Hybrid Intelligent System for Disease Diagnosis Based

on Artificial Neural Networks, Fuzzy Logic, and

Genetic Algorithms

Hamada R.H. Al-Absi1, Azween Abdullah1,

Mahamat Issa Hassan1, and Khaled Bashir Shaban2
1
Department of Computer and Information Sciences, Universiti Teknologi PETRONAS,
Bandar Seri Iskandar, 31750 Tronoh, Perak, Malaysia
2
Computer Science and Engineering Department, College of Engineering, Qatar University,
P.O. Box: 2713, Doha, Qatar
hamada.it@gmail.com,
{azweenabdullah,mahamat.hassan}@petronas.com.my,
khaled.shaban@qu.edu.qa

Abstract. Disease diagnosis often involves acquiring medical images using

devices such as MRI, CT scan, x-ray, or mammograms of patients organs.
Though many medical diagnostic applications have been proposed; finding
subtle cancerous cells is still an issue because they are very difficult to be
identified. This paper presents an architecture that utilizes a learning algorithm,
and uses soft computing to build a medical knowledge base and an inference
engine for classifying new images. This system is built on the strength of
artificial neural networks, fuzzy logic, and genetic algorithms. These machine
intelligence are combined in a complementary approach to overcome the
weakness of each other. Moreover, the system also uses Wavelet Transform and
Principal Component Analysis for pre-processing and feature to produce
features to be used as input to the learning algorithm.

Keywords: Computer Aided Diagnosis, Soft Computing, Artificial Neural

Networks, Fuzzy Logic, Genetic Algorithms.

1 Introduction
Disease diagnosis is an important process in healthcare. This essential process is
conducted by physicians before giving medical treatments to the patients. The
diagnosis is often based on results of blood tests, urine tests and so forth. In cases that
required an examination of internal organs of the patient, physician would refer them
to radiologists to acquiring vital images using devices such as MRI, CT scan, x-ray, or
mammograms, depending on the organ and the suspected disease. In the past, the
radiologists or the physicians undertook themselves the reading and interpreting these
images. Later, computer aided diagnosis (CAD) was introduced in aid of diagnosing
the complex cases. However, the images produced by imaging devices such as for
breast cancer, could be affected by noise and distortion which consequently affect the

A. Abd Manaf et al. (Eds.): ICIEIS 2011, Part II, CCIS 252, pp. 128139, 2011.
Springer-Verlag Berlin Heidelberg 2011
 Hybrid Intelligent System for Disease Diagnosis 129

diagnosis of the radiologists [1]. The noises or distortions in the image could also
cause errors during the diagnosis procedure. For instance, by missing tumors or
wrongly detecting tumors that in fact are non presence (false positives). These
mistakes would certainly influence the final assessment and lead to the wrong
treatment / therapy.
CAD systems such as [2-4] are utilized to support the decision of radiologist in
diagnosing images. Such systems have been reported to increase the performance of
detecting cancer by 19.6% compared to the sole diagnosis taken by a radiologist [5].
CAD systems highlight certain regions that enclose cancer or any sort of
abnormalities that might be overlooked by radiologists. Computer aided diagnosis
systems are often built with algorithms based on artificial neural networks, support
vector machines classifiers and others [3]. However, apart from the success of CAD
systems application, the issue of finding subtle cancerous cells remains cumbersome
as these cells are very difficult to be identified. In addition, [6] reported that some
radiologists tend to pay no attention to detected cancers highlighted by CAD systems.
Those radiologists might have had experiences with CAD systems that wrongly
diagnosed cases which highly affected their trust towards these systems. In this
regard, systems capable to produce accurate detection results (especially for hidden
cancerous cells) are needed.
This paper presents an architecture of a CAD system that utilizes soft
computing technique to analyze images and identify abnormalities. This
architecture combines artificial neural networks, fuzzy logic and genetic
algorithms for the learning and classification tasks. Section 2 presents some related
work in this area. Section 3 explains the proposed architecture and the hybrid
learning algorithm, and section 4 discusses an experiment to evaluate the hybrid
learning algorithm. Finally, the conclusion and a discussion on future work
directions are presented in section 5.

