Tumor detection in T1, T2, FLAIR and MPR brain images using a combination of optimization and fuzzy clustering improved by seed‐based region growing algorithm

Tumor and Edema region present in Magnetic Resonance (MR) brain image can be segmented using Optimization and Clustering merged with seed‐based region growing algorithm. The proposed algorithm shows effectiveness in tumor detection in T1 ‐ w, T2 – w, Fluid Attenuated Inversion Recovery and Multiplanar Reconstruction type MR brain images. After an initial level segmentation exhibited by Modified Particle Swarm Optimization (MPSO) and Fuzzy C – Means (FCM) algorithm, the seed points are initialized using the region growing algorithm and based on these seed points; tumor detection in MR brain images is done. The parameters taken for comparison with the conventional techniques are Mean Square Error, Peak Signal to Noise Ratio, Jaccard (Tanimoto) index, Dice Overlap indices and Computational Time. These parameters prove the efficacy of the proposed algorithm. Heterogeneous type tumor regions present in the input MR brain images are segmented using the proposed algorithm. Furthermore, the algorithm shows augmentation in the process of brain tumor identification. Availability of gold standard images has led to the comparison of the suggested algorithm with MPSO‐based FCM and conventional Region Growing algorithm. Also, the algorithm recommended through this research is capable of producing Similarity Index value of 0.96, Overlap Fraction value of 0.97 and Extra Fraction value of 0.05, which are far better than the values articulated by MPSO‐based FCM and Region Growing algorithm. The proposed algorithm favors the segmentation of contrast enhanced images. © 2017 Wiley Periodicals, Inc. Int J Imaging Syst Technol, 27, 33–45, 2017     

Image registration-based brain tumor detection and segmentation using ANFIS classification approach

Abnormal cells in human brain lead to the development of tumors. Manual detection of this tumor region is a time-consuming process. Hence, this paper proposes an efficient and automated computer-aided methodology for brain tumor detection and segmentation using image registration technique and classification approaches. This proposed work consists of the following modules: image registration, contourlet transform, and feature extraction with feature normalization, classification, and segmentation. The extracted features are optimized using genetic algorithm, and then an adaptive neuro-fuzzy inference system classification approach is used to classify the features for the detection and segmentation of tumor regions in brain magnetic resonance imaging. A quantitative analysis is performed to evaluate the proposed methodology for brain tumor detection using sensitivity, specificity, segmentation accuracy, precision, and Dice similarity coefficient.     

Performance analysis of brain tissues and tumor detection and grading system using ANFIS classifier

Abnormal growth of cells in brain leads to the formation of tumors, which are categorized into benign and malignant. In this article, Co‐Active Adaptive Neuro Fuzzy Inference System (CANFIS) classification based brain tumor detection and its grading system is proposed. It has two phases as brain tumor segmentation and brain tissue segmentation. In brain tumor segmentation, CANFIS classifier is used to classify the test brain image into benign or malignant. Then, morphological operations are applied over the malignant image in order to segment the tumor regions in brain image. The K‐means classifier is used to classify the brain tissues into Grey Matter (GM), White Matter (WM) and Cerebro Spinal Fluid (CSF) regions as three different classes. Next, the segmented tumor is graded as mild, moderate or severe based on the presence of segmented tumor region in brain tissues.     

A fully automated hybrid methodology using Cuckoo‐based fuzzy clustering technique for magnetic resonance brain image segmentation

This article aims at developing an automated hybrid algorithm using Cuckoo Based Search (CBS) and interval type‐2 fuzzy based clustering, so as to exhibit efficient magnetic resonance (MR) brain image segmentation. An automatic MR brain image segmentation facilitates and enables a radiologist to have a brief review and easy analysis of complicated tumor regions of imprecise gray level regions with minimal user interface. The tumor region having severe intensity variations and suffering from poor boundaries are to be detected by the proposed hybrid technique that could ease the process of clinical diagnosis and this tends to be the core subject of this article. The ability of the proposed technique is compared using standard comparison parameters such as mean squared error, peak signal to noise ratio, computational time, Dice Overlap Index, and Jaccard T animoto C oefficient Index. The proposed CBS combined with interval type‐2 fuzzy based clustering produces a sensitivity of 0.7143 and specificity of 0.9375, which are far better than the conventional techniques such as kernel based, entropy based, graph‐cut based, and self‐organizing maps based clustering. Appreciable segmentation results of tumor region that enhances clinical diagnosis is made available through this article and two of the radiologists who have hands on experience in the field of radiology have extended their support in validating the efficiency of the proposed methodology and have given their consent in utilizing the proposed methodology in the processes of clinical oncology.     

