Medical Image Processing

22MD63

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C R C Press L L C , Boca Raton, F L , 2005.

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Pearson Press

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Illustration of various stages of
digital image processing and analysis.

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 1. THE NATURE OF BIOMEDICAL IMAGES

The Nature of Biomedical

Images

The human body is composed of many

systems:

visual system,
cardiovascular system,
musculo-skeletal system,
central nervous system.

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1. THE NATURE OF BIOMEDICAL IMAGES

Each system is made up of several subsystems that carry on

many
Physiological processes.

The visual system:

Performs the tasks of

focusing visual or pictorial information on to the retina,

transduction of the image information into neural signals,
encoding and transmission of the neural signals to
the visual cortex.

The visual cortex is responsible for interpretation of the

image information.

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1. THE NATURE OF BIOMEDICAL IMAGES

Diseases or defects in a physiological system cause alterations in

its normal processes.

Pathological processes affect the performance, health, and

general well-being of the system.

A pathological process is associated with signals and anatomical

features that are different from the corresponding normal
patterns.

With a good understanding of a system of interest, it becomes

possible to observe the corresponding signals and features and
assess the state of the system.

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 1. THE NATURE OF BIOMEDICAL IMAGES 1.1. BODY TEMPERATURE AS AN IMAGE

Body Temperature as an Image

33.5 ◦ C
(a)

Time 08 10 12 14 16 18 20 22 24
(hours)

Figure (a) Measurements of the temperature of a patient presented as a

scalar with one temperature measurement f at a time instant t

Temperature 33.5 33.3 34.5 36.2 37.3

37.5 38.0 37.8 38.0 ( ◦ C)

(b)

Figure (b) an array f (n) made up of several measurements at different instants of time

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1. THE NATURE OF BIOMEDICAL IMAGES 1.1. BODY TEMPERATURE AS AN IMAGE

39

38

37

Temperature in degrees
36

Celsius 35

34

33

32
8 10 12 14 16 18 20 22 24
Time in
hours

(c)

Figure (c): a signal f (t) or f (n). The horizontal axis of the plot represents time in hours; the vertical axis gives
temperature in degrees Celsius. Data courtesy of Foothills Hospital, Calgary.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.1. BODY TEMPERATURE AS AN IMAGE

Infrared imaging:

Thermal sensors with wavelength in the range

3, 000 − 5, 000 nm may be used to capture the heat radiated
or emitted from a body or a part of a body as an image.

Thermal imaging has been investigated as a potential tool for the

detection of breast cancer.

A tumor is expected to be more vascularized than its

neighboring tissues, and hence could be at a slightly higher
temperature.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.1. BODY TEMPERATURE AS AN IMAGE

The skin surface near the tumor may also demonstrate a

relatively high temperature.

Temperature differences up to 2◦C have been measured between

surface regions near breast tumors and neighboring tissues.

Thermography can help in the diagnosis of advanced cancer, but

has limited success in the detection of early breast cancer.

◯c R.M. Rangayyan, CRC

1. THE NATURE OF BIOMEDICAL IMAGES 1.1. BODY TEMPERATURE AS AN IMAGE

(a) (b)

Figure 1.2: Body temperature as a 2D image f (x, y) or f (m, n). The images illustrate
the distribution of surface temperature measured using an infrared camera operating
in the 3, 000 − 5, 000 nm wavelength range.
(a) Image of a patient with pronounced vascular features and benign fibrocysts in the
breasts.
(b) Image of a patient with a malignant mass in the upper-outer quadrant of the left
breast. Images courtesy of P. Hoekstra, III, Therma-Scan, Inc., Huntington Woods, MI.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.1. BODY TEMPERATURE AS AN IMAGE

Thermal images serve to illustrate an important

distinction between two major categories of medical
images:

anatomical or physical images, and

functional or physiological images.

A thermal image is a functional

image.

An ordinary photograph obtained with reflected light is

an anatomical or physical image.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.2. TRANSILLUMINATION

Application for the detection of breast cancer:

Nitrogen-rich compounds preferentially absorb (or attenuate)

infrared radiation.

The fat and fibroglandular tissue in the mature breast

contain much less nitrogen than malignant tissues.

The hemoglobin in blood has a high nitrogen content, and

tumors are more vascularized than normal tissues.

For these reasons, breast cancer appears as a relatively

dark region in a transilluminated image.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.2. TRANSILLUMINATION

The effectiveness of transillumination is limited by scatter and

ineffective penetration of light through a large organ.

Transillumination has been found to be useful in differentiating

between cystic (fluid-filled) and solid lesions.

However, the technique has had limited success in distinguishing

malignant tumors from benign masses.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.5. X-RAY IMAGING

Beer’s law or Beer–Lambert law:

Consider the ray path marked as AB in Figure 1.9.

