bibr" rid="ref2">2</xref>
        ] is the following:


 + )}
 (
      </p>
      <p>+ )}.
{   ∈ {−1,1},
=1 ∈ +
+  ∑</p>
      <p>∑ {0, 1 + (
+  ∑</p>
      <p>
        ∑ {0, 1 − 
where

∑
Moreover, if variables   were fixed, we would obtain a classical supervised SVM
model [
        <xref ref-type="bibr" rid="ref7">7</xref>
        ]. The objective function in problem  is the sum of three terms: the first one
is aimed at maximizing the margin, while the other two ones are aimed at minimizing
a measure of the classification error of the points belonging to the negative bags and of
the points belonging to the positive bags, respectively. Note that the presence of the
unknown labels   in the third term allows the possibility to allocate some points of
positive bags in the negative part with respect to the separating hyperplane. Finally, by
means of the constraints:
∑
∈ +
  +1
2
≥ 1,
the Lagrangian relaxation [
        <xref ref-type="bibr" rid="ref10">10</xref>
        ] of problem  , obtained by relaxing the linear constraints
 


 ( )≜  ,,
  (, ,
      </p>
      <p>)
  () {  ∈ {−1,1},
where  ≥ 0 is the vector of the Lagrangian multipliers in ℝ . Any optimal solution of
(), denoted by ((), (), ()</p>
      <p>), provides a lower bound for problem  , that is
≤  ∗for any λ ≥ 0. The Lagrangian dual problem is defined as:</p>
      <p>{

