Radiation Protection in Digital

Radiology

Digital Radiographic Image

Processing
L05

IAEA
International Atomic Energy Agency
 Educational Objectives

• List three main purposes of digital

image processing
• Explain the term “greyscale histogram”
• Show how radiographic technique
factors affect the greyscale histogram
• Suggest how errors in digital image
processing can contribute to
unnecessary radiation exposure to
patients
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The quality of any monochrome
image can be described in
conventional terms.
• Density (darkness)
• Contrast
• Sharpness
• Noise
• Artefacts

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 Advantages of DR images vs.
analogue images

• Density can be modified.

• Contrast can be modified.
• Sharpness can be modified.
• Noise can be modified.

Result of 20 years of development!

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Advantages of analogue images vs.
DR images

• Density function inherently nice.

• Contrast inherently higher.
• Sharpness inherently higher.
• Noise inherently lower.

Result of 110 years of development!

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 DR density is adjustable and
arbitrary

• Acquisition is independent from display

• Code values in the raw DR image can
be translated to any display level
• This allows DR to compensate for over-
and under-exposure, producing a
consistent appearance

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 selection in screen-film
radiography

Overexpose
Underexposed
d
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DR compensates for incorrect
exposure factor selection

Overexposed Underexposed

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The raw DR image has low contrast

• DR has an extremely wide latitude, which

implies low contrast for an imaging system
that is “display limited” (limited by the
latitude of the display).
• DR code values can be remapped to
generate high contrast for “values of
interest” (VOI), while sacrificing contrast for
other values.
• This is the primary purpose of DR image
processing
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 Idealised Greyscale Histogram

• Goal is to represent
anatomy, A, with good
contrast # pixels
A
• B is air B
D C
• C is scatter contribution
- only outside Exposure (or greyscale)
collimators
• D is scatter contribution Region of clinical interest
-only image of anatomy
outside collimated
area, barium, or lead

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 Increased mAs shifts the Greyscale
Histogram

# pixels
A B
D C

Exposure (or greyscale)

Region of clinical interest

• Changing mAs does not affect subject contrast, as

long as the dynamic range is not exceeded

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 Increased kVp squeezes the
Greyscale Histogram

# pixels
A B
C
D
Exposure (or greyscale)

Region of clinical interest

• Higher kVp => less subject contrast

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Primary job of image processing: identify
values of interest and maximize their
contrast.
contrast
• Detection of collimator boundaries or
anatomy, “exposure recognition”
• Window width and window level are
adjusted relative to greyscale
histogram
• Density is thus also adjusted
• This is “acquisition processing”

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 Did we skip a step?

• How did we assure that the response

of the detector was uniform over the
entire field of view?
• “Pre-acquisition processing”, or
“preprocessing”, corrects for detector
imperfections and variable response.
• Some include auto-ranging in
preprocessing.

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Detector characteristic function
for CR

3 10000

2.5
1000 Film/screen

Intensity (rel)
Density (OD)

2 Histogram
1.5 100 w/contrast
PSL
1 Adjust WW
10
0.5

0 1
0.1 1 10 100 1000
Air KERMA (µGy)

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 Raw data Raw, ranged data

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 “Matched latitude” is another
feature of histogram re-scaling

3 10000

2.5
1000

Intensity (rel)
Histogram 1
Density (OD)

2
Histogram 2
1.5 100 Adjust WW 1
1 Adjust WW 2
10
0.5
0 1
0.1 1 10 100 1000
Air KERMA (µGy)

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 Code values can be remapped in
more complex ways to modify
contrast
• Modifying contrast is the secondary role for
image processing
• Contrast is compromised for some values of
interest in order to enhance contrast in
others
• “post-acquisition processing”

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 There are many brand-names for
post-acquisition processing

• Look-up-table (LUT, Gradation Processing)

• Unsharp Mask (Frequency Processing)
• Multi-frequency Processing (Musica®)
• Multi-Objective Frequency Processing
• Dynamic Range Control
• Tomographic Artifact Suppression
• Energy Subtraction (Dual Energy)

