Dentomaxillofacial Radiology (2001) 30, 1 ± 9

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REVIEW

Radiographic image enhancement. Part I: spatial domain

techniques
M Analoui*,1
1
Oral and Maxillofacial Imaging Research Facility, School of Dentistry, Indiana University, Indiana, USA

Digital image enhancement techniques provide a multitude of choices for improving the visual
quality of diagnostic images. Appropriate choice of such techniques is greatly in¯uenced by the
imaging modality, task at hand and viewing conditions. This sequence of two articles will
provide an overview of underlying concepts, along with algorithms commonly used for
radiographic image enhancement. The ®rst article focuses on spatial domain techniques for
radiographic image enhancement, with particular reference to point processing methods,
histogram modi®cation and unsharp masking.

Keywords: radiographic image enhancement; digital radiography; digital radiography, dental

Introduction

The rapid introduction of direct and indirect digital
imaging systems in medicine and dentistry has created
a wide selection of computer-based methods for
diagnostic imaging. Utilizing the computational power
of new computers, along with the application of digital
imaging algorithms, has a signi®cant impact on
diagnostic utility, as well as treatment planning and
patient education. Although digital imaging techniques
were originally developed to address scienti®c, indus-
trial, and military applications, they have been
routinely adopted into the life sciences. In clinical
diagnosis, such applications include image enhance-
ment and analysis and visualization. In response to
unique demands in medical/dental imaging, several
innovative imaging methods have been, and are being,
developed for the ®rst time. The adoption and
innovation of these processes constantly o€er research-
ers and clinicians new approaches to diagnostic
imaging. It is crucial to understand the mechanisms
by which a given imaging algorithm modi®es an image
so as to be able to assess its impact on diagnostic
quality and hence diagnosis and treatment.
The focus of this article, the ®rst of two, is to o€er a
concise overview of spatial domain image enhancement
methods using examples of oral and maxillofacial
images. The fundamental concepts in digital imaging
*Correspondence to: M Analoui, Oral and Maxillofacial Imaging Research
Facility, School of Dentistry, Indiana University, 1121 West Michigan Street,
Indianapolis, IN 46202, USA
Received 9 September 1999; accepted 12 July 2000
along with classi®cation of digital imaging will be
described. Radiographic examples are included for each
of the enhancement methods discussed in this article.
The methods discussed in these two articles are
chosen from the techniques that are commonly used to
enhance visual quality of radiographic images for
clinical applications. It must be noted that the
intention is not to provide a literature review or
summary of in vitro and clinical studies utilizing image
enhancement methods, but to provide a concise
introduction to the topic, which will lead to a
subsequent paper on the clinical impact of these
methods on image quality and observer performance.
Image data representation
Digital computers, by nature, can handle well-de®ned,
®nite and countable data. Although technological
enhancement in (digital) computer hardware and
software has led to a signi®cant increase in the size
of data being handled by computers, this limitation will
remain as basic characteristic of digital computers.
Assuming an object is composed of a continuum of
elements, its (analog) image will contain the same data
continuity, requiring countless and in®nite number of
elements to represent it. To process such an image by
digital computer, it must be converted to a digital form
with a discrete representation. The discreteness applies
to all attributes of the image, such as geometry,1
intensity2 and time intervals. The conversion process,
 Image enhancement. Part I
M Analoui
2
known as digitization, is de®ned by a
f…x; y; z; t† ! f…m; n; l; k† …1†
where f(x,y,z,t) represents a spatiotemporal continuous
image and f(m,n,l,k) is its discrete representation. Image
digitization involves two distinct processes, (1) sampling,
and (2) quantization.3 In direct digital imaging, both
processes occur within the image receptor and electronic
circuitry for image acquisition, while in indirect imaging
the image is acquired through an analog medium, such
as radiographic ®lm, and then converted into a digital
form through scanning. In this article, I will limit the
discussion to two-dimensional, still, gray-scale images,
independent of imaging modality.
The digital image can be represented in several forms
and domains. Each domain describes the image from a
speci®c perspective, making it more suitable for certain
tasks and operations. Spatial and transform domains
are among the most common methods for image data
representation.
The digital image in the spatial domain can be
represented by a 2D collection of discrete intensity levels,
f…m; n† : m 2 ‰1; MŠ; n 2 ‰1; NŠ; f 2 ‰1; KŠ; …2† b
composed of an MxN array of picture elements (pixels),
with each pixel taking one of K di€erent intensity levels.
This image representation preserves geometric pixel
adjacency in the image. Figure 1 shows an example of
such a spatial image data representation.
Note that the 2D data array does not have any
information on the physical size and spacing of the
pixels. This information is either o€ered as the size of
each pixel or the density of the pixel within the unit
distance or area. For example, current intraoral digital
radiographic imaging systems o€er pixel sizes ranging
from about 20 to 50 mm, which provides a theoretical
resolution limit of 25 to 10 line pairs/mm or 1262 to
505 dots per inch (dpi).

