UNIT V APPLICATIONS OF MEDICAL IMAGE ANALYSIS 9+3

Medical Image compression- DCT and Wavelet transform based image compression, Pre-processing of
medical images -Retinal images, Ultrasound –liver, kidney, Mammogram. Segmentation of ROI -blood
vessels, lesions, tumour, lung nodules, feature extraction- shape and texture, Computer aided diagnosis
system – performance measures (confusion matrix, ROC, AUC).

1. MEDICAL IMAGE COMPRESSION:

Medical image compression refers to the process of reducing the size of medical images while
preserving diagnostic information and image quality to an acceptable level. Medical images, such as X-
rays, CT scans, MRI scans, ultrasound images, and PET scans, are essential for diagnosis, treatment
planning, and monitoring of various medical conditions. However, these images often require large
storage space and transmission bandwidth, making compression necessary for efficient storage,
transmission, and retrieval.

There are several techniques used for medical image compression:

Lossless Compression: Lossless compression algorithms reduce the size of images without losing any
information. They are typically used when preserving all details of the image is critical, such as in
medical records and archives. Examples of lossless compression techniques include Run-Length
Encoding (RLE), Huffman Coding, and Lempel-Ziv-Welch (LZW) algorithm.

Lossy Compression: Lossy compression algorithms reduce the size of images by discarding some
information that is considered less critical to human perception. While lossy compression results in
some loss of image quality, it can achieve higher compression ratios compared to lossless methods. In
medical imaging, lossy compression is often used in scenarios where slight degradation of image quality
is acceptable, such as telemedicine applications. Popular lossy compression techniques include Discrete
Cosine Transform (DCT), Wavelet Transform, and fractal compression.

Wavelet-Based Compression: Wavelet-based compression is widely used in medical imaging because

it can achieve high compression ratios while preserving diagnostic information. This technique
decomposes the image into multiple frequency bands using wavelet transforms and applies compression
to each band separately.

JPEG 2000: JPEG 2000 is an image compression standard that is particularly well-suited for medical
imaging due to its superior compression efficiency and support for both lossy and lossless compression.
It employs wavelet-based techniques and offers functionalities such as region of interest (ROI) coding,
which allows different compression ratios for different parts of the image.

DICOM Compression: DICOM (Digital Imaging and Communications in Medicine) is a standard for
handling, storing, printing, and transmitting medical images and related information. DICOM includes
provisions for image compression, and several compression algorithms, such as JPEG and JPEG 2000,
are supported within the DICOM standard.

Deep Learning-Based Compression: Recent advancements in deep learning have led to the
development of neural network-based compression techniques. These methods learn to represent images
in a compressed form while minimizing the loss of diagnostic information. Deep learning-based
compression algorithms can adapt to the specific characteristics of medical images and achieve
competitive compression performance.When selecting a compression method for medical images, it's
essential to consider factors such as compression ratio, computational complexity, diagnostic quality,
and regulatory compliance. The choice of compression technique often depends on the specific
requirements of the medical imaging application and the preferences of healthcare providers.

IMAGE COPRESSION MODELS:

2. DCT AND WAVELET TRANSFORM BASED IMAGE COMPRESSION:

DCT (Discrete Cosine Transform) and Wavelet Transform are two widely used techniques for image
compression. Here's a brief overview of how each works in the context of compression:

Discrete Cosine Transform (DCT):

The DCT is a mathematical technique that converts spatial information from an image into frequency
information.It transforms image data from the spatial domain into the frequency domain, where most of
the image information is concentrated in a few low-frequency components.

 In DCT-based compression, the image is divided into small blocks (typically 8x8 pixels), and the
DCT is applied to each block independently.
 After the transformation, the high-frequency coefficients, which represent fine details in the
image, are quantized and discarded to achieve compression.
 The remaining coefficients are then encoded and stored using entropy coding techniques such as
Huffman coding.
 JPEG compression, a popular image compression standard, uses DCT as its core compression
technique.
Wavelet Transform:
 The Wavelet Transform also decomposes an image into frequency components but offers a more
flexible representation compared to DCT.
 It decomposes the image into different scales and orientations, capturing both local and global
image features effectively.
 Wavelet-based compression typically involves a multi-resolution analysis where the image is
decomposed into approximation and detail coefficients at different levels of resolution.
 The approximation coefficients represent the low-frequency components of the image, while the
detail coefficients capture the high-frequency components.
 Similar to DCT-based compression, the detail coefficients are quantized and compressed, while
the approximation coefficients may be further decomposed or kept unchanged based on
compression requirements.
 The JPEG 2000 compression standard is based on the Wavelet Transform and offers advantages
such as superior compression efficiency, scalability, and support for region of interest (ROI)
coding.
3. PRE-PROCESSING OF MEDICAL IMAGES:

Pre-processing of medical images involves a series of steps aimed at enhancing image quality,
reducing noise, correcting artifacts, and preparing images for further analysis or interpretation. Here are
some common pre-processing techniques used in medical image processing:

Image Registration: Image registration aligns multiple images of the same subject or different imaging
modalities into a common coordinate system. It ensures spatial correspondence between images,
facilitating comparison, fusion, and analysis.

