Dependence of computer classification of clustered microcalcifications on the correct detection of microcalcifications

Our purpose was to study the dependence of computer performance in classifying clustered microcalcifications as malignant or benign on the correct detection of microcalcifications. Specifically, we studied the effects of computer-detected true-positive microcalcifications and computer-detected false-positive microcalcifications in true microcalcification clusters. Using a database of 100 mammograms, we compared computer classification performance obtained from computer-detected microcalcifications to (1) computer classification performance obtained from manually identified microcalcifications, and (2) radiologists' performance. When an artificial neural network (ANN) was trained with manually identified microcalcifications, computer classification performance was comparable to or better than radiologists' performance as the number of computer-detected true-positive microcalcifications decreased to 40% and as the number of computer-detected false-positive microcalcifications increased to 50%. Further loss in computer-detected true-positive microcalcifications degraded classification performance substantially. Moreover, training the ANN with computer-detected microcalcifications also degraded computer classification performance. These results show that computer performance in classifying clustered microcalcifications as malignant or benign is insensitive to moderate decreases in computer-detected true-positive microcalcifications and moderate increases in computer-detected false-positive microcalcifications.     

Computer aided detection of clusters of microcalcifications on full field digital mammograms

We are developing a computer-aided detection (CAD) system to identify microcalcification clusters (MCCs) automatically on full field digital mammograms (FFDMs). The CAD system includes six stages: preprocessing; image enhancement; segmentation of microcalcification candidates; false positive (FP) reduction for individual microcalcifications; regional clustering; and FP reduction for clustered microcalcifications. At the stage of FP reduction for individual microcalcifications, a truncated sum-of-squares error function was used to improve the efficiency and robustness of the training of an artificial neural network in our CAD system for FFDMs. At the stage of FP reduction for clustered microcalcifications, morphological features and features derived from the artificial neural network outputs were extracted from each cluster. Stepwise linear discriminant analysis (LDA) was used to select the features. An LDA classifier was then used to differentiate clustered microcalcifications from FPs. A data set of 96 cases with 192 images was collected at the University of Michigan. This data set contained 96 MCCs, of which 28 clusters were proven by biopsy to be malignant and 68 were proven to be benign. The data set was separated into two independent data sets for training and testing of the CAD system in a cross-validation scheme. When one data set was used to train and validate the convolution neural network (CNN) in our CAD system, the other data set was used to evaluate the detection performance. With the use of a truncated error metric, the training of CNN could be accelerated and the classification performance was improved. The CNN in combination with an LDA classifier could substantially reduce FPs with a small tradeoff in sensitivity. By using the free-response receiver operating characteristic methodology, it was found that our CAD system can achieve a cluster-based sensitivity of 70, 80, and 90 % at 0.21, 0.61, and 1.49 FPs/image, respectively. For case-based performance evaluation, a sensitivity of 70, 80, and 90 % can be achieved at 0.07, 0.17, and 0.65 FPs/image, respectively. We also used a data set of 216 mammograms negative for clustered microcalcifications to further estimate the FP rate of our CAD system. The corresponding FP rates were 0.15, 0.31, and 0.86 FPs/image for cluster-based detection when negative mammograms were used for estimation of FP rates.     

Characterization of clustered microcalcifications in digitized mammograms using neural networks and support vector machines

OBJECTIVE: Detection and characterization of microcalcification clusters in mammograms is vital in daily clinical practice. The scope of this work is to present a novel computer-based automated method for the characterization of microcalcification clusters in digitized mammograms. METHODS AND MATERIAL: The proposed method has been implemented in three stages: (a) the cluster detection stage to identify clusters of microcalcifications, (b) the feature extraction stage to compute the important features of each cluster and (c) the classification stage, which provides with the final characterization. In the classification stage, a rule-based system, an artificial neural network (ANN) and a support vector machine (SVM) have been implemented and evaluated using receiver operating characteristic (ROC) analysis. The proposed method was evaluated using the Nijmegen and Mammographic Image Analysis Society (MIAS) mammographic databases. The original feature set was enhanced by the addition of four rule-based features. RESULTS AND CONCLUSIONS: In the case of Nijmegen dataset, the performance of the SVM was Az=0.79 and 0.77 for the original and enhanced feature set, respectively, while for the MIAS dataset the corresponding characterization scores were Az=0.81 and 0.80. Utilizing neural network classification methodology, the corresponding performance for the Nijmegen dataset was Az=0.70 and 0.76 while for the MIAS dataset it was Az=0.73 and 0.78. Although the obtained high classification performance can be successfully applied to microcalcification clusters characterization, further studies must be carried out for the clinical evaluation of the system using larger datasets. The use of additional features originating either from the image itself (such as cluster location and orientation) or from the patient data may further improve the diagnostic value of the system.     