Image processing techniques

c
Image processing (IP) in general, refers to a broad class
of algorithms for modi®cation and analysis of an
image. IP could refer to the initial image manipulation
during acquisition, post-processing, or rendering/
visualization. IP classi®cation also may depend on the
objectives in dealing with images. For example a
diagnostician may classify IP algorithms as diagnostic
and non-diagnostic, while the same techniques may be
categorized as invasive (lossy) and non-invasive
(lossless).
Examples of image processing classes include:
(a) Image enhancement,
(b) Image analysis and understanding,
(c) Quantitative imaging,
Figure 1 (a) A digital radiograph rendered as a 2D intensity image.
(d) Image reconstruction and restoration, A sub-section of image (b) and its corresponding gray levels (c) are
(e) Modeling and visualization, also shown. The sub-section of the image is enhanced to make the
(f) Time-varying and functional imaging, gray level variations more visible

Dentomaxillofacial Radiology

(g) Perceptual and cognitive imaging,
(h) Color and multispectral imaging.
Enhancement methods
The principal objective of image enhancement is to
modify attributes of an image to make it more suitable
for a given task and a speci®c observer. During this
process, one or more attributes of the image are
modi®ed. The choice of attributes and the way they are
modi®ed are speci®c to a given task. Moreover,
observer-speci®c factors, such as the human visual
system and the observer's experience, will introduce a
great deal of subjectivity into the choice of image
enhancement methods.
Based on the image data representation space, image
enhancement techniques can be divided into two main
categories: (1) spatial domain and (2) transformed
domain techniques. The focus of this article is on
spatial domain methods, which directly manipulate the
image data array, either by point processing or area
processing. The second article will discuss transform
domain methods in which the image is transformed
into the Fourier domain, processed and then trans-
formed back to the spatial domain.
To provide a uni®ed approach, it is assumed that
image, f, is normalized such that:
f…m; n† 2 ‰0; 1Š; …3†
where 0 and 1 represent black and white, respectively.
This assumption allows us to express the imaging
operator independent of the actual pixel-depth of the
imaging system. Pixel-depth, commonly expressed in
terms of bits/pixel, de®nes number of unique gray
levels that imaging system can provide.
Spatial domain image enhancement
Image processing in the spatial domain can be
expressed by:
g…m; n† ˆ T…f…m; n††; …4†
where f(m,n) is the input image, g(m,n) is the processed
image, and T is the operator de®ning the modi®cation
process.
The operator `T ' is typically a single-valued and
monotone function that can operate on individual
pixels or on selective regions of the image. In point-
…7†
processing, a single pixel value of the input image is
used to compute the corresponding pixel value for the
output image. In regional or area processing, several
pixel values in a neighborhood within the input image
are used to compute the modi®ed image at any given
point. One can consider point processing as a special
case of region processing where the region is composed
of a single pixel.
The point-processing operator can also be expressed
by:
Image enhancement. Part I
M Analoui
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s ˆ T…r†; …5†
where r and s are variables denoting the intensity level
of f(m,n) and g(m,n) at any point (m,n). The following
sections describe several point- and region-based image
enhancement techniques. The second article will also
discuss spatial smoothing, which is another example of
region-based image processing, and compare its
advantages and disadvantages with transform domain
methods.
Linear point processing
Linear point processing is de®ned by:
s ˆ ar ‡ b; …6†
where a and b are two parameters de®ning the
transformation function. As a result of this operation
the variable s can take on any positive or negative
value. Following the common approach that the pixel
value should fall in the range of 0 and 1, the resultant
of the operator should be limited to this range. This
can be achieved through either re-mapping s to [0,1] or
discarding all out-of-range values by clipping them
back to one of the boundary values.
By setting a=1 and varying b one can adjust the image
brightness. Figure 2 shows the mapping and resulting
images for two di€erent b values. Note that when the
brightness of the image is changed, the relative di€erence
between pixel values is preserved. This is an important
property when utilizing the quantitative property of an
enhanced image. Image contrast can be modi®ed by
varying a, as shown in Figure 3. Reverse contrast, a
common contrast modi®cation technique in radiographic
imaging, can be achieved by setting s=7r+1 (Figure 4).
In a more general approach, one can modify both
parameters to obtain the optimal image enhancement
for a given task, image, and viewing condition.
Non-linear point processing
There are in®nite ways in which gray levels can be
modi®ed in a nonlinear fashion.4 Exponential and
logarithmic intensity modi®cations are among closed-
form functions used for this type of image enhance-
ment. The exponential gray level image mapping can
be expressed by:
s ˆ r
where g de®nes the exponent, which can be selected
according to image content and viewing setting. Figure
5 shows how this operation can lead to contrast
enhancement for either low or high gray values.
Another application of the exponential processing
function is the compensation for the non-linear
response of phosphor being used in the computer
display device. This is a built-in contrast manipulation
in CRT-based display devices that can be either
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 Image enhancement. Part I
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a compensated through hardware or by post-processing
of the images.5 By measuring the gamma of a given
display device, one can modify the image so that the
displayed image is rendered in a linear fashion.
Gray level slicing is another type of nonlinear
processing method frequently used to highlight a
range of desired gray levels or to mask out unwanted
gray levels. Figure 6 shows an example of hard limiting
for tissue separation/segmentation. The threshold for

