Models of breast lesions based on three-dimensional X-ray breast images

This paper presents a method for creation of computational models of breast lesions with irregular shapes from patient Digital Breast Tomosynthesis (DBT) images or breast cadavers and whole-body Computed Tomography (CT) images. The approach includes six basic steps: (a) normalization of the intensity of the tomographic images; (b) image noise reduction; (c) binarization of the lesion area, (d) application of morphological operations to further decrease the level of artefacts; (e) application of a region growing technique to segment the lesion; and (f) creation of a final 3D lesion model. The algorithm is semi-automatic as the initial selection of the region of the lesion and the seeds for the region growing are done interactively. A software tool, performing all of the required steps, was developed in MATLAB. The method was tested and evaluated by analysing anonymized sets of DBT patient images diagnosed with lesions. Experienced radiologists evaluated the segmentation of the tumours in the slices and the obtained 3D lesion shapes. They concluded for a quite satisfactory delineation of the lesions. In addition, for three DBT cases, a delineation of the tumours was performed independently by the radiologists. In all cases the abnormality volumes segmented by the proposed algorithm were smaller than those outlined by the experts. The calculated Dice similarity coefficients for algorithm-radiologist and radiologist-radiologist showed similar values. Another selected tumour case was introduced into a computational breast model to recursively assess the algorithm. The relative volume difference between the ground-truth tumour volume and the one obtained by applying the algorithm on the synthetic volume from the virtual DBT study is 5% which demonstrates the satisfactory performance of the proposed segmentation algorithm. The software tool we developed was used to create models of different breast abnormalities, which were then stored in a database for use by researchers working in this field

Breast Tomosynthesis: Aspects on detection and perception of simulated lesions

The aim of this thesis was to investigate aspects on detectability of simulated lesions (microcalcifications and masses) in digital mammography (DM) and breast tomosynthesis (BT). Perception in BT image volumes were also investigated by evaluating certain reading conditions. The first study concerned the effect of system noise on the detection of masses and microcalcification clusters in DM images using a free-response task. System noise has an impact on image quality and is related to the dose level. It was found to have a substantial impact on the detection of microcalcification clusters, whereas masses were relatively unaffected. The effect of superimposed tissue in DM is the major limitation hampering the detection of masses. BT is a three-dimensional technique that reduces the effect of superimposed tissue. In the following two studies visibility was quantified for both imaging modalities in terms of the required contrast at a fixed detection performance (92% correct decisions). Contrast detail plots for lesions with sizes 0.2, 1, 3, 8 and 25 mm were generated. The first study involved only an in-plane BT slice, where the lesion centre appeared. The second study repeated the same procedure in BT image volumes for 3D distributed microcalcification clusters and 8 mm masses at two dose levels. Both studies showed that BT needs substantially less contrast than DM for lesions above 1 mm. Furthermore, the contrast threshold increased as the lesion size increased for both modalities. This is in accordance with the reduced effect of superimposed tissue in BT. For 0.2 mm lesions, substantially more contrast was needed. At equal dose, DM was better than BT for 0.2 mm lesions and microcalcification clusters. Doubling the dose substantially improved the detection in BT. Thus, system noise has a substantial impact on detection. The final study evaluated reading conditions for BT image volumes. Four viewing procedures were assessed: free scroll browsing only or combined with initial cine loops at frame rates of 9, 14 and 25 fps. They were viewed on a wide screen monitor placed in vertical or horizontal positions. A free-response task and eye tracking were utilized to record the detection performance, analysis time, visual attention and search strategies. Improved reading conditions were found for horizontally aligned BT image volumes when using free scroll browsing only or combined with a cine loop at the fastest frame rate

Artificial intelligence in mammographic phenotyping of breast cancer risk: A narrative review

BACKGROUND: Improved breast cancer risk assessment models are needed to enable personalized screening strategies that achieve better harm-to-benefit ratio based on earlier detection and better breast cancer outcomes than existing screening guidelines. Computational mammographic phenotypes have demonstrated a promising role in breast cancer risk prediction. With the recent exponential growth of computational efficiency, the artificial intelligence (AI) revolution, driven by the introduction of deep learning, has expanded the utility of imaging in predictive models. Consequently, AI-based imaging-derived data has led to some of the most promising tools for precision breast cancer screening. MAIN BODY: This review aims to synthesize the current state-of-the-art applications of AI in mammographic phenotyping of breast cancer risk. We discuss the fundamentals of AI and explore the computing advancements that have made AI-based image analysis essential in refining breast cancer risk assessment. Specifically, we discuss the use of data derived from digital mammography as well as digital breast tomosynthesis. Different aspects of breast cancer risk assessment are targeted including (a) robust and reproducible evaluations of breast density, a well-established breast cancer risk factor, (b) assessment of a woman\u27s inherent breast cancer risk, and (c) identification of women who are likely to be diagnosed with breast cancers after a negative or routine screen due to masking or the rapid and aggressive growth of a tumor. Lastly, we discuss AI challenges unique to the computational analysis of mammographic imaging as well as future directions for this promising research field. CONCLUSIONS: We provide a useful reference for AI researchers investigating image-based breast cancer risk assessment while indicating key priorities and challenges that, if properly addressed, could accelerate the implementation of AI-assisted risk stratification to future refine and individualize breast cancer screening strategies

