Classifications

• • G—PHYSICS
  • G06—COMPUTING; CALCULATING OR COUNTING
  • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
  • G06T19/00—Manipulating 3D models or images for computer graphics
• • G—PHYSICS
  • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
  • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
  • G16H30/00—ICT specially adapted for the handling or processing of medical images
  • G16H30/20—ICT specially adapted for the handling or processing of medical images for handling medical images, e.g. DICOM, HL7 or PACS
• • G—PHYSICS
  • G06—COMPUTING; CALCULATING OR COUNTING
  • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
  • G06T2210/00—Indexing scheme for image generation or computer graphics
  • G06T2210/41—Medical
• • G—PHYSICS
  • G06—COMPUTING; CALCULATING OR COUNTING
  • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
  • G06T2219/00—Indexing scheme for manipulating 3D models or images for computer graphics
  • G06T2219/004—Annotating, labelling

Definitions

• Image data sets are in general generated by image generation devices. These image generation devices are, for example, mammography scanners, computed tomography scanners, magnetic resonance imaging scanners and ultra sound scanners, which are, in particular, used for diagnostic purposes.
• the generated image data sets are often transferred to marks generation devices, like a computer-aided-detection device (CAD device), for determining marks indicating certain locations within the image data sets.
• CAD device computer-aided-detection device
• the CAD device can determine marks indicating locations within the image data set, which are suspicious of showing cancer.
• a user like a radiologist, could examine the locations within the image data set indicated by the marks, in order to determine, whether cancer is present or not.
• a method for displaying marks in an image data set is presented, wherein an image data set comprising marks is provided and wherein during a review phase not all marks within the image data set are displayed at the same time.
• One embodiment of the invention is based on the idea, that, if less marks are shown within the image data set at the same time, a user is less confused and the probability of overlooking an important mark is decreased.
• the image data set is a medical image data set, for example, a set of digital mammograms
• the marks are CAD marks
• the sorting criterion is the probability of marking illness, in particular the suspiciousness.
• the medical image data set can, for example, also be a tomosyntheses image data set, a computed tomography image data set, a breast magnetic resonance imaging data set or any other medical image data set.
• the importance of a mark is correlated with the probability of marking illness, e.g., a mark having a higher probability of marking illness has a higher importance than a mark having a lower probability of marking illness.
• the illness is, for example, cancer.
• the suspiciousness is a well defined CAD term and is, for example, provided by a CAD mark generation device and a CAD mark - A -
• the next mark in the generated list is displayed after fulfilling a predetermined switching criterion.
• the predetermined switching criterion is, for example, an input to an apparatus for displaying marks in an image data set, which performs the method in accordance with one embodiment of the invention.
• the apparatus for displaying marks in an image data set can comprise an input device, for example, a keyboard or a mouse, for inputting a signal indicating that the next mark can now be shown.
• the switching criterion is an input criterion, e.g., whether a signal has been inputted indicating that the next mark can now be shown or whether such a signal has not been inputted.
• a user can review a mark within the image data set as long as needed and, after the user has reviewed the respective mark, the user can switch to the next mark. This further decreases the probability of overlooking an important mark and of a misassessment of a mark, in particular, of generating a false negative or a false positive.
• groups of marks being successive in the generated list are shown at the same time. This allows to review several marks, which might be similar with respect to the sorting criterion, at the same time, wherein the speed of reviewing is increased, while, since only groups and not all markers are shown, the user is still not confused by the amount of marks displayed at the same time.
• the image data set is a medical image data set
• the marks are CAD marks
• the sorting criterion is the probability of marking illness, in particular, the suspiciousness.
• the next group is displayed after fulfilling a predetermined switching criterion.
• the operating point is the operating point of the CAD algorithm used by the CAD mark generation device and CAD mark generation computer program.
• the operating point of the CAD algorithm which has been used for determining the respective CAD mark, is also contained in the information of the SR provided from the CAD mark generation device and CAD mark generation computer program.
• the operating point is a measure for the probability of the determination of false positives and false negatives by the CAD algorithm.
