Introduction

Medical imaging and the practice of radiology is a major source of diagnostic

information and is required for guiding and monitoring many therapeutic
procedures. Most clinical facilities now have a complementary selection of imaging
modalities and methods with each contributing specific capabilities and values to the
diagnostic process.
With the advances in medical imaging technology and methods the procedures have
become more complex and their maximum value requires a clinical team (radiologists,
technologists/radiographers, and medical physicists) with the knowledge and
experience to conduct the imaging procedures.

The significant knowledge needs include:

 Image Quality Characteristics that affect visibility of anatomical structures

and signs of pathology (Contrast, Detail, Noise, Spatial, and Artifacts).
 The ability to Evaluate Clinical Images with respect to their image quality
characteristics.
 Image characteristics as determined by the Principles and Design of the
specific imaging modalities and methods (Radiography, Fluoroscopy, CT,
MRI, Ultrasound, and Radionuclide Imaging).
 Optimization of Imaging Procedures with respect to visibility requirements,
risk, and image acquisition time.


 Sampling: The Core Concept of Digital

Audio Recording

The core concept in digital audio recording is sampling. This is the process of
converting continuous analog signals (eg those coming from a microphone) into
discrete time-sampled signals. Once the signal has been converted, what you get
is an audio file (or a stream of numbers if live-streaming) that represent these
sound-waves in the digital domain. These can be streamed to, or stored on, any
digital device (like a computer, iPad, digital handheld recorder). This is analog to
digital conversion (ADC). Once on your computer, digital audio files can be
processed in almost unlimited ways via DSP (digital signal processing).
You then listen back to the digital signals in a reverse of the process when the files are
converted back and played through monitors or headphones. This is digital to analog conversion
(DAC). The DAC reconstructs the original signal.

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Digital image processing

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Time and frequency domain of spectral analysis

Sampling
A continuous time signal can be represented in its samples and can be recovered back
when sampling frequency fs is greater than or equal to the twice the highest frequency
component of message signal. i. e.
fs≥2fm.fs≥2fm.
Proof: Consider a continuous time signal x(t). The spectrum of x(t) is a band limited to
fm Hz i.e. the spectrum of x(t) is zero for |ω|>ωm.
Sampling of input signal x(t) can be obtained by multiplying x(t) with an impulse train
δ(t) of period Ts. The output of multiplier is a discrete signal called sampled signal
which is represented with y(t) in the following diagrams:

Here, you can observe that the sampled signal takes the period of impulse. The
process of sampling can be explained by the following mathematical expression:
To reconstruct x(t), you must recover input signal spectrum X(ω) from sampled signal
spectrum Y(ω), which is possible when there is no overlapping between the cycles of
Y(ω).
Possibility of sampled frequency spectrum with different conditions is given by the
following diagrams:
Aliasing Effect
The overlapped region in case of under sampling represents aliasing effect, which can
be removed by
 considering fs >2fm
 By using anti aliasing filters.
Quantization
image characteristics with processing
Some type of digital image processing is used with most of the medical
imaging modalities.

There are several digital processing methods that can be used to adjust the contrast
characteristics of an image. The two methods that we will consider here are:
• Look Up Table (LUT) processing
• Windowing
Both of these are used in digital radiography as well as with many of the
other imaging modalities.

The basic concept behind window/level is to apply a linear gray-scale transform

function, in the form of a lookup table (LUT) specified by two parameters, window and
level. The end result is that pixel intensities corresponding to a subset of the entire
dynamic range are highlighted, at the expense of those pixels falling outside the
specified range. The LUT processing technique is depicted graphically in Figure 3-11,
 where each pixel in the input image /is mapped to the corresponding pixel in the output
image g, with the new pixel intensity taking on a value specified by the LUT.

LUT Described by Graphs

Let's recall that a LUT indicates what number is to be substituted for each pixel value
during the processing of the image.

It is very helpful to show this relationship between the original pixel values and the
new values with a graph as we see here.

Here we are starting with a simple straight-line or linear graph that shows that the
substituted number is the same as the original image pixel value.

Processing with this LUT does not change the image, it just introduces us to the
concept of LUTs.
LUT Curve

If LUT processing is to change the contrast characteristics of an image it must

substitute numbers that are different from the original pixel values.

Here we see that relationship shown as a curve. Note that the values and positions on
the scale for the three pixel values represented by the colors ( yellow, green, and red)
are now different in the processed image.

You might recognize the shape of this curve as being similar to that of a radiographic
film characteristic (H & D) curve. That is intentional. By processing a digital
radiograph with a LUT with this characteristic it then takes on some of the familiar
contrast "look" of a radiograph recorded on film.

Selection of LUTs

One of the advantages of digital processing is that the processing parameters (factors)
can be selected to produce images with different contrast characteristics.

Here we see curves representing three different LUTs.

Like the characteristic curve of film, the slope of the curve at every point represents
how the contrast will be changed by the processing. Where the curve has a high slope
(steep) the contrast will be increased by the processing. If the slope is small (less than
450) the contrast will be decreased by the processing.

The curve with the greater slope shown here will produce an image with high
contrast. The one with less slope simulates the latitude type film that is used for chest
imaging. We will see the effect of processing with the inverted curve a little later.
In the typical digital radiographic system, a variety of LUTs are installed.

The appropriate LUT is then automatically selected to give the desired contrast
characteristics to match the type of procedure (chest, extremity, etc) that is designated
by the operator.

Processing to Increase Image Contrast

If he original image recorded with most digital radiography systems is displayed

directly, it might have relatively low contrast as we see with the image on the
left. This is because of the wide dynamic exposure range and the linear response of
the digital radiographic receptors. This is actually a desirable characteristic because a
wide range of exposure is recorded and the digital receptor does not suppress or cutoff
the contrast in some of the exposure range as happens with images recorded directly
on film.

The usual procedure is to use processing, as illustrated here, to increase the contrast
for some selected portion of the exposure range. The processing illustrated here
produces an image that is similar to one recorded with a high contrast film. Note: we
do not generally use a high contrast film for chest radiography because it produces an
image with too much area contrast (like the dark lungs shown here).

Processing a Chest Image

Here we see LUT processing that is more appropriate for chest radiography.

In general, it simulates an image recorded on a latitude type film that is used for chest
imaging.

Compared to the high contrast processing that we have just seen, this produces an
image with good object and anatomical structure contrast and visibility throughout
most of the image.

Digital Image Windowing

The ability to window is a valuable feature of all digital images.

Windowing is the process of selecting some segment of the total pixel value range
(the wide dynamic range of the receptors) and then displaying the pixel values within
that segment over the full brightness (shades of gray) range from white to black.

Important point...Contrast will be visible only for the pixel values that are within the
selected window. All pixel values that are either below or above the window will be
all white or all black and display no contrast.

The person controlling the display can adjust both the center and the width of the
window. The combination of these two parameters determine the range of pixel
values that will be displayed with contrast in the image.

Effect of Changing the Window Level

One of the advantages of windowing is that it makes it possible to display and

enhance the contrast in selected segments of the total pixel value range. This can be
compared to the limitations of images displayed on film where the full range of
exposure is displayed in one image and cannot be changed.

With windowing we can create many displayed images, each one "focusing on" a
specific range of pixel values.

As we see here, when the window is set to cover the lower segment of total pixel
value range, we see good contrast in the lighter areas like the medistimum.

Setting the window to the higher segment produces good contrast in the darker areas
like the lungs.