This presentation has prepared by taking material from various books/journal papers for teaching a course in MEDICAL IMAGING.

It has no commercial value and is only for reference purpose.

EE-536 MEDICAL IMAGING

Credit 4 L-3, T-1, P-0

List of Books
S. No. Titles 1 2 Author year 2009 2010 Fundamentals of Medical Paul Suetens Imaging Introduction to Medical Imaging: Nadine Barrie Smith Physics, Engineering and Clinical Applications The Physical Principles of Perry Sprawls, Ph.D nd Medical Imaging, 2 ed The Essential Physics of Medical Imaging (2nd Edition) Jerrold T. Bushberg

3 4 5 6 7 8 9

2010 2002 2005 2009 2009 1998 1995

An Introduction to the Principles of Medical Imaging Chris Guy Digital Image Processing for Medical Applications Digital Image Processing Fundamentals of Electronic Image Processing Machine Vision Geoff Dougherty Gonzalez, Rafael C.; Woods, Richard E. Arthur R Weeks, Jr. SPIE / IEE Series 1996 Ramesh Jain, Rangachar Kasturi &Others

2010 2011

Medical Imaging
1. Introduction to Medical Imaging
2. (i) History of Medical Imaging (ii) EM Spectrum 3. Medical Imaging Modalities 4. X-Ray, Interaction with matter 5. X-Ray equipment, detectors, film, Screen, Image quality 6. Dual Energy X-rays 7. Fluoroscopy 8. Mammography

9.
10. 11. 12. 13. 14. 15. 16. 17. 18 19.

Angiography X-Ray Computed Tomography 2 D and 3 D Imaging MRI Introduction, qualitative description Brain tumors and types Image quality, equipment, clinical use-1 Image quality, equipment, clinical use-2 NMI, SPECT, PET Image quality, equipment, clinical use-1 Image quality, equipment, clinical use-2 Ultrasound Imaging, Introduction, Physics of acoustic waves

20. 21. 22. 23. 24. 25. 26. 27.

Generation & detection, gray scale imaging Doppler Imaging Image quality, equipment, clinical use-1 Image quality, equipment, clinical use-2 Basics of Image enhancement in space & frequency domain -1 Basics of Image enhancement in space & frequency domain-2 Feature extraction, first order statistics and second order statistics Feature extraction: Higher order statistics

28. 29. 30. 31. 32. 33. 34. 35. 36. 37.

Texture analysis Morphological Analysis Enhancement techniques Ridgelet Transform Curvelet Transform Various noise models Image Compression Despecke filtering Cluster based Medical Image segmentation Ultrasound Liver Image Classification I Ultrasound Liver Image Classification II

38. 39. 40. 41. 42.

Segmentation & registration of MRI Detection and Classification of Mammography Images SVM Based Classification of mammography Reduction of blocking artifacts Conclusions

MILESTONES MEDICAL DIAGNOSTIC IMAGING

Date 400 BC 1612 1660 1810 18501900 Development of Discovery Disease concept introduced by Greek physician Hippocrates. Medical Thermometer devised by Italian physician Sanctorius. Light Microscope developed by Dutch naturalist Antohj van Leeuwenhoek. Stethoscope invented by French physician Rene Laennec. Germ theory of disease proposed by French scientist Louis Pasteur and developed by German bacteriologist Robert Koch.

1895 X-rays discovered by German physicist Wilhelm Conrad Roentgen. He also produced the first x-ray picture of the body(his wifes hand) in 1895. 1900 Chest x-ray, widespread use of the chest x-ray made early detection of tuberculosis (which was the most common cause of death) a reality. 1906 X-ray contrast medium. First contrast filled image of the renal system (kidneys). 1910 Barium sulfate introduction of as contrast agent for gastro-intestinal diagnosis. 1910- Theory of Radioactivity published by Marie Curie and 1912 investigation of x-ray radiation for patient therapy (e.g. treatment of cancer).

