The invention relates generally to the field of breast cancer screening, and in particular to a technique of Breast tissue Stiffness Reconstruction from breast surface displacement data in a digital image-based elasto-tomography system.
Breast cancer is a significant health problem in both developed and developing countries. It is estimated that each year the disease is diagnosed in over 1,000,000 women worldwide and is the cause of death in over 400,000 women. There are many treatment options available, including surgery, chemotherapy, radiation therapy, and hormonal therapy. These treatments are significantly more effective in reducing the mortality of the disease with early detection through breast cancer screening programmes.
The standard method for detection of breast cancer is mammography. However mammography can cause significant patient discomfort and requires radiation exposure. Furthermore there are often variable results and inconsistencies in reading and interpreting the images of breast tissue from the X-Ray machine especially for smaller tumour sizes of the order of 1-5 mm.
Digital Image based Elasto-tomography is an emerging technology for non-invasive breast cancer screening without the requirement of radiation. As used herein, Digital Image-based Elasto-Tomography system will be referred to as a DIET system. The DIET system uses digital imaging of an actuated breast surface to determine tissue surface motion. It then reconstructs the three-dimensional internal tissue stiffness distribution from that motion. Regions of high stiffness suggest cancer since cancerous tissue is between 3 and 10 times stiffer than healthy tissue in the breast. This approach eliminates the need for X-Rays and excessive, potentially painful compression of the breast as required in a mammogram. Hence, screening could start much younger and might enjoy greater compliance. Presently, there are other elasto-tomographic methods based on magnetic resonance and ultrasound modalities. Both methods are capable of measuring the tissue elasticity and are undergoing rapid development across the globe. However, they are also costly in terms of equipment and take significant time to use. They are therefore limited for practical screening applications.
The DIET system, in contrast, is silicon based and is thus potentially low cost and portable, so the technology could be used in any medical centre, particularly in remote areas. In addition, the use of silicon technology ensures that as it improves and scales upward in capability so will the DIET system performance. This scalability of performance is not true for X-Ray or ultrasound based approaches.
The DIET system relies on a fast and accurate breast tissue stiffness reconstruction from breast surface displacement data. Furthermore the stiffness distribution must be high resolution to ensure small tumours are not missed. Therefore, there exists a need in the art for very accurate patient-specific parameter identification that can deal with the unique requirements of a DIET system. In addition for clinical effectiveness, the stiffness reconstruction must be done with a minimal amount of computation.
The present invention is directed towards overcoming the problem of very high resolution patient specific parameter identification with a minimal amount of computation in connection with the DIET system; comprising a patient bed, an actuator to induce oscillation in a tissue, such as breast tissue, an array of digital cameras and computer software for processing images of the breast surface and transforming into measured motion, and computer software for converting measured motion into a three-dimensional distribution of stiffness of the breast.
Briefly summarized, according to one aspect of the invention a method for accurately identifying space varying patient specific parameters in a non-linear differential equation model as applied to tissue reconstruction from such a DIET system as described above comprises the steps of providing measured tissue displacement data; formulating a differential equation model describing tissue motion in terms of integrals of the measured tissue displacement data; setting up a system of linear equations in the space varying tissue stiffness parameters and solving by linear least squares to obtain a tissue stiffness distribution. The invention also includes a system comprising the components of the DIET system and a computer that is operable to formulate the differential equation model, set up the system of linear equations, and solve the equations by linear least squares to output a tissue stiffness distribution.
The invention further includes a method comprising the steps of providing a set of measured tissue displacements over a region of the tissue; providing a locally homogenous baseline model having an assumed piecewise constant stiffness distribution for the region; formulating a differential equation model describing tissue motion in terms of integrals of the measured breast tissue displacement data; performing a forward simulation using the model to generate a set of model displacements; and comparing the model displacements to the measured tissue displacements to determine if the region contains a tumour.