Detection and diagnosis of meningioma brain tumor using ANFIS classifier

Tumors are formed in brain due to the uncontrolled development of cells. These tumors can be cured if it is timely detected and by proper medication. This article proposes a computer‐aided automatic detection and diagnosis of meningioma brain tumors in brain images using Adaptive Neuro Fuzzy Inference System (ANFIS) classifier. The proposed system consists of feature extraction, classification, and segmentation and diagnosis sections. In this article, Grey level Co‐occurrence Matric (GLCM) and Grid features are extracted from the brain image and these features are classified using ANFIS classifier into normal or abnormal. Then, morphological operations are used to segment the abnormal regions in brain image. Based on the location of these abnormal regions in brain tissues, the segmented tumor regions are diagnosed.     

Fully automatic method for segmentation of brain tumor from multimodal magnetic resonance images using wavelet transformation and clustering technique

Fully automatic brain tumor segmentation is one of the critical tasks in magnetic resonance imaging (MRI) images. This proposed work is aimed to develop an automatic method for brain tumor segmentation process by wavelet transformation and clustering technique. The proposed method using discrete wavelet transform (DWT) for pre‐ and post‐processing, fuzzy c‐means (FCM) for brain tissues segmentation. Initially, MRI images are preprocessed by DWT to sharpen the images and enhance the tumor region. It assists to quicken the FCM clustering technique and classified into four major classes: gray matter (GM), white matter (WM), cerebrospinal fluid (CSF), and background (BG). Then check the abnormality detection using Fuzzy symmetric measure for GM, WM, and CSF classes. Finally, DWT method is applied in segmented abnormal region of images respectively and extracts the tumor portion. The proposed method used 30 multimodal MRI training datasets from BraTS2012 database. Several quantitative measures were calculated and compared with the existing. The proposed method yielded the mean value of similarity index as 0.73 for complete tumor, 0.53 for core tumor, and 0.35 for enhancing tumor. The proposed method gives better results than the existing challenging methods over the publicly available training dataset from MICCAI multimodal brain tumor segmentation challenge and a minimum processing time for tumor segmentation. © 2016 Wiley Periodicals, Inc. Int J Imaging Syst Technol, 26, 305–314, 2016     

CANFIS based glioma brain tumor classification and retrieval system for tumor diagnosis

Brain tumor classification and retrieval system plays an important role in medical field. In this paper, an efficient Glioma Brain Tumor detection and its retrieval system is proposed. The proposed methodology consists of two modules as classification and retrieval. The classification modules are designed using preprocessing, feature extraction and tumor detection techniques using Co‐Active Adaptive Neuro Fuzzy Inference System (CANFIS) classifier. The image enhancement can be achieved using Heuristic histogram equalization technique as preprocessing and further texture features as Local Ternary Pattern (LTP) features and Grey Level Co‐occurrence Matrix (GLCM) features are extracted from the enhanced image. These features are used to classify the brain image into normal and abnormal using CANFIS classifier. The tumor region in abnormal brain image is segmented using normalized graph cut segmentation algorithm. The retrieval module is used to retrieve the similar segmented tumor regions from the dataset for diagnosing the tumor region using Euclidean algorithm. The proposed Glioma Brain tumor classification methodology achieves 97.28% sensitivity, 98.16% specificity and 99.14% accuracy. The proposed retrieval system achieves 97.29% precision and 98.16% recall rate with respect to ground truth images.     

