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The International Journal of Engineering And Science (IJES)
||Volume|| 2 ||Issue|| 1 ||Pages|| 18-21 ||2013||
ISSN: 2319 – 1813 ISBN: 2319 – 1805
          Computer Aided Detection (CAD) System for Automatic
            Pulmonary NoduleDetection in lungs in CT Scans
                                        1
                                            Veeresh Biradar, 2Upasana Patil
                                                             1, 2
                                                       Faculty
                          Dept.of Computer Science and Engg LAEC, Bidar, Karnataka, India


--------------------------------------------------------Abstract--------------------------------------------------------
The main motto of this paper is to evaluate the performance of the Automated CAD for Lung Nodule Detection
using CT Scans. The CAD system is applied to CT scans collected in a Screening program for lung cancer
detection. Each scan consists of a sequence of about 400 slices stored in DICOM (Digital Imaging and
Communications in Medicine) format. All malignant nodules were detected and a very low false positive
detection rate was achieved. The performance is evaluated as a fully automated computerized method for the
detection of lung nodules in computed tomography (CT) scan in the identification of lung cancers that may be
missed during visual interpretation.

Keywords-Computer Assisted Diagnosis, CT, Lung Cancer, Pulmonary nodules
---------------------------------------------------------------------------------------------------------------------------------------
Date of Submission: 12, December, 2012                                               Date of Publication: 05, January 2013
----------------------------------------------------------------------------------------------------------------------------- ----------

                 I.      Introduction

CT (Computed tomography) is the most sensitive                                     The thin-section CT scan generally
                                                                         generates a large data set, with typically 250–350
and specific diagnostic modality for detecting
                                                                         images of 1-mm section thickness, and it requires
pulmonary nodules (1 3). The reliable detection of
                                                                         radiologists to spend a considerable amount of time
small pulmonary nodules is crucial for the early
                                                                         interpreting the images to produce the appropriate
detection of lung cancer and other nodular lung
                                                                         results. As a means to reduce radiologists'
diseases (1). However, the radiologist’s sensitivity
                                                                         workload, computer-aided detection (CAD)
for the detection of small pulmonary lesions is
                                                                         systems may be used. The automatic CAD systems
limited (1). Nodules may not be detected on CT
                                                                         also help to improve a radiologist's performance in
images because of factors such as a failure to
                                                                         the detection of pulmonary nodules [6] without
perform the necessary systematic search, or an
                                                                         which, it would become a much time consuming
understandable inability to assimilate the vast
                                                                         process for the radiologist and the CAD systems
amount of information contained in the multiple
                                                                         automatically.
images containedin a CT examination (2, 4,
and5).Especially in the central lung regions,
                                                                                  CAD software is useful to supplement
nodules can go undetected because they are
                                                                         radiologists’ detection performance. However, at
confused with blood vessels imaged in cross
                                                                         present, it is not adequate as a stand-alone
section (1, 2). For the differentiation between
                                                                         procedure. Furthermore, all suspected lesions
spherical (nodules) and tubular (vessels) structures,
                                                                         detected by CAD must be interpreted by
contiguous slices have to be evaluated. This is a
                                                                         radiologists to rule out false-positives. In the future,
time consuming task and susceptible to error.
                                                                         temporal comparison should further improve the
However, the utilization of automatic nodule
                                                                         usefulness of CAD in the early detection of lung
detection in clinical situations has recently become
                                                                         cancer.
possible, due to the dramatic increase in computer
performance that has come about over the past
decade (1, 3). The purpose of this study was to                              II.      extraction of pulmonary nodule
evaluate the efficacy of using a computer-aided                                    In order to extract the pulmonary nodule,
detection (CAD) workstation for the detection of                         we perform the following actions. First we remove
lung nodules in clinically acquired chest CT                             the background (i.e., the pixels with the same grey
examinations.                                                            level as the lungs but located outside the chest)
                                                                         from the image. To this aim, due to the high
                                                                         similarity between the grey levels of the lungs and

