Neural Comput & Applic
DOI 10.1007/s00521-013-1437-4
ORIGINAL ARTICLE
Adaptive k-means clustering algorithm for MR breast image
segmentation
Hossam M. Moftah • Ahmad Taher Azar •
Eiman Tamah Al-Shammari • Neveen I. Ghali
Aboul Ella Hassanien • Mahmoud Shoman
Received: 12 February 2013 / Accepted: 22 May 2013
Ó Springer-Verlag London 2013
Abstract Image segmentation is vital for meaningful
analysis and interpretation of the medical images. The most
popular method for clustering is k-means clustering. This
article presents a new approach intended to provide more
reliable magnetic resonance (MR) breast image segmen-
tation that is based on adaptation to identify target objects
through an optimization methodology that maintains the
optimum result during iterations. The proposed approach
improves and enhances the effectiveness and efficiency of
the traditional k-means clustering algorithm. The perfor-
mance of the presented approach was evaluated using
various tests and different MR breast images. The experi-
mental results demonstrate that the overall accuracy
H. M. Moftah
Faculty of Computers and Information,
Beni Suef University, Beni Suef, Egypt
e-mail: hossamm@gmail.com
H. M. Moftah  A. T. Azar  N. I. Ghali  A. E. Hassanien
Scientific Research Group in Egypt (SRGE), Cairo, Egypt
e-mail: nev_ghali@yahoo.com
URL: http://www.egyptscience.net
A. T. Azar (&)
Faculty of Computers and Information,
Benha University, Benha, Egypt
e-mail: ahmad_t_azar@yahoo.com; ahmad_t_azar@ieee.org
E. T. Al-Shammari
Faculty of Computing Science and Engineering,
Kuwait University, Kuwait City, Kuwait
e-mail: dr.eiman@ku.edu.kw
N. I. Ghali
Faculty of Science, Al-Azhar University, Cairo, Egypt
A. E. Hassanien  M. Shoman
Faculty of Computers and Information, Cairo University,
Cairo, Egypt
•
provided by the proposed adaptive k-means approach is
superior to the standard k-means clustering technique.
Keywords K-means clustering  Image segmentation 
Magnetic resonance (MR) image  Breast cancer 
Adaptive segmentation
1 Introduction
Breast cancer is one of the major causes of death all over
the world [1]. It comprises 22.9 % of all cancers in women
[2]. Such a disease requires efficient and accurate diagnosis
to ensure quick and effective treatment. Unfortunately,
accurate diagnosis of mammogram images is difficult and
time-consuming. The development of a computer-aided
diagnosis (CAD) system to assist radiologists in the
detection and classification of breast cancer has been
studied previously [3]. A CAD system is a set of automatic
or semi-automatic tools developed to assist radiologists in
the detection and/or classification of mammographic
abnormalities [4, 5]. The diagnosis system is composed of
a segmentation method, a set of features for classification,
and a classifier [6].
Image segmentation is one of the most crucial tasks in
image processing because it is the main factor in deter-
mining the quality of image analysis. It is also an initial and
substantial step in a series of processes required to best
understand image information [7–10]. The aim of image
segmentation is to partition an image into semantically
interpretable regions with respect to a particular application
and to recognize homogeneous regions within the image as
distinct and belonging to different objects [11].
Segmentation algorithms can be categorized into edge-
based segmentation, region-based segmentation, and data
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clustering. In edge-based techniques, the edges detected in
an image are used for representing object boundaries to
identify these objects. In region-based segmentation, a
region-based technique takes the opposite approach, by, for
example, starting from the middle of an object and then
moving outward until the object boundaries [11– 13].
Data clustering algorithms are based on the whole image
and consider the distance between data. In data clustering,
each pixel of a cluster is not certainly connective. Clus-
tering algorithms can be divided into hierarchical and
partitional techniques [14, 15]. Hierarchical clustering is a
sequential partitioning process, which results in a hierar-
chical nested cluster structure, and partitioning clustering is
an iterative partitioning process [16]. Hierarchical cluster-
ing, also known as connectivity-based clustering, is based
on the core idea of objects being more related to nearby
objects than to objects farther away. These methods con-
nect objects to form clusters on the basis of their distance.
