Systematic Literature Review of Transfer Learning for Pneumonia Classification in Chest X-Rays
DOI:
https://doi.org/10.57152/malcom.v6i2.2470Keywords:
Chest X-Ray, Deep Learning, Pneumonia, Systematic Literature Review, Transfer LearningAbstract
Diagnosis of pneumonia through manual interpretation of Chest X-Ray (CXR) images is often hampered by observer subjectivity and radiologist fatigue, which can potentially lead to misdiagnosis. This study aims to evaluate the effectiveness and development trends of Transfer Learning techniques, particularly the ResNet, VGG, and DenseNet architectures, in pneumonia classification through the Systematic Literature Review (SLR) method. In accordance with the PRISMA protocol, the search was conducted in the Scopus database from 2021 to 2025, yielding 76 articles that met the inclusion criteria. Bibliometric analysis shows that the publication trend, initially triggered by the urgency of the pandemic, has now shifted to a phase of technological maturity, with a focus on integrating Explainable AI (XAI) to address black-box problems. Geographically, research contributions are dominated by institutions in Asia and the Middle East. The main findings confirm that Transfer Learning can significantly improve diagnostic accuracy and initial screening efficiency compared to conventional methods. However, challenges such as data imbalance and the need for clinical validation remain obstacles. This study concludes that the future of computer-assisted diagnosis systems depends on improving model transparency to support precise and reliable Clinical Decision Support Systems (CDSS).
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G. Siracusano, A. La Corte, A. G. Nucera, M. Gaeta, M. Chiappini, and G. Finocchio, ‘Effective processing pipeline PACE 2.0 for enhancing chest x-ray contrast and diagnostic interpretability’, Scientific Reports, vol. 13, no. 1, 2023, doi: 10.1038/s41598-023-49534-y.
M. Mamalakis et al., ‘DenResCov-19: A deep transfer learning network for robust automatic classification of COVID-19, pneumonia, and tuberculosis from X-rays’, Computerized Medical Imaging and Graphics, vol. 94, 2021, doi: 10.1016/j.compmedimag.2021.102008.
A. Tiwari, T. S. Sharan, S. Sharma, and N. Sharma, ‘Deep learning-based automated multiclass classification of chest X-rays into Covid-19, normal, bacterial pneumonia and viral pneumonia’, Cogent Engineering, vol. 9, no. 1, 2022, doi: 10.1080/23311916.2022.2105559.
R. Fan and S. Bu, ‘Transfer-Learning-Based Approach for the Diagnosis of Lung Diseases from Chest X-ray Images’, Entropy, vol. 24, no. 3, 2022, doi: 10.3390/e24030313.
E. Ayan, B. Karabulut, and H. M. Ünver, ‘Diagnosis of Pediatric Pneumonia with Ensemble of Deep Convolutional Neural Networks in Chest X-Ray Images’, Arabian Journal for Science and Engineering, vol. 47, no. 2, pp. 2123–2139, 2022, doi: 10.1007/s13369-021-06127-z.
M. Usman, T. Zia, and A. Tariq, ‘Analyzing Transfer Learning of Vision Transformers for Interpreting Chest Radiography’, Journal of Digital Imaging, vol. 35, no. 6, pp. 1445–1462, 2022, doi: 10.1007/s10278-022-00666-z.
R. Thangaraj, P. P, J. Ramakrishnan, N. Nallakumar, and S. Sivaraman, ‘A deep convolution neural network for automated COVID-19 disease detection using chest X-ray images’, Healthcare Analytics, vol. 4, 2023, doi: 10.1016/j.health.2023.100278.
G. Mohan, M. M. Monica Subashini, S. Balan, and S. Singh, ‘A multiclass deep learning algorithm for healthy lung, Covid-19 and pneumonia disease detection from chest X-ray images’, Discover Artificial Intelligence, vol. 4, no. 1, 2024, doi: 10.1007/s44163-024-00110-x.
S. Katreddi, A. Midatani, A. P. Roy, U. Velpuri, and S. Kasani, ‘Pediatric pneumonia X-ray image classification: predictive model development with DenseNet-169 transfer learning’, Journal of Medical Artificial Intelligence, vol. 8, 2025, doi: 10.21037/jmai-24-356.
