This dissertation is focused on medical care field, introduces common issues of oncology illnesses. Presents the system and particularity of women's breast cancer care and looks into patient's rights and importace of foreknowledge. Also presents activities of non-state nonprofit organization focused on this sphere. The aim of this dissertation is to map involved organizations and analysis of their work. Investigates foreknowledge of patients about knowing of them and also finds topics of their intersect. Key words oncology diagnosis, breast cancer, patients organizations, prevention, second opinion, health service, non-profit non-govermental organizations, information asymmetry, mammography screening, informační asymetrie, mamografický screening

Le cancer du sein est l’affection maligne la plus fréquente chez la femme. Depuis la mise sur pied de programmes de dépistage du cancer du sein au Canada, le taux de mortalité par ce cancer a diminué dès le début des années 2000. Cependant, les immigrantes récentes (depuis moins 10 ans) sont toujours réticentes à la mammographie de dépistage, et ce, comparativement aux femmes nées au Canada et les immigrantes de longue durée (plus de 10 ans). L’objectif de cette thèse est de présenter un état des connaissances et des défis reliés au dépistage du cancer du sein chez les immigrantes. Je présenterai d’abord une revue narrative qui trace un portrait général sur les obstacles et les avantages au recours au dépistage du cancer du sein chez les femmes immigrantes. En me basant sur le cadre conceptuel de Lévesque et collaborateurs, j’ai organisé les données en cinq grandes catégories : 1. « La perception des besoins au recours du dépistage du cancer du sein », 2. « la recherche (seeking) du dépistage du cancer du sein », 3. « l’accès (reaching) au dépistage du cancer du sein », 4. « le recours (utilisation) au dépistage du cancer du sein » et 5. « les suivis réguliers (consequences) du dépistages du cancer du sein ». Je procéderai ensuite à une étude analytique transversale des microdonnées de l’Enquête sur la santé dans les collectivités canadiennes (ESCC, 2013-2014). Cette approche méthodologique permet de mettre à jour les données des recours ou non à la mammographie des femmes de 50 à 69 ans. Plusieurs facteurs sont significativement liés à la non-utilisation de cet examen tel que : l’âge, l’état matrimonial (divorcée, veuve, ou célibataire), le faible revenu, le niveau d’éducation moins élevé, le statut d’immigration, le non-accès à un médecin de famille, l’indice de masse corporelle (obésité de classe 3), le tabagisme, etc. Finalement, une troisième étude qualitative a été menée pour décrire les raisons de non-utilisation de la mammographie de dépistage des femmes immigrantes récentes, d’origine maghrébine à Montréal. Comme dans la revue narrative, en se basant encore sur le cadre conceptuel de Lévesque et collaborateurs, les participantes ont révélé des barrières et des facilitateurs communs à l’accès au dépistage : 1. « La perception des besoins au recours du dépistage du cancer du sein », 2. « la recherche (seeking) du dépistage du cancer du sein », 3. « l’accès (reaching) au dépistage du cancer du sein », 4. « le recours (utilisation) au dépistage du cancer du sein » et 5. « les suivis réguliers (consequences) de dépistages du cancer du sein ». Les résultats de cette thèse ont montré plusieurs barrières (socioéconomiques, socioculturelles et autres) à l’accès au dépistage du cancer du sein et/ou à la mammographie chez les femmes immigrantes. Il serait important de mettre en œuvre des outils interventionnels adaptés selon les barrières communes et les divers besoins des femmes immigrantes afin de promouvoir une culture préventive et d’éclairer leur décision quant à l’utilisation ou non de la mammographie de dépistage. / Breast cancer is the most common malignant disease among women. Since the introduction of breast cancer screening programs in the early 2000s, the mortality rate of women with breast cancer in Canada decreased significantly. Despite this decrease, recent immigrant women (who arrived in the host country less than 10 years ago) in Canada have been found to use breast cancer screening programs less frequently. The purpose of this thesis is to shed some light on the state of knowledge related to breast cancer screening among immigrant women, with emphasis on the challenges they face when accessing or using breast screening programs. We first conducted a literature review to describe the current barriers and benefits of using breast cancer screening among immigrant women. Using Lévesque’s patient-centered access to healthcare framework, the data was organized into five major categories: (1) “perception of needs and desire for screening”, (2) “breast cancer screening seeking”, (3) “breast cancer screening reaching”, (4) “breast cancer screening utilisation”, and (5) “breast cancer screening consequences”. The second study was a cross-sectional analysis of the Canadian Community Health Survey (CCHS, 2013/2014) to update the data regarding the use of mammography services among women aged 50 to 69 years. Several socioeconomic factors were significantly related to the low use of mammography services, including: age, marital status (divorced, widowed, or single), lower income, lower level of education, status of immigration (being an immigrant), lack of access to a family doctor, body mass index (obese class 3), and smoking status (being a smoker), etc. Finally, we present the findings of a qualitative study which was conducted to investigate the barriers and facilitators to mammography screening use among recent immigrant women from Northwest Africa (Tunisia, Algeria, and Morocco) currently residing in Montreal. As in the narrative review, again based on the Lévesque et al. conceptual framework, the participants identified common barriers and facilitators to accessing screening: “perception of needs and 8 desire for screening”, “breast cancer screening seeking”, “breast cancer screening reaching”, “breast cancer screening utilisation”, and “breast cancer screening consequences”. The results of this thesis indicated that there were various barriers (e.g. sociocultural, socioeconomic, etc.) to accessing breast cancer screening and /or mammography among immigrant women. It is important to implement new interventional tools adapted to the common barriers and diverse needs of immigrant women in order to promote preventive culture and enable them to make informed choices regarding screening mammography.

