MIMBCD-UI Information Systems and Computer Engineering
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MIMBCD-UI Medical Imaging Multimodality Breast Cancer Diagnosis User Interface Francisco Maria Galamba Ferrari Calisto Thesis to obtain the Master of Science Degree in Information Systems and Computer Engineering Supervisors: Prof. Jacinto Carlos Marques Peixoto do Nascimento Prof. Daniel Jorge Viegas Gonçalves Examination Committee Chairperson: Prof. Luís Manuel Antunes Veiga Supervisor: Prof. Jacinto Carlos Marques Peixoto do Nascimento Member of the Committee: Prof. Hugo Miguel Aleixo Albuquerque Nicolau February 2018 Acknowledgments We would like to convey our gratefulness to Hospital Fernando Fonseca (HFF) for the collaboration. I would especially like to thank the Doctors Clara Aleluia, Gisela Andrade, Willian Schmitt, Pedro Tomás Marques and Ana Sofia Germano from the HFF for the generous support and medical expertise. Also a great thanks to Doctor Cristina Ribeiro da Fonseca who help this project with all the effort she has. To all of the clinicians and radiologists with somehow helped this project. My appreciation also goes to Bruno Cardoso, Bruno Dias, Daniel Da Costa, Bruno Oliveira, Ana Beatriz Alves, Rodrigo Lourenço, Ricardo Cruz, Filipe Fernandes and João Miranda for help and above all for the good companionship. Thanks to Professors Daniel Simões Lopes and Daniel Mendes for giving us some aid during our research work. A special thanks to my com fellows André Mateus, Gonçalo Pais and João Campos. Not forgetting the presence of Dr Pedro Miraldo, who support our project. Last but not least, thank Joana Teixeira and Lídia Freitas for the feedback. Fundação para a Ciência e a Tecnologia (FCT) and Instituto Superior Técnico (IST) partially supported this work through the FCT/UID/EEA/50009/2013 project, BL89/2017- IST-ID grant. i Abstract Breast cancer is one of the most commonly occurring types of cancer among women. The primary strategy to reduce mortality is early detection and treatment based on medical imaging technologies. The current workflow applied in breast cancer diagnosis involves several imaging multimodalities. The fact that no single modality has high enough sensitivity for a reliable diagnosis supports the need for multi-modal imaging in breast cancer diagnosis. Nevertheless, their combination can significantly in- crease diagnostic accuracy. It also reduces the number of unnecessary biopsies, leading to better patient care and lower health care costs. In this work, we used interaction techniques to build a user interface adapted to the standard needs of a radiology room. This user interface allows the combination of Mammogram (MG), Ultrasound (US), Magnetic Resonance Imaging (MRI) and Text Data to assist the clinician in establishing the diagnosis. The work involves the development and design of a user interface for automatic detection, segmenta- tion and classification from breast MG, US and MRI, as well as, textual data notations and information visualisation. We conclude, through user analysis and evaluation, that our methods, techniques and developments are satisfactory. Moreover, this work provides a framework that can be applied to new medical interaction systems. Keywords: Human computer interaction (HCI), Usability testing, User interface design, User centered design, Health care information systems, Health informatics iii Resumo O cancro de mama é um dos tipos mais comuns de cancro entre as mulheres. A principal estratégia para reduzir a mortalidade é a detecção precoce e o tratamento baseado em tecnologias de imagens médicas. O actual fluxo de trabalho aplicado no diagnóstico do cancro da mama envolve diversas multi- modalidades de imagem. A necessidade de imagem multi-modal no diagnóstico do cancro de mama é baseada no facto de que nenhuma modalidade tem a especificidade e a sensibilidade desejáveis o su- ficiente para o diagnóstico confiável. No entanto, a sua combinação pode aumentar significativamente a precisão do diagnóstico. Tal, reduz o número de biópsias desnecessárias, o que leva a uma melhor assistência ao paciente, reduzindo os custos de cuidados de saúde. Neste trabalho, usamos técnicas de interação para o desenvolvimento de uma interface de utilizador adaptada às necessidades padrão de uma sala de radiologia. Essa interface de utilizador permite a combinação de Mamografia (MG), Ultrasom (US), Ressonância Magnetica (MRI) e dados de texto para ajudar o médico a estabelecer o diagnóstico. O trabalho envolve o desenvolvimento e desenho de uma interface de utilizador para detecção, segmentação e classificação automáticas de mamas em MG, US, MRI, além de notações de dados textuais e visualização de informações. Concluímos, através da análise e avaliacão do utilizador, que os nossos métodos, as nossas técnicas e os nossos desenvolvimentos são satisfatórios. Para além disso, este trabalho fornece um conjunto de regras que podem ser aplicadas a novos sistemas de interação médica. Palavras-Chave: Interação Pessoa-Máquina (IPM), Testes de Usabilidade, Desenho de Interfaces Utilizador, Concepção Centrada no Utilizador, Sistemas de Informação na Saúde, Informática na Saúde v vi Contents List of Tables viii List of Figures ix Acronyms xiii 1 Introduction 1 1.1 Motivation and Context ...................................... 