MEDICAL IMAGING SYSTEMS

CHALLENGES
BY
NZOTTA CHRISTIAN. Ph.D
NNAMDI AZIKIWE UNIVERSITY
NNEWI CAMPUS. ANAMBRA STATE.
 CONTENT
What is Medical Imaging:
Analogue & Digital Imaging

Features of Medical Image.

Geometrical properties
Photographic properties (visibility)

Limitations of Analogue Imaging

Digital versus conventional: similarities & differences

Digital Image characteristics.

Digital Image Acquisition

Digital Flouroscopy
Digital Radiography
Computed Radiography (CR)
Direct read out Digital Radiography (DR)

Digital Image processing

Digital Image display

CRT or Video Monitor
Laser camera printing

Digital Image Quality: Resolution, Density, Contrast & Noise.

Digital Communication Network.

Challenges; personnel, equipment, information

 Medical Imaging:

• This is the production of Images of different

anatomical parts of the body using radiation for
medical application. The Images could be
analogue or digital.
Features of Medical Image
 Radiographic

• Image receptor
• Differential absorption
• Attenuation
• Ionization
• Scattering
• Transmission
• Exit Radiation
 Other forms of medical imaging
• Sonography
• Magnetic Resonance Imaging
• Thermography
• C.T. Imaging
• S.P.E.T.
• Interventional Radiography
• Photography
• ETC
 Properties of Medical Image
• Photographic (visibility of recorded details)
• Density.
• Controlling factors – Milli amperes . Time[Mas]
• Influencing Factors: Kilo voltage, Distance, Grid, Film subject
distance, collimation, ATP, Anode heel, reciprocity law,
Generator output, filtration and processing.
• Contrast
• Controlling Factors: Kilo voltage
•
• Influencing Factors:
• Grid, Collimation, Antero posterior Thickness, Contrast
media, Image processing, Object-to-image receptor distance
 Properties of Medical Image
• Photographic (visibility of recorded
details) Geometric
• Density. • Sharpness
• Controlling factors – MiLli amperes . • Distortion
time • The unsharpness could be,
• Influencing Factors: Kilovoltage, Geometric, Receptor or motion
Distance, Grid, Film subject distance, unsharpness and it could also be
collimation, ATP, Anode heel, distortion of size and shape.
reciprocity law, Generator output, •
filtration and processing.
• Contrast
Controlling Factors: Kilo voltage
Influencing Factors:
• Grid, Collimation, Antero posterior
Thickness, Contrast media, Image
processing, Object-to-image receptor
distance
•
 Limitations of Analogue Imaging

• Superimposition of various body thicknesses.

• Limits visibility if a wide range of structures within the same anatomical part.
• Differentiation of soft tissue structures is limited because the attenuation of
the x-ray beam among the soft tissue is so similar that the contrast is very
poor providing a poor visualization.
• Once the Image has been processed, the Image is permanent and cannot be
adjusted further. If the Image has too much density, it cannot be altered and
must be repeated causing too high exposure dose to the patient.
• The information on the radiograph is limited depending on the densities. The
radiograph does not provide any quantitative information about the
attenuation characteristics of the anatomical tissues.
• Processing time, storage and archival of radiographs have created undesirable
delays and costs.
DIGITAL VERSUS CONVENTIONAL IMAGING,

Similarities Differences

• Appropriate exposure factors must be • The digital Image receptor

selected for the two procedures.
• Proper positioning of patient for all
can respond to a wider
the views is needed for proper Image range of x-ray exposures
visualization. (wide dynamic scale).
• The same accessories and devices are
required like grids and collimators.
• The response of the Image
• Image receptor receives the varying receptor in digital Imaging is
radiation intensities exiting the linear as opposed to the
anatomical part.
curvilinear for radiographic
• Although the Image receptor is
different a latent Image is still film.
processed to form the manifest Image. •
 Differences
• Digital can display a greater range of
radiographic densities.

