Course Information

Lecturers

Prof. Heng Pheng Ann.

Introduction to
Medical Image Processing &
Medical Imaging

Dept of Computer Science and Engineering

Biomedical Engineering
pheng@cuhk.edu.hk

Prof. Wang Defeng
Dept of Imaging and Interventional Radiology

Prof. Defeng WANG

Dept of Imaging and Interventional Radiology, CUHK

Biomedical Engineering
dfwang@cuhk.edu.hk

Prof. Shi Lin
Dept of Medicine and Therapeutics
Biomedical Engineering
shilin@cuhk.edu.hk

Tutor: Mr. Wang Yi (ywang@cse.cuhk.edu.hk)

louwutao@gmail.com

Course Outline

Course Outline

Content

Activities

Introduction

12 lectures

Principles of medical imaging (US, CT, MRI, Nuclear)

1 mid-term exam (Mar 2, 2015)

Visualization

1 final exam (Apr 27, 2015)

Analysis

4 assignments

1 site visit (Apr 13, 2015)

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Grading Scheme

Textbook

Assignment (45% = 20%)

Paul Suetens, Fundamentals of Medical Imaging. Book DOI:

http://dx.doi.org/10.1017/CBO9780511596803. Online ISBN:
9780511596803. Hardback ISBN: 9780521519151

Midterm Exam: 40%

Will only cover content of the first 6 lectures
Final Exam: 40%
Will only cover content of the last 6 lectures

Assignment
Mid-term Exam
Final Exam

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Outline of this Lecture

Basics Concepts in Medical Image Processing

Fundamental concepts about digital image

Basic Image Operations

Grayscale transformation

Geometric transformation

Image filtering

Basics on Medical Imaging

Medical Imaging Principles

Applications

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Basics Concepts in Medical Image

Processing

About digital medical images

1. Building block of an image

1. Building block
2. Grayscale
3. Dimension
4. Quality

2D: Pixels
3D: Voxels

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2. Grayscale

Dynamic range
Say gray values
Dynamic range:
Human eyes cannot distinguish subsequent intensities Ij
and Ij+1 if they differ less than 1%

128

129

128

130
1.5%

0.7%

Integers
if

= 100 n=463;

if

= 1000 n=694

There is no great incentive to display more than 256 shades of gray since
human vision can only resolve about 32 to 64 shades of gray!

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Image Quantization

3. Dimensions

The conversion from analog samples to discrete-valued

samples is called quantization.
For most digital medical image N=4096, i.e.12 bpp
or N= 65536, i.e.16 bpp
8 bpp

4 bpp

2D: X-ray

3D: CT/MRI

Contouring effect
4D: fMRI/Perfusion MRI/etc
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4. Image Quality

Resolution (Spatial)
Dots per inch?

Resolution

The more blurring, the lower is the resolution

Contrast

imaging system, such as focal spot and amount of

detector blur

Noise

scene, such as shape of subject, position and motion

viewing conditions

Artifact

Point Spread
Function (PSF)

Resolution= full width at half maximum (FWHM) of PSF

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Contrast
difference in intensity of adjacent regions of image

Noise

Imaging is a stochastic process!

signal-to-noise ratio (SNR or S/N)

noise can be estimated by making a flat-field image
The noise amplitude = Fourier transform of the autocorrelation
of a flat-field image

Noise in MR image
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Noise and streak artifact (caused by

metal) in CT image

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Source of Noise

Artifacts

Fluctuations in either the imaging system or the

object being imaged.

Ghosting artifact

Quantization Noise: Due to conversion from analog

waveform to digital number.

Quantum Noise: Random fluctuation in the number of
photons emittted and recorded.

Thermal Noise: Random fluctuations present in all
electronic systems.

Motion artifact
(breathing)

Structured Noise: physiological sources, interference

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Resolution as a general concept

Grayscale transformation

Grayscale resolution vs Spatial resolution

Intensity transformation functions.

(a) Contrast stretching function. (b) thresholding function
2562568

32328

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Grayscale transformation

2562562

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Windowing
A popular gray level transformation!
l: window level
w: window size

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Windowing

Image Operation -- Addition

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Image Operation -- Subtraction

Histogram

Four basic image types: dark, light, low contrast,

high contrast, and their corresponding histograms.

Start
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Histogram Equalization

Histogram Equalization

Histogram

Histogram Equalization

Histogram
Equalization
Adaptive
Histogram
Equalization
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Spatial Filtering

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Gaussian filter

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Unsharp masking

Unsharp masking
where

controls the strength of enhancement

Filter size =10

Filter size =60

Filter size =125

Radiography of a hand. (a) Original image I. (b) Smoothed image g I

with g a 3 3 averaging filter. (c) Edges I g I of the image. (d) Unsharp
masked image.
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Geometric Transformations

Basics on Medical Imaging

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Introduction to medical imaging

Inventor of CT

What is medical imaging?

