Improving Medical X-ray Imaging Diagnosis with Attention Mechanisms and Robust Transfer Learning Techniques

Article

Abdulla, S., Das, I., Sheakh, M.A., Tahosin, M.S., Bhuiyan, M., Zaman, S. and Shukla, A.. 2025. "Improving Medical X-ray Imaging Diagnosis with Attention Mechanisms and Robust Transfer Learning Techniques ." IEEE Access. 11, pp. 1-26. https://doi.org/10.1109/ACCESS.2025.3607639
Article Title

Improving Medical X-ray Imaging Diagnosis with Attention Mechanisms and Robust Transfer Learning Techniques

ERA Journal ID210567
Article CategoryArticle
AuthorsAbdulla, S., Das, I., Sheakh, M.A., Tahosin, M.S., Bhuiyan, M., Zaman, S. and Shukla, A.
Journal TitleIEEE Access
Journal Citation11, pp. 1-26
Article Number2169-3536
Number of Pages26
Year2025
PublisherIEEE (Institute of Electrical and Electronics Engineers)
Place of PublicationIEEE
ISSN2169-3536
Digital Object Identifier (DOI)https://doi.org/10.1109/ACCESS.2025.3607639
Web Address (URL)https://ieeexplore.ieee.org/document/11153815?source=AUTHORALERT&dld=dXNxLmVkdS5hdQ%3D%3D
Abstract

ABSTRACT
X-ray imaging remains a cornerstone in medical diagnostics for conditions such as bone fractures, knee osteoarthritis, and lung diseases. However, variability in image quality and dataset diversity presents significant
challenges for automated analysis using deep learning models. This study addresses these issues by proposing
an EfficientNet B0 architecture enhanced with a Convolutional Block Attention Module (CBAM) to improve
classification accuracy and interpretability across multiple X-ray datasets: FracAtlas, Knee, and Lung Xray. A robust preprocessing pipeline comprising LAB color space conversion, morphological filtering,
gamma correction, Non-Local Means denoising, resizing, and normalization was applied to optimize image
quality, with each step’s effectiveness verified through established image quality metrics. Additionally,
geometric augmentation techniques were performed to increase dataset variability and improve model
generalization. Comparative experiments with transfer learning, transformer-based, and attention-based
models identified the attention-based EfficientNet B0 as the best performer. An extensive ablation study on
the Knee X-ray dataset refined hyperparameters to maximize performance. The optimized model achieved
high test accuracies of 98.09%, 97.12%, and 99.51% on FracAtlas, Knee, and Lung datasets, respectively.
Further analyses, including noise robustness testing, k-fold cross-validation, and Grad-CAM visualization,
demonstrated the model’s resilience, consistency, and explainability. The findings highlight the critical
role of attention mechanisms in enhancing feature representation and generalization across heterogeneous
medical imaging tasks. This work lays a foundation for reliable, interpretable AI systems that can support
clinical decision-making, with future efforts focusing on expanding dataset diversity and real-world clinical
validation to accelerate adoption.