A cluster can be described by the maximum distance
needed to connect its parts. Partitioning clustering can be
divided into hard (or crisp) and fuzzy methods [17]. In hard
partitioning clustering methods, each object of the data set
must be assigned to precisely one cluster; hence, the
clusters in a hard partition are disjoint. The major draw-
back of the hard clustering technique is that it may lose
some important information which causes such a grouping
to become meaningless. K-means clustering [18] and par-
titioning around medoids [19, 20] are well-known tech-
niques for performing difficult partitioning tasks. A fuzzy
cluster analysis therefore allows gradual memberships of
data points to the clusters in [0, 1]. This gives the flexibility
to express the fact that the data points belong to more than
one cluster at the same time.
The classical segmentation-based clustering follows a
well-known path that involves several processes including
pattern representation and its available number, and the
scale of the features available to the clustering algorithm.
Some of this information may not be controllable by the
practitioner. In addition to the feature selection, the most
effective subset of the original features is identified for use
in clustering [12]. Further, feature extraction can be defined
as the use of one or more transformations of the input
features to produce new salient features. Either or both of
these techniques can be used for obtaining an appropriate
set of features to use in clustering [21]. In the context of
selecting the list of suitable features, there is a possibility
of selecting a list of multiple features on the basis of the
goal of image segmentation. For instance, while segment-
ing a medical image on the basis of an MRI scan, multiple
features related to intensity, shape, and spatial relationship
can be considered. Feature-based segmentation has several
disadvantages such as if the process of clustering took
place inaccurately, consequently, the segmentation as a
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Neural Comput & Applic
whole will lead to incorrect results, and the final result of
the segmentation would be unchangeable.
We present an efficient segmentation algorithm to over-
come the disadvantages in classical segmentation methods,
such as the k-means clustering algorithm. Clustering and
breast cancer segmentation are performed in parallel using
the concept of adaptation. The k-means algorithm is
enhanced using adaptation phases. In each phase, an
assessment process that compares goodness between the
current phase and the previous one is performed. This pro-
cess then decides whether to store the current clusters or re-
cluster from the last state to generate new clusters.
All the results were compared using different types of
evaluation measures, such as texture-based methods
(entropy, standard deviation, and mean), shape-based
(circularity, orientation, and solidity), and accuracy that
highlights segmentation accuracy.
This paper is organized as follows. Section 2 describes
the related works. Section 3 provides background infor-
mation on k-means clustering. The adaptive k-means seg-
mentation approach is discussed in Sect. 4. Section 5
reports the results of experimental evaluations and com-
parative analysis. Finally, conclusion and future work are
discussed in Sect. 6.
2 Related works
Imaging has become an important component in different
fields of medical and laboratory studies and clinical prac-
tice. [22]. MR imaging (MRI) is a relatively recent diag-
nostic method for the breast, and the role of MRI in breast
cancer diagnosis is evolving. Recently, intelligent tech-
niques, such as artificial neural networks (ANN) [23],
fuzzy sets [24, 25], and support vector machines (SVM),
are being used for image segmentation [26]. Kang et al.
[27] proposed an improved method of breast MRI seg-
mentation with simplified k-means clustered images. In the
same direction of the research, authors in [28] introduced a
comparison between the performance evaluation of meth-
ods used in breast cancer image segmentation. Some of the
recent classification results obtained by other studies for
breast image segmentation are presented in the Table 1.
3 Preliminaries
3.1 Standard k-means clustering
K-means clustering is an algorithm to group objects based
on the features into k number of groups. Grouping is
achieved by minimizing the sum of the squares of distances
between data and the corresponding centroid of the cluster.
Neural Comput & Applic