www.theijes.com                                               The IJES                                                      Page 18
Computer Aided Detection (CAD) System for Automatic Pulmonary NoduleDetection in…
the image background (see Fig. 1,2), we cannot                         In the first and last groups the lungs image
simply apply a thresholding technique. Instead we             represents a smaller percentage of the slice than in
use an ad-hoc operator which, starting from the               the second group. Thanks to the thresholding
four corners of the                                           operator each slice is transformed into a binary
         Image, moves along the four directions               image where the foreground, i.e., the object we are
identifying as background pixels those pixels                 interested in, consists of the lungs and all the rest is
whose grey level is within a pre-fixed range.                 background (see Fig. 4).




                                                                      Fig. 4 The Image after Thresholding.

                                                                        Afterwards, we apply the morphological
Fig. 1. The basic steps for automatical detection of          opening and closing operators so as to improve the
                pulmonary nodules                             image and border definition; this allows us, in
                                                              particular, to enhance the separation between
                                                              distinct regions and to fill the gaps in the borders.
                                                              The resulting image is shown in Fig. 5.




             Fig. 2 A DICOM image

         Otherwise, the scan is interrupted along              Fig. 5 The image after the opening and closing
the direction under examination and the successive                                operators.
row/column is analyzed in a similar way. The                            Pulmonary lobes. Then we reconstruct the
image produced by this operator (shown in Fig. 3)             pulmonary lobes borders so as to reinsert the
is converted to a binary image by means of a                  nodules adjacent to the pleura (juxta-pleura
thresholding technique that uses either a static.             nodules) previously suppressed by the thresholding
depending on the lung zone the slice belongs to               operator.
image. The detection method proposed in this
paper is based on the lung anatomical structure and
spatial characteristics. The image consists slices of
lungs.




                                                                  Fig. 6 Two chains representing the pulmonary
                                                                                      lobes.

                                                                       In order to rebuild the pulmonary lobes
                                                              border parts that have been erroneously eliminated,
                                                              for each pair of border points, we calculate two
 Fig. 3 The Image after Background Removal.                   distances: the Euclidean distance d1 and the
                                                              minimum distance in pixels d2 between the two
                                                              points. We then compute the ratio d2/d1: if it is

www.theijes.com                                        The IJES                                            Page 19
Computer Aided Detection (CAD) System for Automatic Pulmonary NoduleDetection in…
greater than a given threshold the two points        are
candidates for a possible reconstruction.. If        the           IV.    Automated Lung Nodule Detection
condition is satisfied, then the border between      the                             Method
pair of points is rebuilt, i.e., the two points      are                The CAD system consists of CAD server
connected by a line (see Fig 7).                               and CAD workstation. The CT data are transferred
                                                               from the CT scanner to the CAD server over the
                                                               DICOM protocol [10, 11]. The CAD server accepts
                                                               and analyzes the scans by segmenting the lung
                                                               parenchyma from the vessels, mediastinum, and
                                                               chest wall. Other techniques are used to include
                                                               lesions that may be touching the chest wall. The
                                                               CAD workstation is user controlled. The findings
                                                               of CAD are presented in three windows on the
                                                               monitor the original 2D axial images and a lung
      Fig.7 Reconstructed pulmonary lobes.                     nodule map.

          Finally, we apply a region filling operator                    V.    Experimental Results
to the pulmonary lobes chains in order to
reintroduce the original values of grey levels inside                    CAD standalone sensitivity for the 52
the lungs. The resulting images (see Fig. 8), which            solidnodules ≥ 4 mm that were present in the 25
contain only the lung regions, are input to the                current examinations was 65.4% (34/52). The 18
nodule detector. The detection method proposed in              nodules missed by CAD ranged between 4.0 and
this paper is based on the lung anatomical structure           11.9 mm in size and their locations were
and spatial characteristics. In this the image again           juxtapleural (n = 4), peripheral (n = 9), and central
reconstructed from original image after applying               (n = 5). As is customary when evaluating CAD
different steps as explained above. The restored               algorithm performance, the CAD false-marker rate
image reconstruct the pulmonary lobes from                     is determined on normal cases. There were 78
original image as shown fig.8.                                 pulmonary nodules in the 37 scans with nodules.
                                                               Their mean diameter was 7.2 mm (range 4 15.4
                                                               mm). The size distribution of the nodules was 65
                                                               (83%) in the diameter range of 4 10 mm, 12 (16%)
                                                               in the range of 10 15 mm, and one (1%) in the
                                                               range of 15 20 mm. The zonal distribution of the
                                                               nodules was 54 (69%) in the outer third of the lung,
                                                               21 (27%) in the middle third, and three (4%) in the
                                                               inner third shown in fig 9 .
                Fig. 8 Restored image.