• the operating point criterion is fulfilled for a respective CAD mark, if the operating point of this respective CAD mark is equal to a given operating point.
• the given operating point can be given by a user, which inputs the operating point via an input device, like a keyboard or a mouse, to an apparatus for displaying marks in an image data set for performing the method in accordance with one embodiment of the invention. Furthermore, the operating point can also be predetermined.
• the operating point is, for example, described in the section "Correction Items - By Number ", CP 624 of the DICOM Standard.
• microcalcification marks are known to be determined by the CAD algorithm with a high performance (e.g., high specificity and high sensitivity), the use of microcalcification marks for reviewing marks of an image data set can further improve a diagnosis based on this review.
• the user can select via the input device, that only CAD marks are displayed which fulfil the mass criterion, e.g., that only mass marks are shown. Since CAD algorithms determine in general mass marks with a large number of false positives, it is particularly important to review these mass marks carefully. Therefore, particularly during reviewing mass marks the present invention, which assists a user, like a radiologist, in focussing on, in this embodiment, mass marks, is very useful.
• the user can select the mass criterion as the display criterion by inputting a corresponding signal into the apparatus for displaying marks in an image data set via an input device. If the apparatus receives such a signal, only mass marks are displayed.
• an input device is provided for entering at least one displaying criterion as the at least one given displaying criterion in an apparatus for displaying marks in an image data set. This allows to change the number of displayed marks based on user interaction.
• magnification is shown, in particular, automatically and at the same time, at which the corresponding mark is shown in the first display area, both, an overall view and a magnification, are shown at the same time, wherein a further interaction of the user for obtaining such a magnification is not needed, decreasing the time needed for reviewing the marks.
• the image data set is preferentially a medical image data set in one embodiment, and the marks are preferentially CAD marks in one embodiment.
• the image data set is preferentially a mammogram data set in one embodiment, for example, for each breast of a patient a craniocaudal (CC) view image and a mediolateral oblique (MLO) view image, e.g., a mammogram data set comprises preferentially four images in one embodiment, a left and a right CC image, and a left and a right MLO image. It is preferred in one embodiment that a displayed mark is selected, in particular, to be discarded.
• CC craniocaudal
• MLO mediolateral oblique
• a displayed mark is provided with a further mark.
• This can, for example, be performed by inputting the further mark via an input device into an apparatus for displaying marks in an image data set, which performs the method in accordance with one embodiment of the invention.
• the image data set comprises the initially provided marks and the later provided added marks. This allows a user, for example, a radiologist, to add further marks to the image data set.
• the image data set comprises several images and if a mark is displayed in one of these images, being a first image, in at least one of the other images of the image data set a corridor is displayed, which includes a location, which corresponds to a first location in the first image, which is marked by the mark.
• the object in the starting image and/or in the at least one target image, the object can be deformed, and in each or in some of these images the deformation of the object can be different.
• the starting image and/or the at least one target image can be a two-dimensional image, like a absorption or transmission projection, for example, a CC image or a MLO image of a breast, or a three- dimensional image, like a three-dimensional computed tomography image or a three-dimensional magnetic resonance image.
• the starting image and the at least one target image can be two-dimensional images, or one of these images, the starting image or the at least one target image, can be a two- dimensional image, and another image of these images can be a three- dimensional image.
• the first location and the second location can be an image point or an extended region within the respective image. Furthermore, since in different images the object can comprise different deformations and can be imaged from different directions, the shape of the first location and/or the second location can differ from image to image. For example, a location, being in the starting image an image point, can be a line in the at least one target image.
• the distance between the first location and the second location is preferentially in one embodiment the distance between the centres of these locations. But, the distance can also be any distance between a point at or within the first location and a point at or within the second location.
• the centre position of the circle defined by the circular line is preferentially in one embodiment the centre of the second location in the at least one target image.
• the centre position of this circle can be any point at or within the second location within the at least one target image.
• the circular line defines a circle, whose radius corresponds to the distance between the first location and the second location in the starting image.