Summaries in Afrikaans and English / ‘n Praktiese teologiese probleem is in die bediening geïndentifiseer: die man wie se vrou ‘n mastektomie gehad het, word nie pastoraal ondersteun nie. Hierdie probleem is deur middel van kwalitatiewe navorsing ondersoek. Met die kennis uit die navorsing en die literatuurstudie is daaraan die navorsingsdoelstelling beantwoord. Hierdeur is die praktiese teologie op ‘n unieke wyse verryk, deur ‘n wetenskaplike bydrae om die pastorale berader beter te bekwaam. Borskanker is ‘n lewensbedreigde siekte waarop geen man voorberei is nie. Met die verlies van ‘n kosbare liggaamsdeel van die vrou en haar behoefte aan ondersteuning van haar man, begin hy om sy ware-man wees (identiteit) te bevraagteken. Die verlies het ook trauma by die man tot gevolg. As die man deur sy emosies oorweldig word en hy nie oor die vermoë beskik om dit te verwerk nie, kan hy in wanhoop verval. Die man lewe in die postmoderne era. Die uitdagings en onsekerhede van hierdie era het ‘n bydrae tot die ontwikkeling van die “Post-foundational” praktiese teologiese benadering gelewer. Daarom het die navorser besluit om hierdie benadering in die studie te volg. Hierdeur is ‘n gesprek tussen die praktiese teologie, mediese- en geesteswetenskappe vanuit ‘n transversale perspektief moontlik, om die invloed van die mastektomie op die man te bepaal. Duidelike behoeftes en vrae kom navore wat vereis dat die berader homself sal onderskei in kennis van die onderskeie pastorale benaderings en tegnieke, toepaslike mediese, Bybel- en geestes wetenskappe. Die omstandighede waarin die man hom bevind het die bevraagtekening van sy spiritualiteit tot gevolg. Sy spiritualiteit kan vir hom van groot waarde wees. Die doel van die beradingsmodel is om die man te fasiliteer om sy ware identiteit in Christus te ontdek. Deur die genade van die Here word geloofsvolwassenheid in die man ‘n waarheid. Daardeur vind transendering ten opsigte van ‘n “bevraagde identiteit” na ‘n “identiteit van betekenis en hoop” plaas. Deur die werking van die Heilige Gees word die man op die vervulling van God se heilsbeloftes vir die nood waarin verkeer verseker. Die doel van hierdie beradingsmodel vir die praktiese teologie, is ‘n geloofsvolwasse man met ‘n nuwe toekomsverhaal. / A practical theological problem was identified in the ministry: a husband whose wife undergoes a mastectomy does not receive pastoral care. This problem was investigated through a qualitative research study. The research objective was answered by doing research and a literature study. This scientific research enriches the practical theology in an unique way so that the pastoral counsellor is supported and can be more competent. Breast cancer is a life-threatening disease that no husband is prepared for. The wife loses an intimate part of her body and needs to be supported by her husband. He starts to question his own manhood (identity). This loss is also a traumatic experiences for him. He is overwhelmed by his emotions and can fall into despair if he does not have the ability to process the problem. We live in the post-modern era. This has lead to the development of the Post-foundational practical theological approach. The researcher therefore decided to follow this approach in his study. This help to determine the influence of the disruption and uncertainties in the life of the man through a discourse between the practical theology, medical- and human science from a transversal perspective. Evident questions were raised for which the counsellor needs to distinguish himself with knowledge about the various pastoral approaches and techniques, appropriate knowledge of the Bible, medical- and human science. The circumstances in which the man finds himself raise questions about the meaning of his spirituality. Spirituality can be of great help for the husband. The aim of this counseling model is to facilitate the husband through the narrative approach to find the meaning of his true identity in Christ. Through the grace of God the husband becomes spiritually mature. The dependence on God through a process of transcendence changes the ‘question identity’ to an ‘identity of value and hope’. Through the work of Holy Spirit the husband is reassured of the fulfillment of the promises of salvation by God. The aim of this counseling model for the practical theology is a spiritually matured husband with a new future story. / Practical Theology / D. Th. (Practical Theology)

