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

Modified mass-spring system for physically based deformation modeling

Mass-spring systems are considered the simplest and most intuitive of all deformable models. They are computationally efficient, and can handle large deformations with ease. But they suffer several intrinsic limitations. In this book a modified mass-spring system for physically based deformation modeling that addresses the limitations and solves them elegantly is presented. Several implementations in modeling breast mechanics, heart mechanics and for elastic images registration are presented

Modified mass-spring system for physically based deformation modeling

Mass-spring systems are considered the simplest and most intuitive of all deformable models. They are computationally efficient, and can handle large deformations with ease. But they suffer several intrinsic limitations. In this book a modified mass-spring system for physically based deformation modeling that addresses the limitations and solves them elegantly is presented. Several implementations in modeling breast mechanics, heart mechanics and for elastic images registration are presented

A review of bioengineering techniques applied to breast tissue: Mechanical properties, tissue engineering and finite element analysis

Female breast cancer was the most prevalent cancer worldwide in 2020, according to the Global Cancer Observatory. As a prophylactic measure or as a treatment, mastectomy and lumpectomy are often performed at women. Following these surgeries, women normally do a breast reconstruction to minimize the impact on their physical appearance and, hence, on their mental health, associated with self-image issues. Nowadays, breast reconstruction is based on autologous tissues or implants, which both have disadvantages, such as volume loss over time or capsular contracture, respectively. Tissue engineering and regenerative medicine can bring better solutions and overcome these current limitations. Even though more knowledge needs to be acquired, the combination of biomaterial scaffolds and autologous cells appears to be a promising approach for breast reconstruction. With the growth and improvement of additive manufacturing, three dimensional (3D) printing has been demonstrating a lot of potential to produce complex scaffolds with high resolution. Natural and synthetic materials have been studied in this context and seeded mainly with adipose derived stem cells (ADSCs) since they have a high capability of differentiation. The scaffold must mimic the environment of the extracellular matrix (ECM) of the native tissue, being a structural support for cells to adhere, proliferate and migrate. Hydrogels (e.g., gelatin, alginate, collagen, and fibrin) have been a biomaterial widely studied for this purpose since their matrix resembles the natural ECM of the native tissues. A powerful tool that can be used in parallel with experimental techniques is finite element (FE) modeling, which can aid the measurement of mechanical properties of either breast tissues or scaffolds. FE models may help in the simulation of the whole breast or scaffold under different conditions, predicting what might happen in real life. Therefore, this review gives an overall summary concerning the human breast, specifically its mechanical properties using experimental and FE analysis, and the tissue engineering approaches to regenerate this particular tissue, along with FE models

Image-guided Breast Biopsy of MRI-visible Lesions with a Hand-mounted Motorised Needle Steering Tool

A biopsy is the only diagnostic procedure for accurate histological confirmation of breast cancer. When sonographic placement is not feasible, a Magnetic Resonance Imaging(MRI)-guided biopsy is often preferred. The lack of real-time imaging information and the deformations of the breast make it challenging to bring the needle precisely towards the tumour detected in pre-interventional Magnetic Resonance (MR) images. The current manual MRI-guided biopsy workflow is inaccurate and would benefit from a technique that allows real-time tracking and localisation of the tumour lesion during needle insertion. This paper proposes a robotic setup and software architecture to assist the radiologist in targeting MR-detected suspicious tumours. The approach benefits from image fusion of preoperative images with intraoperative optical tracking of markers attached to the patient's skin. A hand-mounted biopsy device has been constructed with an actuated needle base to drive the tip toward the desired direction. The steering commands may be provided both by user input and by computer guidance. The workflow is validated through phantom experiments. On average, the suspicious breast lesion is targeted with a radius down to 2.3 mm. The results suggest that robotic systems taking into account breast deformations have the potentials to tackle this clinical challenge.Comment: Submitted to 2021 International Symposium on Medical Robotics (ISMR

Data-driven patient-specific breast modeling: a simple, automatized, and robust computational pipeline

Background: Breast-conserving surgery is the most acceptable option for breast cancer removal from an invasive and psychological point of view. During the surgical procedure, the imaging acquisition using Magnetic Image Resonance is performed in the prone configuration, while the surgery is achieved in the supine stance. Thus, a considerable movement of the breast between the two poses drives the tumor to move, complicating the surgeon's task. Therefore, to keep track of the lesion, the surgeon employs ultrasound imaging to mark the tumor with a metallic harpoon or radioactive tags. This procedure, in addition to an invasive characteristic, is a supplemental source of uncertainty. Consequently, developing a numerical method to predict the tumor movement between the imaging and intra-operative configuration is of significant interest. Methods: In this work, a simulation pipeline allowing the prediction of patient-specific breast tumor movement was put forward, including personalized preoperative surgical drawings. Through image segmentation, a subject-specific finite element biomechanical model is obtained. By first computing an undeformed state of the breast (equivalent to a nullified gravity), the estimated intra-operative configuration is then evaluated using our developed registration methods. Finally, the model is calibrated using a surface acquisition in the intra-operative stance to minimize the prediction error. Findings: The capabilities of our breast biomechanical model to reproduce real breast deformations were evaluated. To this extent, the estimated geometry of the supine breast configuration was computed using a corotational elastic material model formulation. The subject-specific mechanical properties of the breast and skin were assessed, to get the best estimates of the prone configuration. The final results are a Mean Absolute Error of 4.00 mm for the mechanical parameters E_breast = 0.32 kPa and E_skin = 22.72 kPa. The optimized mechanical parameters are congruent with the recent state-of-the-art. The simulation (including finding the undeformed and prone configuration) takes less than 20 s. The Covariance Matrix Adaptation Evolution Strategy optimizer converges on average between 15 to 100 iterations depending on the initial parameters for a total time comprised between 5 to 30 min. To our knowledge, our model offers one of the best compromises between accuracy and speed. The model could be effortlessly enriched through our recent work to facilitate the use of complex material models by only describing the strain density energy function of the material. In a second study, we developed a second breast model aiming at mapping a generic model embedding breast-conserving surgical drawing to any patient. We demonstrated the clinical applications of such a model in a real-case scenario, offering a relevant education tool for an inexperienced surgeon

Complexity Reduction in Image-Based Breast Cancer Care

The diversity of malignancies of the breast requires personalized diagnostic and therapeutic decision making in a complex situation. This thesis contributes in three clinical areas: (1) For clinical diagnostic image evaluation, computer-aided detection and diagnosis of mass and non-mass lesions in breast MRI is developed. 4D texture features characterize mass lesions. For non-mass lesions, a combined detection/characterisation method utilizes the bilateral symmetry of the breast s contrast agent uptake. (2) To improve clinical workflows, a breast MRI reading paradigm is proposed, exemplified by a breast MRI reading workstation prototype. Instead of mouse and keyboard, it is operated using multi-touch gestures. The concept is extended to mammography screening, introducing efficient navigation aids. (3) Contributions to finite element modeling of breast tissue deformations tackle two clinical problems: surgery planning and the prediction of the breast deformation in a MRI biopsy device