Let N i denote the number of X-ray photons incident upon

the body being imaged, within a specified time interval.

Let N o be the number of photons exiting the body.

The mutually parallel rays within the plane PQRS are represented
by the coordinates (t, s) that are at an angle θ with respect to the
(x, y) coordinates, with the s axis being parallel to the rays.

s = − x sin θ + y cos θ.

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 1. THE NATURE OF BIOMEDICAL IMAGES 1.5. X-RAY IMAGING

z z

Q’ Q R
No ds
S A Ni
P
P’ B
y

y X rays

x
2D projection 3D object
Figure 1.9: An X- ray image or a typical radiograph is a 2D projection or planar image of a 3D object. The entire
object is irradiated with X rays. The projection of a 2D cross-sectional plane P Q R S of the object is a 1D profile
P’Q’ of the 2D planar image.

A measurement of the exiting X rays gives us only an integral of µ(x, y) over the
ray.
The internal details of the body along the ray path are compressed onto a single
point on the film or a single measurement.

The radiographic image produced is a 2D planar image of the 3D object, where the
internal details are superimposed.
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1. THE NATURE OF BIOMEDICAL IMAGES 1.5. X-RAY IMAGING

A thick screen provides a high efficiency of conversion of X

rays to light, but causes loss of resolution due to blurring.

The typical thickness of the phosphor layer in screens is in

the range 40 − 100 µm .
X rays

A
light B screen
film
Figure 1.10: Blur caused by a thick screen. Light emanating from point A in the screen is spread over a larger
area on the film than that from point B.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.5. X-RAY IMAGING

A fluoroscopy system uses an image intensifier and a video

camera in place of the film to capture the image and display it
on a monitor as a movie or video.

Images are acquired at a rate of 2 − 8 frames/s (fps) , with

the X-ray beam pulsed at 30 − 100 ms per frame.

In computed radiography (CR), a photo-stimulable phosphor

plate (made of europium-activated barium fluorohalide) is used
instead of film to capture and temporarily hold the image.

The latent image is scanned using a laser and digitized.

In digital radiography (DR), the film or the entire screen-

film combination is replaced with solid-state electronic
detectors.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.5. X-RAY IMAGING

Examples: Figures 1.11 (a) and (b) show the posterior-anterior

(PA, that is, back-to-front) and lateral (side-to-side) X-ray images
of the chest of a patient.

(a) (b)

Figure 1.11: (a) Posterior-anterior and (b) lateral chest X- ray images of a patient. Images courtesy of Foothills
Hospital, Calgary.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.5. X-RAY IMAGING

Imaging of soft-tissue organs such as the breast is performed

with low-energy X rays in the range of 25 − 32 kV p.
The use of a higher kV p would result in low
differential attenuation and poor tissue-detail visibility
or few
A contrast.
other energy levels used in projection radiography
are:
– abdomen: 60 − 100 kV p;
– chest: 80 − 120 kV p;
– skull: 70 − 90 kV p.
The kV p to be used depends upon the distance between
the X-ray source and the patient, the size (thickness) of the
patient, the type of grid used, and several other factors.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.5. X-RAY IMAGING

Beam hardening: The X rays used in radiographic imaging

are typically not monoenergetic; they possess X-ray photons
over a certain band of frequencies or EM energy levels.
As the X rays propagate through a body, the lower-energy
photons get absorbed preferentially, depending upon the
length of the ray path through the body and the
attenuation characteristics of the tissues along the path.

The X rays that pass through the object at longer

distances from the source will possess relatively fewer
photons at lower-energy levels than at the point of entry
(and hence a relatively higher concentration of higher-
energy photons).

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1. THE NATURE OF BIOMEDICAL IMAGES 1.5. X-RAY IMAGING

This is known as beam hardening: leads to incorrect

estimation of the attenuation coefficient in CT imaging.

The effect of beam hardening may be reduced by prefiltering

or prehardening the X-ray beam and narrowing its spectrum.

The use of monoenergetic X rays from a synchrotron or a

laser obviates this problem.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.5. X-RAY IMAGING

Scatter and the use of grids: As an X-ray beam propagates

through a body, photons are lost due to absorption and
scattering at each point in the body.
The angle of the scattered photon is a random variable.
A scattered photon contributes to noise at the point where
it strikes the detector.
Scattering results in the loss of contrast.
The noise effect of the scattered radiation is significant
in gamma-ray emission imaging.
The effect of scatter may be reduced by the use of
grids, collimation, or energy discrimination.
Scattered (secondary) photons usually have lower
energy levels than the primary photons.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.5. X-RAY IMAGING

