title: A complete software application for automatic registration of x-ray mammography and magnetic resonance images.
abstract: OBJECTIVE
  This work presents a complete and automatic software application to aid radiologists in breast cancer diagnosis. The application is a fully automated method that performs a complete registration of magnetic resonance (MR) images and x-ray (XR) images in both directions (from MR to XR and from XR to MR) and for both x-ray mammograms, craniocaudal (CC), and mediolateral oblique (MLO). This new approximation allows radiologists to mark points in the MR images and, without any manual intervention, it provides their corresponding points in both types of XR mammograms and vice versa.
  
  
  METHODS
  The application automatically segments magnetic resonance images and x-ray images using the C-Means method and the Otsu method, respectively. It compresses the magnetic resonance images in both directions, CC and MLO, using a biomechanical model of the breast that distinguishes the specific biomechanical behavior of each one of its three tissues (skin, fat, and glandular tissue) separately. It makes a projection of both compressions and registers them with the original XR images using affine transformations and nonrigid registration methods.
  
  
  RESULTS
  The application has been validated by two expert radiologists. This was carried out through a quantitative validation on 14 data sets in which the Euclidean distance between points marked by the radiologists and the corresponding points obtained by the application were measured. The results showed a mean error of 4.2 ± 1.9 mm for the MRI to CC registration, 4.8 ± 1.3 mm for the MRI to MLO registration, and 4.1 ± 1.3 mm for the CC and MLO to MRI registration.
  
  
  CONCLUSIONS
  A complete software application that automatically registers XR and MR images of the breast has been implemented. The application permits radiologists to estimate the position of a lesion that is suspected of being a tumor in an imaging modality based on its position in another different modality with a clinically acceptable error. The results show that the application can accelerate the mammographic screening process for high risk populations or for dense breasts.
authors.affiliation: LabHuman, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Solves-Llorens
authors.affiliation: LabHuman, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: Rupérez
authors.affiliation: LabHuman, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Monserrat
authors.affiliation: Hospital Clínica Benidorm, Avda. Alfonso Puchades, 8, 03501 Benidorm (Alicante), Spain.
authors.forename: E
authors.initials: E
authors.lastname: Feliu
authors.affiliation: Hospital Clínica Benidorm, Avda. Alfonso Puchades, 8, 03501 Benidorm (Alicante), Spain.
authors.forename: M
authors.initials: M
authors.lastname: García
authors.affiliation: Hospital Universitari y Politècnic La Fe, Bulevar Sur, 46026 Valencia, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Lloret
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001940:Breast / Q000473:pathology / Q000503:physiopathology; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology; D003198:Computer Simulation; D005260:Female; D020342:Finite Element Analysis; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D008954:Models, Biological; D010363:Pattern Recognition, Automated / Q000379:methods*; D010369:Pectoralis Muscles / Q000473:pathology; D012984:Software