Technique and process to create images of human
body
i.

Clinical usage: reveal, diagnose and examine diseases

ii.

Anatomy study

iii.

Physiology study

Godfrey Newbold Hounsfield CBE, FRS

1979 Nobel Laureate
(1919 - 2004)
Physiology and Medicine

First published X ray image,

Created by Rontgen, 1895.
This technology breakthrough
awarded Nobel Prize in Physics
in 1901.

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Introduction to medical imaging

Basic principles of medical imaging

What is medical imaging?

Four diagnostic methods() from Chinese

medicine:

Cross discipline topic

i.

Mathematics
 Radon transform
 Image registration

ii.

Physics

1) Wng() Observe
2) Wn() Hear

 X-ray
 Ultrasound
 Endoscopy
 Magnetic resonance

iii.

3) Wn() Ask
4) Qi () - Touch

Chemistry
 Spectroscopy imaging

iv.
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and more1
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Basic principles of medical imaging

Basic principles of medical imaging

How the four diagnostic methods are applied in

medical imaging:

How the four diagnostic methods are applied in

medical imaging:

1) Wng() Observe

2) Wn() Hear

Visualize anatomical information in a non-invasive way

Minimal intervention to patients

Modality examples:

Anatomical structures can be reconstructed by echoes from

internal organs

Modality examples:

i.

X-ray computed tomography (CT)

i.

Ultrasound diagnostic

ii.

Magnetic resonance imaging (MRI)

ii.

Echocardiography

iii.

Endoscopy

iv. Thermography

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Basic principles of medical imaging

Basic principles of medical imaging

How the four diagnostic methods are applied in

medical imaging:

How the four diagnostic methods are

applied in medical imaging:

3) Wn() Ask

4) Qi () - Touch

Doctors carry out consultations with patients to get consistent

diagnosis with medical images

Palpation is a new diagnostic approach for soft

tissues

Emerged since last decade

Modality examples:
i.

Ultrasound elasticity imaging (USE)

ii.

Magnetic resonance elasticity

imaging (MRE)

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Pressure distribution
of soft tissues

Development in medical imaging

Chronicle of major modern medical imaging
techniques

Development in medical imaging

1917
Invention of
Radon
transform

1895
Discovery of Xray

1953
First successful
measurement in
heart cavity by
ultrasound (US)

1984
US FDA approved
first commercial
magnetic resonance
scanner (MR)

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1934
Discovery of
artificial
radionuclides

1961
Building of first
positron emission
tomography (PET)

1971
First brain scan by
computed
tomography (CT)

1990s
Elastography was
emerged

Now
More and more
techniques are still
developing

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Multimodal imaging techniques

Commonly used techniques:

1) X-ray/Radiography (X-Ray)

Multimodal imaging techniques

2) Diagnostic ultrasound (US)

3) Computed tomography (CT)
4) Magnetic Imaging Resonance (MRI)
5) Nuclear imaging: Positron emission tomography
(PET)

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Biomedical Imaging
X-ray/Radiograph
Different materials have different
absorption rate in x-ray

X-ray/Radiograph

Advantage: Short scanning time,

relatively inexpensive
Concern: Ionizing Radiation

Ordinary x-ray film photograph and

mammogram

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Biomedical Imaging
X-ray/Radiograph

Biomedical Imaging
X-ray/Radiograph
Mammogram

X-ray image of Scoliosis

Measurement of Cobbs
angle
Evaluation of the severity

A specific type of low-dose x-ray system

Early detection and diagnosis of breast

diseases in women

Screen healthy women for

signs of breast cancer

Treatment planning
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Biomedical Imaging
Ultrasound
Locate objects by reflection of
ultrasound

Diagnostic Ultrasound

Radiation free
Inexpensive
Mobile scanner

Converting sound into images

Quick, and interactive with patient.