Robust brain MRI denoising and segmentation using enhanced non‐local means algorithm

Image denoising is an integral component of many practical medical systems. Non‐local means (NLM) is an effective method for image denoising which exploits the inherent structural redundancy present in images. Improved adaptive non‐local means (IANLM) is an improved variant of classical NLM based on a robust threshold criterion. In this paper, we have proposed an enhanced non‐local means (ENLM) algorithm, for application to brain MRI, by introducing several extensions to the IANLM algorithm. First, a Rician bias correction method is applied for adapting the IANLM algorithm to Rician noise in MR images. Second, a selective median filtering procedure based on fuzzy c‐means algorithm is proposed as a postprocessing step, in order to further improve the quality of IANLM‐filtered image. Third, different parameters of the proposed ENLM algorithm are optimized for application to brain MR images. Different variants of the proposed algorithm have been presented in order to investigate the influence of the proposed modifications. The proposed variants have been validated on both T1‐weighted (T1‐w) and T2‐weighted (T2‐w) simulated and real brain MRI. Compared with other denoising methods, superior quantitative and qualitative denoising results have been obtained for the proposed algorithm. Additionally, the proposed algorithm has been applied to T2‐weighted brain MRI with multiple sclerosis lesion to show its superior capability of preserving pathologically significant information. Finally, impact of the proposed algorithm has been tested on segmentation of brain MRI. Quantitative and qualitative segmentation results verify that the proposed algorithm based segmentation is better compared with segmentation produced by other contemporary techniques.     

Unsupervised tissue classification of brain MR images for voxel‐based morphometry analysis

In this article, a fully unsupervised method for brain tissue segmentation of T1‐weighted MRI 3D volumes is proposed. The method uses the Fuzzy C‐Means (FCM) clustering algorithm and a Fully Connected Cascade Neural Network (FCCNN) classifier. Traditional manual segmentation methods require neuro‐radiological expertise and significant time while semiautomatic methods depend on parameter's setup and trial‐and‐error methodologies that may lead to high intraoperator/interoperator variability. The proposed method selects the most useful MRI data according to FCM fuzziness values and trains the FCCNN to learn to classify brain’ tissues into White Matter, Gray Matter, and Cerebro‐Spinal Fluid in an unsupervised way. The method has been tested on the IBSR dataset, on the BrainWeb Phantom, on the BrainWeb SBD dataset, and on the real dataset “University of Palermo Policlinico Hospital” (UPPH), Italy. Sensitivity, Specificity, Dice and F‐Factor scores have been calculated on the IBSR and BrainWeb datasets segmented using the proposed method, the FCM algorithm, and two state‐of‐the‐art brain segmentation software packages (FSL and SPM) to prove the effectiveness of the proposed approach. A qualitative evaluation involving a group of five expert radiologists has been performed segmenting the real dataset using the proposed approach and the comparison algorithms. Finally, a usability analysis on the proposed method and reference methods has been carried out from the same group of expert radiologists. The achieved results show that the segmentations of the proposed method are comparable or better than the reference methods with a better usability and degree of acceptance.     

NeXt for neuro‐radiosurgery: A fully automatic approach for necrosis extraction in brain tumor MRI using an unsupervised machine learning technique

Stereotactic neuro‐radiosurgery is a well‐established therapy for intracranial diseases, especially brain metastases and highly invasive cancers that are difficult to treat with conventional surgery or radiotherapy. Nowadays, magnetic resonance imaging (MRI) is the most used modality in radiation therapy for soft‐tissue anatomical districts, allowing for an accurate gross tumor volume (GTV) segmentation. Investigating also necrotic material within the whole tumor has significant clinical value in treatment planning and cancer progression assessment. These pathological necrotic regions are generally characterized by hypoxia, which is implicated in several aspects of tumor development and growth. Therefore, particular attention must be deserved to these hypoxic areas that could lead to recurrent cancers and resistance to therapeutic damage. This article proposes a novel fully automatic method for necrosis extraction (NeXt), using the Fuzzy C‐Means algorithm, after the GTV segmentation. This unsupervised Machine Learning technique detects and delineates the necrotic regions also in heterogeneous cancers. The overall processing pipeline is an integrated two‐stage segmentation approach useful to support neuro‐radiosurgery. NeXt can be exploited for dose escalation, allowing for a more selective strategy to increase radiation dose in hypoxic radioresistant areas. Moreover, NeXt analyzes contrast‐enhanced T1‐weighted MR images alone and does not require multispectral MRI data, representing a clinically feasible solution. This study considers an MRI dataset composed of 32 brain metastatic cancers, wherein 20 tumors present necroses. The segmentation accuracy of NeXt was evaluated using both spatial overlap‐based and distance‐based metrics, achieving these average values: Dice similarity coefficient 95.93% ± 4.23% and mean absolute distance 0.225 ± 0.229 (pixels).     