The TOMMY trial: a comparison of TOMosynthesis with digital MammographY in the UK NHS Breast Screening Programme--a multicentre retrospective reading study comparing the diagnostic performance of digital breast tomosynthesis and digital mammography with digital mammography alone.

BACKGROUND: Digital breast tomosynthesis (DBT) is a three-dimensional mammography technique with the potential to improve accuracy by improving differentiation between malignant and non-malignant lesions. OBJECTIVES: The objectives of the study were to compare the diagnostic accuracy of DBT in conjunction with two-dimensional (2D) mammography or synthetic 2D mammography, against standard 2D mammography and to determine if DBT improves the accuracy of detection of different types of lesions. STUDY POPULATION: Women (aged 47-73 years) recalled for further assessment after routine breast screening and women (aged 40-49 years) with moderate/high of risk of developing breast cancer attending annual mammography screening were recruited after giving written informed consent. INTERVENTION: All participants underwent a two-view 2D mammography of both breasts and two-view DBT imaging. Image-processing software generated a synthetic 2D mammogram from the DBT data sets. RETROSPECTIVE READING STUDY: In an independent blinded retrospective study, readers reviewed (1) 2D or (2) 2D + DBT or (3) synthetic 2D + DBT images for each case without access to original screening mammograms or prior examinations. Sensitivities and specificities were calculated for each reading arm and by subgroup analyses. RESULTS: Data were available for 7060 subjects comprising 6020 (1158 cancers) assessment cases and 1040 (two cancers) family history screening cases. Overall sensitivity was 87% [95% confidence interval (CI) 85% to 89%] for 2D only, 89% (95% CI 87% to 91%) for 2D + DBT and 88% (95% CI 86% to 90%) for synthetic 2D + DBT. The difference in sensitivity between 2D and 2D + DBT was of borderline significance (p = 0.07) and for synthetic 2D + DBT there was no significant difference (p = 0.6). Specificity was 58% (95% CI 56% to 60%) for 2D, 69% (95% CI 67% to 71%) for 2D + DBT and 71% (95% CI 69% to 73%) for synthetic 2D + DBT. Specificity was significantly higher in both DBT reading arms for all subgroups of age, density and dominant radiological feature (p < 0.001 all cases). In all reading arms, specificity tended to be lower for microcalcifications and higher for distortion/asymmetry. Comparing 2D + DBT to 2D alone, sensitivity was significantly higher: 93% versus 86% (p < 0.001) for invasive tumours of size 11-20 mm. Similarly, for breast density 50% or more, sensitivities were 93% versus 86% (p = 0.03); for grade 2 invasive tumours, sensitivities were 91% versus 87% (p = 0.01); where the dominant radiological feature was a mass, sensitivities were 92% and 89% (p = 0.04) For synthetic 2D + DBT, there was significantly (p = 0.006) higher sensitivity than 2D alone in invasive cancers of size 11-20 mm, with a sensitivity of 91%. CONCLUSIONS: The specificity of DBT and 2D was better than 2D alone but there was only marginal improvement in sensitivity. The performance of synthetic 2D appeared to be comparable to standard 2D. If these results were observed with screening cases, DBT and 2D mammography could benefit to the screening programme by reducing the number of women recalled unnecessarily, especially if a synthetic 2D mammogram were used to minimise radiation exposure. Further research is required into the feasibility of implementing DBT in a screening setting, prognostic modelling on outcomes and mortality, and comparison of 2D and synthetic 2D for different lesion types. STUDY REGISTRATION: Current Controlled Trials ISRCTN73467396. FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 4. See the HTA programme website for further project information.This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 4. See the HTA programme website for further project information.Gilbert FJ, Tucker L, Gillan MGC, Willsher P, Cooke J, Duncan KA, et al. The TOMMY trial: a comparison of TOMosynthesis with digital MammographY in the UK NHS Breast Screening Programme – a multicentre retrospective reading study comparing the diagnostic performance of digital breast tomosynthesis and digital mammography with digital mammography alone. Health Technol Assess 2015;19(4). © Queen’s Printer and Controller of HMSO 2015. This work was produced by Gilbert et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Model observer for optimizing digital breast tomosynthesis for detection of multifocal and multicentric breast cancer