         III.     Lung Nodule Detection
          Lung nodule detection is a very difficult
step in a CAD system development. Actually, in
CT lung images, nodules are frequently attached to
blood vessels or to the pleura; further their grey
tone is so similar to vessels sections that traditional
intensity-based methods are inappropriate. Instead,                Figure 9. After a Corrected lung boundary was
an effective nodule detection algorithm must take                                    determined
both the grey level and the object shape into
account. More precisely, let v(x,y,z) denote an
image voxel (i.e., a 3D point) and I(x,y,z) its
intensity. For each voxel we define an infinitely
differentiable 3D function f(x,y,z) as the
convolution of I(x,y,z) with a smoothing filter
g(x,y,z): f (x, y, z) = I (x, y, z)⊕ g(x, y, z) . In this
case we use 3D Gaussian function as smoothing
filter.
                                                               Fig.10—Histogram shows distribution of effective
                                                                 nodule diameters for 149 lung nodules ≥ 2 mm
                                                                   identified on 54 current CT examinations.


www.theijes.com                                         The IJES                                         Page 20
Computer Aided Detection (CAD) System for Automatic Pulmonary NoduleDetection in…
          In addition to the standard 2D axial
images, two other views are provided on two                    [6].   M.J.R. Dalrymple-Hay, N.E. Drury, ―Screening
smaller screens. In the upper left corner, a lung                     for lung cancer‖, Journal of the Royal Society of
map corresponding to a maximum intensity                              Medicine, vol. 94, January 2001, pp. 2-5.
projection (MIP) view of the coronal images
references the location of the CAD marks. In the
lower left corner, an interactive 3D view of the
CAD-detected nodule (highlighted in green) is
displayed together with the surrounding pulmonary
vasculature, which can be rotated in real time to
permit the reader to decide if the candidate nodule
is truly a real nodule and, if so, to determine if the
CAD segmentation correctly includes only that
portion of the nodule without adjacent non nodular
structures, such as adjacent vessels and pleural
surfaces shown in fig.10.

  VI.       Conclusion And Future Work
          We have described a CAD system for
automated segmentation and reconstruction of
pulmonary parenchyma, and nodule detection. The
results achieved by applying the system to a
database consisting of eight CT scans with a total
of more than 2400 digital images have been judged
definitely good by experienced chest radiologists.
In particular, as regards nodule detection, all
malignant nodules were detected and a very low
false-positive detection rate was achieved.

         In the future research, we will improve the
method for excluding interference and propose an
effective method to detect the nodules as many as
possible. For example, we will category the
possible type of the nodules and the interference
structures. But we will use the enhancement way to
make them up. After that a tree branch will be used
to separate the different types deeply. It will cost
the processing speed if we accomplish the ideas
above, and we’ll concern the time that consumed as
well.
                     References
[1].   M.J.R. Dalrymple-Hay, N.E. Drury, ―Screening
       for lung cancer‖, Journal of the Royal Society of
       Medicine, vol. 94, January 2001, pp. 2- 5.
[2].   P.S.P. Wang, Y.Y. Zhang, ―A fast and flexible
       thinning algorithm‖, IEEE Trans. Computers, vol.
       38, n. 5, May 1989, pp. 741-745.
[3].   T. Nawa, T. Nakagawa, S. Kusano, Y. Kawasaki,
       Y. Sugawara, H. Nakata, ―Lung cancer screening
       using low-dose spiral CT: results of baseline and
       1-year follow-up studies‖, Chest, vol. 122, n.v1,
       July 2002, pp. 15-20.
[4].   HenschkeCI, McCauley DI, Yankelevitz DF, et al.
       Early Lung Cancer Action Project: overall design
       and findings from baseline screening. Lancet 1999;
       354: 99–105. CrossRefMedlineWeb of Science.
[5].   J. Dehmeshki, X. Ye, J. Costello, ―Shape based
       region growing using derivatives of 3D medical
       images: Application to semi-automated detection
       of pulmonary modules‖, International Conference
       on Image Processing, vol. 1, 2003, pp. 1085-1088.