A wavelet-based algorithm for detecting clustered microcalcifications in digital mammograms.

A computerized scheme to detect clustered microcalcifications in digital mammograms has been developed. Detection of individual microcalcifications in regions of interest (ROIs) was also performed. The mammograms were previously classified into fatty and dense, according to their breast tissue. The most appropriate wavelet basis and reconstruction levels were selected. To select the wavelet basis, 40 profiles of microcalcifications were decomposed and reconstructed using different types of wavelet functions and different combinations of wavelet coefficients. The symlets with a basis of length 8 were chosen for fatty tissue. For dense tissue, the Daubechies' wavelets with a four-element basis were employed. Two methods to detect individual microcalcifications were evaluated: (a) two-dimensional wavelet transform, and (b) one-dimensional wavelet transform. The second technique yielded the best results, and was used to detect clustered microcalcifications in the complete mammogram. When detecting individual microcalcifications by using two-dimensional wavelet transform we have obtained, for fatty ROIs, a sensitivity of 71.11% at a false positive rate of 7.13 per image. For dense ROIs the sensitivity was 60.76% and the false positive rate, 7.33. The areas (A1) under the AFROC curves were 0.33+/-0.04 and 0.28+/-0.02, respectively. The one-dimensional wavelet transform method yielded 80.44% of sensitivity and 6.43 false positives per image (A1=0.39+/-0.03) for fatty ROIs, and 62.17% and 5.82 false positives per image (A1=0.37+/-0.02) for dense ROIs. For the detection of clusters of microcalcifications in the entire mammogram, the sensitivity was 80.00% with 0.94 false positives per image (A1=0.77+/-0.09) for fatty mammograms, and 72.85% of sensitivity at a false positive detection rate of 2.21 per image (A1=0.64+/-0.07) for dense mammograms. Globally, a sensitivity of 76.43% at a false positive detection rate of 1.57 per image was obtained.     

Segmentation of suspicious clustered microcalcifications in mammograms

We have developed a multistage computer-aided diagnosis (CAD) scheme for the automated segmentation of suspicious microcalcification clusters in digital mammograms. The scheme consisted of three main processing steps. First, the breast region was segmented and its high-frequency content was enhanced using unsharp masking. In the second step, individual microcalcifications were segmented using local histogram analysis on overlapping subimages. For this step, eight histogram features were extracted for each subimage and were used as input to a fuzzy rule-based classifier that identified subimages containing microcalcifications and assigned the appropriate thresholds to segment any microcalcifications within them. The final step clustered the segmented microcalcifications and extracted the following features for each cluster: the number of microcalcifications, the average distance between microcalcifications, and the average number of times pixels in the cluster were segmented in the second step. Fuzzy logic rules incorporating the cluster features were designed to remove nonsuspicious clusters, defined as those with typically benign characteristics. A database of 98 images, with 48 images containing one or more microcalcification clusters, provided training and testing sets to optimize the parameters and evaluate the CAD scheme, respectively. The results showed a true positive rate of 93.2% and an average of 0.73 false positive clusters per image. A comparison of our results with other reported segmentation results on the same database showed comparable sensitivity and at the same time an improved false positive rate. The performance of the CAD scheme is encouraging for its use as an automatic tool for efficient and accurate diagnosis of breast cancer.     

Computer-aided diagnosis scheme for histological classification of clustered microcalcifications on magnification mammograms