Réalisé en cotutelle avec Dr. Béatrice Godard, Professeure titulaire à l'Université de Montréal. / Les écrits scientifiques ont démontré un écart important entre les populations, quant à la survie du cancer du sein. Il s’avèrerait que les femmes immigrantes meurent davantage du cancer du sein que les non-immigrantes. Plusieurs études attribuent ce phénomène à une faible adhérence à la mammographie chez ces femmes. Ainsi, une détection trop tardive de la maladie réduit évidemment les chances de survie. Au Québec, le Programme Québécois de Dépistage du Cancer du Sein envoie une lettre d’invitation aux femmes dès qu’elles atteignent 50 ans. Cette lettre est une prescription pour une mammographie de dépistage. Cette étude a démontré que cette lettre est une barrière à la mammographie pour les communautés immigrantes de Montréal, plus précisément la communauté haïtienne défavorisée, et ce en raison de leur faible niveau de littératie. Suite aux résultats obtenus, nous suggérons des modifications à cette lettre d’invitation, afin qu’elle puisse être accessible à toutes les femmes, dont les femmes de milieux défavorisés. / Research has demonstrated significant disparities amongst populations in regard to chances of survival to breast cancer. It has proven to be the case that immigrant women are more likely to die of breast cancer than non-immigrants. Several studies attribute this to poor adherence to mammography testing within this group of women. Thus, late detection of this disease unavoidably reduces their chances of survival. In Quebec, the Quebec Breast Cancer Screening Program sends a letter of invitation to women when they attain 50 years of age. This letter is a prescription for a screening mammogram. The present study has demonstrated that this letter is a barrier for immigrant communities in Montreal, ore specifically the underprivileged Haitian community. This is due to their low level of literacy. Consecutive to the results obtained in this study, we suggest modifications to the letter of invitation, in order to ensure that its content is accessible to all women, including women in underprivileged circumstances.

Early detection is vital to successfully treating breast cancer, and mammography screening is the most efficient and wide-spread method to reach this goal. Imaging low-contrast targets, while minimizing the radiation exposure to a large population is, however, a major challenge. Optimizing the image quality per unit radiation dose is therefore essential. In this thesis, two optimization schemes with respect to x-ray photon energy have been investigated: filtering the incident spectrum with refractive x-ray optics (spectral shaping), and utilizing the transmitted spectrum with energy-resolved photon-counting detectors (spectral imaging). Two types of x-ray lenses were experimentally characterized, and modeled using ray tracing, field propagation, and geometrical optics. Spectral shaping reduced dose approximately 20% compared to an absorption-filtered reference system with the same signal-to-noise ratio, scan time, and spatial resolution. In addition, a focusing pre-object collimator based on the same type of optics reduced divergence of the radiation and improved photon economy by about 50%. A photon-counting silicon detector was investigated in terms of energy resolution and its feasibility for spectral imaging. Contrast-enhanced tumor imaging with a system based on the detector was characterized and optimized with a model that took anatomical noise into account. Improvement in an ideal-observer detectability index by a factor of 2 to 8 over that obtained by conventional absorption imaging was found for different levels of anatomical noise and breast density. Increased conspicuity was confirmed by experiment. Further, the model was extended to include imaging of unenhanced lesions. Detectability of microcalcifications increased no more than a few percent, whereas the ability to detect large tumors might improve on the order of 50% despite the low attenuation difference between glandular and cancerous tissue. It is clear that inclusion of anatomical noise and imaging task in spectral optimization may yield completely different results than an analysis based solely on quantum noise. / QC 20100714

