Luận văn thạc sĩ Vật lý kỹ thuật: Ứng dụng kỹ thuật xử lý ảnh phân cực trong hỗ trợ chẩn đoán bệnh viêm lộ tuyến cổ tử cung

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NGUYӈN NGӐC QUǣNH

ӬNG DӨNG KӺ THUҰT XӰ /éҦNH 3+Æ1&ӴC TRONG HӚ TRӦ CHҬ1Ĉ2È1%ӊNH

*KLU}KӑWrQKӑc KjPKӑc vӏ YjFKӳ Nê

- -

NHIӊM VӨ LUҰ19Ă17+Ҥ&6Ƭ

Hӑ WrQKӑFYLrQ1*8<ӈN NGӐC QUǣNH MSHV: 1870331 1Jj\WKiQJQăPVLQK22/02/1995 1ѫLVLQKBӃn Tre &KX\rQQJjQK9ұt lê.ӻ thuұt 0mVӕ: 8520401

,7Ç1Ĉӄ 7¬,ӬNG DӨNG KӺ THUҰT XӰ /éҦNH 3+Æ1&ӴC TRONG

HӚ TRӦ CHҬ1Ĉ2È1%ӊ1+9,Ç0/Ӝ TUYӂN CӘ TӰ CUNG.

II NHIӊM VӨ 9¬1ӜI DUNG:

- 7uP KLӇu vӅ bӋnh Yj FiF SKѭѫQJ SKiS FKҭQ ÿRiQ EӋQK YLrP Oӝ tuyӃn cә tӱ cung (CTC)

- 7uPKLӇu kӻ thuұt thu nhұn ҧQK&7&SKkQFӵc chҩWOѭӧQJFDRFiFWKXұWWRiQxӱ OêҧQK&7&SKkQFӵFSKѭѫQJSKiSÿiQKJLiPӭFÿӝ bӋQKYLrPOӝ tuyӃn CTC

- Thu nhұn KuQK ҧnh SKkQFӵc trҳng YLrPOӝ tuyӃn CTC cӫDWuQKQJX\ӋQYLrQWUѭӟFYjVDXNKLSKӃt Lugol tҥLSKzQJNKiPVҧn phө khoa bҵQJP{KuQKPi\soi CTC kӻ thuұt sӕ vӟi nguӗQViQJWUҳQJSKkQFӵc

- ;k\Gӵng thuұWWRiQ[ӱ OêҧQKÿӇ WăQJWѭѫQJSKҧQYjWiFKYQJOӝ tuyӃn CTC mӝWFiFKWӵ ÿӝng

- 3KkQWtFKYj[ӱ OêKuQKҧQKWKXÿѭӧFWK{QJTXDFiFWKXұWWRiQÿѭӧF[k\Gӵng WUrQSKҫn mӅm MATLAB

- ĈiQKJLiNӃt quҧ thu nhұQÿѭӧcVRViQKYӟi chuҭQYjQJ - ҧnh sau khi phӃt Lugol

- ;k\Gӵng thuұt WRiQÿiQKJLiPӭFÿӝ bӋQKYLrPOӝ tuyӃQYjNLӇm chӭng vӟi kӃt quҧ cӫDEiFVƭ

- KӃt luұQYj ÿѭDUDKѭӟQJSKiWWULӇn trong thӡi gian tӟi

,,,1*¬<*,$21+,ӊM VӨ: *KLWKHRWURQJ4ĈJLDRÿӅ WjL : 11/02/2019 ,91*¬<+2¬17+¬1+1+,ӊM VӨ: *KLWKHRWURQJ4ĈJLDRÿӅ WjL :