The histological classification of clustered microcalcifications on mammograms can be difficult, and thus often require biopsy or follow-up. Our purpose in this study was to develop a computer-aided diagnosis scheme for identifying the histological classification of clustered microcalcifications on magnification mammograms in order to assist the radiologists' interpretation as a "second opinion." Our database consisted of 58 magnification mammograms, which included 35 malignant clustered microcalcifications (9 invasive carcinomas, 12 noninvasive carcinomas of the comedo type, and 14 noninvasive carcinomas of the noncomedo type) and 23 benign clustered microcalcifications (17 mastopathies and 6 fibroadenomas). The histological classifications of all clustered microcalcifications were proved by pathologic diagnosis. The clustered microcalcifications were first segmented by use of a novel filter bank and a thresholding technique. Five objective features on clustered microcalcifications were determined by taking into account subjective features that experienced the radiologists commonly use to identify possible histological classifications. The Bayes decision rule with five objective features was employed for distinguishing between five histological classifications. The classification accuracies for distinguishing between three malignant histological classifications were 77.8% (7/9) for invasive carcinoma, 75.0% (9/12) for noninvasive carcinoma of the comedo type, and 92.9% (13/14) for noninvasive carcinoma of the noncomedo type. The classification accuracies for distinguishing between two benign histological classifications were 94.1% (16/17) for mastopathy, and 100.0% (6/6) for fibroadenoma. This computerized method would be useful in assisting radiologists in their assessments of clustered microcalcifications.     

Computer-aided detection system for clustered microcalcifications: comparison of performance on full-field digital mammograms and digitized screen-film mammograms

We have developed a computer-aided detection (CAD) system to detect clustered microcalcifications automatically on full-field digital mammograms (FFDMs) and a CAD system for screen-film mammograms (SFMs). The two systems used the same computer vision algorithms but their false positive (FP) classifiers were trained separately with sample images of each modality. In this study, we compared the performance of the CAD systems for detection of clustered microcalcifications on pairs of FFDM and SFM obtained from the same patient. For case-based performance evaluation, the FFDM CAD system achieved detection sensitivities of 70%, 80% and 90% at an average FP cluster rate of 0.07, 0.16 and 0.63 per image, compared with an average FP cluster rate of 0.15, 0.38 and 2.02 per image for the SFM CAD system. The difference was statistically significant with the alternative free-response receiver operating characteristic (AFROC) analysis. When evaluated on data sets negative for microcalcification clusters, the average FP cluster rates of the FFDM CAD system were 0.04, 0.11 and 0.33 per image at detection sensitivity level of 70%, 80% and 90% compared with an average FP cluster rate of 0.08, 0.14 and 0.50 per image for the SFM CAD system. When evaluated for malignant cases only, the difference of the performance of the two CAD systems was not statistically significant with AFROC analysis.     

Parameter optimization of a computer-aided diagnosis scheme for the segmentation of microcalcification clusters in mammograms

Our purpose in this study is to develop a parameter optimization technique for the segmentation of suspicious microcalcification clusters in digitized mammograms. In previous work, a computer-aided diagnosis (CAD) scheme was developed that used local histogram analysis of overlapping subimages and a fuzzy rule-based classifier to segment individual microcalcifications, and clustering analysis for reducing the number of false positive clusters. The performance of this previous CAD scheme depended on a large number of parameters such as the intervals used to calculate fuzzy membership values and on the combination of membership values used by each decision rule. These parameters were optimized empirically based on the performance of the algorithm on the training set. In order to overcome the limitations of manual training and rule generation, the segmentation algorithm was modified in order to incorporate automatic parameter optimization. For the segmentation of individual microcalcifications, the new algorithm used a neural network with fuzzy-scaled inputs. The fuzzy-scaled inputs were created by processing the histogram features with a family of membership functions, the parameters of which were automatically extracted from the distribution of the feature values. The neural network was trained to classify feature vectors as either positive or negative. Individual microcalcifications were segmented from positive subimages. After clustering, another neural network was trained to eliminate false positive clusters. A database of 98 images provided training and testing sets to optimize the parameters and evaluate the CAD scheme, respectively. The performance of the algorithm was evaluated with a FROC analysis. At a sensitivity rate of 93.2%, there was an average of 0.8 false positive clusters per image. The results are very comparable with those taken using our previously published rule-based method. However, the new algorithm is more suited to generalize its performance on a larger population, depends on two monotonic outputs making its evaluation much easier and can be trained in an automatic way making practical its application on a large database.     

An SVM classifier to separate false signals from microcalcifications in digital mammograms.

In this paper we investigate the feasibility of using an SVM (support vector machine) classifier in our automatic system for the detection of clustered microcalcifications in digital mammograms. SVM is a technique for pattern recognition which relies on the statistical learning theory. It minimizes a function of two terms: the number of misclassified vectors of the training set and a term regarding the generalization classifier capability. We compare the SVM classifier with an MLP (multi-layer perceptron) in the false-positive reduction phase of our detection scheme: a detected signal is considered either microcalcification or false signal, according to the value of a set of its features. The SVM classifier gets slightly better results than the MLP one (Az value of 0.963 against 0.958) in the presence of a high number of training data; the improvement becomes much more evident (Az value of 0.952 against 0.918) in training sets of reduced size. Finally, the setting of the SVM classifier is much easier than the MLP one.     