• this radius can be substantially equal to this distance, e.g., it is preferred in one embodiment that a difference length between this radius and this distance is smaller than 10 percent of this distance. It is further preferred in one embodiment that this difference length is smaller than 5 percent of this distance, and it is further preferred in one embodiment that this distance is equal to the radius. That the radius corresponds to the distance also means that, if the object in the at least one target image is magnifiedly shown with respect to the starting image of this object, this radius is substantially equal to an accordingly magnified distance.
• the radius is substantially equal to twice a distance between the first location and the second location in the starting image. If the starting image and the at least one target image show the object with different magnifications, the difference between the radius and the accordingly magnified distance is preferentially in one embodiment smaller than 10 percent of the accordingly magnified distance, further preferred in one embodiment smaller than 5 percent of the accordingly magnified distance and further preferred in one embodiment equal to zero.
• This embodiment is based on the idea that the first location in the starting image corresponds with a high probability to a region within the at least one target image, which is located within the corridor within the at least one target image. Therefore, the user, like a radiologist, can focus on the corridor, if the user wants to find a region within the at least one target image, which corresponds to the first location within the starting image. The determination of this corridor can be carried out with low computational effort.
• This low computational effort is particularly important, if the user is a radiologist and if the images are medical images.
• a radiologist has to review a large number of medical images in a short time, for example, 200 images in two hours. It is therefore important to determine the corridors very fast, in order to not let a radiologist wait and waist his time.
• MLO or ML image is different to the deformation of the breast in a CC image. Furthermore, the breast in a MLO or ML image has been viewed from another direction than in a CC image. But, although the breast is viewed from different directions and deformed differently, the distance between the first location within the breast and the nipple of the breast being the second location is substantially invariant in the different mammographic views, e.g., this distance does not change very much. It exists therefore a high probability, that a region, which corresponds to a first location in a starting mammogram, is located within the corridor in at least one target mammogram.
• the presentation method of presenting an image of an object is therefore particularly applicable, if corresponding locations or regions have to be found in different mammograms of the same breast.
• the first location is in one embodiment preferentially marked by a CAD mark determined by using a CAD algorithm.
• CAD marks are used, in order to help a radiologist to find suspicious regions within a medical image, like a mammogram.
• a CAD mark marks a region within a mammogram, which is, with respect to the CAD algorithm used by a CAD computer program and/or a CAD device, suspicious of marking an illness, in particular, of marking cancer. If different CAD marks are shown one after another within the image data set in accordance with a generated list, the first location is preferentially in one embodiment the location within an image, being the first image, which is marked by the currently displayed CAD mark. This allows a user to easily review regions, which correspond to the first location, in the at least one target image. Thus, the same region can be viewed in different images of the same object. This improves the review results of a user, like a radiologist.
• the step of providing the second location within the starting image and the at least one target image comprises a step of automatically detecting the second location in at least one of the starting image and the at least one target image.
• the automatic detection of the second location allows to automatically determine and display the corridor in the at least one target image, if a mark marking a first location in the starting image is displayed.
• the step of providing the second location within the starting image and the at least one target image comprises a step of providing an input unit for inputting the second location within the starting image and the at least one target image.
• the input unit for example, a graphical user interface, allows a user to input the second location in the starting image and/or in at least one of the at least one target image.
• the second location can preferentially be provided in one embodiment within an image by clicking with a mouse pointer on the respective location within the respective image. This allow a user to easily provide the second location in at least one of the starting image and the at least one target image.
• the step of providing the second location within the starting image and the at least one target image comprises a step of providing an input unit for correcting the position of the second location at least within one of the starting image and the at least one target image.
• the input unit is, for example, a graphical user interface, which allows a user, for example, by using a drag-and-drop operation, to move the second location to another position within the respective image. This allows a user to easily modify the position of a second location which has been provided, for example, by an automatic second location detection system.
• a system is, for example, a nipple detection system using a nipple detection computer program for detecting the nipple of a breast automatically.
• Such a system is, for example, disclosed in Zhou C, Chan HP, Paramagul C, Roubidoux MA, Sahiner B, Hadjiiski LM, Petrick N, "Computerized nipple identification for multiple image analysis in computer- aided diagnosis", Med Phys. 2004 Oct, 31 (10):2871-82.