Table 1 Related work of recent studies in MRI image segmentation

Author Method Accuracy

Hassanien et al. [29] Support vector machines (SVM) and pulse-coupled Proposed SVM (98 %), compared with the following:
neural networks rough sets (92.5 %), neural network (91 %), decision
trees (89 %), and fuzzy artmap (88 %)
Al-Faris et al. [30] Modified automatic seeded region growing based on RO mean of the proposed method (0.704), TNF mean
PSO (0.851), TPF mean (0.792), and MCS mean (0.209)
Ertas et al. [31] Cellular neural networks and 3D template matching Detection sensitivity of the proposed method = 100 %,
false-positive detections (31 %/lesion, 10 %/slice)
Preim et al. [32] Computer-aided diagnosis in breast DCE-MRI Significant differences of the proposed method(p \ 0.005;
AUC 0.7)
Li et al. [33] Nonrigid registration algorithm The mean error and the standard deviation of the proposed
method (0.59 ± 0.25 mm for the tumor contracted by
70 %; 0.58 ± 0.27 mm for the tumor contracted by 95
%), compared with the unconstrained ABA algorithm
(1.13 ± 0.42 mm for the tumor contracted by 70 %;
1.49 ± 0.65 mm for the tumor contracted by 95 %))
Wei et al. [34] Adaptive moment preserving method for MAE and RMSE of AMP were 9.2 and 12; MAE and
segmentation of fibroglandular tissue (AMP) RMSE of FCM were 14.5 and 17.7
Joshi et al. [35] Nonparametric mixture model within level set For patient number 1: Minimum circumferential resection
framework margin (CRM) using the proposed approach = 0 mm,
CRM of the manual result = 0 mm. For patient number
10: CRM = 3.7 mm, CRM of the manual result = 3.2 mm
Lucht et al. [36] Neural network-based segmentation Dynamic MRI examination of a 43-year-old woman with a
carcinoma in the right breast (patient number 1): Results
of the pharmacokinetic analysis. Each of the 16 colors
represents a combination of discrete levels of the
pharmacokinetic parameters amplitude A (0.02 B A B
0.6, 0.6 \ A B 1.2, 1.2 \ A B 1.8, and A [ 1.8)
Chen et al. [37] An iterative scheme utilizing the combination of The range and the mean ± standard deviation of CV for FV
nonparametric nonuniformity normalization (N3) measured from left and right breasts, as well as the left-to-
and fuzzy C-Means (FCM)-based algorithms right difference: The mean CV was 7.5 % for left breast,
(noted as N3?FCM) also 7.5 % for right breast, and the mean left-to-right
difference is relatively small, 1.2 % ± 1.1 %
Kannan et al. [38] Kernel FCM in segmentation Silhouette width (SW) of the proposed method = 0.78, SW
of standard fuzzy c-means = 0.52

The main idea is to assign k-centroids for each cluster; in this case, a squared-error function. The objective func-
however, a better way to select k is to place them as far tion is defined as follows:
away from each other as possible and associate each data
point in a given data set with the nearest centroid. This first X
x X
k

step is complete when there are no longer points pending J¼ kxij  Cj k2 ð1Þ
j¼1 i¼1
[15]. At this point, k new centroid must be recalculated as
barycenters of the clusters resulting from the previous step. where kxij  Cj k2 is a distance measure between a data
Given these new k new centroids, a new binding between point and the cluster center. This is an indicator of the
the same data set points and the nearest new centroid must distance between the n data points and their respective
be performed [15]. The k centroids change their location cluster centers. Algorithm (1) shows the steps for seg-
iteratively until no more changes occur. Finally, the menting images into regions using the k-means clustering
k-means algorithm aims to minimize an objective function, algorithm.

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4 Adaptive k-mean segmentation approach
In this study, the adaptive k-means segmentation technique
will be used to segment breast MRI images to diagnose breast
cancer in women. Unlike the standard k-means, two addi-
tional features are considered in the segmentation process:
brightness and circularity. These features are included
because brighter and more circular objects are commonly
identified as breast cancer. Figure 1 shows a block diagram
of the proposed approach. As shown in Fig. 1, the presented
approach is comprised of two fundamental phases: the ini-
tialization phase and the adaptive segmentation phase.
1. Initialization phase An image clustering process using
k-means is applied for a low number of iterations
n (i.e. n = 10 iterations), and a goodness function is
calculated. This phase is the first iteration of the
proposed adaptive segmentation approach.
2. Adaptive segmentation phase Image clustering and
breast cancer segmentation processes are performed.
K-means clustering is applied for new n number of
iterations (i.e., n = 10 iterations) starting from the last
iteration in the initialization phase. This process
contains several sub-processes: feature-based calcula-
tion, feature-based evaluation process, new centers
generation process, and object selection.
These two phases are described in detail in the following
section along with the steps involved and the feature
characteristics for each phase.
4.1 Initialization phase
The initialization phase is the first step of the adaptive
segmentation approach by applying k-means clustering for
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Neural Comput & Applic
n iterations. New centers are distributed to create the initial
new clusters. Goodness is calculated for the first time in
this iteration. The goodness function is defined as the
average circularity of all resulting objects. The circularity
ratio is the ratio of the area of the shape to the area of a
circle with equal perimeter, which is expressed mathe-
matically as:
4PA
fcirc ¼ ð4Þ
P2
where P and A are the perimeter and area of the object,
respectively. The fcirc function is equal to one for a circle
and less than one for any other shape. The area is obtained
using the total number of pixels in each separated cluster.
The goodness function is calculated using Eq. (5).
PM
fcirci  Ai
GOODNESS ¼ i¼1 PM ð5Þ
i¼1 Ai
where fcirci is the circularity ratio of ith object and Ai is the
area of the ith object. The object circularity ratio is mul-
tiplied by the object area to maximize the values of large
objects and minimize the values of small objects.
4.2 Adaptive segmentation phase
The adaptive segmentation phase is the core of the pro-
posed algorithm. In this phase, the k-means algorithm is
applied for another n iterations starting from the last iter-
ation(initialization phase). The feature-based calculation
process is applied to recalculate goodness using Eq (5).
Then, the feature-based evaluation process is applied, to
compare the current goodness with the goodness of the last
iteration. If the current goodness is better, that is, the new
goodness value is less than the previous value, then the
Neural Comput & Applic