7S+&0QJj\WKiQJQăP

75ѬӢNG KHOA KHOA HӐC ӬNG DӨNG

LӠI CҦ0Ѫ1

ĈӇKRjQWKjQKWӕWOXұQYăQQj\W{LÿmQKұQÿѭӧc sӵ Kѭӟng dүQYjKӛWUӧYӅPӑLPһWFӫD1KjWUѭӡQJTXê7Kҫ\&{FiFDQKFKӏJLDÿuQKYjFiFEҥQ%ҵQJVӵNtQKWUӑQJYjELӃWѫQVkXVҳFW{L[LQJӱLOӡLFҧPѫQFKkQWKjQKÿӃn:

x %DQ *LiP +iӋX 3KzQJ ĈjR tҥR VDX Ĉҥi hӑF KRD KRD KӑF ӬQJ GөQJWUѭӡQJĈҥi hӑF%iFK.KRD±ĈҥLKӑF4XӕFJLD7KjQKphӕ Hӗ &Kt0LQKÿmtҥo mӑLÿLӅu kiӋn thuұn lӧLFKRW{L trong suӕWTXiWUuQKKӑc tұp

x &iF7Kҫ\&{WKXӝF%ӝP{Q9ұWOê.ӻWKXұWÿmWUX\ӅQÿҥWFKRW{LQKӳQJNLӃQWKӭFNӻQăQJYjNLQKQJKLӋPWURQJTXiWUuQKKӑFWұS

x TiӃQVƭ/ê$QK7~ThҥFVƭ7UҫQ9ăQ7LӃn, ThҥFVƭ3KDQ1JӑF.KѭѫQJ&iWÿmWұQ WuQK FKӍ EҧR ÿӏQK KѭӟQJ WUX\ӅQ ÿҥW QKӳQJ NLӃQ WKӭF FKX\rQ P{Q FNJQJQKѭJLҧLÿiSQKӳQJWKҳFPҳFÿӇ W{LFyWKӇ KRjQWKjQKWӕt luұQYăQQj\

x &iFWKjQKYLrQWKXӝFQKyPQJKLrQFӭu PKzQJWKtQJKLӋm (PTN) ĈR4uang hӑc ± PTN TrӑQJ ÿLӇm Quӕc gia ĈLӅu khiӇn sӕ Yj ӻ thuұt hӋ thӕng (DCSELab) ÿmKӛ trӧYjÿyQJJySêNLӃQ

x *LDÿuQKEҥQEq QKӳQJQJѭӡL WKkQ OX{QErQFҥnh,ӫQJKӝYjÿӝQJYLrQW{LKRjQWKjQKOXұQYăQWURQJNKҧ QăQJWӕt nhҩWFyWKӇ

6DXFQJW{L[LQNtQKFK~FTXê7Kҫy, &{Fӫa TUѭӡQJĈҥi hӑF%iFK.KRD±ĈҥLKӑF4XӕFJLD7KjQKSKӕ Hӗ &Kt0LQKFNJQJQKѭTXê7Kҫy, &{WURQg bӝ P{QVұWOê.ӻ thuұt thұt dӗLGjRVӭc khӓHQKLӅXQLӅPYXLÿӇ tiӃp tөc thӵc hiӋn sӭ mӋnh FDRÿҽp cӫDPuQKOjWUX\ӅQÿҥt kiӃn thӭc cho thӃ hӋ mai sau