• the presentation method for presenting an image of an object further comprises the step of providing an input unit for inputting the distance for providing the distance or the step of determining the distance between the first location and the second location in the starting image.
• a user can enter the distance between the first location and the second location in a presentation device for presenting an image of an object in accordance with one embodiment of the invention.
• a user can determine the distance between a first location and a second location being the location of the nipple of the breast from the present ultrasound and/or breast magnetic resonance imaging images, and the user can enter this determined distance into the presentation device for presenting an image of an object in accordance with one embodiment of the invention.
• the distance between the first location and the second location has not to be determined within the starting image, but this distance can be provided by a user, who knows this distance, for example, from present images of the object, for example, of the breast.
• This present images can differ from the starting image and the at least one target image.
• the starting image and the at least one target image can be digital mammograms acquired by a digital mammography device, and the present images, from which the user has determined the distance, can be an image from other modalities, like images from an ultrasound device, a magnetic resonance imaging device or a computed tomography device.
• the present images from which the user has determined the distance
• the corridor is determined such that the circular line is located in the middle of the corridor. This leads to a corridor having a high probability of containing a region, which corresponds to the first position, in the at least one target image.
• the first location is extended and that the step of determining the corridor comprises following steps: determining the smallest distance and the largest distance between the second location and the extended first location within the starting image, determining the corridor such that it contains all image points of the at least one target image having a distance to the second location which is smaller than the largest distance and larger than the smallest distance. This further increases the probability of the corridor of containing a region, which corresponds to a first location within the starting image, within the at least one target image.
• an input unit is provided for inputting a width value or that a width value is predefined, wherein the corridor is determined such that it contains all image points of the at least one target image having a distance to the second location which is smaller than the largest distance multiplied by the sum of one and the width value and larger than the smallest distance multiplied by the difference between one and the width value.
• the input unit for inputting a width value is preferentially a graphical user interface in one embodiment, which allows a user to input a width value, for example, via a keyboard or a mouse.
• the width of the corridor depends on the distance between the first location and the second location and, thus, a useable width of the corridor can easily be inputted by a user.
• the width value can also be predefined. If the width value is predefined, the input unit for inputting a width value does not have to be provided.
• a preferred width value is 25 percent in one embodiment. It is further preferred in one embodiment that the part of the at least one target image, which is located inside of the corridor, is presented more prominent than the part of the at least one target image which is located outside of the corridor.
• the user Since the part of the at least one target image, which is located inside of the corridor, is presented more prominent than the part of the at least one target image, which is located outside of the corridor, the user, like radiologist, is focused on the corridor and not distracted by the part of the at least one target image located outside of the corridor. This further increases the assistance of finding corresponding regions in different images.
• the part of the at least one target image, which is located outside of the corridor is preferentially in one embodiment shown less prominent by dimming this part.
• the dimming is preferentially in one embodiment carried out such that the user can still see the outline of the object, in particular, of the breast, in the dimmed part, and that the user can easily focus on the corridor.
• the dimming is preferentially performed by decreasing the brightness in one embodiment.
• only the part of the at least one target image can be shown, which is located inside of the corridor, e.g., the part of the at least one target image, which is located outside of the corridor, is, in this embodiment, not shown.
• the image data set comprises a first kind of marks and at least one second kind of marks, wherein during the review phase not all marks of the first kind of marks are displayed at the same time and wherein during the review phase all marks of at least one kind of the at least one second kind of marks are displayed at the same time.
• the marks of the first kind of marks are displayed as claimed at least in one of the claims 2 to 17.
• the information from these at least one second kind of marks can also be used during the review phase, which can improve the assistance of a user, like a radiologist, in reviewing marks.
• the marks are CAD marks
• the first kind of marks are preferentially mass marks in one embodiment
• the at least one second kind of marks are preferentially microcalcification marks in one embodiment.
• a method for displaying marks in an image data set is presented, wherein an image data set comprising marks is provided, wherein in an overview phase all marks are displayed, wherein in a review phase the marks are displayed as defined in one of the claims 1 to 18 and wherein the overview phase is arranged before and/or after the review phase.