1906 Electrocardiograph (ECG) invented by Dutch physiologist Willem Einthoven to monitor and record the electric signature of the heart. 1924 Radiographic imaging of the gallbladder, bile duct and blood vessels for the time. 1929 Cardiac catheterization first performed by Forssmann on himself. 1932 Transmission electron microscope (TEM) Constructed by German scientists Max Knoll and Ernst Ruska. 1945 Coronary artery imaging. Visualization of (blood vessels that feed the heart). 1950 Nuclear Medicine applied imaging the kidneys, heart, and skeletal system.

1955

1955 1957

X-ray image Intensifier-Television units to allow dynamic x-ray imaging of moving scenes. These fluoroscopic movies provided new information of the beating heart and its blood vessels. Panoramic x-ray images of the entire jaw and teeth. Fiber endoscopy pioneered by South African-born physician Basil Hirschowitz at the University of Michigan. Ultrasound imaging is developed to look at the abdomen and kidneys, fetal body, carotid blood vessels and heart. X-ray mammography finds widespread application in imaging the breast.

1960

1970

1972 Computed Tomography (CT) scanning invented by British engineer Godfrey Hounsfield of EMI Laboratories, England, and South African born physicist Allan Cormack of Tufts University, Massachusetts. 1976 Coronary Angioplasty was introduced by surgeon Andreas Gruentzig at the University Hospital, Zurich, Switzerland. This technique uses x-ray fluoroscopy to guide the compression of plaques and minimize the dangerous constriction of the heart vessels.

1978 Digital radiography: the TV signal from the x-ray system is converted to a digital picture which can then be enhanced for clearer diagnosis and stored digitally for future review. 1980 Magnetic Resonance Imaging (MR) of the brain was first done on a clinical patient. MRI was developed by Paul Lauterbur and scientists at Thorn-EMI Laboratories, England, and Nottingham University, England. 1984 3-Dimensional image processing using digital computers and CT or MR data, three dimensional images of bones and organs were first made. 1985 Clinical Positron Emission Tomography (PET) scanning developed by scientists at the University of California.

1985 Clinical Networks were first implemented to allow digital diagnostic images to be shared between physicians via computer network, allowing a doctor in Boston to review a CT examination from a patient in Beijing, China. 1989 Spiral CT allows fast volume scanning of an entire organ during a single, short patient breath hold of 20 to 30 seconds. Spiral CT had caused a renaissance in CT and lead the way to significant developments like CT Angiography. 1989 MR Angiography developed and clinically available to allow non-imaging of the blood vessels without radiation or contrast injection.

1993 Echo Planar MR Imaging (EPI) developed and clinically available to allow MR systems to provide early detection of acute stroke. EPI also makes possible functional imaging, for instance of brain activity allowing doctors to investigate the function of different centers of the mind. 1993 Open MRI Systems developed to allow MR scanning of severely claustrophobic or obese patients who could not tolerate convention MR imaging in a close bore system.

Fields using DIP

Late 1960s & early 1970, use of DIP techniques in
Medical imaging Remote earth resources observations Astronomy Computerized Axial Tomography in early 1970s by Sir Godfrey N. Hounsfield & Prof Allan M. Cormack ( 1979 Nobel Prize in Medicine) Whereas X-ray was discovered in 1895 by Wilhelm Conrad Roentgen ( 1901 Nobel Prize)

X-Ray

18

INFRARED

19

DIMENSIONALITY OF DIGITAL IMAGE

Dimension 2

Dimension 1

20

Image Processing Examples

21

Image Processing Examples

22

Image Processing Examples

23

Image Processing Examples

24

Classification of Images
Electromagnetic Energy Spectrum Acoustic (sound) Electron Microscopy Synthetic-Computer generated

