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IEEE Access

Automatic Image Segmentation of Breast Thermograms for

Cancer Detection

Journal: IEEE Access

Manuscript ID Access-2018-04197

Manuscript Type: Original Manuscript

Date Submitted by the Author: 19-Mar-2018

Complete List of Authors: Adel, Mai; Higher Institute of Engineering and Technology, New Cairo
Academy, Electronics and communication;
Abdelhamid, Bassant; Ain Shames University Faculty of Engineering,
Electronics and Communications Engineering
Elramly, Salwa; Ain Shames Faculty of Engineering, Electronics and
Communications Engineering

Keywords: Cancer detection, Image classification, Image segmentation

Subject Category<br>Please
select at least two subject
Imaging, Signal processing, Biomedical Engineering
categories that best reflect the
scope of your manuscript:

Additional Manuscript
Breast cancer, Thermograms, Segmentation, Classification

For Review Only

Page 1 of 15 IEEE Access

Automatic Image Segmentation of Breast
8 Thermograms for Cancer Detection
1 2 2
10 Mai Adel , Bassant Abdelhamid , (Member, IEEE), Salwa Hussein El-Ramly , (Senior
11 Member, IEEE)
12 1
Higher Institute of Engineering and Technology, New Cairo Academy, Cairo, Egypt.
Faculty of Engineering, Ain Shams University, Cairo, Egypt.

14 Corresponding author: Mai Adel (e-mail: mai.adel@ et5.edu.eg).

17 ABSTRACT Breast cancer has a great attention worldwide due to the increase of the number of patients,
18 especially women, suffering from this disease. However, breast cancer can be cured if it is detected in its
19 early stages. Breast thermography is a promising screening technique for the early detection of breast
20 cancer. In this paper, an automatic segmentation algorithm for frontal breast thermograms is proposed to
21 help therapists to analyze breast thermograms for early breast cancer detection. The proposed algorithm
22 performance is evaluated using two databases. The proposed algorithm proves its ability to successfully
23 segment all types of breasts (small, medium, large, asymmetric and flat). Moreover, quantitative measures
24 are computed to verify the capability of the proposed algorithm. To complete the classification, a series of
25 statistical, texture and run length features were extracted and the most effective ones are fed forward to an
26 artificial neural network and a support vector machine for automatic classification into sick or healthy. The
27 effectiveness of our proposed algorithm is compared to previous works in terms of the classification
28 accuracy and the sensitivity and proves its superiority over the existing algorithms.
INDEX TERMS Breast cancer, Classification, Thermograms, Segmentation.
I. INTRODUCTION dense breasts. Moreover, it may lead to cancer due to the
Breast cancer is the most terrifying disease around the repeated exposure to X-ray radiation during the
world, especially among women. It is the main reason of examination. Furthermore, it is time consuming, expensive
500,000 deaths among women globally. The number of the and not preferred by patients. This is due to the discomfort
affected women reached approximately 1.5 million in 2010 during the examination because of the compression of the
[1]. Recently, statistical studies estimated that, in Egypt and breast between flat surfaces to improve the image quality
Morocco, the number of breast cancer sufferers are higher [4, 5].
among women of ages 45 to 49 years than ones of ages 65 Due to the limitations associated with mammography, it
to 69 [2]. According to the World Health Organization is necessary to develop an alternative screening technique.
(WHO) International Agency for Research on Cancer Thus, breast thermography has been lately utilized for early
(IARC), this type of cancer is the second most important breast cancer detection, because it is patient-friendly as it is
public health problem after lung cancer [3]. Unfortunately, painless, quick, non-contact, very safe, and has less price
breast cancer cannot be predicted because its reasons are compared to other screening systems. Additionally, it is
not clearly known until now. However, early detection suitable for breasts of all sizes, density, implanted breast,
reduces the use of treatments, increases the relief chances of for pregnant or nursing women, and post-operative women.
the affected woman and decreases the mortality rate in the Furthermore, it could be useful, especially in less developed
breast cancer. countries. This is because thermal cameras have low cost,
Many screening techniques such as mammography, small size and mobile, which allow screening of large
ultrasound and Magnetic Resonance Imaging (MRI), are populations in non-hospital settings [6].
continuously developed to diagnose this disease as early as Thermography measures the infrared radiations emitted
possible, especially that it cannot be detected during self- by the body to record the breast surface temperature
examination. Currently, mammography is considered the variations. These variations depend on the metabolic
golden standard screening method and is the most widely activity, the blood flow, and the temperature of the
used. However, it is not effective for young women with surroundings. Thus, the presence of a tumour mutates the
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3 normal temperature on the skin surface. Therefore, healthy
breast produces a symmetric temperature distribution while Thermogram
4 Image
5 cancerous and pre-cancerous tissues cause a temperature
6 rise compared to the normal area tissues. This is due to the
7 over production of blood vessels around cancerous cells to
8 supply nutrients for their faster growth [7]. This rise of the Pre-processing and
9 temperature appears as hot spots in thermograms and segmentation
10 causes asymmetric temperature distribution between the
11 two breasts.
12 Thermography is a promising screening tool due to its Feature extraction
13 ability to diagnose breast cancer many years before and selection
14 mammography [4]. However, analysis of thermograms may
15 be inconsistent and difficult if it depends on human
16 sensitivity, e.g.; detecting asymmetries simply through the
human eye especially when the image is relatively Classification
17 using SVM/ANN
18 symmetric. Thus, using intelligent systems, computer vision
19 and pattern recognition techniques result in a good and
20 consistent diagnosis performance utilizing breast
21 thermograms [8].
The main contributions of this paper are: (1) propose a Sick Healthy
23 new automatic pre-processing and segmentation algorithm
24 that is applied to segment left and right breasts, (2) propose FIGURE 1. Breast cancer detection system.