Τα παραγόμενα πρωτογενή ηλεκτρόνια εντός του φωτοαγώγιμου υλικού ενός μαστογραφικού ανιχνευτή ενεργού μήτρας άμεσης μετατροπής κατά την ακτινοβόληση, αποτελούν το πρωτογενές σήμα το οποίο προχωρώντας σχηματίζει το τελικό σήμα (εικόνα). Έτσι, η ποιότητα της μαστογραφικής εικόνας εξαρτάται άμεσα από τα χαρακτηριστικά των πρωτογενών ηλεκτρονίων. Ερευνώνται οι διαδικασίες σχηματισμού του πρωτογενούς σήματος και τα χαρακτηριστικά των πρωτογενών ηλεκτρονίων σε κατάλληλα φωτοαγώγιμα υλικά, όπως τα a-Se, a-As2Se3, GaSe, GaAs, Ge, CdTe, CdZnTe, Cd0.8Zn0.2Te, ZnTe, PbO, TlBr, PbI2 και HgI2, με την ανάπτυξη μοντέλου προσομοίωσης με τεχνικές Monte Carlo της παραγωγής των πρωτογενών ηλεκτρονίων για διάφορα φάσματα ακτίνων Χ στο μαστογραφικό εύρος ενεργειών. Το μοντέλο προσομοιώνει την αλληλεπίδραση φωτονίων-ύλης και την ατομική αποδιέγερση. Επιπρόσθετα, ειδικότερα για το a-Se, πραγματοποιείται μία προκαταρτική μελέτη της συσχέτισης των χαρακτηριστικών αρχικού και τελικού σήματος, με επίλυση των εξισώσεων του Νεύτωνα για την ολίσθηση των πρωτογενών ηλεκτρονίων στο κενό υπό την επίδραση ενός απλού ηλεκτρικού πεδίου. Για το ίδιο υλικό, αναπτύσσεται αφενός μεν αλγόριθμος υπολογισμού της κατανομής του ηλεκτρικού δυναμικού εντός του ανιχνευτή με χρήση υπάρχουσας αναλυτικής λύσης αφετέρου δε ένα πρωταρχικό μοντέλο Monte Carlo για τις ηλεκτρονιακές αλληλεπιδράσεις. Τα σημαντικότερα ευρήματα είναι: (i) το ποσοστό των πρωτογενών ηλεκτρονίων που εκπέμπονται εμπρόσθια είναι περίπου 60 % με την πιθανότερη πολική γωνία εκπομπής μεταξύ 50ο και 70ο, (ii) τα ηλεκτρόνια εκπέμπονται σε δύο λοβούς γύρω από τις αζιμουθιακές γωνίες φ=0 και π, (iii) περίπου το 80 % των πρωτογενών ηλεκτρονίων παράγεται στο σημείο πρόσπτωσης των ακτίνων Χ ενώ η πλειονότητά τους παράγεται εντός των πρώτων 300 μm από την επιφάνεια του ανιχνευτή, (iv) οι χωρικές κατανομές των ηλεκτρονίων στα a-Se, a-As2Se3, GaSe, GaAs, Ge, PbO και TlBr είναι σχεδόν ανεξάρτητες του μαστογραφικού φάσματος ενώ στα υπόλοιπα υλικά παρουσιάζουν φασματική εξάρτηση, (v) για το πρακτικό μαστογραφικό εύρος (15-40 keV) και στο πρωταρχικό στάδιο της δημιουργίας του σήματος τα a-Se, a-As2Se3 και Ge έχουν την ελάχιστη αζιμουθιακή ομοιομορφία κατά την εκπομπή των ηλεκτρονίων ενώ τα CdZnTe, Cd0.8Zn0.2Te και CdTe τη μέγιστη, το a-Se παρουσιάζει την καλύτερη ενδογενή χωρική διακριτική ικανότητα αλλά το μικρότερο παραγόμενο αριθμό ηλεκτρονίων, το PbO παρουσιάζει το ελάχιστο χώρο παραγωγής πρωτογενών ηλεκτρονίων (ακτίνας R=200 μm, βάθους Dmax=320 μm), ενώ το CdTe το μέγιστο (R=500 μm, Dmax=660 μm), (vi) τέλος, υπάρχουν σημαντικές ενδείξεις ότι τα PbI2 και HgI2 αποτελούν τις καλύτερες επιλογές φωτοαγώγιμου υλικού. / The x-ray induced primary electrons inside the photoconductor of direct conversion digital flat panel mammographic detectors, comprise the primary signal which propagates in the material and forms the final signal (image). Consequently, the quality of the mammographic image strongly depends on the characteristics of primary electrons. An investigation is made concerning the primary signal formation and the characteristics of primary electrons inside a-Se, a-As2Se3, GaSe, GaAs, Ge, CdTe, CdZnTe, Cd0.8Zn0.2Te, ZnTe, PbO, TlBr, PbI2 and HgI2, which are suitable photoconductors for direct detectors. A Monte Carlo model has been developed that simulates the primary electron production inside the materials mentioned for various x-ray spectra in the mammographic energy range. The model simulates the photon interactions and the atomic deexcitations. Furthermore, particularly for a-Se, a preliminary study is made concerning the correlation between the characteristics of primary and final signal, solving Newton’s equations of electron drifting in vacuum under the influence of a simple electric field. For the same material, an algorithm that calculates the electric potential distribution inside the detector from an existing analytical solution has been developed as well as a primitive Monte Carlo model for electron interactions. The most important findings are: (i) the percentage of primary electrons being forwards ejected is approximately 60 % with the most probable polar angles ranging from 50o to 70o, (ii) the electrons prefer to be emitted at two lobes around azimuthal angles φ=0 and π, (iii) approximately 80% of primary electrons are produced at the point of x-ray incidence whereas their majority is produced within the first 300 μm from detector’s surface, (iv) the electron spatial distributions for a-Se, a-As2Se3, GaSe, GaAs, Ge, PbO and TlBr are almost spectral independent while for the rest of materials there is a spectral dependence, (v) at the practical mammographic energies (15-40 keV) and at the primitive stage of signal formation a-Se, a-As2Se3 and Ge have the minimum azimuthal uniformity in electron emission whereas CdZnTe, Cd0.8Zn0.2Te and CdTe the maximum one, a-Se has the best inherent spatial resolution but the minimum number of primary electrons, PbO has the minimum bulk space in which electrons can be produced (radius R=200 μm, depth Dmax=320 μm) whereas CdTe has the maximum one (R=500 μm, Dmax=660 μm), (vi) finally, there is strong evidence indicating that PbI2 and HgI2 could be the best choices for this kind of applications.

