journal article·2025-11-06Open access

Adaptive Multi-Scale Feature Learning Module for Pediatric Pneumonia Recognition in Chest X-Rays

Petra Radočaj, Goran Martinović, Dorijan Radočaj

Applied Sciences· Volume 15· Issue 21

Abstract

Pneumonia remains a major global health concern, particularly among pediatric populations in low-resource settings where radiological expertise is limited. This study investigates the enhancement of deep convolutional neural networks (CNNs) for automated pneumonia diagnosis from chest X-ray images through the integration of a novel module combining Inception blocks, Mish activation, and Batch Normalization (IncMB). Four state-of-the-art transfer learning models—InceptionV3, InceptionResNetV2, MobileNetV2, and DenseNet201—were evaluated in their base form and with the proposed IncMB extension. Comparative analysis based on standardized classification metrics reveals consistent performance improvements across all models with the addition of the IncMB module. The most notable improvement was observed in InceptionResNetV2, where the IncMB-enhanced model achieved the highest accuracy of 0.9812, F1-score of 0.9761, precision of 0.9781, recall of 0.9742, and strong specificity of 0.9590. Other models also demonstrated similar trends, confirming that the IncMB module contributes to better generalization and discriminative capability. These enhancements were achieved while reducing the total number of parameters, indicating improved computational efficiency. In conclusion, the integration of IncMB significantly boosts the performance of CNN-based pneumonia classifiers, offering a promising direction for the development of lightweight, high-performing diagnostic tools suitable for real-world clinical application, particularly in underserved healthcare environments.
Source: crossref · Quality: baseline

Research context

OpenAlex topics: COVID-19 diagnosis using AI · Pneumonia and Respiratory Infections · AI in cancer detection

SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.

Affiliations

Layer d.o.o., Vukovarska cesta 31, 31000 Osijek, Croatia

Faculty of Electrical Engineering, Computer Science and Information Technology, Josip Juraj Strossmayer University of Osijek, Kneza Trpimira 2B, 31000 Osijek, Croatia

Faculty of Agrobiotechnical Sciences Osijek, Josip Juraj Strossmayer University of Osijek, Vladimira Preloga 1, 31000 Osijek, Croatia

References (74)

