WO2012153250A1 - Breast cancer risk assessment - Google Patents

Breast cancer risk assessment Download PDF

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Publication number
WO2012153250A1
WO2012153250A1 PCT/IB2012/052242 IB2012052242W WO2012153250A1 WO 2012153250 A1 WO2012153250 A1 WO 2012153250A1 IB 2012052242 W IB2012052242 W IB 2012052242W WO 2012153250 A1 WO2012153250 A1 WO 2012153250A1
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WO
WIPO (PCT)
Prior art keywords
breast
image data
congruency
information
asymmetry
Prior art date
Application number
PCT/IB2012/052242
Other languages
French (fr)
Inventor
Michael Grass
Klaus Erhard
Tim Nielsen
Original Assignee
Koninklijke Philips Electronics N.V.
Philips Intellectual Property & Standards Gmbh
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Filing date
Publication date
Application filed by Koninklijke Philips Electronics N.V., Philips Intellectual Property & Standards Gmbh filed Critical Koninklijke Philips Electronics N.V.
Publication of WO2012153250A1 publication Critical patent/WO2012153250A1/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/50—Clinical applications
    • A61B6/502—Clinical applications involving diagnosis of breast, i.e. mammography
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/52—Devices using data or image processing specially adapted for radiation diagnosis
    • A61B6/5211—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data
    • A61B6/5217—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data extracting a diagnostic or physiological parameter from medical diagnostic data
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/52—Devices using data or image processing specially adapted for radiation diagnosis
    • A61B6/5211—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data
    • A61B6/5229—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data combining image data of a patient, e.g. combining a functional image with an anatomical image
    • A61B6/5235—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data combining image data of a patient, e.g. combining a functional image with an anatomical image combining images from the same or different ionising radiation imaging techniques, e.g. PET and CT
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T7/00—Image analysis
    • G06T7/0002—Inspection of images, e.g. flaw detection
    • G06T7/0012—Biomedical image inspection
    • G06T7/0014—Biomedical image inspection using an image reference approach
    • 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
    • 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
    • G16H40/00—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices
    • G16H40/60—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices
    • G16H40/63—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices for local operation
    • 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
    • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
    • G16H50/20—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for computer-aided diagnosis, e.g. based on medical expert systems
    • 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
    • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
    • G16H50/30—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for calculating health indices; for individual health risk assessment
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/02—Devices for diagnosis sequentially in different planes; Stereoscopic radiation diagnosis
    • A61B6/025—Tomosynthesis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/04—Positioning of patients; Tiltable beds or the like
    • A61B6/0407—Supports, e.g. tables or beds, for the body or parts of the body
    • A61B6/0414—Supports, e.g. tables or beds, for the body or parts of the body with compression means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/44—Constructional features of apparatus for radiation diagnosis
    • A61B6/4429—Constructional features of apparatus for radiation diagnosis related to the mounting of source units and detector units
    • A61B6/4452—Constructional features of apparatus for radiation diagnosis related to the mounting of source units and detector units the source unit and the detector unit being able to move relative to each other
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/46—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment with special arrangements for interfacing with the operator or the patient
    • A61B6/461—Displaying means of special interest
    • A61B6/463—Displaying means of special interest characterised by displaying multiple images or images and diagnostic data on one display
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/48—Diagnostic techniques
    • A61B6/486—Diagnostic techniques involving generating temporal series of image data
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/52—Devices using data or image processing specially adapted for radiation diagnosis
    • A61B6/5294—Devices using data or image processing specially adapted for radiation diagnosis involving using additional data, e.g. patient information, image labeling, acquisition parameters
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T2207/00—Indexing scheme for image analysis or image enhancement
    • G06T2207/10—Image acquisition modality
    • G06T2207/10116—X-ray image
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T2207/00—Indexing scheme for image analysis or image enhancement
    • G06T2207/30—Subject of image; Context of image processing
    • G06T2207/30004—Biomedical image processing
    • G06T2207/30068—Mammography; Breast

Definitions

  • the present invention relates to breast cancer screening, and in particular to a breast cancer screening apparatus, an X-ray imaging system for breast cancer screening, a method for providing information for breast cancer screening, a computer program element and a computer-readable medium.
  • Breast cancer screening is an important tool to detect cancer developments in an early stage. Mammography images are used to visually detect abnormalities by a doctor. US 2011/0026667 Al describes computed tomography based imaging for breast tissue examinations. For example, breast density is used as a factor for breast cancer risk assessment. It has been shown that a substantial percentage of developing breast cancers is not detected.
  • the following described aspects of the invention apply also for the breast cancer screening apparatus, the X-ray imaging system for breast cancer screening, the method for providing information for breast cancer screening, the program element and the computer-readable medium.
  • a breast cancer screening apparatus comprising a processing device and an output device.
  • the processing device comprises: i) an input unit configured to provide first image data of a breast of a patient, and second image data of a breast of the patient; ii) a registration unit configured to register the first image data and the second image data; and iii) a determination unit configured to determine non-congruency between the breast of the first image data and the breast of the second image data.
  • the output device is configured to provide non-congruency information to a user.
  • the input unit is configured to provide first image data of a first breast of a pair of breasts of a patient, and second image data of a second breast of the pair of breasts.
  • the registration unit is configured to register the first breast data and the second breast.
  • the determination unit is configured to determine asymmetry between the first and the second breast.
  • the output device is configured to provide asymmetry information to a user.
  • the first and second image data are preferably X-ray image data.
  • the image data is tomosynthesis data.
  • the image data is acquired with Magnetic resonance imaging (MRI or MR) or X-ray computed tomography (CT).
  • MRI Magnetic resonance imaging
  • CT X-ray computed tomography
  • the input unit is configured to provide a first 3D image data set and a second 3D image data set.
  • the registration unit is configured to spatially register the first 3D image data set and the second 3D image data set.
  • the determination unit is configured to determine spatial non-congruency between the first and the second breast.
  • the output device is configured to provide spatial non-congruency information to a user.
  • the determination unit is configured to determine spatial asymmetry
  • the output device is configured to provide spatial asymmetry information.
  • the output device is configured as a multivariate user interface, which provides the non-congruency information as multivariate non-congruency information indicating at least two measured non-congruency or asymmetry parameters.
  • the output device is configured to provide the asymmetry information as multivariate asymmetry information indicating at least two measured asymmetry parameters.
  • the determination unit is configured to determine the non-congruency based on parameters related to the breast tissue as well as breast tissue unrelated parameters.
  • the determination unit is configured to determine the non-congruency based on image-based parameters in combination with non image-based parameters, wherein the image-based parameters relate to parameters detectable and/or determinable from the first and/or second image data, and wherein the non image-based parameters refer to parameters detected during the acquisition of the first and/or the second image data.
  • the determination unit is configured to determine the asymmetry based on parameters related to the breast tissue as well as breast tissue unrelated parameters.
  • an X-ray imaging system for breast cancer screening comprising: an X-ray image acquisition device with an X- ray source and an X-ray detector, and a breast cancer screening apparatus according to one of the above-described aspects and exemplary embodiments.
  • the X-ray image acquisition device is configured to acquire the first image data of a breast of a patient and the second image data of a breast of the patient.
  • the X-ray image acquisition device is configured to acquire the first image data of a first breast of a patient and the second image data of a second breast of the patient.
  • the X-ray image acquisition device provides tomosynthesis data sets for the first and the second image data.
  • a method for providing information for breast cancer screening comprising the following steps: a) providing first image data of a breast of a patient and providing second image data of a breast of the patient; b) registering of the first image data and the second image data; c) determining non-congruency between the breast of the first image data and the breast of the second image data; and d) providing non-congruency information to a user.
  • the non-congruency is determined by determining those features, which are not congruent.
  • the determination of non-congruency comprises the determination of disparate features.
  • the determination of non-congruency comprises the determination of inconsistency between the first and the second image data.
  • the determination of non- congruency also comprises the determination of imparity or diversity between the first and the second image.
  • the non-congruency information may also comprise information about the congruent features, i.e. it may also comprise congruency information.
  • step a) first image data of a first breast of a pair of breasts of the patient, and second image data of a second breast of the pair of breasts is provided.
  • step b) the first breast and the second breast are registered.
  • step c) asymmetry between the first and the second breast is determined.
  • step d) asymmetry information is provided to a user.
  • the term "asymmetry" relates to differences between the two breasts of a pair of breasts, for example differences in dimensions, shape, tissue structure, tissue composition etc.
  • the registration of the two breasts comprises as a basic sub-step a mirrored projection of one breast onto the other breast, wherein the mirror axis can be an imaginary axis arranged between the two breasts.
  • the two breasts are than elastically registered to each other.
  • the first breast is the left breast of the patient and the second breast is the right breast of the patient.
  • asymmetry is the non-congruency between a first and a second breast of a pair of breasts.
  • the non-congruency between the first and the second image data e.g. the asymmetry between the left and the right breast of the patient
  • the non-congruency or asymmetry can be taken as an additional risk factor for breast cancer.