Grid: Array of mutually parallel X-ray absorbing strips if the

X rays are in a parallel beam (as in chest imaging),
or converging toward the X-ray source in the case of
a diverging beam (as in breast imaging).
Lattice or honeycomb grids with parallel strips in criss-cross
patterns are also used in mammography.
X-ray photons that arrive via a path that is not aligned with
the grids will be stopped from reaching the detector.
parallel X rays

A
F

E parallel grid
B C
screen-film
A’ D

Figure 1.12: Use of parallel grids to reduce scatter. X rays that are parallel to the grids reach the film; for
example, line AA’. Scattered rays A B, AC, and A E have been blocked by the grids; however, the scattered ray
A D has reached the film in the illustration.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.5. X-RAY IMAGING

A typical grid contains thin strips of lead or aluminum with

a strip density of 25 − 80 lines/cm and a grid height to
width ratio in the range of 5 : 1 to 12 : 1.
strip
The space between the grids is filled with low-attenuation
material such as wood.
A stationary grid produces a line pattern that is
superimposed upon the image.
Grid artifact is prevented in a reciprocating grid, where the
grid is moved about 20 grid spacings during exposure: the
movement smears the grid shadow and renders it invisible.
Low levels of grid artifact may appear if the bucky does not
move at a uniform pace or starts moving late or ends
movement early with respect to the X-ray exposure
interval. Disadvantages: double radiation dose, reduced
contrast.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.5. X-RAY IMAGING

(a) (b)

Figure 1.13: X- ray images of a part of a phantom: (a) with, and (b) without grid artifact. Image courtesy of L.J.
Hahn, Foothills Hospital, Calgary.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.5. X-RAY IMAGING

Figure 1.14: X- ray image of the American College of Radiology ( A C R ) phantom for mammography. The
pixel-value range [117, 210] has been linearly stretched to the display range [0, 255] to show the details. Image
courtesy of S. Bright, Sunnybrook & Women’s College Health Sciences Centre, Toronto, ON, Canada.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.5. X-RAY IMAGING

Photon detection noise:

Interaction between an X-ray beam and a detector:
Photons lost due to scatter and absorption.
Some photons may pass through unaffected (or undetected).
The small size of the detectors in DR and CT imaging
reduces their detection efficiency.
Scattered and undetected photons cause noise.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.5. X-RAY IMAGING

Ray stopping by heavy implants:

Extremely heavy parts or components, such as metal screws
or pins in bones and surgical clips that are nearly X-ray-
opaque and entirely stop the incoming X-ray photons, can
completely block an X-ray beam.
No photons would be detected at the corresponding point
of exit from the body.
The attenuation coefficient for the corresponding path
would be indefinite, or within the computational context,
infinity.
A reconstruction algorithm would not be able to redistribute
the attenuation values over the points along the
corresponding ray path in the reconstructed image.
This leads to streaking artifacts in CT images.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.5. X-RAY IMAGING

Special techniques for enhanced X-ray imaging:

digital subtraction angiography (DSA).

dual-energy imaging.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.5. X-RAY IMAGING

1.5.1 Breast cancer and mammography

Cancer is caused when a single cell or a group of cells escapes

from the usual controls that regulate cellular growth, and
begins to multiply and spread.

This activity results in a mass, tumor, or neoplasm.

Many masses are benign; that is, the abnormal growth is

restricted to a single, circumscribed, expanding mass of cells.

Some tumors are malignant: the abnormal growth invades

the surrounding tissues and may spread, or metastasize, to
distant areas of the body.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.5. X-RAY IMAGING

Benign masses may lead to complications.

Malignant tumors are serious: cancer.

The majority of breast tumors will have metastasized before

reaching a palpable size.

Mammography has gained recognition as the single most

successful technique for the detection of early, clinically occult
breast cancer.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.5. X-RAY IMAGING

Mammograms are analyzed by radiologists specialized in

mammography.

A normal mammogram typically depicts converging patterns of

fibroglandular tissues and vessels.

Any feature that causes a departure from or distortion with

reference to the normal pattern is viewed with suspicion
and analyzed with extra attention.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.5. X-RAY IMAGING

X-ray source (target)

Filter
Collimating
diaphragm

Breast
compression
paddle

Compressed
breast

Focused
grid

Screen-film
Figure 1.15: A typical mammography setup. cassette

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1. THE NATURE OF BIOMEDICAL IMAGES 1.5. X-RAY IMAGING

(a) (b)

Figure 1.16: (a) Cranio-caudal ( C C ) and (b) medio-lateral oblique (MLO) mammograms of the same breast
of a subject. The MLO view demonstrates architectural distortion due to a spiculated tumor near the upper
right-hand corner edge. Images courtesy of Screen Test — Alberta Program for the Early Detection of Breast
Cancer.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.5. X-RAY IMAGING

Important signs of abnormalities and cancer:

calcifications,
masses,
localized increase in
density,
asymmetry between the left and right breast images, and
architectural distortion.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.6. TOMOGRAPHY

1.6 Tomography

Problem: visualizing the details of the interior of the human

body or other objects.