www.theijes.com                                         The IJES                                            Page 21

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The International Journal of Engineering and Science (The IJES)

  • 1. The International Journal of Engineering And Science (IJES) ||Volume|| 2 ||Issue|| 1 ||Pages|| 18-21 ||2013|| ISSN: 2319 – 1813 ISBN: 2319 – 1805 Computer Aided Detection (CAD) System for Automatic Pulmonary NoduleDetection in lungs in CT Scans 1 Veeresh Biradar, 2Upasana Patil 1, 2 Faculty Dept.of Computer Science and Engg LAEC, Bidar, Karnataka, India --------------------------------------------------------Abstract-------------------------------------------------------- The main motto of this paper is to evaluate the performance of the Automated CAD for Lung Nodule Detection using CT Scans. The CAD system is applied to CT scans collected in a Screening program for lung cancer detection. Each scan consists of a sequence of about 400 slices stored in DICOM (Digital Imaging and Communications in Medicine) format. All malignant nodules were detected and a very low false positive detection rate was achieved. The performance is evaluated as a fully automated computerized method for the detection of lung nodules in computed tomography (CT) scan in the identification of lung cancers that may be missed during visual interpretation. Keywords-Computer Assisted Diagnosis, CT, Lung Cancer, Pulmonary nodules --------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 12, December, 2012 Date of Publication: 05, January 2013 ----------------------------------------------------------------------------------------------------------------------------- ---------- I. Introduction CT (Computed tomography) is the most sensitive The thin-section CT scan generally generates a large data set, with typically 250–350 and specific diagnostic modality for detecting images of 1-mm section thickness, and it requires pulmonary nodules (1 3). The reliable detection of radiologists to spend a considerable amount of time small pulmonary nodules is crucial for the early interpreting the images to produce the appropriate detection of lung cancer and other nodular lung results. As a means to reduce radiologists' diseases (1). However, the radiologist’s sensitivity workload, computer-aided detection (CAD) for the detection of small pulmonary lesions is systems may be used. The automatic CAD systems limited (1). Nodules may not be detected on CT also help to improve a radiologist's performance in images because of factors such as a failure to the detection of pulmonary nodules [6] without perform the necessary systematic search, or an which, it would become a much time consuming understandable inability to assimilate the vast process for the radiologist and the CAD systems amount of information contained in the multiple automatically. images containedin a CT examination (2, 4, and5).Especially in the central lung regions, CAD software is useful to supplement nodules can go undetected because they are radiologists’ detection performance. However, at confused with blood vessels imaged in cross present, it is not adequate as a stand-alone section (1, 2). For the differentiation between procedure. Furthermore, all suspected lesions spherical (nodules) and tubular (vessels) structures, detected by CAD must be interpreted by contiguous slices have to be evaluated. This is a radiologists to rule out false-positives. In the future, time consuming task and susceptible to error. temporal comparison should further improve the However, the utilization of automatic nodule usefulness of CAD in the early detection of lung detection in clinical situations has recently become cancer. possible, due to the dramatic increase in computer performance that has come about over the past decade (1, 3). The purpose of this study was to II. extraction of pulmonary nodule evaluate the efficacy of using a computer-aided In order to extract the pulmonary nodule, detection (CAD) workstation for the detection of we perform the following actions. First we remove lung nodules in clinically acquired chest CT the background (i.e., the pixels with the same grey examinations. level as the lungs but located outside the chest) from the image. To this aim, due to the high similarity between the grey levels of the lungs and www.theijes.com The IJES Page 18