  • the non-congruency between a prior breast examination and a follow-up examination of one breast is analyzed and provided as feedback to the radiologist.
  • a congruency change in the breast tissue may be an indication for breast cancer and should lead to increased attention of the diagnosing radiologist.
  • the non-congruency or asymmetry determination also for three-dimensional data provides an improved knowledge about the actual situation of the breast tissue structure. By providing a multivariate display, the reading radiologist is provided with improved and more detailed information allowing a better fine-tuning and evaluation when performing the breast cancer risk assessment.
  • the non-congruency or asymmetry determination based on parameters not only related to the breast tissue or to the image-based parameters, but also based on breast tissue unrelated parameters, or non image-based parameters, allows more sophisticated and thus more precise information about the current non-congruency or asymmetry situation, thus leading to an improved breast cancer risk assessment.
  • FIG. 1 illustrates a breast cancer screening apparatus according to an
  • FIG. 2 illustrates a further exemplary embodiment of a breast cancer
  • FIG. 3 illustrates a further exemplary embodiment of a breast cancer
  • FIG. 4 illustrates an example of a multivariate user interface according to an exemplary embodiment of the invention.
  • FIG. 5 illustrates a further example of a multivariate user interface according to an exemplary embodiment of the invention.
  • FIG. 6 illustrates a further example of a breast cancer screening apparatus according to an exemplary embodiment of the invention.
  • FIG. 7 illustrates a further example of a multivariate user interface according to the invention.
  • FIG. 9 schematically illustrates basic method steps of a method for providing information for breast cancer screening according to an exemplary embodiment of the invention.
  • FIG. 10 illustrates a further exemplary embodiment of a method according to the invention.
  • . 11 to 15 show further examples of methods according to the invention.
  • Fig. 1 illustrates a breast cancer screening apparatus 10 with a processing device 12 and an output device 14.
  • the processing device comprises an input unit 2, which is configured to provide first image data 3 of a breast of a patient.
  • the input unit 2 is also configured to provide second image data 4 of a breast of the patient.
  • the processing device 12 further comprises a registration unit 5, which is configured to register the first image data and the second image data.
  • the processing device 12 also comprises a determination unit 6, which is configured to determine non-congruency between the breast of the first image data and the breast of the second image data.
  • the output device 14 is configured to provide non-congruency information 7 to a user.
  • the processing device comprises an input unit 16, which is configured to provide first image data 18 of a first breast of a pair of breasts of a patient.
  • the input unit 16 is also configured to provide second image data 20 of a second breast of the pair of breasts.
  • the processing device 12 further comprises a registration unit 22, which is configured to register the first breast and the second breast.
  • the processing device 12 also comprises a determination unit 24, which is configured to determine asymmetry between the first and the second breast.
  • the output device 14 is configured to provide asymmetry information 26 to a user.
  • the first image data 3, 18 and /or the second image data 4, 20 can be provided to the input unit 2, 16 from an external source, such as, for example, an image acquisition device (not further shown) or a database (also not shown).
  • the provision of the respective image data is indicated with respective lines 28, 30, entering the box representing the processing device 12.
  • Connecting lines 32, 34 indicate the data processing provided by the processing device 12. It is noted that the connecting lines are only shown schematically.
  • the input unit 2, 16, the registration unit 5, 22 and the determination unit 6, 24 can be provided as separate units or also as an integrated part of the processing device 12, for example as an integrated circuit or part thereof.
  • the output device 14 can also be provided as an integrated part of the processing device 12 or as a separate unit or device.
  • the first and second image data are X-ray image data acquired by an X-ray system.
  • the image data can be provided by a mammography system providing 2D images.
  • the non-congruency is determined by determining those features, which are not congruent or common between the two images.
  • the non-congruency information may also comprise information about the congruent features, i.e. it may also comprise congruency information.
  • differences between the two breasts of a pair of breasts are determined.
  • the registration of the two breasts may comprise a mirrored projection of one breast onto the other breast as a sub-step.
  • the two breasts are than elastically registered to each other.
  • the term "non-congruency" relates to differences between the two data sets of the same breast, for example differences in dimensions, shape, tissue structure, tissue composition etc.
  • the registration of the two breasts comprises as a basic sub-step a direct elastic registration of the two image data sets, in 2D or 3D.
  • the non-congruency or asymmetry may be determined for image data from different points in time. For example, the same breast can be examined at a first stage and at a second stage, e.g. after a certain period of time such as one or two years or several months. If non-congruency is determined, this may be an indicator for upcoming breast cancer development, which then triggers the attention and awareness of the doctor and the patient. For example, the time intervals for a follow-up examination can be adapted according to the determined non-congruency.
  • the input unit is configured to provide a first 3D image data set and a second 3D image data set.
  • the registration unit is configured to spatially register the first 3D image data set and the second 3D image data set.
  • the determination unit is configured to determine spatial non-congruency between the first and the second breast.
  • the output device is configured to provide spatial non-congruency information to a user.
  • the determination unit is configured to determine spatial asymmetry between the first and the second breast and the output device is configured to provide spatial asymmetry information to the user.
  • the output device is configured as a multivariate user interface 36, which is configured to provide the non- congruency information as multivariate non-congruency information 38 indicating at least two measured non-congruency parameters.
  • the output device is configured to provide non-congruency information for a single measured non-congruency asymmetry parameter.
  • the output device is configured to provide the asymmetry information as multivariate asymmetry information indicating at least two measured asymmetry parameters
  • the output device is configured to provide asymmetry information for a single measured asymmetry parameter.
  • the multivariate non-congruency or asymmetry information can be provided as combined graphical diagrams, wherein the term multivariate refers to the simultaneous indication, or illustration, display, observation etc., of at least two predetermined parameters.
  • the parameters may be simultaneously observed or measured.
  • the non-congruency or asymmetry information relates to spatial, i.e. three-dimensional non-congruency or asymmetry respectively, and the output device is configured to display the multivariate information in 2D.
  • the display is flat and thus 2D, it is possible to provide spatial non-congruency or spatial asymmetry information, because the volumetric parameters can be presented also in form of the multivariate arrangement.
  • a one- dimensional non-congruency / asymmetry value can be deduced by computing the average value over the complete volume of the breast (global) or over a region of interest (local).
  • the resulting non-congruency value, or asymmetry value respectively can be displayed with the multivariate user interface 36. For example as one of a plurality of data points on a curve in a spider plot (see below) or one of a plurality of bars (see further below).
  • the non-congruency or asymmetry is determined in a global sense, wherein the term "global" refers to the complete volume of the breast.
  • the non-congruency or asymmetry can also be determined for local non-congruency or asymmetry respectively, wherein the term "local” refers to measures relating to a part of interest, i.e. not automatically the complete volume of the breast. For example, the local determination relates to a spatial part of interest, or a sub-volume of interest.
  • the term “local” can also relate to the measurements in a certain layer or slice of the breast.
  • “Local” can refer to the region of interest, for example the particular field of view. For example, the user can zoom in or out of the graphical representation of the breast in order to define the region of interest.
  • the term "spatial” refers to three-dimensional aspects, such as location or position in space, volumetric dimensions and volumetric relations etc.
  • the output device can be a display device configured to display the non- congruency or asymmetry information.
  • the display device is a user interface unit.
  • the input unit may be configured to provide a first 2D image data set and a second 2D image data set instead or in addition to the 3D data sets.
  • Fig. 4 shows an example for the multivariate asymmetry information 38 in form of a spider plot 40 with a web-like structure 42.
  • the spider plot has an outer value 44 indicating correlation of the first breast and the second breast and an inner value 46 at the centre 48 of the web indicating anti-correlation of the two breasts.
  • a plurality of different radial directions 50a, 50b, 50c, 50d, 50e and 50f is provided indicating a plurality of different measures.
  • the output device is configured to provide the multivariate asymmetry information as the spider-plot.
  • a different number can be provided, for example three, four, five or seven and higher.
  • the different measures comprise or relate to parameters for which non- congruency or asymmetry between the two breasts is determined.
  • the radial direction indicated with 50a relates to amount of adipose tissue
  • the reference number 50b to compression force relates to amount of adipose tissue
  • 50c relates to compression height
  • 50d relates to pressure
  • 50e to pectoralis-mamilla distance
  • 50f amount of glandular tissue.
  • Fig. 4 schematically shows three different congruent/ non-congruent measurements, respectively symmetric/asymmetric measurements, in form of a first curve 52, a second curve 54 and a third curve 56.
  • a key 58 on the right side of the spider web indicates the three curves 52, 54 and 56.
  • the first curve 52 relates to a determined congruent (or symmetric) situation
  • the second curve 54 to a first non-congruent (or asymmetric) situation
  • the third curve 56 to a second non-congruent (or asymmetric) situation.
  • the web-like structure 42 comprises a plurality of different radial directions, as mentioned above, indicated with reference numeral 60 and the index a-f according to the plurality of different measures, indicated with 50a-50f.
  • circumferential concentric lines are provided in a manner according to the sub-divided range between the outer value 44 and the inner value 46. Between the outer value and the inner value, a circumferential line 62 representing the value 0 is provided, wherein the outer value represents the value 1 and the inner value represents the value -1.