Noise Reduction: Medical images often suffer from noise introduced during acquisition or transmission
processes. Various filtering techniques, such as median filtering, Gaussian smoothing, and wavelet
denoising, can be employed to reduce noise while preserving important image features.

Intensity Normalization: Intensity normalization adjusts the intensity values of pixels to ensure
consistency and comparability across images. It corrects for variations in image intensity caused by
differences in acquisition parameters, equipment settings, or tissue properties.

Contrast Enhancement: Contrast enhancement techniques adjust the image histogram to improve
visual perception and highlight important structures or features. Histogram equalization, contrast
stretching, and adaptive histogram modification are commonly used methods for enhancing image
contrast.

Artifact Removal: Artifacts, such as motion artifacts, metal artifacts, and radiofrequency interference,
can degrade image quality and affect diagnostic accuracy. Pre-processing techniques like interpolation,
inpainting, and image inpainting can be employed to remove or minimize artifacts.

Edge Enhancement: Edge enhancement techniques emphasize edges and boundaries in the image to
improve delineation of anatomical structures and lesions. Edge-preserving smoothing filters, such as
bilateral filtering and anisotropic diffusion, can enhance edges while reducing noise.

Image Resampling: Image resampling adjusts the spatial resolution of images to match the desired
resolution or scale. It is often performed to standardize image size, aspect ratio, and pixel dimensions
across different imaging modalities or processing pipelines.

Image Cropping and Segmentation: Image cropping and segmentation isolate regions of interest
within the image, removing irrelevant background information and focusing on specific anatomical
structures or lesions. Segmentation algorithms, such as thresholding, region growing, and active
contours, are used to delineate structures based on intensity, texture, or spatial characteristics.

Image Fusion: Image fusion combines information from multiple imaging modalities or imaging
sequences to create composite images with complementary information. Fusion techniques, such as
multi-resolution blending, wavelet fusion, and principal component analysis, integrate images while
preserving relevant details and features.

Data Augmentation: Data augmentation techniques artificially increase the diversity of training data by
applying transformations such as rotation, translation, scaling, and flipping. Augmentation helps
improve the robustness and generalization of machine learning models trained on limited datasets.
These pre-processing techniques play a crucial role in enhancing the quality, consistency, and
interpretability of medical images, thereby supporting accurate diagnosis, treatment planning, and
medical research. The choice of pre-processing methods depends on the specific characteristics of the
imaging data, the imaging modality used, and the requirements of downstream analysis or applications.

4. RETINAL IMAGES, ULTRASOUND

For retinal images and ultrasound images, specific pre-processing techniques are employed to address
the unique characteristics and challenges associated with each imaging modality. Here are some pre-
processing techniques commonly used for retinal and ultrasound images:

Retinal Images:
Image Enhancement: Retinal images often suffer from low contrast and uneven illumination.
Techniques such as histogram equalization, contrast stretching, and adaptive histogram modification can
enhance image contrast and improve visualization of retinal structures.
Vessel Segmentation: Retinal vessel segmentation separates blood vessels from the background and
other retinal structures. Various segmentation algorithms, including thresholding, region growing, and
model-based methods, can be used to detect and delineate blood vessels.
Lesion Detection and Segmentation: Automatic detection and segmentation of retinal lesions, such as
microaneurysms, exudates, and hemorrhages, are crucial for early diagnosis and monitoring of retinal
diseases like diabetic retinopathy. Machine learning and deep learning techniques, including
convolutional neural networks (CNNs), are commonly employed for lesion detection and segmentation.
Optic Disc and Macula Localization: Accurate localization and segmentation of the optic disc and
macula are essential for automated analysis of retinal images. Template matching, active contours, and
deep learning-based methods are used to detect and segment these anatomical landmarks.
Noise Reduction: Retinal images may contain noise introduced during image acquisition or processing.
Filters such as median filtering, Gaussian smoothing, and wavelet denoising can be applied to reduce
noise while preserving image details.
Geometric Correction: Geometric distortions, such as rotation, scaling, and shearing, may occur in
retinal images due to eye movement or image acquisition conditions. Geometric correction techniques
ensure spatial consistency and alignment of retinal images for accurate analysis and comparison.

