Notebook Six

Now that x-rays photons have been converted into electrical signals, these signals
are ready to be processed and manipulated. This will happen with both PSP systems and
FPD systems. The only difference is that a reader is used only for PSP systems, but
everything else in the process and fairly similar.

Preprocessing takes place in the computer and postprocessing is done by the

technologist.

PSP Reader Functions:

The program searches for anatomy recorded on the imaging plate by finding the
collimation edges and then gets rid of any scatter outside of those edges.
The data within the collimated field will produce a graphic representation of the
optimal densities called a histogram. The value of each tone is on the horizontal
axis while the number of pixels is on the vertical axis. Values to the very left
represent black and they get brighter as you go to the right.
Image Sampling:
The plate is scanned and the images location is determined.
The size of the signal is determined and a value is placed on each pixel.
From here, a histogram is made which allows the system to find the useful signal
by locating the minimum (S1) and maximum (S2) signal within the anatomic regions
of interest on the image and then plots the intensities of the signal on the histogram.
The intensities show up on the histogram show up as a graph.
X-axis = amount of exposure read
Y-axis = number of pixels for each exposure.
Low energy (low kVp) = a wider histogram
High energy (high kVp) = a narrower histogram.
The shape of the histogram is anatomy specific.

Digital Radiography Image Sampling:

The Nyquist Theorem:
This theory states that when sampling a signal, the sampling frequency must be
greater than twice the frequency of the input signals so that the reconstruction of the
original image will be as close to the original signal as possible.
If there are too few pixels sampled, it could results in a decrease in
resolution.

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 Vice Versa, if there is oversampling, this will not result in additional useful
information.
The number of conversions that occur is PSP imaging that result in loss of detail
are:
Electrons to light
Light to digital information
Digital to analog signal
Aliasing:
This is known as foldover or biasing and causes mirroring of the signal at
the frequency
Aliasing will produce a wrap around image which appears as two images
superimposed that are slightly out of alignment.
Critical frequency: when a sampled frequency is exactly at the Nyquist
frequency often a zero amplitude will result. Results from frequency phase
shifts will cause aliasing of the signal.
Automatic Rescaling:
This means that images are produced with uniform density and contrast,
regardless of the amount of exposure.
This will happen when the exposure is greater or less than what is needed to
produce an image. Automatic rescaling will occur in efforts to display the
pixels for the area of interest.
Problems can occur with rescaling like quantum mottle, which is the failure of
an imaging system to record densities, usually caused by a lack of x-ray
photons. Or, if too much exposure is used, it results in a loss of contrast and
loss of distinct edges, because there is an increase in scatter production.
It is important to remember that rescaling in NOT a substitute for appropriate
technical factors.
Dose Creep refers to the use of automatic rescaling without regard to
appropriate exposure amount.

Look Up Table (LUT): is a histogram of the luminance values derived during image
acquisition.
It is used as a reference to evaluate the raw information and correct the luminance
values.
All pixels are changed to a new grey value
The final image will result in the appropriate appearance in brightness
(density) and contrast.
There is an LUT for every atomic part
Contrast can be changed by increasing or decreasing the slope of the graph.

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 The brightness (density) can be increased or decreased by moving the line up or
down the y-axis.

Quality Control Workstation Functions:

Image processing parameters:
Digital systems have a greater dynamic range than film/screen imaging.
The initial digital image has all shades of gray visible giving the image a very wide
latitude. If all shades were left in the image there would be very low contrast. So to
avoid this, digital systems use various contrast enhancement parameters. These
parameters differ from manufacturer.
Contrast Manipulation:
This involves converting the digital input data to an image with appropriate
brightness and contrast using contrast enhancements parameters.
Image contrast is controlled by using a parameter that changes the steepness of the
exposure gradient.
Using a different parameter, the brightness can be varied at the toe and shoulder of
the curve to remove the extremely low and extremely high values.
There can also be another parameter that allows brightness to remain unchanged,
while the contrast varies.
These types of parameters should only be used to enhance the image.
Spatial Frequency Resolution:
This term refers to detail or sharpness of the image.
In film/screen, sharpness can be controlled by many things like focal spot size,
screen/film speed and OID.
Focal spot and OID affect image sharpness in both film/screen and digital. With
digital though, you can further control the sharpness by adjusting processing
parameters.
When using processing parameters, you must be careful because if you use the
wrong algorithm, the image formation can be degraded.
Once the image is stored in PACs, all post processing activities result in a loss of
information from the original image and this takes away from the radiologist.
Spatial Frequency Filtering:
Edge Enhancement occurs when fewer pixels in the neighborhood are included in
the signal average.
This happens because once the signal is obtained for each pixel, the signals are
averages to shorten processing time and storage. The more pixels there are, the
smoother the image looks.
The signal strength of one pixel is averaged with the strength of adjacent pixels.
The smaller the neighbourhood, the greater the enhancement is.

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 High-Pass Filtering is when the frequencies of areas of interest are known, those
frequencies can be amplified while other frequencies can be suppressed.
This increases contrast and edge enhancement.
It is useful for enhancing large structures, but it can also be noisy.
Suppressing frequencies, also known as masking frequencies can result in the loss
of small details.
Low-Pass Filtering, also known as smoothing, occurs by averaging each pixels
frequency with surrounding pixel values to remove high-frequency noise.
Results in a reduction of noise and contrast
Useful for viewing small structures.

Basic Functions of the Processing System:

Image manipulation:
Window and level are the most common processing parameters for brightness and
contrast.
Window level: Controls how bright or dark the screen is.
The higher the level is, the darker the image will be.
Window Width: Controls the ratio of black and white; contrast.
The wider the window width, the lower the contrast
One direction controls brightness and the other direction controls contrast.
Background Removal or Shuttering:
Veil glare: Excess light that causes over sensitization of a chemical within the eye
called rhodopsin, and results in temporary white light blindness.
In digital imaging, shuttering is used to blacken out the white collimation
borders, eliminating veil glare.
Removing the white unexposed borders results in an overall smaller number of
pixels and reduces the amount of information to be stored.
Image Orientations: Refers to the way anatomy is orientated on the imaging plate.
The reader has to know where the patients head and feet are.
The image displays exactly as it was read unless it is told to do otherwise.
Image Stitching: When anatomy is too large to fit on one cassette, multiple images can be
stitched together using special software programs.
Image stitching eliminates the need for large cassettes.
Image Annotation: This is a function that allows selection of present terms or manual text
input, and comes in handy when additional information is necessary.
Depending on the setup of the system, some annotations may not transfer over to
PACs.
This is why it is crucial to use left and Right markers with initials on them
when taking the image.

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Magnification: There are two basic types of magnification techniques that come standard
with digital systems.
One technique functions as a magnifying glass n a sense that a box placed over a
small segment of anatomy on the main image shows the underlying anatomy
magnified.
The other technique is a zoom technique. This allows you to magnify the whole
image.

Image Management:
Patient Demographic Input:
Patient demographics include:
Patient name
Healthcare facility
Patient identification number
Date of birth
Examination date
The patient name must be entered the exact same way for every exam.
Manual Send: A function that allows the QC technologist to select one or more local
computers to receive the images.
Archive Query: A function that allows retrieval of images from PACs based on
Date examination
Patient name or number
Examination number
Pathologic condition
Anatomic area

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