7{L[LQFKkQWKjQKFҧPѫQ/

TP H͛ &Kt0LQK, nJj\09 WKiQJQăP2019

HӑFYLrQ

Nguy͍n Ng͕c QuǤnh

7Ï07ҲT

9LrPOӝ tuyӃn cә tӱ FXQJ&7& OjPӝt trong ba bӋnh phө khoa phә biӃQYjFytӹ lӋ mҳc phҧi cao nhҩt hiӋn nay FQJ Yӟi bӋQK YLrP kP ÿҥR Yj Uӕi loҥn kinh nguyӋt BӋnh NK{QJFKӍ Jk\SKLӅQWRiLWURQJcuӝc sӕQJJLDÿuQKPjFzQҧQKKѭӣng QJKLrPWUӑng tӟi sӭc khӓe cӫa phө nӳ ÿһc biӋWOjVӭc khӓe sinh sҧn9LrPOӝ tuyӃn OjNKӣi nguӗn cӫa mӝt sӕ bӋnh phө khoa nguy hiӇPÿӗng thӡLFNJQJFKtQKOjQJX\rQQKkQJk\Y{VLQKKLӃm muӝn NӃXNK{QJÿѭӧFSKiWKLӋn sӟPYjÿLӅu trӏ kӏp thӡi, YLrPOӝ tuyӃn sӁ trӣ WKjQKPӝt trong nhӳQJQJX\rQJk\XQJWKѭ&7&Ĉk\Ojung WKѭFyWӹ lӋ mҳFYjWӹ lӋ tӱ vong xӃp thӭ KDLWURQJFiFXQJWKѭphө khoa ӣ nӳ giӟi HiӋQQD\SKѭѫQJSKiSÿѭӧc sӱ dөQJÿӇ chҭn ÿRiQYLrPOӝ tuyӃQ&7&OjVRL&7&kӃt hӧp phӃt Lugol DӵDYjRVӵ bҳWPjXFӫa LXJROEiFVƭFyWKӇ ÿѭDUDÿiQKJLiYӅ WuQKWUҥng bӋQKFNJQJQKѭSKiWÿӗ ÿLӅu trӏ7X\QKLrQSKѭѫQJSKiSQj\Fyÿӝ nhҥy Yjÿӝ ÿһc hiӋXFKѭDFDR7KrPYjRÿyNӃt quҧ phө thuӝFYjR nhiӅu yӃu tӕ QKѭFKҩt Oѭӧng LXJROWKDRWiFSKӃt, kinh nghiӋPÿӑc kӃt quҧ cӫDEiF VƭWӕn thӡi gian, chi SKtYjJk\ NKyFKӏXtWQKLӅu cho bӋQKQKkQ NKLSKӃt mӝt loҥLKyD FKҩWYjRYQJnhҥy cҧm ĈӇ QkQJ FDR FKҩW Oѭӧng trong chҭQ ÿRiQ EӋnh, nhiӅX QJKLrQ Fӭu ÿmKѭӟQJ ÿӃQ FiF Nӻ thuұt tӵ ÿӝng nhұn diӋQ Yj SKkQ YQJ ҧnh nhҵP ÿiQK JLi YjNKRDQKYQJEӋQKOêPӝWFiFKWӵ ÿӝQJ4XDÿyJySSKҫQQkQJFDRÿӝ FKtQK[iFtiӃt kiӋm thӡL JLDQ FKL SKt Yj Kҥn chӃ yӃu tӕ chӫ TXDQ NKL ÿiQK JLi Eҵng mҳt WKѭӡng

Trong luұQYăQQj\Nӻ thuұt xӱ Oêҧnh SKkQFӵc trҳng CTC lӝ tuyӃn dӵDYjRFiFÿһFWtQKTXDQJKӑc cӫDP{&7&QKѭKҩp thөWiQ[ҥ tҥLFiFSKә hҩp thө NKiFnhau ÿѭӧFQJKLrQFӭXYj[k\Gӵng KӃt quҧ xӱ OêҧQKJL~SQkQJFDRÿӝ WѭѫQJSKҧn YjÿiQKGҩXYQJYLrPOӝ tuyӃn mӝWFiFKWӵ ÿӝng +uQKҧnh sau SKkQÿRҥn YQJOӝ tuyӃn ÿѭӧc kiӇm chӭQJ ÿӝ FKtQK [iF GӵD WUrQ WLrX chuҭQ YjQJ - ҧnh phӃt Lugol CuӕLFQJGӵDYjRNӃt quҧ SKkQÿRҥQFyWKӇ WtQKWRiQFKtQK[iFGLӋQWtFKYQJOӝ tuyӃn nhҵm hӛ trӧ EiFVƭWURQJYLӋFÿѭDUDNӃt luұn vӅ mӭFÿӝ bӋQKYjSKѭѫQJiQÿLӅu trӏ ph hӧp