  • congruent or symmetric breasts appear as circular web around the value plus 1.
  • some of the congruency / symmetry measures will be significantly less than plus 1 resulting in significant outliers and/or an irregular web structure, which can thus be easily be perceived by the doctor, for example.
  • the multivariate non-congruency / asymmetry information for example the spider plot 40 would be continuously or stepwise adapted to the changing situation.
  • Fig. 5 shows an example for the multivariate non-congruency / asymmetry information 38 in form of a spider plot 40 in combination with a first pair of images 61 of the two breasts and a second pair of images 63 of the two breasts, wherein the two pairs show the same pair of breast from different viewing directions.
  • a line 65 in the first pair of images 61 is indicating a segmentation of the pectoralis muscle - and as such not an asymmetry measure. However, from this line the distance of the mamilla from the pectoralis muscle or its surface in the right and left image can be determined and compared to each other. This can then be used to derive or measure an asymmetry parameter.
  • an input device 64 can be provided and the processing device can be configured to adapt the multivariate non-congruency / asymmetry information while scrolling through different layers of the breast.
  • the output device is configured to provide the multivariate non-congruency / asymmetry information 38 as a set of bars 66a-66g indicating non-congruency / asymmetry values for respective measured non- congruency / asymmetry parameters.
  • the output device is configured to provide a respective image of the right and the left breast for visualizing the respective layer or area for which the non-congruency / asymmetry is indicated with the set of bars 66.
  • an image 68 of one of the breasts and an image 70 of the other one of the breasts are shown in combination with the multivariate non-congruency / asymmetry information.
  • the output device may be configured to provide the multivariate asymmetry information as a set of bars indicating asymmetry values for respective measured asymmetry parameters.
  • the multivariate non-congruency / asymmetry display would be updated according to the new region of interest.
  • the respective non-congruent or asymmetric parts of the first and second breast are highlighted.
  • the congruent (or symmetric) parts are shown in an attenuated manner.
  • determined non-congruency or asymmetry can be indicated with a marker.
  • the display showing the respective information to the user can be a
  • the determination unit is configured to determine the non-congruency based on parameters related to the breast tissue as well as breast tissue unrelated parameters.
  • the determination unit is configured to determine the asymmetry based on parameters related to the breast tissue as well as breast tissue unrelated parameters.
  • the determination unit is configured to determine the non- congruency or asymmetry based on hybrid data, wherein at least one parameter for the non- congruency / asymmetry determination is derived by computing at least one breast tissue related parameter and at least one breast tissue unrelated parameter (see below).
  • the parameters related to the breast tissue comprise at least one of the group of local difference measure, global difference measure, or a combination of local and global difference measures, areal measures, correlation measures, histogram measures, texture measures, changes in the volumetric or planar breast density, variations in the breast shape, variations in the glandular to adipose tissue boundary shape, differences in size and orientation of the pectoralis muscle, distance of the mamilla to the pectoralis/chest wall, and the like.
  • the measures comprise volumetric or spatial measures.
  • the determination unit is configured to determine the non-congruency based on image-based parameters in combination with non image-based parameters.
  • the image-based parameters relate to parameters detectable and/or determinable from the first and/or second image data.
  • the non image-based parameters refer to parameters detected during the acquisition of the first and/or the second image data.
  • the determination unit is configured to determine the asymmetry based on image-based parameters in combination with non image-based parameters.
  • the non image-based parameters comprise metadata, wherein the metadata comprises at least one of the group of compression force, compression thickness value and the like.
  • metadata comprises at least one of the group of compression force, compression thickness value and the like.
  • metadata relates to such parameters for example, provided by an acquisition arrangement in addition to the actual image data.
  • a threshold can be predetermined for the respective measures and the non- congruency or asymmetry information can be provided in case the determined non-congruency or asymmetry exceeds the predetermined threshold. This allows for a certain degree of robustness, since a non-congruency, or an asymmetry respectively can always exist, however not responsible for breast cancer development. Therewith, a user's attention is not distracted in such cases where there actually is no breast cancer related non-congruency or asymmetry, which is achieved by providing non-congruency or asymmetry information only above a certain threshold.
  • a base non-congruency / asymmetry shift can be considered.
  • the base non-congruency / asymmetry shift can be derived from statistical investigations, for example via calibration with a database, and/or from subjective empirical examinations, i.e. by the user himself.
  • a biased non- congruency / asymmetry may thus not be further considered, which biased non-congruency / asymmetry is considered as being non-indicative for breast cancer.
  • the X-ray imaging system 100 comprises an X-ray image acquisition device 110 with an X-ray source 112 and an X-ray detector 114.
  • a breast cancer screening apparatus 10 according to one of the above-described exemplary
  • the X-ray image acquisition device 110 is configured to acquire the first image data of a breast of a patient and the second image data of a breast of the patient.
  • the X-ray image acquisition device is configured to acquire the first image data of a first breast of a patient and the second image data of a second breast of the patient.
  • the X-ray imaging system 100 can be provided as a stand-up device where the patient is standing next to the system during the image acquisition.
  • the X-ray imaging system comprises a main support structure 116 to which the X-ray image acquisition device 110 is movably mounted.
  • the X-ray image acquisition device 110 can move along a guiding structure 118 in a vertical manner, i.e. up and down. Therewith, it is possible to adjust the image acquisition device 110 to different heights of the patients.
  • the patient stands such that the examined breast rests on the detector 114 which is provided with an according surface.
  • a compression plate or compression paddle 120 is then brought into contact with the breast in order to temporarily fixate the breast for the duration of the image acquisition. Therefore, a paddle support structure 122 allows vertical as well as inclined movements of the paddle to allow a comfortable compression of the breast. The compression is necessary for the required image quality.
  • the breast cancer screening apparatus 10 is only schematically shown.
  • the processing device 12 and the output device 14 are schematically shown with a so to speak base box resting on the floor of a hospital room or doctor's practice, for example. Further, for providing the non congruency or asymmetry information to a user, a display 124 is indicated.
  • the X-ray image acquisition device 110 provides tomosynthesis data sets for the first and the second image data.
  • the tomosynthesis data sets are acquired in symmetric position of the patient relative to the tomography acquisition.
  • any other type of X-ray image acquisition system can be provided, for example systems where the patient is laying on a table, CT systems, C-arm systems etc.
  • Fig. 9 shows basic steps of a method 200 for providing information for breast cancer screening, comprising the following steps:
  • a first provision sub-step 201 first image data 202 of a breast of a patient is provided.
  • second provision sub-step 203 second image data 204 of a breast of the patient is provided.
  • a registration step 205 the first image data and the second image data are registered.
  • non-congruency 207 between the breast of the first image data and the breast of the second image data is determined.
  • asymmetry information 209 is provided to a user.
  • Fig. 10 shows a further example of the method, comprising: In a first provision sub-step 210, first image data 212 of a first breast of a pair of breasts of a patient is provided. In a second provision sub-step 214, second image data 216 of a second breast of the pair of breasts is provided. In a registration step 218, the first breast and the second breast are registered. In a determination step 220, asymmetry 221 between the first and the second breast is determined. In a further provision step 222, asymmetry information 224 is provided to a user.
  • asymmetry is the non-congruency between a first and a second breast of a pair of breasts.
  • the first provision sub-step 210 and the second provision sub-step 214 are also referred to as step a), the registration step 218 as step b), the determination step 220 as step c), and the further provision step 222 as step d).
  • the first and second image data are provided as X-ray image data.
  • the first image data may comprise a first 2D image data set and the second image data comprises a second 2D image data set.
  • the first image data comprises a first 3D image data set and the second image data comprises a second 3D image data set.
  • Step b) comprises a spatial registration of the first 3D image data set and the second 3D image data set.
  • Step c) comprises determining spatial non-congruency between the first and second breast.
  • step d) comprises providing spatial non-congruency information to the user.
  • step c) comprises determining spatial asymmetry between the first and second breast
  • step d) comprises providing spatial asymmetry information to the user.
  • the non-congruency or asymmetry is determined based on image-based parameters 226 in combination with non image-based parameters 228. It is noted that in Fig. 11 no further differentiation in the reference numbers is made between the first image (or first breast) and the second image (or second breast) related data. The combination of the two different parameters types is indicated with arrows 230 entering the box 222 representing the non- congruency / asymmetry determination step.
  • the image-based parameters relate to parameters detectable and/or determinable from the first and/or second image data, which is why the respective data are first provided to the registration step 218.
  • the non image-based parameters may refer to parameters detected during the acquisition of the first and/or the second image data.
  • the non-congruency or asymmetry is determined based on parameters 232 related to the breast tissue as well as breast tissue unrelated parameters 234. Again, the reference numbers are not differentiated between the first and second breast in Fig. 12.
  • the two different types of parameters 232, 234 are provided as a respective data set, indicated with dotted line frame 236.
  • the two data sets 236 are registered to each other, as indicated with a box 238. Once the data sets are registered, the respective parameter types are provided to the determination step 220.
  • the non-congruency or asymmetry is determined based on hybrid data.