The goal of medical imaging is to acquire and display images of human anatomy and function such that they can be optimally interpreted by a trained observer, e.g., a radiologist. Start-of-art medical image quality is measured by the performance of an observer on a given clinical task. Since psychophysical studies are resource intensive, model observers are widely used as a surrogate in task-based assessment of image quality. Model observers are typically designed to detect at most one abnormality, e.g., a single lesion. However, in clinical practice, there may be multiple abnormalities in a single set of images, which can have a significant impact on treatment planning and outcomes. For example, patients with multifocal and multicentric breast cancer (MFMC), i.e., the presence of two or more tumor foci within the same breast, are more likely to undergo mastectomy rather than breast conservation therapy. Detecting multiple breast tumors is challenging because the prevalence of tumors varies significantly across breast regions, and radiologists do not know the number or location of tumors a priori. The vision of this dissertation is that digital breast tomosynthesis (DBT) has the potential to improve the detection of MFMC, and may offer advantages such as fewer false-positive findings, lower cost, and better accessibility. This dissertation focuses on the design and applications of a model observer to optimize DBT system geometries for detection of multiple breast tumors. This is significant and innovative because prior efforts to optimize DBT image quality only considered unifocal breast cancer scenarios. We highlight the following two main aspects of contributions in this dissertation: (1) We have developed a novel model observer that detects multiple abnormalities in anatomical backgrounds. (2) We have employed the extended 3D multi-lesion model observer to identify DBT system geometries that are most effective for the detection of MFMC. Our results demonstrate that the presence of more than one tumor present distinct challenges to DBT optimization, and that DBT geometries that yield images that are informative for the task of detecting unifocal breast cancer may not necessarily be informative for the task of detecting MFMC. We are validating the clinical relevance of our model observer studies with an ongoing human observer study with experienced breast imaging radiologists.Electrical and Computer Engineerin

Enhancing the image quality of digital breast tomosynthesis

A novel imaging technology, digital breast tomosynthesis (DBT), is a technique that overcomes the tissue superposition limitation of conventional mammography by acquiring a limited number of X-ray projections from a narrow angular range, and combining these projections to reconstruct a pseudo-3D image. The emergence of DBT as a potential replacement or adjunct to mammographic screening mandates that solutions be found to two of its major limitations, namely X-ray scatter and mono-energetic reconstruction methods. A multi-faceted software-based approach to enhance the image quality of DBT imaging has the potential to increase the sensitivity and specificity of breast cancer detection and diagnosis. A scatter correction (SC) algorithm and a spectral reconstruction (SR) algorithm are both ready for implementation and clinical evaluation in a DBT system and exhibit the potential to improve image quality. A principal component analysis (PCA) based model of breast shape and a PCA model of X-ray scatter optimize the SC algorithm for the clinical realm. In addition, a comprehensive dosimetric characterization of a FDA approved DBT system has also been performed, and the feasibility of a new dual-spectrum, single-acquisition DBT imaging technique has also been evaluated.Ph.D

Computer-aided Detection of Breast Cancer in Digital Tomosynthesis Imaging Using Deep and Multiple Instance Learning

Breast cancer is the most common cancer among women in the world. Nevertheless, early detection of breast cancer improves the chance of successful treatment. Digital breast tomosynthesis (DBT) as a new tomographic technique was developed to minimize the limitations of conventional digital mammography screening. A DBT is a quasi-three-dimensional image that is reconstructed from a small number of two-dimensional (2D) low-dose X-ray images. The 2D X-ray images are acquired over a limited angular around the breast. Our research aims to introduce computer-aided detection (CAD) frameworks to detect early signs of breast cancer in DBTs. In this thesis, we propose three CAD frameworks for detection of breast cancer in DBTs. The first CAD framework is based on hand-crafted feature extraction. Concerning early signs of breast cancer: mass, micro-calcifications, and bilateral asymmetry between left and right breast, the system includes three separate channels to detect each sign. Next two CAD frameworks automatically learn complex patterns of 2D slices using the deep convolutional neural network and the deep cardinality-restricted Boltzmann machines. Finally, the CAD frameworks employ a multiple-instance learning approach with randomized trees algorithm to classify DBT images based on extracted information from 2D slices. The frameworks operate on 2D slices which are generated from DBT volumes. These frameworks are developed and evaluated using 5,040 2D image slices obtained from 87 DBT volumes. We demonstrate the validation and usefulness of the proposed CAD frameworks within empirical experiments for detecting breast cancer in DBTs