25 a series of features (collected from different papers in the

literature) to improve the accuracy of cancer detection. ROI image. Since the accuracy of the classification mainly
26 depends on the segmented image, thus image segmentation
27 These features are extracted from the segmented breast
images. Statistical t-test is performed to select the is considered the most challenging step. For that reason,
28 some researchers prefer manual segmentation like in [9],
29 significant features, for automatic classification using an
Artificial Neural Network (ANN) and a Support Vector while others consider automatic segmentation to reduce
30 human errors.
31 Machine (SVM). Unlike results reported in previous works,
the proposed system using SVM achieves 90% accuracy, Some approaches for automatic segmentation were
32 developed in [8, 10-15]. In [10], Canny edge detector was
33 83.3% sensitivity and 92.86% specificity. However, the
ANN demonstrates 100% sensitivity 92.9 % specificity and applied with a threshold value to get the prominent lower
34 parabolic boundary of each breast in a breast grey scale
35 95% accuracy.
The rest of the paper is organized as follows: Section II image. Then, an individual mask was designed for each
36 breast. On the other hand, authors in [11] proposed centroid
37 presents a brief review about breast cancer system. Section
III illustrates the proposed image pre-processing and detection of the processed image which intercepts the two
38 parabolic curves derived from the lower boundaries of the
39 segmentation algorithm. Section IV describes the breast
cancer detection system to classify the patient. Section V breasts. After that, the two breasts were segmented using
40 middle line along the centroid. In [12], authors utilize a
41 presents the experimental results along with performance
analysis for image segmentation and classification. Section database which contains ROI in grey scale version, then
42 automatic identification of the binarized image centroid was
43 VI provides a comparative study of the proposed system
with other previous works. Finally, Section VII concludes exploited to separate the right and left breasts. This
44 separation was done by a vertical cut through the centroid.
45 the paper.
In [13], the segmentation method depends on that the
46 breast’s region occupies nearly half of the image height
47 while the other area includes women shoulders and
Any Computer Aided Detection (CAD) system for breast
48 stomach. Thus, the authors specified a cropping rectangle
cancer detection mainly consists of three stages: image pre-
49 and created a cropping tool along with the specified
processing and segmentation, feature extraction and
50 rectangle to extract ROI. Then, ROI is converted to a binary
selection, and classification as shown in Fig.1.
51 image and black columns are eliminated from the image
53 Over the past few years, CAD system has been studied in In [8,14,15], edge detection was exploited to extract the
54 different works. Typically, it is started by obtaining Region boundaries of the breasts, after that Hough Transform (HT)
55 Of Interest (ROI) in the pre-processing step. Then, image is applied to extract the lower breast boundaries. However,
56 segmentation is utilized to separate the breasts from the it failed to correctly segment flat breasts, because it is too
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3 sensitive to small changes in the curvature [8]. Moreover, method for edge extraction, and a strategy depends on
4 HT consumes more than 96% of the processing time for the utilizing mathematical morphology and cubic-spline
5 ROI segmentation [7]. interpolation for fully automatic segmentation.
6 In addition, some automatic approaches were depending Moreover, some drawbacks were mentioned such as lack
7 on the breast borders [16-19]. In [16], authors proposed the of symmetry for ROI , and a portion of the breast may be
8 segmentation of left and right breasts based on detecting the lost in the detected ROI which may lead to wrong
9 borders for the breasts (upper, lower, left and right borders) classification because it may include the cancer [22].
10 using Horizontal Projection Profile (HPP) and Vertical
11 Projection Profile (VPP). HPP/VPP is a 1D histogram with B. FEATURE EXTRACTION AND SELECTION
12 a number of entries equal to the number of white pixels in As mentioned before, temperature variation in the breasts
13 each row/column. Finally, authors segmented the two may be missed by analysts. Therefore, automated methods
14 breasts through the center of the ROI. Authors in [17] for asymmetry detection in breast thermogram are required
15 presented an automatic segmentation approach based on the to provide accurate decision about the breast status. The
16 detection of the upper and lower boundaries. They extracted features from the segmented breasts play a vital
17 considered a threshold based on the highest temperature, a role to identify the slight difference in the temperature for
18 thinning filter and morphological opening to detect the both breasts which can be missed by radiologists.
19 inframammary curve. Then, the lower limit was defined as Statistical and texture features are the most popular
20 the lowest pixel of the detected curve. For upper boundary features as in [13, 19]. Some papers were utilizing the
21 detection, the edged image was scanned row-wise starting texture features only as in [9], or statistical features only as
22 from the top of the image. Axilla location is defined when in [10, 11]. However, some authors proposed the use of run
23 the scanned row cuts at least four pixels from the outer length features along with the texture features as in [23,
24 boundaries. 24].
25 Furthermore, in [18], authors extracted ROI using upper In [25], authors utilized curvelet-based texture features
26 and lower limits. For lower limit detection, the hypothesis including energy, contrast, correlation, sum of squares
27 that the maximum temperature occurs in inframammary variance, inverse difference moment, sum variance, sum
28 fold was followed. Then, to extract breast boundaries, entropy, entropy, difference variance, difference entropy,
29 image was divided vertically into two halves, each half was information measures of correlation 1 and 2, and statistical
30 then scanned horizontally to locate first white pixel in each features for diagnosis such as mean, median, mode,
31 row. Then, axilla point was defined as the maximum variance and standard deviation. On the other hand, in [26],
32 curvature point. In [19], authors utilized HPP method to Higher Order Spectral (HOS) features which are defined as
33 detect the inframammary point, thus the row with first high multi-dimensional Fourier transforms of the higher order
34 HPP value was considered as lower limit. Right and left moments were proposed. Radon transform was utilized to
35 limits were located with respect to concurring pixel value of convert images into one dimensional (1D), and then HOS
36 the first vertical line drawn through arm on the breast. were extracted from this image.
37 Upper limits were also defined based on coinciding pixel On the other hand, authors in [18] employed discrete