Laminagraphy, planigraphy, or “classical” tomography used

synchronous movement of the X-ray source and film in such a
way as to produce a relatively sharp image of a single focal
plane of the object, with the images of all other planes being
blurred.

The smearing of information from the other planes of the object

causes loss of contrast in the plane of interest.

CT imaging made film-based tomography obsolete.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.6. TOMOGRAPHY

X2 X1
Path of source movement X-ray
source

A B Patient
Table
C1 C2
Film
A1 B1 A2 B2 cassett
e
Path of film movement

Figure 1.17: Synchronized movement of the X- ray source and film to obtain a tomographic image of the focal
plane indicated as AB.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.6. TOMOGRAPHY

Figure 1.18: Tomographic image of a patient in a longitudinal (coronal) plane through the chest. Reproduced with
permission from R.A. Robb, “ X- ray computed tomography: An engineering synthesis of multiscientific principles”,
CRC Critical Reviews in Biomedical Engineering, 7:264–333, March 1982. ◯c CRC Press.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.6. TOMOGRAPHY

Computed tomography: The technique of CT imaging was

developed during the late 1960s and the early 1970s,
producing images of cross-sections of the human head and
body as never seen before (noninvasively and
nondestructively!).
In the simplest form of CT imaging, only the desired
cross-sectional plane of the body is irradiated using a
finely collimated ray of X-ray photons.

Ray integrals are measured at many positions and angles

around the body, scanning the body in the process.

The principle of image reconstruction from projections, is then

used to compute an image of a section of the body: hence the
name computed tomography.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.6. TOMOGRAPHY

Q’
Q R

No P S Ni
B A
X rays
P’

1D Projection 2D Section
Figure 1.19: In the basic form of C T imaging, only the cross-sectional plane of interest is irradiated with X rays.
The projection of the 2D cross-sectional plane P Q R S of the object is the 1D profile P’Q’ shown. Compare this
case with the planar imaging case illustrated in Figure 1.9. Reproduced, with permission, from R.M. Rangayyan
and A. Kantzas, “Image reconstruction”, Wiley Encyclopedia of Electrical and Electronics Engineering, Supplement
1, Editor: John G. Webster, Wiley, New York, NY, pp 249–268, 2000. ◯c This material is used by permission of John
Wiley & Sons, Inc.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.6. TOMOGRAPHY

Figure 1.20: (a) Translate-rotate scanning geometry for parallel-ray projections; (b) translate-rotate scanning
geometry with a small fan-beam detector array; (c) rotate-only scanning geometry for fan-beam projections;
(d) rotate-only scanning geometry for fan-beam projections using a ring of detectors. Reproduced with permission
from R.A. Robb, “ X- ray computed tomography: An engineering synthesis of multiscientific principles”, CRC
Critical Reviews in Biomedical Engineering, 7:264–333, March 1982. ◯c CRC Press.
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1. THE NATURE OF BIOMEDICAL IMAGES 1.6. TOMOGRAPHY

Figure 1.21: Electronic steering of an X- ray beam for motion-free scanning and C T imaging. Reproduced with
permission from D.P. Boyd, R.G. Gould, J.R. Quinn, and R . Sparks, “Proposed dynamic cardiac 3-D densitometer
for early detection and evaluation of heart disease”, IEEE Transactions on Nuclear Science, 26(2):2724–2727, 1979.
◯c IEEE.
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1. THE NATURE OF BIOMEDICAL IMAGES 1.6. TOMOGRAPHY

Figure 1.22: C T image of a patient showing the details in a cross-section through the head (brain). Image courtesy
of Foothills Hospital, Calgary.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.6. TOMOGRAPHY

Figure 1.23: C T image of a patient showing the details in a cross-section through the abdomen. Image courtesy
of Foothills Hospital, Calgary.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.6. TOMOGRAPHY

(a)

(b)

Figure 1.24: C T image of a patient scaled to (a) show the details of the lungs; and (b) display the mediastinum in
detail — the details of the lungs are not visible in this rendition. Images courtesy of Alberta Children’s Hospital,
Calgary.
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1. THE NATURE OF BIOMEDICAL IMAGES 1.7. NUCLEAR MEDICINE IMAGING

1.7 Nuclear Medicine

Imaging

In nuclear medicine imaging, a small quantity of a

radiopharmaceutical is administered into the body orally, by
intravenous injection, or by inhalation.

The radiopharmaceutical is designed so as to be absorbed by and

localized in a specific organ of interest.

