WO2016057960A1 - Apparatus, system and method for cloud based diagnostics and image archiving and retrieval - Google Patents

Abstract

A cloud based system for image diagnostics and analysis is provided. In an embodiment, the cloud based system is used for analysis of mammograms to automatically determine if there are areas of abnormality through the use of an advanced artificial intelligence (Al) based diagnostic. This cloud based system allows any physician to use the advanced artificial intelligence (Al) based diagnostics from anywhere in the world without requiring any additional hardware and high upfront expenses because only a very small fee is required for each evaluated mammogram (pay as you go). An online image archiving system is also provided for training images to improve the diagnostics.

Description

Apparatus, System and Method for Cloud Based Diagnostics and Image

Archiving and Retrieval

Cross Reference To Related Applications

[001]This patent application claims the benefit of and priority to U.S. Provisional Patent Application Serial No. 62/062,806, filed on October 10, 2014, titled "Apparatus, System And Method For Cloud Based Diagnostics And Image Archiving," the disclosure of which is hereby incorporated by reference for all purposes.

Technical Field

[002]Cloud based services featuring one or more of the following: diagnostics and computer aided detection and diagnostics (CAD), including but not limited to cancer diagnostics, image/picture archiving and communication systems (PACS).

Background

[003]Breast cancer is the second most deadly disease in the world. If diagnosed in its early stages it can be cured but if diagnosed in later stages the risk of mortality rises. One of the best early detection tools available for cancer is diagnostic imaging. For example, mammograms and other imaging techniques take images of the breast tissue with the goal of finding breast cancer early (before it has a chance to grow or spread), which greatly improves the chance of surviving cancer.

[004] In a diagnostic environment, the images of the breast are studied to evaluate areas of concern. In certain circumstances, multiple or magnified images are taken of areas of abnormal tissue to make the evaluation of the area easier. For example, one type of diagnostic imaging is an ultrasound in addition to a mammogram. These diagnostic mammograms can be used in several different ways, including for example, confirming whether or not an area of concern is actually abnormal or not. The diagnostic mammogram can reveal that an area thought to be abnormal is actually normal tissue, or it can confirm that there is some abnormality and that there should be further investigation. [005]The cost of doctor evaluation of images vastly increases the cost of cancer screening. For many people, the cost of cancer screening is prohibitive due to the rising costs of health care. As a result, there has been an increase in the use of computer aided detection and diagnostic (CAD) systems for cancer screening. In embodiments, these CAD systems can use automated systems to help detect areas of concern in images that are recommended for further evaluation by a doctor as possible cancer. The CAD systems can be used to help narrow down the number of images that need to be evaluated by a doctor or professional and can also help the accuracy of cancer screening. Two CAD systems currently on the market are R2 Image Checker (offered by Hologic) and iCAD (offered by Carestream), both of which are breast cancer CAD systems. However, these systems require special hardware, technical support for setting up a system at the health care provider's office, require storage of the images on local machines for evaluation, and do not offer cloud services and image storage that can be accessed anywhere Internet access is available, among other deficiencies. A comparative study found in the attached Appendix shows that embodiments of the present invention are superior to the existing alternatives.

[006]There is a need for a cloud based system that features CAD and imaging storage. There is also a need for a cloud based system with CAD features that is available to facilities with limited budgets, for example on a pay per study basis, where the system and service does not require technical support, setup and hardware, and that allows comparison of images across different facilities across the world. Furthermore, there is also a need to combine CAD with PACS using artificial intelligence (Al) and machine learning (ML) in order to improve diagnostic outcome because much better clinical diagnostics are possible if past images can be considered to evaluate changes in a potentially cancerous region.

Summary

[007]Embodiments of the present invention provide an apparatus, method and system that feature one or more of the following: CAD, PACS, and imaging storage. Embodiments of the present invention also utilize hardware that is local to the user as well as hardware that is on remote servers, for example on the cloud. Embodiments of the present invention also utilize artificial intelligence (Al) and machine learning (ML). In certain embodiments, the apparatus, method or system combine PACS and CAD. By combining PACS and CAD, the apparatus, method or system can advantageously provide data from a remote server, such as a cloud server, and that same remote server or other remote servers can also provide archive of images, where those images can be used in the computer aided detection and diagnostics. By combining the CAD and PACS on the remote server, processing associated with the image diagnostics, image archiving, and other CAD and PACS features can be done on the remote server rather than at a local user's workstation, saving user system resources and bandwidth on the user's Internet connection from not having to transfer the images used for the image diagnostics each time. For example, since the remote server is used for the combined PACS and CAD functionality, the same data can be used on the same server as both a reference for the image diagnostics and for the image archiving. In embodiments, of the apparatus, method and system, archiving of images on remote servers accessible to a variety of local users is a valuable asset that can be used for a variety of purposes, including but not limited to comparative effectiveness research (CER) that were not previously available. Also, in embodiments with image archiving on remote servers accessible to local users, reference images of similar types of features can be made available on a much larger scale, where users across the globe will have access to a library of images on remote servers, for example on the cloud, where reference can be made to images having similar characteristics, for example with reference to a particular type of mass with certain characteristics at a given location on the body. With this unique reference tool, the effectiveness of the computer aided detection and diagnostic is greatly improved as well as the user's knowledge base for treatment, for example, where the image archive system can show other instances of similar types of cancer and outcomes of treatments.

[008] In embodiments of the present invention, cloud based systems and devices are provided that provide for image storing, image archiving, image processing, image analysis, and image comparisons. In embodiments, access as well as comparison of images across different facilities is provided because the images are stored in the cloud rather than only stored locally.

[009] In embodiments of the present invention, cloud based computer aided detection and diagnostics (CAD) are offered in combination with an picture/image archiving and communication (PACS) system. In an embodiment, PACS is a backend image archiving system. The combination of a cloud based CAD and PACS system is valuable because, among other reasons, it allows on an on-demand basis through the Internet around the world, reference to existing mammography and other images from electronic diagnostic databases for diagnoses validations and comparisons. In embodiments, the CAD and PACS system is offered as a "software as a service" (SAAS) or "data as a service" (DAAS) through the cloud. SAAS and DAAS are valuable systems that utilize hardware in a unique fashion. For example, in embodiments, apparatus, methods and systems are provided that provide computer aided image diagnostics, image archiving as well as data to remote users across the Internet and can provide these things on an "on demand" basis across geographic regions, across computer and hardware platforms, and across organizational separation of provider and consumer. Advantages with regards to hardware occur on many levels, including with regards to processing power and memory and bandwidth requirements. For example, instead of a local user having to utilize memory on storing images locally, having to utilize processing power at a local computer processor, or having to gather images for comparison on the computer aided detection and diagnostics system locally, the user can use remote servers, which may have higher processing power and more capabilities, that are configured according to embodiments with CAD and PACS systems. With images stored in remote servers and computer aided detection and diagnostics on the remote servers, users that are geographically dispersed can all utilize the CAD and PACS system and the same database of images, diagnostics, and treatment information, even at the same time in embodiments.

[0010]ln embodiments of the present invention, advanced image classification methods, such as unique photometric and texture features, are provided, included classification methods that utilize machine learning (ML) and artificial intelligence (Al). Examples of the photometric and texture features include but are not limited to the six cancer classification features discussed herein, such as center of gravity and correlation, some of which are texture and some of which are photometric.

[0011] In embodiments, diagnostic and classification decisions may be automated.

