Symmetric Biomechanically Guided Prone-to-Supine Breast Image Registration

Abstract

Prone-to-supine breast image registration has potential application in the fields of surgical and radiotherapy planning, image guided interventions, and multi-modal cancer diagnosis, staging, and therapy response prediction. However, breast image registration of three dimensional images acquired in different patient positions is a challenging problem, due to large deformations induced to the soft breast tissue caused by the change in gravity loading. We present a symmetric, biomechanical simulation based registration framework which aligns the images in a central, virtually unloaded configuration. The breast tissue is modelled as a neo-Hookean material and gravity is considered as the main source of deformation in the original images. In addition to gravity, our framework successively applies image derived forces directly into the unloading simulation in place of a subsequent image registration step. This results in a biomechanically constrained deformation. Using a finite difference scheme avoids an explicit meshing step and enables simulations to be performed directly in the image space. The explicit time integration scheme allows the motion at the interface between chest and breast to be constrained along the chest wall. The feasibility and accuracy of the approach presented here was assessed by measuring the target registration error (TRE) using a numerical phantom with known ground truth deformations, nine clinical prone MRI and supine CT image pairs, one clinical prone-supine CT image pair and four prone-supine MRI image pairs. The registration reduced the mean TRE for the numerical phantom experiment from initially 19.3 to 0.9 mm and the combined mean TRE for all fourteen clinical data sets from 69.7 to 5.6 mm.

Breast tissue stiffness estimation for surgical guidance using gravity-induced excitation

“…Mechanical models for breast deformation have also been created for needle path and biopsy planning (Misra et al 2008, Vancamberg et al 2010), breast augmentation planning and simulation (Roose et al 2005, del Palomar et al 2008, de Heras Ciechomski et al 2012), and radiation therapy targeting (Eiben et al 2016). Within these applications, various material constitutive models have been employed.…”

“…However, when contact forces or gravitational loading conditions are applied, absolute material property values are required. There are several models that incorporate gravitational loading and/or contact forces for applications in aligning prone and supine images (Eiben et al 2016), modeling mammographic compressions (Chung et al 2008b), and performing image-to-physical space registration of preoperative breast image volumes for use in guiding surgery (Conley et al 2015). In many of these studies, the material properties are estimated using literature values and are not patient specific.…”

Surgery of nonpalpable breast cancer: First step to a virtual per‐operative localization? First step to virtual breast cancer localization

“…Modeling breasts deformation was not an easy task. Breast shape can vary significantly between the imaging and surgical positions, especially in patients with large breast volume . Moreover, breast and skin elasticity depends on the age, hormonal status and many other factors.…”

“…Breast shape can vary significantly between the imaging and surgical positions, especially in patients with large breast volume. 11 In radiology, it could be helpful for tumors only visible in breast MRI by guiding the second look ultrasound. An expensive MRIguided biopsy could be avoided.…”

Systematic feasibility analysis of a quantitative elasticity estimation for breast anatomy using supine/prone patient postures

“…Various deformable image registration algorithms have been investigated by peers specifically for the proneto-supine breast transition. 24,33,34 Future work will focus on further investigating a deformable image registration technique that provides accurate ground-truth data and a oneto-one correspondence between breast tissue in the prone and supine positions.…”