• a selection is performed as defined in claim 14, wherein an overview phase is arranged after the review phase and wherein in the review phase after the overview phase only non-selected marks are displayed. Since finally only non-selected marks are displayed, marks, which have been selected by the user, in particular, as being of no importance, are not shown, further decreasing the probability of overlooking important marks.
• an apparatus for displaying marks in an image data set comprising a displaying unit, wherein the apparatus is adapted for displaying not all marks within the image data set at the same time on the displaying unit during a review phase.
• the apparatus comprises a list generation unit for generating a list of the marks by sorting the marks depending on a predetermined sorting criterion and wherein the apparatus unit is adapted for displaying the marks temporally one after another within the image data set in accordance with the generated list during the review phase.
• the image data set is a medical image data set, wherein the marks are CAD marks and wherein the sorting criterion is the probability of marking illness, in particular the suspiciousness.
• the apparatus is adapted for displaying the next mark in the generated list after fulfilling a predetermined switching criterion. It is further preferred in one embodiment that the apparatus is adapted for displaying an indication indicating the position of the displayed mark within the list and/or the overall number of marks to be displayed.
• the apparatus comprises a list generation unit for generating a list of the marks by sorting the marks depending on a predetermined sorting criterion, wherein the apparatus comprises a grouping unit for grouping the marks into groups wherein each group contains marks being successive in the generated list and wherein the displaying unit is adapted for displaying the groups temporally one after another within the image data set during the review phase.
• the image data set is a medical image data set, wherein the marks are CAD marks and wherein the sorting criterion is the probability of marking illness. It is further preferred in one embodiment that the sorting criterion is the suspiciousness.
• the apparatus is adapted for displaying the next group after fulfilling a predetermined switching criterion. It is further preferred in one embodiment that the apparatus is adapted for displaying only marks fulfilling at least one given displaying criterion. It is further preferred in one embodiment that the image data set is a medical image data set, wherein the marks are CAD marks and wherein the at least one given displaying criterion is at least one of a microcalcification criterion, a mass criterion and an operating point criterion.
• the displaying unit comprises at least a first display area and a second display area, wherein the apparatus is adapted for displaying in both display areas one or several marks within the image data set and for displaying in the second display area a region around the one or several marks with a larger magnification than in the first display area.
• the image data set is a medical image data set and that the marks are CAD marks.
• the image data set is a mammogram data set.
• the apparatus is adapted for selecting a displayed mark, in particular, to be discarded.
• the apparatus is adapted for displaying only non-selected marks, after selecting a displayed mark.
• the apparatus is adapted for providing a displayed mark with a further mark.
• an apparatus for displaying marks in an image data set comprising a displaying unit for displaying the image data set and the marks, wherein the apparatus is adapted for displaying in an overview phase all marks, for displaying in a review phase the marks as defined in one of the claims 1 to 18 and for arranging the overview phase before and/or after the review phase. It is preferred in one embodiment that the apparatus is adapted for arranging an overview phase after the review phase and for displaying in the overview phase after the review phase only non-selected marks.
• an imaging system comprising: an image data set generating unit for generating an image data set, - a marks generating unit for generating marks depending on the generated image data set, an apparatus for displaying marks within an image data set as defined in claim 21.
• Fig. 1 shows a schematic view of an imaging system in accordance with the invention
• Fig. 2 shows a schematic view of an apparatus for imaging marks within an image data set in accordance with the invention
• Fig. 3 shows a flow chart of an embodiment of a method for displaying marks within an image data set in accordance with the invention
• Fig. 4 shows exemplarily an image data set and CAD marks
• Fig. 5 shows exemplarily an image data set and a CAD mark in a first display area and in a second display area, wherein the CAD mark and the image data set are magnified in the second display area,
• Fig. 6 shows a flowchart of a further embodiment of a method for displaying marks within an image data set in accordance with the invention
• Fig. 7 shows a further embodiment of a method for displaying marks within an image data set in accordance with the invention.