• An Imaging Systems dynamic range can be

expressed numerically as a ratio, the greater
the ratio, the greater the dynamic range.
 Characteristics of digital Images
• The digital Image is composed of numerical
data that can be easily manipulated by a
computer by post processing enhancement.
This process allows for the manipulation of
the Image in a variety of ways such as
subtraction contrast and edge enhancement.
 DIGITAL IMAGE CHARACTERISTICS
• The location of the Pixel within the Image
matrix corresponds to an area within the
patient or volume of Tissue. For a given
anatomical area (Image size) a matrix size of
1024 x 1024 has 1,048,576 Individual pixels
while a matrix size of 2048 x 2048 has 4
194,304. Image quality is improved with a
larger matrix size that includes a greater
number of smaller pixels.
 D. IMAGE CHARACTERISTICS
• A numerical value (bit) representing a shade of grey is stored in each pixel. This
shade of grey is viewed as brightness on a cathode ray tube (CRT) or video
monitor.
• The Brightness in each pixel is represented by a long list of digital numbers
(digital code). Each number represents the intensity of a pixel and the numbers
location in the list represents the pixels representation on the Image. Each
pixel represents a volume of tissue Imaged.
• Each pixel has a bit dept and the number of bits determines the number of
shades of gray the system is capable of displaying on the digital Image. An 8-bit
pixel can display 256 shades of gray where as a 10-12 bit can display 1024 x
4096 shades of gray respectively.
• Increasing the matrix size increases the number of pixels. There by increasing
the quality of the Image. Decreasing the matrix size decreases the number if
pixels thereby decreasing the quality of the Image.
•
 Digital Image Acquisition

• Three stages are involved in digital Imaging.

• Image Acquisition
• Image Processing
• Image Display
• Once the exit radiation is converted to
numerical (digital) data, Image processing and
display are the same. Exceptions are film
digitizers and digital flouroscopy.
 Digital Flouroscopy:
• The exit radiation is absorbed by the input
phosphor, converted to electrons, sent to the
output phosphor, released as visible light and
converted to an electronic video signal for
transmission to the TV monitor. In digital
fluoroscopy an analogue to digital converter
(ADC) is used to convert the analogue
(continuous) video signal to digital (numeric)
data. The Image is then viewed on a high
resolution video monitor. This conversion
creates room for Image manipulation.
 Digital Radiography

• The major difference between digital

fluoroscopy / film digitizers and digital
radiography (DR) is in the method of Image
acquisition.
• Computed radiography (CR) and Direct Read
out digital Radiography (DR) has an Image
receptor that receives the exit radiation and
converts the varying x-ray intensities into
digital data.
 Computed Radiography

• The Exit radiation interacts with the Imaging plate (IP).

• The photon intensities are absorbed by the photo
stimulable phosphor.
• Part of the absorbed photon are given out as light
(luminescence) while part of the photon energy is stored in
the phosphor to produce latent Image
• Through the Image plate can store the absorbed energy for
several hours. The latent Image must be processed on time
else it will fade.
• This latent Image is placed in a reader unit that converts the
analog Image into digital Image for processing computer.
 DIGITAL IMAGE PROCESSING

• This is the evaluation and manipulation of the digital data before

display.
• The digital data are used to construct a histogram or graphic display
of the distribution of the pixel values. Each image has its own
histogram and it is evaluated to determine the adequacy of the
image receptor exposure to the X rays.
• If the histogram suggests a low or high exposure, the electrical
signal will be adjusted accordingly to compensate for the error.
Processing algorithms or mathematical formulas are used to
formulate image reconstruction for the specific type of examination
performed. The Radiographer must indicate the correct radiographic
procedure so that the appropriate algorithm is performed else the
resulting image will not have the right reconstruction.
 DIGITAL IMAGE DISPLAY

• Once the image has been produced in digital

format it can be displayed on a CRT, Printed on
film, sent to a distant location or stored on a
magnetic or optical disk.
 CRT or video monitoring. [Soft copy
viewing]
• The following are four post processing manipulations.

1. SUBTRATION: A process that can remove superimposed so

that anatomical structure of interest is more visible. Because the
image is in a digital format, the computer can subtract selected
brightness[definite heights of histogram] to create an image
without the images of the superimposed subtracted histogram.
2. Contrast Enhancement: This technigue alters the pixel value to
display different brightness levels.
3. Edge Enhancement: This improves the visibility of small high
contrast structures.
4. Black / White reversal: Reverses the gray scale from the
original radiograph.
LASER CAMERA PRINTING. [Hard copy viewing]

• Digital images can be altered while been

viewed on CRT and the printed onto a film by
a laser camera. Multiple images can be printed
on a single sheet and multiple copies of
images can be printed that were processed
differently.