38 values of this line on the arm from both sides. After that, wavelet transform (DWT) on the segmented image to
39 authors extracted the inframammary curves; extension of obtain the Initial Feature point Image (IFI). After that, the
40 the first two longer curves was done using curve fitting to mean, variance, entropy, skewness, and kurtosis were
41 find their intersection point. Left and right breasts were computed. Recently, in [27], a new local texture feature
42 separated with respect to this point. extraction technique was developed called block variance.
43 Recently, authors in [20] proposed the use of Smallest This technique characterizes the contrast texture in the grey
44 Univalue Segment Assimilating Nucleus (SUSAN) edge scale thermogram using the local intensity variations.
45 detector. They utilized directional SUSAN edge detector In order to improve the classification accuracy, authors in
46 for the extraction of the bottom breast boundary. Initially, [13, 19, 23-26] suggested to analyse the extracted features
47 they used circle HT to locate each breast center point. After before being utilized in the classification stage. Thus, they
48 that, SUSAN edge detector was applied along with cubic employed student t-test to select the most significant
49 parabolic interpolation, to determine the bottom breasts’ features, and remove other redundant features.
50 boundaries. Then, Canny edge detector was utilized to
51 determine breasts’ boundaries. The final breast edge points C. CLASSIFICATION
were determined by the intersection of the boundaries and In this stage, some authors classified the images using
the bottom of the points for breast boundaries. asymmetry analysis of the extracted features along with
A survey of different studies was reported in [21]. Most histogram generation [10, 11]. Authors in [9] exploited
of them jointly use an edge detection technique with HT to three different classifiers (SVM, K-Nearest Neighbour (K-
extract the ROI. Several segmentation techniques were also NN) and Naive Bayes). Another classification approach
discussed such as automatic algorithm based on level set based on the use of one classifier was presented in [13,19,
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3 24-26] where the authors utilized the SVM. It works well Algorithm 1: Proposed Image Pre-processing Approach
4 on a wide range of classification problems. SVMs have 1: Read original thermal image X.
5 some disadvantages; the main one is that the classification 2: Convert X to grey scale image G.
6 results depend on the proper selection of the kernel's and 3: Apply median filter to G.
7 soft margin parameters. In addition to that, it runs slowly. 4: Determine the height of G as Z.
8 On the other hand, ANN was utilized by the authors in 5: Define upper ratio U, initially set U=¼, may be changed
9 [18, 23, 26, 27] where it is suitable to solve the according to axilla position found in Algorithm 2.
10 classification problems especially in medical diagnosis, 6: Compute the upper part N = round (Z*U).
11 because ANNs are perfect in distinguishing the diseases 7: Extract the upper part of the image Gu (1: N, :).
12 using images [28]. ANN learns how to identify the disease 8: Extract ROI part GL (N+1: end, :).
13 by training with examples. Thus, the details of how to
14 recognize the disease is not required. However, ANNs have
the disadvantage that there is no common rule to decide B. ROI SEGMENTATION
their structure, and they expend long time for training. An automatic segmentation algorithm is proposed to
Compared with other classifiers, ANN is chosen due to its segment the left and right breasts from the ROI image,
highly accurate results, error reduction and speed of based on the breast structure. The breast is determined by
execution [29]. the axilla, passing through a point with maximum curvature
and ends with the inframammary incision as shown in Fig.3.
III. PROPOSED PRE-PROCESSING AND The proposed algorithm depends on finding these three
21 SEGMENTATION ALGORITHM points. This is done by tracking the ROI boundary.
22 In this section, an automatic pre-processing and Segmentation is performed through the following steps:
23 segmentation algorithm is proposed. This algorithm is
24 based on the breast structure and the fact that the breast has
Step I: Binary Image Conversion
25 a parabolic curved shape. Initially, ROI is extracted from
The ROI image is converted to a binary image using
26 the original image in the pre-processing stage, and then
threshold value which is chosen to be half of the
27 breast boundary is tracked, to determine the breast area.
maximum intensity in any grey image which is 255
28 After that morphological operations are applied to detect
(i.e.; ). The binary conversion is done in order to
29 the breast parabolic curve. Finally, curve fitting technique
be able to clearly study the boundary of the breasts. The
30 binary image bin
L (x, y) can be defined as:
is employed to segment the breast using parabolic curve
31 points and a cropping algorithm. The algorithm steps will
32 bin ( )
be discussed in detail in the following subsections. L ( ) { ( )
33 ( )
where are the pixel locations in the image. Breast
35 Image de-noising is an important step in image pre-
boundary is defined as the curve separating the background
36 processing. It ought to minimize the noise and preserve the
(zeros in binary image) and the breast area (ones in the
37 edges. The median filter is widely utilized to perform de-
binary image).
38 noising due to its ability to preserve edges [30]. Therefore,
39 in the presented algorithm, Median filter is applied to the
40 original grey image to remove either the impulsive noise or
41 the salt and pepper noise in the image which is resulting
42 from thermal camera defects.
43 The distance between thermal camera and patient during
44 the procedure of examination results in the inclusion of ROI
45 and other parts of the body. Therefore, it is required to find
46 the ROI part. Thus, in this paper, Algorithm (1) is proposed
47 to horizontally divide the image into two parts (upper part
48 of the body and ROI part) as shown in Fig.2.
49 It is worthy noting that the upper ratio (U) may be
50 automatically adjusted in this algorithm to remove as much
51 as possible from undesired parts of the body. Thus, FIGURE 2. Image pre-processing approach.
52 Algorithm (1) may be repeated with different U values
53 during the segmentation step.
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3 Step II: Breast Points Determination
4 Breast boundary is traced to locate three points: axilla,
5 maximum curvature point and inframammary incision as
6 shown in Fig.3. For the right breast (left part in the image)
7 the axilla point (local maximum point) is determined by the
8 point at which the position of the white pixels at the
9 boundary increases, and then decreases starting from the
10 top left of the image. After the axilla, the maximum
11 curvature point (local minimum point) is determined by the
12 pixel at the position where the white pixels decreases and
13 then increases. After the curvature point, the position of the
14 white pixels increases again, till it reaches a constant value FIGURE 3. Breast structure.