  • at least one parameter for the non-congruency / asymmetry determination is derived by computing at least one breast tissue related parameter and at least one breast tissue unrelated parameter.
  • the hybrid data is also referred to as mixed or composite data.
  • the contact area of the breast with the resting surface and the paddle surface respectively is measured in the image data and thus derived from the image.
  • the compression force is determined during the acquisition. With both parameters it is possible to compute the pressure.
  • a sub-step 240 data from the breast tissue related parameters 232 and data from the breast tissue unrelated parameters 234 is computed in a sub-step 240.
  • the result of this computation sub-step 240 is then provided to the non-congruency / asymmetry determination step 220, i.e. to step c).
  • the tissue related parameters 232 and/or the tissue unrelated parameters 234 can also be provided to the determination step 220, which is indicated with respective dotted lines 242.
  • the parameters 232 related to the breast tissue comprises at least one of the group of local difference measure, global difference measure, or a combination of local and global difference measure, indicated with reference numeral 242a, areal measures 242b, correlation measures 242c, histogram measures 242d, texture measures 242e, changes in the volumetric planar breast density 242f, variations in the breast shape 242g, variations in the glandular to adipose tissue boundary shape 242h, differences in size and orientation of the pectoralis muscle 242i, and distance of the mamilla to the pectoralis muscle and/or chest wall 242j, etc., as shown in Fig. 14.
  • Fig. 15 illustrates an example, where the image-based parameters, as mentioned above, comprise metadata 244, wherein the metadata comprise at least one of the group of compression force 244a, compression value 244b, and the like.
  • a threshold is predetermined for the respective measures and the non-congruency / asymmetry information is provided in case the determined non-congruency / asymmetry exceeds the predetermined threshold.
  • a base non-congruency / asymmetry shift is considered, wherein the base non- congruency / asymmetry shift is derived from statistical investigations and/or subjective empirical examinations.
  • a biased non-congruency (or biased asymmetry) is not further considered which is considered as being non-indicative for breast cancer.
  • the first and the second 2D or 3D data sets are tomosynthesis data sets.
  • the non-congruency information is provided as multivariate non-congruency information relating to at least two measured non-congruency parameters.
  • the multivariate asymmetry information is provided as multivariate asymmetry information relating to at least two measured asymmetry parameters (not further shown).
  • the method may comprise that the multivariate non-congruency (or asymmetry) information is a spider plot, wherein the spider plot has an outer value indicating correlation of the first breast and the second breast, and an inner value at the centre of the web indicating anti-correlation of the two breasts.
  • a plurality of different radial directions is provided indicating a plurality of different measures.
  • a spider plot is provided in which determined asymmetry is provided for a number of breast pairs.
  • a spider plot is provided in which determined non-congruency / asymmetry is provided for different points in time for the pair of breasts providing temporal non-congruency information, or temporal asymmetry information respectively.
  • the multivariate non-congruency / asymmetry information may be provided as a set of bars indicating non-congruency / asymmetry values for respective measured non- congruency / asymmetry parameters, wherein the bars can be adapted while scrolling through different layers of breast.
  • the non-congruency / asymmetry information may be provided as coded image content, wherein parts of the respective breast, for which parts non-congruency or asymmetry respectively is determined, are adjusted according to a predetermined code.
  • the non-congruency or asymmetric parts maybe colour-coded or pattern-coded.
  • the respective non-congruent or asymmetric parts of the first and second breast are highlighted and the congruent or symmetric parts are shown in an attenuated manner.
  • the congruent / symmetric parts can be at least partly masked out.
  • the non-congruency / asymmetry information is provided as a separate image.
  • the non-congruency or asymmetry information may be provided within an image generated from the respective 2D or 3D data set.
  • the generated image may be a 2D projection showing a 2D slice of the 3D data set.
  • the generated image may alternatively be a 2D projection of the 3D data set.
  • the non-congruency / asymmetry can be shown in combination with an image of at least a part of the respective breast or the respective pair of breasts.
  • the image of at least a part of the respective breast is a 3D representation generated from the respective 3D image data set.
  • a non- congruency change or asymmetric change in the breast tissue seen in the image data of the first and second breast, or left and right breast, which may be an indication for breast cancer. This leads to an improved detection rate in X-ray based breast cancer screening.
  • a computer program or a computer program element is provided that is characterized by being adapted to execute the method steps of the method according to one of the preceding embodiments, on an appropriate system.
  • the computer program element might therefore be stored on a computer unit, which might also be part of an embodiment of the present invention.
  • This computing unit may be adapted to perform or induce a performing of the steps of the method described above. Moreover, it may be adapted to operate the components of the above described apparatus.
  • the computing unit can be adapted to operate automatically and/or to execute the orders of a user.
  • a computer program may be loaded into a working memory of a data processor.
  • the data processor may thus be equipped to carry out the method of the invention.
  • This exemplary embodiment of the invention covers both, a computer program that right from the beginning uses the invention and a computer program that by means of an up-date turns an existing program into a program that uses the invention.
  • the computer program element might be able to provide all necessary steps to fulfil the procedure of an exemplary embodiment of the method as described above.
  • a computer readable medium such as a CD-ROM
  • the computer readable medium has a computer program element stored on it which computer program element is described by the preceding section.
  • a computer program may be stored and/or 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.
  • the computer program may also be presented over a network like the World Wide Web and can be downloaded into the working memory of a data processor from such a network.
  • a medium for making a computer program element available for downloading is provided, which computer program element is arranged to perform a method according to one of the previously described embodiments of the invention.

Abstract

The present invention relates to breast cancer screening. In order to improve the detection rate in breast cancer screening and to enhance cancer risk assessment, according to the present invention, first image data (202) of a breast of a patient is provided (201); and second image data (204) of a breast of the patient. The first image data and the second image data are registered (205) and non-congruency (207) between the breast of the first image data and the breast of the second image data is determined (206). The non-congruency information (209) is provided (208) to the user. For example, the first and second image data are 3D image data sets. According to an example, the non-congruency information is provided as multivariate non-congruency information indicating at least two measured non-congruency parameters. According to a further example, the non-congruency is determined based on parameters related to the breast tissue as well as breast tissue unrelated parameters.

Description

BREAST CANCER RISK ASSESSMENT
FIELD OF THE INVENTION
The present invention relates to breast cancer screening, and in particular to a breast cancer screening apparatus, an X-ray imaging system for breast cancer screening, a method for providing information for breast cancer screening, a computer program element and a computer-readable medium.
BACKGROUND OF THE INVENTION
Breast cancer screening is an important tool to detect cancer developments in an early stage. Mammography images are used to visually detect abnormalities by a doctor. US 2011/0026667 Al describes computed tomography based imaging for breast tissue examinations. For example, breast density is used as a factor for breast cancer risk assessment. It has been shown that a substantial percentage of developing breast cancers is not detected.
SUMMARY OF THE INVENTION
It is an object of the present invention to improve the detection rate in breast cancer screening and to enhance cancer risk assessment.
The object of the present invention is solved by the subject-matter of the independent claims, wherein further embodiments are incorporated in the dependent claims.
It should be noted that the following described aspects of the invention apply also for the breast cancer screening apparatus, the X-ray imaging system for breast cancer screening, the method for providing information for breast cancer screening, the program element and the computer-readable medium.
According to a first aspect of the present invention, a breast cancer screening apparatus is provided, comprising a processing device and an output device. The processing device comprises: i) an input unit configured to provide first image data of a breast of a patient, and second image data of a breast of the patient; ii) a registration unit configured to register the first image data and the second image data; and iii) a determination unit configured to determine non-congruency between the breast of the first image data and the breast of the second image data. The output device is configured to provide non-congruency information to a user.
According to an exemplary embodiment of the invention, the input unit is configured to provide first image data of a first breast of a pair of breasts of a patient, and second image data of a second breast of the pair of breasts. The registration unit is configured to register the first breast data and the second breast. The determination unit is configured to determine asymmetry between the first and the second breast. The output device is configured to provide asymmetry information to a user.
The first and second image data are preferably X-ray image data. For example, the image data is tomosynthesis data.
According to another example, the image data is acquired with Magnetic resonance imaging (MRI or MR) or X-ray computed tomography (CT).
According to an exemplary embodiment of the invention, the input unit is configured to provide a first 3D image data set and a second 3D image data set. The registration unit is configured to spatially register the first 3D image data set and the second 3D image data set. The determination unit is configured to determine spatial non-congruency between the first and the second breast. The output device is configured to provide spatial non-congruency information to a user.
According to a further exemplary embodiment, the determination unit is configured to determine spatial asymmetry, and the output device is configured to provide spatial asymmetry information.
According to a further exemplary embodiment, the output device is configured as a multivariate user interface, which provides the non-congruency information as multivariate non-congruency information indicating at least two measured non-congruency or asymmetry parameters.
According to a further example, the output device is configured to provide the asymmetry information as multivariate asymmetry information indicating at least two measured asymmetry parameters.
According to a further exemplary embodiment, the determination unit is configured to determine the non-congruency based on parameters related to the breast tissue as well as breast tissue unrelated parameters.