Show source-provided references
1. Altalhi, A. (2025, October 08). Review: Pediatric Pneumonia, Etiology, Diagnosis and Management. Available online: https://www.iajps.com/March-2020/issue_20march_171.php.
2. Paediatric Pneumonia: A Guide to Diagnosis, Investigation and Treatment10.1016/j.paed.2021.03.005 ↗
3. Barson, W.J., Kaplan, S., and Torchia, M. (2025, October 08). Pneumonia in Children: Epidemiology, Pathogenesis, and Etiology. UpToDate Walth. MAAccessed January 28 2018. Available online: http://bvndtp.org.vn/wp-content/uploads/2017/01/Pneumonia-in-childre1.doc.
4. Complicated Pneumonia in Children10.1016/S0140-6736(20)31550-6 ↗
5. Comorbidities, Clinical Signs and Symptoms, Laboratory Findings, Imaging Features, Treatment Strategies, and Outcomes in Adult and Pediatric Patients with COVID-19: A Systematic Review and Meta-Analysis10.1016/j.tmaid.2020.101825 ↗
6. ARI Review group What Are the Risk Factors for Death among Children with Pneumonia in Low- and Middle-Income Countries? A Systematic Review10.7189/jogh.13.05003 ↗
7. A Deep Learning Method for Predicting the COVID-19 ICU Patient Outcome Fusing X-Rays, Respiratory Sounds, and ICU Parameters10.1016/j.eswa.2023.121089 ↗
8. (2025, June 27). Pneumonia in Children. Available online: https://www.who.int/news-room/fact-sheets/detail/pneumonia.
9. Respiratory Infections in Low and Middle-Income Countries
10. Clinical and Etiological Exploration of Ventilator-Associated Pneumonia in the Intensive Care Unit of a Developing Country
11. Epidemiology and Etiology of Childhood Pneumonia in 2010: Estimates of Incidence, Severe Morbidity, Mortality, Underlying Risk Factors and Causative Pathogens for 192 Countries
12. A Deep Learning Model for the Diagnosis and Discrimination of Gram-Positive and Gram-Negative Bacterial Pneumonia for Children Using Chest Radiography Images and Clinical Information10.2147/IDR.S404786 ↗
13. Lung Ultrasound and Procalcitonin, Improving Antibiotic Management and Avoiding Radiation Exposure in Pediatric Critical Patients with Bacterial Pneumonia: A Randomized Clinical Trial10.1186/s40001-024-01712-y ↗
14. Biagi, C., Cavallo, A., Rocca, A., Pierantoni, L., Antonazzo, D., Dondi, A., Gabrielli, L., Lazzarotto, T., and Lanari, M. (2021). Pulmonary and Extrapulmonary Manifestations in Hospitalized Children with Mycoplasma Pneumoniae Infection. Microorganisms, 9.10.3390/microorganisms9122553 ↗
15. Impact of Viral Radiographic Features on Antibiotic Treatment for Pediatric Pneumonia10.1093/jpids/piab132 ↗
16. A Deep-Learning Pipeline for the Diagnosis and Discrimination of Viral, Non-Viral and COVID-19 Pneumonia from Chest X-Ray Images10.1038/s41551-021-00704-1 ↗
17. Comparing Ultrasound, Chest X-Ray, and CT Scan for Pneumonia Detection10.2147/MDER.S501714 ↗
18. Radiographic Findings of Adenoviral Pneumonia in Children10.1016/j.clinimag.2024.110111 ↗
19. Standardized Interpretation of Chest Radiographs in Cases of Pediatric Pneumonia From the PERCH Study10.1093/cid/cix082 ↗
20. Lung Ultrasound Compared to Chest X-Ray for Diagnosis of Pediatric Pneumonia: A Meta-Analysis10.1002/ppul.24020 ↗
21. Lung Ultrasound for the Diagnosis of Pneumonia in Children: A Meta-Analysis10.1542/peds.2014-2833 ↗
22. Lung Ultrasound for Diagnosis of Pneumonia in Emergency Department10.1007/s11739-015-1297-2 ↗
23. Community and Hospital Acquired Pneumonia10.1053/j.ro.2021.10.006 ↗
24. A New Hybrid Approach for Pneumonia Detection Using Chest X-Rays Based on ACNN-LSTM and Attention Mechanism10.1007/s11042-024-18401-x ↗
25. 2D-CNN Architecture for Accurate Classification of COVID-19 Related Pneumonia on X-Ray Images
26. Radočaj, P., Radočaj, D., and Martinović, G. (2025). Pediatric Pneumonia Recognition Using an Improved DenseNet201 Model with Multi-Scale Convolutions and Mish Activation Function. Algorithms, 18.10.3390/a18020098 ↗
27. Efficient Deep Learning Approach for the Classification of Pneumonia in Infants from Chest X-Ray Images10.18280/ts.410314 ↗
28. Radočaj, P., and Martinović, G. (2025). Interpretable Deep Learning for Pediatric Pneumonia Diagnosis Through Multi-Phase Feature Learning and Activation Patterns. Electronics, 14.10.3390/electronics14091899 ↗