[0012]ln embodiments of the present invention, systems, devices and methods are provided that integrate and compare images from multiple imaging techniques, such as, but not limited to, mammography, ultrasound, PET scan, MRI, and Terahertz Imaging (multi-faceted diagnosis).

[0013]ln embodiments of the present invention, the images are compared based on pixel brightness and position based on x, y, z, coordinates. This image comparison can be used to compare multiple images of the same area, perhaps taken at different times, or to compare images of concern against other images known to have cancer or images known to be cancer free, in order to determine if there is potentially cancer in the images of concern. Other ways of comparing images or areas of tissue are also possible in addition to comparing pixel brightness and position, including but not limited to use of other parameters, such as, but not limited to, biomarkers, genotype, pathological findings, and temporal changes. These other parameters can be used as input data for classification, interpretation, evaluation, prediction, extrapolation, and analysis, of the area of concern, such as breast tissue.

[0014] In embodiments, apparatus, systems and methods are provided that utilize artificial intelligence (Al) and machine learning (ML) to integrate information obtained from prior images into a diagnostic tool to analyze a current image. In an embodiment, the prior images are stored in an image/picture archiving and communication system (PACS). In an embodiment having a PACS system, information from the prior images is used to improve computer aided detection and diagnostics. For example, an embodiment of the invention uses prior images of patient as an archive or a baseline map. Those prior images can then be used to compare against newer images to detect temporal changes. For example, in an embodiment, temporal changes in mammogram images are considered in making a diagnosis. Temporal changes in breast cancer are important because if the shape and size of a suspicious region has changed between the current image and the image from the past year (the prior image is provided in the PACS system), then there is a higher chance that it could be cancer (the diagnosis of which is provided in the CAD system). By providing the PACS system to enter prior images, especially in a cloud system, embodiments of the present invention allow for the use of images from different hospitals and health facilities.

[0015]Moreover, in embodiments, images from numerous patients are stored in remote servers, for example in the cloud, where they can be used as reference images for the computer aided detection and diagnostic (CAD) systems, such as for cancer screening. For example, in embodiments of the present invention, the CAD system can utilize the PACS system to reference images out of a database where those referenced images have a similar diagnosis. The cloud servers and image diagnostic systems can provide diagnostic decisions based on the CAD and PACS system and can justify its diagnostics based on reference images from the cloud database having the PACS system.

[0016]The artificial intelligence in embodiments of the present apparatus, systems and methods, is utilized to make comparisons between an image of interest and the reference images stored in the PACS system on the cloud. This Al uses a number of predefined factors to compare the image of interest to historical images that have a known diagnosis, such as being cancerous or cancer free. Based on machine learning, the Al system is able to catalog the known historical images and whether the images have areas that could be cancerous.

[0017]Embodiments of the present invention, including but not limited to one or more of apparatus, systems and methods utilizing local computers, remote servers, local and remote memory, specialized methods, and configured hardware, provide a very powerful diagnostic tool that is convenient to use and share information across the Internet. No other system provides cloud processing and storage that combines an image/picture archiving and communication system (PACS) that is integrated with a computer aided detection and diagnostic system (CAD) utilizing a known artificial intelligence system (Al) such that the CAD can be based on a historical database of images in the PACS system thereby improving the accuracy of the diagnostic system.

[0018]With the increasing number of features, categories, combination of relevant information and other factors that should be considered in a CAD system, it is increasingly difficult, if not impossible, for a human to consider all possible

combinations and resulting outcomes simultaneously. However, embodiments of the present invention allow for the CAD system to continue to become more powerful, advanced and sophisticated over time, providing for new associations, correlations, or causations to be considered in the diagnosis. In one embodiment, users, such as doctors, are able to associate certain features with cancer. For example, if some doctors come to the conclusion that a common co-occurrence of a small circular abnormal region in the breast (which would normally be considered benign and not cancerous) together with some other occurrence, such as swelling around the abnormal region, is associated with cancer, then the CAD system will identify

(unsupervised learning), confirm and then use this co-occurrence as a flag to diagnose cancer in the image. In embodiments, the CAD system can also inform users, such as doctors or others in the scientific community, when a new or improved type of classification or factor used to detect cancer (e.g., a diagnostic) is discovered or when other relevant associations and co-occurrences of two prior unrelated clinical features now have a correlation worth noting. In another example, as individual genomic patient data becomes available, embodiments of the present invention can utilize the CAD system combined with Al learning to classify oncogenic mutations, alone or with other classifications or factors, to improve the diagnosis of cancer. In another example, the system can search medical publications, or other documents on the Internet, to find or verify new clinically found relevant associations for diagnosis. For example, if research finds that if a woman's milk duct angles are greater than 30 degrees that she is at risk of cancer because of angiogenesis, then that will be added as a factor or classification for the diagnosis decision in the system. In other embodiments, the system integrates patient information into the diagnosis decision, such as information from a patient questionnaire about symptoms, eating habits, drug use, etc., where that patient information can be used to find new associations and possible classifications to improve diagnosis.

[0019]Since non-imaging information will be gradually integrated into the diagnostic and classification making process, different machine learning (ML) processes will be tested and modified to improve diagnostic and classification outcome.

[0020] In other embodiments of the present invention, three dimension (X, Y, Z coordinates) information is considered in the diagnosis. For example, in embodiments for reviewing mammograms, tomosynthesis data can be used as the 3D input data and factors relevant to 3D imaging can be used as the classifications for scanning the 3D data and detecting if there are any cancerous regions. In other embodiments, the classifications and scanning techniques used for 2D images is adapted for use with 3D image data.

[0021]ln other embodiments of the present invention, improvements to imaging technology are utilized. For example, embodiments will be able to improve diagnostics by using improved grey scale resolution. For example, increasing the currently most commonly used 255 incremental levels on the grey scale makes image brightness an even more sensitive decision factor when comparing images or applying CAD to an image. With such improvements, many small differences in details in images that cannot be detected by the human eye will be able to be used as a classification or decision factor with embodiments of the present invention for applying CAD in a PACS system to diagnose cancer, for example.

[0022]Combining features from one or more of these embodiments makes this system a significant advancement over any known diagnostic system. Use of the cloud system to provide SAAS or DAAS with PACS and CAD features, together with the use of artificial intelligence (Al) to improve the diagnostic classifications and associations, provides a more robust and accessible diagnostic tool. By providing embodiments of the present invention via apparatus, systems and methods on the cloud, the user, such as a doctor, can communicate with other doctors and provide feedback on image diagnosis and also provide reference images that can help train the diagnostic system. The system can also provide feedback to doctors who have differing diagnosis on similar images, thereby improving the communication and diagnostics among doctors. For example, if two doctors made different diagnosis even though the mammograms used for that diagnosis are very similar, embodiments of the present invention can inform the doctors and recommend additional diagnostic procedures for making the final diagnosis.

[0023] Embodiments of the present invention organize information using triplets consisting of subject, predicate and object. The subjects and objects will be classified in entities, i.e. sub-categories, e.g. cells, drugs, disease, protein, DNA, mutations, risk factors, diagnosis, symptoms, drug interactions, etc. The unified medical language (UML) can be used for defining the subjects and objects. The predicate is the relation between subject and object, e.g. binding, interacting, reacting, increasing, decreasing, improving, etc. Such a machine readable triplet can become the input data for analyzing and drawing conclusions using machine learning (ML) artificial intelligence (Al) and other decision making processes. An example for such a triplet would be "Aspirin" (subject) "reduces" (predicate) "headaches" (object). Similarly, embodiments of the present invention utilize Al combined with input images, such as mammograms or other images having known diagnosis (e.g., cancerous or cancer free), to catalog a decision matrix that is then compared to an image of interest. The system will base its diagnostic decision based on the associations and classifications that were input into the CAD and Al system such that the final diagnosis can be based on an expanding set of data, features, training examples, supervised learning, processes, associations and other capabilities.