ABSTRACT

Cervical ectropion is one of the three most common gynecological diseases and has the highest incidence rate today, along with vaginitis and menstrual disorders The disease is not only a nuisance in family life but also a severe affection to women's health, especially in reproduction health Cervical ectropion is the origin of some dangerous gynecological diseases and is also the cause of infertility If not detected early and treated promptly, the disease will become one of the causes of cervical cancer This is the cancer with the incidence and death rate ranked second among gynecological cancers in women Currently, the method used to diagnose cervical ectropion is colposcopy with Lugol Based on Lugol's discoloration, doctors can make an assessment of the condition as well as a treatment plan However, this method has low sensitivity and specificity In addition, the results depend on many factors such as Lugol quality, manipulation, the doctor's experience in reading the results, time-consuming and costly, discomfort for patients when applying chemicals to the genital area Today, in order to improve the quality of disease diagnosis, many studies have turned to automatic image recognition and segmentation techniques to automatically evaluate and localize the pathology This method contributes to improving accuracy, saving time and costs, and limiting subjective factors when judging by eyes

In this study, the technique of processing white polarized images of cervical ectropion based on the optical properties of cervical tissue such as absorption, scattering at different absorption spectra was studied and formulated The image processing results help improve the contrast ratio and mark the cervical ectropion area automatically This method is verified for accuracy based on the gold standard - cervical images with Lugol Finally, based on the results of the segment one can calculate the exact area of the disease area This assists the doctor in making conclusions about the extent of the disease and the appropriate treatment plan

LӠ,&$0Ĉ2$1

LuұQYăQQj\OjF{QJWUuQKQJKLrQFӭu cӫDFiQKkQW{Lÿѭӧc thӵc hiӋQGѭӟi sӵ Kѭӟng dүn khoa hӑc cӫa TiӃn Vƭ /ê$QK7~ThҥFVƭ TrҫQ9ăQ7LӃn Yj ThҥFVƭ Phan NgӑF.KѭѫQJ&iW

&iF Vӕ liӋu, nhӳng kӃt luұQ QJKLrQ FӭX ÿѭӧF WUuQK Ej\ WURQJ OXұQ YăQ Qj\KRjQWRjQWUXQJWKӵc