Les écrits scientifiques ont démontré un écart important entre les populations, quant à la survie du cancer du sein. Il s’avèrerait que les femmes immigrantes meurent davantage du cancer du sein que les non-immigrantes. Plusieurs études attribuent ce phénomène à une faible adhérence à la mammographie chez ces femmes. Ainsi, une détection trop tardive de la maladie réduit évidemment les chances de survie. Au Québec, le Programme Québécois de Dépistage du Cancer du Sein envoie une lettre d’invitation aux femmes dès qu’elles atteignent 50 ans. Cette lettre est une prescription pour une mammographie de dépistage. Cette étude a démontré que cette lettre est une barrière à la mammographie pour les communautés immigrantes de Montréal, plus précisément la communauté haïtienne défavorisée, et ce en raison de leur faible niveau de littératie. Suite aux résultats obtenus, nous suggérons des modifications à cette lettre d’invitation, afin qu’elle puisse être accessible à toutes les femmes, dont les femmes de milieux défavorisés. / Research has demonstrated significant disparities amongst populations in regard to chances of survival to breast cancer. It has proven to be the case that immigrant women are more likely to die of breast cancer than non-immigrants. Several studies attribute this to poor adherence to mammography testing within this group of women. Thus, late detection of this disease unavoidably reduces their chances of survival. In Quebec, the Quebec Breast Cancer Screening Program sends a letter of invitation to women when they attain 50 years of age. This letter is a prescription for a screening mammogram. The present study has demonstrated that this letter is a barrier for immigrant communities in Montreal, ore specifically the underprivileged Haitian community. This is due to their low level of literacy. Consecutive to the results obtained in this study, we suggest modifications to the letter of invitation, in order to ensure that its content is accessible to all women, including women in underprivileged circumstances. / Réalisé en cotutelle avec Dr. Béatrice Godard, Professeure titulaire à l'Université de Montréal.

The aim of the current thesis is the exploitation of texture analysis approaches for the computer-aided diagnosis (CADx) of breast cancer. The first objective of the presented thesis is the exploitation of texture properties of the tissue surrounding microcalcifications (MCs) on x-ray mammograms for its differentiation into malignant or benign type. This approach is differentiated from previously reported texture-based CADx schemes by analyzing the “net texture pattern” of the underlying breast tissue, removing any bias introduced by the presence of MCs. This is achieved by employing a “coarse” MC segmentation step, relaxing requirements for accurate segmentation in morphology-based CADx schemes, and subsequently “excluding” the segmented MCs from the tissue area being analyzed by means of texture analysis approaches. The discriminating ability of the MCs surrounding tissue texture analysis approach is compared to that of a current state-of-the-art texture analysis approach and to a morphology-based one, employing supervised classification schemes. Classification performance is evaluated by means of Receiver Operating Characteristic (ROC) analysis on a dataset of 108 pleomorphic MC clusters originating from the Digital Database for Screening Mammography (DDSM). Results suggested that the exploitation of texture properties of the tissue surrounding MCs on screening x-ray mammograms accounts for a competitive new methodological approach towards computer-aided diagnosis of breast cancer. The second objective of the current thesis is the exploitation of lesion enhancement kinetics heterogeneity for the differentiation of breast lesions in Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI). This approach is differentiated from previously reported studies by investigating the texture of the lesion not as depicted on a single post-contrast frame but by considering serial post-contrast data. This is achieved by generating parametric maps the reflect lesion enhancement kinetics properties and then subjecting the parametric maps to texture analysis. The discriminating ability of the enhancement kinetics “texture” analysis approach is compared to that of current state-of-the-art approach of single time frame texture analysis, employing supervised classification schemes. Classification performance is evaluated by means of ROC analysis on a dataset of 81 mass-like lesions, originating from a locally