2 Related Work

In computer aided diagnosis, many applications have been developed to assist

radiologists in diagnosing diseases. Most of the applications are focusing on the
diagnosis of cancer, since it is one of the main causes of deaths in the world.
Diagnosing or detecting cancers, as well as other diseases in early stages bring an
impact on the cure at later treatment.
Ramirez et al. [7] presented a system aimed at diagnosing Alzheimers disease and
detecting it in its early stage using support vector machine classifier and classification
tree. The proposed method attained 96% accuracy in the classification task. Azvine et
al. [8] experimented the usage of expert system method to design a clinical decision
support system to aid the diagnosis in otology. They experimented with some of the
soft computing algorithms (neural network and fuzzy logic) and they support these
algorithms in future medicine applications. Economou et al. [9] designed a computer
aided diagnosis for pulmonary disease in which the system aimed to support
physicians in their diagnosis and gave them a trust factor to make decisions. Another
system developed by Nazmy et al [10] was to diagnose focal liver lesions based on
CT images. Features were extracted and feed to a neural network classifier. The
130 H.R.H. Al-Absi et al.

system was based on 2D images and as some abnormalities were hidden, a 3D image
was needed to enable the detection. A system introduced by Raja et al. [11] is aimed
for a computer aided system for early diagnosis of Alzheimer disease based on single-
photon emission computed tomography (SPECT) image feature selection and random
forest classifier. The project achieved 96% classification accuracy. The above
applications are considered successful in the area of computer aided systems CAD to
diagnose different diseases. However, diagnosing subtle cancer cells is still an issue
that need to be addressed by developing better algorithms capable of revealing these
cells.

2.1 Soft Computing and Disease Diagnosis

Soft computing aims at solving uncertain, imprecise or partially true problems [12].
Fuzzy Logic (FL), Neural Network (NN) and Genetic Algorithm (GA) etc. are some
techniques for soft computing. The idea of hybrid intelligent systems is to combine
more than one methodology to complement each other [13]. Nazmy et al. [14] for
instance developed an adaptive neuro-fuzzy inference system (ANFIS) for
classification of ECG signals. The performance of this classifier has been tested and
the result achieved a rate of 97% accuracy. Raja et al. [15] meanwhile developed a
computer aided diagnosis system using NN-FL hybrid technique for diagnosing
ultrasound kidney images. Another application of NN-FL technique in detecting
tumors in medical images was developed by [16]. This system used a hybrid
combination of NN-FL with expert system to classify tumors in images. A breast
cancer diagnosis system proposed in [17] was based on FL-GA to detect the
Wisconsin breast cancer diagnosis (WBCD). The system has been tested and show
average accuracy of 97%. In addition, [18] proposed a FL-GA approach for the
classification of epilepsy risk level from EEG signals. This technique performed well
with the accuracy reaching more than 90%. A system has been developed to predict
the lung sounds using a hybrid system of NN-GA [19]. Another application of NN-
GA was also developed to analyze digital mammograms [20]. A soft computing
methodology is demonstrated when NN, FL and GA were combined in one system to
solve a specific problem. A system that combined the three methodologies was
proposed in [21]. The purpose of the system was to interpret medical images by
classifying and detecting any abnormalities. Other systems in [22] and [23] utilized
the same methodology and the results of all systems have been reported to be very
good.
Methodologies such as NN-FL, NN-GA and FL-GA have been used in many
applications. However, in regard to the technique where the three methodologies are
combined in a hybrid system, there are still limited applications of this approach.
According to [24], NN-FL-GA has the smallest number of published papers. Only 5
papers in the period 1995-2007. NN-FL-GA methodology has a great advantage
either in complementing each other or in solving each others limitation. Hence, more
applications should be developed in computer aided diagnosis where the accuracy is
the most important issue.
 Hybrid Intelligent System for Disease Diagnosis 131

The various forms of combining soft computing methodologies forming hybrid

systems are discussed in Yardimci papers [24]. Table 1 summarizes the most common
soft computing combinations.

Table 1. Common soft computing combination in hybrid systems

Combination Description
NN-FL NN controlled by FL
FL controller tuned by NN
NN-GA GA used to pre-process the
input parameters that train the
NN
FL-GA GA controlled by FL
FL controller tuned by GA

