Medical Image Processing

Part II – Medical Imaging

Imaging Modalities
Electromagnetic Spectrum
◦ Depending on the energy level of the
wave, different imaging modalities arise

Ionizing Radiation
◦ Projection radiography
◦ Computed tomography
◦ Nuclear Medicine

Non-Ionizing Imaging Methods

◦ Ultrasound
◦ Magnetic resonance imaging (MRI)
Projection Radiography
Projection Radiography
History of the X-ray
◦ Invented by accident by German physicist Wilhelm Roentgen while experimenting with electron beams
and gas discharge tubes
◦ Noticed florescent screen in his lab glowed green while he performed the experiments although it was
shieled by heavy cardboard boxes (which surprised him that the radiation is penetrating)
◦ As part of his investigation, he put his hand in between the ray direction  discovering X-rays
Projection Radiography
Projection radiography  Typical X-ray systems
Why is it called “projection” radiography?
◦ This modality represents the projection a 3-D object on a 2-D image
Advantages of projection radiography
◦ Short exposure time (0.1 seconds)
◦ Production of large area image
◦ Low cost
◦ Low radiation exposure
◦ Excellent contrast and spatial resolution
Disadvantages
◦ Lack of depth resolution
◦ Superimpositions of shadows from overlying and underlying tissues sometimes “hide” important lesions 
limits contrast
Uses
◦ Screen for pneumonia, heart disease, lung disease, bone fractures, caner, and vascular diseases
Projection Radiography
How does an X-ray work?
◦ X-ray tube  generates short pulse of x-rays as a beam
◦ X-rays are shorter, higher energy waves and are produced by the movement of
electrons within atoms

◦ X-ray photons travel through the air and reach the body where they
interact with atoms
◦ As photons hit atoms, atoms absorbs some/all photons energy and excite their electron
to a different orbit level

◦ When x-rays reach the body, they can either

◦ 1) totally absorbed by the body (shows up as white on x-ray image),
◦ 2) travel through the body (at different absorption rates),
◦ 3) scattered within the body

◦ X-ray photons that are not absorbed by the body arrive at the detector
to create the x-ray image (show up dark on an image)
X-ray Photon Attenuation in the Body
When x-ray photons enter the human body, they are attenuated at
different rates depending on the material (bone, soft tissue, muscle tissue,
lungs, air, etc.) they pass through and the x-ray energies

This differential attenuation gives rise to the contrast in an X-ray image

◦ Dense material (bones, metal, etc)  shows up as white
◦ Non-absorbed rays (passing through air)  show up as black
◦ Fat and muscles show up as shades of gray

In certain circumstances, we may want to artificially change the natural

attenuation of the body prior to detecting the x-rays.
◦ Compensation filters
◦ Contrast agents
Compensation Filter
Thick body parts or dense materials (metal, bones, etc.) stop more x-rays than thinner body
parts and normal soft tissue
◦ i.e. Torso attenuates more x-rays in the middle than at its edges b/c its thicker in the middle

Compensation filter is a special shaped aluminum or a leaded plastic object that can be placed
between the x-ray source and the patient that proportions the amount of the x-ray photons
according to body “thickness”
◦ Filter is thicker where the body part is thinner and vise versa
Contrast Agents
Different soft tissues structures are difficult to visualize
because of insufficient intrinsic contrast due to small
differential attenuation.
Contrast agents introduced into the body in order to
increase x-ray absorption within specific anatomical region
 enhancing image contrast.
Three main contrast agents used for x-ray:
◦ Iodine (Z=53, Ek= 33.2 keV) enhance imaging blood vessels,
heart chambers, tumors, infections, and thyroid.
◦ Barium (Z=56, Ek= 37.4 keV) enhance imaging gastrointestinal
tract.
◦ Air (inflating the lungs) enhance imaging the lung
◦ Air does not absorb x-ray photons

** Mask mode radiography!

Scattered X-ray Photons within Body
◦ Scattered photons that reach the detector show up on the x-ray as “fog”
◦ Decreases contrast and clarity of image

◦ Scattered photon does not image the tissue it passes though in the right
location of the image, so it causes fog in the image
◦ This fog is an artifact and is due to the “randomness” of the scattered x-rays

