Chapter 1

Introduction to Medical Imaging Systems

Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . .
Image . . . . . . . . . . . . . . . . . . . . . . . .
History . . . . . . . . . . . . . . . . . . . . . . .
Course philosophy . . . . . . . . . . . . . . . . .
Medical imaging systems overview . . . . . . . . .
The ideal medical imaging modality . . . . . . .
Introduction to primary modalities . . . . . . . . . . .
Radiographic imaging . . . . . . . . . . . . . . . .
Nuclear imaging . . . . . . . . . . . . . . . . . .
Nuclear magnetic resonance imaging (NMR) or MRI
Ultrasound imaging . . . . . . . . . . . . . . . . .
Modality comparison . . . . . . . . . . . . . . . .
Other modalities . . . . . . . . . . . . . . . . . .

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1.1
1.2
1.2
1.2
1.3
1.4
1.5
1.5
1.6
1.6
1.6
1.7
1.7

Introduction
We begin with a brief overview of what is meant by imaging, some history and philosophy, and a survey of the modalities that will
be covered.
Numerous books have been written on medical imaging [16], medical physics and instrumentation [79], imaging more generally
[1012], tomography and image reconstruction [1318], MRI [1922], and many other related topics.
(A few of these are on reserve at Engineering Library for EECS 516.)

1.1

c J. Fessler, August 2, 2009, 21:21 (student version)

1.2

Image
American Heritage Dictionary, 3rd edition:
A reproduction of the form of a person or an object, especially a sculptured likeness.
Physics. An optically formed duplicate, counterpart, or other representative reproduction of an object, especially an optical
reproduction of an object formed by a lens or mirror.
One that closely or exactly resembles another; a double: He is the image of his uncle.
...

History
Prior to the development of medical imaging, doctors diagnosed and treated patients without being to see their insides, except
through exploratory surgery.
Medical imaging dates to the discovery of X-rays by William Rontgen on Nov. 8, 1895.
Shortly after their discovery, X-rays were used to produce shadowgrams of the body.
1896 Antoine Henri Becquerel discovers radioactivity accidentally, while investigating phosphorescence in uranium salts.
1898 Pierre and Marie Curie (PhD student of Becquerel) discover radium and polonium (named after Maries native Poland)
Marie got her PhD 5 years later in 1903. That same year she and Pierre and Becquerel shared the Nobel prize in Physics!
She got a 2nd Nobel Prize in Chemistry in 1911 for her radium purification work.
After an initial flurry of activity in the early 20th century culminating in the invention of the first practical X-ray tube by
Coolidge in 1913, Radiography (i.e., the use of X-rays to image internal organs) progressed slowly until the early 1960s.
Since the 1960s, with the invention of X-ray computed tomography (which lead to the 1979 Nobel Prize for Physiology and
Medicine to Cormack and Hounsfield), radiographic applications have increased enormously.
For a fascinating history of X-ray imaging, see [23].
Starting in the 1970s and continuing to the present, many other modalities have been applied to medical imaging:
Ultrasound, Magnetic Resonance Imaging (MRI), and Nuclear Medicine: SPECT and PET
Since the 1970s, two other modalities have been investigated with limited commercial success:
Microwave imaging [24] Why? ??
Visible Light Imaging (or near visible) Why? ??
(Nevertheless, both remain active research areas and optical imaging is seeing increased interest.)
Two other modalities have been used with some success for a limited set of applications:
Resistive Imaging (i.e., low-frequency EM), and Thermal Imaging (surface or near surface features)
The general technical development of medical imaging since the mid 1960s has followed two paths:
More sophisticated systems and applications using conventional modalities. These improvements have been based primarily
on the availability of more powerful computers and electronics, e.g., helical scan CT, fully 3D PET.
Identification of new modalities e.g., photo-acoustic imaging, or major variants of old modalities, e.g., Doppler ultrasound.
Today, medical imaging is a vibrant field where innovative researchers continually discover new ways to improve image
quality and explore novel techniques.

