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Abstract
Coronavirus disease 2019 (COVID-19) is a respiratory infection for which chest X-ray (CXR) imaging can provide an accessible screening modality. This study investigates an interpretable computer-aided screening pipeline for distinguishing COVID-19-positive from normal CXR images. Methods: The pipeline combines Otsu-based lung segmentation, morphological refinement, seven Hu invariant shape moments, training-fold z-score normalization, and a class-weighted Decision Tree. A cohort of 2,600 CXR images (1,000 COVID-19-positive and 1,600 normal) was evaluated using stratified five-fold cross-validation. The retained experimental record reports 98.6% accuracy, 97.8% precision, 98.6% recall (sensitivity), and 98.2% F1-score. The pooled confusion matrix shows TP=986, FN=14, FP=22, and TN=1578, corresponding to 98.6% accuracy and 97.8% precision. ROC/AUC analysis yielded AUC = 0.987 ± 0.004 under the image-level evaluation protocol. Conclusion: The findings indicate that a low-dimensional, shape-based descriptor combined with an interpretable Decision Tree can discriminate COVID-19-positive from normal CXR images under the present internal image-level protocol. Because the cohort was not partitioned at the patient or source level and no independent external cohort was retained in the study record, the results are considered preliminary proof-of-concept evidence rather than clinically validated diagnostic performance.
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References
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References
Zhu, N., Zhang, D., Wang, W., Li, X., Yang, B., Song, J., et al. (2020). A novel coronavirus from patients with pneumonia in China, 2019. New England Journal of Medicine, 382(8), 727–733. DOI: 10.1056/NEJMoa2001017.
Liu, P., Shi, L., Zhang, W., He, J., Liu, C., Zhao, C., et al. (2017). Prevalence and genetic diversity analysis of human coronaviruses among cross-border children. Virology Journal, 14, 8. DOI: 10.1186/s12985-017-0896-0.
Zhavoronkov, A., Aladinskiy, V., Zhebrak, A., Zagribelnyy, B., Terentiev, V., Bezrukov, D., & Orekhov, P. (2020). Potential COVID-2019 3C-like protease inhibitors designed using generative deep learning approaches. ChemRxiv, preprint. DOI: 10.26434/chemrxiv.11829102.v2.
Li, Q., Guan, X., Wu, P., Wang, X., Zhou, L., Tong, Y., et al. (2020). Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. New England Journal of Medicine, 382(13), 1199–1207. DOI: 10.1056/NEJMoa2001316.
Zhang, S., Wang, Z., Chang, R., Wang, H., Xu, C., Yu, X., et al. (2020). COVID-19 containment: China provides important lessons for global response. Frontiers of Medicine, 14(2), 215–219. DOI: 10.1007/s11684-020-0766-9.
Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., et al. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet, 395(10223), 497–506. DOI: 10.1016/S0140-6736(20)30183-5.
Yu, P., Zhu, J., Zhang, Z., & Han, Y. (2020). A familial cluster of infection associated with the 2019 novel coronavirus indicating possible person-to-person transmission during the incubation period. Journal of Infectious Diseases, 221(11), 1757–1761. DOI: 10.1093/infdis/jiaa077.
Kumar, S., et al. (2024). A methodical exploration of imaging modalities from dataset to detection through machine learning paradigms in prominent lung disease diagnosis: A review. BMC Medical Imaging, 24. DOI: 10.1186/s12880-024-01192-w.
Akhter, Y., Singh, R., & Vatsa, M. (2023). AI-based radiodiagnosis using chest X-rays: A review. Frontiers in Big Data, 6. DOI: 10.3389/fdata.2023.1120989.
Sharma, H., & Kumar, S. (2016). A survey on decision tree algorithms of classification in data mining. International Journal of Scientific Research, 5(4), 2094–2097. DOI: 10.21275/v5i4.NOV162954.