15 which means that the breast ends. At this point, the

16 inframammary incision is located. It is worthy noted that image, then a linear function is used in fitting for
17 the opposite will be done for the breast in the right part (left not losing the lower quadrant of the breast because
18 breast) starting from the top right. it may include cancer as mentioned before.
19 Breast area in grey version is located by a vertical cut 5. The fitting curve divides the image into breast
20 through the center of the image and a horizontal cut at the region and part of the chest region. After fitting,
21 axilla. It has to be mentioned that the proposed algorithm the chest region is replaced by black pixels.
22 does not cut through the inframammary incision because 6. Finally, cropping algorithm is applied to autofit the
23 some images have the nipple at that point. Thus, the cut is breast to reduce the excess black area (chest
24 determined by axilla for not losing a part of the breast. region). This starts with binary image conversion,
25 It is worthy noted that in some cases the axilla point is then tracing to get the first white pixels from all
26 not clear to be determined as in flat boundary breasts. To corners, and the cropped image is defined by those
27 accommodate this type of breasts, the segmentation process pixels (top, bottom, left and right). The proposed
28 will be done on the ROI. The algorithm in this case will not segmentation algorithm can be summarized as
29 depend on the axilla position but on the parabolic curve Algorithm (2).
30 step. Thus, the horizontal cropping step at the axilla point
31 will not be performed here. However, a vertical cropping at IV. BREAST CANCER DETECTION SYSTEM
32 the center of the ROI will be carried out and step III is To evaluate the effectiveness of the proposed segmentation
33 executed. method, the complete system for breast cancer detection is
Step III: Parabolic Curve Detection
34 applied using the proposed pre-processing and
An algorithm is proposed to precisely detect the breasts
35 segmentation algorithms (see Fig.1.). Then, the feature
(left and right) obtained from the previous step. The
36 extraction and classification stages are briefly illustrated in
procedures are:
37 the next subsections.
1. Sobel/Canny detector can be used for edge
detection. Canny detector performs better than
Sobel detector in case of low quality images. On Series of features are extracted from the segmented breasts
the other hand, Sobel detector has less that can be classified into:
computational power and time to produce an edged
43 These features can be computed directly from the image
2. Morphological operations are used to clearly
44 histogram. Thus, they are considered as the simplest of all
obtain the breast structure using the connected
45 statistical features. These features include: skewness,
components method.
46 kurtosis, variance, mean, median and standard deviation
3. For right breast, extract the points from the most
47 [11].
right connected component. Also, for left breast,
points from the first component (leftmost) are
49 High level statistical information can be extracted using
utilized. For flat boundary breasts, the row
50 Grey Level Co-occurrence Matrix (GLCM), which is a
position of the first extracted point determines
51 well-known texture analysis method [32]. The GLCM
whether U is updated (repeat Algorithm 1 and 2)
52 estimates the texture of an image by calculating how often
or continues in the curve fitting step.
53 pairs of pixels with specific intensities occur in a predefined
4. Curve fitting is applied to finally segment the
54 spatial proximity. Texture features, in [33], are then
breasts. It is done by finding the coefficients of the
55 extracted from the GLCM. These features include: energy,
second order polynomial which best fits with the
56 contrast, correlation, sum of squares-variance, inverse
extracted points. If the curve reaches the end of the
57 difference moment, sum variance, sum entropy, entropy,
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3 Algorithm 2: Proposed ROI Segmentation Approach Grey Level Run Length Matrix (GLRLM) computes how
Initialization: Flat = 0 many pixels of a given grey value occur in sequence for a
6 1: Convert ROI image to binary image bin L using threshold . given direction. It is used to extract the seven run length
7 2: Scan all pixels of binL to find the boundary pixels. features including short run emphasis, long run emphasis,
3: For the right breast, trace the boundary pixels to detect grey level non-uniformity, run percentage, run length non-
local maximum point. uniformity, low grey level rum emphasis and high grey
4: If local maximum point exists level run emphasis [23].
Then Find the axilla point and go to step 5.
Else Therefore, the total number of features is 33 features
Flat =1; (statistical, texture and run length). They are extracted
Divide GL into two parts (left and right) from the center. from left and right breasts. The feature vector for each
14 Then go to step 9. image is the absolute differences between feature values of
15 End If the two breasts.
16 5: If axilla position < 1/3 height of GL, then set U =1/2, and
17 repeat Algorithm 1 and continue the next steps with the new B. CLASSIFICATION
18 cropped image. Else, nothing to be done. In this stage, the feature vector is fed to a classifier in
19 6: After locating axilla, continue tracing pixels to detect the order to be categorized into either healthy or sick patient.
20 local minimum point (maximum curvature point). Supervised learning, such as SVM and ANN, is preferred
21 7: Continue tracing after maximum curvature point till the x in case of classification problems. In this paper, the
22 location begins to remain constant, this means that breast is performance of ANN and SVM classifiers are compared.
23 ended. Inframammary incision point is detected. Neural networks are intelligent computer systems
24 8: Crop breast area (left and right) in grey scale version,
resembling the human brain in its “learning” and
25 horizontal cut at axilla and vertical cut at the center of the
“generalization” abilities. For this reason, they are
26 image (GL).
extensively used for data classification, pattern
27 9: Detect the edges using Sobel/Canny operator.
recognition, and predictive analysis [34]. Generally, the
28 10: Determine the breast structure by using connected