According to a further exemplary embodiment, the determination unit is configured to determine the non-congruency based on image-based parameters in combination with non image-based parameters, wherein the image-based parameters relate to parameters detectable and/or determinable from the first and/or second image data, and wherein the non image-based parameters refer to parameters detected during the acquisition of the first and/or the second image data.
According to a further example, the determination unit is configured to determine the asymmetry based on parameters related to the breast tissue as well as breast tissue unrelated parameters.
According to a second aspect of the invention, an X-ray imaging system for breast cancer screening is provided, comprising: an X-ray image acquisition device with an X- ray source and an X-ray detector, and a breast cancer screening apparatus according to one of the above-described aspects and exemplary embodiments. The X-ray image acquisition device is configured to acquire the first image data of a breast of a patient and the second image data of a breast of the patient.
According to a further example, the X-ray image acquisition device is configured to acquire the first image data of a first breast of a patient and the second image data of a second breast of the patient.
According to a further exemplary embodiment, the X-ray image acquisition device provides tomosynthesis data sets for the first and the second image data.
According to a third aspect of the present invention, a method for providing information for breast cancer screening is provided, the method comprising the following steps: a) providing first image data of a breast of a patient and providing second image data of a breast of the patient; b) registering of the first image data and the second image data; c) determining non-congruency between the breast of the first image data and the breast of the second image data; and d) providing non-congruency information to a user.
The term "congruency" or "congruence" relates to those features, which are congruent or common between the two images, for example same or similar features.
According to the invention, the non-congruency is determined by determining those features, which are not congruent. The determination of non-congruency comprises the determination of disparate features. The determination of non-congruency comprises the determination of inconsistency between the first and the second image data. The determination of non- congruency also comprises the determination of imparity or diversity between the first and the second image. The non-congruency information may also comprise information about the congruent features, i.e. it may also comprise congruency information.
According to a further example, in step a) first image data of a first breast of a pair of breasts of the patient, and second image data of a second breast of the pair of breasts is provided. In step b) the first breast and the second breast are registered. In step c) asymmetry between the first and the second breast is determined. And in step d) asymmetry information is provided to a user.
The term "asymmetry" relates to differences between the two breasts of a pair of breasts, for example differences in dimensions, shape, tissue structure, tissue composition etc. For example, the registration of the two breasts comprises as a basic sub-step a mirrored projection of one breast onto the other breast, wherein the mirror axis can be an imaginary axis arranged between the two breasts. The two breasts are than elastically registered to each other. For example, the first breast is the left breast of the patient and the second breast is the right breast of the patient.
According to the invention, asymmetry is the non-congruency between a first and a second breast of a pair of breasts.
According to an aspect of the invention, the non-congruency between the first and the second image data, e.g. the asymmetry between the left and the right breast of the patient, is forming the basis for an improved breast cancer risk assessment, since the non- congruency or asymmetry can be taken as an additional risk factor for breast cancer.
According to another aspect of the invention, the non-congruency between a prior breast examination and a follow-up examination of one breast, is analyzed and provided as feedback to the radiologist. A congruency change in the breast tissue, for example, may be an indication for breast cancer and should lead to increased attention of the diagnosing radiologist. The non-congruency or asymmetry determination also for three-dimensional data provides an improved knowledge about the actual situation of the breast tissue structure. By providing a multivariate display, the reading radiologist is provided with improved and more detailed information allowing a better fine-tuning and evaluation when performing the breast cancer risk assessment. The non-congruency or asymmetry determination based on parameters not only related to the breast tissue or to the image-based parameters, but also based on breast tissue unrelated parameters, or non image-based parameters, allows more sophisticated and thus more precise information about the current non-congruency or asymmetry situation, thus leading to an improved breast cancer risk assessment. These and other aspects of the present invention will become apparent from and elucidated with reference to the embodiments described hereinafter.
BRIEF DESCRIPTION OF THE DRAWINGS
Exemplary embodiments of the invention will be described in the following with reference to the following drawings.
1 illustrates a breast cancer screening apparatus according to an
exemplary embodiment of the invention.
2 illustrates a further exemplary embodiment of a breast cancer
screening apparatus according to the invention.
3 illustrates a further exemplary embodiment of a breast cancer
screening apparatus according to the invention.
4 illustrates an example of a multivariate user interface according to an exemplary embodiment of the invention.
5 illustrates a further example of a multivariate user interface according to an exemplary embodiment of the invention.
6 illustrates a further example of a breast cancer screening apparatus according to an exemplary embodiment of the invention.
7 illustrates a further example of a multivariate user interface according to the invention.
8 schematically shows an X-ray imaging system for breast cancer
screening according to an exemplary embodiment of the invention.
9 schematically illustrates basic method steps of a method for providing information for breast cancer screening according to an exemplary embodiment of the invention.
10 illustrates a further exemplary embodiment of a method according to the invention.
. 11 to 15 show further examples of methods according to the invention.
DETAILED DESCRIPTION OF EMBODIMENTS
Fig. 1 illustrates a breast cancer screening apparatus 10 with a processing device 12 and an output device 14. The processing device comprises an input unit 2, which is configured to provide first image data 3 of a breast of a patient. The input unit 2 is also configured to provide second image data 4 of a breast of the patient.
The processing device 12 further comprises a registration unit 5, which is configured to register the first image data and the second image data. The processing device 12 also comprises a determination unit 6, which is configured to determine non-congruency between the breast of the first image data and the breast of the second image data.
The output device 14 is configured to provide non-congruency information 7 to a user.
According to a further example, shown in Fig. 2, the processing device comprises an input unit 16, which is configured to provide first image data 18 of a first breast of a pair of breasts of a patient. The input unit 16 is also configured to provide second image data 20 of a second breast of the pair of breasts. The processing device 12 further comprises a registration unit 22, which is configured to register the first breast and the second breast. The processing device 12 also comprises a determination unit 24, which is configured to determine asymmetry between the first and the second breast. The output device 14 is configured to provide asymmetry information 26 to a user.
For example, the first image data 3, 18 and /or the second image data 4, 20 can be provided to the input unit 2, 16 from an external source, such as, for example, an image acquisition device (not further shown) or a database (also not shown). The provision of the respective image data is indicated with respective lines 28, 30, entering the box representing the processing device 12. Connecting lines 32, 34 indicate the data processing provided by the processing device 12. It is noted that the connecting lines are only shown schematically. It is further noted that the input unit 2, 16, the registration unit 5, 22 and the determination unit 6, 24 can be provided as separate units or also as an integrated part of the processing device 12, for example as an integrated circuit or part thereof. Further, the output device 14 can also be provided as an integrated part of the processing device 12 or as a separate unit or device.
For example, the first and second image data are X-ray image data acquired by an X-ray system. For example, the image data can be provided by a mammography system providing 2D images.
As indicated above, according to the invention, the non-congruency is determined by determining those features, which are not congruent or common between the two images. The non-congruency information may also comprise information about the congruent features, i.e. it may also comprise congruency information. As indicated above, for the asymmetry, differences between the two breasts of a pair of breasts are determined. The registration of the two breasts may comprise a mirrored projection of one breast onto the other breast as a sub-step. The two breasts are than elastically registered to each other.
In case of a comparison of the same breast, e.g. over time or before and after treatment, the term "non-congruency" relates to differences between the two data sets of the same breast, for example differences in dimensions, shape, tissue structure, tissue composition etc. For example, the registration of the two breasts comprises as a basic sub-step a direct elastic registration of the two image data sets, in 2D or 3D.
The non-congruency or asymmetry may be determined for image data from different points in time. For example, the same breast can be examined at a first stage and at a second stage, e.g. after a certain period of time such as one or two years or several months. If non-congruency is determined, this may be an indicator for upcoming breast cancer development, which then triggers the attention and awareness of the doctor and the patient. For example, the time intervals for a follow-up examination can be adapted according to the determined non-congruency.
Of course, a comparison over time can also be achieved for an image of one breast and an image from the other breast, which has been acquired at a different point in time.
According to a further exemplary embodiment (not shown), the input unit is configured to provide a first 3D image data set and a second 3D image data set. The registration unit is configured to spatially register the first 3D image data set and the second 3D image data set. The determination unit is configured to determine spatial non-congruency between the first and the second breast. The output device is configured to provide spatial non-congruency information to a user.
According to a further example, the determination unit is configured to determine spatial asymmetry between the first and the second breast and the output device is configured to provide spatial asymmetry information to the user.
As shown in Fig. 3, according to a further example, the output device is configured as a multivariate user interface 36, which is configured to provide the non- congruency information as multivariate non-congruency information 38 indicating at least two measured non-congruency parameters.
According to a further example, not shown, the output device is configured to provide non-congruency information for a single measured non-congruency asymmetry parameter.
According to a further example, not shown, the output device is configured to provide the asymmetry information as multivariate asymmetry information indicating at least two measured asymmetry parameters
According to a further example, not shown, the output device is configured to provide asymmetry information for a single measured asymmetry parameter.