KeywordsX-ray image classification, transfer learning, attention mechanism, medical image analysis, explainable AI
Article Publishing Charge (APC) FundingResearcher
Contains Sensitive ContentDoes not contain sensitive content
ANZSRC Field of Research 2020420308. Health informatics and information systems
Byline AffiliationsUniSQ College (English Language)
UniSQ College
Chittagong University of Engineering and Technology, Bangladesh
Daffodil International University, Bangladesh
University of South Australia
Khulna University of Engineering and Technology, Bangladesh
Khulna University, Bangladesh
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EEG sleep stages identification based on weighted undirected complex networks
Diykh, Mohammed, Li, Yan and Abdulla, Shahab. 2020. "EEG sleep stages identification based on weighted undirected complex networks." Computer Methods and Programs in Biomedicine. 184, pp. 1-14. https://doi.org/10.1016/j.cmpb.2019.105116
Fractal dimension undirected correlation graph-based support vector machine model for identification of focal and non-focal electroencephalography signals
Diykh, Mohammed, Abdulla, Shahab, Saleh, Khalid and Deo, Ravinesh C.. 2019. "Fractal dimension undirected correlation graph-based support vector machine model for identification of focal and non-focal electroencephalography signals." Biomedical Signal Processing and Control. 54, pp. 1-10. https://doi.org/10.1016/j.bspc.2019.101611
Sleep EEG signal analysis based on correlation graph similarity coupled with an ensemble extreme machine learning algorithm
Abdulla, Shahab, Diykh, Mohammed, Lafta, Raid Luaibi, Saleh, Khalid and Deo, Ravinesh C.. 2019. "Sleep EEG signal analysis based on correlation graph similarity coupled with an ensemble extreme machine learning algorithm." Expert Systems with Applications. 138, pp. 1-15. https://doi.org/10.1016/j.eswa.2019.07.007
An Efficient Texture Descriptor for the Detection of License Plates From Vehicle Images in Difficult Conditions
Al-Shemarry, Meeras Salman, Li, Yan and Abdulla, Shahab. 2020. "An Efficient Texture Descriptor for the Detection of License Plates From Vehicle Images in Difficult Conditions." IEEE Transactions on Intelligent Transportation Systems. 21 (2), pp. 553-564. https://doi.org/10.1109/TITS.2019.2897990
A feature extraction technique based on tunable Q-factor wavelet transform for brain signal classification
Al Ghayab, Hadi Ratham, Li, Yan, Siuly, S. and Abdulla, Shahab. 2019. "A feature extraction technique based on tunable Q-factor wavelet transform for brain signal classification." Journal of Neuroscience Methods. 312, pp. 43-52. https://doi.org/10.1016/j.jneumeth.2018.11.014
A new approach to spread-spectrum OFDM
Alhasnawi, Mohammad Kaisb Layous, Addie, Ronald G. and Abdulla, Shahab. 2018. "A new approach to spread-spectrum OFDM." 15th International Joint Conference on e-Business and Telecommunications (ICETE 2018) - Volume 1: DCNET, ICE-B, OPTICS, SIGMAP and WINSYS. Porto, Portugal 26 - 28 Jul 2018 https://doi.org/10.5220/0006828602810288
Epileptic seizures detection in EEGs blending frequency domain with information gain technique
Al Ghayab, Hadi Ratham, Li, Yan, Siuly, Siuly and Abdulla, Shahab. 2019. "Epileptic seizures detection in EEGs blending frequency domain with information gain technique." Soft Computing. 23 (1), pp. 227-239. https://doi.org/10.1007/s00500-018-3487-0
Epileptic EEG signal classification using optimum allocation based power spectral density estimation
Al Ghayab, Hadi Ratham, Li, Yan, Siuly, Siuly and Abdulla, Shahab. 2018. "Epileptic EEG signal classification using optimum allocation based power spectral density estimation." IET Signal Processing. 12 (6), pp. 738-747. https://doi.org/10.1049/iet-spr.2017.0140
The perceived public value of social media in Queensland local Councils
Attiya, Ahmed Muyed, Cater-Steel, Aileen, Soar, Jeffrey and Abdulla, Shahab. 2017. "The perceived public value of social media in Queensland local Councils." Riemer, Kai, Indulska, Marta and Tuunainen, Virpi Kristiina (ed.) 28th Australasian Conference on Information Systems (ACIS 2017). Hobart, Australia 04 - 06 Dec 2017 Hobart, Australia.
Developing a tunable Q-factor wavelet transform based algorithm for epileptic EEG feature extraction
Al Ghayab, Hadi Ratham, Li, Yan, Siuly, Siuly, Abdulla, Shahab and Wen, Paul. 2017. "Developing a tunable Q-factor wavelet transform based algorithm for epileptic EEG feature extraction." Siuly, Siuly, Huang, Zhisheng, Aickelin, Uwe, Zhou, Rui, Wang, Hua, Zhang, Yanchun and Klimenko, Stanislav (ed.) 6th International Conference on Health Information Science (HIS 2017). Moscow, Russian Federation 07 - 09 Oct 2017 Germany. https://doi.org/10.1007/978-3-319-69182-4_6
Nursing students’ readiness for the numeracy needs of their program: students’ perspective
Galligan, Linda, Frederiks, Anita, Wandel, Andrew P., Robinson, Clare, Abdulla, Shahab and Hussain, Zanubia. 2017. "Nursing students’ readiness for the numeracy needs of their program: students’ perspective." Adults Learning Mathematics: An International Journal. 12 (1), pp. 27-38.