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 Code values can be remapped to a
non-linear function
• This function might have lower contrast for
lighter and darker features with higher
contrast for values in the middle range, to
achieve a film-like appearance.
• Code values within the values of interest are
translated by means of a Look-up Table
(LUT).
• This is “Gradation Processing”,
“Sensitometry”, and “grey-scale rendition”

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Raw, ranged data Gradation-processed data

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 The DR image has limited
sharpness
• Sharpness is limited by pixel dimensions
• The smallest feature that can be resolved by CR
is a “line pair” represented by one “dark” pixel
next to a “light” pixel.
• Maximum spatial resolution is the sampling rate
(pixels per mm) divided by 2 (pixels per line pair)
• This is also called the “Nyquist Frequency” or
“Nyquist Limit”
• A large format cassette with 2000 pixels along
the 35 cm dimension would have about 6 pixels
per mm and a maximum spatial resolution of 3
lp/mm

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 Practical resolution is less than the
Nyquist frequency
• Factors besides sampling
compromise sharpness
• X-ray focal spot dimensions
• Blur in Indirect DR and CR
• Optical and mechanical
imprecision in IDR and CR
• Afterglow in fast-scan
dimension in CR
• Limit of resolution is where
Modulation Transfer Function
(MTF) has decreased to 10%

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 Enhancing sharpness:
sharpness a secondary
purpose of image processing

• If one can selectively increase the

contrast of features in the image that
represent large changes in code value
over a few pixels, one can increase
sharpness.
• Two methods
• Unsharp Mask (Frequency Processing)
• Musica® Edge Contrast
• “edge restoration”
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 Unsharp mask process

• Start with original image

• Create a blurred version of the original image by
averaging all pixels within a small region called a
“kernel”.
• A large kernel blurs large features
• A small kernel blurs small features
• Subtract the blurred image from the original image to
make a difference image or mask
• The mask contains features that were NOT blurred
• Add the mask back to the original image
• Resulting image has enhanced features that were
NOT blurred
• Enhancement controlled by a “boost” factor

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 Unsharp mask process

blurred

Original image rred Blurred image

bl u
i g –
Or

Orig + Diff

Difference image Sharpened image

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 Musica® Edge Contrast
• Raw image is decomposed into sub-bands, each
representing an octave of spatial frequencies.
• Adding all sub-bands together would reconstitute the
original image
• The contrast of features in each sub-band is modified
according to a function.
• The degree of enhancement is controlled by the value
of a single parameter.
• Differential enhancement is controlled by a second
parameter value.
• The modified sub-bands are added back together to
create a modified image.
• Extra enhancement of high frequency sub-bands
emphasizes edges

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Raw, ranged data Gradation-processed data

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Musica® Processed data Gradation-processed data

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 blurred
Dynamic
Range
Control
Original image rred)Blurred image
u
(actually a f(bl
form of
“contrast
enhancement
Orig + f(blurred)
”)

DRC image
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 Dual Energy Subtraction Imaging:
Uses low energy image and high
energy image …

• Two images are acquired

• Weighted combination and subtraction of these
images produces “bone only” and “soft tissue
only “ images
• Quality of images depends on energy separation

Bone only image Soft tissue only image

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 Conventional vs. DES
images

Where is the lesion? Is it calcified?

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 Sufficient x-rays must reach the
detector to produce the
radiographic image.
• At the same dose, the smaller the pixel size,
the fewer x-rays in each pixel, and the worse
the noise.
• Larger the pixel size, worse the sharpness.
Air KERMA Photons Noise
(µGy) /100m X100m (%)

0.9 133 8.6

0.09 13 27.4

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IAEA 9 µGy 34
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 Post-acquisition processing can
reduce noise.
noise (generic term is
“noise reduction”)
• Because noise is considered as high
frequency variation, attenuating high spatial
frequencies can reduce noise.
• This is effectively a “high pass filter”
• Unsharp Mask can do this
• Musica® Noise Reduction can do this
• This also attenuates small clinical features!
• Corollary is that, enhancing small features
also enhances noise!