The gamma-ray photons emitted as a result of radioactive decay

of the radiopharmaceutical are used to form an image that
represents the distribution of radioactivity in the organ.

Nuclear medicine imaging is used to map physiological function

such as perfusion and ventilation of the lungs, and blood supply
to the musculature of the heart, liver, spleen, and thyroid gland.
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1. THE NATURE OF BIOMEDICAL IMAGES 1.7. NUCLEAR MEDICINE IMAGING

Whereas X-ray images provide information related to density and

may be used to detect altered anatomy, nuclear medicine imaging
helps in examining altered physiological (or pathological)
functioning of specific organs in a body.

Commonly used isotopes in nuclear medicine imaging:

Technetium as 9 9 m Tc — gamma-ray photons at 140 keV .

Thallium as 201T l at 70 keV or 167 keV .
Iodine as 131 I (for thyroid imaging).

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1. THE NATURE OF BIOMEDICAL IMAGES 1.7. NUCLEAR MEDICINE IMAGING

The scintillation gamma camera or the Anger camera uses a

large thallium-activated sodium iodide [ Na I ( Tl ) ] detector,
typically 40 cm in diameter and 10 mm in thickness.

The gamma camera consists of three major parts:

a collimator,
a detector, and
a set of PMTs.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.7. NUCLEAR MEDICINE IMAGING

Image computer

Position Pulse
height Image
analysis
analysis

Photomultiplier
tubes (PMTs)

* * NaI(Tl) crystal detector

Collimator

Gamma rays
emitted

Patient

Figure 1.25: Schematic (vertical sectional) representation of a nuclear medicine imaging system with an Anger
camera.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.7. NUCLEAR MEDICINE IMAGING

Collimator:
Array of holes separated by lead septa.
Allow passage of the gamma rays that arrive along a
certain path of propagation, and to block (absorb) all
gamma rays outside a narrow solid angle of acceptance.
Made of lead alloys, but other materials such as
tantalum, tungsten, and gold have also been used.
Different geometries of collimator holes: triangular, square,
hexagonal, and round patterns.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.7. NUCLEAR MEDICINE IMAGING

Two key factors in collimator design:

– Geometric efficiency — the fraction of the gamma-ray

photons from the source that are transmitted through the
collimator to the detector.
– Geometric (spatial) resolution.
In general, for a given type of collimator, the higher
the efficiency, the poorer is the resolution.
The resolution of a collimator is increased if the size of the
holes is reduced or if the collimator thickness is increased.
However, these measures decrease the number of photons that
will reach the crystal, and hence reduce the sensitivity
and efficiency of the system.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.7. NUCLEAR MEDICINE IMAGING

The efficiency of a typical collimator is about 0.01%:

only 1 in every 10, 000 photons emitted is passed by
the collimator to the crystal.
The most commonly used type of collimator is
the parallel-hole collimator.
Other designs include diverging, converging, fan-beam, and
pin-hole collimators.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.7. NUCLEAR MEDICINE IMAGING

Detector:
Usually a N a I ( T l ) crystal of 6 − 13 mm thickness.
The crystal absorbs the gamma-ray photons that pass through
the collimator holes, and reemits their energy as visible light
(scintillation).
The thickness of the crystal determines the absorbed
fraction of the gamma-ray photons by the photoelectric
effect.
A thick crystal has better absorption than a thin crystal;
however, a thick crystal scatters and absorbs the light before
it reaches the back surface of the crystal.
A crystal of thickness 10 mm absorbs about 92% of
the photons received at 140 keV .

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1. THE NATURE OF BIOMEDICAL IMAGES 1.7. NUCLEAR MEDICINE IMAGING

Photomultiplier tubes:
The crystal is optically coupled at its back surface to an
array of PMTs.
Scintillations within the crystal are converted by the
photocathodes at the front of the PMTs to photoelectrons,
which are accelerated toward each of a series of dynodes held
at successively higher potentials until they reach the anode at
the back of the tube.
The photoelectrons produce a number of secondary electrons
at each dynode, leading to a current gain of the order of 106.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.7. NUCLEAR MEDICINE IMAGING

Image computer:
The current pulses produced by the PMTs in response to
scintillations in the crystal are applied to a resistor matrix that
computes the points of arrival of the corresponding
gamma-ray photons.
The amplitudes of the pulses represent the energy
deposited by the gamma rays.
A pulse-height analyzer is used to select pulses that are within
a preset energy window corresponding to the peak energy of
the gamma rays.
The pulse-selection step reduces the effect of scattered rays at
energy levels outside the energy window used.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.7. NUCLEAR MEDICINE IMAGING

The major disadvantages of SPECT are poor spatial resolution

and high noise content.

The intrinsic resolution of a typical gamma camera (crystal) is

3 − 5 mm .