components method. network is exposed to two phases, which are training and
11: Extract the points from the resulted connected testing phase. For training phase, the network is trained
components. In case of right breast, the points from the with known images and their corresponding diagnosis to
nearest to the end of the image component (rightmost determine the ANN structure and initial weights. The
component) are utilized. While, in case of left breast, the training process is repeated to obtain the most appropriate
points from the leftmost component are utilized. structure. Then, the trained network can be applied to
12: If Flat = 1 classify an unknown image either sick or healthy.
Check the first point position of the connected On the other hand, SVM seeks to construct an optimal
component separating hyper-plane that distinguishes between the
37 If the position < 2/3 height of GL, samples of different classes. The basic idea of SVM is to
38 Set U=0.5 maximize the margin between sick and healthy classes of
39 Repeat Algorithm 1 the training data. Moreover, kernel functions are used to
40 Go to step 1 in Algorithm 2 transform the input data to high-dimensional space to be
41 Else more distinguishable compared with the input data.
42 Go to step 13 Although SVM performs well with few training samples,
43 end If the selection of the kernel function and its parameters are
44 end If the major disadvantage [26]. The efficiency of both
45 13: If the extracted points reach the end of the breast, apply classifiers is evaluated using three measures: accuracy,
46 curve fitting using a first order polynomial. Else, apply curve sensitivity and specificity. That can be calculated as follow
47 fitting using a second order polynomial.
48 14: Excess body part after fitting is replaced by black pixels, TN T
49 the resulted image K. ccuracy (2)
50 15: Convert K to binary, scan all pixels of K, determine first
51 white pixel from all corners (right, left, top, and bottom). Sensitivity
52 16: Crop K using the specified corner pixels.
53 difference-variance, auto-correlation, homogeneity, Specificity
54 dissimilarity, inverse difference normalized, sum average, TN F
where True Negative (TN) represents the number of healthy
55 cluster prominence, cluster shade, maximum probability,
people that are correctly distinguished as healthy, True
56 difference entropy, information measures of correlation 1 Positive (TP) represents the number of sick people that are
57 and information measures of correlation 2.
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3 correctly distinguished as sick, False Negative (FN) Then, the segmentation algorithm is applied to the ROI
represents the number of sick people that are incorrectly image. Fig.5 shows the resultant image of each step in the
distinguished as healthy, and finally False Positive (FP) algorithm in detail.
represents the number of healthy people that are incorrectly
distinguished as sick. C. SEGMENTATION EVALUATION
8 In order to justify the presented work, the algorithm is
V. EXPERIMENTAL RESULTS AND PERFORMANCE tested using the images of DMR and UFBE databases. The
10 validity of the segmentation algorithm is assessed
In this section, MATLAB R2013b is utilized to simulate the
11 qualitatively and quantitatively as in the following sub-
proposed system. The simulation is executed using a
12 sections.
computer with the following specifications: Intel (R) Core
13 (TM) i7- 4500U CPU 1.8 GHz and 8 GB RAM, operating 1) QUALITATIVE ANALYSIS
14 system-64 bits. In the next sub-section, the utilized In order to present the results qualitatively, the algorithm is
15 databases are provided. Then, in the following sub-sections, applied to DMR images, the final segmented right and left
16 the results of each stage are presented to verify the breasts are shown in Table I. It is concluded that for all
17 capability of the proposed detection system. breast types, the proposed segmentation algorithm properly
18 separates the two breasts from each other and from the
19 A. DATABASES original image. In addition, the proposed algorithm is able
20 Two famous public databases are utilized for simulation. to split the two breasts for flat/flat boundary body (case 5
21 Database (1): is available in [35] and is called Database of and 7).
22 Mastology Research (DMR). It consists of breast Another qualitative assessment for the proposed
23 thermograms of different views for each patient (frontal algorithm is to compare the segmented ROI with the
24 view and lateral view). In this paper, only frontal view corresponding GT as shown in Fig.6. The proposed
25 images are considered. FLIR SC-620 thermal camera was algorithm is performed on UFPE images which are
26 utilized with a spatial resolution of 640 480 pixels for the associated with their GT, and is compared with other two
27 acquisition of the images. The image set consists of 102 existing methods (Least Squares Fitting (LSF) and uniform
28 frontal view thermal breast images among them, 30 images quadratic Basis-SPline (BSP)) [38]. Four images are
29 are of sick patients. Sobel detector is preferred with this selected from the database as examples to show the
30 database to allow only strong edges to be included in the performance of the proposed algorithm. These images are
31 output image. IR_5687, IR_3330, IR_5986, IR_3967 representing the
32 Database (2): which is retained by the Universidade Federal
medium, small, asymmetric and large breasts, respectively.
33 de PErnambuco (UFPE), and available online in [36].
34 Images of this database were acquired with a FLIR S45
35 thermal camera with a spatial resolution of 320 240
36 pixels. These images have their respective Ground Truth
37 (GT) [37]. It is to be mentioned that UFBE images have
38 less resolution than DMR database. Thus, Canny edge
39 detector performs better than Sobel detector with this
40 database. (a) Original Image (d) Original Image
43 SEGMENTATION (b) Upper Part (e) Upper Part
44 In database, thermal images contain other portions of the
45 body, so pre-processing is needed to get ROI. Since images
46 are not of the same size, thus the upper ratio (U) is
47 differently adjusted in some images. This occurs if axilla
48 location found to be less than 1/3 of the lower part which
49 means that the axilla position is falsely detected less than
(c) ROI Part (f) ROI Part
50 quarter of the original image, and then the upper ratio is
(I) U= 1/4 (II) U= 1/2
