Analytical derivation of elasticity in breast phantoms for deformation tracking

Patient-specific biomedical modeling of the breast is of interest for medical applications such as image registration, image guided procedures and the alignment for biopsy or surgery purposes. The computation of elastic properties is essential to simulate deformations in a realistic way. This study presents an innovative analytical method to compute the elastic modulus and evaluate the elasticity of a breast using magnetic resonance (MRI) images of breast phantoms.An analytical method for elasticity computation was developed and subsequently validated on a series of geometric shapes, and on four physical breast phantoms that are supported by a planar frame. This method can compute the elasticity of a shape directly from a set of MRI scans. For comparison, elasticity values were also computed numerically using two different simulation software packages.Application of the different methods on the geometric shapes shows that the analytically derived elongation differs from simulated elongation by less than 9% for cylindrical shapes, and up to 18% for other shapes that are also substantially vertically supported by a planar base. For the four physical breast phantoms, the analytically derived elasticity differs from numeric elasticity by 18% on average, which is in accordance with the difference in elongation estimation for the geometric shapes. The analytic method has shown to be multiple orders of magnitude faster than the numerical methods.It can be concluded that the analytical elasticity computation method has good potential to supplement or replace numerical elasticity simulations in gravity-induced deformations, for shapes that are substantially supported by a planar base perpendicular to the gravitational field. The error is manageable, while the calculation procedure takes less than one second as opposed to multiple minutes with numerical methods. The results will be used in the MRI and Ultrasound Robotic Assisted Biopsy (MURAB) project

Symmetric Biomechanically Guided Prone-to-Supine Breast Image Registration

Prone-to-supine breast image registration has potential application in the fields of surgical and radiotherapy planning, image guided interventions, and multi-modal cancer diagnosis, staging, and therapy response prediction. However, breast image registration of three dimensional images acquired in different patient positions is a challenging problem, due to large deformations induced to the soft breast tissue caused by the change in gravity loading. We present a symmetric, biomechanical simulation based registration framework which aligns the images in a central, virtually unloaded configuration. The breast tissue is modelled as a neo-Hookean material and gravity is considered as the main source of deformation in the original images. In addition to gravity, our framework successively applies image derived forces directly into the unloading simulation in place of a subsequent image registration step. This results in a biomechanically constrained deformation. Using a finite difference scheme avoids an explicit meshing step and enables simulations to be performed directly in the image space. The explicit time integration scheme allows the motion at the interface between chest and breast to be constrained along the chest wall. The feasibility and accuracy of the approach presented here was assessed by measuring the target registration error (TRE) using a numerical phantom with known ground truth deformations, nine clinical prone MRI and supine CT image pairs, one clinical prone-supine CT image pair and four prone-supine MRI image pairs. The registration reduced the mean TRE for the numerical phantom experiment from initially 19.3 to 0.9 mm and the combined mean TRE for all fourteen clinical data sets from 69.7 to 5.6 mm

Prone to supine surface-based registration for surgical planning in breast cancer treatment

Breast cancer is the most common invasive cancer in women worldwide. Many women with breast cancer have their malignant tumors detected before the lesions become clinically palpable. Occult lesions must be marked for the surgeon to ensure that they can be effectively resected. Image-guided wire localization (WGL) is the current standard of care for the excision of non-palpable carcinomas during breast conserving surgery. The integration of the information from multimodal imaging may be especially relevant in surgical planning as complement or an alternative to WGL. The combination of information from images in different positions is especially difficult due to large breast deformation. This work presents a system based on surface registration to localize the lesion in the operative position, starting from a prone MRI study and a surface of the patient in the supine positon. The pre-operative surface from the MRI is registered to the surface obtained in a supine position similar to the intraoperative setting. Triangular meshes have been used to model breast surface in both positions and surfaces are aligned using a Laplacian deformation with fiducials automatically obtained from 3 anatomical references. The evaluation of the methodology has been carried out in 13 cases in which a supine- CT was available achieving an average localization error of 6.7 m

Breast Tumor Localization by Prone to Supine Landmark Driven Registration for Surgical Planning

Breast cancer is the most common cancer in women worldwide. Screening programs and imaging improvements have increased the detection of clinically occult non-palpable lesions requiring preoperative localization. Wire guided localization (WGL) is the current standard of care for the excision of non-palpable carcinomas during breast conserving surgery. Due to the current limitations of intraoperative tumor localization approaches, the integration of multimodal imaging information may be especially relevant in surgical planning. This research proposes a novel method for performing preoperative image-to-surgical surface data alignment to determine the position of the tumor at the time of surgery and aid preoperative planning. First, the volume of the breast in the surgical position is reconstructed and a set of surface correspondences is defined. Then, the preoperative (prone) and intraoperative (supine) volumes are co-registered using landmark driven non-rigid registration methods. We compared the performances of diffeomorphic and Bspline based registration methods. Finally, our method was validated using clinical data from 67 patients considering as target registration error (TRE) the distance between the estimated tumor position and the reference surgical position. The proposed method achieved a TRE of 16.21 ± 8.18 mm and it could potentially assist the surgery planning and guidance of breast cancer treatment in the clinical practice.This work was supported in part by the Spanish Ministry of Science and Innovation under Project RTI2018-098682-B-I00 (MCIU/AEI/FEDER,UE), Project PI18/01625 (Instituto de Salud Carlos III) and Grant BGP18/00178 under Beatriz Galindo Programme; in part by the European Union's European Regional Development Fund (ERDF); and in part by the Madrid Government (Comunidad de Madrid-Spain) under the Multiannual Agreement with Universidad Politécnica de Madrid in the line Support for Research and Development Projects for Beatriz Galindo researchers, in the context of the V Plan Regional de Investigación Científíca e Innovación Tecnológica (PRICIT)