The net resolution including the effect of the collimator,

expressed as the full width at half the maximum (FWHM) of
the image of a thin line source (the line spread function or LSF)
is
7.5 − 10 mm .

The main causes of noise are quantum mottle due to the low
number of photons used to create images, and the random
nature of gamma ray emission.

Structured noise may also be caused by nonuniformities in the

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1. THE NATURE OF BIOMEDICAL IMAGES 1.7. NUCLEAR MEDICINE IMAGING

Single-photon emission computed tomography:

SPECT scanners usually gather 64 or 128 projections spanning

180◦ or 360◦ around the patient.

Individual scan lines from the projection images may then

be processed through a reconstruction algorithm to obtain
2D sectional images.

Coronal, sagital, and oblique sections may then be created

from the 3D dataset.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.7. NUCLEAR MEDICINE IMAGING

Circular scanning is commonly used to acquire projection images

of the body at different angles.

However, some clinical studies use elliptical scanning so as to

keep the camera close to the body.

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Figure 1.26: A planar or projection image of a patient used for myocardial S P E C T imaging. The two horizontal
lines indicate the limits of the data used to reconstruct the S P E C T images shown in Figure 1.27. Image courtesy
of Foothills Hospital, Calgary.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.7. NUCLEAR MEDICINE IMAGING

(a)

(b)

(c)
Figure 1.27: S P E C T imaging of the left ventricle. (a) Short-axis images. (b) Horizontal long axis images.
(c) Vertical long axis images. In each case, the upper panel shows four S P E C T images after exercise (stress),
and the lower panel shows the corresponding views before exercise (rest). Images courtesy of Foothills Hospital,
Calgary.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.7. NUCLEAR MEDICINE IMAGING

Positron emission tomography (PET):

Certain isotopes of carbon ( 11 C ), nitrogen (13 N ), oxygen (15O),

and fluorine (18F ) emit positrons and are suitable for nuclear
medicine imaging.

PET is based upon the simultaneous detection of the two

annihilation photons produced at 511 keV and emitted in
opposite directions when a positron loses its kinetic energy
and combines with an electron: coincidence detection.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.7. NUCLEAR MEDICINE IMAGING

In one mode of data collection, a ring of bismuth-germanate

detectors is used to gather emission statistics that correspond to
a projection of a transversal section.

Spatial resolution: typically 5 mm .

Useful in functional imaging and physiological analysis of

organs.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.8. ULTRASONOGRAPHY

1.8 Ultrasonography

Ultrasound in the frequency range of 1 − 20 M H z is used

in diagnostic ultrasonography.

The velocity of propagation of ultrasound through a

medium depends upon its compressibility:

lower compressibility results in higher velocity.

Typical velocities in human tissues:

330 m/s in air (the lungs);

1, 540 m/s in soft tissue; and
3, 300 m/s in bone.
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A wave of ultrasound may get reflected, refracted, scattered, or

absorbed as it propagates through a body.

Most modes of diagnostic ultrasonography are based upon the

reflection of ultrasound at tissue interfaces.

A gel is used to minimize the presence of air between the

transducer and the skin to avoid reflection at the skin
surface.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.8. ULTRASONOGRAPHY

Typically, pulses of ultrasound of about 1 µs duration at a

repetition rate of about 1, 000 pps (pulses per second)
are
applied, and the resulting echoes are used for locating
tissue interfaces and imaging.
Large, smooth surfaces in a body cause specular reflection,
whereas rough surfaces and regions cause nonspecular
reflection or diffuse scatter.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.8. ULTRASONOGRAPHY

The normal liver, for example, is made up of clusters of parenchyma

that are of the order of 2 mm in size.

Considering an ultrasound signal at 1 M H z and assuming a

propagation velocity of 1, 540 m/s , the wavelength is
1.54 mm : of the order of the size of parenchymal clusters.

For this reason, ultrasound is scattered in all directions by

the liver, which appears with a speckled texture.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.8. ULTRASONOGRAPHY

Fluid-filled regions such as cysts have no internal structure,

generate no echoes except at their boundaries, and appear
as black regions on ultrasound images.

Absorption of ultrasound by bone causes shadowing in images:

tissues past bones and dense objects along the path of

propagation of the beam are not imaged accurately.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.8. ULTRASONOGRAPHY

The quality of ultrasonographic images is affected by

multiple reflections,

speckle noise due to scattering, and

spatial distortion due to refraction.

Spatial resolution of ultrasound

images: 0.5 − 3 mm .