The multivariate non-congruency or asymmetry information can be provided as combined graphical diagrams, wherein the term multivariate refers to the simultaneous indication, or illustration, display, observation etc., of at least two predetermined parameters. The parameters may be simultaneously observed or measured.
For example, the non-congruency or asymmetry information relates to spatial, i.e. three-dimensional non-congruency or asymmetry respectively, and the output device is configured to display the multivariate information in 2D. Therewith, although the display is flat and thus 2D, it is possible to provide spatial non-congruency or spatial asymmetry information, because the volumetric parameters can be presented also in form of the multivariate arrangement.
For example, if the non-congruency or asymmetry information relates to spatial, i.e. three-dimensional non-congruency / asymmetry information, then a one- dimensional non-congruency / asymmetry value can be deduced by computing the average value over the complete volume of the breast (global) or over a region of interest (local). The resulting non-congruency value, or asymmetry value respectively, can be displayed with the multivariate user interface 36. For example as one of a plurality of data points on a curve in a spider plot (see below) or one of a plurality of bars (see further below).
According to a further aspect of the invention, the non-congruency or asymmetry is determined in a global sense, wherein the term "global" refers to the complete volume of the breast.
The non-congruency or asymmetry can also be determined for local non-congruency or asymmetry respectively, wherein the term "local" refers to measures relating to a part of interest, i.e. not automatically the complete volume of the breast. For example, the local determination relates to a spatial part of interest, or a sub-volume of interest. The term "local" can also relate to the measurements in a certain layer or slice of the breast. "Local" can refer to the region of interest, for example the particular field of view. For example, the user can zoom in or out of the graphical representation of the breast in order to define the region of interest. The term "spatial" refers to three-dimensional aspects, such as location or position in space, volumetric dimensions and volumetric relations etc.
The output device can be a display device configured to display the non- congruency or asymmetry information.
According to a further aspect, the display device is a user interface unit.
The input unit may be configured to provide a first 2D image data set and a second 2D image data set instead or in addition to the 3D data sets.
Fig. 4 shows an example for the multivariate asymmetry information 38 in form of a spider plot 40 with a web-like structure 42. The spider plot has an outer value 44 indicating correlation of the first breast and the second breast and an inner value 46 at the centre 48 of the web indicating anti-correlation of the two breasts. As can be seen, a plurality of different radial directions 50a, 50b, 50c, 50d, 50e and 50f is provided indicating a plurality of different measures.
According to a further example, the output device is configured to provide the multivariate asymmetry information as the spider-plot.
Instead of the exemplarily shown six different measures, a different number can be provided, for example three, four, five or seven and higher.
The different measures comprise or relate to parameters for which non- congruency or asymmetry between the two breasts is determined. For example, the radial direction indicated with 50a relates to amount of adipose tissue, the reference number 50b to compression force, 50c to compression height, 50d to pressure, 50e to pectoralis-mamilla distance, and 50f to amount of glandular tissue.
Fig. 4 schematically shows three different congruent/ non-congruent measurements, respectively symmetric/asymmetric measurements, in form of a first curve 52, a second curve 54 and a third curve 56. A key 58 on the right side of the spider web indicates the three curves 52, 54 and 56. For example, the first curve 52 relates to a determined congruent (or symmetric) situation, the second curve 54 to a first non-congruent (or asymmetric) situation and the third curve 56 to a second non-congruent (or asymmetric) situation.
It is further noted that the web-like structure 42 comprises a plurality of different radial directions, as mentioned above, indicated with reference numeral 60 and the index a-f according to the plurality of different measures, indicated with 50a-50f. Further, circumferential concentric lines, indicated with reference numeral 62, are provided in a manner according to the sub-divided range between the outer value 44 and the inner value 46. Between the outer value and the inner value, a circumferential line 62 representing the value 0 is provided, wherein the outer value represents the value 1 and the inner value represents the value -1.
As can be seen, congruent or symmetric breasts appear as circular web around the value plus 1. In case of a non-congruent or an asymmetric breast pair respectively, some of the congruency / symmetry measures will be significantly less than plus 1 resulting in significant outliers and/or an irregular web structure, which can thus be easily be perceived by the doctor, for example.
According to a further example of the invention, it is possible to examine different regions or depths of the two breasts and the determination of the respective non- congruency asymmetry, for which the user can so to speak move the non-congruency or asymmetry determination plane or region of interest within the volume in case of 3D image data set as a basis. In such case, the multivariate non-congruency / asymmetry information, for example the spider plot 40 would be continuously or stepwise adapted to the changing situation.
Fig. 5 shows an example for the multivariate non-congruency / asymmetry information 38 in form of a spider plot 40 in combination with a first pair of images 61 of the two breasts and a second pair of images 63 of the two breasts, wherein the two pairs show the same pair of breast from different viewing directions. As an example, a line 65 in the first pair of images 61 is indicating a segmentation of the pectoralis muscle - and as such not an asymmetry measure. However, from this line the distance of the mamilla from the pectoralis muscle or its surface in the right and left image can be determined and compared to each other. This can then be used to derive or measure an asymmetry parameter.
Of course, the example shown can also be applied for examination of non- congruency of only one breast.
As shown in Fig. 6, an input device 64 can be provided and the processing device can be configured to adapt the multivariate non-congruency / asymmetry information while scrolling through different layers of the breast.
According to a further example, shown in Fig. 7, the output device is configured to provide the multivariate non-congruency / asymmetry information 38 as a set of bars 66a-66g indicating non-congruency / asymmetry values for respective measured non- congruency / asymmetry parameters. As shown in Fig. 7, it is also possible to display a respective image of the right and the left breast for visualizing the respective layer or area for which the non-congruency / asymmetry is indicated with the set of bars 66. As an example, an image 68 of one of the breasts and an image 70 of the other one of the breasts are shown in combination with the multivariate non-congruency / asymmetry information.
The output device may be configured to provide the multivariate asymmetry information as a set of bars indicating asymmetry values for respective measured asymmetry parameters.
It is noted that the above-described combination with an actual image of the breast under investigation can also be combined with any other type of multivariate non- congruency or asymmetry information, for example combined with a spider plot 40 as described in Fig. 4.
When a user scrolls through the depth of the breast, i.e. through the different layers in form of slice-wise provided 2D image data representing 3D image data, the bars would constantly or stepwise change according to the respective situation.
Similarly, when a user changes the region of interest, for example by moving or deforming a contour indicating the region of interest, within a 2D slice or a 2D mammogram, the multivariate non-congruency / asymmetry display would be updated according to the new region of interest.
According to a further example, not shown, for providing the non-congruency or asymmetry information, the respective non-congruent or asymmetric parts of the first and second breast are highlighted. The congruent (or symmetric) parts are shown in an attenuated manner.
According to a further example, not shown, in an image showing at least a part of the breast, determined non-congruency or asymmetry can be indicated with a marker.
The display showing the respective information to the user can be a
monochrome display, preferably with a high resolution. Of course, in such case the respective illustrations of the multivariate non-congruency / asymmetry information would be adapted accordingly to different line thicknesses and line patterns or patterns of the bar in order to achieve the necessary differentiation.
According to a further example, the determination unit is configured to determine the non-congruency based on parameters related to the breast tissue as well as breast tissue unrelated parameters.
According to a further example, the determination unit is configured to determine the asymmetry based on parameters related to the breast tissue as well as breast tissue unrelated parameters. For example, the determination unit is configured to determine the non- congruency or asymmetry based on hybrid data, wherein at least one parameter for the non- congruency / asymmetry determination is derived by computing at least one breast tissue related parameter and at least one breast tissue unrelated parameter (see below).
According to a further exemplary embodiment, the parameters related to the breast tissue comprise at least one of the group of local difference measure, global difference measure, or a combination of local and global difference measures, areal measures, correlation measures, histogram measures, texture measures, changes in the volumetric or planar breast density, variations in the breast shape, variations in the glandular to adipose tissue boundary shape, differences in size and orientation of the pectoralis muscle, distance of the mamilla to the pectoralis/chest wall, and the like.
In case of 3D data and the volumetric non-congruency or asymmetry determination respectively, the measures comprise volumetric or spatial measures.
According to a further example, also illustrated in relation with the following descriptions of methods according to the invention, the determination unit is configured to determine the non-congruency based on image-based parameters in combination with non image-based parameters. The image-based parameters relate to parameters detectable and/or determinable from the first and/or second image data. The non image-based parameters refer to parameters detected during the acquisition of the first and/or the second image data.
According to a further example, not shown, the determination unit is configured to determine the asymmetry based on image-based parameters in combination with non image-based parameters.
For example, the non image-based parameters comprise metadata, wherein the metadata comprises at least one of the group of compression force, compression thickness value and the like. The term "metadata" relates to such parameters for example, provided by an acquisition arrangement in addition to the actual image data.
A threshold can be predetermined for the respective measures and the non- congruency or asymmetry information can be provided in case the determined non-congruency or asymmetry exceeds the predetermined threshold. This allows for a certain degree of robustness, since a non-congruency, or an asymmetry respectively can always exist, however not responsible for breast cancer development. Therewith, a user's attention is not distracted in such cases where there actually is no breast cancer related non-congruency or asymmetry, which is achieved by providing non-congruency or asymmetry information only above a certain threshold.
