Computer-aided diagnosis for World Health Organization-defined chest radiograph primary-endpoint pneumonia in children



The chest radiograph is the most common imaging modality to assess childhood pneumonia. It has been used in epidemiological and vaccine efficacy/effectiveness studies on childhood pneumonia.


To develop computer-aided diagnosis (CAD4Kids) for chest radiography in children and to evaluate its accuracy in identifying World Health Organization (WHO)-defined chest radiograph primary-endpoint pneumonia compared to a consensus interpretation.

Materials and methods

Chest radiographs were independently evaluated by three radiologists based on WHO criteria. Automatic lung field segmentation was followed by manual inspection and correction, training, feature extraction and classification. Radiographs were filtered with Gaussian derivatives on multiple scales, extracting texture features to classify each pixel in the lung region. To obtain an image score, the 95th percentile score of the pixels was used. Training and testing were done in 10-fold cross validation.


The radiologist majority consensus reading of 858 interpretable chest radiographs included 333 (39%) categorised as primary-endpoint pneumonia, 208 (24%) as other infiltrate only and 317 (37%) as no primary-endpoint pneumonia or other infiltrate. Compared to the reference radiologist consensus reading, CAD4Kids had an area under the receiver operator characteristic (ROC) curve of 0.850 (95% confidence interval [CI] 0.823–0.876), with a sensitivity of 76% and specificity of 80% for identifying primary-endpoint pneumonia on chest radiograph. Furthermore, the ROC curve was 0.810 (95% CI 0.772–0.846) for CAD4Kids identifying primary-endpoint pneumonia compared to other infiltrate only.


Further development of the CAD4Kids software and validation in multicentre studies are important for future research on computer-aided diagnosis and artificial intelligence in paediatric radiology.

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The study received Carnegie PhD Fellowship funding and a South African Medical Research Council Self-Initiated Research Grant. We thank staff at the Respiratory and Meningeal Pathogens Research Unit involved in enrolling study patients: Azwifarwi Mudau, Debra Katisi, Audrey Kubheka, Magare Lelaka, Tsekabe Makgoba, Matshediso Moilwa, Malebo Motiane, Sibonsile Moya, Thondani Netshishivhe, Minah Nkuna, Mmabatho Selela, Ndulela Titi, Nonhlanhla Tsholetsane, Lerato Mapetla and Gudani Singo.

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Correspondence to Nasreen Mahomed.

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Mahomed, N., van Ginneken, B., Philipsen, R.H.H.M. et al. Computer-aided diagnosis for World Health Organization-defined chest radiograph primary-endpoint pneumonia in children. Pediatr Radiol 50, 482–491 (2020).

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  • Accuracy
  • Children
  • Computer-aided diagnosis
  • Pneumonia
  • Primary-endpoint
  • Radiography
  • World Health Organization