7{L[LQKRjQWRjQFKӏXWUiFKQKLӋm vӅ lӡLFDPÿRDQQj\

HӑFYLrQ

Nguy͍n Ng͕c QuǤnh

DANH MӨ&+Î1+ҦNH vii

DANH MӨC BҦNG BIӆU viii

1.1.1 7uQKKuQKEӋQKYLrPOӝ tuyӃQ&7&WUrQWKӃ giӟi 5

7uQKKuQKEӋQKYLrPOӝ tuyӃQ&7&WURQJQѭӟc 8

1.2 TӘ1* 48$1 &È& 3+ѬѪ1* 3+È3 &+Ҭ1 Ĉ2È1 %ӊ1+ 9,Ç0 /Ӝ TUYӂN CTC 13

1.2.1 3KѭѫQJSKiSVRL&7& 13

1.2.2 3KѭѫQJSKiSVRLCTC kӃt hӧp phӃt Lugol 14

1.3 TӘNG QUAN Vӄ 3+ѬѪ1*3+È3;Ӱ /éҦ1+9¬.Ӻ THUҰ73+Æ1CӴC 16

DANH MӨ&+Î1+ҦNH

+uQK Thi͇t b͓ soi c͝ t͵ cung kͿ thu̵t s͙ KN-2200 [32] 14

+uQK ̪QK&7&WU˱ͣF$ YjVDX% NKLSK͇t Lugol 15

+uQK V͓ WUtFͯD&7&WURQJF˯WK͋ [53] 21

+uQK C̭XWU~FP{K͕c cͯa bi͋XP{OiW>@ 22

+uQK C̭XWU~FP{K͕c cͯa bi͋XP{WX\͇n [54] 25

+uQK 0{W̫ chi ti͇t c̭XWU~FEL͋XP{WX\͇n [54] 25

+uQK +uQK̫nh m̩FKPiXErQG˱ͣi bi͋XP{WUͭ [55] 26

+uQK 0{W̫ v͓ WUtUDQKJLͣLOiWWUͭ [54] 26

+uQK V͓ WUtFͯa ranh giͣLOiWWUͭ TXDFiFJLDLÿR̩n [2] 27

+uQK 0{W̫ TXiWUuQKFKX\͋n s̫QWKjQKEL͋XP{OiW>@ 28

+uQK 0{W̫ YQJFKX\͋n ti͇p [33] 30

+uQK 4XiWUuQKKuQKWKjQKYQJO͡ tuy͇n [58] 32

+uQK ̪QK&7&YLrPO͡ tuy͇n [60] 34

+uQK7uQKWU̩QJYLrPO͡ tuy͇Q&7&TXDFiFF̭Sÿ͡ [63] 35

+uQK+uQK̫nh vͣLFiFÿ͡ SKkQJL̫i NKiFQKDX 38

+uQK 0{W̫ s͹ t̩RWKjQKiQKViQJSKkQF͹c [65] 39

+uQK 0{KuQKWKL͇t b͓ soi CTC 44

+uQK 6˯ÿ͛ QJX\rQOêKR̩Wÿ͡ng cͯDPi\VRL&7& 45

+uQK 6˯ÿ͛ SKkQÿR̩QYQJO͡ tuy͇n CTC 47

+uQK Minh h͕DTX\WUuQKWK͹c hi͏n thu̵WWRiQO͕c trung v͓ 47

+uQK V͓ WUtYjF̭XWU~FFͯDFiFOR̩i bi͋XP{WURQJ&7& 48

+uQK 7˱˯QJWiFJLͷDiQKViQJYͣLP{&7& 49

+uQK Ph͝ h̭p thͭ cͯDR[\KHPRJORELQYjGHR[\KHPRJORELQWURQJP{&7& 50

+uQK 6˯ÿ͛ WăQJW˱˯QJSK̫QYQJO͡ tuy͇n CTC 52

+uQK 6˯ÿ͛ SKkQÿR̩QYQJO͡ tuy͇n 54

+uQK ̪QKVRL&7&$ Yj& ̪nh g͙FWU˱ͣFYjVDXNKLSK͇t Lugol; 57

+uQK 7iFKNrQKPjXR, B, G tͳ ̫nh tr̷ng 58

+uQK ĈiQKJLiKDLSK˱˯QJSKiSN͇t hͫp ̫nh (B ± 5 Yj*± R) 60

+uQK 7ăQJW˱˯QJSK̫QYjSKkQÿo̩QYQJO͡ tuy͇n 62

DANH MӨC BҦNG BIӆU

B̫ng 1.1 Tͽ l͏ YLrPO͡ tuy͇n CTC [9] 6 B̫ng 4.1 Th͙QJNrPͱFÿ͡ YLrPO͡ tuy͇n 56

DANH 6È&+ &È&THUҰT NGӲ VIӂT TҲT

3KѭѫQJ SKiS TXDQ ViW &7&bҵng mҳW WKѭӡng vӟi Lugol 3% - 5%

CE Columnar Epithelium BiӇXP{WX\Ӄn SE Squamous Epithelium BiӇXP{OiW SCJ Squamocolumnar Junction Ranh giӟLOiWWUө