[0024]ln embodiments, an improved Support Vector Machine (SVM) is provided. Normal SVM could only distinguish between two classes, e.g. cancer or not cancer. In embodiments, SVM is improved to distinguish between 5 classes. This classification module is more memory efficient, utilizing only a subset of training points in the decision function (called support vectors). In embodiments, SVMs are more memory efficient and provide for increased processing speed because they provide decision boundaries that can be learned using a kernel. SVMs have faster training speed, but the runtime complexity of a nonlinear SVM classifier is high. Also, boosted decision trees have faster classification speed, but are significantly slower to train and the complexity of training can grow exponentially with the number of classes. In embodiments, linear kernel SVMs are provided for real-time applications to provide both improved training and classification speeds, with significantly less memory requirements than non-linear kernels due to compact representation of the decision function. This modified 5 level SVM classification can be used for cancer staging into the following already clinically used categories: (i) stage 1 cancer, (ii) stage 2 cancer, (iii) stage 3 cancer, (iv) stage 4 cancer and (v) cancer free. The number of classification categories can be increased beyond 5 as needed.

[0025] Embodiments of apparatuses, systems and methods of the present invention provide an on-demand, cloud-based, integrated solution for helping detect breast cancer. Embodiments provide an artificial intelligence platform that uses machine learning image analysis to continually improve as it reads more cases, providing cutting-edge technology support to physicians as they evaluate patients. Embodiments provide a turnkey PACS solution, reducing the need to maintain an entire network solution internally, and integrate with electronic medical records. Embodiments of the PACS solution provide virtual machines and cloud storage to store and manage image archives for use and retrieval. Embodiments of the PACS system provide secure private access on a HIPPA-compliant network. Embodiments of the PACS system integrate via HL7 compliant protocols. Embodiments of the PACS system integrate with existing electronic medical records systems (EMRs), such as Cerner or Epic, or with a clearinghouse service that provides secure data exchange via APIs.

[0026] Embodiments of apparatuses and systems according to the present invention include remote servers, cloud servers, virtual machines, processors, storage space, memory space, and Internet bandwidth to provide the infrastructure to provide a user with image storage and retrieval as well as computer aided image processing as described herein. A user can utilize a variety of different devices to access the remote PACS and CAD systems, including use of a local computer terminal as well as a portable device such as a smartphone or a tablet.

[0027] Embodiments of apparatuses, systems and methods of the present invention provide benefits to three main groups: patients, providers, and payers. Patients benefit by a rapid evaluation of their mammogram such that they can receive their results before they leave their appointment, as well as reducing false positive and false negative results. Providers are able to practice more time at the top of their license, seeing patients and providing treatment, and spending less time on documentation and reading cases off a screen. This increases the throughput of any given physician as well. Embodiments reduce the infrastructure requirements on providers, allowing smaller and more remote practices to offer access to care by eliminating the need for a high-end radiology suite, including workstations, ultra-high resolution monitors, expensive seat license software, and the support staff to handle operations, upgrades, and maintenance. All groups benefit from a lower total cost of ownership by our scalable solution that can adapt to however many cases they have. Payers benefit by reducing the total cost to treat their at-risk populations, not to mention by identifying these populations sooner. Early detection of cancer is key to successful survival, and it is also key to cost-effective treatments. A late stage cancer case requires ten-fold the cost to treat as an early-stage case ($140k v. $12k), and the prognosis is less certain with more aggressive complicated late stage cases. Brief Description of the Drawings

[0028]Figure 1 illustrates an embodiment of a system where the pre-processing of a mammogram includes pectoral muscle removal from the image.

[0029]Figure 2 illustrates an auto-scanning method embodiment.

[0030]Figure 3 illustrates an auto-scanning method embodiment.

[0031]Figure 4A-4D illustrates an embodiment of how critical regions of interest are evaluated.

[0032]Figure 5 illustrates an embodiment of an output of the auto-scanning methods.

[0033]Figure 6 is a work flow diagram of an embodiment of image processing.

[0034]Figures 7A-7E illustrate an embodiment utilizing manual scanning of an image.

[0035]Figure 8 illustrates an embodiment of an input vector for a Support Vector Machine (SVM).

[0036]Figure 9 illustrates an embodiment of a strategy formulation for a Support Vector Machine (SVM).

[0037]Figure 10 illustrates an embodiment of the workflow utilizing apparatuses, systems and methods of the present invention.

Detailed Description

[0038]Embodiments of the present invention allow for the use of worldwide accessible supercomputing resources over the "cloud" that improves image diagnostics, including for example in breast cancer screening and diagnosis for embodiments that compare images of breast tissue. These advanced diagnostic techniques allow a user to store images, set reproducible diagnostic standards, reduce diagnostic costs and provide comparable data for further research.

[0039]Use of the cloud, otherwise known as "cloud computing," is the delivery of computing over the Internet. Use of the cloud requires access to the Internet or a network that allows the use of shared resources, software, and information. Embodiments of the present invention provide diagnostic services over the cloud on remote servers, which can be provided as a service, sometimes called "software as a service" (SAAS), and also provide data such as images and diagnosis and treatment information over the cloud saved on remote servers, sometimes called "data as a service" (DAAS). This allows any physician to use advanced artificial intelligence (Al) based diagnostics and high end and specialized processors and memory and other computer components and specialized systems and processes from anywhere in the world without requiring additional local hardware and high upfront expenses because only a very small fee is required for each evaluated mammogram (pay as you go).

[0040]ln embodiments, the merger of image archiving, sometimes called PACS, and computer aided detection and diagnostics, sometimes called CAD, provides for improved apparatuses, systems and methods. By providing the image archiving, the same data can be used as a private archive as well as an archive of reference images for the image diagnosis and computer aided detection and diagnostics. The same data and images can be used for a variety of purposes by many different users across the Internet by having it available on the cloud or remote servers, saving space and increasing reference data, thereby improving the diagnostic system. For example, data communication is more efficient and requires less bandwidth because a remote server with archived images is available to be used by multiple users across the Internet without requiring transfer of the images to each of the users for diagnostic purposes. The computer aided detection and diagnostics can be performed at the remote server using the archived images with the results being transferred to the user, saving the users from requiring additional bandwidth to transfer all the images used for the comparative diagnostics, save all the images used for the comparative diagnostics, or have the specialized processors, methods or systems used to perform the diagnostics. The processors, computers, systems and methods used to perform high end dimage diagnostics are complicated and require many resources. By moving those processors, computers, systems and methods to a remote server, for example on the cloud, the image diagnostics can be distributed and made available to many user across the Internet. Moreover, the diagnostic tasks can be divided into subtasks over a multi-core server, which can accomplish the desired calculations and processing in a much more efficient and powerful way. Also, by providing resources over the cloud, the model is elastic allowing for more resources to be added on demand and automatically provided to all the relevant users simultaneously over the Internet.