ULTRASOUND IMAGES:
Speckle Reduction: Ultrasound images are often affected by speckle noise, which can degrade image
quality and hinder interpretation. Speckle reduction techniques, including median filtering, anisotropic
diffusion, and non-local means filtering, can effectively suppress speckle noise while preserving image
features.
Edge Enhancement: Edge enhancement techniques highlight boundaries and edges in ultrasound
images, improving the visualization of anatomical structures and lesions. Edge-preserving filters, such
as edge enhancement filters and structure-enhancing diffusion filters, can be applied to enhance image
sharpness and clarity.
Segmentation: Segmentation of anatomical structures and lesions in ultrasound images is essential for
quantitative analysis and diagnosis. Region-based methods, active contours, and machine learning
algorithms can be used for segmentation tasks, including organ delineation, tumor detection, and
measurement of anatomical dimensions.
Texture Analysis: Texture analysis techniques quantify textural patterns and heterogeneity in
ultrasound images, providing valuable information for characterizing tissue properties and detecting
abnormalities. Statistical features, texture descriptors, and machine learning-based classifiers can be
used for texture analysis and classification tasks.
Motion Compensation: Ultrasound images may be affected by motion artifacts caused by patient
movement or probe manipulation. Motion compensation techniques, such as motion estimation and
image registration, can correct for motion artifacts and improve image quality for more accurate
diagnosis and analysis.
Resolution Enhancement: Ultrasound images may have limited spatial resolution, particularly in deep
tissue regions. Super-resolution techniques, interpolation methods, and multi-frame averaging can
enhance spatial resolution and detail visibility in ultrasound images, enabling better visualization of fine
structures and abnormalities.

5. LIVER, KIDNEY, MAMMOGRAM. SEGMENTATION OF ROI:

Segmentation of regions of interest (ROI) in medical images such as liver, kidney, and mammograms is
crucial for various diagnostic and clinical applications. Here are some common approaches for
segmenting ROIs in these types of medical images:

Liver and Kidney Segmentation:

Thresholding Techniques: Simple thresholding methods can be effective for segmenting liver and
kidney regions based on their intensity values in CT (Computed Tomography) or MRI (Magnetic
Resonance Imaging) images. Global or adaptive thresholding methods can be used to separate the liver
and kidney from surrounding tissues.
Region Growing: Region growing algorithms start from a seed point and iteratively grow regions based
on similarity criteria, such as intensity or texture. Liver and kidney regions can be segmented by seeding
from known locations and expanding the regions until a stopping criterion is met.
Active Contour Models: Active contour or snake models deform iteratively to minimize an energy
function that combines image properties and contour smoothness. These models can be used to delineate
liver and kidney boundaries by initializing contours near the organ boundaries and allowing them to
evolve until convergence.
Machine Learning-Based Segmentation: Machine learning algorithms, such as random forests,
support vector machines (SVMs), and convolutional neural networks (CNNs), can be trained to
automatically segment liver and kidney regions from medical images. These methods learn features
from annotated training data and predict segmentations for unseen images.
Atlas-Based Segmentation: Atlas-based segmentation involves registering a pre-segmented atlas image
to a target image and transferring the segmentation to the target image. Liver and kidney atlases can be
constructed from annotated images, and registration techniques such as affine or deformable registration
can be used for segmentation.

6. MAMMOGRAM SEGMENTATION:
Thresholding and Region Growing: Mammogram segmentation often involves separating the breast
tissue from the background and identifying regions corresponding to lesions or abnormalities.
Thresholding followed by region growing can be used to segment breast tissue, while additional
processing steps may be employed for lesion segmentation.
Active Contour Models: Active contour models can be utilized for segmenting breast boundaries and
lesion regions in mammograms. These models can be initialized near the breast boundary or lesion
locations and iteratively evolve to accurately delineate the regions of interest.
Texture Analysis: Texture analysis techniques can be applied to mammograms to identify regions with
characteristic texture patterns associated with abnormalities such as masses or microcalcifications.
Texture features extracted from mammogram patches can be used to classify and segment abnormal
regions.
Deep Learning-Based Segmentation: Deep learning methods, particularly convolutional neural
networks (CNNs), have shown promising results for mammogram segmentation tasks. CNN
architectures can be trained end-to-end to directly predict breast and lesion segmentations from
mammogram images, eliminating the need for handcrafted features.
Multi-Modality Fusion: Mammogram segmentation can benefit from multi-modality fusion, where
information from complementary imaging modalities (e.g., ultrasound or MRI) is integrated to improve
segmentation accuracy and robustness.