51 adjusted to be ½ of the original image. The result of this
52 step using DMR images is shown in Fig.4. FIGURE 4. Pre-processing results.
53 In Fig.4 (a) to (c), the algorithm shows its ability to
54 separate the ROI from the original image. Furthermore, it is
55 shown that when other body portions consume more area in
56 thermal image, as shown in 4(d), the upper ratio (U) must
57 be updated to accurately extract the ROI image as in 4(f).
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3 Filtered ROI Part TABLE I
6 Step I case
Breast Thermal
Right Breast Left Breast
Type image
8 Binary image
9 1 Small
Right breast Left breast
13 Step II
2 Medium
16 Breast Area Images 3 Large
4 Asymmetric
20 Step III
Edge Images
23 5 Flat
Nipple at
26 inframam-
27 mary
28 incision
Connected Components
30 7
proposed algorithm is capable of determining the breast
boundaries with acceptable error from the GT.
35 Curve Fitting
37 To validate the proposed algorithm, ROI segmented result
38 and GT in binary version are overlapped. From the resultant
39 overlapped image, six measures are computed including
40 Final Images
ACCuracy (ACC), SENsitivity (SEN), SPEcificity (SPE),
41 Positive Predictive (PDP) and Negative Predictive (PDN)
42 and EFFiciency (EFF).
43 To simplify the evaluation, combination of these
44 FIGURE 5. Segmentation steps resulted images.
parameters is presented by ROI-Index and Youden index
45 (Y-index). ROI-index is defined as ROI-index=100× (1-
46 In Fig.6-a, the proposed algorithm, LSF, BSP, and GT are
ACC×PDP×PDN). Thus, it provides a reliable appraisal for
47 represented by grey, red, blue and green lines, respectively.
comparison between segmentation result and GT. Small
48 It is obvious that the proposed algorithm can sufficiently
value of this measure indicates that the result look more
49 extract ROI boundaries and is closer to the GT than other
similar to the corresponding GT. On the other hand, Y-
50 methods. index is expressed as SEN+SPE-1 As its value approaches
51 On the other hand, Fig.6-b shows that the left and right 1, this indicates better performance [38]. These measures
52 breasts are appropriately separated. It is observed from are computed and listed in Table II.
53 images IR_3330 and IR_3967 that both LSF and BSP In addition, a comparison between the proposed algorithm
54 methods could not accurately detect the breast boundaries and LSF, BSP is provided. It can be concluded that
55 especially the bottom boundaries. Consequently, the quantitative measures of the proposed scheme are satisfactory
56 and comparable with other existing methods.
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IR_5687 IR_3330 IR_5986 IR_3967
13 (a)
20 FIGURE 6. a) Segmentation by the proposed algorithm is in grey, by LSF in red, by BSP in blue and the ground truth is in green lines. b) Segmented
left and right breasts by the proposed algorithm.
24 Image IR_5883 IR_1283 IR_3739
27 Overlapped
28 images
31 Segmentation
32 method
Proposed LSF BSP Proposed LSF BSP Proposed LSF BSP
ACC 0.9873 0.9833 0.9830 0.9862 0.9796 0.9794 0.9888 0.9818 0.9828
34 SEN 0.9942 0.9897 0.9935 0.9944 0.9935 0.9936 0.9979 0.9929 0.9941
35 SPE 0.9724 0.9768 0.9722 0.9714 0.9654 0.9648 0.9656 0.9638 0.9646
36 EFF 0.9833 0.9832 0.9828 0.9829 0.9795 0.9792 0.9817 0.9783 0.9793
PDP 0.9873 0.9777 0.9735 0.9843 0.9672 0.9666 0.9867 0.9778 0.9784
37 PDN 0.9872 0.9893 0.9897 0.9932 0.9883 0.9903
0.9932 0.9933 0.9943
38 ROI-index 3.7716 4.8914 4.9557 3.9282 5.8974 5.9655 2.9912 5.1228 4.7756
39 Y-index 0.9666 0.9665 0.9657 0.9658 0.9589 0.9584 0.9635 0.9567 0.9587
43 It has to be mentioned that the images in Table II are D. FEATURE STATISTICAL ANALYSIS
44 chosen from the tested images in the database to present In order to improve the performance of the classifier and to
45 different cases, e.g.; large breast, medium breast shifted to the decrease the computational complexity, the feature vector
46 left, and flat boundary breast, respectively. It is clear that the must include the pertinent information of the image.
47 proposed algorithm performs well in these cases. Student t-test is employed with the 33 extracted features
48 Moreover, the computational time of the proposed and the probability value (p-value) is computed for each
algorithm is compared to the HT. The proposed algorithm feature. The p-value of each feature is evaluated in Tables
has an average run time equals to 3.43 and 3.3 seconds for 3 to 5.The feature is important if its p-value is less than
DMR database and UFPE database, respectively. However, 0.05 [25]. Tables III to V present this value for GLCM,
Hough transform has an average run time equals to 9.4 and statistical features and GLRLM. From Table III, it is
52 6.23 seconds. Also, authors in [20] reported that the
53 concluded that, the most significant features for GLCM are
execution time of one image in UFPE database with 320 the correlation, information measure of correlation 1,
54 240 resolution was 6 seconds.
55 inverse difference moment, inverse difference normalized,
56 and dissimilarity. In contrast, statistical features are not
57 discriminative.as shown in Table IV. Finally, as observed
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from Table V low grey level run emphasis is chosen for TABLE V
4 GLRLM. Therefore, the final feature vector consists of the Healthy samples Sick samples
selected six features. p-
5 Feature Mean standard Mean standard
TABLE III deviation deviation
7 Healthy samples Sick samples
Run percentage 0.464 0.393 0.467 0.448 0.97
8 Feature mean standard mean standard p-value Run length non-
deviation deviation 0.649 0.302 0.549 0.476 0.205
9 uniformity
Homogeneity 0.406±0.48 0.476±0.499 0.51
10 Short run
0.269 0.514 0.448 0.532 0.11
11 Energy 0.509 0.459 0.358 0.505 0.14 emphasis
12 Entropy 0.453 0.466 0.344 0.492 0.29 Grey level non-
0.746 0.293 0.600 0.496 0.067
13 Sum of square uniformity
0.360 0.474 0.456 0.487 0.36
14 variance
Low grey level
15 Difference run emphasis
0.304 0.499 0.610 0.458 0.0047
0.648 0.361 0.794 0.358 0.07
16 variance
High grey level
17 Dissimilarity 0.382 0.519 0.701 0.375 0.0030 run emphasis
0.502 0.416 0.355 0.573 0.15
18 Difference
0.388 0.515 0.564 0.454 0.11
19 entropy Long run
0.504 0.514 0.478 0.538 0.82
20 Inverse
21 difference 0.644 0.351 0.798 0.358 0.04
22 moment
23 Sum entropy 0.457 0.466 0.329 0.496 0.22 A feed forward Back Propagation (BP) neural network was
Sum average 0.359 0.453 0.428 0.510 0.50 utilized with Levenberg–Marquardt training algorithm to