[0041]Use of cloud servers in embodiments improves performance of the overall system, including other servers, memory, processors and other hardware. Use of the cloud provides a unique platform for image diagnostic resources because the images used for the computer aided detection and diagnostics, where other images are used for comparative image processing, are based on a highly virtualized infrastructure. For example, use of cloud servers and a cloud system provides a broader computing environment in terms of accessible interfaces, near-instant elasticity and scalability, and multi-tenancy. A cloud server can be like a like a typical server, or can be a much more sophisticated server with higher end components, processors and memories.

[0042]Another advancement in embodiments is demand scalability, where use of the cloud and cloud based servers provides a runtime that allows for the addition of more memory, RAM and storage to perform a particular user's work on priority or on a pay for what you use basis.

[0043]Use of artificial intelligence (Al) as a diagnostic aid is beneficial because it adds objective and reproducible clinical decision components to cancer classification. It can alert physicians to clinically relevant abnormalities that are otherwise challenging to detect.

[0044]Machine-learning (ML) and Support Vector Machines (SVM) have been widely applied for Natural Language Processing, text mining, protein and gene expression pattern analysis and particularly image processing. SVM gradually improves, with each iteration, as it bases future classifications on past associations between image features and diagnoses. As used in embodiments of the present system, SVM is also able to use multifaceted diagnostics based on a combination of multiple tools, including but not limited to mammograms, ultrasounds, MRIs, Terahertz Imaging, temporal changes and other tools.

[0045] Embodiments of the present invention also provide online image archiving, where those images can be used to train the diagnostic software and can be used to compare against future images input into the system.

[0046] Described below is an embodiment of the present invention for inputting, processing, and analyzing mammogram images.

[0047]Data can be input into the mammogram embodiment in several ways.

[0048] 1. Image Input

[0049] Images can be uploaded to the cloud or remote servers from a local machine or other directory accessible from the Internet. Images can also be fetched from an archive from a PACS database. Embodiments provide apparatuses, systems, and methods that convert medical images, such as images in DICOM format with a variety of image data in headers and footers and other places within the image, to another format that includes only a pixels matrix and image identifier. Conversion of the image reduces the size of the image to a minimum, saving in memory needs and bandwidth requirements for saving and transferring the image. Moreover, converting the image provides a savings in processing requirements, wherein only a portion of the image is needed for the diagnostics processing. With the reformatted and converted image, the size is reduced and the transfer of data from the user workstation to the remote server or the cloud uses only a minimum amount of bandwidth. For example, DICOM images can be converted to high resolution Jpg images to reduce the size of the image. Embodiments provide apparatuses, systems, and methods that convert DICOM data to JPEG using a local user's workstation. Conversion of the image to JPEG reduces the size of the image to a minimum to include only a pixels matrix and image identifier. This way transfer of data from the user workstation to the remote server or the cloud uses only a minimum amount of bandwidth. The uploaded image is transferred to the cloud system server and the image is distributed to the master client and slave clients according to the current burden of the system and burden sharing requirements. In an embodiment, a processor performs a lossless compression of an image prior to it being transferred to the remote server or cloud for storage or diagnostic processing. In the lossless compression, all header and footer data is removed, leaving only leaving an image pixels matrix and an identification name of image. Images can be read as a pixel matrix where each pixel has some value which represents its brightness and color contents. In embodiments, the lossless compression of the image occurs at the user computer. In an embodiment, the lossless compression is performed on a DICOM image with the compressed image being saved in a JPEG format. Other improvements in embodiments from the lossless compression of the images includes transfer of the images from the user to the remote server much quicker with much less bandwidth (for example, the compressed image may only be a few megabytes versus 30-50 megabytes for a DICOM image). Moreover, the cloud server can process the compressed or JPEG image much faster with fewer computing resources and processing requirements than a larger DICOM image, which requires more complicated processing. [0050]Other options are available for image input into image storage or diagnostic analysis, including any available option that can input the image to the service via a computer, internal or external network, or over the Internet.

[0051]2. Image Pre-Processing

[0052] Images that are input into the cloud service allow for various pre-processing of the images, wherein the preprocessing of images is optional. For example, the cloud service provides a web-based DICOM viewer with preprocessing tools, including but not limited to tools that allow for zooming in and out in the image, change of contrast in the image, changing the background of the image (such as a black background or a white background), adding text to the image, rotating the image, adding angle and length measurements, as well as other pre-processing options.

[0053]These pre-processing tools, as well as others, allow for refinement of the image that can greatly increase the accuracy of the analysis of the image for cancer screening. Because of the complex formulation of mammograms at the photographic level, mammographic images are hard to interpret and analyze. Much care has to be taken in the pre-processing of the mammogram prior to making them ready for later- stage processing.

[0054] In an embodiment, pre-processing of the image provides for a refining step where unwanted detail and artifacts are removed from the image. This refinement step improves the quality of the image and helps with correct segmentation of the image, accurate feature extraction and localization of abnormalities that may be present in the mammogram. Pre-processing therefore makes it more likely that the computer aided detection and diagnosis (CAD) system correctly analyzes the image and finds potential abnormalities.

[0055]ln an embodiment, an option for pre-processing of mammograms includes pectoral muscle removal from the image. This option is available for mammograms having a mediolateral oblique (MLO) view, which is often allied with the anatomical features, such as a pectoral girdle. The pectoral girdle in images often results in false positives in cancer screening rendering the image diagnostics less efficient in its accuracy and precision. The pectoral muscles have bright intensities (closer to larger gray levels) in the image and can often become mixed up with the tumor region (which is also brighter). The pectoral muscles should be removed for more efficient functioning of the computer aided detection and diagnosis (CAD) system.

[0056]Figure 1 illustrates a system where the pre-processing of a mammogram includes pectoral muscle removal from the image. This process includes the following steps as shown in Figure 1 : (i) input of a digital image of the breast, (ii) creation of a binary image of the breast, (iii) creation of a masked image of the breast, (iv) creation of a Gaussian threshold level for the image, (v) creation of another binary image based in part on the Gaussian threshold level for the image, (vi) removal of black regions from the image that correspond to the pectoral muscles, and (vii) creation of the final image of the breast with pectoral girdle removed.

[0057]As can be seen in the images of steps (v) and (vi), pectoral muscle comes into view as a bright triangular piece in the upper left or upper right corner (depending on right or left breast) of the image. For correct removal and accurate positioning, it is important that no other region apart from the pectoral girdle is removed. The process for removing the pectoral girdle utilizes pixel intensity to pick out the black areas. The pixels can be counted from these corners for all the simultaneous non- zero (non-black) values. Since the tumor is spread in the breast tissue, there are often discontinuities in the pattern. The larger band of highest uniformity in the brightness intensity can be picked out, which is the pectoral girdle.

[0058]This procedure is improved by converting the grayscale image shown in step (i) to a binary image (0 or 1 /black and white) in step (ii). The connected white areas with grayscale level 1 are marked and when matched with the original image of the breast, the first connected white region is removed. In this way, tags are no longer a part of the image, for example in step (iii) having the masked image of the breast. The image is then passed through a Gaussian window in step (iv) and the filtered image is obtained with regions in black and white belonging to a certain threshold window width value in step (v). With this, the pectoral muscle becomes black and the largest marked area. Similarly, all the connected black regions are removed except for the largest black region i.e. pectoral muscle in step (vi). The resulting image in step (vi) is then a companion masked image from step (iii). The black portion of the pectoral girdle when multiplied with the original image, that portion becomes zero or black (0^*45=0). The resultant image in step (vii) is free of all the tags and pectoral muscle. [0059]3. Auto-Scanning of the Image

[0060]Users also have the option of auto-scanning images that are input into the cloud service. Figures 2 and 3 illustrate auto-scanning methods. In embodiments having auto scanning, the system scans the image and marks all regions of suspected cancer. In embodiments, this process divides an image into 4*4 grids. Other grid resolutions are also possible. To minimize the chance that a critical region gets erroneously overlooked because it is at the borderline between two regions, partial overlapping two- window process is applied, which entails processing both windows parallel in each thread (also called multithreading) to decrease processing time.