29. Pan, Z., Wang, H., Wan, J., Zhang, L., Huang, J., and Shen, Y. (2024). Efficient Federated Learning for Pediatric Pneumonia on Chest X-Ray Classification. Sci. Rep., 14.10.1038/s41598-024-74491-5 ↗
30. An Efficient Deep Learning Approach to Pneumonia Classification in Healthcare10.1155/2019/4180949 ↗
31. A New Method for Long-Term Temperature Compensation of Structural Health Monitoring by Ultrasonic Guided Wave10.1016/j.measurement.2025.117310 ↗
32. Artificial Intelligence: Learning and Limitations10.37394/232010.2020.17.10 ↗
33. A Mixed-Scale Dynamic Attention Transformer for Pediatric Pneumonia Diagnosis10.1016/j.displa.2024.102953 ↗
34. Applying Artificial Intelligence to Pediatric Chest Imaging: Reliability of Leveraging Adult-Based Artificial Intelligence Models10.1016/j.jacr.2023.07.004 ↗
35. Esposito, C., Hong, J., and Choo, K.-K.R. (2019). Optimization of GPU Memory Usage for Training Deep Neural Networks. Pervasive Systems, Algorithms and Networks, Springer International Publishing.10.1007/978-3-030-30143-9 ↗
36. Liang, G., and Zheng, L. (2020). A Transfer Learning Method with Deep Residual Network for Pediatric Pneumonia Diagnosis. Comput. Methods Programs Biomed., 187.10.1016/j.cmpb.2019.06.023 ↗
37. Luján-García, J.E., Yáñez-Márquez, C., Villuendas-Rey, Y., and Camacho-Nieto, O. (2020). A Transfer Learning Method for Pneumonia Classification and Visualization. Appl. Sci., 10.10.3390/app10082908 ↗
38. Ability of Artificial Intelligence to Identify Self-Reported Race in Chest X-Ray Using Pixel Intensity Counts
39. Comparison of Gray-Scale Inversion to Improve Detection of Pulmonary Nodules on Chest X-Rays Between Radiologists and a Deep Convolutional Neural Network10.1067/j.cpradiol.2022.11.004 ↗
40. Bhatt, D., Patel, C., Talsania, H., Patel, J., Vaghela, R., Pandya, S., Modi, K., and Ghayvat, H. (2021). CNN Variants for Computer Vision: History, Architecture, Application, Challenges and Future Scope. Electronics, 10.10.3390/electronics10202470 ↗
41. Variability in the Interpretation of Chest Radiographs for the Diagnosis of Pneumonia in Children10.1002/jhm.955 ↗
42. Grayscale Images Colorization with Convolutional Neural Networks10.1007/s00500-020-04711-3 ↗
43. Sotirov, S., Orozova, D., Angelov, B., Sotirova, E., and Vylcheva, M. (2025). Transforming Pediatric Healthcare with Generative AI: A Hybrid CNN Approach for Pneumonia Detection. Electronics, 14.10.3390/electronics14091878 ↗
44. Transfer Learning Approach for Pediatric Pneumonia Diagnosis Using Channel Attention Deep CNN Architectures10.1016/j.engappai.2023.106416 ↗
45. Lan, X., Zhang, Y., Yuan, W., Shi, F., and Guo, W. (2024). Image-Based Deep Learning in Diagnosing Mycoplasma Pneumonia on Pediatric Chest X-Rays. BMC Pediatr., 24.10.1186/s12887-024-05204-0 ↗
46. Khan, E., Rehman, M.Z.U., Ahmed, F., Alfouzan, F.A., Alzahrani, N.M., and Ahmad, J. (2022). Chest X-Ray Classification for the Detection of COVID-19 Using Deep Learning Techniques. Sensors, 22.10.3390/s22031211 ↗
47. Attention-Based DenseNet for Pneumonia Classification10.1016/j.irbm.2021.12.004 ↗
48. Napravnik, M., Hržić, F., Urschler, M., Miletić, D., and Štajduhar, I. (2025). Lessons Learned from RadiologyNET Foundation Models for Transfer Learning in Medical Radiology. Sci. Rep., 15.10.1038/s41598-025-05009-w ↗
49. RadImageNet: An Open Radiologic Deep Learning Research Dataset for Effective Transfer Learning10.1148/ryai.210315 ↗
50. Deng, Z., Shen, Y., Kim, H.J., Jeong, W.-K., Aviles-Rivero, A.I., He, J., and Zhang, S. (2025). Navigating Data Scarcity Using Foundation Models: A Benchmark of Few-Shot and Zero-Shot Learning Approaches in Medical Imaging. Foundation Models for General Medical AI, Springer Nature Switzerland.10.1007/978-3-031-73471-7 ↗
51. Radočaj, P., Radočaj, D., and Martinović, G. (2024). Image-Based Leaf Disease Recognition Using Transfer Deep Learning with a Novel Versatile Optimization Module. Big Data Cogn. Comput., 8.10.3390/bdcc8060052 ↗
52. Identifying Medical Diagnoses and Treatable Diseases by Image-Based Deep Learning10.1016/j.cell.2018.02.010 ↗