The invention has the advantages of high efficiency in computation, unique, convex parameter identification, and avoiding very complex finite element forward solver based routines which are highly non-linear, non-convex and starting point dependent. The invention has the flexibility to increase the resolution of space varying patient specific parameters while still maintaining a linear and convex optimization solution with no significant increase in computation.
These and other aspects, objects, features and advantages of the present invention will be more clearly understood and appreciated from a review of the following description of the preferred embodiment and appended claims, and by reference to the accompanying drawings.
The present invention is disclosed with reference to the accompanying drawings, wherein:
Corresponding reference characters indicate corresponding parts throughout the several views. The examples set out herein illustrate several embodiments of the invention but should not be construed as limiting the scope of the invention in any manner.
To appreciate the significantly large computational savings and vastly improved accuracy and reliability that integral based parameter identification methods can obtain compared to the current standard non-linear regression, in connection with a DIET system, it is helpful to review the principles and techniques of the non-linear methods.
Accordingly, referring to
The major computationally expensive step is the process of solving the mathematical model using finite element methods which must be performed many times for each updated guess of the stiffness distribution. The goal is to eventually find a stiffness distribution which minimizes the error between simulated motion and measured motion satisfying some error tolerance. For realistic stiffness distributions and tissue geometries, any finite element method must use potentially 104-106 nodes for sufficient accuracy. Even by breaking the region of interest into smaller sub-regions would require very large computational power only suitable for supercomputers. There is also the problem of converging to the wrong solution, that is, a local minima that can arise from a badly chosen initial stiffness distribution. The conventional solution to this issue is to start at many potentially different starting points, which further significantly increases computational time.
The present invention is generally shown in
As shown in
Referring now to
The integrals by their nature tend to average out the noise associated with the measurements, and thus act as a low pass filter. Other methods of smoothing, for example a Gaussian filter, or simple moving average, distort the measured motion which would result in errors in the measured stiffness. The integral formulation provides a filtering method that is invariant to the tissue motion thus gives a high accuracy in the calculation of three-dimensional stiffness values. This invariance arises from the fact that for small tissue motion the mathematical model given by the Navier-Stokes Equation is an accurate description of the real motion. So by inserting real data into an integral formulation of the model, a set of linear equations in terms of the unknown stiffness values can be set up that accurately describes the tissue motion. The coefficients of the unknown stiffness values are all integrals of the measured noisy data.
Integrals are effectively areas or volumes under curves of surfaces, thus noise has little effect on their numerical values. Also, since the optimisation is now linear, no false solutions corresponding to local minima can occur and it gives greater scope for increasing the resolution of the stiffness distribution to potentially pick up smaller tumours without a significant effect on computation. Furthermore, the inverse construction algorithm could readily be performed on a standard PC.
To demonstrate the computational efficiency and accuracy of the integral method compared to the non-linear method, values of a=−0.5, b=−0.2 and c=0.8 are chosen and 400 is solved analytically with an initial condition y(0)=1. The analytical solution is defined:
This solution is discretized as shown in the discretized cure 500 of
The computational time and solutions are shown in Table 1. Also shown is the computational times and the solution for the non-linear method which involves an initial guess for a, b and c in Equation (1) followed by an iterative method of changing a, b and c until the least squares error between Equation (1) and
This is standard non-linear regression. The results show that for the nonlinear method the final solution is highly starting point dependent. That is, the non-linear method can converge to a false solution if a bad starting point is chosen. The integral method found the correct solution immediately and is 1000-10,000 times faster than the non-linear method in this example.
where K1=1, K2=2, K3=1 and U(0)=0, U(3)=1.
In this case the results are constrained to be either healthy tissue or tissue corresponding to a tumour wherein A(x)=1 corresponds to healthy tissue, A(x)=2 corresponds to cancerous tissue and U(x) is the tissue displacement. The differential equation 600 is integrated once to give 602 and again to give 604. The equation is then split into three equations in 606 corresponding to the three tissue regions. This is simplified in 608, which is the full integral formulation of 600 with unknown parameters K1, K2, K3, a, b1, b2, b3. Note that a, b1, b2, and b3 are extra parameters added as they depend on values of U at the points x=0, 1, and 2 and U′(0), which could potentially bias the solution because of noise. Making them extra unknowns avoids this possibility.