7. BLOOD VESSELS, LESIONS, TUMOUR, LUNG NODULES, FEATURE EXTRACTION:

In the context of medical imaging, particularly in fields like radiology, pathology, and oncology, the
detection and characterization of blood vessels, lesions, tumors, and lung nodules are critical tasks.
Feature extraction plays a significant role in identifying relevant information from medical images to aid
in the diagnosis and treatment planning process. Here's how feature extraction can be applied to each of
these areas:

1. Blood Vessels:

 Intensity-Based Features: Features such as mean intensity, standard deviation of

intensity, and histogram-based features can be extracted to characterize blood vessels based on
their pixel intensity.
 Texture Features: Textural patterns within blood vessels, such as smoothness, coarseness,
or roughness, can be quantified using texture analysis techniques like gray-level co-occurrence
matrix (GLCM) or local binary patterns (LBP).
 Geometric Features: Geometric characteristics like vessel diameter, tortuosity, branching
patterns, and vessel length can be extracted to provide structural information about blood
vessels.
 Vessel Enhancement Features: Features extracted from vessel-enhanced images obtained
through techniques like vesselness filtering or Hessian-based methods can help highlight and
characterize blood vessels more effectively.

2. Lesions and Tumors:

 Shape Features: Features related to the shape of lesions or tumors, such as area,
perimeter, compactness, circularity, sphericity, and eccentricity, can be extracted to describe
their morphological characteristics.
 Intensity Distribution Features: Statistical measures of pixel intensities within the lesion
or tumor region, including mean, variance, skewness, and kurtosis, can provide information
about their internal composition.
 Texture Features: Similar to blood vessels, texture analysis techniques can be applied to
characterize the textural properties of lesions or tumors, which may indicate different tissue
types or pathological conditions.
 Margin Features: Features describing the margin or boundary of lesions, such as
irregularity, spiculation, or lobulation, can be indicative of malignancy or benignity.
 Vascularization Features: Features related to the presence and distribution of blood
vessels within or around lesions, such as vessel density, can be extracted using methods like
vessel segmentation and analysis.

3. Lung Nodules:

 Size and Shape Features: Features such as nodule diameter, volume, sphericity, solidity,
and elongation can be extracted to characterize lung nodules.
 Density Features: Measures of nodule density, including mean density, variance of
density, and distribution of density values, can provide information about nodule composition.
  Texture Features: Texture analysis techniques can be applied to characterize the internal
texture patterns of lung nodules, which may be indicative of benign or malignant nodules.
 Margin Features: Similar to lesions and tumors, features describing the margin
characteristics of lung nodules, such as spiculation or lobulation, can be informative for
distinguishing between different nodule types.

These extracted features serve as quantitative descriptors of anatomical and pathological structures in
medical images, which can then be used as input for classification algorithms (e.g., machine learning
classifiers) to aid in automated detection, segmentation, and characterization of blood vessels, lesions,
tumors, and lung nodules in medical imaging applications.
8. COMPUTER-AIDED DIAGNOSIS (CAD) SYSTEM

A Computer-Aided Diagnosis (CAD) system is a software tool designed to assist healthcare

professionals in interpreting medical images and making diagnostic decisions. These systems are
particularly prevalent in fields like radiology, pathology, and dermatology. Here's how they typically
work:

1. Image Acquisition: The process begins with the acquisition of medical images such as X-rays, MRI
scans, CT scans, ultrasound images, or histopathology slides.

2. Image Preprocessing: Raw medical images often contain noise and artifacts that can affect the
accuracy of analysis. Preprocessing techniques are applied to enhance the quality of images, which may
include noise reduction, contrast enhancement, and image normalization.

3. Feature Extraction: CAD systems extract relevant features or characteristics from the preprocessed
images. These features can include shape, texture, intensity, and other quantitative measures that are
important for diagnosis.

4. Feature Selection: Not all extracted features are equally relevant for diagnosis. Feature selection
techniques are used to identify the most informative and discriminative features that can differentiate
between normal and abnormal tissues or structures.

5. Classification or Decision Making: Once the relevant features are extracted and selected, a
classification algorithm is employed to classify the image into different categories (e.g., normal vs.
abnormal). Machine learning techniques such as support vector machines (SVM), neural networks,
decision trees, or deep learning models are commonly used for this purpose.

6. Integration with Clinical Workflow: The CAD system provides diagnostic output to the healthcare
professional, aiding them in their decision-making process. This output may include probability scores,
heatmaps indicating regions of interest, or specific diagnostic recommendations.

CAD systems offer several benefits:

 Increased Accuracy: By assisting healthcare professionals in analyzing medical images, CAD

systems can help improve diagnostic accuracy and reduce the risk of errors.

 Efficiency: CAD systems can analyze images much faster than humans, potentially reducing the
time required for diagnosis and treatment planning.

 Standardization: CAD systems can help standardize diagnostic procedures and reduce
variability in interpretation between different practitioners.
  Education and Training: CAD systems can also be valuable tools for medical education and
training, allowing students and junior healthcare professionals to learn from automated analysis
and diagnostic recommendations.

However, CAD systems also have limitations, including the need for large datasets for training, the
potential for false positives or false negatives, and the risk of overreliance on automated analysis
without human oversight. Overall, CAD systems have the potential to significantly enhance diagnostic
capabilities in healthcare, particularly in fields where medical imaging plays a critical role.