Automated classification of clustered microcalcifications into malignant and benign types

The objectives in this study were to design and test a fully automated method for classification of microcalcification clusters into malignant and benign types, and to compare the method's performance with that of radiologists. A novel aspect of the approach is that the relative location and orientation of clusters inside the breast was taken into account for feature calculation. Furthermore, correspondence of location of clusters in mediolateral oblique (MLO) and cranio-caudal (CC) views, was used in feature calculation and in final classification. Initially, microcalcifications were automatically detected by using a statistical method based on Bayesian techniques and a Markov random field model. To determine malignancy or benignancy of a cluster, a method based on two classification steps was developed. In the first step, classification of clusters was performed and in the second step a patient based classification was done. A total of 16 features was used in the study. To identify meaningful features, a feature selection was applied, using the area under the receiver operating characteristic (ROC) curve (Az value) as a criterion. For classification the k-nearest-neighbor method was used in a leave-one-patient-out procedure. A database of 192 mammograms with 280 true positive detected microcalcification clusters was used for evaluation of the method. The set consisted of cases that were selected for diagnostic work up during a 4 year period of screening in the Nijmegen region (The Netherlands). Because of the high positive predictive value in the screening program (50%), this set did not contain obvious benign cases. The method's best patient-based performance on this set corresponded with Az = 0.83, using nine features. A subset of the data set, containing mammograms from 90 patients, was used for comparing the computer results to radiologists' performance. Ten radiologists read these cases on a light-box and assessed the probability of malignancy for each patient. All participants had experience in clinical mammography and participated in our observer study during the last 2 days of a 2-week training session leading to screening mammography certification. Results on the subset showed that the method's performance (Az = 0.83) was considerably higher than that of the radiologists (Az = 0.63).     

Computerized detection of clustered microcalcifications in digital mammograms: applications of artificial neural networks.

Artificial neural networks have been applied to the differentiation of actual "true" clusters from normal parenchymal patterns and also to the differentiation of actual clusters from false-positive clusters as reported by a computerized scheme for the detection of microcalcifications in digital mammograms. The differentiation was carried out in both the spatial and frequency domains. The performance of the neural networks was evaluated quantitatively by means of receiver operating characteristic (ROC) analysis. It was found that the networks could distinguish clustered microcalcifications from normal nonclustered areas in the frequency domain, and that they could eliminate approximately 50% of false-positive clusters of microcalcifications while preserving 95% of the positive clusters, when applied to the results of the automated detection scheme. A large, comprehensive training database is needed for neural networks to perform reliably in clinical situations.     

Multiplexed Wavelet Transform Technique for Detection of Microcalcification in Digitized Mammograms

Wavelet transform (WT) is a potential tool for the detection of microcalcifications, an early sign of breast cancer. This article describes the implementation and evaluates the performance of two novel WT-based schemes for the automatic detection of clustered microcalcifications in digitized mammograms. Employing a one-dimensional WT technique that utilizes the pseudo-periodicity property of image sequences, the proposed algorithms achieve high detection efficiency and low processing memory requirements. The detection is achieved from the parent–child relationship between the zero-crossings [Marr-Hildreth (M-H) detector] /local extrema (Canny detector) of the WT coefficients at different levels of decomposition. The detected pixels are weighted before the inverse transform is computed, and they are segmented by simple global gray level thresholding. Both detectors produce 95% detection sensitivity, even though there are more false positives for the M-H detector. The M-H detector preserves the shape information and provides better detection sensitivity for mammograms containing widely distributed calcifications.Permission has been granted by the Departmental Research Committee, Department of Electronics, Cochin University of Science and Technology, for pursuing research in the field of automated detection of microcalcification in digitized mammograms.     