Iterative simulations to estimate the elastic properties from a series of MRI images followed by MRI-US validation

The modeling of breast deformations is of interest in medical applications such as image-guided biopsy, or image registration for diagnostic purposes. In order to have such information, it is needed to extract the mechanical properties of the tissues. In this work, we propose an iterative technique based on finite element analysis that estimates the elastic modulus of realistic breast phantoms, starting from MRI images acquired in different positions (prone and supine), when deformed only by the gravity force. We validated the method using both a single-modality evaluation in which we simulated the effect of the gravity force to generate four different configurations (prone, supine, lateral, and vertical) and a multi-modality evaluation in which we simulated a series of changes in orientation (prone to supine). Validation is performed, respectively, on surface points and lesions using as ground-truth data from MRI images, and on target lesions inside the breast phantom compared with the actual target segmented from the US image. The use of pre-operative images is limited at the moment to diagnostic purposes. By using our method we can compute patient-specific mechanical properties that allow compensating deformations

Surface Driven Biomechanical Breast Image Registration

Biomechanical modelling enables large deformation simulations of breast tissues under different loading conditions to be performed. Such simulations can be utilised to transform prone Magnetic Resonance (MR) images into a different patient position, such as upright or supine. We present a novel integration of biomechanical modelling with a surface registration algorithm which optimises the unknown material parameters of a biomechanical model and performs a subsequent regularised surface alignment. This allows deformations induced by effects other than gravity, such as those due to contact of the breast and MR coil, to be reversed. Correction displacements are applied to the biomechanical model enabling transformation of the original pre-surgical images to the corresponding target position. The algorithm is evaluated for the prone-to-supine case using prone MR images and the skin outline of supine Computed Tomography (CT) scans for three patients. A mean target registration error (TRE) of 10:9 mm for internal structures is achieved. For the prone-to-upright scenario, an optical 3D surface scan of one patient is used as a registration target and the nipple distances after alignment between the transformed MRI and the surface are 10:1 mm and 6:3 mm respectively

Integration of biomechanical models into image registration in the presence of large deformations

Prone-to-supine breast image registration has potential application in the fields of surgical and radiotherapy planning, and image guided interventions. However, breast image registration of three-dimensional images acquired in different patient positions is a challenging problem, due to large deformations induced to the soft breast tissue caused by the change in gravity loading. Biomechanical modelling is a promising tool to predict gravity induced deformations, however such simulations alone are unlikely to produce good alignment due to inter-patient variability and image acquisition related influences on the breast shape. This thesis presents a symmetric, biomechanical simulation based registration framework which aligns images in a central, stress-free configuration. Soft tissue is modelled as a neo-Hookean material and external forces are considered as the main source of deformation in the original images. The framework successively applies image derived forces directly into the unloading simulation in place of a subsequent image registration step. This results in a biomechanically constrained deformation. Using a finite difference scheme enables simulations to be performed directly in the image space. Motion constrained boundary conditions have been incorporated which can capture tangential motion of membranes and fasciae. The accuracy of the approach is assessed by measuring the target registration error (TRE) using nine prone MRI and supine CT image pairs, one prone-supine CT image pair, and four prone-supine MRI image pairs. The registration reduced the combined mean TRE for all clinical data sets from initially 69.7mm to 5.6mm. Prone-supine image pairs might not always be available in the clinical breast cancer workflow, especially prior to surgery. Hence an alternative surface driven registration methodology was also developed that incorporates biomechanical simulations, material parameter optimisation, and constrained surface matching. For three prone MR images and corresponding supine CT-derived surfaces a final mean TRE of 10.0mm was measured

Towards an in-plane methodology to track breast lesions using mammograms and patient-specific finite-element simulations

In breast cancer screening or diagnosis, it is usual to combine different images in order to locate a lesion as accurately as possible. These images are generated using a single or several imaging techniques. As x-ray-based mammography is widely used, a breast lesion is located in the same plane of the image (mammogram), but tracking it across mammograms corresponding to different views is a challenging task for medical physicians. Accordingly, simulation tools and methodologies that use patient-specific numerical models can facilitate the task of fusing information from different images. Additionally, these tools need to be as straightforward as possible to facilitate their translation to the clinical area. This paper presents a patient-specific, finite-element-based and semi-automated simulation methodology to track breast lesions across mammograms. A realistic three-dimensional computer model of a patient''s breast was generated from magnetic resonance imaging to simulate mammographic compressions in cranio-caudal (CC, head-to-toe) and medio-lateral oblique (MLO, shoulder-to-opposite hip) directions. For each compression being simulated, a virtual mammogram was obtained and posteriorly superimposed to the corresponding real mammogram, by sharing the nipple as a common feature. Two-dimensional rigid-body transformations were applied, and the error distance measured between the centroids of the tumors previously located on each image was 3.84 mm and 2.41 mm for CC and MLO compression, respectively. Considering that the scope of this work is to conceive a methodology translatable to clinical practice, the results indicate that it could be helpful in supporting the tracking of breast lesions