3 A Proposed Hybrid System Based on ANN, FL, and GA

In this section, an intelligent system based on hybrid soft computing methodology is

presented. The system integrates artificial neural networks, fuzzy logic and genetic
algorithms by combining the strength and features of the three methods with regard to
disease diagnosis requirements in the context of learning capability.
The system is developed wtih two phases, learning phase and diagnosis phase. The
system goes through a learning procedure before diagnosing the diseases. An image
dataset which represents the suspected disease is required for the learning task. The
dataset is subject to a noise reduction procedure using wavelet transform and PCA-
Wavelet method to extract its features. Then, GA will be utilized to select the most
significant features to be used in training the algorithm. We introduce a learning
algorithm which is based on the combination of artificial neural networks, fuzzy logic
and genetic algorithms. The algorithm (discussed in section 3.3) will produce a
knowledge base (KB) that shall be consulted when diagnosing new images. In the
event of KB cannot diagnose a new image, the algorithm will re-train itself to learn
this new case (after the new case has been classified by an expert). This will enhance
the KB and increase its ability to diagnose more cases. Figure 1 shows an activity
diagram that demonstrates the flow of the first phase of the system.
In diagnosis phase, new images (different from the images used to train the system)
are used as inputs. The knowledge base that was built during the learning phase will
provide a diagnostic decision for new images. In this phase, each image will be
subjected to a noise removal process. This process is to reduce the amount of noise or
distortion in the image to produce a better outcome. After that, the de-noised treated
image will be subjected to feature extraction and segmentation and can be input to the
classification algorithm to make a diagnostic decision. Figure 2 shows an activity
diagram of the second phase of the system.
132 H.R.H. Al-Absi et al.

Fig. 1. Activity diagram of the first phase (learning phase) of the system

Fig. 2. Activity diagram of the second phase (diagnosis phase) of the system

The architecture of the proposed system is in figure 3 which shows the integration
of the training phase and the diagnosing phase.
 Hybrid Intelligent System for Disease Diagnosis 133

Fig. 3. The proposed architecture of a hybrid disease diagnosis system using neural network,
fuzzy logic and genetic algorithm

3.1 Noise Reduction

The acquired image(s) will be filtered by the system to reduce the noises acquired
during the acquisition process. In this project, Wavelet Transform (WT) is one of the
techniques that is used in signal processing to suppress noise. WT can be defined as
follows [25]:

(1)

(2)

Where the Pm is a signal that is the approximation of the f(x) at a resolution m, and the
Qm is a signal that is the difference between the approximation Pm 1 and Pm.
134 H.R.H. Al-Absi et al.

3.2 Feature Extraction

After the images have been de-noised, a feature extraction process will be applied to
extract the most important features for image classification. Texture features will be
extracted here to obtain descriptors that can lead to better performance. It has been
proven that texture descriptors are more effective than shape descriptors in providing
more information of the images [26]. PCA-Wavelet technique will be used to extract
the features and to segment the image(s). The feature extraction process is conducted
in which 2D-Discrete wavelet transform decomposes an image to reduce its resolution
and then the PCA uses eigenfeatures to extract object features from the image [27].

3.3 Learning Algorithm

After the features extraction, the next step is to use these features as input to the
learning algorithm. The algorithm combines the strength of the three methodologies
to form a strong algorithm. The strengths include the optimization of GA, the learning
capability of ANN, and the uncertainty and imprecision tolerance of FL that will be
utilized in the learning of the ANN.
Since the system is expected to be able to retrain itself if it is not being able to
decide whether an image contains abnormalities or not, and since retraining the whole
network is time consuming and not practical, the network type that will be used in this
system must have some sort of memory that stores the output weights of the network
after training, which to be combined with the new data. Recurrent Neural Network
(RNN) [28] is a type of artificial neural networks that enclose a memory or a context
layer that memorizes / keeps the outputs weights of the hidden layer. The context
layer uses these weights as an input to the hidden layer after a period of time (small
delay in time) [28] this can be utilized to retrain the network once new data is
presented and a retraining of the system is needed.
In this hybrid system, the first step is selecting the most significant features out of a
huge number of features that were extracted. Genetic algorithm performs feature
selection in order to reduce the amount of features used to train the algorithm. In
addition to that, GA is used to optimize the initial weights of the neural network.
Although artificial neural networks capability in learning has made it applicable in
many applications, however, the network deals only with crisp values which make it
not suitable in application that are based on imprecision or uncertainty. For that, in
order to enhance the capability of ANN under uncertainty or partially truth situation,
it is combined with fuzzy logic to improve the performance. Fuzzy rules are
represented in if-then approach, e.g. they can be expressed in the form if x is A, then y
is B. The role of fuzzy here is to deal with uncertainty and imprecision and combine
those features with the learning ability of neural network. Therefore, by combining
these two methods in a medical imaging application (which has lots of uncertainties
due to the nature of images and information enclosed in them i.e. organs,
abnormalities...etc); the system would contribute to minimize errors and maximize the
diagnosis accuracy. On the other hand, in fuzzy logic, not all fuzzy rules would
contribute to the best results. Therefore, they need to be refined. For this, GA is used
to optimize the fuzzy rules by selecting the most significant rules making the
performance of the algorithm better. Figure 4 shows the learning algorithm using the
combined soft computing techniques of NN-FL-GA.
 Hybrid Intelligent System for Disease Diagnosis 135

Fig. 4. The components of the learning algorithm

4 Experiments

4.1 Experiments Set Up

For the purpose of evaluating the accuracy of the hybrid learning algorithm presented
in the preceding section, experiment was conducted using NeuroSolutions software to
test the algorithm. NeuroSolutions is a simulation environment that provides a
platform for the development of neural network applications.

