WO2014055707A1 - Détection automatisée d'anomalies suspectées dans les images échographiques du sein - Google Patents

Détection automatisée d'anomalies suspectées dans les images échographiques du sein Download PDF

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Publication number
WO2014055707A1
WO2014055707A1 PCT/US2013/063149 US2013063149W WO2014055707A1 WO 2014055707 A1 WO2014055707 A1 WO 2014055707A1 US 2013063149 W US2013063149 W US 2013063149W WO 2014055707 A1 WO2014055707 A1 WO 2014055707A1
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Prior art keywords
breast
coronal
image
dimensional
ultrasound
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PCT/US2013/063149
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English (en)
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Wei Zhang
Shih-Ping Wang
Alexander SCHEIDER
Nico Karssemeijer
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Qview, Inc.
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Publication of WO2014055707A1 publication Critical patent/WO2014055707A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/08—Detecting organic movements or changes, e.g. tumours, cysts, swellings
    • A61B8/0833—Detecting organic movements or changes, e.g. tumours, cysts, swellings involving detecting or locating foreign bodies or organic structures
    • A61B8/085—Detecting organic movements or changes, e.g. tumours, cysts, swellings involving detecting or locating foreign bodies or organic structures for locating body or organic structures, e.g. tumours, calculi, blood vessels, nodules
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/08—Detecting organic movements or changes, e.g. tumours, cysts, swellings
    • A61B8/0825—Detecting organic movements or changes, e.g. tumours, cysts, swellings for diagnosis of the breast, e.g. mammography
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/46—Ultrasonic, sonic or infrasonic diagnostic devices with special arrangements for interfacing with the operator or the patient
    • A61B8/461—Displaying means of special interest
    • A61B8/466—Displaying means of special interest adapted to display 3D data
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/52—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/5215—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data
    • A61B8/5223—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data for extracting a diagnostic or physiological parameter from medical diagnostic data
    • 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
    • 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
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/48—Diagnostic techniques
    • A61B8/483—Diagnostic techniques involving the acquisition of a 3D volume of data
    • 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
    • G06T2207/10132—Ultrasound 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
    • G06T2207/20—Special algorithmic details
    • G06T2207/20092—Interactive image processing based on input by user
    • G06T2207/20104—Interactive definition of region of interest [ROI]
    • 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 method and system described in this patent specification relate to displaying 3D breast ultrasound images and other information in a manner believed to better assist their reading and interpretation by physicians or other users of the method and system. More specifically, the patent specification relates to a method and system of displaying a feature weighted volumetric 2D coronal image as a "guide" for users to find abnormalities in 3D breast ultrasound images more quickly and with less errors, in accordance with the method and system described herein.
  • This invention is in the field of early detection of breast cancer.
  • the expected statistical figures for breast cancer in 2013 are: approximately 230,000 new cases and 40,000 deaths. The mortality rate would be lowered if breast cancers could be detected in the earlier stage.
  • Screening with X-ray mammography has been the gold standard for the early detection of breast cancer.
  • X-ray mamrnography has been found to be inadequate in depicting regions of breast covered by the dense breast tissues.
  • Recent clinical studies show that breast ultrasound could be very effective for breasts with dense tissues, particularly automated 3D breast ultrasound.
  • the only breast ultrasound system that received USFDA approval for breast cancer screening so far is an automated 3D breast ultrasound system using a chestward compression scanning procedure.
  • a computer workstation system for ultrasound examination of a patient's breast.
  • the system includes: a storage system for an image dataset in the form of a plurality of two-dimensional scan images representative of a chestwardly compressed breast sonographically scanned using an automated three-dimensional breast ultrasound acquisition system; a processor configured to: (a) generate a three-dimensional volumetric dataset based on said image dataset; (b) segment and filter said three-dimensional volumetric dataset; and (c) generate a two-dimensional coronal guide image based on the segmented and filtered three-dimensional volumetric dataset, wherein said two-dimensional guide image includes visually enhanced suspected abnormalities within said segmented and filtered three-dimensional volumetric dataset if present in the breast; and an interactive user interface configured to: (a) electronically display to a user said coronal guide image; (b) receive user input indicating a user's selection of a suspected abnormality; and (c) in response to the user's selection displaying one or more of the plurality of two-dimensional scan