train the network for classifying the images into sick and
26 Sum variance 0.403 0.449 0.421 0.501 0.86
healthy. The designed network consists of an input layer, a
Inverse linear output layer and a tan-sigmoid hidden layer. Each
28 difference 0.295 0.590 0.670 0.404 0.0019 layer contains several processing elements called neurons.
29 normalized
The input layer consists of 6 neurons, which equals to the
number of the selected absolute feature differences between
31 Auto correlation 0.365 0.475 0.461 0.488 0.36
the two breasts, normalized in the range of [-1,1] to ensure
32 Maximum efficient and fast training of the data set [39] .
33 probability
0.463 0.444 0.403 0.499 0.55
On the other hand, the output layer consists of one
Cluster neuron that will be 0 for a sick person or 1 for a healthy
35 prominence
0.273 0.509 0.306 0.557 0.77
person. For the successful training, some of the network
Information parameters must be set. Mean square error (MSE) is equal
37 measure of 0.382 0.439 0.662 0.374 0.0029 to 0.01, learning rate set to 0.3, momentum constant set to
38 Correlation 1
0.3 and the maximum number of epochs set to 2000. To
39 Information improve the network generalization and to avoid over
40 measure of 0.486 0.491 0.453 0.524 0.762
fitting, the input data set is divided: 70% for training (20
41 Correlation 2
sick, 52 healthy), 10% validation (4 sick, 6 healthy), 20%
42 Cluster shade 0.387 0.437 0.498 0.442 0.24
testing (6 sick, 14 healthy).
43 Contrast 0.648 0.361 0.794 0.358 0.065 It is very important to choose the correct number of
Correlation 0.314 0.539 0.649 0.417 0.0030 neurons in the middle layer of the network to reduce the
time of the training process. No specific rule is followed to
46 TABLE IV calculate the number of hidden neurons, some architectures
were designed and tested till satisfactory performance
48 Healthy samples Sick samples
results are reached to identify the number of hidden neurons
49 Feature Mean standard Mean standard p-value
deviation deviation [39]. Thus, the effect of the number of hidden neurons is
50 0.31
Mean 0.347 0.451 0.451 0.506 evaluated to assess its effect on the classification.
51 0.87
Skewness 0.37 0.440 0.361 0.559 Different structures (hidden neurons) are trained and
52 0.13
Variance 0.38 0.48 0.539 0.406 simulated. Each topology has been trained and simulated
53 0.57
Kurtosis 0.383 0.497 0.447 0.574 for 10 times to avoid the effect of the random weight
54 0.92
Median 0.439 0.532 0.428 0.504 initialization [40] and their performances are compared.
Standard The performance analysis of different network structures is
56 deviation
0.379 0.488 0.533 0.408 0.13
promoting the network structure with 4 hidden neurons
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3 compared to other structures with classification accuracy patients. Thus, the Receiver Operating Characteristic
4 95%, sensitivity 100%, and specificity 92.9 %. (ROC) curve is used to quantify the results. In ROC, the
5 The performance of the chosen network is then tested efficiency of diagnostic system relies on two parameters:
6 when it is applied to completely unknown images in order true positive rate (i.e.; sensitivity) and false positive rate.
7 to check the generalization of the network. The extracted False positive rate is defined as healthy patient falsely
8 feature difference vectors from unknown images are fed to identified as sick patients (i.e.; 1- specificity). Typically,
9 the network without the corresponding target vector, the the Area Under the Curve (AUC) near to 1 indicates that
10 output is expected to be 1 in case of healthy and 0 in case of the system is able to differentiate the abnormal breast
11 sick patient. The simulated output of the neural network is thermograms from the normal breast ones. Therefore, a
12 decided whether the patient is sick or healthy using a comparison is conducted between ROC of the proposed
13 threshold value. Where, the patient is to be sick if simulated network and ROC of network and features in [23] as shown
14 output < 0.5 and healthy if simulated output > 0.5. The in Fig.7, the proposed system attained AUC of 0.9643
15 classification output of the chosen ANN is presented in which is higher than the AUC of the network in [23].
16 Table VI when applied to unknown images where I1, I2, Moreover, a comparative study is executed for our
17 …, I7 represent the unknown images. feature set against the used ones in [24] for diagnosis of the
18 In an attempt to ensure the effectiveness of the selected breast cancer using breast thermograms. In [24], authors
19 features, ANN performance when using 33 features is have extracted 16 texture features from the GLCM and
20 compared with the performance using the selected features. GLRLM for each image. However, they have used only
21 In case of 33 input neurons, 21 hidden neurons are utilized. four features: moment1, moment3, run percentage and grey
22 The ANN achieves an accuracy of 90% and specificity level non-uniformity and fed to SVM classifier. In this
23 85.7%. This results support the efficiency of the selected paper, 20 features from GLCM and 7 features from the
24 features. GLRLM are extracted from the segmented left and right
25 The features of the training data are fed to the SVM. In breasts. Then, the absolute difference of the feature vectors
26 order to attain satisfactory classification accuracy, various is fed to the neural network with 17 hidden neurons.
27 Kernel functions are tested, such as linear, Radial Basis Reported results are compared with our results in Table
28 function (RBF), POLYnomial (poly), quadratic and Multi VIII. It can be seen that our proposed method performs
29 Layer Perceptron (MLP). better regarding the classification accuracy, sensitivity,
30 The performance of the classifier is assessed by specificity and AUC. However, the AUC is 0.81, which is
31 computing the accuracy, sensitivity and specificity as less compared to our method as shown in Fig.7. This means
32 shown in Table VII. SVM is tested for the selected features that these features are not sufficient for having high ROC.
33 and the total features. It is clear that the SVM with RBF
kernel function has better performance than other functions TABLE VI
35 whatever the number of features. UNKNOWN IMAGES
36 It is worthy to mention that the parameter of RBF that Image I1 I2 I3 I4 I5 I6 I7
37 control the over fitting and the nonlinearity of the SVM are Expected output 0 0 0 1 1 1 1