[0061]ln a first method of auto-scanning illustrated in Figure 2, a first method of a partial overlapping two-window process is applied by moving a sliding window to the right by overlapping with half of an area of the previous windows thus covering the horizontal distance with a total of 7 sliding windows. In this method shown in Figure 2, the sliding overlapping window moves horizontally by overlapping half (50%) of the area of the previous window. To move along the entire horizontal line across the 4*4 grid, seven sliding windows are needed.

[0062]ln the first method of auto-scanning illustrated in Figure 2, the cropped out image is given to the auto-scanning unit and the image is divided into a 4*4 grid. Every block of the image is individually processed such that after processing, the auto-scanning unit moves on to the next block. By utilizing this auto-scanning method, it is less likely that a part of a mammogram will be mistakenly cropped out or mutilated. This is because in each row, every block or 1 /4th of a row is reviewed before moving on to the next part of a row, and as the auto-scan progresses, the previous block's half portion is considered and made into the next half of the next block. This process repeats itself until the entire image is auto-scanned. Each row of the image is covered with the auto-scan with the process moving horizontally over the image row by row until the last block in the last row is processed.

[0063]A second method of auto-scanning is illustrated in Figure 3. The second method also utilizes moving 50% overlapping sliding windows vertically downwards a 4*4 grid with 7 sliding windows. Similar to the first method of auto-scanning, a 4*4 grid of the entire image is created with blocks of the image processed with 1/2 of the processed block being taken into account for the next step of processing and repeating of the scanning through the ending block of the last row. In the second method of auto- scanning, the process is followed vertically scanning column-wise, whereas the first method is auto-scanned horizontally. As shown in Figure 2, a patterned grid is made on the image and processing is done column wise. For every chunk that undergoes checking, half of it is considered in the next act of checking together with the next immediate block. This ensures that no details are missed while scanning down the image column-wise.

[0064]A difference between method 1 and 2 is that in method 1 the sliding window moves horizontally to the right in 7 steps by overlapping with half of the area of the previous window, and in method 2 the sliding window is moving downwards in 7 steps by overlapping with half of the area of the previous window. Hence, the main difference between methods 1 and 2 is that the sliding window moves in different directions, the first horizontally and the second vertically.

[0065]4. Evaluation of Auto-Scanned Image

[0066]For every block of the 4*4 grid chunks shown in Figures 2 and 3 for the auto- scanning methods 1 and 2, the one or more of the following six cancer classification relevant features are evaluated: (i) correlation, (ii) center of gravity (COG), (iii) medium versus low optical density, (iv) low average distance, (v) compactness of combined medium and high density regions, and (vi) fractal dimension. This list of cancer classification features is representative only, but not exhaustive. Any relevant cancer classification feature may be added and evaluated as part of the auto-scanning methods. Indeed, more clinically relevant graphical and non-graphical features are able to be added and their evaluation implemented in the auto-scanning features.

[0067]The six cancer classification features are described in more detail below:

[0068](i) Correlation is a Markovian texture feature that produces a large value if an object contains large connected subcomponents of constant gray level and with large gray level differences between adjacent components. m¾(m)

[0070](ii) Center of gravity (COG) is a non-Markovian texture feature that represents the distance from the geometrical center of the object to the "center of gravity" of the optical density, normalized by the object radius.

[0071]

where ;r_c md y_c are the oonfifiates of die object centxoid,

nd ODsu is leined as

[0072](iii) Medium versus low optical density is a discrete texture feature that represents the ratio of the averages of the optical densities (OD) of the medium density region to the low density region.

[0074] (iv) Low average distance is a discrete texture feature that represents the average separation between the low density pixel and the center of the object circle.

[0076](v) Compactness of combined medium and high density regions is a discrete texture feature that characterizes the compactness of the combined medium and high density regions.

[0078](vi) Fractal dimension is a measure of three fractal texture features, fractal1_area, the area of the three dimensional surface of the object's optical density, fractal2_area, another fractal dimension but based on an image in which four adjacent pixels forming corners of squares are averaged into single pixels, and fractal_dimn calculated as the difference between logarithms of fractal1_area and fractal2_area. This gives a measure of the fractal behavior of the image. This feature has an extended form of three values named as FDavg, FDsd and FDIac.

„ log( f me alL r ) h^fradall we }

[0080]These cancer classification features are applied to distinguish between normal and abnormal regions of the mammogram. The values for the cancer classification features for every region are compared with those stored in a set of training data of the support vector machine (SVM). Classification into normal and abnormal regions of the mammograms is therefore made based on an automatic process. Images result for each region, with a description of the region being normal or abnormal based on the auto-scanning.

[0081]ln other embodiments, cancer classification methods incorporate three- dimensional image analysis (e.g., tomosynthesis) and multifaceted diagnostics, i.e. considering data from different image techniques, such as X-ray, ultrasound, MRI, CAT scan, and Terahertz imaging. In other embodiments, cancer classification methods incorporate non-image based features, such as genotype, biomarker, transcriptome analysis, blood tests, pathological findings from biopsies and others. Thus, the cancer classification features described above do not limit the features that can be incorporated into the auto-scanning or analysis of the image.

[0082]5. Evaluation of critical regions of interest (ROI)

[0083]Figures 4A-4D illustrate how critical regions of interest are evaluated in an embodiment. Figure 4A is an example of an image that went through image preprocessing with the pectoral girdle removed. Figure 4A is ready to be auto-scanned. Figure 4B shows the image of Figure 4A with the region being auto-scanned highlighted in black. Because there was a bright spot (i.e., a region of interest (ROI)) in the portion being auto-scanned, it was cropped out of the image for auto-scanning and shown in alternative outputs in Figures 4C and 4D. The region of interest is not necessarily "cropped out" of the figure, but it is highlighted to show what region is being auto-scanned. The region of interest is then auto-scanned and evaluated by the support vector machine (SVM) for classification as normal or abnormal based on the cancer classification features. In Figure 4C, an abnormality is confirmed for the region of interest after auto scanning. In Figure 4D, normality is confirmed for the region of interest after auto scanning.

[0084]6. Output of Auto-Scan

[0085]Abnormality and normality is determined using the auto-scanning of the region of interest. Using the cancer classification features of the auto-scanning method, a decision component in the SVM will compare the output of the cancer classification features to data in the cloud from past auto-scanning and training to distinguish between cancer and non-cancer. The decision component then decides based on set tolerances whether a region of interest is normal or abnormal. In embodiments, the decision component is a module working on the SVM or another compatible machine learning process or algorithm.

[0086] If the decision component declares a region of interest as normal then it sends the "normal" decision to an output component. If the decision component decides the region of interest is abnormal then the region of interest goes to another highlighting component. At this additional highlighting component, the abnormal mass is encircled and the output component then calculates an x-axis, y-axis, size and status for the abnormal mass.