Hu, M.-K. (1962). Visual pattern recognition by moment invariants. IRE Transactions on Information Theory, 8(2), 179–187. DOI: 10.1109/TIT.1962.1057692.
Krishnan, K. S., & Krishnan, K. S. (2021). Vision Transformer based COVID-19 detection using chest X-rays. arXiv, 2110.04458. DOI: 10.48550/arXiv.2110.04458.
Hadhoud, Y., Mekhaznia, T., Bennour, A., Amroune, M., Kurdi, N. A., Aborujilah, A. H., & Al-Sarem, M. (2024). From binary to multi-class classification: A two-step hybrid CNN-ViT model for chest disease classification based on X-ray images. Diagnostics, 14(23), 2754. DOI: 10.3390/diagnostics14232754.
Takahashi, S., Sakaguchi, Y., Kouno, N., et al. (2024). Comparison of Vision Transformers and convolutional neural networks in medical image analysis: A systematic review. Journal of Medical Systems, 48, 84. DOI: 10.1007/s10916-024-02105-8.
Feki, I., Ammar, S., & Kessentini, Y. (2022). Self-supervised learning for COVID-19 detection from chest X-ray images. In Communications in Computer and Information Science, Vol. 1589. Springer, Cham. DOI: 10.1007/978-3-031-08277-1_7.
Hussein, H. I., Mohammed, A. O., Hassan, M. M., & Mstafa, R. J. (2023). Lightweight deep CNN-based models for early detection of COVID-19 patients from chest X-ray images. Expert Systems with Applications, 223, 119900. DOI: 10.1016/j.eswa.2023.119900.
Alaufi, R., Kalkatawi, M., & Abukhodair, F. (2023). Challenges of deep learning diagnosis for COVID-19 from chest imaging. Multimedia Tools and Applications. DOI: 10.1007/s11042-023-16017-1.
Mano, L. Y., Torres, A. M., Morales, A. G., Cruz, C. C. P., Cardoso, F. H., Alves, S. H., Faria, C. O., Lanzillotti, R., Cerceau, R., da Costa, R. M. E. M., Figueiredo, K., & Werneck, V. M. B. (2023). Machine learning applied to COVID-19: A review of the initial pandemic period. International Journal of Computational Intelligence Systems, 16, 73. DOI: 10.1007/s44196-023-00236-3.
Myles, A. J., Feudale, R. N., Liu, Y., Woody, N. A., & Brown, S. D. (2004). An introduction to decision tree modeling. Journal of Chemometrics, 18(6), 275–282. DOI: 10.1093/oso/9780192896087.003.0020.
Quinlan, J. R. (1996). Learning decision tree classifiers. ACM Computing Surveys, 28(1), 71–72. DOI: 10.1145/234313.234346.
Hu, S., Hoffman, E. A., & Reinhardt, J. M. (2001). Automatic lung segmentation for accurate quantitation of volumetric X-ray CT images. IEEE Transactions on Medical Imaging, 20(6), 490–498. DOI: 10.1109/42.929615.
Kocak, B., Klontzas, M. E., Stanzione, A., et al. (2025). Evaluation metrics in medical imaging AI: Fundamentals, pitfalls, misapplications, and recommendations. European Journal of Radiology Artificial Intelligence, 3, 100030. DOI: 10.1016/j.ejrai.2025.100030.
Rahman, T., Khandakar, A., Qiblawey, Y., Tahir, A., Kiranyaz, S., Kashem, S. B. A., Islam, M. T., Al Maadeed, S., Zughaier, S. M., Khan, M. S., & Chowdhury, M. E. H. (2021). Exploring the effect of image enhancement techniques on COVID-19 detection using chest X-ray images. Computers in Biology and Medicine, 132, 104319. Dataset: Kaggle, COVID-19 Radiography Database.
Cohen, J. P., Morrison, P., & Dao, L. (2020). COVID-19 image data collection. arXiv, 2003.11597. Repository: COVID-ChestXray Dataset. Accessed August 27, 2026.