Computerized detection of masses in digital mammograms: automated alignment of breast images and its effect on bilateral-subtraction technique.

An automated technique for the alignment of right and left breast images has been developed for use in the computerized analysis of bilateral breast images. In this technique, the breast region is first identified in each digital mammogram by use of histogram analysis and morphological filtering operations. The anterior portions of the tracked breast border and computer-identified nipple positions are selected as landmarks for use in image registration. The paired right and left breast images, either from mediolateral oblique or craniocaudal views, are then registered relative to each other by use of a least-squares matching method. This automated alignment technique has been applied to our computerized detection scheme that employs a nonlinear bilateral-subtraction method for the initial identification of possible masses. The effectiveness of using bilateral subtraction in identifying asymmetries between corresponding right and left breast images is examined by comparing detection performances obtained with various computer-simulated misalignments of 40 pairs of clinical mammograms. Based on free-response receiver operating characteristic and regression analyses, the detection performance obtained with the automated alignment technique was found to be higher than that obtained with simulated misalignments. Detection performance decreased gradually as the amount of simulated misalignment increased. These results indicate that automatic alignment of breast images is possible and that mass-detection performance appears to improve with the inclusion of asymmetric anatomic information but is not sensitive to slight misalignment.