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1. THE NATURE OF BIOMEDICAL IMAGES 1.8. ULTRASONOGRAPHY

A mode:
A single transducer is used in this mode.
The amplitude (A) of the echoes is displayed on the
vertical axis, with the corresponding depth (related to the
time of arrival of the echo) on the horizontal axis.
The A mode is useful in distance measurement (ranging), with
applications in the detection of retinal detachment and the
detection of shift of the midline of the brain.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.8. ULTRASONOGRAPHY

M mode:
This mode produces a display with time on the horizontal
axis and echo depth on the vertical axis.
The M mode is useful in the study of movement or
motion (M), with applications in cardiac valve motion
analysis.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.8. ULTRASONOGRAPHY

B mode:
An image of a 2D section or slice of the body is produced
by using a single transducer to scan the region of interest or
by using an array of sequentially activated transducers.
Real-time imaging is possible at 15 − 40 fps .
The B mode is useful in studying large organs, such as
the liver, and in fetal imaging.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.8. ULTRASONOGRAPHY

Doppler ultrasound:
Based upon the change in frequency of the investigating beam
caused by a moving target (the Doppler effect).
Useful in imaging blood flow.
Detection of turbulence and retrograde flow: useful in the
diagnosis of stenosis or insufficiency of cardiac valves
and plaques in blood vessels.
Doppler imaging may be used to obtain a combination
of anatomic information with B-mode imaging and flow
information obtained using pulsed Doppler.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.8. ULTRASONOGRAPHY

Special probes:
A variety of probes have been developed for
ultrasonography of specific organs and for special
applications:
– endovaginal probes for fetal imaging,
– transrectal probes for imaging the prostate,
– transesophageal probes for imaging the heart via the
esophagus, and
– intravascular probes for the study of blood vessels.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.8. ULTRASONOGRAPHY

Examples:

Echocardiography — ultrasonography for the assessment of the

functional integrity of heart valves.

An array of ultrasound transducers is used in the B mode to

obtain a video illustrating the opening and closing activities of
the valve leaflets.

Useful in the detection of stenosis and loss of flexibility of

the cardiac valves due to calcification.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.8. ULTRASONOGRAPHY

(a) (b)

Figure 1.28: Two frames of the echocardiogram of a subject with normal function of the mitral valve. (a) Mitral
valve in the fully open position. (b) Mitral valve in the closed position. Images courtesy of Foothills Hospital,
Calgary.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.8. ULTRASONOGRAPHY

Figure 1.29: M-mode ultrasound image of a subject with normal function of the mitral valve. The horizontal
axis represents time. The echo signature of the mitral valve leaflets as they open and close is illustrated. Image
courtesy of Foothills Hospital, Calgary.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.8. ULTRASONOGRAPHY

In spite of limitations in image quality and resolution,

ultrasonography is an important medical imaging modality due to
the nonionizing nature of the medium.

Ultrasonography is particularly useful in fetal imaging.

Figure 1.30: B-mode ultrasound (3.5 M H z ) image of a fetus (sagital view). Image courtesy of Foothills Hospital,
Calgary.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.8. ULTRASONOGRAPHY

Ultrasonography is also useful in

tomographic imaging,
discriminating between solid masses and fluid-filled cysts in the
breast, and
tissue characterization.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.9. MAGNETIC RESONANCE IMAGING

1.9 Magnetic Resonance

Imaging

MRI is based on nuclear magnetic resonance (NMR):

the behavior of nuclei under the influence of externally

applied magnetic and EM (RF) fields.

A nucleus with an odd number of protons or neutrons has an

inherent nuclear spin and exhibits a magnetic moment: such
a nucleus is said to be NMR-active.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.9. MAGNETIC RESONANCE IMAGING

The commonly used modes of MRI rely on:

hydrogen ( 1 H or proton),
carbon ( 13 C ),
fluorine (19F ), or
phosphorus (31P ).

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1. THE NATURE OF BIOMEDICAL IMAGES 1.9. MAGNETIC RESONANCE IMAGING

In the absence of an external magnetic field, the vectors of

magnetic moments of active nuclei have random
orientations, resulting in no net magnetism.

When a strong external magnetic field H o is applied ( z axis),

some of the nuclear spins of active nuclei align with the field
(parallel or antiparallel):

the forced alignment results in a net magnetization vector.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.9. MAGNETIC RESONANCE IMAGING

The magnetic spin vector of each active nucleus precesses

about the z axis at a frequency known as the Larmor frequency:

ωo = γH o ,

(1.4)
where γ is the gyromagnetic ratio of the nucleus considered.

For protons, γ = 42.57 M H z T −1 .

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1. THE NATURE OF BIOMEDICAL IMAGES 1.9. MAGNETIC RESONANCE IMAGING

MRI involves controlled perturbation of the precession of

nuclear spins, and measurement of the RF signals emitted when
the perturbation is stopped and the nuclei return to their previous
state of equilibrium.

MRI is an intrinsically 3D imaging procedure.