To demonstrate the robustness of the integral method under noise, 600 is solved and shown in the output curve 700 of
In this two-dimensional case, four integrals and a special choice of integration limits are required in Step 304 to completely remove the derivatives in the formulation of Step 1000. The integral formulation is shown in Step 1002. The following example shows how a typical second order partial derivative is reduced to only terms involving u and integrals of u:
Applying a substitution z1=x0+x and z2=x0−x yields a right hand side of Equation (2);
Combining the double integral in the left hand side of Equation (2) with the double integral with respect to y eliminates all partial derivatives with respect to both x and y.
To obtain the final derivative-free formulation corresponding to Step 304, the stiffness distribution E=E(x, y) is assumed to be piecewise constant over the domain of interest. An example of a domain and stiffness distribution 1100 is given in
To demonstrate the concept of applying Steps 300-308 in
To generate “measured” data for this example, a tumour 10 times stiffer than healthy tissue is placed at the (6,5) position in
{(x, y):0.06≦x≦0.07, 0.05≦y≦0.06}.
All the surrounding tissue values are held constant at a Young's modulus of 30 kPa representing healthy tissue and Poisson's ratio is taken as ν=0.49, closely representing human tissue.
The tissue is initially actuated at 50 Hz with an amplitude of 1 mm at the right hand boundary of
However, in the integral formulation of Steps 1002-1006, extensive simulation has shown that the ability to identify a tumour is not significantly affected by increasing Poisson's ratio ν from the value of 0.49; which is the value used to generate the illustrative measured data of Step 302. A value of ν=0.5 corresponds to incompressible tissue, which can be alternatively formulated as zero divergence in the displacement vector field, or ux+vy=0. The incompressible two-dimensional Navier-Stokes equations are defined as follows:
Equations (4) and (5) can be obtained from the Equations in Step 1000 by the substitution λ=−G. Note that the assumption of λ=−G is only used to reconstruct the stiffness in Step 302; the full two-dimensional compressible Navier-Stokes Equations in Step 1000 are used to generate the illustrative measured data for the example. The major advantage of the incompressibility, or λ=−G assumption, is that the resulting formulation in Steps 1004-1006, is very robust to noise, and only requires a very low data resolution in the measured tissue displacements.
Random uniformly distributed noise is now placed on the displacement data graph 1400 of
Therefore, although the exact stiffness value of 300 kPa (i.e., ten times the value for healthy tissue, which was set at 30 kPa) is not found for the position of the tumour, there is a very significant change in stiffness observed, which is more than sufficient to accurately identify the tumour. The higher than normal healthy tissue value is due to some modelling error from the incompressibility assumption, but this does not effect detection of the tumour.
The method of Steps 1002-1006 can also be applied to different boundary conditions) positions of tumour and actuation frequencies. The graph 1700 of
The accuracy of the method with high noise and low resolution is important as it opens the possibility of cheap, crude and easily portable measurement systems for roughly estimating displacements inside a breast. For example, a simple ultra-sound system could be combined with highly accurate surface measurements from the digital cameras, significantly enhancing the ability to detect tumours.
Note that the stiffness distribution of
Finally, an alternative concept that will complement the approach of Steps 1002-1006 is presented to allow further flexibility and power to the overall methodology. The method looks to develop a measure of local homogeneity throughout the domain so that cancer will show up as a large error between the measured displacement and the simulated displacement from an assumed locally homogeneous model. In other words instead of directly calculating the stiffness of every segment in the global domain to detect cancer, a low resolution stiffness distribution is assumed throughout the domain, for example a piecewise constant stiffness 3 cm×3 cm elements. This simplified, locally homogeneous model can be rapidly and accurately fitted using the method of Steps 1002-1006 and would readily take into account the natural variations in healthy tissue.