[0087]As a result of the two auto-scanning methods described above, two images with marked areas result, shown in Figure 5. The two images show the marked regions from the two auto-scanning methods. The resultant images have significantly marked circles around the regions of interest. The circled areas are then compared with each other and commonality between the regions of interest can be verified. This comparison step improves the accuracy of the auto-scan. The comparison step also helps ensure that no region of abnormality is missed and also that some regions originally marked as abnormal may be deemed to be normal after comparison. The common regions from the comparison can be sent for more authentication testing in the system as well as manual scanning with deeper investigation.

[0088]7. Work flow diagram.

[0089]Figure 6 illustrates a workflow of an embodiment of the above described methods, including input of the image, auto-scanning of the image using method 1 and method 2 with the cancer classification features using the SVM, identification of regions of interest, and output as to whether the region of interest is normal or abnormal.

[0090]8. Manual Scanning of the Image

[0091]ln an embodiment, manual scanning of an image is provided, as illustrated in Figures 7A-7E. Manual scanning of an image allows a user to flag a suspicious area in an image through vertical and horizontal dragging. The region of interest identified by the user is cropped out, and results are made in terms of a mass in the region of interest in terms of the mass's size, radius, x-axis, y-axis the vector input and the classification into the normal/abnormal class. In manual scanning user crops region of intrest(ROI), Instead of whole image transfer it transfer only portion which consume less bandwidth and instead of whole images it process only signle window this way this uses less memory and processing.

[0092]For every manually dragged or cropped out portion, the cancer classification features are applied to help determine whether that portion of the mammogram is normal or abnormal. Manual scanning can be made repeatedly with each manual scan pertaining to different dimensions of the image. Figure 7A shows vertical cropping of the image and Figure 7B shows the cropped out image after vertical cropping. Figure 7C shows the vertically cropped out image ready for horizontal cutting and Figure 7D shows the desired region of interest cropped out by the user. Figure 7E shows the region of Interest (ROI) that is obtained and converted to a binary image with a zoomed in mass cropped out of a sharper contrast. The area that is identified as the region of interest is then auto-scanned.

[0093]ln an embodiment, an output of the manual-scan process provides the following data points: (i) X-Axis: the location X-coordinates of an abnormal mass, (ii) Y-Axis: the Y-coordinates of the abnormal mass, (iii) Size: the size of the cropped mass, (iv) Classification based on the shape of mass and (v) Status: whether the area identified is normal or abnormal from the results of the auto-scan cancer classification features for the area identified in the manual-scan. More output data, features and parameters may be added later.

[0094]9. Reference Studies:

[0095]ln an embodiment, if a user is interested to see images and what other radiologists described as abnormal, the user can query the database on the cloud service and the service will find the most closely relevant images from the database. The cloud service will remove all patient information from the header and footer of the image. This reference image can then be used by the user to make determinations regarding the current image under consideration.

[0096J10. Alternative embodiments

[0097] In addition to use for cancer screening, the above described cloud based service can analyze images of any sort for data of interest utilizing artificial intelligence, machine learning and other decision making procedures to improve the analysis and diagnostics. For example, image classification based on analysis of an image's pixel brightness and location (x, y, z, coordinates) and elucidating any kind of associations between data is possible for any area of study. Applying this approach to mammography is only an embodiment. Diagnostic classification decisions as described above only require pixel brightness and three-dimensional location (x, y, z, coordinates) as input data, and such image analysis can be used to detect not only other cancer types, but can also be applied to any other fields because whatever the application, there simply needs to be an adjustment as to how the pixel brightness and location (x, y, z, coordinates) are evaluated because the selection and interpretation of the discriminatory relevant features need only be adjusted for their respective applications, e.g. diagnostic procedures, weather forecasts, material science, biological tissue status, pathology, toxic effects of drugs, etc. For example, auto-scanning of images of weather patterns can be used to determine the path and strengths of hurricanes and tornadoes simply based on variations of brightness for each pixel location transmitted by our weather satellites. The above described methods of image comparison can be used with known methods of machine learning (ML) and artificial intelligence (Al) not only in in breast cancer diagnostics, but also many more applications like, but not limited to, distinguishing between broken bones requiring surgery from severe swellings. Moreover, the imaging techniques that can be used is not limited for the method can be easily adjusted based on the specific requirements of different imaging techniques, including X-ray, ultrasound, MRI, PET scan and Terahertz Imaging simultaneously, which is also known as multifaceted diagnostics. Also, increasing digital image resolution and pixel brightness discrimination, as well as non- image-based data, such as bio-markers, genomics, gene expression patterns, past diagnosis, symptoms and responses to drugs, etc. will be combined and considered simultaneously with constantly improving ML processes and algorithms.

[0098] 11. Machine Learning

[0099] Embodiments of the present invention utilize machine learning to apply classifications, scan images, and to improve diagnostics. Known machine learning techniques may be used. For example, a Support Vector Machine (SVM) is one significant type of data classifier that applies machine learning (ML) based upon mathematical knowledge of calculus and vector geometry to construct artificial intelligent networks. Support Vector Machine (SVM) is able to make classifications based on two or more classes of information.

[00100]ln embodiments of the present invention, Support Vector Machine (SVM) is used to train the system with known images and learn the values of classifications used for improving the accuracy of the diagnostic. Numerical values for each of the classification features is fetched from the known images (such as cancer classification features like (i) correlation, (ii) center of gravity (COG), (iii) medium versus low optical density, (iv) low average distance, (v) compactness of combined medium and high density regions, and (vi) fractal dimension). These features are then classified as vectors for a single class of normal or abnormal. The image of interest is then examined for the classification features and compared to the known images and classification values using the SVM. Comparing the values of the classification features of the known images to the values of the classification features of the image of interest results in a conclusion that the image of interest is either more similar to one set of images (e.g., images known to have cancer) or another set of known images (e.g., images known to be cancer free).

[00101]ln embodiments, the Syntax for training the SVM include values of vectors assigned for two groups and a "Group" matrix containing a numerical binary classification into 1 or 0. In an exemplary embodiment for detecting cancer in mammograms, the vector values come in a row for six classification features -- Correlation, Center of Gravity (COG), medium versus optical density (Med vs low OD), low average distance (low avg dist), compactness of medium and high density regions (medhi-OD-comp), and fractal dimension (fractal_dimn) respectively. Moreover, Fractal_Dimn has further been divided into 3 values, as itself as an average for fractal1_area and fractal2_area (FDavg, FDsd, FDIac). The "training" occurs when the vector values are stored in a matrix with a "group" matrix for every row corresponding to each of the classification features and the collection of vector values are classified into one of two binary classifications, such as 0 corresponding to cancerous or abnormal and 1 corresponding to non-cancerous or normal. An example input vector is shown in Figure 8, with every value in the input vector corresponding to the ordered sequence of the six classification features for breast cancer. The SVM utilizes a process to match the input vector values with the trained matrix of vector values. After it has made the comparison of the known vector values and the vector values of the image of interest, the SVM will return with a conclusion, for example, 1 to represent a normal group of vector values or 0 to represent an abnormal group of vector values. Based on this output value, a decision can be made by the system as to whether the image is normal or abnormal, cancerous or non-cancerous. Figure 9 demonstrates the basic method of using SVM to learn from prior images, using (a) vector generation to extract and store the values for the desired features or classifications that will be used to compare against other images, (b) class assortment of the extracted feature or classification values based on a binary result, such as normal or abnormal, and (c) comparing the sample or image of interest through the feature extraction process and compare the values using the SVM classifier, thereby matching the extracted values with the group that it most closely resembles (e.g., the "closest class").

