Deep learning is being employed in disease detection and classification based on medical images for clinical decision making. It typically requires large amounts of labelled data; however, the sample size of such medical image datasets is generally small. This study proposes a novel training framework for building deep learning models of disease detection and classification with small datasets. Our approach is based on a hierarchical classification method where the healthy/disease information from the first model is effectively utilized to build subsequent models for classifying the disease into its sub-types via a transfer learning method. To improve accuracy, multiple input datasets were used, and a stacking ensembled method was employed for final classification. To demonstrate the method’s performance, a labelled dataset extracted from volumetric ophthalmic optical coherence tomography data for 156 healthy and 798 glaucoma eyes was used, in which glaucoma eyes were further labelled into four sub-types. The average weighted accuracy and Cohen’s kappa for three randomized test datasets were 0.839 and 0.809, respectively. Our approach outperformed the flat classification method by 9.7% using smaller training datasets. The results suggest that the framework can perform accurate classification with a small number of medical images.
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