Gamma-Ray Imaging
Used in Nuclear Medicine & Astronomical Observations In nuclear medicine
To inject radioactive isotope that emits gamma rays as it decays Images are formed from emission collected by gamma ray detectors Used for bone pathology such as infection or tumor

NUCLEAR MEDICINE FUNCTIONS OF ORGANS

Abdomen Brain Blood Breast Hepatobiliary Heart Kidney Liver Lungs to check gastrointestinal bleeding to look for tumors blood cell disorders breast cancers gallbladder bile duct functions coronary artery disease renal functions cirosis or metastatic cancers pulmonary functions blood clot etc

NUCLEAR MEDICINE or RADIONUCLIDE

Functional and anatomical information about organs Fused image of Nuclear Med & MR acquisition MR gives excellent anatomical details SPECT gives excellent functional

Positron Emission Tomography

Same principle as that of X-Ray tomography In place of X-Rays, radioactive isotopes are used that emits Positrons as it decays When positron meets an electron, both are annihilated and two gamma rays are given off Gamma rays are detected and tomography image is created In image shown here displays a visible tumor in lungs

PET

SOME APPLICATIONS OF PET

Study of epilepsy evaluation of stroke Study of dementia alzheimers parkinsons Brain tumors Coronary artery disease to study of transient ischemia Differentiation between active tumor growth and necrotic ie dead

SPECT
Single positron emission computed tomography
It uses gamma camera which can rotate and computer reconstruction similar to PET PET may be more sensitive than SPECT but PET scanners are more costly

X-Rays
Analog X-Rays Digital X-Rays Dual Energy X-Rays Fluoroscopy CT Imaging Angiography Mammography

 Photographic film affected by x-rays Digital x-rays use

Digitizing x-rays film X-rays after passing the body falls on phosphor screen to convert x-rays to light and than on light sensitive detectors

Angiography
Contrast enhancement radiography Used to obtain images of blood vessels A catheter is inserted into blood vessel and guided to the area to be studied An x-ray contrast media is inserted by catheter This enhances the contrast of blood vessels to see irregularities & blockages Image subtraction is used to enhance further contrast of blood vessels

CONTRAST MATERIAL
substance that has a different opacity from soft tissue on radiography or computed tomography. Includes: Barium or water, for gastrointestinal tract opaque. Iodine in water, for arthrography. Water soluble iodine, to make blood vessels opaque; to demonstrate the inner structures of the urinary tract (kidneys, ureters and bladder); and to outline joints (the spaces between two bones). Iodine mixed with water or oil to evaluate the fallopian tubes and lining of the uterus. Sterile saline (salt water) is used during hysterosonography.

ANGIOGRAPHY EQUIPMENT

X-RAY RADIOGRAPHY
X-ray Source

3-D Object or Patient

Anti-scatter Grid X-ray Screen Film X-ray Screen

2-D Projection Image

CHEST RADIOGRAPH

Computerized Tomography
3-D capabilities Numerous slices are taken to generate images Images are created using mathematical model of the body and a computer

3-D CONFIGURATION
y x

X-Y Slices

y x
(x,y; z) 15

z
Iin(x; y,z) 11 12 22 42 52 62 72 82 92

Iout(x; y,z)

FIRST GENERATION SCANNERS

CT SCANNER

Source Rotation Path Source

Ring of Detectors

X-rays

Object

CT CHEST IMAGES

FLUOROSCOPY
Flouro (short) scopy x-ray procedure for real time digital acquisition

DIGITAL X-RAYS
Lower dose of x-ray can give same high resolution as with film x-ray Image can be enhanced by DIP Can be stored & retrieved Is being used in breast imaging and biopsy

ULTRAVIOLET BAND
Application of ultraviolet light This includes lithography, industrial inspection, microscopy, lasers, biological imaging & astronomical observations Used in fluorescence microscopy Mineral fluorescence when UV light is focused on it UV itself is not visible but when a photon of UV radiations collide with electron in an atom of a fluorescent material, it elevate the electron to a higher energy level Excited electron relaxes to lower level and emits light in the form of lower energy photons in visible (red) light region Emission light reaches the eye or detector