  • a method and system for processing and displaying breast ultrasound information wherein a 2D feature weighted volumetric coronal image as a "guide” or “road map” is generated from the 3D ultrasound data volume to represent the 3D dataset with the goal of emphasizing abnormalities within the breast while excluding non-breast structures, particularly those external to the breast such as ribs and chest wall, in accordance with the method and system described herein.
  • the 2D feature weighted volumetric guide is displayed in the form of a 2D coronal guide image together with a display as in current commercial automated 3D breast ultrasound systems employing chestward compression scans, where a 2D original axial scan image, and a 2D orthogonal (constructed to be orthogonal to the axial scan) image are displayed with the composite 2D coronal thick-slice image(s).
  • a 2D original axial scan image, and a 2D orthogonal (constructed to be orthogonal to the axial scan) image are displayed with the composite 2D coronal thick-slice image(s).
  • the 2D coronal guide image is displayed together with just the 2D original axial scan image for the quickest review and a snippet of one or more 2D coronal thick-slices. It is sometimes useful to show the coronal thick-slice image, because readers would like to confirm their assessment by examining the presence of spiculations of a mass nodule that only show in composite coronal thick-slices. The quick review of the 2D axial scan images is done in the manner described above.
  • the 2D coronal guide image is displayed in inverted polarity. That is, in regular guides, the abnormalities are dark colored on relatively light breast tissue background, and in the inverted polarity guides, the abnormalities are light colored on a relatively dark breast tissue background. A reason is that some readers prefer to read the inverted polarity guides, which resemble mammograms (also with light colored abnormalities on a dark background).
  • the 2D coronal guide image is generated through a process of segmenting away non-breast structure and using a filter to enhance the remaining volumetric breast tissue to make the abnormalities more visible and more prominent.
  • the filter includes a computer aided detection (CAD) algorithm that can detects and ranks the lesions by likelfhood.
  • CAD computer aided detection
  • the 2D coronal guide image is displayed on a separate monitor situated adjacent to the display monitor of a commercial automated 3D breast ultrasound system.
  • the 2D coronal guide image is displayed on a separate sheet of paper to be viewed with the display monitor of a commercial automated 3D breast ultrasound system.
  • FIG. 1 illustrates aspects of a known commercial system using a 2 mm thick coronal thick-slice as a road map
  • FIG. 2 illustrates aspects of chestward compression scan orientation in relationship to a 2D coronal thick-slice according to prior art, as well as a volume from which a 2D coronal volumetric guide is derived, according to some embodiments;
  • FIG. 3 illustrates aspects of a start up screen with four coronal guide images, according to some embodiments
  • Fig. 4 illustrates aspects of a displayed coronal guide image, an original 2D axial slice, an orthogonal 2D slice, and a coronal thick-slice, according to some embodiments;
  • Fig. 5 is a diagram illustrating aspects of a system for generating and displaying a two-dimensional coronal guide image, according to some embodiments;
  • Fig. 6 is a flow chart illustrating aspects of generating and displaying a two-dimensional coronal guide image, according to some embodiments
  • Fig. 7 illustrates effects of segmenting non-breast structures and filter enhancement of a minimum voxel value projection; according to some embodiments.
  • Fig. 8 illustrates aspects of a displayed inverted coronal guide image along with an original 2D axial slice, an orthogonal 2D slice, and a coronal thick- slice, according to some embodiments.
  • Fig, 9 illustrates aspects of a displayed coronal guide image along with an original 2D axial slice with a snippet of a coronal thick slice, according to some embodiments.
  • the first major problem of breast cancer screening is the "cost". Since breast cancer has a very low prevalence rate such that one cancer is generally found in 200 to 300 patients screened, the per patient screening cost must be kept low, typically to the range of $100-1200, in order to achieve a reasonable cost per cancer detected. This cost range is generally translated into limiting reading/interpretation time to about 3 minutes per patient and an automated scanning system with a throughput of over 2,000 patients per year. For screening X-ray mammography, where only 4 new images are generated per patient, this 3-minute interpretation time requirement is relatively easily met. However, for breast ultrasound screening, where over 1 ,200 to 3,000 new images are generated per patient, the 3 minutes of reading/ interpretation time limit becomes a real challenge.
  • the commercial automated 3D breast ultrasound systems all perform chestward compression scans. That is, the ultrasound beam is generally directed chestward during the scan while the breast is generally compressed chestward.