For the determination of the threshold, a base non-congruency / asymmetry shift can be considered. For example, the base non-congruency / asymmetry shift can be derived from statistical investigations, for example via calibration with a database, and/or from subjective empirical examinations, i.e. by the user himself.
For the determination of the spatial non-congruency / asymmetry, a biased non- congruency / asymmetry may thus not be further considered, which biased non-congruency / asymmetry is considered as being non-indicative for breast cancer.
With reference to Fig. 8, an X-ray imaging system 100 for breast cancer screening is described in the following. The X-ray imaging system 100 comprises an X-ray image acquisition device 110 with an X-ray source 112 and an X-ray detector 114. A breast cancer screening apparatus 10 according to one of the above-described exemplary
embodiments or examples or aspects, is also provided. The X-ray image acquisition device 110 is configured to acquire the first image data of a breast of a patient and the second image data of a breast of the patient.
According to a further example, not shown, the X-ray image acquisition device is configured to acquire the first image data of a first breast of a patient and the second image data of a second breast of the patient.
For example, the X-ray imaging system 100 can be provided as a stand-up device where the patient is standing next to the system during the image acquisition.
Therefore, the X-ray imaging system comprises a main support structure 116 to which the X- ray image acquisition device 110 is movably mounted. For example, the X-ray image acquisition device 110 can move along a guiding structure 118 in a vertical manner, i.e. up and down. Therewith, it is possible to adjust the image acquisition device 110 to different heights of the patients. For the image acquisition, the patient stands such that the examined breast rests on the detector 114 which is provided with an according surface. Next, a compression plate or compression paddle 120 is then brought into contact with the breast in order to temporarily fixate the breast for the duration of the image acquisition. Therefore, a paddle support structure 122 allows vertical as well as inclined movements of the paddle to allow a comfortable compression of the breast. The compression is necessary for the required image quality. Once the breast is held between the detector 114 and the paddle 120, X-ray radiation is generated by the X-ray source 112 and the breast is then illuminated.
Next to the X-ray image acquisition device 110 and the respective support structure 116, the breast cancer screening apparatus 10 is only schematically shown. The processing device 12 and the output device 14 are schematically shown with a so to speak base box resting on the floor of a hospital room or doctor's practice, for example. Further, for providing the non congruency or asymmetry information to a user, a display 124 is indicated.
According to an exemplary embodiment of the invention, the X-ray image acquisition device 110 provides tomosynthesis data sets for the first and the second image data. For example, the tomosynthesis data sets are acquired in symmetric position of the patient relative to the tomography acquisition.
It is noted that any other type of X-ray image acquisition system can be provided, for example systems where the patient is laying on a table, CT systems, C-arm systems etc.
With reference to Figs. 9 to 15, exemplary embodiments of methods for providing information for breast cancer screening are described in the following.
Fig. 9 shows basic steps of a method 200 for providing information for breast cancer screening, comprising the following steps: In a first provision sub-step 201, first image data 202 of a breast of a patient is provided. In a second provision sub-step 203, second image data 204 of a breast of the patient is provided. In a registration step 205, the first image data and the second image data are registered. In a determination step 206, non-congruency 207 between the breast of the first image data and the breast of the second image data is determined. In a further provision step 208, asymmetry information 209 is provided to a user.
Fig. 10 shows a further example of the method, comprising: In a first provision sub-step 210, first image data 212 of a first breast of a pair of breasts of a patient is provided. In a second provision sub-step 214, second image data 216 of a second breast of the pair of breasts is provided. In a registration step 218, the first breast and the second breast are registered. In a determination step 220, asymmetry 221 between the first and the second breast is determined. In a further provision step 222, asymmetry information 224 is provided to a user.
According to the invention, asymmetry is the non-congruency between a first and a second breast of a pair of breasts.
The first provision sub-step 210 and the second provision sub-step 214 are also referred to as step a), the registration step 218 as step b), the determination step 220 as step c), and the further provision step 222 as step d).
For example, the first and second image data are provided as X-ray image data. In step a), the first image data may comprise a first 2D image data set and the second image data comprises a second 2D image data set.
According to a further exemplary embodiment (not shown), in step a) the first image data comprises a first 3D image data set and the second image data comprises a second 3D image data set. Step b) comprises a spatial registration of the first 3D image data set and the second 3D image data set. Step c) comprises determining spatial non-congruency between the first and second breast. And step d) comprises providing spatial non-congruency information to the user.
According to a further exemplary embodiment (not shown), step c) comprises determining spatial asymmetry between the first and second breast, and step d) comprises providing spatial asymmetry information to the user.
According to a further exemplary embodiment, shown in Fig. 11 , in step c), the non-congruency or asymmetry is determined based on image-based parameters 226 in combination with non image-based parameters 228. It is noted that in Fig. 11 no further differentiation in the reference numbers is made between the first image (or first breast) and the second image (or second breast) related data. The combination of the two different parameters types is indicated with arrows 230 entering the box 222 representing the non- congruency / asymmetry determination step.
For example, the image-based parameters relate to parameters detectable and/or determinable from the first and/or second image data, which is why the respective data are first provided to the registration step 218. The non image-based parameters may refer to parameters detected during the acquisition of the first and/or the second image data.
According to a further exemplary embodiment, shown in Fig. 12, in step c), the non-congruency or asymmetry is determined based on parameters 232 related to the breast tissue as well as breast tissue unrelated parameters 234. Again, the reference numbers are not differentiated between the first and second breast in Fig. 12.
For example, the two different types of parameters 232, 234 are provided as a respective data set, indicated with dotted line frame 236. For the non-congruency / asymmetry determination, i.e. the comparison between two breasts, the two data sets 236 are registered to each other, as indicated with a box 238. Once the data sets are registered, the respective parameter types are provided to the determination step 220.
According to a further exemplary embodiment, the non-congruency or asymmetry is determined based on hybrid data. For example, at least one parameter for the non-congruency / asymmetry determination is derived by computing at least one breast tissue related parameter and at least one breast tissue unrelated parameter. The hybrid data is also referred to as mixed or composite data.
For example, the contact area of the breast with the resting surface and the paddle surface respectively is measured in the image data and thus derived from the image. The compression force is determined during the acquisition. With both parameters it is possible to compute the pressure.
As an example, in Fig. 13 data from the breast tissue related parameters 232 and data from the breast tissue unrelated parameters 234 is computed in a sub-step 240. The result of this computation sub-step 240 is then provided to the non-congruency / asymmetry determination step 220, i.e. to step c). Of course, the tissue related parameters 232 and/or the tissue unrelated parameters 234 can also be provided to the determination step 220, which is indicated with respective dotted lines 242.
For example, the parameters 232 related to the breast tissue comprises at least one of the group of local difference measure, global difference measure, or a combination of local and global difference measure, indicated with reference numeral 242a, areal measures 242b, correlation measures 242c, histogram measures 242d, texture measures 242e, changes in the volumetric planar breast density 242f, variations in the breast shape 242g, variations in the glandular to adipose tissue boundary shape 242h, differences in size and orientation of the pectoralis muscle 242i, and distance of the mamilla to the pectoralis muscle and/or chest wall 242j, etc., as shown in Fig. 14.
Fig. 15 illustrates an example, where the image-based parameters, as mentioned above, comprise metadata 244, wherein the metadata comprise at least one of the group of compression force 244a, compression value 244b, and the like.
According to a further example of a method, not shown, a threshold is predetermined for the respective measures and the non-congruency / asymmetry information is provided in case the determined non-congruency / asymmetry exceeds the predetermined threshold.
According to a further example of a method, for the determination of the threshold, a base non-congruency / asymmetry shift is considered, wherein the base non- congruency / asymmetry shift is derived from statistical investigations and/or subjective empirical examinations.
For example, for the determination of a spatial non-congruency or spatial asymmetry, a biased non-congruency (or biased asymmetry) is not further considered which is considered as being non-indicative for breast cancer.
According to an aspect of the invention, the first and the second 2D or 3D data sets are tomosynthesis data sets.
According to a further example of the method, not shown, the non-congruency information is provided as multivariate non-congruency information relating to at least two measured non-congruency parameters.
In case the non-congruency comprises asymmetry information, the multivariate asymmetry information is provided as multivariate asymmetry information relating to at least two measured asymmetry parameters (not further shown).
For example, as also described with reference to a device, the method may comprise that the multivariate non-congruency (or asymmetry) information is a spider plot, wherein the spider plot has an outer value indicating correlation of the first breast and the second breast, and an inner value at the centre of the web indicating anti-correlation of the two breasts. A plurality of different radial directions is provided indicating a plurality of different measures.
For example, a spider plot is provided in which determined asymmetry is provided for a number of breast pairs.
For example, a spider plot is provided in which determined non-congruency / asymmetry is provided for different points in time for the pair of breasts providing temporal non-congruency information, or temporal asymmetry information respectively.
