Simulation based analysis of automated classification of medical images

Objectives: The ability of various classifiers to discriminate between normal and glaucomatous eyes based on features derived from automated analysis of loser scanning images of the eye background is investigated. Methods: To compare the classifiers without overoptimization for a given dotaset, we use a simulation model to create topography images. We designed three different simulation setups as model of extreme situations and medical subgroups. Results. Neither linear nor tree-based classifiers are ideal for all setups. The most robust performance is obtained by a combination of both, so-called Double-Bagging. Classification of real data from a case-control study shows best results with Double-Bagging. All results obtained with the analysis method extracting features automatically are worse than those obtained by the some classifiers but with features derived from an analysis method that requires intervention of a physician. Conclusions: Robust classification results for classification of laser scanning images obtained with the Heidelberg Retina TomogTaph are achieved by combined classifiers. The examined automated procedure causes an increased misclassification error compared to the established clinical routine requiring an expert physician's intervention.