Computer-aided detection of clustered microcalcifications on digital mammograms

A computer-aided diagnosis scheme to assist radiologists in detecting clustered microcalcifications from mammograms is being developed. Starting with a digital mammogram, the scheme consists of three steps. First, the image is filtered so that the signal-to-noise ratio of microcalcifications is increased by suppression of the normal background structure of the breast. Secondly, potential microcalcifications are extracted from the filtered image with a series of three different techniques: a global thresholding based on the grey-level histogram of the full filtered image, an erosion operator for eliminating very small signals, and a local adaptive grey-level thresholding. Thirdly, some false-positive signals are eliminated by means of a texture analysis technique, and a non-linear clustering algorithm is then used for grouping the remaining signals. With this method, the scheme can detect approximately 85% of true clusters, with an average of two false clusters detected per image.     

Computerized Segmentation Method for Individual Calcifications Within Clustered Microcalcifications While Maintaining Their Shapes on Magnification Mammograms

In a computer-aided diagnosis (CADx) scheme for evaluating the likelihood of malignancy of clustered microcalcifications on mammograms, it is necessary to segment individual calcifications correctly. The purpose of this study was to develop a computerized segmentation method for individual calcifications with various sizes while maintaining their shapes in the CADx schemes. Our database consisted of 96 magnification mammograms with 96 clustered microcalcifications. In our proposed method, a mammogram image was decomposed into horizontal subimages, vertical subimages, and diagonal subimages for a second difference at scales 1 to 4 by using a filter bank. The enhanced subimages for nodular components (NCs) and the enhanced subimages for both nodular and linear components (NLCs) were obtained from analysis of a Hessian matrix composed of the pixel values in those subimages for the second difference at each scale. At each pixel, eight objective features were given by pixel values in the subimages for NCs at scales 1 to 4 and the subimages for NLCs at scales 1 to 4. An artificial neural network with the eight objective features was employed to enhance calcifications on magnification mammograms. Calcifications were finally segmented by applying a gray-level thresholding technique to the enhanced image for calcifications. With the proposed method, a sensitivity of calcifications within clustered microcalcifications and the number of false positives per image were 96.5% (603/625) and 1.69, respectively. The average shape accuracy for segmented calcifications was also 91.4%. The proposed method with high sensitivity of calcifications while maintaining their shapes would be useful in the CADx schemes.     

Image feature analysis and computer-aided diagnosis in digital radiography. I. Automated detection of microcalcifications in mammography

We have investigated the application of computer-based methods to the detection of microcalcifications in digital mammograms. The computer detection system is based on a difference-image technique in which a signal-suppressed image is subtracted from a signal-enhanced image to remove the structured background in a mammogram. Signal-extraction techniques adapted to the known physical characteristics of microcalcifications are then used to isolate microcalcifications from the remaining noise background. We employ Monte Carlo methods to generate simulated clusters of microcalcifications that are superimposed on normal mammographic backgrounds. This allows quantitative evaluation of detection accuracy of the computer method and the dependence of this accuracy on the physical characteristics of the microcalcifications. Our present computer method can achieve a true-positive cluster detection rate of approximately 80% at a false-positive detection rate of one cluster per image. The potential application of such a computer-aided system to mammographic interpretation is demonstrated by its ability to detect microcalcifications in clinical mammograms.     

Enhancement of Microcalcifications Based on Fractal Techniques in Mammograms

Microcalcification clusters in mammograms are an important early sign of breast cancer.The enhancement of microcalcifications in mammograms is one of the most important preprocessing techniques for the extraction of cluster microcalcifications.In this paper,we present a novel method for the enhancement of microcalcifications.Firstly,the initial microcalcification edges were extracted by using kirsch edge operator,and the discontinouse edges were linked by employing fractal technique.Then,the continuous closed edges of microcalcifications were filled by using seed filling algorithm.The pixel values of the filled region were replaced by the corresponding pixel values in the original image.Finally,the enhancement of microcalcifications in mammograms was achieved by adding the filled image to the original image.We evaluated the performance of our algorithm by using 50 regions of interesting (ROIs) with microcalcification clusters from DDSM database.The experiment results demonstrate that our CAD system can give better enhancement effect compared with other methods.     