2 1.2 Challenges ............................................ 4 1.3 Contributions ........................................... 5 1.4 Document Structure ....................................... 6 2 Related Work 7 2.1 Definitions ............................................. 7 2.1.1 Methodology ....................................... 9 2.2 Clinical Domain .......................................... 12 2.2.1 Activity-Based Computing ................................ 12 2.2.2 Fine-Needle Aspiration ................................. 12 2.2.3 Picture Archiving and Communication Systems .................... 13 2.2.4 Computer-Aided Diagnosis ............................... 13 2.2.5 Patient Visualization ................................... 14 2.2.6 Patient Progress ..................................... 15 2.2.7 Interaction System .................................... 16 2.2.7.1 CAS & CADx .................................. 17 2.2.7.2 User Interface for CADx ............................ 17 2.3 User-Centered Design ...................................... 18 2.3.1 Prototyping ........................................ 19 2.4 Environments ........................................... 19 2.5 Systems .............................................. 21 2.6 Overview ............................................. 23 3 Methodology 25 3.1 Questionnaires .......................................... 27 3.2 Prototypes ............................................ 28 3.3 Interviews & Observation .................................... 36 vii 4 Implementation 41 4.1 System Architecture ....................................... 41 4.1.1 Image Processing .................................... 42 4.1.2 Proposed Architecture Components .......................... 45 4.1.3 Auxiliary Files ....................................... 49 4.2 Services .............................................. 50 4.3 User and Technical Manuals .................................. 50 5 Experimental Evaluation 51 5.1 Approach ............................................. 51 5.1.1 Participants ........................................ 52 5.1.2 Apparatus ......................................... 53 5.1.3 Tasks ........................................... 54 5.1.4 Statistical Data Analysis ................................. 56 5.2 Evaluation ............................................. 58 5.2.1 Quantitative Evaluation ................................. 58 5.2.1.1 Time Evaluation ................................ 59 5.2.1.2 Accuracy Evaluation .............................. 60 5.2.1.3 Number of Interactions Evaluation ...................... 60 5.2.1.4 Number of Errors Evaluation ......................... 61 5.2.2 Qualitative Evaluation .................................. 62 5.2.2.1 Positive and Negative Affect Scale ...................... 62 5.2.2.2 Intrinsic Motivation Inventory ......................... 63 5.2.2.3 Experience Needs Satisfaction ........................ 63 6 Results 65 6.1 Performance ........................................... 65 6.1.1 Time Results ....................................... 65 6.1.2 Accuracy Results ..................................... 67 6.1.3 Number of Interactions Results ............................. 67 6.1.4 Number of Errors Results ................................ 68 6.2 User Experience ......................................... 69 6.3 Summary ............................................. 72 7 Recommendations & Discussion 75 7.1 Functional ............................................. 75 7.2 User Interface ........................................... 76 7.3 Limitations ............................................ 76 7.4 Future Work ............................................ 77 8 Conclusion 79 Bibliography 81 A Main Appendix 90 B External Source 95 viii List of Tables 2.1 Table of Systems & Topics for the Related Work ........................ 23 5.1 Table of Radiologist Expert Level ................................ 52 5.2 Table of Patient Studies ..................................... 56 6.1 Time (seconds) Performance Results. ............................. 66 6.2 Accuracy Results. ........................................ 67 6.3 Num. of Anno. vs Hit Rate Score (HRS) Results. ....................... 67 6.4 Total Number of Interactions. .................................. 68 6.5 Total Number of Errors. ....................................