Diabetic foot ulcer segmentation using logistic regression, DBSCAN clustering and mathematical morphology operators

Digital images are used for evaluation and diagnosis of a diabetic foot ulcer. Selecting the wound region (segmentation) in an image is a preliminary step for subsequent analysis. Most of the time, manual segmentation isn't very reliable because specialists could have different opinions over the ulcer border. This fact encourages researchers to find and test different automatic segmentation techniques. This paper presents a computer-aided ulcer region segmentation algorithm for diabetic foot images. The proposed algorithm has two stages: ulcer region segmentation, and post-processing of segmentation results. For the first stage, a trained machine learning model was selected to classify pixels inside the ulcer's region, after a comparison of five learning models. Exhaustive experiments have been performed with our own annotated dataset from images of Cuban patients. The second stage is needed because of the presence of some misclassified pixels. To solve this, we applied the DBSCAN clustering algorithm, together with dilation, and closing morphological operators. The best-trained model after the post-processing stage was the logistic regressor (Jaccard Index $0.81$, accuracy $0.94$, recall $0.86$, precision $0.91$, and F1 score $0.88$). The trained model was sensitive to irrelevant objects in the scene, but the patient foot. Physicians found these results promising to measure the lesion area and to follow-up the ulcer healing process over treatments, reducing errors.