DR L05 Web

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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Radiation Protection in Digital Radiology
L05 Digital Radiographic Image Processing
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 overand under-exposure, producing a
consistent appearance
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selection in screen-film
radiography
Overexpose
d
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Underexposed
DR compensates for incorrect

exposure factor selection
Overexposed
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Underexposed
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
# pixels
contrast
B is air
C is scatter contribution
- only outside
collimators
D is scatter contribution
-only image of anatomy
outside collimated area,
barium, or lead
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A
D
Exposure (or greyscale)
Region of clinical interest
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Increased mAs shifts the Greyscale

Histogram
# pixels
A
D
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
D
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
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Raw data
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Raw, ranged data

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Matched latitude is another

feature of histogram re-scaling
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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

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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
d
e
r
r
blu
Orig
Original image
Blurred image
Orig + Dif
Diference image
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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.
Diferential 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

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Musica Processed data

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Dynamic
Range
Control
(actually a
form of
contrast
enhancement
)
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blurred
Original image urred)Blurred image

f(bl
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

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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.
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9 Gy
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3 Gy
35
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0.9 Gy
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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 efectively 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
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Images with very diferent greyscale histogra

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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:
different
contrast
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Better
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 reexposure 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 1217(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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Radiation Protection in Digital

Radiation Protection in Digital Radiology

L05 Digital Radiographic Image Processing

The quality of any monochrome

Radiation Protection in Digital Radiology

L05 Digital Radiographic Image Processing

Advantages of DR images vs.

Radiation Protection in Digital Radiology

L05 Digital Radiographic Image Processing

Advantages of analogue images vs.

Radiation Protection in Digital Radiology

L05 Digital Radiographic Image Processing

DR density is adjustable and

Radiation Protection in Digital Radiology

L05 Digital Radiographic Image Processing

L05 Digital Radiographic Image Processing

DR compensates for incorrect

Radiation Protection in Digital Radiology

L05 Digital Radiographic Image Processing

The raw DR image has low contrast

Radiation Protection in Digital Radiology

L05 Digital Radiographic Image Processing

Idealised Greyscale Histogram

Exposure (or greyscale)

Radiation Protection in Digital Radiology

Region of clinical interest

L05 Digital Radiographic Image Processing

Increased mAs shifts the Greyscale

Exposure (or greyscale)

Region of clinical interest

Changing mAs does not affect subject contrast, as long as

Radiation Protection in Digital Radiology

L05 Digital Radiographic Image Processing

Increased kVp squeezes the

Exposure (or greyscale)

Region of clinical interest

Higher kVp => less subject contrast

Radiation Protection in Digital Radiology

L05 Digital Radiographic Image Processing

Primary job of image processing: identify

Radiation Protection in Digital Radiology

L05 Digital Radiographic Image Processing

Did we skip a step?

Radiation Protection in Digital Radiology

L05 Digital Radiographic Image Processing

Detector characteristic function

Radiation Protection in Digital Radiology

L05 Digital Radiographic Image Processing

Radiation Protection in Digital Radiology

Raw, ranged data

Matched latitude is another

Radiation Protection in Digital Radiology

L05 Digital Radiographic Image Processing

Code values can be remapped in

Radiation Protection in Digital Radiology

L05 Digital Radiographic Image Processing

There are many brand-names for

Radiation Protection in Digital Radiology

L05 Digital Radiographic Image Processing

Code values can be remapped to a

Radiation Protection in Digital Radiology

L05 Digital Radiographic Image Processing

Raw, ranged data