Accurate Recognition of Pneumonia and COVID-19 by Geometric Shape Normalization of Lung Region using Automatic Landmark Detection and Piecewise Affine Warping

This paper presents an automatic system for recognizing pulmonary diseases in chest X-rays using geometric normalization of the lung region. The method combines three modules: (1) a ResNet-18 landmark detector with coordinate attention that predicts 15 lung-contour landmarks, achieving a mean localization error of 3.61 pixels through an ensemble of four models with test-time augmentation; (2) a geometric normalizer based on Generalized Procrustes Analysis, Delaunay triangulation, and piecewise affine warping to map each lung region to a standardized shape; and (3) a ResNet-18 classifier with transfer learning and SAHS contrast enhancement to classify images as COVID-19, Viral Pneumonia, or Normal. On the COVID-19 Radiography Database, the normalized-image classifier achieved 98.60+/-0.26% accuracy and 98.00% F1-Macro using five-fold cross-validation. Although original images produced slightly higher raw accuracy, Grad-CAM and cropping experiments suggest that this advantage is partly influenced by acquisition artifacts. In contrast, geometrically normalized images outperformed artifact-masked/cropped unaligned images on both the COVID-19 Radiography Database (98.60% vs. 96.24%) and a balanced adult-pediatric mixed dataset including pediatric cases from the Kermany dataset (94.67% vs. 94.17%). These results suggest that anatomical alignment can provide a more controlled and artifact-resistant representation for pulmonary disease recognition.