MRI brain image classification—a hybrid approach

The present article proposes a novel computer‐aided diagnosis (CAD) technique for the classification of the magnetic resonance brain images. The current method adopt color converted hybrid clustering segmentation algorithm with hybrid feature selection approach based on IGSFFS (Information gain and Sequential Forward Floating Search) and Multi‐Class Support Vector Machine (MC‐SVM) classifier technique to segregate the magnetic resonance brain images into three categories namely normal, benign and malignant. The proposed hybrid evolutionary segmentation algorithm which is the combination of WFF(weighted firefly) and K‐means algorithm called WFF‐K‐means and modified cuckoo search (MCS) and K‐means algorithm called MCS‐K‐means, which can find better cluster partition in brain tumor datasets and also overcome local optima problems in K‐means clustering algorithm. The experimental results show that the performance of the proposed algorithm is better than other algorithms such as PSO‐K‐means, color converted K‐means, FCM and other traditional approaches. The multiple feature set comprises color, texture and shape features derived from the segmented image. These features are then fed into a MC‐SVM classifier with hybrid feature selection algorithm, trained with data labeled by experts, enabling the detection of brain images at high accuracy levels. The performance of the method is evaluated using classification accuracy, sensitivity, specificity, and receiver operating characteristic (ROC) curves. The proposed method provides highest classification accuracy of greater than 98% with high sensitivity and specificity rates of greater than 95% for the proposed diagnostic model and this shows the promise of the approach. © 2015 Wiley Periodicals, Inc. Int J Imaging Syst Technol, 25, 226–244, 2015     

A deep learning model integrating convolution neural network and multiple kernel K means clustering for segmenting brain tumor in magnetic resonance images

In medical imaging, segmenting brain tumor becomes a vital task, and it provides a way for early diagnosis and treatment. Manual segmentation of brain tumor in magnetic resonance (MR) images is a time‐consuming and challenging task. Hence, there is a need for a computer‐aided brain tumor segmentation approach. Using deep learning algorithms, a robust brain tumor segmentation approach is implemented by integrating convolution neural network (CNN) and multiple kernel K means clustering (MKKMC). In this proposed CNN‐MKKMC approach, classification of MR images into normal and abnormal is performed by CNN algorithm. At next, MKKMC algorithm is employed to segment the brain tumor from the abnormal brain image. The proposed CNN‐MKKMC algorithm is evaluated both visually and objectively in terms of accuracy, sensitivity, and specificity with the existing segmentation methods. The experimental results demonstrate that the proposed CNN‐MKKMC approach yields better accuracy in segmenting brain tumor with less time cost.     

Enhancing level set brain tumor segmentation using fuzzy shape prior information and deep learning

Magnetic resonance imaging (MRI) brain tumor segmentation is a crucial task for clinical treatment. However, it is challenging owing to variations in type, size, and location of tumors. In addition, anatomical variation in individuals, intensity non-uniformity, and noises adversely affect brain tumor segmentation. To address these challenges, an automatic region-based brain tumor segmentation approach is presented in this paper which combines fuzzy shape prior term and deep learning. We define a new energy function in which an Adaptively Regularized Kernel-Based Fuzzy C-Means (ARKFCM) Clustering algorithm is utilized for inferring the shape of the tumor to be embedded into the level set method. In this way, some shortcomings of traditional level set methods such as contour leakage and shrinkage have been eliminated. Moreover, a fully automated method is achieved by using U-Net to obtain the initial contour, reducing sensitivity to initial contour selection. The proposed method is validated on the BraTS 2017 benchmark dataset for brain tumor segmentation. Average values of Dice, Jaccard, Sensitivity and specificity are 0.93 ± 0.03, 0.86 ± 0.06, 0.95 ± 0.04, and 0.99 ± 0.003, respectively. Experimental results indicate that the proposed method outperforms the other state-of-the-art methods in brain tumor segmentation.     