• Fig. 8 shows a further embodiment of a method for displaying marks within an image data set in accordance with the invention.
• Fig. 1 shows a schematic view of an imaging system 1 comprising an image data set generating unit 2, a CAD mark generation unit 3 and an apparatus for displaying marks in an image data set 4.
• the image data set generation unit 2 is, for example, a device for acquiring digital mammograms, a computed tomography device, a magnetic resonance imaging device, a tomosyntheses device or any other medical imaging device.
• the image data set generating unit 2 generates image data sets and transfers them to the CAD mark generating unit 3 and to the apparatus 4 for displaying marks in an image data set.
• the CAD mark generation unit 3 generates from the image data sets received from the image data set generation unit 4 CAD marks using known CAD algorithms.
• Such CAD mark generation units 3 and CAD algorithms are, for example, the Image Checker System produced by R2 Technology Inc. and the Second Look Digital System produced by iCAD Inc.
• the generated CAD marks are transferred from the CAD mark generation unit 3 to the apparatus 4 for displaying marks in an image data set.
• the apparatus 4 for displaying marks in an image data set is, in more detail, schematically shown in Fig. 2.
• the apparatus 4 for displaying marks in an image data set comprises an image data set receiving unit 5 for receiving image data sets from the image data set generation unit 2.
• the apparatus 4 comprises further a CAD mark receiving unit 6 for receiving CAD marks from the CAD mark generation unit 3.
• the CAD marks are preferentially in one embodiment transferred and received in the DICOM format, in particular, as a DICOM CAD Structure Report (SR).
• the CAD marks e.g., in particular, the SR, is transferred from the CAD mark receiving unit 6 to a list generation unit 7.
• the list generation unit 7 can forward the CAD marks to a control unit 8 without modifications, or the list generation unit 7 can generate a list of the marks by sorting the marks depending on a predetermined sorting criterion and the sorted CAD marks can be transferred from the list generation unit 7 to the control unit 8.
• the control unit 8 receives image data sets from the image data set receiving unit 5 and inputs from an input unit 9.
• the input unit 9 is, for example, a keyboard or a mouse.
• the control unit 8 is connected to a display unit 10 for displaying CAD marks and image data sets.
• the apparatus 4 for displaying marks in an image data set further comprises a grouping unit 1 1 , which receives sorted CAD marks from the list generation unit 7 for grouping these CAD marks into groups of CAD marks, which are transferred to the control unit 8.
• the control unit 8 controls the image data set receiving unit 5, the CAD mark receiving unit 6, the list generation unit 7, the input unit 9, the displaying unit 10 and the grouping unit 11 in accordance with a method for displaying marks in an image data set, which will be described further below.
• the apparatus for displaying marks in an image data set is preferentially a computer system comprising the different units 5 to 11 in one embodiment. Theses units can be realised by computer programs and/or dedicated hardware. In accordance with one embodiment of the invention, the apparatus for displaying marks in an image data set can also comprise less, additional and/or other units, as long as the apparatus still allows to display not all marks within the image data set at the same time. For example, instead of separate list generation unit 7 and grouping unit 11 , a single unit can be used having the same functional features as the list generation unit 7 and the grouping unit 1 1 together. Furthermore, the image data set receiving unit 5 and the CAD mark receiving unit 6 could be integrated into one receiving unit, which receives both, the image data set and the CAD marks.
• the invention is not limited to the data paths within the apparatus 4 for displaying an image data set, which have been described above.
• the image data sets and CAD marks could be directly transferred to the display unit 10, and not via the control unit 8, while the control unit 8 still controls the data transfer within the apparatus 4 for displaying an image data set.
• step 101 the apparatus 4 for displaying marks in an image data set receives an image data set from the image data set generation unit 2 and CAD marks from the CAD mark generation unit 3.
• the image data set and the corresponding CAD marks can already be present on the apparatus 4 for displaying marks in an image data set such that an acquisition and/or determination and/or receiving of these data is not necessary. Step 101 would therefore be omitted.
• step 102 the image data set and the CAD marks have been transferred to the displaying unit 10, which displays the image data set and the CAD marks.