Fig. 1 Block diagram of the proposed approach

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current state is stored and the old results are destroyed. In 5 Experimental results and comparative analysis
the case that the current goodness is worse (new goodness
value is greater than the previous value), the new centers 5.1 Evaluation measures
generation process is applied to generate new clusters from
the brightest two clusters (target objects) and store other Segmentation performance was evaluated using perfor-
clusters without change using Algorithm (2). These pro- mance indices such as accuracy, entropy, standard devia-
cesses are repeated until the goodness result remains tion, and mean. Betanzos has previously defined an
unchanged or the number of algorithm iterations N is accuracy measure with multiple object types of an object
reached. Finally, the object selection process is applied to [39]. Suppose that an image contains N object types. The
select the most circular objects (circularity ratio close to 1). accuracy measure is computed using Eq. (9):
The proposed system has been developed completely in our X
N
CSP
laboratory. The proposed adaptive segmentation algorithm Accuracy ¼ ð9Þ
is described in detail in Algorithm (3). i¼1
TNP

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where CSP is the correct segmented pixel in ith object and
TNP is the total number of pixels in the ith object. The
accuracy measure determines how different the segmented
image is from a region manually segmented by an expert.
Texture-based measures such as mean(measure of
brightness), entropy(measure of randomness), and stan-
dard deviation(measure of contrast) have been proven to
be computationally efficient [40, 41]. Shape-based mea-
sures such as orientation(measure the angle in degrees
ranging from -90 to 90° between the x-axis and the
major axis of the ellipse that has the same second
moments as the region) and solidity (measure the pro-
portion of the pixels in the convex hull that are also in the
region). The circularity ratio is the ratio of the area of the
shape to the area of a circle having the same perimeter,
which is expressed in Eq. (4).
In medical research, supervised evaluation is widely
used. Such evaluation computes the difference between the
ground truth and the segmentation result using a given
evaluation metric [39]. In this paper, the manual segmen-
tation is used to reflect the ground truth. Furthermore,
segmentation algorithms are evaluated by comparing the
result from a segmented image against the result from a
manual segmented, which is often referred to as a gold
standard [39] or ‘‘ground truth.’’ The degree of similarity
between the manual segmented and machine segmented
images reflects the accuracy of the segmented image.
Fig. 2 Breast cancer segmentation using the proposed method (sample 1): a original breast image (BS1); b iteration 1; c iteration 5; d iteration
7; e iteration 10; and f selected objects (final result)
5.2 Experimental results
This section discusses segmentation results generated from
different images with varying the value of k. First, for
breast MRI gray-scale images, the proposed algorithm is
applied. Then, a comparative analysis, based on the seg-
mentation accuracy, between results obtained from the
proposed algorithm and the results previously obtained by
applying the k-means segmentation algorithm to the same
dataset are discussed.
For the assessment of the quality of the segmentation
results, three types of evaluation measures such as accu-
racy, texture-based measures (entropy, standard deviation
(STD), and mean), and shape-based measures (circularity,
orientation, and solidity) are used to determine how far the
actually segmented image is from the ideal one. All results
were compared using the segmentation accuracy measure
to assess the strength of both algorithms to segment the
affected part in the investigated organ.
Experiments were performed using the proposed adap-
tive k-means and standard k-means algorithms on medical
images. The images used in our experiments were collected
from the MRI scans of breast cancer patients with general
intrinsic tissue variation.
Figures 2, 3, 4, 5, 6 show the experimental results that
highlight the segmentation accuracy for three breast MRI
samples (BS1, BS2, and BS3) selected from the total
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 Neural Comput & Applic