[00102]There are several sources for images that can be used for the machine learning. For example, users of the system can be encouraged to provide final diagnostic decisions for the images under consideration. In embodiments, a PACS database stores the images and the associated diagnostic outcomes. These images can be used as training images for the SVM system. For example, images that are confirmed abnormal will have certain vector values for the syntax used for the SVM, (e.g., values for the cancer classification factors). The SVM will associate images with similar vector values as also being abnormal. The more images stored on the PACS database and run through the SVM system the more the system will improve because it is getting more and more training images and the corresponding diagnoses (supervised learning) for making diagnoses for new images of interest.

[00103]ln embodiments, another tool for improving the machine learning includes the use of graphical tools allowing a user (such as a doctor) to edit images, and the ability to highlight and circle any aspect or region in the images that are important to the final diagnosis. That way the system will associate characteristics of those regions with the final diagnosis of abnormal (e.g., cancerous) or normal (e.g., non-cancerous). Machine learning can also be used to classify stages of cancer in an image. For example, based on learning from characteristics of images confirmed to be stages 1 through 4 of cancer or confirmed to be primary or secondary (metastatic) tumors in mammograms, the machine learning techniques can find common characteristics in images of interest to identify what stage of cancer or type of tumor is present in the image. Similarly, embodiments of the system will incorporate feedback data regarding misdiagnoses (i.e. false positives and false negatives). Whenever a misdiagnosis is identified, the SVM system will improve because it is getting training on the characteristics of images that have produced such misdiagnoses.

[00104]ln embodiments, pathologic evaluations of potentially cancerous biopsies are used to improve image diagnostics. Co-occurrences of certain pathological and radiological observations can be correlated to indicate the presence or absence of cancer and those co-occurrences can be flagged in the evaluation of the image of interest when present. Machine learning processes, such as SVM, can learn from those co-occurrences and improve diagnostics in combination with other cancer classification factors.

[00105]12. Treatment Options

[00106]ln embodiments, the system recommends treatment options, for example, drugs, radiation, immunotherapy, nanoparticle therapy, or clinical trials, based on past experiences with images that are similar to the image under consideration (for example, images of certain types of cancer with similar features that are classified as the same cancer subtype). The machine learning process or support vector machine or other parts of the system can store information regarding what types of cancers responded well or poorly to certain cancer treatment regimens. The system can compare what kind of treatment regimens have worked better than others, including but not limited to clinical trials or proven treatment methods. In embodiments, information repositories such as Pubmed are monitored for treatment options for different types of cancers to include in updated treatment option alerts. In embodiments, observations from newly identified clinical features are also included in the machine learning to improve the diagnostic system.

[00107]13. Patient-Client Communication

[00108]Since the number of known impact factors affecting carcinogenesis is expected to rise at an increasing rate, embodiments of the present invention include a portal for a patient to query information from, interact with, and communicate information to the system. For example, a patient can use the system to ask a physician specific questions reading treatment options and communicate with several doctors at once. Increasing a patient's involvement, knowledge and understanding of his/her medical problems, and expanding the ability to communicate with physicians around the globe regarding diagnosis and treatment options, is becoming increasingly important due to a rising proportion of an aging population and an increasing national and global shortage of qualified and specialized physicians. In embodiments, the system can communicate doctor recommendations to the user, for example, referrals to the most appropriate, experienced and qualified cancer specialist for the specific cancer detected in an image scanned and evaluated by the SVM system. [00109]Providing breast cancer diagnostics is only the first step in developing an increasingly complex and sophisticated classification and decision making system, which can be applied to any area, based on the consideration and evaluation of an ever increasing amount of partially interdependent input data.

[00110]With reference to Figure 10, an embodiment utilizing a system with parallel processing is described and depicted with improved processing and response time.

[00111]Step 1 : A processor and a memory at a user workstation, which may be a computer or portable device, processes a DICOM image to a JPEG image, including through lossless compression. The user then transmits the compressed image to a remote server using a communications processor over the Internet with the user workstation. At the remote server, which may be a cloud server, the transmitted image goes through preprocessing, which can include, for example, Auto Pectoris girdle removal, image enhancement, and other processing.

[00112]Step 2: On the remote server, the preprocessed image is divided into 16 parts and processed on multiple cores of the remote server in parallel. In an embodiment, the following steps are performed on each part of the image: features of the image are extracted, the extracted features are converted into vectors as input parameters to a Support Vector Machine (SVM), for example an SVM class, and the SVM returns a status indicating if there are any abnormal regions.

[00113]Step 3: Results from processing of all 16 parts go through post processing which includes but is not limited to the remote server processing unit combining the results of the parallel image processing and returning the results back to the user via an interface.

[00114]Embodiments utilizing parallel processing provide improved efficiency in processing speed as well as required processing resources. For example, take the following variables, T = Total processing time, T1 = Time consumed by preprocessing, T2 = Time consumed by processing of 16 image parts, T3 = Time consumed by Post Processing. In a Sequential Case, T = T1 + T2 + T3, whereas in the Parallel Case provided by embodiments of the invention T = T1 + T2/n + T3, where n is the number of cores processing the image. T2 is a major component of processing time amounting up to 80% of total time T. T2 is reduced by n times in embodiments with parallel processing, thereby reducing processing time. [00115]ln embodiments, with reference to Figure 10, each of the elements shown in a blue cloud or blue box include (or interact with) one or more of the following: a processor, memory and other hardware components configured for the combined image archival and retrieval and image processing system and methods described herein. In embodiments, each of the elements shown in a blue cloud are part of a cloud system having resources at one or more remote servers or remote computing devices.

[00116]ln embodiments, the Reference Database is embodied in a remote server having a database processor and database memory, wherein the Reference Database receives reports from a user as well as reference images from the user, where the user may be a radiologist sending radiology reports and reference radiology images to the Reference Database.

[00117]ln embodiments, the Image Archive is embodied in a remote server having an image archive processor and image archive memory, wherein the Image Archive receives and transmits compressed images (in DICOM or JPEG format for example) to and from the user, which may be a radiologist sending or receiving lossless compressed DICOM images. In embodiments, the Image Archive provides secure image processing, storage and archiving and retrieval.

[00118]ln embodiments, the Reference Images Archive is embodied in a remote server having a reference images archive processor and reference images archive memory, wherein the Reference Images Archive receives processed images (in DICOM or JPG format for example) and image identifications (IDs) and transmits reference images and reports to the user. In embodiments, the Reference Images Archive provides secure image processing, storage and archiving and retrieval.

[00119]ln embodiments, the Support Vector Machine (SVM) is embodied in a remote server having a SVM processor and SVM memory, wherein the SVM receives images from one or more sources, for example an Image Processing 2D and 3D unit, as well as reference images having certain verified features, such as verified masses or cancer or verified false positives or false negatives. The SVM stores the image received from the Image Processing unit and stores the verified reference images and then compares the stored received image and stored reference images using, for example, the techniques described herein for comparing images and providing computer aided detection and diagnostic (CAD) processing.