The multivariate non-congruency / asymmetry information may be provided as a set of bars indicating non-congruency / asymmetry values for respective measured non- congruency / asymmetry parameters, wherein the bars can be adapted while scrolling through different layers of breast.
The non-congruency / asymmetry information may be provided as coded image content, wherein parts of the respective breast, for which parts non-congruency or asymmetry respectively is determined, are adjusted according to a predetermined code.
The non-congruency or asymmetric parts maybe colour-coded or pattern-coded.
According to a further example of the method, the respective non-congruent or asymmetric parts of the first and second breast are highlighted and the congruent or symmetric parts are shown in an attenuated manner. For example, the congruent / symmetric parts can be at least partly masked out. According to a further example of the invention, the non-congruency / asymmetry information is provided as a separate image.
The non-congruency or asymmetry information may be provided within an image generated from the respective 2D or 3D data set.
The generated image may be a 2D projection showing a 2D slice of the 3D data set. The generated image may alternatively be a 2D projection of the 3D data set.
As indicated above, the non-congruency / asymmetry can be shown in combination with an image of at least a part of the respective breast or the respective pair of breasts.
The image of at least a part of the respective breast is a 3D representation generated from the respective 3D image data set.
According to an aspect of the invention, it is possible to determine a non- congruency change (or asymmetric change) in the breast tissue seen in the image data of the first and second breast, or left and right breast, which may be an indication for breast cancer. This leads to an improved detection rate in X-ray based breast cancer screening.
According to another aspect of the invention, it is possible to determine a non- congruency change in the breast tissue seen in the image data of a prior and a follow up breast examination of the same breast, which may be an indication for breast cancer.
In another exemplary embodiment of the present invention, a computer program or a computer program element is provided that is characterized by being adapted to execute the method steps of the method according to one of the preceding embodiments, on an appropriate system.
The computer program element might therefore be stored on a computer unit, which might also be part of an embodiment of the present invention. This computing unit may be adapted to perform or induce a performing of the steps of the method described above. Moreover, it may be adapted to operate the components of the above described apparatus. The computing unit can be adapted to operate automatically and/or to execute the orders of a user. A computer program may be loaded into a working memory of a data processor. The data processor may thus be equipped to carry out the method of the invention.
This exemplary embodiment of the invention covers both, a computer program that right from the beginning uses the invention and a computer program that by means of an up-date turns an existing program into a program that uses the invention.
Further on, the computer program element might be able to provide all necessary steps to fulfil the procedure of an exemplary embodiment of the method as described above.
According to a further exemplary embodiment of the present invention, a computer readable medium, such as a CD-ROM, is presented wherein the computer readable medium has a computer program element stored on it which computer program element is described by the preceding section.
A computer program may be stored and/or 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.
However, the computer program may also be presented over a network like the World Wide Web and can be downloaded into the working memory of a data processor from such a network. According to a further exemplary embodiment of the present invention, a medium for making a computer program element available for downloading is provided, which computer program element is arranged to perform a method according to one of the previously described embodiments of the invention.
It has to be noted that embodiments of the invention are described with reference to different subject matters. In particular, some embodiments are described with reference to method type claims whereas other embodiments are described with reference to the device type claims. However, a person skilled in the art will gather from the above and the following description that, unless otherwise notified, in addition to any combination of features belonging to one type of subject matter also any combination between features relating to different subject matters is considered to be disclosed with this application.
However, all features can be combined providing synergetic effects that are more than the simple summation of the features.
While the invention has been illustrated and described in detail in the drawings and foregoing description, such illustration and description are to be considered illustrative or exemplary and not restrictive. The invention is not limited to the disclosed embodiments. Other variations to the disclosed embodiments can be understood and effected by those skilled in the art in practicing a claimed invention, from a study of the drawings, the disclosure, and the dependent claims.
In the claims, the word "comprising" does not exclude other elements or steps, and the indefinite article "a" or "an" does not exclude a plurality. A single processor or other unit may fulfil the functions of several items re-cited in the claims. The mere fact that certain measures are re-cited in mutually different dependent claims does not indicate that a combination of these measures cannot be used to advantage. Any reference signs in the claims should not be construed as limiting the scope.

Claims

CLAIMS:
1. A breast cancer screening apparatus (10) comprising:
a processing device (12); and
an output device (14);
wherein the processing device comprises i) an input unit (2) configured to provide first image data (3) of a breast of a patient, and second image data (4) of a breast of the patient; ii) a registration unit (5) configured to register the first image data and the second image data; and iii) a determination unit (6) configured to determine non-congruency between the breast of the first image data and the breast of the second image data; and
wherein the output device is configured to provide non-congruency information
(7) to a user.
2. Apparatus according to claim 1,
wherein the input unit (16) is configured to provide first image data (18) of a first breast of a pair of breasts of the patient, and second image data (20) of a second breast of the pair of breasts;
wherein the registration unit (22) is configured to register the first breast and the second breast;
wherein the determination unit (24) is configured to determine asymmetry between the first and the second breast; and
wherein the output device is configured to provide asymmetry information (26) to a user.
3. Apparatus according to claim 1 or 2, wherein the input unit is configured to provide a first 3D image data set and a second 3D image data set;
wherein the registration unit is configured to spatially register the first 3D image data set and the second 3D image data set;
wherein the determination unit is configured to determine spatial non- congruency between the first and the second breast; and wherein the output device is configured to provide spatial non-congruency information to a user.
4. Apparatus according to claim 1, 2 or 3, wherein the output device is configured as a multivariate user interface (36), which is configured to provide the non-congruency information as multivariate non-congruency information (38) indicating at least two measured non-congruency parameters.
5. Apparatus according to claim 1, 2, 3 or 4, wherein the output device is configured to provide the multivariate non-congruency information as a spider-plot (40) with a web-like structure (42); wherein the spider plot has an outer value (44) indicating correlation of the fist breast and the second breast; and an inner value (46) at the centre (48) of the web indicating anti-correlation of the two breasts; and wherein a plurality (50a-f) of different radial directions is provided indicating a plurality of different measures.
6. Apparatus according to one of the preceding claims, wherein the output device is configured to provide the multivariate non-congruency information as a set of bars (66) indicating non-congruency values (66a-66g) for respective measured non-congruency parameters.
7. Apparatus according to one of the preceding claims, wherein the determination unit is configured to determine the non-congruency based on parameters related to the breast tissue as well as breast tissue unrelated parameters.
8. Apparatus according to one of the preceding claims, wherein the parameters related to the breast tissue comprise at least one of the group of:
local difference measure, global difference measures, or a combination of local and global difference measures;
areal measures;
correlation measures;
histogram measures;
texture measures;
changes in the volumetric or planar breast density; variations in the breast shape;
variations in the glandular to adipose tissue boundary shape;
differences in size and orientation of the pectoralis muscle;
distance of the mamilla to the pectoralis
distance of the mamilla to the chest wall.
9. Apparatus according to one of the preceding claims, wherein the determination unit is configured to determine the non-congruency based on image-based parameters in combination with non image-based parameters; wherein the image-based parameters relate to parameters detectable and/or determinable from the first and/or second image data; and wherein the non image-based parameters refer to parameters detected during the acquisition of the first and/or the second image data.
10. An X-ray imaging system (100) for breast cancer screening comprising:
an X-ray image acquisition device (110) with an X-ray source (112) and an X- ray detector (114); and
a breast cancer screening apparatus (10) according to one of the claims 1 to 9; wherein the X-ray image acquisition device is configured to acquire the first image data of a breast of a patient and the second image data of a breast of the patient.
11. X-ray system according to claim 10, wherein the X-ray image acquisition device provides tomosynthesis data sets for the first and the second image data.
12. A method (200) for providing information for breast cancer screening, the method comprising the following steps:
a) providing (201) first image data (202) of a breast of a patient; and providing (203) second image data (204) of a breast of the patient;
b) registering (205) of the first image data and the second image data;
c) determining (206) non-congruency (207) between the breast of the first image data and the breast of the second image data; and
d) providing (208) non-congruency information (209) to a user.
13. Method (200) according to claim 12, wherein the steps comprise: a) providing (210) first image data (212) of a first breast of a pair of breasts of the patient; and providing (214) second image data (216) of a second breast of the pair of breasts; b) registering (218) the first breast and the second breast;
c) determining (220) asymmetry (221) between the first and the second breast; and
d) providing (222) asymmetry information (224) to a user.
14. Method according to claim 12 or 13, wherein in step a) the first image data comprises a first 3D image data set and the second image data comprises a second 3D image data set;
wherein step b) comprises a spatial registering of the first 3D image data set and the second 3D image data set;
wherein step c) comprises determining spatial non-congruency between the first and the second breast; and
wherein step d) comprises providing spatial non-congruency information to the user.
15. Method according to claim 12, 13 or 14, wherein the non-congruency information is provided as multivariate non-congruency information relating to at least two measured non-congruency parameters.
16. Computer program element for controlling a device according to one of the claims 1 to 11, which, when being executed by a processing unit, is configured to perform the method steps of one of the claims 12 to 15.
17. Computer readable medium having stored the program element of claim 16.
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