c
b

d c

Figure 2 E€ect of change in the brightness, (a) original image, (b) Figure 3 E€ect of change in the contrast operated on the image
Mapping functions, result of (c) increasing brightness and (d) shown in Figure 2a. (a) Mapping functions, result of (b) increasing
reducing brightness by 0.25 unit contrast and (c) reducing contrast

Dentomaxillofacial Radiology
 Image enhancement. Part I
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a a

b b

Figure 4 Reverse contrast mapping and resultant image c

each segment can be set manually or automatically.

Morphological ®ltering6 also represents a broad class
of non-linear operation and has been shown to be
e€ective for image enhancement.7

Lookup table approach

Another approach to point-based image enhancement

is through the use of lookup tables. The lookup table
de®nes how each input value is mapped to the output
value and can approximate a single- or multi-valued
function. For intensity images, the lookup table is a
linear array of indices, while for color images there is
one array for each color. To speed up image rendering,
it is common to pre-compute such a table (for linear
and nonlinear operators) and use it when needed.
Histogram modi®cation
A histogram is a one-dimensional probability density
function (PDF) of gray levels present in an image.3 The
histogram describes the global gray level distribution of
pixels within an image. Figure 7 shows a panoramic
image and its associated histogram.
Figure 5 (a) Exponential mapping function and resultant images
with (b) g51 and (c) g41
Histogram-based enhancement techniques are de-
vised to enhance an image by modifying its histogram.
The histogram modi®cation problem can be for-
mulated as follows:
Given:
(1) PDF of the input image pr(r)
(2) PDF of the desired image ps(s)
Compute:
A transformation function T, to modify gray
values of the input image to achieve the desired
PDF.

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b Figure 8 Histogram equalized image and its associated histogram

The ®rst step in this process is to select the desired PDF

for a given image. Such a selection is typically both a
function of image content and the task at hand. For
example, the most common histogram modi®cation
technique, histogram equalization, tends to re-distribute
the gray levels in such a way that there is a uniform
distribution of gray levels in the output range. Figure 8
shows the panoramic image displayed in Figure 7 after
histogram equalization and its associated histogram.
Note that although the modi®ed histogram is less
skewed toward the low gray values, it is not uniformly
distributed. This is due to the small number of gray
Figure 6 Gray level slicing function and its resultant image levels (256 levels) available in this image. As the number
of possible gray levels, i.e. pixel depth, increases, the
modi®ed histogram tends more toward a ¯at shape. The
following list shows some of typical histogram models
used for histogram modi®cation.9