Edge detection using Chebyshev's orthogonal polynomial and brain extraction from magnetic resonance images of human head

In this article, we propose a new edge detecting method based on the transform coefficients obtained by a point spread function constructed out of Chebyshev's orthogonal polynomials. This edge detector finds edges similar to that of Prewitt and Roberts but is robust against additive and multiplicative noises. We also propose a new scheme to extract brain portion from the magnetic resonance images (MRI) of human head scan by making use of the of the new edge detector. The proposed scheme involves edge detection, morphological operations, and largest connected component analysis. Experiments conducted by applying the proposed scheme on 19 volumes of MRI collected from Internet Brain Segmentation Repository (IBSR) show that the proposed brain extraction scheme performed better than the popular Brain Extraction Tool (BET). The performance of the proposed scheme is measured by computing the Dice coefficient (D) and Jaccard similarity index (J). The proposed method produced a value of 0.9068 for D and 0.8321 for J.     

Brain Tumor Segmentation in Multimodal MRI Using U-Net Layered Structure

The brain tumour is the mass where some tissues become old or damaged, but they do not die or not leave their space. Mainly brain tumour masses occur due to malignant masses. These tissues must die so that new tissues are allowed to be born and take their place. Tumour segmentation is a complex and time-taking problem due to the tumour’s size, shape, and appearance variation. Manually finding such masses in the brain by analyzing Magnetic Resonance Images (MRI) is a crucial task for experts and radiologists. Radiologists could not work for large volume images simultaneously, and many errors occurred due to overwhelming image analysis. The main objective of this research study is the segmentation of tumors in brain MRI images with the help of digital image processing and deep learning approaches. This research study proposed an automatic model for tumor segmentation in MRI images. The proposed model has a few significant steps, which first apply the pre-processing method for the whole dataset to convert Neuroimaging Informatics Technology Initiative (NIFTI) volumes into the 3D NumPy array. In the second step, the proposed model adopts U-Net deep learning segmentation algorithm with an improved layered structure and sets the updated parameters. In the third step, the proposed model uses state-of-the-art Medical Image Computing and Computer-Assisted Intervention (MICCAI) BRATS 2018 dataset with MRI modalities such as T1, T1Gd, T2, and Fluid-attenuated inversion recovery (FLAIR). Tumour types in MRI images are classified according to the tumour masses. Labelling of these masses carried by state-of-the-art approaches such that the first is enhancing tumour (label 4), edema (label 2), necrotic and non-enhancing tumour core (label 1), and the remaining region is label 0 such that edema (whole tumour), necrosis and active. The proposed model is evaluated and gets the Dice Coefficient (DSC) value for High-grade glioma (HGG) volumes for their test set-a, test set-b, and test set-c 0.9795, 0.9855 and 0.9793, respectively. DSC value for the Low-grade glioma (LGG) volumes for the test set is 0.9950, which shows the proposed model has achieved significant results in segmenting the tumour in MRI using deep learning approaches. The proposed model is fully automatic that can implement in clinics where human experts consume maximum time to identify the tumorous region of the brain MRI. The proposed model can help in a way it can proceed rapidly by treating the tumor segmentation in MRI.     

Multi‐modal brain tumor image segmentation based on SDAE

Accurate tumor segmentation has the ability to provide doctors with a basis for surgical planning. Moreover, brain tumor segmentation needs to extract different tumor tissues (Edema, tumor, tumor enhancement, and necrosis) from normal tissues which is a big challenge because tumor structures vary considerably across patients in terms of size, extension, and localization. In this article, we evaluate a fully automated method for segmenting brain tumor images from multi‐modal magnetic resonance imaging volumes based on stacked de‐noising auto‐encoders (SDAEs). Specially, we adopted multi‐modality information from T1, T1c, T2, and Flair images, respectively. We extracted gray level patches from different modalities as the input of the SDAE. After trained by the SDAE, the raw network parameters will be obtained, which are adopted as a parameter of the feed forward neural network for classification. A simple post‐processing is implemented by threshold segmentation method to generate a mask to get the final segmentation result. By evaluating the proposed method on the BRATS 2015, it can be proven that our method obtains the better performance than other state‐of‐the‐art counterpart methods. And a preliminary dice score of 0.86 for whole tumor segmentation has been achieved.     