S. R. Sannasi Chakravarthy, N. Bharanidharan, C. Vinothini, V. Kumar V, T. R. Mahesh, and S. Guluwadi, ‘Adaptive Mish activation and ranger optimizer-based SEA-ResNet50 model with explainable AI for multiclass classification of COVID-19 chest X-ray images’, BMC Medical Imaging, vol. 24, no. 1, 2024, doi: 10.1186/s12880-024-01394-2.
M. H. Al-Adhaileh et al., ‘DLAAD-deep learning algorithms assisted diagnosis of chest disease using radiographic medical images’, Frontiers in Medicine, vol. 11, 2024, doi: 10.3389/fmed.2024.1511389.
A. Shanmugavelu and A. L. R. P. Arul Leena Rose, ‘Efficient lung disease classification through luminescent feature selection using firefly algorithm’, IAES International Journal of Artificial Intelligence, vol. 14, no. 4, pp. 3099–3108, 2025, doi: 10.11591/ijai.v14.i4.pp3099-3108.
P. Garg, M. Gautam, B. Chugh, and K. Dwivedi, ‘Employing transfer learning techniques for COVID-19 detection using chest X-ray’, International Journal of Advances in Applied Sciences, vol. 13, no. 3, pp. 680–688, 2024, doi: 10.11591/ijaas.v13.i3.pp680-688.
J. Sofia Jennifer and T. Sharmila, ‘A Neutrosophic Set Approach on Chest X-rays for Automatic Lung Infection Detection’, Information Technology and Control, vol. 52, no. 1, pp. 37–52, 2023, doi: 10.5755/j01.itc.52.1.31520.
S. Chakraborty, S. Paul, and K. M. A. Hasan, ‘A Transfer Learning-Based Approach with Deep CNN for COVID-19- and Pneumonia-Affected Chest X-ray Image Classification’, SN Computer Science, vol. 3, no. 1, 2022, doi: 10.1007/s42979-021-00881-5.
I. Ahmad, A. Merla, F. Ali, B. Shah, A. A. AlZubi, and M. A. AlZubi, ‘A deep transfer learning approach for COVID-19 detection and exploring a sense of belonging with Diabetes’, Frontiers in Public Health, vol. 11, 2023, doi: 10.3389/fpubh.2023.1308404.
P. P. Malla, S. Sahu, R. Tadeusiewicz, and P. P?awiak, ‘AI Enabled Pneumonia Detection and Diagnosis Based on the Concatenation Approach: A Framework for Healthcare Sustainability’, International Journal of Applied Mathematics and Computer Science, vol. 35, no. 2, pp. 341–355, 2025, doi: 10.61822/amcs-2025-0024.
S. R. Nayak, J. Nayak, U. Sinha, V. Arora, U. Ghosh, and S. C. Satapathy, ‘An Automated Lightweight Deep Neural Network for Diagnosis of COVID-19 from Chest X-ray Images’, Arabian Journal for Science and Engineering, vol. 48, no. 8, pp. 11085–11102, 2023, doi: 10.1007/s13369-021-05956-2.
Y. Kateb, H. Meglouli, and A. Khebli, ‘Coronavirus Diagnosis Based on Chest X-Ray Images and Pre-Trained DenseNet-121’, Revue d’Intelligence Artificielle, vol. 37, no. 1, pp. 23–28, 2023, doi: 10.18280/ria.370104.
M. A. As’ari and N. I. A. Manap, ‘Covid-19 detection from chest x-ray images: comparison of well-established convolutional neural networks models’, International Journal of Advances in Intelligent Informatics, vol. 8, no. 2, pp. 224–236, 2022, doi: 10.26555/ijain.v8i2.807.
I. Ahmed, G. Jeon, and A. Abdellah, ‘An IoT-enabled smart health care system for screening of COVID-19 with multi layers features fusion and selection’, Computing, vol. 105, no. 4, pp. 743–760, 2023, doi: 10.1007/s00607-021-00992-0.
A. Anis, T. Z. Xuan, J. H. Chuah, J. Usman, P. Qian, and K. W. Lai, ‘A comparative study of multiple neural network for detection of COVID-19 on chest X-ray’, Eurasip Journal on Advances in Signal Processing, vol. 2021, no. 1, 2021, doi: 10.1186/s13634-021-00755-1.
M. Vazralu and M. Madiajagan, ‘Multiclass Classification of Chest X-rays based Pulmonary Disorder Using a Specialized VGG-19 Deep Neural Network’, Journal of Innovative Image Processing, vol. 7, no. 4, pp. 1153–1167, 2025, doi: 10.36548/jiip.2025.4.004.