  • This method has many advantages over the earlier non chestward-compressed ultrasound scanning methods such as the method that clamps the breast between a vise-like scanning plates, as in the case of mammography. Namely, the advantages are: patient comfort is much better, the breast tissue is thinner during 5 the scan, and high higher ultrasound frequency could be employed resulting in much better image quality.
  • This is chestward compressed scan method is described more in details in US 7,828,733, which also taught the use of a composite 2D coronal thick-slice method that could be used as a guide or road map to aid the more rapid search for abnormalities. Instead of searching through
  • Fig. 1 illustrates aspects of a known commercial system using a 2 mm thick coronal thick-slice as a road map.
  • Fig. 1 illustrates a prior art road map in the form of currently used commercial "composite coronal thick-slice" method for the reading/interpreting of the 3D breast ultrasound images.
  • Fig. 1 illustrates a prior art road map in the form of currently used commercial "composite coronal thick-slice * method for the reading/interpreting of the 3D breast ultrasound images.
  • the current commercial automated 3D breast ultrasound systems typically use a thick-slice 100 having a thickness of 2 mm (range around 0.5 to 2 mm), although the 7,828,733 U.S. patent discussed a range of 2-20 mm when first filed in 2004.
  • Moving to thinner and thinner thickness with commercial systems means that readers must search through more thick slices, e.g., 20 to 30 composite coronal thick-slices per scan currently, although it can be a 10x reduction of search volume vs. the raw 2D axial scan images.
  • Fig. 2 illustrates aspects of chestward compression scan orientation in relationship to a 2D coronal thick-slice according to prior art, as well as a volume from which a 2D coronal volumetric guide is derived, according to some embodiments.
  • Fig. 2 illustrates chestward compression scan orientation in relationship to a 2D coronal thick-slice guide (k,l,m,n) and the volume (a,b,c,d,e,f,g,h) from which the 2D coronal volumetric guide is derived.
  • Chestwall 200 is shown.
  • the planes a,b,c,d to e,f,g,h are the original axial scanned images.
  • Fig. 3 illustrates aspects of a start up screen with four coronal guide images, according to some embodiments.
  • Fig. 3 illustrates a typical startup screen of the workstation after a patient scan by the automated 3D ultrasound breast system, which screen shows a set of coronal guide images, one corresponds to each scan. Although in this patient there are only 2 scans per breast, current commercial systems may take up to 5 scans per breast. The most prominent abnormality is on the R-Lat coronal guide image.
  • Fig. 3 illustrates a typical startup screen of the workstation after a patient scan by an automated 3D ultrasound breast system, which shows a set of coronal guide images 310, 312, 314 and 316, with one guide image corresponding to each scan. Although there could be 5 scans per breast, Fig. 3 shows just 2 scans per breast for this patient. The most prominent abnormality, 305, is on the R-Lat coronal guide image.
  • Fig. 4 illustrates aspects of a displayed coronal guide image, an original 2D axial slice, an orthogonal 2D slice, and a coronal thick-slice, according to some embodiments.
  • Fig. 4 illustrates a screen resulting after clicking the prominent abnormality 405 in the R-Lat coronal guide image 420. Since the xyz coordinates have been previously computed, the click on 405 immediately brings up the corresponding abnormality 406 in 2-D coronal thick-slice 400. Also, the corres ponding abnormality 407 in the axial image 402 as well as abnormality 408 in the orthogonal image 404.
  • X-direction is the axial direction, usually parallel to the patient's head-to-toe direction, and is also the direction of the linear ultrasound scanning.
  • Y-direction is parallel to the patient's left-right direction.
  • Z-direction is the chestward direction.
  • the reader in most cases a radiologist, can quickly review the 2D axial scan images by activating the scroll bar in the guide and scroll through the axial images. Likewise, the orthogonal images can be reviewed quickly by activating the corresponding scroll bar.
  • a blank coronal guide image can mean the absence of any significant or prominent abnormalities in the guide image and the associated 3D breast volume.
  • Fig. 4 illustrates what happens after clicking the prominent abnormality in the R-Lat coronal guide image. Since the xyz coordinates have been previously computed, the click immediately brings up the corresponding abnormality in the axial image as well as in the orthogonal image.
  • X-direction is the axial direction, usually parallel to the patient's head-to-toe direction, and is also the direction of the linear ultrasound scanning.
  • Y-direction is parallel to the patient's left-right direction.
  • Z-direction is the chestward direction.
  • the reader in most cases a radiologist, can quickly review the 2D axial scan images by activating the scroll bar in the guide and scroll through the axial images. Likewise, the orthogonal images can be reviewed quickly by activating the corresponding scroll bar.
  • a blank coronal guide image can mean the absence of any significant or prominent abnormalities in the guide image and the associated 3D breast volume.