Fig. 3 Breast cancer segmentation using proposed method (sample 2): a original Breast Sample 2 image(BS2);b iteration 1; c iteration
5;d iteration 7;e iteration 10; and f selected objects (final result)

Fig. 4 Breast cancer segmentation using proposed method (sample 3): a original Breast Sample 3 image (BS3); b iteration 1; c iteration 5;
d iteration 7; e iteration 10; and f selected objects (final result)

examined breast MRI samples. As shown in Figs. 2, 3, 4,
the results are based on the images of the segmented
regions that represent the affected part of the breast using
the proposed algorithm. Figures 2, 3, and 4 display four
iterations (1, 5, 7, and 10 iterations) and selected objects
that represent the final result. There were 10 iterations in
total. Figure 2a–f show the original breast MRI images for
sample 1(BS1) using the proposed approach, results for
iterations 1, 5, 7, and 10, and the final objects selected to
represent the segmented results, respectively. The result
presented in Fig.2f outperformed the standard k-means
result presented in Fig. 5c when compared with the man-
ually segmented region of interest (ROI) from the anno-
tated sample 1 (BS1) presented in Fig. 5a.

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Neural Comput & Applic

Fig. 5 Comparative results. Proposed approach versus k-means segmentation for breast MRI images: a manual breast cancer segmentation
(ideal case); b breast cancer segmentation using the proposed approach; c breast cancer segmentation using standard k-means

Fig. 6 Goodness distribution in each iteration for each sample a goodness distribution for sample 1(BS1); b goodness distribution for sample
2(BS2); and c goodness distribution for sample 3(BS3)

Similarly, Fig. 3a–f illustrate the original and resulting
breast MRI image for sample 2 (BS2). The achieved result
presented in Fig. 3f outperformed the k-means result pre-
sented in Fig. 5c.
Similarly, Fig. 4a–f illustrate the original and resulting
breast MRI image for sample 3 (BS3). The achieved result
presented in Fig. 4f outperformed the k-means result pre-
sented in Fig. 5c.
Figure 5 shows comparative results that highlight the
segmentation accuracy of both the proposed adaptive
k-means and the standard k-means algorithm for the
examined breast MRI samples. Figure 5a–c show the

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desired manually segmented region for the examined breast

MRI samples (BS1, BS2, and BS3), the results for this
region using the proposed algorithm, and the standard
k-means algorithm, respectively.
Figure 6a–c show the goodness distribution for each
iteration of the examined breast MRI samples (BS1, BS2,
and BS3). The segmentation accuracy for the ROI, which is
the area that contains cancer, was also evaluated.

