Development of a clinically applicable matching tool between MRI and close-up X-ray mammograms for the purpose of MRI-matching guided stereotactic breast biopsy

这项D-A-CH提案的目的是建立一种基于精确模拟女性乳房生物力学的匹配磁共振成像（MRI）和近距离立体定向活检x射线乳房x线照片的新方法，这可以将MRI检测到的乳房病变的检查成本效益提高50%。我们的目标是将仅在MRI中可见的病变信息转移到乳房x线摄影近距离投影视图上，具有足够的注册精度，以适应基于乳房x线摄影的病变检查，从而减少对昂贵且耗时的MRI活检的需求。这种登记的挑战是模拟乳房在接受乳房x线摄影压迫时的大量非线性变形，应对由于个体定位而导致的压缩过程的患者特异性变化，以及将MRI信息与立体定向活检期间进行的近距离乳房x线摄影视图相匹配，这并不覆盖整个乳房。为了在临床环境中准确预测病变位置，必须确定生物力学模型所需的复杂性，以克服非线性变形，同时在注册精度和计算时间上满足临床需求。此外，重要的是要确定和考虑影响匹配准确性的因素，如解剖学、临床或生物力学特征。在这个拟议的项目中，我们将通过患者特定的生物力学模型来模拟乳房在接受乳房x光摄影压迫时的变形来解决这些研究问题。本项目将探讨x线引导活检的临床可行性，仅根据MRI结果制定必要的软件和工作流程，同时考虑匹配准确性和工作流程速度的临床相关性。该项目将提供一种可直接应用于临床实践的最终方法。我们在KIT和MUW的研究团队在乳房图像配准的技术方面以及诊断性乳房成像和干预的临床需求方面提供了综合经验。本提案中的研究将为生物力学驱动的乳房图像配准的临床应用提供新的见解，使成本降低高达50%，解决进行mri引导干预的设备短缺问题，从而大大促进和加快mri检测到乳房病变的患者的检查。

The aim of this D-A-CH proposal is to establish a novel method for matching magnetic resonance imaging (MRI) and close-up stereotactic biopsy X-ray mammograms based on accurate simulation of the biomechanics of the female breast, which could improve the cost-effectiveness of the work-up of MRI-detected breast lesions up to 50%. We aim to transfer information of lesions only visible in MRI onto mammographic close-up projection views with sufficient registration accuracy to fit a mammogram-based lesion workup and thereby reduce the need for costly and time-consuming MRI biopsies. The challenges of such a registration are to model the substantial non-linear deformations of the breast undergoing mammographic compression, to cope with patient-specific variabilities of the compression process due to individual positioning and to match the MRI information to close-up mammography views performed during stereotactical biopsy, which do not cover the complete breast. For accurate prediction of a lesion position in these views in a clinical setting, it is essential to identify the required complexity of a biomechanical model overcoming the non-linear deformation while at the same time serving clinical needs in both registration accuracy and computation time. Moreover, it is important to identify and consider factors influencing matching accuracy like anatomical, clinical or biomechanical features. In this proposed project we will address these research questions by means of patient specific biomechanical models to simulate the deformation of the breast undergoing mammographic breast compression. The project will investigate the clinical feasibility of X-ray guided biopsy, which is planned based on MRI findings only by developing the necessary software and workflow while considering the clinical relevance of matching accuracies and workflow speed. The project will provide a final method which can directly be implemented into clinical practice. Our research team at KIT and MUW provides combined experience with respect to technical aspects of breast image registration and clinical needs of diagnostic breast imaging and intervention. The research in this proposal will provide new insights in the clinical application of biomechanically driven breast image registration, enable a cost reduction of up to 50%, address the shortage of facilities performing MRI-guided interventions and thus considerably facilitate and fasten work-up of patients with MRI-detected breast lesions.