≜ 
≥0</p>
      <p>
        ( )= 
  ∈ {−1,1},
≥0 
+ ∈ 
,,
it is possible to obtain an optimal solution to  by using any dual ascent
is nondifferentiable, the use of nonsmooth optimization
with, of course,  
solving  
method. Since problem  
uate the objective function  
face problem  
techniques is in order. We adopt the subgradient method [
        <xref ref-type="bibr" rid="ref18">18</xref>
        ], that we stop after a
prefixed maximum number of iterations. Note that, at each iteration, it is necessary to
eval(). This is a difficult task because it requires in turn to
(), that we solve approximately by means of a Block Coordinate
Descent (BCD) algorithm [
        <xref ref-type="bibr" rid="ref20">20</xref>
        ]. In fact we alternately fix the value of vector  and of
the couple (, 
): for any λ ≥0, when variables   are kept fixed, problem  
(),
reduces to solving a classical SVM quadratic program; vice-versa, when the couple
(,
      </p>
      <p>)is fixed, it is possible to solve it, with respect to  , by inspection.</p>
      <p>
        In case BCD provides an infeasible solution to the original problem, such solution may
be easily modified to obtain feasibility, giving, in this way, an upper bound (the
incumbent) on the optimal solution of P. A simplified scheme of the MIL algorithm is
reported in Figure 1; further details can be found in [
        <xref ref-type="bibr" rid="ref3">3</xref>
        ].
The algorithm presented in the previous section has been adopted in two types of
numerical experimentations: preliminarily for classifying color images and successively
for classifying dermoscopic images.
      </p>
      <p>
        In the first numerical preliminary experiment (see [
        <xref ref-type="bibr" rid="ref4">4</xref>
        ]) we have generated one hundred
color images of 128x128 pixels dimension, divided into two different classes, positive
and negative. We have considered positive each image (bag) containing the yellow
color and negative the images without yellow (Figure 2).
      </p>
      <p>We have performed a segmentation process by means of some image processing
standard Matlab routines. In particular, given a bitmap image, this image is read by the
“imread” Matlab routine, which provides a 128x128 matrix, the indexed image, each
element corresponding to a pixel and containing a triplet which represents the RGB (red,
green, blue) scale. In fact, the first value of each triplet represents the red pixel intensity,
the second one represents the green pixel intensity and the last one represents the blue
pixel intensity. Once the indexed image has been generated, the successive step consists
in converting each indexed image (and the corresponding color map) into an RGB
image by means of the “ind2rgb” Matlab subroutine. After that, we have proceeded by
grouping the pixels in square sub-regions of appropriate dimension: each sub-region
forms the so called “blob”. For each blob, we have computed the average of the RGB
intensities and the differences between this value and the same quantity calculated for
the adjacent blobs (up, down, left, right).</p>
      <p>We recall that a crucial issue in a Support Vector Machine type approach is the choice
of parameter C, which generally is performed among a grid of possible values.
We report the results obtained fixing C = 10, since in correspondence to this value the
classification algorithm has exhibited the best performance. In discriminating between
positive and negative color images, we have considered the following two cases. In the
first one we have generated, for ten times, a testing set by choosing ten different images
(five positive and five negative), so that each time the remaining ninety ones (forty-five
positive and forty-five negative) have constituted the training set.</p>
      <p>In the table reported in Figure 2, for each trial, we report the training and the testing
correctness percentage, respectively, with the average for both of them in the last row.</p>
      <p>With Yellow</p>
      <p>
        Without Yellow
In the second case, we have performed a leave-one-out cross validation, obtaining
84.07% and 83% as training and testing correctness, respectively. We have noted that,
among the seventeen failures in the testing set, fifteen are positive images and two are
negative images. Considering the fifteen misclassified positive images it is worth
noting that, apart two images, all of them contain a very small yellow colored region.
In the second type of numerical experiment, the MIL classification algorithm proposed
in [
        <xref ref-type="bibr" rid="ref3">3</xref>
        ] has been applied to classification of some medical dermoscopic images drawn
from the database PH2 [
        <xref ref-type="bibr" rid="ref14">14</xref>
        ]. The image are in 8-bit RGB color with a resolution of
768x560 pixels. These images have been classified as common nevus or melanoma by
expert dermatologists considering the manual segmentation of the skin lesion, the
clinical and histological diagnosis and dermoscopic criteria (asymmetry, colors, pigment
network, particular structures).
      </p>
      <p>In our experiments, none of the features resulting from the manual analysis was used
in the automatic classification process. We have only considered negative the images
of common nevi and positive the images of melanomas. The dataset considered consists
of 40 images of melanoma and 40 images of common nevi. To contain the number of
instances, we first reduced the image resolution to 128x128 pixels and subsequently we
have considered square blobs of 32x32 pixel size. We have adopted a be-level 10-fold
cross-validation, listing the corresponding results in Figure 3, where we report, for each
fold, the testing correctness, the testing sensitivity, the testing specificity and the CPU
time. The results are very promising, even because they have been obtained from photos
with a small resolution (128x128 pixels): we note in fact that in three cases (folds n. 2,
4 e 7) the algorithm has been able to correctly classify all the images in the testing set.
We conclude this section by noting that the healthy image with the green box (see
Figure 3), characterized by a lot of hair, is the unique misclassified image belonging to the
testing set of fold n. 10. This suggests that better results could be obtained by using
preprocessing techniques aimed at eliminating the presence of possible noises.</p>
      <p>Melanomas</p>
      <p>
        Common Nevi
In this paper, we have presented an application of a Multiple Instance Learning
approach on color and melanoma images, obtaining promising results, both in terms of
classification accuracy and CPU times. MIL paradigm fits very well on image
classifications because it is able to detect global information (bags) by working at the local
level (instance-level). Future research could consist in designing more sophisticated
segmentation techniques, aiming to improve the classification performance. Moreover,
it would be useful also to test the performance of the proposed algorithm considering
preprocessing steps for the optimization of medical images [
        <xref ref-type="bibr" rid="ref22">22</xref>
        ]. The inclusion of
geometry and textures features may also enrich the classification performance of the
proposed model [
        <xref ref-type="bibr" rid="ref21">21</xref>
        ]. As for a future extension, we plan to integrate the proposed method
into a more general purpose medical information system in order to test and validate its
effectiveness on larger datasets also related to different diseases [
        <xref ref-type="bibr" rid="ref23 ref24">23, 24</xref>
        ].
      </p>
    </sec>
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