◦ Methods to reduce the effects of scatter in radiography:

◦ 1- Grids  thin strips of lead that when carefully placed allow photons that travel from source to
detector to pass and photons that arise from scattering area absorbed by lead grid
◦ 2- Air gaps  Provide small air gap between film and body to allow scattered photons to escape but
this increases blurring in x-ray image
◦ 3 - Image processing  noise removal, image sharpening, power-law transforms, etc.
Detector
Two main x-ray detectors:
1. Film-Screen
Intensifying screens are used to stop most of the incoming x-rays and convert them to light to
expose the photographic film.
◦ How?  through phosphor (Phosphor: transform x-ray photons into light photons. )
◦ The photographic film is sensitive to light
◦ The light photons then travel into the film, causing it to be exposed and to form a latent image.

2. Digital X-ray detectors

The image is converted to digital data in real-time and is available for review within seconds
◦ Uses x-ray sensitive plates that converts x-ray photons to a small flash of optical photons
◦ The optical photons hit the surface of a 2-D grid of photodiodes (flat panel of digital detectors),
converting the information into electrical signals that can be reconstructed to produce the image
Computed Tomography
(CT)
Computed Tomography
Computed tomography (CT) uses a combination of X-rays and a computer to create images of
organs, bones, and tissues.
Images are produced by rotating a thin x-ray beam around an area of the body, generating
multiple images of the internal structure from many angles.
Computer uses the images and a reconstruction algorithm to create a cross-sectional image of
the imaged structure
The multiple cross-sectional images are then stacked to create a 3-D image of the structure
Computed Tomography
X-RAY CT

 Creates 2D images  Creates 3D images

 Expensive and not easily available in rural and small
Inexpensive and easily available hospitals

 Internal organ injury details are not easily  Used to produce deep and high-quality images
visible  uses 360-degree X-ray beam and images are digitals
(seen on a computer screen)
 Can focus on a target area better than X-ray
 Doctors use them to guide treatment plans and
procedures, such as biopsies, surgeries, and radiation
therapy.
 CT allows you to not only locate where a tumor is (via
X-ray imaging), but also measure its shape and size (b/c
the 3D reconstructed image)
Computed Tomography
Anteroposterior chest X-ray VS CT scan chest demonstrating pneumothorax (collapsed lung)

Anteroposterior chest X-ray revealing no evidence of pneumothorax (Image A).

CT chest performed immediately after X-ray indicates pneumothorax (Image B)
Image Enhancement for CT
Image Enhancement for CT in the Lit
Enhancement variable K

Enhancement algorithm:

Enchantment architecture:

Before After
Nuclear Medicine
Nuclear Medicine
X-ray and CT rely on the transmission of photons through the body to form images and allow us to view structural
information of areas of the body.
Nuclear medicine relies on the emission of photons from within the body to examine both functional and structural
information of certain organs.
◦ Different radionuclides travel through the blood to different organs and are held in normal and abnormal tissues differentially

How does nuclear medicine work?

◦ Uses small amounts of radioactive materials (“radiotracer”) to examine organ function and structure.
◦ Radiotracers emit ionizing radiation upon decay.
◦ Radioactive decay is a function of time. As time passes, the radiotracers emit ionizing radiation characterized by certain energies and
half-lives.
◦ As the radiation is being emitted from the body, it is captured via different imaging methods.

The properties of the radiopharmaceuticals can be altered to distribute to different tissues (bone, tissue, etc.)
After injection of radiotracer, imaging is done after some time to detect area of primary abnormal accumulation of the
radiopharmaceutical (takes place in active tissues)
◦ Can be used to detect cancer tissue, inflamed or necrotic tissues, etc.
Nuclear Medicine
Benefits of nuclear medicine:
◦ Functional imaging  assess the functions of various part of the body
◦ Diagnostics  can detect diseases earlier than other diagnostic methods

Three main forms of nuclear medicine images:

◦ Planar Scintigraphy
◦ Single photon emission computer tomography (SPECT)
◦ Pistron emission tomography (PET)
Planar Scintigraphy (Gamma Scan)
Planar images are formed by projection (as in projection radiography – normal X-ray)
Here we are interested not in total intensity of the radiation, but in the detected decay rate PER TIME.
Thus, nuclear medicine images are built event-by-event and result in 2D images.