  • 2. Computer Aided Detection (CAD) System for Automatic Pulmonary NoduleDetection in… the image background (see Fig. 1,2), we cannot In the first and last groups the lungs image simply apply a thresholding technique. Instead we represents a smaller percentage of the slice than in use an ad-hoc operator which, starting from the the second group. Thanks to the thresholding four corners of the operator each slice is transformed into a binary Image, moves along the four directions image where the foreground, i.e., the object we are identifying as background pixels those pixels interested in, consists of the lungs and all the rest is whose grey level is within a pre-fixed range. background (see Fig. 4). Fig. 4 The Image after Thresholding. Afterwards, we apply the morphological Fig. 1. The basic steps for automatical detection of opening and closing operators so as to improve the pulmonary nodules image and border definition; this allows us, in particular, to enhance the separation between distinct regions and to fill the gaps in the borders. The resulting image is shown in Fig. 5. Fig. 2 A DICOM image Otherwise, the scan is interrupted along Fig. 5 The image after the opening and closing the direction under examination and the successive operators. row/column is analyzed in a similar way. The Pulmonary lobes. Then we reconstruct the image produced by this operator (shown in Fig. 3) pulmonary lobes borders so as to reinsert the is converted to a binary image by means of a nodules adjacent to the pleura (juxta-pleura thresholding technique that uses either a static. nodules) previously suppressed by the thresholding depending on the lung zone the slice belongs to operator. image. The detection method proposed in this paper is based on the lung anatomical structure and spatial characteristics. The image consists slices of lungs. Fig. 6 Two chains representing the pulmonary lobes. In order to rebuild the pulmonary lobes border parts that have been erroneously eliminated, for each pair of border points, we calculate two Fig. 3 The Image after Background Removal. distances: the Euclidean distance d1 and the minimum distance in pixels d2 between the two points. We then compute the ratio d2/d1: if it is www.theijes.com The IJES Page 19
  • 3. Computer Aided Detection (CAD) System for Automatic Pulmonary NoduleDetection in… greater than a given threshold the two points are candidates for a possible reconstruction.. If the IV. Automated Lung Nodule Detection condition is satisfied, then the border between the Method pair of points is rebuilt, i.e., the two points are The CAD system consists of CAD server connected by a line (see Fig 7). and CAD workstation. The CT data are transferred from the CT scanner to the CAD server over the DICOM protocol [10, 11]. The CAD server accepts and analyzes the scans by segmenting the lung parenchyma from the vessels, mediastinum, and chest wall. Other techniques are used to include lesions that may be touching the chest wall. The CAD workstation is user controlled. The findings of CAD are presented in three windows on the monitor the original 2D axial images and a lung Fig.7 Reconstructed pulmonary lobes. nodule map. Finally, we apply a region filling operator V. Experimental Results to the pulmonary lobes chains in order to reintroduce the original values of grey levels inside CAD standalone sensitivity for the 52 the lungs. The resulting images (see Fig. 8), which solidnodules ≥ 4 mm that were present in the 25 contain only the lung regions, are input to the current examinations was 65.4% (34/52). The 18 nodule detector. The detection method proposed in nodules missed by CAD ranged between 4.0 and this paper is based on the lung anatomical structure 11.9 mm in size and their locations were and spatial characteristics. In this the image again juxtapleural (n = 4), peripheral (n = 9), and central reconstructed from original image after applying (n = 5). As is customary when evaluating CAD different steps as explained above. The restored algorithm performance, the CAD false-marker rate image reconstruct the pulmonary lobes from is determined on normal cases. There were 78 original image as shown fig.8. pulmonary nodules in the 37 scans with nodules. Their