TZ Transformation zone 9QJFKX\Ӈn tiӃp

MӢ ĈҪU

Lӝ tuyӃn cә tӱ cung (CTC) xҧy ra khi FiFWӃ EjRWӯ ErQWURQJFӫa ӕng CTC ±ÿѭӧc gӑLOjWӃ EjR ELӇXP{ tuyӃn mӣ rӝQJUDErQQJRjLSKҫQkPÿҥo cӫa CTC ± ÿѭӧc gӑLOjELӇXP{OiW>-3] Lӝ tuyӃQOjPӝWWuQKWUҥQJVLQKOêEuQKWKѭӡng phә biӃn ӣ nӳ giӟLÿһc biӋWOjSKө nӳ FyWKDLSKө nӳ ÿDQJGQJWKXӕc ngӯDWKDLOjPWăQJWәQJOѭӧQJHVWURJHQ WURQJFѫWKӇ [4-5@ 7UrQ WKӵc tӃ, lӝ tuyӃQ NK{QJSKҧLOjbӋQKNK{QJSKҧLOjXQJWKѭYjNK{QJҧQKKѭӣQJÿӃn khҧ QăQJVLQKVҧn cӫa phө nӳ MһFGYұy, lӝ tuyӃn CTC nӃXNK{QJÿѭӧFWKHRG}LYjÿLӅu trӏ kӏp thӡi WKѭӡng dүn ÿӃQWuQKWUҥQJYLrPQKLӉPÿѭӧc gӑLOjYLrPOӝ tuyӃn CTC &iFWULӋu chӭQJWK{QJWKѭӡng bao gӗm hiӋQWѭӧQJWăQJWLӃt dӏFKWURQJkPÿҥo, ngӭDQJi\NKtKѭFyPLchҧ\PiXkPÿҥo, chҧ\PiXKұXP{QÿDXYQJFKұX«>6] Theo thӕQJNrtӹ lӋ mҳc bӋQKQj\GDRÿӝng tӯ ÿӃn 50% [6-9]

Ӣ ViӋt Nam, YLrPOӝ tuyӃQ&7&OjPӝt trong ba loҥi bӋnh phө khoa FyWӹ lӋ mҳc phҧi cao nhҩt hiӋn nay FQJYӟi bӋQKYLrPkPÿҥRYjUӕi loҥn kinh nguyӋt Khi NK{QJÿѭӧFÿLӅu trӏ sӟPYLrPQKLӉPFyWKӇ Ok\ODQVDQJFiFEӝ phұQOkQFұQJk\ra biӃn chӭQJYLrPWҳFYzLWUӭng, ӕng dүn trӭQJYLrPQLrPPҥc CTCJk\Fҧn trӣ tiQKWUQJJһp trӭng Yj ÿk\FNJQJOjmӝt trong nhӳQJQJX\rQQKkQKjQJÿҫXJk\Y{sinh, hiӃm muӝn %rQ FҥQK ÿy QhiӅX QJKLrQ Fӭu FNJQJ chӍ ra rҵng, YLrP Oӝ tuyӃn OLrQ TXDQ ÿӃn nhiӅu loҥi bӋQK Ok\ WUX\ӅQ TXD ÿѭӡQJ WuQK Gөc bao gӗm bӋnh Chlamydia [4,10-11@ YLUXV Jk\ VX\ JLҧm miӉn dӏch ӣ QJѭӡi (Human immunodeficiency virus ± HIV) [11-12@ YLUXV X QK~ ӣ QJѭӡi (Human papilloma virus ± HPV) [13] 7uQKWUҥng YLrPOӝ tuyӃQÿӇ TXiOkXNK{QJÿLӅu trӏ FzQOjPӝt trong nhӳQJQJX\rQQKkQKjQJÿҫXJk\UDXQJWKѭCTC Ĉk\ OjFăQEӋQKXQJWKѭÿӭng thӭ WѭWURQJFiFORҥLXQJWKѭYjÿӭng thӭ KDLWURQJFiFXQJWKѭSKө khoa ӣ nӳ giӟi vӅ tӹ lӋ mҳc phҧLFNJQJQKѭWӹ lӋ tӱ vong 7URQJÿyFyNKRҧQJWUѭӡQJKӧSxҧy ra ӣFiFQѭӟFÿDQJSKiWWULӇn [14] 9uYұy, SKiWKLӋn sӟPYQJOӝ tuyӃQ&7&ÿӇ [iF ÿӏnh mӭF ÿӝ Yj WKHR G}L WLӃn triӇn cӫa bӋnh trӣ QrQ Fy ê QJKƭD Yj FҫQ ÿѭӧc TXDQWkP

HiӋQQD\WURQJOkPVjQJSKѭѫQJSKiSVRL&7&NӃt hӧp vӟi phӃt Lugol iodine SKѭѫQJSKiS9,/,