Characterizing the Clustered Microcalcifications on Mammograms to Predict the Pathological Classification and Grading: A Mathematical Modeling Approach

In this study, we explore a mathematical model to characterize the clustered microcalcifications on mammograms for predicting the pathological classification and grading. Our database consists of both retrospective cases (78 cases) and prospective cases (31 cases) with pathologically diagnosed clusters of microcalcifications on mammograms. The microcalcifications were divided into four grades: grade 0, benign breast disease including mastopathies (n = 12) and fibroadenomas (n = 20); grade 1, well-differentiated infiltrating ductal carcinoma (n = 12); grade 2, moderately differentiated infiltrating ductal carcinoma (n = 38); grade 3, poorly differentiated infiltrating ductal carcinoma (n = 27). A feature parameter, defined as the pattern form factor of microcalcification cluster θ by us, combines five computer-extracted image parameters of microcalcification clusters of those mammograms. In every case, only one imaging was selected for modeling analysis. A total of 109 imagings were adopted in current study. We find the existence of a positive relationship between the feature parameter θ and pathological grading G of microcalcifications in retrospective cases, which was expressed as G =  6.438 + 1.186 ×  Ln <θ>. The model above has been verified further by the prospective study with a comparative evaluation accuracy of approximately 77.42%. The binary predication simply for both benignancy and malignancy was also included using same but reshuffled data, and the receiver operating characteristic (ROC) analysis was performed with ROC value 0.74351∼0.79891. As one candidate for feature parameter in computer-aided diagnosis, the pattern form factor θ of clustered microcalcifications may be useful to predict the pathological grading and classification of microcalcification clusters on mammography in breast cancer.     

Categorical variables, interactions and generalized additive models. Applications in computer-aided diagnosis systems

Recently, the generalized additive models (GAMs) have been presented as a novel statistical approach to distinguish lesion/non-lesion in computer-aided diagnosis (CAD) systems. In this paper, we present an extension of the GAM that allows for the introduction of factors and their interactions with continuous variables, for reducing false positives in a CAD system for detecting clustered microcalcifications in digital mammograms. The results obtained have shown an increase in the sensitivity from 83.12% to 85.71%, while the false positive rate was drastically reduced from 1.46 to 0.74 false detections per image.     

Detection of clustered microcalcifications using spatial point process modeling

In this work we propose a spatial point process (SPP) approach to improve the detection accuracy of clustered microcalcifications (MCs) in mammogram images. The conventional approach to MC detection has been to first detect the individual MCs in an image independently, which are subsequently grouped into clusters. Our proposed approach aims to exploit the spatial distribution among the different MCs in a mammogram image (i.e. MCs tend to appear in small clusters) directly during the detection process. We model the MCs by a marked point process (MPP) in which spatially neighboring MCs interact with each other. The MCs are then simultaneously detected through maximum a posteriori (MAP) estimation of the model parameters associated with the MPP process. The proposed approach was evaluated with a dataset of 141 clinical mammograms from 66 cases, and the results show that it could yield improved detection performance compared to a recently proposed support vector machine (SVM) detector. In particular, the proposed approach achieved a sensitivity of about 90% with the FP rate at around 0.5 clusters per image, compared to about 83% for the SVM; the performance of the proposed approach was also demonstrated to be more stable over different compositions of the test images.     

A computer-aided design mammography screening system for detection and classification of microcalcifications

This paper presents a prototype of a computer-aided design (CAD) diagnostic system for mammography screening to automatically detect and classify microcalcifications (MCCs) in mammograms. It comprises four modules. The first module, called the Mammogram Preprocessing Module, inputs and digitizes mammograms into 8-bit images of size 2048x2048, extracts the breast region from the background, enhances the extracted breast and stores the processed mammograms in a data base. Since only clustered MCCs are of interest in providing a sign of breast cancer, the second module, called the MCCs Finder Module, finds and locates suspicious areas of clustered MCCs, called regions of interest (ROIs). The third module, called the MCCs Detection Module, is a real time computer automated MCCs detection system that takes as inputs the ROIs provided by the MCCs Finder Module. It uses two different window sizes to automatically extract the microcalcifications from the ROIs. It begins with a large window of size 64x64 to quickly screen mammograms to find large calcified areas, this is followed by a smaller window of size 8x8 to extract tiny, isolated microcalcifications. Finally, the fourth module, called the MCCs Classification Module, classifies the detected clustered microcalcifications into five categories according to BI-RADS (Breast Imaging Reporting and Data System) format recommended by the American College of Radiology. One advantage of the designed system is that each module is a separate component that can be individually upgraded to improve the whole system. Despite that it is still is a prototype system a preliminary clinical evaluation at TaiChung Veterans General Hospital (TCVGH) has shown that the system is very flexible and can be integrated with the existing Picture Archiving and Communications System (PACS) currently implemented in the Department of Radiology at TCVGH.