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 Optimization in DR imaging cannot
ignore patient dose!
• In order to make a diagnostic radiographic
image, a sufficient number of x-rays must
reach the detector.
• Unfortunately, the x-rays must pass through
the patient to reach the detector.
• The ALARA Principle dictates that the
examination should be performed with the
lowest reasonable dose to the patient.

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 Acquisition processing involves
assumptions:
• Radiographic technique
• Composition of anatomic region imaged
• Use of collimation

Images with very different greyscale histograms

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 Post-acquisition processing is
controlled by exam-specific
parameters
• There are literally thousands of
permutations of allowable parameter
settings.
• Extreme values can have dramatic
effects on the image.
• There is no general agreement on the
optimum values for the parameters.

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 Auxiliary purpose of image
processing: improve usability
• Imprint demographic
overlays
• Add annotations
• Apply borders or shadow
masks
• Flip and rotate
• Increase magnification
• Conjoin images
• Scoliosis
• Full leg
• Modify sequence of views

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Conjoined images: early vs. modern

Note: Better
different contrast
contrast matching

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 Inappropriate roles for image
processing
• Compensate for
inappropriate radiographic
technique
• Compensate for poor
calibration of acquisition
and display
• Deletion of non-diagnostic
images
Recovery of non-diagnostic
images to prevent re-
exposure is last resort, not
routine activity!

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Bad practice still translates into bad
images.

Automation has not been

invented to correct for
• patient motion
• poor inspiration
• bad positioning
• improper collimation
• incorrect alignment of x-ray
beam and grid
• wrong exam performed
• wrong patient examined
• double-exposure.

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Radiographers need to recognize image
artefacts ...
• … and take appropriate
action when artefacts occur.

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 Conclusions:

• DR image quality can be described in

conventional terms.
• DR image processing has three purposes:
• Identify values of interest and maximize their
contrast
• Modify contrast within values of interest
• Improve usability of the image
• Image quality cannot be optimized without
considering patient dose.

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 Answer True or False

• Acquired images from DR system are

independent of display
• DR has wide latitude
• Spatial resolution of DR images are
limited by pixel dimensions

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 Answer True or False

• True. Acquisition is independent from

display, code values in the raw DR image
can be translated to any display level
• True. DR has extremely wide latitude, ie., it
has low contrast and is limited by the
latitude of the display
• True. The factors involved are focal spot
thickness, blur in indirect DR (IDR) and CR,
after glow and optical and mechanical
imprecision in IDR and CR.
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 References

• Flynn MJ Processing digital radiographs of specific body parts.

Advances in Digital Radiography: RSNA Categorical Course in
Diagnostic Radiology Physics. Samei E and Flynn MJ eds (2003)
71-78.
• Seibert JA Digital radiographic image presentation:
preprocessing methods. Advances in Digital Radiography:
RSNA Categorical Course in Diagnostic Radiology Physics.
Samei E and Flynn MJ eds (2003),63-70.
• Chotas HG, Ravin CE. Digital radiography with photostimulable
storage phosphor: control of detector latitude in chest
imaging. Invest Radiol 27 (1992),822-828.
• Huda W, Slone RM, Arreola M, Hoyle BA, Jing Z. Significance of
exposure data recognizer modes in computed radiography.
SPIE 2708 (1996),609-616.

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 References (continued)

• Freedman M, Pe E, Mun SK, Lo SCB, Nelson M. The potential

for unnecessary patient exposure from the use of
storage phosphor imaging systems. SPIE 1897(1993) 472-
479.
• Gur D, Fuhman CR, Feist JH, Slifko R, Peace B. Natural
migration to a higher dose in CR imaging. Proc Eighth
European Congress of Radiology. Vienna Sep 12-
17(1993)154.
• Huda W, Slone RM, Belden CJ, Williams JL, Cumming WA,
Palmer CK. Mottle on computed radiographs of the chest
in pediatric patients. Radiology 199 (1996) 249-252.

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