mean diameter was 7.2 mm (range 4 15.4 mm). The size distribution of the nodules was 65 (83%) in the diameter range of 4 10 mm, 12 (16%) in the range of 10 15 mm, and one (1%) in the range of 15 20 mm. The zonal distribution of the nodules was 54 (69%) in the outer third of the lung, 21 (27%) in the middle third, and three (4%) in the inner third shown in fig 9 . Fig. 8 Restored image. III. Lung Nodule Detection Lung nodule detection is a very difficult step in a CAD system development. Actually, in CT lung images, nodules are frequently attached to blood vessels or to the pleura; further their grey tone is so similar to vessels sections that traditional intensity-based methods are inappropriate. Instead, Figure 9. After a Corrected lung boundary was an effective nodule detection algorithm must take determined both the grey level and the object shape into account. More precisely, let v(x,y,z) denote an image voxel (i.e., a 3D point) and I(x,y,z) its intensity. For each voxel we define an infinitely differentiable 3D function f(x,y,z) as the convolution of I(x,y,z) with a smoothing filter g(x,y,z): f (x, y, z) = I (x, y, z)⊕ g(x, y, z) . In this case we use 3D Gaussian function as smoothing filter. Fig.10—Histogram shows distribution of effective nodule diameters for 149 lung nodules ≥ 2 mm identified on 54 current CT examinations. www.theijes.com The IJES Page 20
  • 4. Computer Aided Detection (CAD) System for Automatic Pulmonary NoduleDetection in… In addition to the standard 2D axial images, two other views are provided on two [6]. M.J.R. Dalrymple-Hay, N.E. Drury, ―Screening smaller screens. In the upper left corner, a lung for lung cancer‖, Journal of the Royal Society of map corresponding to a maximum intensity Medicine, vol. 94, January 2001, pp. 2-5. projection (MIP) view of the coronal images references the location of the CAD marks. In the lower left corner, an interactive 3D view of the CAD-detected nodule (highlighted in green) is displayed together with the surrounding pulmonary vasculature, which can be rotated in real time to permit the reader to decide if the candidate nodule is truly a real nodule and, if so, to determine if the CAD segmentation correctly includes only that portion of the nodule without adjacent non nodular structures, such as adjacent vessels and pleural surfaces shown in fig.10. VI. Conclusion And Future Work We have described a CAD system for automated segmentation and reconstruction of pulmonary parenchyma, and nodule detection. The results achieved by applying the system to a database consisting of eight CT scans with a total of more than 2400 digital images have been judged definitely good by experienced chest radiologists. In particular, as regards nodule detection, all malignant nodules were detected and a very low false-positive detection rate was achieved. In the future research, we will improve the method for excluding interference and propose an effective method to detect the nodules as many as possible. For example, we will category the possible type of the nodules and the interference structures. But we will use the enhancement way to make them up. After that a tree branch will be used to separate the different types deeply. It will cost the processing speed if we accomplish the ideas above, and we’ll concern the time that consumed as well. References [1]. M.J.R. Dalrymple-Hay, N.E. Drury, ―Screening for lung cancer‖, Journal of the Royal Society of Medicine, vol. 94, January 2001, pp. 2- 5. [2]. P.S.P. Wang, Y.Y. Zhang, ―A fast and flexible thinning algorithm‖, IEEE Trans. Computers, vol. 38, n. 5, May 1989, pp. 741-745. [3]. T. Nawa, T. Nakagawa, S. Kusano, Y. Kawasaki, Y. Sugawara, H. Nakata, ―Lung cancer screening using low-dose spiral CT: results of baseline and 1-year follow-up studies‖, Chest, vol. 122, n.v1, July 2002, pp. 15-20. [4]. HenschkeCI, McCauley DI, Yankelevitz DF, et al. Early Lung Cancer Action Project: overall design and findings from baseline screening. Lancet 1999; 354: 99–105. CrossRefMedlineWeb of Science. [5]. J. Dehmeshki, X. Ye, J. Costello, ―Shape based region growing using derivatives of 3D medical images: Application to semi-automated detection of pulmonary modules‖, International Conference on Image Processing, vol. 1, 2003, pp. 1085-1088. www.theijes.com The IJES Page 21