High resolution for superficial
structures.
Fast > tracking of motion Cardiovascular

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Biomedical Imaging
Ultrasound Applications

Diagnose diseases related to:
heart and blood vessels,
abdominal aorta,
liver,
gallbladder,

Computed tomography (CT)

spleen,

Virtual slicing and 3D segmentations

pancreas,
kidneys,
bladder,
uterus,
ovaries,
infants etc.
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Biomedical Imaging
CT

Biomedical Imaging
CT Applications

Using computer-processed x-rays to produce

tomographic images (virtual slices)

Head traumas, skull fractures

3-D reconstruction of internal structures

Advantage: Cross-sectional image, see anatomy
and pathology clearly

Blood clots, tumors, and infections

Disadvantage: Radiation dose

Vertebrae, intervertebral discs and spinal cord

Bone mass density in evaluating osteoporosis

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Biomedical Imaging
MRI
Base on magnetic resonance of molecules (Protons)
Strength of magnetic field 1.5T / 3.0T machines in PWH

Magnetic Resonance Imaging

Advantages:
Excellent anatomical detail and strong grey/white matter contrast
Non-invasive

Structural magnetic resonance imaging

Non-ionizing radiation

Functional magnetic resonance imaging

High resolution compared to PET

Diffusion tensor imaging

Disadvantages:
Long scanning time
Expensive

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Biomedical Imaging
MRI

Advanced MR imaging (1)

Structural Magnetic Resonance Imaging (sMRI)

Application of MR imaging

Resonance - Spinning Protons Boost Radio Signal

Head and neck

a radio-frequency (RF) pulse is applied

Internal organs

Induced proton spin flips

Spine

Return to equilibrium: referred to as relaxation

Vessel

The radiofrequency (RF) emitted by the response (echo) in different types of

biological tissues is detected.

Limb and joint

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Advanced MR imaging (1)

Advanced MR imaging (2)

Structural Magnetic Resonance Imaging (sMRI)

Functional Magnetic Resonance Imaging (fMRI)

Advantages and Disadvantages

Principle: Determination of the BOLD signals

Detect neural activity in the brain

Advantages:

Measure the hemodynamic response in blood flow change

sMRI reveals the brain anatomy

Excellent anatomical detail and
strong grey/white matter contrast

Non-invasive

Non-ionizing radiation

High resolution compared to that of
CT

Disadvantages (compared to CT):

Relatively long scanning time

Costly
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Axial T2-weighted MR images of a patient

neural activity
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 blood oxygen and glucose  fMRI signal

Advanced MR imaging (2)

Functional Magnetic Resonance Imaging (fMRI)
Application: clinical diagnosis and research tool

Creative intelligence can be measured by fMRI G

Clinical diagnosis

Presurgical mapping
Risk assessment of invasive brain surgery
Assessment of brain injury
Assessment of patients with disorders of consciousness

Research applications

Mapping brain functions

Detect abnormal neural activity for patients with brain disease

E.g., Alzheimer's disease, Parkinson's disease

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The neurons in our brain

Advanced MRI imaging (3)

Diffusion Tensor Imaging -- Principle
DT-MRI (DTI):
a well-established and
unique imaging technique
measures diffusion tensor of
water in tissues
provides biologically and
clinically relevant information

Isotropic

Anisotropic

tissue composition
physical properties of tissue
constituents
tissue microstructure, architectural
organization

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White matter fibers in the brain

Basser 1999, Westen, 2007

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Transportation map of the world

Map of the brain

Nuclear Imaging

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New Paradigm
PRECLINICAL Alzheimers Disease

Nuclear Medicine Tomography

Positron emission tomography (PET)

Sperling RA, et al. Alzheimers & Dementia 2011; 7:280-292

11C, 13N, 15O, 18F

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Fusion Imaging

Nuclear Medicine Tomography (1)

Positron emission tomography (PET) (Cont)
Application: clinical diagnosis
and research tool

Heavily in clinical oncology
(e.g. detection of tumor and
metastases)

Diffuse brain disease (e.g.
dementia)

PET

Pre-clinical animal studies

Good molecular
Provide structural
and functional
details
detail
Lack of anatomical
details

Baseline and 52 weeks followup of the

same 85 yrs AD patient
(A)&(B): PET scan
(C)&(D): Structural MRI scan
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CT

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Fused PET/CT
Both structural and
functional information

Comparison of various imaging modalities

Fusion Imaging PET/CT Scanner

Resolution

Cost

Radiation safety

PET

CT
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Application of medical imaging

Several computer assisted interventions:
1) Surgical planning and evaluation

Application of medical imaging

2) Surgical navigation
3) Computer aided diagnosis
4) Remote medical consultation

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Computer assisted surgery

Surgical planning and evaluation
Improve accuracy in planning and operation of
surgeries
Able to rehearse in virtual 3D space
Training young physicians to perform complex
procedures
Enhance the identification of surgical anatomy

Computer aided diagnosis

Methodology
1. Image pre-processing
2. Segmentation
3. Structure/region of interest (ROI) analyze
4. Evaluation/classification for analyzed image

Computer aided diagnosis

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Enjoy the course!

Appreciate the beauty of
medical imaging!
Image courtesy of Dr K. H. Fung.
Image courtesy of Dr K. H. Fung.

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Griffith and Genant. Curr Rheumatol Rep.

2011;13:241-250.