Cited by 82Infrared Thermography in MedicineDiabetic Foot Ulcer Assessment and ManagementArtificial Intelligence in Healthcare

A Novel Machine Learning Approach for Severity Classification of Diabetic Foot Complications Using Thermogram Images

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Khandakar, Amith, Chowdhury, Muhammad E. H., Reaz, Mamun Bin Ibne, Ali, Sawal Hamid Md, Kiranyaz, Serkan, Rahman, Tawsifur, Chowdhury, Moajjem Hossain, Ayari, Mohamed Arselene +4 more·2022·Sensors

Abstract

Diabetes mellitus (DM) is one of the most prevalent diseases in the world, and is correlated to a high index of mortality. One of its major complications is diabetic foot, leading to plantar ulcers, amputation, and death. Several studies report that a thermogram helps to detect changes in the plantar temperature of the foot, which may lead to a higher risk of ulceration. However, in diabetic patients, the distribution of plantar temperature does not follow a standard pattern, thereby making it difficult to quantify the changes. The abnormal temperature distribution in infrared (IR) foot thermogram images can be used for the early detection of diabetic foot before ulceration to avoid complications. There is no machine learning-based technique reported in the literature to classify these thermograms based on the severity of diabetic foot complications. This paper uses an available labeled diabetic thermogram dataset and uses the k-mean clustering technique to cluster the severity risk of diabetic foot ulcers using an unsupervised approach. Using the plantar foot temperature, the new clustered dataset is verified by expert medical doctors in terms of risk for the development of foot ulcers. The newly labeled dataset is then investigated in terms of robustness to be classified by any machine learning network. Classical machine learning algorithms with feature engineering and a convolutional neural network (CNN) with image-enhancement techniques are investigated to provide the best-performing network in classifying thermograms based on severity. It is found that the popular VGG 19 CNN model shows an accuracy, precision, sensitivity, F1-score, and specificity of 95.08%, 95.08%, 95.09%, 95.08%, and 97.2%, respectively, in the stratification of severity. A stacking classifier is proposed using extracted features of the thermogram, which is created using the trained gradient boost classifier, XGBoost classifier, and random forest classifier. This provides a comparable performance of 94.47%, 94.45%, 94.47%, 94.43%, and 93.25% for accuracy, precision, sensitivity, F1-score, and specificity, respectively.

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  • Khandakar et al. reported that a CNN and k-means clustering technique using thermogram images to classify thermograms based on severity of diabetic foot complications found that VGG 19 CNN model showed accuracy, precision, sensitivity, F1 score, and specificity of 95.08%, 95.08%, 95.09%, 95.08%, and 97.2%, respectively.

    “it was found that the popular VGG 19 CNN model showed an accuracy, precision, sensitivity, F1 score, and specificity of 95.08%, 95.08%, 95.09%, 95.08%, and 97.2%, respectively, in the stratification of severity”

    From Artificial intelligence in diabetes management: Advancements, opportunities, and challenges (2023) · cites this paper as Khandakar et al.114

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  • One study classified thermogram images based on the severity of diabetic foot complications with 95.08% accuracy.

    “For evaluation of diabetic foot, one study classified thermogram images based on the severity of diabetic foot complications (95.08% accuracy)114”

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Research works printed but not linked: 5

  1. [58]Simonyan K. Zisserman A. Very deep convolutional networks for large-scale image recognition arXiv 2014 1409.1556
  2. [68]Arthur D. Vassilvitskii S. k-Means++: The Advantages of Careful Seeding ACM Digital Library Stanford, CA, USA 2006
  3. [80]Zhang Y. Support vector machine classification algorithm and its application Proceedings of the International Conference on Information Computing and Applications Springer Berlin/Heidelberg, Germany 2012 179 186
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  5. [90]Saeys Y. Abeel T. Van de Peer Y. Robust feature selection using ensemble feature selection techniques Proceedings of the Joint European Conference on Machine Learning and Knowledge Discovery in Databases Springer Berlin/Heidelberg, Germany 2008 313 325

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Authors
Khandakar, A., Chowdhury, M. E. H., Reaz, M. B. I., Ali, S. H. M., Kiranyaz, S., Rahman, T., Chowdhury, M. H., Ayari, M. A., Alfkey, R., Bakar, A. A. A., Malik, R. A., & Hasan, A.
Affiliations
  • Qatar University (QA)
  • National University of Malaysia (MY)
  • Department of Electrical Engineering, Qatar University, Doha 2713, Qatar
  • Hamad Medical Corporation (QA)
  • Weill Cornell Medical College in Qatar (QA)
Corresponding author
  • Chowdhury, Muhammad E. H.
  • Reaz, Mamun Bin Ibne
Venue
Sensors
Publisher
MDPI AG
Published
2022-06-02
Volume
22
Issue
11
Pages
4249
ISSN
1424-8220 (ISSN-L)
OpenAlex
W4281750928
Cited by
74
References
85
Citations by year
2026: 15 · 2025: 22 · 2024: 18 · 2023: 14 · 2022: 5
FWCI
8.39
Type
journal article
Language
en
Open access
Locations
  • Sensors (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Qatar University QSpace (Qatar University) (submittedVersion)
Funders
  • Qatar National Research Fund (QNRF) (NPRP12S-0227-190164, IRCC-2021-001, DPK-2021-001)
  • International Research Collaboration Co-Fund (IRCC) (NPRP12S-0227-190164, IRCC-2021-001, DPK-2021-001)
  • Universiti Kebangsaan Malaysia (NPRP12S-0227-190164, IRCC-2021-001, DPK-2021-001)
Topics
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Infrared Thermography in Medicine
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
  • Health Sciences › Health Professions › Health Information Management › Artificial Intelligence in Healthcare
Keywords
diabetic foot, diabetic foot ulcer, infrared thermography, severity classification, plantar temperature, K-means clustering, stacking classifier, XGBoost, random forest, gradient boosting, diabetes complications
MeSH terms
Machine Learning, Algorithms, Diabetes Mellitus, Humans, Thermography, Neural Networks, Computer, Diabetic Foot

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