For a given healthy stiffness of 30 kPa, if there is a 300 kPa 1 cm×1 cm tumour present, a 3 cm×3 cm element would only show at best an average stiffness of
(30×8+300)/9=60 kPa,
which is borderline between the healthy and cancer range. However, the reconstructed, low resolution, stiffness distribution could he used to generate displacements from one forward simulation of this locally homogeneous model. A region that contains a small tumour will then be highly non-homogeneous, and will thus show up as error between the simulated displacements and the measured displacements. On the other hand, regions containing healthy tissue will have a very good model fit by the forward simulation and thus show significantly smaller error. Steps 1900-1906 of
To prove the concept of
However, in Step 1906, a direct comparison of the homogeneous model generated displacements with the measured data is not sufficient since a tumour has both local effects and global effects on the displacement. Thus the algorithm allows translation of local regions to remove the major global effects and to enhance the local effect of the tumour on its surrounding area.
Let um and vm denote the horizontal and vertical measured displacements that result from a tumour placed at some (I,J) position in the global domain of
X
(m)(x)=um(x,
Y
(m)(y)=vm(
An example of the lines L
Assume that the average stiffness Eavg of the global domain of
X
(h)(x)=uh(x,
Y
(h)(y)=vh(
The graph 2100 of
As can be seen in
Note that the mean in Equations (11) and (12) is essentially a moving 11 point average. Subtracting the moving mean in Equations (11) and (12) ensures that if parts of X
The curve 2200 of
Similarly to Equations (10)-(13), a distance metric is defined between the curves Y
where:
Ŷ
(m)(xi)=Y
Ŷ
(h)(xj)=Y
A distance metric combining Equations (10) and (14) is now defined to enhance the detection of cancer:
where umedian(m) and vmedian(m) are the median absolute values of the measured displacements of um and vm, which are used to ensure the metric is approximately on the same scale as the measured data. Equation (18) defines a smooth surface over the global domain of
In summary, Equations (6)-(18) are used to compare the displacements of Step 1904 with the measured tissue displacements, thus completing the final Step 1906.
The graph 2300 of
To further demonstrate this method, a 5 mm×5 mm tumour is placed at the position 0.056≦x≦0.061, 0.05≦y≦0.055 and Steps 1900-1906 are applied. The result is shown in the graph 2500 of
Finally, the same approach as outlined above for the two-dimensional case can be applied to the full three-dimensional compressible Navier-Stokes Equations defined:
Equations (20)-(22) can be reformulated by using six integrals over the coordinates x, y and z;
which are of the same form as the four integrals in Step 1002. Furthermore, the incompressibility condition can be readily applied in the three-dimensional case by again setting the divergence to zero, ux+vy+wz=0 resulting in the following equations:
As with the two-dimensional case, substituting λ=−G into the full compressible three-dimensional Navier-Stokes equations results in Equations (24)-(26). The integrals of Equation (19) remove all derivatives in both the compressible and incompressible three-dimensional Navier-Stokes equations. The incompressible form of λ=−G is then used to reconstruct stiffness by setting up an over-determined system of linear equations and solving by linear least squares.
While the invention has been described in terms of steady state motion, one will note that the tissue may be actuated at a frequency that varies with time, an amplitude that varies with time, or both. In these non-steady state cases, the Navier-Stokes equations will include a time component and the process will include the integral of the equations with respect to time as well as space before conducting the linear least squares analysis.
While the invention has been described with reference to preferred embodiments, it will be understood by those skilled in the art that various changes may be made and equivalents may be substituted for elements thereof to adapt to particular situations without departing from the scope of the invention. Therefore, it is intended that the invention not be limited to the particular embodiments disclosed as the best mode contemplated for carrying out this invention, but that the invention will include all embodiments falling within the scope and spirit of the appended claims.