Visible & Infrared Bands

Light microscope Micro-inspection of material characterization, pharmaceuticals, remote sensing like NASAs LANDSAT etc

Microwave Band
RADAR RADAR waves can penetrate clouds, and can see through vegetation, ice & dry sand It works like a flash camera ie it provides its own illumination ie microwave pulses and take a snap shot. It uses an antenna and digital computer processing

INFRARED VIDEO IMAGING

Radio Band
Medicine & astronomy MRI

MAJOR MRI SCANNER VENDORS

Philips Intera CV

Siemens Sonata General Electric CV/i

MRI Uses Three Magnetic Fields

Static High Field (B0)
Creates or polarizes signal 1000 Gauss to 100,000 Gauss
Earths field is 0.5 G

Radiofrequency Field (B1)

Excites or perturbs signal into a measurable form On the order of O.1 G but in resonance with MR signal RF coils also measure MR signal Excited or perturbed signal returns to equilibrium
Important contrast mechanism

Gradient Fields
1-4 G/cm Used to image: determine spatial position of MR signal

THERMOGRAPHY
Any object above absolute zero will radiate electromagnetic radiations/energy to an extent governed by its radiant emitance the use of thermography in cancer detection is based upon the assumption that a temperature difference exists between a malignant tumor and the surrounding tissue.

ULTRASOUND
medical

ULTRASOUND

ULTRASOUND
Ultrasound uses the transmission and reflection of acoustic energy.

prenatal ultrasound image clinical ultrasound system

ULTRASOUND

A pulse is propagated and its reflection is received, both by the transducer. Key assumption: - Sound waves have a nearly constant velocity of ~1500 m/s in H2O. - Sound wave velocity in H2O is similar to that in soft tissue. Thus, echo time maps to depth.

ULTRASOUND: RESOLUTION AND TRANSMISSION FREQUENCY

Tradeoff between resolution and attenuation higher frequency shorter wavelength higher dB attenuation

Power loss:

cm MHz

Typical Ultrasound Frequencies: Deep Body 1.5 to 3.0 MHz Superficial Structures 5.0 to 10.0 MHz e.g. 15 cm depth, 2 MHz, 60 dB round trip

Why not use a very strong pulse? Ultrasound at high energy can be used to ablate (kill) tissue. Cavitation (bubble formation) Temperature increase is limited to 1 C for safety.

FRACTAL IMAGING
Computer generated images Iterative reproduction of a basic pattern according to some mathematical rules Flight simulators, medical training

CLINICAL APPLICATIONS
X-Ray/ CT Chest + widely used + CT excellent Abdomen Head needs contrast + X-ray - is good + CT for bone excellent CT - bleeding, trauma no, + excellent poor + heart problems with gas + extensive use Merge w/ CT + PET in heart + growing cardiac applications + minor role + standard

Ultrasound

Nuclear MR

CLINICAL APPLICATIONS
X-Ray/ CT Cardiovascular + X-ray Excellent, with catheter-injected contrast Skeletal / Muscular + strong for skeletal system

Ultrasound + real-time + non-invasive + cheap but, poorer images Nuclear + functional information on perfusion MR + getting better High resolution Myocardium viability

not used + Research in elastography

+ functional - bone marrow + excellent

Conventional X-ray

Projection/Tomogr aphy Mainly Anatomical / Functional Interventional options? Maximum imaging depth in soft tissue Spatial resolution in plane of imaging (typical) Slice thickness (typical) Safety

Projection Anatomical Yes Metres 0.1 mm

X-ray Computed Radioisotope Tomography (CT) Imaging (Nuclear Medicine) Tomography Both Anatomical No Metres 0.25 mm Functional No Body thickness 5 to 10 mm