Uniform (equalization)
1
ps …s† ˆ rmin < s < rmax
rmax ÿ rmin

Exponential
ps …s† ˆ eÿ…sÿrmin † s  rmin

Rayleigh
s ÿ rmin ÿ…sÿrmin †
ps …s† ˆ e 22 s  rmin …9†
 2

Figure 7 A digital panoramic radiograph and its associated

histogram. The PDF values at low gray levels are truncated and Hyperbolic (Cube Root)
graph is scaled to better depict variation in the entire range. A
signi®cant number of pixels are clustered at the lower end of gray scale 1 sÿ2=3
ps …s† ˆ
3 r1=3
max ÿ r
1=3
min
Employing probability theory8 it can be shown that a
single-valued, and monotone transformation, T, can be
found to transform the PDF of image from pr(r) to ps(s) Hyperbolic (Logarithmic)
  1
dr ps …s† ˆ
ps …s† ˆ pr …r† …8† s‰ln…rmax † ÿ ln…rmin †Š
ds rˆTÿ1 …s†

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 Image enhancement. Part I
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Figure 9 demonstrates another example of histogram
equalization. The radiographic image shown in the
upper left corner of Figure 9 is the image of a copper
coin captured by a CCD-based image receptor. Note
that the pixel values are densely clustered at the two
ends of the gray scale. Redistributing the gray level to
equalize the histogram reveals the content of image
clearly.
While histogram modi®cation method, based on
speci®c target histograms, o€ers a simple and
computationally inexpensive implementation, it treats
the entire content of the image uniformly, regardless of
the local variation of gray levels. This may lead to loss
of visual quality of images for certain areas (e.g. gray
level saturation in the upper left corner of Figure 8)
and increased visibility of noise, as is evident in Figure
9. Occurrence of such artifacts can be controlled by
selectively and adaptively modifying the histogram
based on local gray level statistics. Such techniques
are generally referred to as adaptive histogram
enhancement (AHE) methods.10,11 Figure 10 shows the
result of the AHE approach proposed by Pizer et al.10
In this approach, histogram modi®cation is applied to
a series of overlapping windows to address the local
variation within the image.

Image sharpening

Psychophysical experiments indicate that photographic

and radiographic images with enhanced edges are often
more pleasing to the human visual system (HVS) than
the original images.12 Thus, edge enhancement techni-
ques have been proposed to utilize this inherent property
of the HVS. Edge enhancement can be implemented
through ®ltering an image in the spatial and transformed
domains. The general theme in all these approaches is
selectively increasing the visibility of edges.
A common approach to enhance edges is dividing
an image into smooth and sharp (or low and high
frequency) images. Then, the edges are sharpened by
either de-emphasizing the smooth portion or
accentuating the sharp portion, or a combination
of both.

Figure 9 Original digital radiograph and its histogram (top row). Figure 10 Adaptively histogram equalized version of the image
Histogram equalized image and its histogram (bottom row) shown in Figure 7

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 Image enhancement. Part I
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a c

b d

Figure 11 E€ect of unsharp masking for di€erent a values. (a) Original image, (b) a=0.5, (c) a=1.0 and (d) a=5.0

Unsharp masking is one of the techniques typically
used for edge enhancement. In this approach, a
smoothed version of the image is subtracted from the
original image, hence tipping the image balance toward
the sharper content of the image. The process can be
de®ned by:
g…m; n† ˆ …1 ‡ † f …m; n† ÿ f …m; n† h…m; n† …10†
where h(m,n) is a smoothing kernel, and a de®nes the
degree of edge enhancement. The above equation can
be re-arranged as the following:
g…m; n† ˆ f …m; n† ‡ ‰ f …m; n† ÿ f …m; n† h…m; n†Š …11†
visually acceptable images. The choice of such
techniques is a function of the speci®c task, image
content, observer characteristics, and viewing condi-
tions. Although I do not discuss the computational
cost of enhancement algorithms in this article it may
play a critical role in choosing an algorithm for real-
time applications. For pedagogical reasons, the
enhancement algorithms were discussed individually
in this article. Despite the e€ectiveness of each of these
algorithms when applied separately, in practice one has
to devise a combination of such methods to achieve
more e€ective image enhancement.

which describes the process as adding edge information

to the image for sharpening. Figure 11 shows examples
of unsharp masking for three di€erent a values.
Concluding remarks
Image enhancement algorithms o€er a wide variety of
approaches for modifying diagnostic images to achieve
Acknowledgments
The author would like to express his gratitude for
constructive comments and suggestions by the reviewers
and especially to Dr Andre Mol, University of North
Carolina at Chapel Hill, School of Dentistry and Dr Edwin
Parks, Indiana University School of Dentistry.

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