In planar scintigraphy, subject lays under the scintillation

camera after being injected by the radiotracer.
The Scintillation crystals capture the emitted
electromagnetic radiation and convert it to light photons
that are then captured by photomultiplier tubes and get
transformed into an electrrical signal
SPECT
SPECT imaging is similar to planar imaging, except now we are able to
produce 3D image information via cross-sectional slices through the
patient.
How?
◦ Patient is injected with gamma-emitting radioisotope
◦ SPECT imaging is performed by using a gamma camera to acquire multiple 2-D
images (called projections), from multiple angles.
◦ A computer program applies a tomographic reconstruction algorithm to
multiple projections, yielding a 3-D data set.
Uses:
◦ Functional brain imaging – allows cerebral blood flow to be assessed
◦ Myocardial perfusion imaging – functional cardia imaging for diagnosing heart
disease
◦ Determining which parts of the brain are being affected by epilepsy and
seizures, dementia, clogged blood vessels, etc.
◦ Bone fracture and cancer in bones Areas of bone healing or cancer
progression usually light up on SPECT scans
 PET
Main different between SPECT and PET is the type of radiotracers
used.
SPECT uses gamma-rays directly emitted by radiotracer
PET uses special radiotracers that produce small particles called
positrons.
A positron is a particle with roughly the same mass as an electron
but oppositely charged.
What happens when positrons and electrons meet?
◦ Positrons react with electrons in the body and when these two particles
combine they annihilate each other.
◦ This annihilation produces a small amount of energy in the form of two
photons (gamma rays) that shoot off in opposite directions.
◦ The detectors in the PET scanner measure these photons and use this
information to create images of internal organs.
PET
PET
Ultrasound
Ultrasound
Ultrasound scans uses high-frequency sound waves (above 20kHz) to
create images.
It uses a transducer that has piezoelectric crystals that converts electrical
signals to acoustic signals and vise-versa.
Transducer transmit ultrasound waves into the body that then hit and are
reflected from various tissues with different densities and characteristics
◦ creating various “echoes” traveling back to the transducer
The reflected echoes are captured by the transducer and converted into a
signal.
A computer then transforms the electrical into points of brightness on an
image that correspond to the anatomic position and strength of reflected
echoes
Ultrasound requires transducer motion to create an image with a
suitable range-of-view.
Ultrasound
Advantages:
◦ Non-ionizing imaging modality
◦ Good for soft-tissue imaging that do not show up clearly by x-ray
◦ Excellent for blood-flow analysis
◦ Fairly inexpensive
◦ Can be repeated often

Disadvantages:
◦ Poor resolution
◦ Cannot image any anatomical structure with air (lungs or bowl)
◦ Operator dependent
◦ Not good for head or neck imaging as ultrasounds are absorbed by bones
MRI
MRI
•Produces cross-sectional images of the human body in any
direction
•Can be used to visualize strokes, inflammation, cancers, and
damage to muscles and tendons, and imaging blood vessels
and the heart
 MRI
•Human body consists of mainly… water (H2O). The hydrogen nuclei contains
protons that spin randomly.
•MRIs employ powerful magnets which produce a strong magnetic field that
forces protons in the body to align with that field.
•When a radiofrequency current applied, the protons are stimulated, and
spin out of equilibrium, straining against the pull of the magnetic field.
•When the radiofrequency field is turned off, the proton return to their
alignment of the magnetic field and release electromagnetic energy
•MRI sensors are able to detect the electromagnetic energy released
•The time it takes for the protons to realign with the magnetic field, as well
as the amount of energy released, changes depending on the environment
and the chemical nature of the molecules.
•Physicians are able to tell the difference between various types of tissues
based on these magnetic properties
MRI
MRI
ADVANTAGES DISADVANTAGES

Excellent soft tissue resolution Long imaging time

Non-ionizing Patient must remain motionless
Multi-plane imaging Cannot be used on patients with pacemakers
or any metallic devices in body
Functional MRI  brain activity assessment by
measuring blood flow and neuronal activation
(color coding dependent on strength of
activation (bloodflow) across brain )