Magnetic Emission Ultrasound Imaging Positron Resonance Imaging (1 to 10 MHz) Tomography (PET) (MRI) Tomography Tomography Tomography Both Possible Body thickness 0.5 mm Both Yes Body thickness 0.5 mm Functional No Body thickness 5 to 10 mm

n/a

1 to 5 mm

n/a or 5 to 10 mm Ionising radiation leads to a moderately higher radiation dose than for conventional x-rays

3 to 10 mm

1 mm

10 mm

Ionising radiation Ionising radiation leads to a radiation leads to a higher dose radiation dose than for conventional xrays Examination time Short Medium Physical property Linear attenuation Linear attenuation of tissue coefficient coefficient associated with image formation Relative capital Low cost* Relative cost per Low patient study* Comments Interventional studies such as cardiac catheterisation take longer and are costlier than radiographic studies Fairly high Medium May be called CAT (Computerized axial tomography). Current interest in multi-detector CT.

A range of hazards arising from strong and time varying electromagnetic fields. Long Long Tracer isotope is Proton density and involved in metabolic nuclear magnetic process; measure resonance relaxation concentration times. Fairly high Medium to high Some gamma camera systems also have PET capability, but these have lower sensitivity than dedicated PET systems High High Open systems or special facility needed for intraoperative use. Tailored sequences used for functional measures.

Thermal effects and Ionising radiation cavitations leads to a moderately higher radiation dose than for conventiona x-rays Medium Long Primarily acoustic Tracer isotope is impedance: involved in metabolic differences lead to process; measure reflections at concentration boundaries Medium High Low Blocked by bone. The Doppler effect is used for measuring the velocity of blood flow High A cyclotron is used to produce specia isotopes; this must be located close by Current interest in combined CT/PET systems and PET/MR

High frequency ultrasound

Fluorescence microscopy

Optical coherence tomography Tomography Anatomical

In vivo confocal microscopy Tomography Anatomical 400 m 2 to 5 m 0.5 m Consult special guidelines regarding use in eye Uses reflected light or fluorescence

Projection/To mography Mainly Anatomical / Functional Maximum imaging depth in soft tissue Spatial resolution Depth resolution Safety

Tomography Anatomical

Projection Functional

Spectrophotometric intracutaneous analysis Projection Both

Diffuse optical tomography Tomography Functional

Terahertz pulsed imaging Both Both

High resolution MRI Tomography Anatomical

4 mm 20 m 9 m Thermal effects and cavitations

0.5 mm 1 m n/a May involve administration of fluorophores.

2 to 3 mm 10 m 5 to 15 m Consult special guidelines regarding use in eye Refractive index. Interferometri c techniques used to infer time of flight OCT. Can be used endoscopically. Visible light.

2 mm Up to 10 m n/a

15 cm

Few mm 350 m 40 m Thermal effects

cm 100 m 100 m Hazards from strong and time varying electromagnetic fields Proton density and nuclear magnetic resonance relaxation times Using special small coils in a 1.5-3T whole body scanner.

1 to 3 mm 1 to 3 mm Thermal effects

Physical property of tissue associated with image formation Comments

Primarily acoustic impedance: differences lead to reflections at boundaries 20-200 MHz. High frequency Doppler under development

Decay time of fluorescence induced by laser light, plus spectrum and intensity, give molecular envir e.g. FLIM Fluorescence Lifetime Imaging. Visible light.

Accessible tissue surfaces, planes parallel to surface. Visible light.

Effect of the skins chromophores(h aemoglobin, melanin, collagen, dermal melanin) SIAscopy analytical version of dermatoscopy or ELM. Visible light & NIR.

Refractive index and scattering, chromophore content and absorption Monitor tissue and blood oxygenation levels. Near infrared (NIR).

Complex refractive index affecting pulses of radiation.

Also spectroscopy. mmwave imaging is a passive technique at similar frequency.