Pipeline for Advanced Contrast Enhancement (PACE) of Chest X-ray in Evaluating COVID-19 Patients by Combining Bidimensional Empirical Mode Decomposition and Contrast Limited Adaptive Histogram Equalization (CLAHE)

COVID-19 is a new pulmonary disease which is driving stress to the hospitals due to the large number of cases worldwide. Imaging of lungs can play a key role in the monitoring of health status. Non-contrast chest computed tomography (CT) has been used for this purpose, mainly in China, with significant success. However, this approach cannot be massively used, mainly for both high risk and cost, also in some countries, this tool is not extensively available. Alternatively, chest X-ray, although less sensitive than CT-scan, can provide important information about the evolution of pulmonary involvement during the disease; this aspect is very important to verify the response of a patient to treatments. Here, we show how to improve the sensitivity of chest X-ray via a nonlinear post-processing tool, named PACE (Pipeline for Advanced Contrast Enhancement), combining properly Fast and Adaptive Bidimensional Empirical Mode Decomposition (FABEMD) and Contrast Limited Adaptive Histogram Equalization (CLAHE). The results show an enhancement of the image contrast as confirmed by three widely used metrics: (i) contrast improvement index, (ii) entropy, and (iii) measure of enhancement. This improvement gives rise to a detectability of more lung lesions as identified by two radiologists, who evaluated the images separately, and confirmed by CT-scans. The results show this method is a flexible and an effective approach for medical image enhancement and can be used as a post-processing tool for medical image understanding and analysis.