available Database. Results suggested that texture features extracted from parametric maps that reflect lesion washout properties can discriminate malignant from benign lesions more efficiently as compared to texture features extracted from either the 1st post-contrast frame lesion area or from a parametric map that reflects lesion initial uptake. Results of the current thesis suggest the contribution of texture analysis methods in breast imaging for the quantification of both anatomical and functional tissue heterogeneity, providing important information for breast cancer diagnosis. / Στα πλαίσια της παρούσας Διατριβής μελετήθηκε η συμβολή μεθόδων ανάλυσης υφής μαστογραφικών εικόνων στη διάγνωση καρκίνου του μαστού. Η μελέτη εστιάσθηκε σε δύο διαγνωστικά προβλήματα τα οποία αποτελούν ανοικτά ζητήματα τόσο στην κλινική ρουτίνα όσο και στις μεθοδολογικές προσεγγίσεις αυτόματων συστημάτων ανάλυσης εικόνας για την υποβοήθηση της διάγνωσης με χρήση υπολογιστή (Computer-aided diagnosis - CADx). Το πρώτο διαγνωστικό πρόβλημα στο οποίο εστίασε η παρούσα Διατριβή αφορά στο χαρακτηρισμό μικροαποτατινώσεων στη μαστογραφία ακτίνων-Χ. Στην παρούσα μελέτη ακολουθείται μια διαφορετική προσέγγιση για τη διάγνωση συστάδων μικροαποτιτανώσεων, βάσει της οποίας μελετάται η ετερογένεια του ιστού ο οποίος περιβάλλει τις μικροαποτιτανώσεις. Ο «περιβάλλων ιστός» προκύπτει από εφαρμογή μεθόδου τμηματοποίησης των μικροαποτιτανώσεων και εξαίρεσής τους από την περιοχής ενδιαφέροντος. Οι απαιτήσεις ακρίβειας της μεθόδου τμηματοποίησης στην προσέγγιση ανάλυση υφής του «περιβάλλοντος ιστού» είναι μειωμένες, σε σχέση με τις αντίστοιχες μεθόδους των CADx συστημάτων βάσει μορφολογίας, καθώς απαιτείται μόνο «αδρός» καθορισμός των ορίων τους. Η ετερογένεια του περιβάλλοντος ιστού μελετήθηκε βάσει μεθόδων εξαγωγής χαρακτηριστικών υφής εικόνας, σε δείγμα 108 συστάδων μικροαποτιτανώσεων, που αντλήθηκαν από μαστογραφικές εικόνες της ψηφιακής βάσης αναφοράς Digital Database for Screening Mammography. Η διαχωριστική ικανότητα των εξαχθέντων χαρακτηριστικών υφής διερυνήθηκε με χρήση επιβλεπόμενων σχημάτων ταξινόμησης. Η ακρίβεια ταξινόμησης αξιολογήθηκε βάσει του εμβαδού της καμπύλης απόκρισης παρατηρητών. Η προσέγγιση «ανάλυσης υφής του περιβάλλοντος ιστού» συγκρίθηκε με την τρέχουσα μέθοδο ανάλυσης υφής εικόνας περιοχής ενδιαφέροντος που εμπεριέχει τη συστάδα μικροαποτιτανώσεων, αλλά και με προσέγγιση βάσει ανάλυσης μορφολογίας μικροαποτιτανώσεων. Τα αποτελέσματα της παρούσας μελέτης συνιστούν ότι η προσέγγιση ανάλυσης υφής «του περιβάλλοντος ιστού» αποτελεί μία νέα ανταγωνιστική μεθοδολογία στη διάγνωση καρκίνου του μαστού υποβοηθούμενη από υπολογιστή. Το δεύτερο διαγνωστικό πρόβλημα στο οποίο εστίασε η παρούσα Διατριβή αφορά στο χαρακτηρισμό χωροκατακτητικών αλλοιώσεων στη μαστογραφία μαγνητικής τομογραφίας με χρήση σκιαγραφικού (Dynamic Contrast-Enhanced Magnetic Resonance Imaging: DCE-MRI). Στην παρούσα μελέτη διερευνάται η ικανότητα ποσοτικοποίησης της ετερογένειας των αλλοιώσεων ως προς τη δυναμική τους συμπεριφορά για τη διάγνωση χωροκατακτητικών αλλοιώσεων στη DCE-MRI. Για το σκοπό αυτό δημιουργήθηκαν τρεις παραμετρικοί χάρτες βάσει υπολογισμού τριών δυναμικών χαρακτηριστικών των αλλοιώσεων σε επίπεδο εικονοστοιχείου, οι οποίοι αποτέλεσαν τη βάση για την εφαρμογή μεθόδου ανάλυσης υφής εικόνας, βάσει μητρών συνεμφάνισης στο πεδίο διαβαθμίσεων του γκρι. Μελετήθηκε η διαχωριστική ικανότητα μεμονωμένων χαρακτηριστικών υφής αλλά και επιλεχθέντων υποσυνόλων από κάθε παραμετρικό χάρτη με χρήση επιβλεπόμενων σχημάτων ταξινόμησης. Η ακρίβεια ταξινόμησης αξιολογήθηκε βάσει του εμβαδού της καμπύλης απόκρισης παρατηρητών. Η μέθοδος συγκρίθηκε με τη συμβατική προσέγγιση ποσοτικοποίησης ετερογένειας της αλλοίωσης σε συγκεκριμένο χρονικό στιγμιότυπο, όπως υιοθετείται από τρέχουσες προσεγγίσεις συστημάτων CADx στη DCE-MRI, σε δείγμα 81 αλλοιώσεων. Τα χαρακτηριστικά υφής που εξήχθησαν από χάρτες που εκφράζουν τη μεταβολή του σήματος κατά τη φάση της έκπλυσης του σκιαγραφικού παρουσίασαν την υψηλότερη ακρίβεια ταξινόμησης η οποία ήταν στατιστικώς σημαντικά διαφορετική συγκρινόμενη με χαρακτηριστικά που εξήχθησαν είτε από χάρτη που εκφράζει μεταβολή του σήματος κατά τη φάση της πρόσληψης του σκιαγραφικού ή από αλλοίωση όπως απεικονίζεται σε συγκεκριμένο χρονικό στιγμιότυπο. Τα αποτελέσματα της παρούσας Διατριβής υποδηλώνουν την ικανότητα μεθόδων ανάλυσης υφής στη μαστογραφική απεικόνιση για την ποσοτικοποίηση τόσο της ανατομικής όσο και της λειτουργικής ετερογένειας των αλλοιώσεων, παρέχοντας σημαντική πληροφορία για τη διάγνωση καρκίνου του μαστού.