Person identification by gait analysis using photogrammetry techniques and foot pressure sensing matt
Majeed, Ammar, Chong, Albert K. and Abdulla, Shahab. 2017. "Person identification by gait analysis using photogrammetry techniques and foot pressure sensing matt." Al-Jumaily, Adel Ali, Barifcani, Ahmed and Al-Jumaily, Ahmed (ed.) 1st MoHESR and HCED Iraqi Scholars Conference in Australasia 2017 (ISCA 2017). Melbourne, Australia 05 - 06 Dec 2017 Melbourne, Australia.
Ensemble of adaboost cascades of 3L-LBPs classifiers for license plates detection with low quality images
Al-Shemarry, Meeras Salman, Li, Yan and Abdulla, Shahab. 2018. "Ensemble of adaboost cascades of 3L-LBPs classifiers for license plates detection with low quality images." Expert Systems with Applications. 92, pp. 216-235. https://doi.org/10.1016/j.eswa.2017.09.036
Robust internal model control for depth of anaesthesia
Abdulla, Shahab Anna and Wen, Peng. 2011. "Robust internal model control for depth of anaesthesia." International Journal of Mechatronics and Automation. 1 (1), pp. 1-8. https://doi.org/10.1504/IJMA.2011.039150
Depth of anaesthesia patient models and control
Abdulla, Shahab and Wen, Peng. 2011. "Depth of anaesthesia patient models and control." Guo, Shuxiang, Touge, Tetsuo and Xiufen, Ye (ed.) 2011 IEEE/ICME International Conference on Complex Medical Engineering (ICME 2011). Harbin, China 22 - 25 May 2011 United States. https://doi.org/10.1109/ICCME.2011.5876701
Classification of epileptic EEG signals based on simple random sampling and sequential feature selection
Al Ghayab, Hadi, Li, Yan, Abdulla, Shahab, Diykh, Mohammed and Wan, Xiangkui. 2016. "Classification of epileptic EEG signals based on simple random sampling and sequential feature selection." Brain Informatics. 3 (2), pp. 85-91. https://doi.org/10.1007/s40708-016-0039-1
Students' mathematical preparation: differences in staff and student perceptions
Wandel, Andrew P., Robinson, Clare, Abdulla, Shahab, Dalby, Tim, Frederiks, Anita and Galligan, Linda. 2015. "Students' mathematical preparation: differences in staff and student perceptions." International Journal of Innovation in Science and Mathematics Education. 23 (1), pp. 82-93.
Students' mathematical preparation Part A: lecturers' perceptions
Galligan, Linda, Wandel, Andrew, Pigozzo, Robyn, Frederiks, Anita, Robinson, Clare, Abdulla, Shahab and Dalby, Tim. 2013. "Students' mathematical preparation Part A: lecturers' perceptions." Deborah, King, Birgit, Loch and Leanne, Rylands (ed.) 9th Delta Conference of Teaching and Learning of Undergraduate Mathematics and Statistics 2013: Shining Through the Fog. Kiama, Australia 24 - 29 Nov 2013 Sydney, Australia.
Students' mathematical preparation Part B: students' perceptions
Dalby, Tim, Robinson, Clare, Abdulla, Shahab, Galligan, Linda, Frederiks, Anita, Pigozzo, Robyn and Wandel, Andrew. 2013. "Students' mathematical preparation Part B: students' perceptions." King, Deborah, Loch, Birgit and Rylands, Leanne (ed.) 9th Delta Conference of Teaching and Learning of Undergraduate Mathematics and Statistics 2013: Shining Through the Fog. Kiama, Australia 24 - 29 Nov 2013 Sydney, Australia.