• a visualization of the image data set containing the CAD marks can, for example, be performed after a user has requested such a visualization by using the input unit 9. If a user inputs such a request, in this embodiment, the control unit 8 receives this request and controls the displaying unit 10 such that it shows the image data set and the CAD marks, in particular, in an overview phase, all CAD marks, which haven been determined by the CAD mark generation unit 3. In other embodiments, step 102 can be omitted.
• a visualization of the image data set and the CAD marks is exemplary shown in Fig. 4. In Fig.
• the digital mammograms 20a, ..., 2Od, 21a, ...., 21d are shown.
• the digital mammograms 20a, ...., 2Od are current mammograms, and the digital mammograms 21a, ..., 21 d are prior mammograms of an earlier examination of the breasts.
• the digital mammograms 20a, ..., 2Od (for each breast a CC-view image and a MLO-view image) constitute one image data set. Within this image data set four CAD marks C1 , C2, C3, M1 are displayed.
• the list generation unit 7 generates a list of the CAD marks by sorting the marks depending on a predetermined sorting criterion.
• This sorting criterion is in this embodiment the suspiciousness.
• the suspiciousness is also known as the certainty of finding.
• a mark having a large suspiciousness has a large probability of marking illness, in particular, of marking cancer.
• the suspiciousness is contained in the SR, which has in step 101 been transferred from the CAD mark generation unit 3 to the apparatus 4 for displaying marks in an image data set.
• a SR has been transferred containing the CAD marks and further information, which is defined in the corresponding DICOM standard.
• the CAD marks' degree of suspiciousness decreases in the following order: C1 , M1 , C2, C3.
• step 104 the CAD marks are displayed temporally one after another within the image data set on the displaying unit 10 in accordance with the generated list, e.g., in this embodiment, at first the CAD mark C1 is displayed.
• the displaying unit 10 displays in this embodiment the respective CAD mark on a first display area and on a second display area.
• the respective CAD mark is displayed within a view of the respective image of the image data set showing the whole image containing the respective CAD mark.
• the respective CAD mark is shown in a magnified view.
• Such a visualization on the displaying unit 10 is exemplarily shown in Fig. 5.
• Fig. 5 shows two images 20a, 20b of the current image data set, and images 21 a,
• first CAD mark C1 is displayed in a first display area 22 such that substantially the whole corresponding image 20a is shown, while in a second display area 23 the CAD mark and the surrounding breast tissue are shown magnifiedly.
• the first display area 22 and the second display 23 show an indication 24 indicating the position of the displayed CAD mark C1 within the list, which has been generated in step 103.
• step 105 the user has the possibility to select the present CAD mark.
• a selected CAD mark is discarded.
• the selection of a CAD mark can be performed by using the input unit 9.
• Fig. 5 shows in the second display area 23 the letters "X" and "A". If the user pushes with a mouse pointer the letter "X” the CAD mark C1 will be selected, e.g., will be discarded, while, if the user pushes with the mouse pointer the letter
• the CAD mark C1 will be accepted, and preferentially the next mark will be shown in one embodiment.
• the apparatus 4 for displaying marks in an image data set can also be configured that each non-selected CAD mark is an accepted mark.
• step 105 can be omitted.
• Step 107 After the apparatus for displaying marks in an image data set has received a signal from the input unit 9 indicating that the next CAD mark can be displayed, it is determined whether a next CAD mark exists in the list, which has been generated in step 103. If such a next CAD mark exists, the method continues with the next CAD mark with step 104. If a next CAD mark does not exist, all selected CAD marks are displayed on the displaying unit 10 in an overview phase in step 107. Step 107 can be omitted.
• the next CAD mark can, for example, be displayed on the display unit 10, if a user pushes with a mouse pointer the letter ,,A", which is shown in the second display area 23 in Fig. 5.
• the steps 103 to 106 define the review phase, during which not all marks within the image data set are displayed at the same time, wherein the attention of the user is focused on the respective CAD mark and wherein, thus, the probability of overlooking an important CAD mark is decreased.
• a user can add additional marks, which can be displayed within the image data set.
