title: Simulation based analysis of automated, classification of medical images.
abstract: OBJECTIVE
  The ability of various classifiers to discriminate between normal and glaucomatous eyes based on features derived from automated analysis of laser scanning images of the eye background is investigated.
  
  
  METHODS
  To compare the classifiers without over-optimization for a given dataset, 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 same 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 Tomograph 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.
authors.affiliation: Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-University Erlangen-Nuremberg, Waldstrasse 6, 91054 Erlangen, Germany. Berthold.Lausen@rzmail.uni-erlangen.de
authors.forename: W
authors.initials: W
authors.lastname: Adler
authors.forename: T
authors.initials: T
authors.lastname: Hothorn
authors.forename: B
authors.initials: B
authors.lastname: Lausen
mesh_terms: D001331:Automation; D016022:Case-Control Studies; D003952:Diagnostic Imaging / Q000379:methods*; D005858:Germany; D005901:Glaucoma / Q000145:classification / Q000175:diagnosis; D006801:Humans; D018613:Microscopy, Confocal