Table 2. Sample data

Col1 Col2 Col3 Col4 Col5 Col6 Col7 Col8 Col9 Col10 Col11
63375 9 1 2 6 4 10 7 7 2 4
76389 10 4 7 2 2 8 6 1 1 4
95719 6 10 10 10 8 10 7 10 7 4
128059 1 1 1 1 2 5 5 1 1 2
142932 7 6 10 5 3 10 9 10 2 4
144888 8 10 10 8 5 10 7 8 1 4
145447 8 4 4 1 2 9 3 3 1 4
160296 5 8 8 10 5 10 8 10 3 4
167528 4 1 1 1 2 1 3 6 1 2
183913 1 2 2 1 2 1 1 1 1 2
136 H.R.H. Al-Absi et al.

A dataset of breast cancer developed by the University of Wisconsin Hospitals [29]

was utilized in this experiment. The dataset contains 699 instances with 10 attributes
for each instance. As shown in table 2, the first column in the dataset represents the
instance ID, the columns 2-10 represent the instances which have 2 possible outputs:
benign or malignant. Column 11 represent the desired outputs where 2 is for benign
and 4 for malignant.
In this test, three different experiments were performed with different methods
which are neural network with fuzzy logic, neural network with genetic algorithms
and the presented learning algorithm.

4.2 Experiments Results

The hybrid learning algorithm was built using the NeuroSolutions graphical interface
tool. All parts of the system were connected to form the learning algorithm for the
three methods experimented. Figure 5 illustrates the NeuroSolutions Breadboard of
the hybrid learning algorithm presented in this paper.

Fig. 5. The Hybrid method developmented on NeuroSolution simulation environment

To evaluate the hybrid learning algorithm and comparing it with other methods,
699 samples were used in each experiment, where 60 % is for training, 20% is for
cross validation and 20% for testing (139 samples). Table 3 reports the results
obtained from the experiments.
As shown in the table, the performance of the proposed method is better than the
neural network with fuzzy logic, however, neural network with genetic algorithm is
better than the hybrid method. This could be due to the amount of the sample data that
was used for the training phase. Neural network applications require large dataset for
the training phase to produce better performance and with the combination of the
three methodologies in a hybrid system, the sample data for training should be larger
than the data that was used in this experiment.
Generally, the performance reported in these experiments shows some evidences
that the hybrid system may perform better than other methods which were discussed
in the previous sections.
 Hybrid Intelligent System for Disease Diagnosis 137

Table 3. Results of the experiments on the breast cancer dataset

No. of Testing
Method samples Correct Incorrect Accuracy

Neural Network with Fuzzy

139 134 5 96.40
Logic

Neural Network with Genetic

139 136 3 97.84
Algorithms
Hybrid Method (Neural
Network, Fuzzy Logic and 139 135 4 97.12
Genetic Algorithm)

5 Conclusions and Future Work

This paper presents an architecture of a hybrid disease diagnosing system. The system
integrates soft computing methodologies (artificial neural networks, fuzzy logic and
genetic algorithms) to build the diagnostic software application. As shown in the
architecture, the system has a learning capability to accumulate knowledge, which can
be utilized in diagnosing new images. Currently, the system is in the design phase. An
experiment to evaluate the performance of the hybrid learning algorithm was carried
out, and the preliminary results suggest that it is performing better than other
methods. However, the results can be improved by testing the hybrid system with a
larger dataset and by fine tuning the NeuroSolutions breadboard of the hybrid
learning algorithm.
Future direction of this work includes implement and assess the whole components
of the system using benchmark data. This system is expected to contribute to the
advancement of automated healthcare system by providing accurate diagnoses of
illnesses and revealing the hidden/subtle regions that might contain cancerous cells.

Acknowledgement. The authors would like to thank the University of Wisconsin

Hospitals, Madison;Dr. William H. Wolberg for providing the breast cancer dataset
that was used in this work.

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