Summaries in Afrikaans and English / ‘n Praktiese teologiese probleem is in die bediening geïndentifiseer: die man wie se vrou ‘n mastektomie gehad het, word nie pastoraal ondersteun nie. Hierdie probleem is deur middel van kwalitatiewe navorsing ondersoek. Met die kennis uit die navorsing en die literatuurstudie is daaraan die navorsingsdoelstelling beantwoord. Hierdeur is die praktiese teologie op ‘n unieke wyse verryk, deur ‘n wetenskaplike bydrae om die pastorale berader beter te bekwaam. Borskanker is ‘n lewensbedreigde siekte waarop geen man voorberei is nie. Met die verlies van ‘n kosbare liggaamsdeel van die vrou en haar behoefte aan ondersteuning van haar man, begin hy om sy ware-man wees (identiteit) te bevraagteken. Die verlies het ook trauma by die man tot gevolg. As die man deur sy emosies oorweldig word en hy nie oor die vermoë beskik om dit te verwerk nie, kan hy in wanhoop verval. Die man lewe in die postmoderne era. Die uitdagings en onsekerhede van hierdie era het ‘n bydrae tot die ontwikkeling van die “Post-foundational” praktiese teologiese benadering gelewer. Daarom het die navorser besluit om hierdie benadering in die studie te volg. Hierdeur is ‘n gesprek tussen die praktiese teologie, mediese- en geesteswetenskappe vanuit ‘n transversale perspektief moontlik, om die invloed van die mastektomie op die man te bepaal. Duidelike behoeftes en vrae kom navore wat vereis dat die berader homself sal onderskei in kennis van die onderskeie pastorale benaderings en tegnieke, toepaslike mediese, Bybel- en geestes wetenskappe. Die omstandighede waarin die man hom bevind het die bevraagtekening van sy spiritualiteit tot gevolg. Sy spiritualiteit kan vir hom van groot waarde wees. Die doel van die beradingsmodel is om die man te fasiliteer om sy ware identiteit in Christus te ontdek. Deur die genade van die Here word geloofsvolwassenheid in die man ‘n waarheid. Daardeur vind transendering ten opsigte van ‘n “bevraagde identiteit” na ‘n “identiteit van betekenis en hoop” plaas. Deur die werking van die Heilige Gees word die man op die vervulling van God se heilsbeloftes vir die nood waarin verkeer verseker. Die doel van hierdie beradingsmodel vir die praktiese teologie, is ‘n geloofsvolwasse man met ‘n nuwe toekomsverhaal. / A practical theological problem was identified in the ministry: a husband whose wife undergoes a mastectomy does not receive pastoral care. This problem was investigated through a qualitative research study. The research objective was answered by doing research and a literature study. This scientific research enriches the practical theology in an unique way so that the pastoral counsellor is supported and can be more competent. Breast cancer is a life-threatening disease that no husband is prepared for. The wife loses an intimate part of her body and needs to be supported by her husband. He starts to question his own manhood (identity). This loss is also a traumatic experiences for him. He is overwhelmed by his emotions and can fall into despair if he does not have the ability to process the problem. We live in the post-modern era. This has lead to the development of the Post-foundational practical theological approach. The researcher therefore decided to follow this approach in his study. This help to determine the influence of the disruption and uncertainties in the life of the man through a discourse between the practical theology, medical- and human science from a transversal perspective. Evident questions were raised for which the counsellor needs to distinguish himself with knowledge about the various pastoral approaches and techniques, appropriate knowledge of the Bible, medical- and human science. The circumstances in which the man finds himself raise questions about the meaning of his spirituality. Spirituality can be of great help for the husband. The aim of this counseling model is to facilitate the husband through the narrative approach to find the meaning of his true identity in Christ. Through the grace of God the husband becomes spiritually mature. The dependence on God through a process of transcendence changes the ‘question identity’ to an ‘identity of value and hope’. Through the work of Holy Spirit the husband is reassured of the fulfillment of the promises of salvation by God. The aim of this counseling model for the practical theology is a spiritually matured husband with a new future story. / Philosophy, Practical and Systematic Theology / D. Th. (Practical Theology)