[00120]ln embodiments, the Image Processing 2D and 3D unit is embodied in a remote server having a Image Processing 2D and 3D unit processor and Image Processing 2D and 3D unit memory, wherein the Image Processing 2D and 3D unit receives requests for computer aided detection and diagnostic (CAD) processing, including for creating a lossless compressed JPEG image from a DICOM image and for providing image processing of an image against reference images to find regions of interest, for example for finding potential masses and cancer. In embodiments, the Image Processing 2D and 3D unit uses the SVM for the CAD processing and also sends the image after lossless compression of the DICOM image to a JPG image to the Reference Images Archive. The Image Processing 2D and 3D unit also, in embodiments, sends the feature values of the image after CAD processing (for example whether there were regions of interest in the image and the characteristics of those regions) to the Reference Database along with the image identification (ID) for storage and later use in comparing to other images. The Image Processing 2D and 3D unit also, in embodiments, sends the results of the CAD processing of the image to the user, including whether the image has regions of interest that may be cancerous and a version of the image with the region of interest highlighted or marked.

[00121]ln embodiments, the Accounts management unit is embodied in a remote server having an Accounts management processor and an Accounts management memory, wherein the Accounts management unit receives data from a User Login, in the form of encrypted data in a secure communication environment, and can communicate back to the user whether or not the login was successful or whether the user is verified to go onto the system. If the user is verified to use the system, the Accounts management system is capable of authorizing the system depicted in Figure 10 to perform the requests of the user, including for example the CAD and PACS functions described herein.

[00122]ln embodiments, the User Login and User Interface units are embodied in a user's device, such as a workstation or a mobile computing device like a laptop, tablet or smartphone, having a User processor and a User memory, wherein the User Login interacts with the Accounts management to login the user to the system depicted in Figure 10 and the User Interface provides the mechanism where the User can enter data, upload images for processing and storage in the CAD and PACS system, provide other system requests, edit account information and make payments for use of the system, among other functions.

[00123]AII of the elements depicted in Figure 10 have parts that can be embodied in hardware and have functions that can be performed by software. Moreover, all of the elements depicted in Figure 10 have parts that can be embodied in virtual servers. Also, the elements depicted outside the User Interface and User Login can be embodied in the same server, remote server, cloud device, or other hardware separate from the User device. Also, in embodiments, one, or more, or all of the elements depicted in Figure 10 can be in the same device within separate modules, with the same or separate processors and with the same or separate memories.

[00124]Embodiments described herein are tools that enhance a physician's capabilities for making a diagnosis, for example diagnosing whether a particular patient has breast cancer from looking at mammogram images processed using the apparatuses, systems or methods described hererin. For example, the physician may use computer aided detection of data (like CAD marks on a scan) for coming to a medical diagnosis. As such, CAD, as described herein, is a computer aided detection and diagnostic system, where the system can perform detection functions, for example comparing an image of interest against reference images to see if there are regions of possible cancer, and mark those regions as a diagnostic for a physician to use to make a final medical diagnosis. The CAD system can be configured to perform detection or diagnosis functions or both.

[00125]From the foregoing, it will be appreciated that specific embodiments of the invention have been described herein for purposes of illustration, but that various modifications may be made without deviating from the scope of the invention. Accordingly, the invention is not limited to the specific embodiments described herein. APPENDIX -- Comparative Study Results

[00127]Confusion Matrix

[00128]Calculated parameters:

[00129]Evidence of superior performance when compared to other diagnostic systems:

[00130]An embodiment of the diagnostic system disclosed herein shows superior performance in the comparison table above with results at least 10% better than those of existing systems. Moreover, existing systems do not offer cloud based solutions. Furthermore, existing systems do not provide the combination and simultaneous application, integration and working together of CAD and PACS as provided in embodiments of the present invention.

Claims

CLAIMS We claim:

1. A method of providing image processing comprising:

storing reference image data in a memory of a data archive;

evaluating the reference image data with a computer aided detection and diagnostic device comprising a support vector machine;

performing an evaluation of an image of interest sent to the computer aided detection and diagnostic device, wherein the diagnostic evaluation of the image of interest is based at least in part on the evaluation of the reference image data by the support vector machine and comparison of that data to the image of interest.

2. The method of claim 1 , wherein the data archive is located on a first remote server and the computer aided detection and diagnostic device is located on a second remote server.

3. The method of claim 2, wherein the images are mammograms and the evaluation is for identifying cancer.

4. The method of claim 3, wherein the image processing is offered based on a fee based on the number of mammograms uploaded by a user for evaluation.

5. A system for image processing comprising:

an image archiving and communication device comprising a communications module configured to receive digital image data and a memory configured to store the digital image data;

a computer aided detection device comprising a processor configured to evaluate images, wherein the computer aided detection device further comprises support vector machine module configurable to match an image to a set of pre-configured criteria, wherein the image archiving and communication device and the computer aided detection device are communicatively coupled to the Internet.

6. The system of claim 5, wherein the pre-configured criteria relate to data from images stored in the image archiving and communication device.

7. The system of claim 6, wherein the pre-configured criteria relate to diagnosing cancer.

8. The system of claim 7, wherein the images comprise mammograms.

9. The system of claim 8, wherein the image processing is offered as a pay-as- you-go service.

10. The system of claim 5, wherein the processor of the computer aided detection device is configured to perform horizontal and vertical scanning of the image data and compare the image data on a pixel by pixel basis based on x, y, z, coordinates.

11. An apparatus for comparing images comprising: a scanning module configured to compare a set of images based on pixel brightness and position based on x, y, z, coordinates, wherein the scanning module is configured to perform horizontal and vertical scanning of each of the set of images with partial overlapping of each image using two-window scanning process; and a comparison module configured to receive data from the scanning module to compare the set of images based on a predefined set of criteria.

12. A method for analyzing an image on a cloud based system comprising: inputting an image into the cloud based system, pre-processing of the image using the cloud based system, auto-scanning of the pre-processed image using the cloud based system, wherein the auto-scanning includes use of a support vector machine to analyze the pre-processed image based on classification features, wherein the auto-scanning includes comparison of values of the classification features of the pre-processed image to values of the classification features for other images; and identification of regions of interest in the image based on the auto-scanning.

13. A server for parallel processing of images comprising: a communications module configured to receive image data over an Internet connection; a pre-processing module configured to divide the image into portions for parallel processing; a multi-core processing module configured to receive and process the divided image data in parallel processing across the multiple cores, with each parallel process comprising processing of a separate portion of the image data by a support vector machine to identify regions of interest in the image data; a post-processing module configured to combine results of the parallel processing of the image and returning the results back to a user via the communications module.

14. A system for storage, retrieval and processing of images, comprising: a reference database embodied in a remote server having a reference database processor and a reference database memory, wherein the reference database is configured to receive, store, and transmit reference image data; an image archive embodied in a remote server having an image archive processor and image archive memory, wherein the image archive is configured to receive, store, and transmit compressed images; a support vector machine embodied in a remote server having a processor and memory configured to receive images from one or more sources and compare the received images to data stored on the reference database and images stored on the image archive.

15. The system of claim 15 wherein the reference database, image archive and support vector machine are within the same remote server.

16. A device for processing an image, comprising: a first memory configured to store reference image data; a second memory configured to store image data of interest; a processor comprising a support vector machine configured to compare the image data of interest to the reference image data using cancer classifications, wherein the processor is configured to perform horizontal and vertical scanning of the image data and compare the image data on a pixel by pixel basis based on x, y, z, coordinates.

17. The device of claim 16 in a plurality of servers, wherein the first memory is within a first server, the second memory is within a second server, and the processor is within a third server, wherein each of the three servers are communicatively coupled.