Model based predictive control of depth of anaesthesia
Abdulla, Shahab, Wen, Peng, Zude, Zhou and Quan, Liu. 2012. "Model based predictive control of depth of anaesthesia." Chih-Hsing, Chu, Smith, Shana and Hong, Hocheng (ed.) 2012 International Conference on Innovative Design and Manufacturing (ICIDM 2012). Taipei, Taiwan 12 - 14 Dec 2012 Taiwan.
The effects of time-delay on feedback control of depth of anesthesia
Abdulla, Shahab A. and Wen, Peng. 2012. "The effects of time-delay on feedback control of depth of anesthesia." Zhang, Yuan-Ting, Naghavi, Morteza, Bonato, Paolo and Carmen, C. Y. Poon (ed.) 2012 IEEE-EMBS International Conference on Biomedical and Health Informatics: Global Grand Challenge of Health Informatics (BHI 2012). Hong Kong and Shenzhen, China 02 - 07 Jan 2012 Hong Kong, China. https://doi.org/10.1109/BHI.2012.6211747
Depth of anaesthesia control investigation using robust deadbeat control technique
Abdulla, Shahab and Wen, Peng. 2012. "Depth of anaesthesia control investigation using robust deadbeat control technique." Tetsuo, Kobayashi, Tetsuo, Touge, Hisao, Tachibana and Jinglong, Wu (ed.) 2012 International Conference on Complex Medical Engineering (ICME 2012). Kobe, Japan 01 - 04 Jul 2012 Piscataway, NJ. United States. https://doi.org/10.1109/ICCME.2012.6275636
Depth of anaesthesia control techniques and human body models
Abdulla, Shahab Anna. 2012. Depth of anaesthesia control techniques and human body models. PhD Thesis Doctor of Philosophy. University of Southern Queensland.
Convection drying process modeling and simulation study based on tomato
Shahab, Anna, Wen, Peng and Richard, George. 2009. "Convection drying process modeling and simulation study based on tomato." Giannoccaro, Nicola Ivan and Klingajay, Mongkorn (ed.) International Conference on Robotics, Informatics, Intelligence Control System Technology (RIIT 2009). Bangkok, Thailand 11 - 14 Dec 2009 Bangkok, Thailand.
Fruit drying process: analysis, modeling and simulation
Abdulla, Shahab, Wen, Paul, Landers, Richard and Yousif, B. F.. 2011. "Fruit drying process: analysis, modeling and simulation." Scientific Research and Essays. 6 (23), pp. 4915-4924.
The design and investigation of model based internal model control for the regulation of hypnosis
Abdulla, Shahab, Wen, Peng and Xiang, Wei. 2010. "The design and investigation of model based internal model control for the regulation of hypnosis." Kuo, Way, Tsui, Lap Chee and Sung, Jao Yiu (ed.) IEEE/NANOMED 2010: Promoting Good Health with Nanotechnology. Hong Kong, China 05 - 09 Dec 2010 Hong Kong. https://doi.org/10.1109/NANOMED.2010.5749833
Depth of anesthesia control using internal model control techniques
Anna, Shahab and Wen, Peng. 2010. "Depth of anesthesia control using internal model control techniques." Li, Yan, Yang, Jiajia, Wen, Peng and Wu, Jinglong (ed.) 2010 IEEE/ICME International Conference on Complex Medical Engineering (ICME 2010). Gold Coast, Australia 13 - 15 Jul 2010 Piscataway, NJ. United States. https://doi.org/10.1109/ICCME.2010.5558825
Excel files of bispectral index (BIS), anaesthesia levels and nominal patient data based on sensitivity to anaesthesia
Abdulla, Shahab. 2008. Excel files of bispectral index (BIS), anaesthesia levels and nominal patient data based on sensitivity to anaesthesia. Toowoomba. University of Southern Queensland. https://doi.org/10.26192/q37yw