the cost (C) and sigma. Experimentally, C=15 and sigma = Simulated output 0.3 0.47 0.18 0.86 0.8 0.8 0.7
39 0.6 result in the best performance.
Finally, a comparative study with previous works is Kernel Number of
42 function features
Sensitivity Specificity Accuracy
presented in terms of performance accuracy, sensitivity and
specificity to the testing data.
44 Linear 6 0.1667 0.6429 0.5000
Features and neural network used in [23] are utilized
45 33 0.33 0.50 0.45
with our image data set. In [23], authors extracted 27
46 Quadratic 6 0.5000 0.9286 0.80
features from GLCM and GLRLM, but they have only
47 33 0.33 0.85 0.7
considered 10 GLCM and 3 GLRLM. Their features and
their neural network structure are used with our data set, the poly 6 0.8333 0.8571 0.8500
result is presented in Table VIII. It is shown that our results
50 33 0.166 0.9286 0.700
are high compared to the results reported in [23].
51 MLP 6 0.5000 0.5714 0.5500
In medical diagnostics, sensitivity is the ability of a
52 33 0.1667 0.3571 0.30
system to correctly identify sick people (true positive rate).
53 RBF 6 0.8333 0.9286 0.90
While specificity is the system ability to distinguish healthy
people (true negative rate). Therefore, sensitivity and 33 0.166 0.9286 0.700
specificity measurements depend mainly on the number of
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6 Method Features Number of images / Performance Measurements
7 Image Database or
Accuracy Specificity Sensitivity AUC
8 camera type Classifier
(%) (%) (%)
10 [23] 10 GLCM and 27 (18 abnormal, 9 ANN 85.19 77.78 88.89 NA
11 normal), leave one out for
12 testing/med2000ed images
13 [24] GLCM and 50 (25 normal, 25 SVM 88.10 90.48 85.71 0.881
abnormal), 14 used for
testing (7 in each class)
using 3 fold cross
16 validation / Database from
17 the Department of
18 Diagnostic Radiology,
Singapore General
19 Hospital.
Proposed Selected 102 (72 normal, 30 ANN 95 92.9 100 0.9643
21 System abnormal), (6 sick, 14
GLCM and SVM 90 92.86 83.33 0.881
22 health) used for testing/
23 GLRLM DMR images.
24 Proposed 10 GLCM and 3 102 (72 normal, 30 ANN in [23] 95 100 83.3 0.90
25 Segmentation GLRLM as in [23] abnormal), ( 6 sick , 14
26 health ) used for testing/
DMR images
28 Proposed 20 GLCM and 7 102 (72 normal, 30 ANN 90 85.7 100 0.81
29 Segmentation GLRLM as in [24] abnormal), ( 6 sick , 14
30 health ) used for testing/
DMR images
32 Recently, in [27], a new local texture feature extraction
33 technique was developed called block variance, a feature
34 vector of 32 features were then fed to feed forward neural
35 network. Accuracy, sensitivity, specificity, AUC
36 measurements of 90%, 95%, 85 % and 0.953 respectively
37 were reported.
38 On the other hand, authors in [26] compared the
39 performance of ANN and SVM. They reported that ANN
40 achieves better performance than SVM. An accuracy of
41 80%, sensitivity 76%, specificity 84% and AUC equals to
42 0.80 were achieved using SVM classifier. However, ANN
43 classifier presents 90% accuracy, 92% sensitivity, 88% FIGURE 7. ROC Comparison of ANN with SVM, ANN in [23] and ANN in
44 specificity and AUC equals to 0.90. In the sake of a fair [24].
45 comparison, the same training and testing images are
46 performed using ANN and SVM. It is obvious from Table VII. CONCLUSION
47 VIII that, ANN achieves better performance than SVM. In this paper, an automatic approach for diagnosing breast
48 Moreover, Fig.7 provides ROC curves of the two thermogram has been proposed. This approach includes an
49 classifiers. It is clearly seen that ANN consumes higher automatic algorithm for the pre-processing and
50 AUC than the dotted line which represents the SVM where segmentation of frontal breast thermogram images into left
51 AUC equals to 0.881. Hence, it is concluded from this and right breasts. Quantitative analysis confirms the
52 comparison that ANN affords better classification accuracy validity of the proposed algorithm with the Ground Truth,
53 than SVM. and presents the compatibility of the proposed algorithm
54 with other two algorithms. Although the proposed
55 algorithm has low complexity, it has a comparable
56 performance with previous works. Furthermore, in this
57 paper, features were extracted from both breasts, significant
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Mai Adel received her B.Sc. degree in electronics and communications engineering from Faculty of Engineering, Ain
9 Shams University, Cairo, Egypt, in 2012. She is now M.Sc. Candidate in electronics and communications Department,
10 Faculty of Engineering, Ain Shams University, Cairo, Egypt, since 2013. She worked at Higher Institute of
11 Engineering and Technology, New Cairo Academy, Cairo, Egypt as a demonstrator in 2013.
17 BASSANT ABDELHAMID received her B.Sc. and M.Sc. degrees in communications and electronic engineering
18 from Ain Shams University, Egypt in 2006 and 2010, respectively, and received her Ph.D. in communications and
19 electronic engineering from E-JUST University in 2013. She worked at Ain Shams University as a demonstrator,
teaching assistant, and assistant professor in 2006, 2010, and 2013, respectively. During her Ph.D., she worked as a
20 special research student at Kyushu University, Japan. She is specialized in communications engineering, digital signal
21 processing, mobile communications, and statistical signal processing.
SALWA H. EL-RAMLY received her BSc. Degree 1967, MSc. Degree 1972 from Faculty of Engineering, Ain Shams
University, Egypt and PhD degree 1976 from Nancy University, France. She is now Professor Emeritus with the
Electronics and Communications Engineering Department, Faculty of Engineering, Ain Shams University; where she
26 was the Head of the Department (2004- 2006). Her research field of interest is Wireless Communication Systems and
27 Signal Processing, Language Engineering, Coding, Encryption, and Radars. She is the IEEE Signal Processing Chapter
28 chair in Egypt. She was awarded Ain Shams Award of Appreciation in Engineering Sciences (2010), Award of
29 Excellence from the Society of Communications Engineers (2009) and Award of Excellence from the Egyptian Society
30 of Language Engineering. She shared in the establishment of the Egyptian Society of Language Engineering in 1996,
31 and is now its President. She published more than hundred scientific papers and supervised more than 100 MSc and
PhD thesis.
60 For Review Only