Automated Breast Ultrasound for Ductal Pattern Reconstruction: Ground Truth File Generation and CADe Evaluation

The purpose of this study was the generation of ground truth files (GTFs) of the breast ducts from 3D images of the Invenia (TM) Automated Breast Ultrasound System (ABUS) system (GE Healthcare, Little Chalfont, UK) and the application of these GTFs for the optimization of the imaging protocol and the evaluation of a computer aided detection (CADe) algorithm developed for automated duct detection. Six lactating, nursing volunteers were scanned with the ABUS before and right after breastfeeding their infants. An expert in breast ultrasound generated rough outlines of the milk-filled ducts in the transaxial slices of all image volumes and the final GTFs were created by using thresholding and smoothing tools in ImageJ. In addition, a CADe algorithm automatically segmented duct like areas and its results were compared to the expert's GTFs by estimating true positive fraction (TPF) or % overlap. The CADe output differed significantly from the expert's but both detected a smaller than expected volume of the ducts due to insufficient contrast (ducts were partially filled with milk), discontinuities, and artifacts. GTFs were used to modify the imaging protocol and improve the CADe method. In conclusion, electronic GTFs provide a valuable tool in the optimization of a tomographic imaging system, the imaging protocol, and the CADe algorithms. Their generation, however, is an extremely time consuming, strenuous process, particularly for multi-slice examinations, and alternatives based on phantoms or simulations are highly desirable.