5.3 Comparative analysis

This section describes a comparative analysis using dif-

ferent evaluation measures such as accuracy, texture-based
Fig. 7 Comparative analysis using accuracy measure (proposed
method vs. k-means) measures (entropy, standard deviation (STD), and mean),
and shape-based measures (circularity, orientation, and
solidity). Figure 7 depicts a comparative analysis that
Table 2 Evaluation measures of manual segmentation results: breast highlights the segmentation accuracy of both the proposed
samples (BS1, BS2, and BS3) k-means and standard k-means algorithms for the exam-
Measures BS1 BS1 BS2 BS3 BS3 ined breast MRI samples. The comparative analysis was
(Obj1) (Obj2) (Obj1) (Obj1) (Obj2) performed for ROI in the segmented images as shown in
Fig. 5.
Entropy 0.9859 0 0.9911 0.9111 0.9873
As presented in Fig. 7, for the examined breast MRI
STD 0.4952 0 0.4973 0.4689 0.4961
samples (BS1, BS2, and BS3), the average accuracy of the
Mean 0.5697 0 0.5556 0.6737 0.5663
segmented ROI using the proposed approach was 89.47 %
Circularity 0.4256 0.7345 0.5274 0.6111 0.5725
(90.83 % for BS1, 87.77 % for BS2, and 89.81 % for
Orientation 81.7690 -7.6651 -63.1427 -51.8649 7.6776
BS3). The average accuracy of the segmented ROI using
Solidity 0.7957 0.8824 0.8068 0.8808 0.8667
standard k-means was 69.19 % (44.01 % for BS1, 77.04 %
for BS2, and 86.54 % for BS3).
Tables 2, 3, and 4 show a comparative analysis that
Table 3 Evaluation measures of proposed algorithm segmentation highlights the segmentation evaluation for both the pro-
results: breast samples (BS1, BS2, and BS3)
posed k-means and standard k-means algorithms, and a
Measures BS1 BS1 BS2 BS3 BS3 comparison with the manual segmentation results, respec-
(Obj1) (Obj2) (Obj1) (Obj1) (Obj2)
tively. The evaluation measures classified into two types of
Entropy 0.9989 0 0.9664 0.8379 0.9973 measures: texture-based measures (entropy, standard
STD 0.4997 0 0.4889 0.4427 0.4996 deviation (STD), and mean) and shape-based measures
Mean 0.5195 0 0.6075 0.7325 0.5307 (circularity, orientation, and solidity).
Circularity 0.2860 0.5884 0.6512 0.7049 0.4291 Table 2 shows the evaluation measures of the manual
Orientation 80.2057 -2.5617 -68.1403 -44.8950 -25.6164 segmentation results for the breast samples (BS1, BS2, and
Solidity 0.7335 0.8000 0.8738 0.9126 0.7908 BS3)(number of connected objects = 2 for BS1, 1 for BS2
and 2 for BS3).
Table 3 shows the evaluation measures of the proposed
algorithm for breast samples (BS1, BS2, and BS3)(number
Table 4 Evaluation measures of k-means segmentation results: of connected objects = 2 for BS1, 1 for BS2 and 2 for BS3),
breast samples (BS1, BS2, and BS3) respectively.
Measures BS1 BS1 BS2 BS3 BS3 Table 4 shows the evaluation measures of the standard
(Obj1) (Obj2) (Obj1) (Obj1) (Obj2) k-means algorithm results for breast samples (BS1, BS2,
Entropy 0.9913 0 0.9993 0.9309 0
and BS3)(number of connected objects = 2 for BS1, 1 for
STD 0.4972 0 0.5002 0.4759 0
BS2 and 2 for BS3). The comparative analysis highlights
Mean 0.5547 0 0.4840 0.6535 0
that the proposed approach outperformed the standard
k-means method in different evaluation measures.
Circularity 0.1969 1.0936 0.5460 0.5625 0.6745
The comparative analysis highlighted that the achieved
Orientation 84.6609 37.8190 -69.5785 -51.2629 10.1873
results of the proposed approach outperformed k-means
Solidity 0.7140 0.9167 0.6630 0.8620 0.8673
when using different evaluation measures. For instance, the

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results achieved using the proposed approach for
BS3(Obj2) were as follows: Entropy = 0.9973, STD =
0.4996, Mean = 0.5307, those achieved using k-means
were as follows: Entropy = 0, STD = 0, Mean = 0, and
using the manual segmentation were as follows: Entropy =
0.9873, STD = 0.4961, Mean = 0.5663.
6 Conclusions and future work
Segmentation is vital in most tasks requiring image analysis.
The success or failure of such tasks is a direct result of the
success or failure of segmentation. It links the gap between
low-level image processing and high-level image process-
ing. An efficient breast cancer segmentation algorithm was
presented that employs adaptation to identify target objects
through an optimization methodology that maintains the
optimal result during its iterations. The process of segmen-
tation is implemented by using the concept of adaptation in
each iteration and maintaining the best results. The results
showed that the proposed algorithm succeeds in improving
the conventional method. The examined breast MRI samples
may contain different objects which may be mixed with other
objects. The proposed system outperformed standard
k-means by approximately 51.5 % in sample 1 BS1
(162*180), 12 % in sample 2 BS2(179*251), and 3.5 % in
sample 3 BS3 (370*216).
The benefits of the proposed algorithm are as follows:
(1) We do not need additional operations after clustering to
identify the target objects (breast cancer), because breast
cancer segmentation and identification are performed dur-
ing image clustering process. (2) The proposed method
improves and enhances the effectiveness and the efficiency
of the traditional k-means clustering algorithm. (3) We
recommend the proposed method to be used in medical
image segmentation particularly the segmentation and
recognition of cancers, because the major types of cancers
are circular; therefore, the proposed method is very useful
in medical diagnosis and medical image analysis.
Future work may include using adaptation in different
algorithms, such as bio-inspired algorithms, and adding new
goodness functions to solve new medical imaging problems.
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