Segmentation of tumor using PCA based modified fuzzy C means algorithms on MR brain images

In the field of medical sciences, automatic detection of tumor using magnetic resonance (MR) brain images is a major research area. The goal of the proposed work is to identify the tumors in MR images using segmentation methods and to locate the affected regions of the brain more accurately. Medical images have vast information but they are difficult to examine with lesser computational time. An innovative process is proposed to extract tumor cells using the discrete wavelet transform (DWT). After extracting features with DWT feature reduction is carried out with the principal component analysis (PCA). Modified fuzzy C means (MFCM) technique is used for segmenting the tumor cells. The efficiency of the proposed method to identify different abnormalities in real MR images for intracranial neoplasm detection, tuberculoma, and bilateral thalamic fungal granulomas identification is tested. The results obtained are shown in-terms of Accuracy, Dice Similarity Index (DSI), and Jaccard Index (JI) measures. The performance of the proposed method is tested in terms of performance measures like Accuracy, DSI, and JI. These results are compared with the conventional fuzzy C means (FCM) method.     

Performance analysis of computer aided brain tumor detection system using ANFIS classifier

The abrupt changes in brain cells due to the environmental effects or genetic disorders leads to form the abnormal lesions in brain. These abnormal lesions are combined as mass and known as tumor. The detection of these tumor cells in brain image is a complex task due to the similarities between normal cells and tumor cells. In this paper, an automated brain tumor detection and segmentation methodology is proposed. The proposed method consists of feature extraction, classification and segmentation. In this paper, Grey Level Co‐Occurrence Matrix (GLCM), Discrete Wavelet Transform (DWT) and Law's texture features are used as features. These features are fed to Adaptive Neuro Fuzzy Inference System (ANFIS) classifier as input pattern, which classifies the brain image. Morphological operations are now applied on the classified abnormal brain image to segment the tumor regions. The proposed system achieves 95.07% of sensitivity, 99.84% of specificity and 99.80% of accuracy for tumor segmentation.     

An efficient approach for brain image (tissue) compression based on the position of the brain tumor

Medical image processing plays an important role in brain tissue detection and segmentation. In this paper, a computer aided detection of brain tissue compression based on the estimation of the location of the brain tumor. The proposed system detects and segments the brain tissues and brain tumor using mathematical morphological operations. Further, the brain tissue with tumor is compressed using lossless compression technique and the brain tissue without tumor is compressed using lossy compression technique. The proposed method achieves 96.46% sensitivity, 99.20% specificity and 98.73% accuracy for the segmentation of white matter regions from the brain. The proposed method achieves 98.16% sensitivity, 99.36% specificity and 98.78% accuracy for the segmentation of cerebrospinal fluid (CSF) regions from the brain and also achieves 93.07% sensitivity, 98.79% specificity and 97.63% accuracy for the segmentation of grey matter regions from the brain. This paper focus the brain tissue compression based on the location of brain tumor. The grey matter of the brain is applied to lossless compression due to the presence of the tumor in grey matter of the brain. The proposed system achieves 29.23% of compression ratio for compressing the grey matter of the brain region. The white matter and CSF regions of the brain are applied to lossy compression due to the non‐presence of the tumor. The proposed system achieves 39.13% of compression ratio for compressing the white matter and also achieves 37.5% of compression ratio for compressing the CSF tissue. © 2016 Wiley Periodicals, Inc. Int J Imaging Syst Technol, 26, 237–242, 2016     

Automatic liver tumor segmentation on multiphase computed tomography volume using SegNet deep neural network and K-means clustering

Liver and liver tumor segmentations are essential in computer-aided systems for diagnosing liver tumors. These systems must operate on multiphase computed tomography (CT) images instead of a single phase for accurate diagnosis for clinical applications. We have proposed a framework that can perform segmentation from quadriphasic CT data. The liver was segmented using a fine-tuned SegNet model and the liver tumor was segmented using the K-means clustering method coupled with a power-law transformation-based image enhancement technique. The best values for liver segmentation achieved were: Dice Coefficient = 96.46 ± 0.48%, Jaccard Index = 93.16 ± 0.89%, volumetric overlap error = 6.84 ± 0.89% and average symmetric surface distance = 0.59 ± 0.3 mm and the results for liver tumor delineation were Dice Coefficient = 85.07 ± 4.5%, Jaccard Index = 74.29 ± 6.8%, volumetric overlap error = 25.71 ± 6.8% and average symmetric surface distance = 1.14 ± 1.3 mm. The proposed liver segmentation method based on deep learning is fully automatic, robust, and effective for all phases. The image enhancement technique has shown promising results and aided in better liver tumor segmentation. The liver tumors were segmented satisfactorily; however, improvements concerning false positive reduction can further increase the accuracy.