  • Fig. 5 is a diagram illustrating aspects of a system for generating and displaying a two-dimensional coronal guide image, according to some embodiments.
  • Fig. 5 illustrates a block diagram of a workstation system for the storage of data, processing to generate display the 2D Coronal guide image for the reading/interpreting of the 3D breast ultrasound images according to a preferred embodiment.
  • FIG. 5 illustrates in block diagram form a workstation system 510 for the storage of data and processing to generate display the 2D Coronal guide image for the reading/interpreting of the 3D breast ultrasound images according to a preferred embodiment. Shown in workstation 510 is storage 524, processor 522 for generating 2-D coronal guide image, and a display 526. Also shown the 3-D breast ultrasound acquisition system 530 as the source of
  • Fig. 6 is a flow chart illustrating aspects of generating and displaying a two-dimensional coronal guide image, according to some embodiments. Fig. 6 illustrates a process flow leading to the generation of the 2D Coronal guide image.
  • Fig. 6 illustrates a flow process in generating the 2D coronal guide image.
  • the flowchart illustrates an algorithm that can be used in each module, such as breast tissue segmentation or chestwall/rib detection.
  • the skin, chest-wall and ribs are detected.
  • the region containing only breast tissue is segmented. Skin region can be simply defined as the region within certain distance range from the top, say 0 to 2mm.
  • the Filtering step 616 the 3D volume image is filtered by a group of filters that are designed to suppress noise and artifacts and enhance lesions.
  • the filters can be a gradient conversion filter and a line conversion filter.
  • the gradient conversion filter is designed to enhance the dark rounded shapes and the line conversion filter is designed to enhance lines radiating from a center which resemble a speculation or architectural distortion.
  • Another example of the filter can be a computer aided detection (CAD) algorithm 620 that can detects and rank the lesions by likelihood.
  • Other filters 622 can be derived from techniques such as minimum voxel value, Doppler data, and/or elastography data.
  • the weights, w(x, y, z) for compounding are generated by combining the outputs of the filters.
  • the weight is also normalized from 0 to 1 as the probability of a voxel overlap with a cancer lesion.
  • the atlas image ⁇ ( ⁇ , y) is generated by projecting the volumetric image along the z direction (excluding skin, chestwall and rib regions) modulated by the weight.
  • the equation below shows one example of the projection by taking the minimum value of the weighted intensity alone the z axis.
  • I(x, y, z) is the intensity or voxel value of the 3D ultrasound volumetric image.
  • Fig. 7 illustrates effects of segmenting non-breast structures and filter enhancement of a minimum voxel value projection; according to some embodiments.
  • Fig. 7 illustrates effects of segmenting and filter enhancement of coronal image.
  • Fig. 7 illustrates the profound effect of segmentation and filter enhancement of volumetric coronal image.
  • 700 shows a 2mm 2D coronal thick- slice image. After searching by scrolling through approximately 30 such images in the chestward (z-direction) direction, a cancer like abnormality 705 is found.
  • 720 shows the volumetric compounding by showing the 2D coronal image of average voxel value projection average, by taking the average voxel value alone the z direction (perpendicular to the coronal image plane and chestwall) of the breast. The cancer like abnormality is not visible in this image.
  • 740 shows a similar projection along the z-direction using the minimum voxel value. Again, the cancer like abnormality is not visible.
  • 760 shows the minimum voxel value volumetric projection after segmenting non-breast tissues and application of filter enhancement, which process has been described above. The cancer like abnormality 765 is now very visible.
  • Fig. 8 illustrates aspects of a displayed inverted coronal guide image along with an original 2D axial slice, an orthogonal 2D slice, and a coronal thick- slice, according to some embodiments.
  • Fig. 8 illustrates a 2D coronal guide image 820 in reverse polarity, which some readers may prefer.
  • Fig. 9 illustrates aspects of a displayed coronal guide image along with an original 2D axial slice with a snippet of a coronal thick slice, according to some embodiments.
  • Fig. 9 illustrates an example with fewer display components, including the 2D coronal guide, just one set of 2D images from the scan for review and scroll review, and a snippet or whole of the 2D coronal thick-slice.
  • the display of the 2D coronal thick-slice may be useful because readers may like to confirm their assessment by examining the presence of spiculations of the mass nodule which only show in the 2D composite coronal thick-slices.
  • Fig. 9 illustrates an example with fewer display components, including the 2D coronal guide 920.
  • the display of the 2D coronal thick-slice may be useful because readers may like to confirm their assessment by examining the presence of spiculations of the mass nodule which only show in the 2D composite coronal thick-slices. Clicking the abnormality 940 in guide image 920 automatically brings up the corresponding abnormalities 942 and 944 in images 902 and snippet 930, respectively.

