• Francisco Veredas, Héctor Mesa, and Laura Morente.
• Departamento de Lenguajes y Ciencias de la Computación, Universidad de Málaga, Málaga, 29071 Spain. fvn@uma.es
• IEEE Trans Med Imaging. 2010 Feb 1; 29 (2): 410-27.

AbstractA pressure ulcer is a clinical pathology of localized damage to the skin and underlying tissue caused by pressure, shear, or friction. Diagnosis, treatment, and care of pressure ulcers are costly for health services. Accurate wound evaluation is a critical task for optimizing the efficacy of treatment and care. Clinicians usually evaluate each pressure ulcer by visual inspection of the damaged tissues, which is an imprecise manner of assessing the wound state. Current computer vision approaches do not offer a global solution to this particular problem. In this paper, a hybrid approach based on neural networks and Bayesian classifiers is used in the design of a computational system for automatic tissue identification in wound images. A mean shift procedure and a region-growing strategy are implemented for effective region segmentation. Color and texture features are extracted from these segmented regions. A set of k multilayer perceptrons is trained with inputs consisting of color and texture patterns, and outputs consisting of categorical tissue classes which are determined by clinical experts. This training procedure is driven by a k-fold cross-validation method. Finally, a Bayesian committee machine is formed by training a Bayesian classifier to combine the classifications of the k neural networks. Specific heuristics based on the wound topology are designed to significantly improve the results of the classification. We obtain high efficiency rates from a binary cascade approach for tissue identification. Results are compared with other similar machine-learning approaches, including multiclass Bayesian committee machine classifiers and support vector machines. The different techniques analyzed in this paper show high global classification accuracy rates. Our binary cascade approach gives high global performance rates (average sensitivity =78.7% , specificity =94.7% , and accuracy =91.5% ) and shows the highest average sensitivity score ( =86.3%) when detecting necrotic tissue in the wound.

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