Ç. Polat, O. Karaman, C. Karaman, G. Korkmaz, M. C. Balci, and S. E. Ercan, ‘COVID-19 diagnosis from chest X-ray images using transfer learning: Enhanced performance by debiasing dataloader’, Journal of X-Ray Science and Technology, vol. 29, no. 1, pp. 19–36, 2021, doi: 10.3233/XST-200757.
R. B. Fricks et al., ‘Deep learning classification of COVID-19 in chest radiographs: Performance and influence of supplemental training’, Journal of Medical Imaging, vol. 8, no. 6, 2021, doi: 10.1117/1.JMI.8.6.064501.
X. Xue et al., ‘Design and Analysis of a Deep Learning Ensemble Framework Model for the Detection of COVID-19 and Pneumonia Using Large-Scale CT Scan and X-ray Image Datasets’, Bioengineering, vol. 10, no. 3, 2023, doi: 10.3390/bioengineering10030363.
M. Mujahid, F. Rustam, R. Alvarez, J. Luís Vidal Mazón, I. T. Torre Diez, and I. Ashraf, ‘Pneumonia Classification from X-ray Images with Inception-V3 and Convolutional Neural Network’, Diagnostics, vol. 12, no. 5, 2022, doi: 10.3390/diagnostics12051280.
S. Godbole, A. Kattukaran, S. Savla, V. Pradhan, P. Kanani, and D. Patil, ‘Enhancing Paediatric Pneumonia Detection and Classification Using Customized CNNs and Transfer Learning Based Ensemble Models’, International Research Journal of Multidisciplinary Technovation, vol. 6, no. 6, pp. 38–53, 2024, doi: 10.54392/irjmt2463.
Y. Hadhoud et al., ‘From Binary to Multi-Class Classification: A Two-Step Hybrid CNN-ViT Model for Chest Disease Classification Based on X-Ray Images’, Diagnostics, vol. 14, no. 23, 2024, doi: 10.3390/diagnostics14232754.
D. S. Al-Dulaimi, A. G. Mahmoud, N. M. Hassan, A. alkhayyat, and S. A. Majeed, ‘Development of Pneumonia Disease Detection Model Based on Deep Learning Algorithm’, Wireless Communications and Mobile Computing, vol. 2022, 2022, doi: 10.1155/2022/2951168.
H. Aljuaid, H. Adlan, B. Alkebsi, B. S. Alfurhood, A. Liotta, and L. Cavallaro, ‘An experimental comparison of deep learning models for pneumonia classification from chest X-ray images’, Biomedical Signal Processing and Control, vol. 112, 2026, doi: 10.1016/j.bspc.2025.108742.
A. K. Das, S. Kalam, C. Kumar, and D. Sinha, ‘TLCoV- An automated Covid-19 screening model using Transfer Learning from chest X-ray images’, Chaos, Solitons and Fractals, vol. 144, 2021, doi: 10.1016/j.chaos.2021.110713.
A. Sultana et al., ‘A Real Time Method for Distinguishing COVID-19 Utilizing 2D-CNN and Transfer Learning’, Sensors, vol. 23, no. 9, 2023, doi: 10.3390/s23094458.
E. Chamseddine, N. Mansouri, M. Soui, and M. Abed, ‘Handling class imbalance in COVID-19 chest X-ray images classification: Using SMOTE and weighted loss’, Applied Soft Computing, vol. 129, 2022, doi: 10.1016/j.asoc.2022.109588.
S. Sarp et al., ‘An XAI approach for COVID-19 detection using transfer learning with X-ray images’, Heliyon, vol. 9, no. 4, 2023, doi: 10.1016/j.heliyon.2023.e15137.
G. L. E. Maquen-Niño, J. G. Nuñez-Fernandez, F. Y. Taquila-Calderon, I. Adrianzén-Olano, P. Villa, and G. Carrión-Barco, ‘Classification Model Using Transfer Learning for the Detection of Pneumonia in Chest X-Ray Images’, International Journal of Online and Biomedical Engineering, vol. 20, no. 5, pp. 150–161, 2024, doi: 10.3991/ijoe.v20i05.45277.
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Copyright (c) 2026 Erlan Bachtiar, Amir Hamzah Dinnillah, Yan Rianto

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