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Abstract

La présente invention concerne un procédé et un système pour le traitement et l'affichage d'informations d'échographie mammaire. Une image coronale volumétrique pondérée à caractéristique 2D en tant que « guide » ou « feuille de route » est générée à partir du volume de données échographiques 3D pour représenter l'ensemble de données 3D dans le but de mettre en évidence des anomalies dans le sein tout en excluant les structures non mammaires, en particulier celles externes au sein telles que les côtes et la paroi thoracique.
PCT/US2013/063149 2012-10-02 2013-10-01 Détection automatisée d'anomalies suspectées dans les images échographiques du sein WO2014055707A1 (fr)

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US201261709136P 2012-10-02 2012-10-02
US61/709,136 2012-10-02
US201261728166P 2012-11-19 2012-11-19
US61/728,166 2012-11-19
US201361830241P 2013-06-03 2013-06-03
US61/830,241 2013-06-03
US201361860900P 2013-07-31 2013-07-31
US61/860,900 2013-07-31

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Cited By (3)

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Publication number Priority date Publication date Assignee Title
EP3116402A4 (fr) * 2013-10-02 2018-01-17 Qview Medical Inc. Équipement automatisé de mammographie par ultrasons et procédés utilisant des assistants de navigateur améliorés
EP3027116B1 (fr) * 2013-07-31 2019-07-03 Qview Medical, Inc. Temps de lecture d'image réduit et flux de patients amélioré dans l'échographie mammaire automatisée à l'aide d'images d'ensemble amplifiées de navigateur de sein entier
US11439362B2 (en) 2010-07-19 2022-09-13 Qview Medical, Inc. Automated ultrasound equipment and methods using enhanced navigator aids

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US20100280375A1 (en) * 2003-11-28 2010-11-04 U-Systems, Inc. Breast Ultrasound Examination Including Scanning Through Chestwardly Compressing Membrane And Processing And Displaying Acquired Ultrasound Image Information
US8096949B2 (en) * 2008-07-02 2012-01-17 U-Systems, Inc. User interface for ultrasound mammographic imaging
US8162833B2 (en) * 2000-11-24 2012-04-24 U-Systems, Inc. Thick-slice ultrasound images derived from ultrasonic scans of a chestwardly-compressed breast of a supine patient

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Publication number Priority date Publication date Assignee Title
US8162833B2 (en) * 2000-11-24 2012-04-24 U-Systems, Inc. Thick-slice ultrasound images derived from ultrasonic scans of a chestwardly-compressed breast of a supine patient
US20100280375A1 (en) * 2003-11-28 2010-11-04 U-Systems, Inc. Breast Ultrasound Examination Including Scanning Through Chestwardly Compressing Membrane And Processing And Displaying Acquired Ultrasound Image Information
US8096949B2 (en) * 2008-07-02 2012-01-17 U-Systems, Inc. User interface for ultrasound mammographic imaging

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US11439362B2 (en) 2010-07-19 2022-09-13 Qview Medical, Inc. Automated ultrasound equipment and methods using enhanced navigator aids
EP3027116B1 (fr) * 2013-07-31 2019-07-03 Qview Medical, Inc. Temps de lecture d'image réduit et flux de patients amélioré dans l'échographie mammaire automatisée à l'aide d'images d'ensemble amplifiées de navigateur de sein entier
EP3116402A4 (fr) * 2013-10-02 2018-01-17 Qview Medical Inc. Équipement automatisé de mammographie par ultrasons et procédés utilisant des assistants de navigateur améliorés

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