53. Team, K. (2025, June 29). Keras Documentation: Keras 3 API Documentation. Available online: https://keras.io/api/.
54. (2025, June 29). Module: Tf|TensorFlow v2.16.1. Available online: https://www.tensorflow.org/api_docs/python/tf.
55. Szegedy, C., Liu, W., Jia, Y., Sermanet, P., Reed, S., Anguelov, D., Erhan, D., Vanhoucke, V., and Rabinovich, A. (2015, January 7–12). Going Deeper with Convolutions. Proceedings of the IEEE Conference on Computer Vision and Pattern Recognition, Boston, MA, USA.10.1109/CVPR.2015.7298594 ↗
56. Inception and ResNet Features Are (Almost) Equivalent10.1016/j.cogsys.2019.10.004 ↗
57. Misra, D. (2020, January 7–10). Mish: A Self Regularized Non-Monotonic Activation Function. Misra, Diganta. Proceedings of the British Machine Vision Conference 2020, Online.10.5244/C.34.191 ↗
58. Radočaj, P., Radočaj, D., and Martinović, G. (2025). Optimizing Convolutional Neural Network Architectures with Optimal Activation Functions for Pediatric Pneumonia Diagnosis Using Chest X-Rays. Big Data Cogn. Comput., 9.10.3390/bdcc9020025 ↗
59. (2025, June 30). Batch Normalization|Proceedings of the 32nd International Conference on International Conference on Machine Learning—Volume 37. Available online: https://dl.acm.org/doi/10.5555/3045118.3045167.
60. Awe, O.O., and Vance, E.A. (2025). Machine Learning Evaluation of Imbalanced Health Data: A Comparative Analysis of Balanced Accuracy, MCC, and F1 Score. Practical Statistical Learning and Data Science Methods: Case Studies from LISA 2020 Global Network, USA, Springer Nature Switzerland.
61. Silhavy, R., and Silhavy, P. (2023). A Review of Evaluation Metrics in Machine Learning Algorithms. Artificial Intelligence Application in Networks and Systems, Springer International Publishing.10.1007/978-3-031-35314-7 ↗
62. Comparative Analysis of Radiological and Machine Learning-Based Interpretations for Differentiating COVID-19 and Pneumonia
63. (2025, June 30). Inception-v4, Inception-ResNet and the Impact of Residual Connections on Learning|Proceedings of the Thirty-First AAAI Conference on Artificial Intelligence. Available online: https://dl.acm.org/doi/10.5555/3298023.3298188.
64. PlaneNet: An Efficient Local Feature Extraction Network10.7717/peerj-cs.783 ↗
65. Batch Normalization Embeddings for Deep Domain Generalization10.1016/j.patcog.2022.109115 ↗
66. (2025, June 30). Understanding Batch Normalization|Proceedings of the 32nd International Conference on Neural Information Processing Systems. Available online: https://dl.acm.org/doi/10.5555/3327757.3327868.
67. Greenspan, H., Madabhushi, A., Mousavi, P., Salcudean, S., Duncan, J., Syeda-Mahmood, T., and Taylor, R. (2023). CheXstray: A Real-Time Multi-Modal Monitoring Workflow for Medical Imaging AI. Medical Image Computing and Computer Assisted Intervention—MICCAI 2023, Springer Nature Switzerland.10.1007/978-3-031-43996-4 ↗
68. (2025, June 30). Characterizing Parameter Scaling with Quantization for Deployment of CNNs on Real-Time Systems|ACM Transactions on Embedded Computing Systems. Available online: https://dl.acm.org/doi/full/10.1145/3654799.
69. A Healthcare System Employing Lightweight CNN for Disease Prediction with Artificial Intelligence10.2174/0118749445302023240520111802 ↗
70. A Machine Learning Approach on Chest X-Rays for Pediatric Pneumonia Detection10.1177/20552076231180008 ↗
71. Alsharif, R., Al-Issa, Y., Alqudah, A.M., Qasmieh, I.A., Mustafa, W.A., and Alquran, H. (2021). PneumoniaNet: Automated Detection and Classification of Pediatric Pneumonia Using Chest X-Ray Images and CNN Approach. Electronics, 10.10.3390/electronics10232949 ↗
72. Apply a Cnn-Based Ensemble Model to Chest-x Ray Image-Based Pneumonia Classification
73. A Federated Learning Framework for Pneumonia Image Detection Using Distributed Data10.1016/j.health.2023.100204 ↗
74. Patidar, M., Pandey, G., Koolagudi, S.G., S, K.K., and Chandra, V. (2024, January 8–10). Enhancing Paediatric Healthcare: Deep Learning-Based Pneumonia Diagnosis from Children’s Chest X-Rays. Proceedings of the 2024 Sixteenth International Conference on Contemporary Computing, Noida, India.10.1145/3675888.3676041 ↗