No mechanical scanning is involved: slice selection and scanning

are performed electronically by the use of magnetic field
gradients and RF pulses.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.9. MAGNETIC RESONANCE IMAGING

Main components and principles of MRI:

A magnet: strong, uniform field, 0.5 − 4 T .

The stronger the magnetic field, the more spins are aligned
in the parallel state versus the antiparallel state, and the
higher will be the signal-to-noise ratio (SNR) of the data
acquired.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.9. MAGNETIC RESONANCE IMAGING

An RF transmitter to deliver an RF electromagnetic pulse

H1 to the body being imaged.
The RF pulse provides a perturbation: it causes the axis of
precession of the net spin vector to deviate or “flip” from the
z axis.
The frequency of the RF field must be the same as that of
precession of the active nuclei, such that the nuclei can
absorb energy from the RF field (“resonance”).
The frequency of RF-induced rotation is given by

ω1 = γH 1 .

(1.5)

When the RF perturbation is removed, the active nuclei return

to their unperturbed states (alignment with H o ) through
various relaxation processes, emitting energy in the form of
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1. THE NATURE OF BIOMEDICAL IMAGES 1.9. MAGNETIC RESONANCE IMAGING

A gradient system to apply to the body a

controlled space-variant and time-variant magnetic
field

h(t, x) = G(t) · x,

(1.6)
where x is a vector representing the spatial coordinates, G
is the gradient applied, and t is time.
The components of G along the z direction as well as in the
x and y directions are controlled individually (the x − y
plane is orthogonal to the z axis).

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1. THE NATURE OF BIOMEDICAL IMAGES 1.9. MAGNETIC RESONANCE IMAGING

The gradient causes nuclei at different positions to precess

at different frequencies, and provides for spatial coding of
the signal emitted from the body.
The Larmor frequency at x is given by

ω(x) = γ(H o + G · x). (1.7)

Nuclei at specific positions in the body may be excited

selectively by applying RF pulses of specific frequencies.
The combination of the gradient fields and the RF pulses
applied is called the pulse sequence.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.9. MAGNETIC RESONANCE IMAGING

An RF detector system to detect the RF signals emitted

from the body.
The RF signal measured outside the body represents the
sum of the RF signals emitted by active nuclei from a
certain part or slice of the body, as determined by the pulse
sequence.
The spectral spread of the RF signal due to the application
of gradients provides information on the location of the
corresponding source nuclei.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.9. MAGNETIC RESONANCE IMAGING

A computing and imaging system to reconstruct images

from the measured data, as well as process and display the
images.
Depending upon the pulse sequence applied, the RF signal
sensed may be formulated as the 2D or 3D Fourier transform
of
Thethedata
image to be reconstructed.
measured correspond to samples of the 2D Fourier
transform of a sectional image located on concentric
squares or circles.
The Fourier method of image reconstruction from projections
may then be used to obtain the image.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.9. MAGNETIC RESONANCE IMAGING

Various pulse sequences may be used to measure different

parameters of the tissues in the body being imaged.

The image obtained is a function of the nuclear spin density

in space and the corresponding parameters of the relaxation
processes involved.

Longitudinal magnetization: component of the magnetization

vector along the direction of the external magnetic field.

Longitudinal relaxation: process by which longitudinal

magnetization returns to its state of equilibrium (realignment with
the external magnetic field) after an excitation pulse.

The time constant of longitudinal relaxation: T1.

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A 90◦ RF pulse causes the net magnetization vector to be

oriented in the plane perpendicular to the external magnetic field:
this is known as transverse magnetization.

When the excitation is removed, the affected nuclei return to their

states of equilibrium, emitting a signal, known as the
free-induction decay (FID) signal, at the Larmor frequency.

Decay time constant of transverse magnetization: T2.

Range of T1 for various types of tissues: 200 ms to 2, 000

ms . Range of T2 values: 80 ms to 180 ms .

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1. THE NATURE OF BIOMEDICAL IMAGES 1.9. MAGNETIC RESONANCE IMAGING

MRI is suitable for functional imaging.

The increased supply of oxygen (or oxygenated blood) to

certain regions of the brain due to related stimuli may be
recorded on MR images.

The difference between the prestimulus and post-stimulus images

may then be used to analyze the functional aspects of specific
regions of the brain.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.9. MAGNETIC RESONANCE IMAGING

Figure 1.31: Sagital section of the MR image of a patient’s knee. Image courtesy of Foothills Hospital, Calgary.

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1. THE NATURE OF BIOMEDICAL IMAGES 1.9. MAGNETIC RESONANCE IMAGING

(a) (b) (c)

Figure 1.32: (a) Sagital, (b) coronal, and (c) transversal (cross-sectional) MR images of a patient’s head. Images
courtesy of Foothills Hospital, Calgary.

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