• the method for displaying marks within an image data set can be modified such that during performing this method a user can input a signal to the apparatus 4 indicating that now all marks, which have been reviewed and which have not been discarded, shall be shown on the displaying unit 10.
• the method for displaying marks within an image data set can further be modified such that, after all of these marks have been shown, the method continues, if a further signal is inputted to the apparatus 4 by using the input unit 9 indicating that the review of the marks should continue.
• Steps 201 and 202 are identical to steps 101 and 102.
• step 203 only CAD marks are displayed at the same time during the review phase, which fulfil a predetermined displaying criterion.
• This displaying criterion can, for example, be a microcalcification criterion, a mass criterion or an operating point criterion.
• the displaying criterion can also be a combination of these criterions. It can be configured, for example, by the user, which of these criterions or which combination of these criterion form the displaying criterion.
• Step 204 corresponds to step 105 and can be omitted. Furthermore, as already described in more detail with respect to step 107, in step 205 all marks are displayed within the image data set, which have not been selected, e.g., in this embodiment, which have not been discarded.
• Steps 301 and 302 correspond to steps 101 and 102.
• step 303 the CAD marks are restricted as described with respect to step 203.
• the following steps 304 to 308 are performed only with the CAD marks, which fulfil the displaying criterion of step 303. Except for the restriction to CAD marks, which fulfil the displaying criterion, the steps 304 to 308 correspond to the above described steps 103 to 107. Also step 306 can be omitted.
• Steps 401 and 402 correspond to steps 101 and 102.
• the restriction in step 403 corresponds to the restriction of step 203. This restriction step 403 can be omitted in this embodiment.
• the list generation step 404 corresponds to step 103.
• the grouping unit 1 1 groups CAD marks into groups, wherein each group contains CAD marks being successive in the list, generated in step 404.
• a first group could contain the marks C1 , M1 and a second group could contain the marks C2, C3.
• steps 406 to 408 correspond to steps 104 to 106, except for the difference that in step 406 all marks of the group are displayed at the same time and that, in step 408, it is checked, whether a next group exists.
• Step 409 corresponds to step 107.
• the viewing step 102, 202, 303, the restriction step 203, 303 and the list generation step 103, 304 can be mixed in the respective flowcharts shown in Figures 3, 6 and 7, if present.
• the image data set comprises several images and if a mark is displayed in one of these image, being a first image, in at least one of the other images, being at least one target image, of the image data set a corridor is in one embodiment preferentially displayed, which includes a location, which corresponds to the location in the starting image, which is marked by the respective mark.
• the display criterion is an operating point criterion
• preferentially only CAD marks are displayed in one embodiment, which correspond to a given operating point.
• This operating point can be entered into an apparatus for displaying marks in an image data set, for example, by using a graphical user interface comprising a sliding scale, wherein, preferentially in one embodiment, by using the sliding scale one of three operating points can be selected.
• the sorting criterion and/or the displaying criterion can also be a value, which is or depends on the architectural noise.
• the architectural noise is related to the probability of marking illness, in particular, the probability of marking cancer.
• the architectural noise can be formed by a seemingly random pattern, which is formed by various tissues in the breast (ducts, lobules and connective tissue). In the science of image analysis there are various measures for noise (entropy, Fourier power spectrum, fractal dimension, etc.). In combination with some image processing, such as edge enhancement, and enhancement of linear structures etc., this mathematical concepts can be used to quantify the architectural noise in mammograms.
• CAD marks are not limited to a certain CAD mark generation unit. These embodiments can be performed independent of the respective CAD mark algorithm used by the CAD mark generation unit. These embodiments only require CAD marks, but it is not important how these CAD marks have been determined.
• a computer program may be stored/distributed on a suitable medium, such as an optical storage medium or a solid-state medium supplied together with or as part of other hardware, but may also be distributed in other forms, such as via the Internet or other wired or wireless telecommunication systems.
• a suitable medium such as an optical storage medium or a solid-state medium supplied together with or as part of other hardware, but may also be distributed in other forms, such as via the Internet or other wired or wireless telecommunication systems.

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