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-02-23T14:02:54Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) tese-completa-Sidney_Lima_v21.pdf: 4757211 bytes, checksum: 205170db8b002cc2ab72255ab77628a3 (MD5) / Made available in DSpace on 2017-02-23T14:02:54Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) tese-completa-Sidney_Lima_v21.pdf: 4757211 bytes, checksum: 205170db8b002cc2ab72255ab77628a3 (MD5) Previous issue date: 2016-02-25 / REUNI / O câncer de mama é a principal causa de morte de mulheres adultas por câncer no mundo. Do ponto de vista clínico, a mamografia é ainda a mais efetiva tecnologia de diagnóstico do câncer de mama, dada a grande difusão de uso e interpretações dessas imagens. De acordo com o estado da arte da classificação de lesões em mamogramas, as wavelets têm apresentado os melhores resultados do ponto de vista da taxa de classificação, quando utilizadas como etapa de préprocessamento que decompõe a imagem original em imagens de detalhes (verticais, horizontais e diagonais) e aproximações para, a partir dessas imagens componentes, serem extraídos atributos de textura. Neste trabalho, propõe-se a Decomposição baseada em Aproximações Morfológicas em regiões de interesse em mamogramas. O método proposto tem por base a decomposição inspirada em wavelets que emprega filtros não lineares passa-baixas e passa-altas, baseados em aberturas e fechamentos, que por sua vez são construídos a partir dos operadores morfológicos clássicos de erosão e dilatação. Neste trabalho, são propostas aproximações aritméticas para esses dois operadores morfológicos clássicos, substituindo os desvios condicionais, presentes na Morfologia Matemática, por operações aritméticas de somas, subtrações e multiplicações, computacionalmente mais rápidas. O trabalho proposto compara o tempo estimado de execução entre as aproximações aritméticas propostas e as operações morfológicas clássicas utilizando a notação Big-Oh e também faz uso de estimativas baseadas em arquitetura de hardware pipeline. Em todas as estimativas e cenários reais, as aproximações morfológicas propostas são mais rápidas do que a morfologia clássica. Além disso, por não empregar unidade de hardware em ambiente pipeline para tratamento de desvios condicionais, as aproximações morfológicas propostas se tornam uma solução mais barata, ocupa menos espaço, mais propícia à miniaturização, consome menos energia e reduz o número de codificações da UC (Unidade de Controle). Logo, as Aproximações Morfológicas criadas são superiores à morfologia clássica nos principais requisitos para o bom funcionamento do hardware. Quanto à classificação, a Decomposição baseada em Aproximações Morfológicas alcança um desempenho médio de 84,65% na distinção entre casos normais, benignos e malignos. Os classificadores empregados são redes neurais ELM e SVM, cujas classes são definidas de acordo com os critérios da American College of Radiology. Foram usadas 355 imagens de mama adiposa da base de dados IRMA, com 233 casos normais, 66 benignos e 56 malignos. Como método de tratamento da base de dados, foram estudados pesos ponderando a fronteira de decisão das redes neurais. / According to the World Health Organization, breast cancer is the main cause of death of women round the world. From the clinical point of view, mammography is still the most effective diagnostic technology, given the wide diffusion of the use and interpretation of these images. According the state-of-the-art lesions classification on mammograms, wavelets have produced the best results from the viewpoint of precision, when used as a preprocessing step that decomposes the original image into approximation and detail images (vertical, horizontal and diagonal) in order to, from these components images, extract shape or texture attributes. This work proposes the decomposition Morphological-based in regions of interest on mammograms. The proposed method is inspired on wavelets decomposition employing nonlinear low-pass and high-pass filters, based on openings and closings, which are constructed from classical morphological operators of erosion and dilation. In this work, we propose approaches of classical morphology, replacing the conditional branches, present in Mathematical Morphology, by arithmetic operations of addition, subtraction and multiplication, computationally faster. The proposed work compares the estimated run time of proposed arithmetic approximations and classical morphological operations using Big-Oh notation and also the thesis uses notation based on pipeline hardware architecture. In all real scenarios, our morphological operations are faster than classical morphology. Also, by not employing hardware unit in pipeline environment for treating conditional branches, the proposed morphology approximation becomes a cheaper solution, occupies less space, more propitious to miniaturization, consumes less power, and reduces the Control Unit coding number. Then, our approaches of classical morphology are superior to classical morphology in key requirements of hardware solution. Regarding the classification, the proposed decomposition reaches an average performance of 84.65% in distinguishing normal, benign, and malignant cases. Classifiers are neural networks ELM and SVM, classes are defined according American College of Radiology criteria. They are employed 355 adipose breast images with 233 normal cases, 66 benign and 56 malignant. As database processing method, weights were studied considering the decision boundary of neural networks.