Course philosophy
Medical imaging is a very interdisciplinary field, and uses concepts from mathematics, physics, statistics, engineering, biology,
and medicine. Obviously a single course cannot cover all aspects of all modalities!
The focus in this course will be the systems aspects as follows.
The basic physics governing each imaging modality will be developed as needed to understand imaging principles.
Sources and detectors will be described phenomenologically as part of the introduction to each modality.
A system model of each imaging system will be developed.
The basic imaging equations will be derived.
Differences in noise characteristics and image artifacts due to physical differences in the basic physics will be identified.
Fundamental similarities between the imaging equations of different modalities will be stressed. For example, we will see how
Fourier reconstruction of NMR and CT data is very similar to lens forming in phased array ultrasound.
Fundamental differences between data from different modalities will also be discussed.

c J. Fessler, August 2, 2009, 21:21 (student version)

1.3

Medical imaging systems overview

Medical imaging systems are based on the physical interaction between some energy source and the human body. (Exceptions,
such as phonocardiography and thermography, that use internal energy sources within the body are rare and represent very
few applications).
The following figure gives a generic block diagram of a typical modern electronic medical imaging system.

Energy
Source

Body

Energy
Detector

Source
Electronics

Electronic
Control

Detector
Electronics

Computer
Control

Digital
Conversion

Human
Interface
Image
Formation

Display

Digital
Processing

Digital
Storage

c J. Fessler, August 2, 2009, 21:21 (student version)

1.4

In this course our view of a medical imaging system will look more like one of the following.

Input Image

System Function

Output Image

f (x, y)

g(x, y)

f (x, y, z)

g(x, y, z)

Design Parameters

Input Image

f (x, y)
f (x, y, z)

g = S[f ]

Raw Data

Output Image

Instrument

Image
Formation

Design Parameters

Design Parameters

g(x, y)
g(x, y, z)
g = S[f ]

System Function

S
The input image is also called the object being scanned.
The output image is often routed to image processing to enhance visualization or to quantify object characteristics.
For each modality, our primary goals will be to
Understand what f (x, y) represents physically (with minimal discussion of the medical relevance of f (x, y)).
Understand how g(x, y) is formed from the acquired raw data.
Determine S or equivalently the associated point spread function (PSF).
Examine how S changes with the various instrumentation design parameters and image formation design parameters.
If system is to be useful, the output g should be a representative reproduction of the input f .

The ideal medical imaging modality

Before introducing the specifics of the common medical imaging modalities, it is useful to consider the following question.
What are are the characteristics of an ideal medical imaging system?

Unfortunately, no single modality provides all of these, hence modern radiology departments are equipped with several different
types of systems, each with their own strengths and limitations.

c J. Fessler, August 2, 2009, 21:21 (student version)

1.5

Introduction to primary modalities

This course emphasizes the following modalities.
Basic Radiography and Fluoroscopy
(Transmission of X-rays through the body)
X-ray Computed Tomography (CT)
Nuclear Medicine (SPECT, PET)
(Emission of -rays from decaying radioisotopes deposited (e.g., injected) into the body)
Magnetic Resonance Imaging (MRI)
(Concentration and decay parameters of resonant 1 H nuclei)
Ultrasound
(Reflection of ultrasonic pulses transmitted into the body)
The general principles and methods of analysis that we use also apply to the many other medical imaging modalities, and to
non-medical imaging as well.
We will discuss image post-processing methods little (if at all), because they generally are less effective than making improvements
to the imaging method itself.
Radiographic imaging
Transmission of EM Waves Through 25cm of Soft Tissue
0

10

10

10

10

Transmission

Transmission

10

10

Diagnostic
Xrays

10

10

10

1.5 T MRI H O
2
63 MHz = TV 3

10

10

10

10

10
4

10

10
10
Wavelength [Angstroms]

10

10
10
Wavelength [meters]

The figure above, adapted from [1, Fig. 1.1], graphs the transmission coefficient through 25 cm of tissue (roughly the diameter of
a head) as a function of the EM free space wavelength.
Useful constants for interpreting that figure.
108 cm = 1010 m = 100 pm
1 A=
c = 299792.5103 (speed of light in m/s)
h = 6.62621027 (Plancks constant in ergsec)
1.602071012 erg = 1 eV (electron volt)
To convert wavelength in meters to photon energy E in eV, use E = h(c/)/(1.60207 1012 )
11012 m = 1 pm is associated with a photon energy of about 1.24 MeV, and
So 0.01A=
51011 m = 50 pm is associated with a photon energy of about 25 keV.
0.5A=
At long wavelengths the attenuation is manageable, but the resolution is very poor.
At a free space wavelength of 1 cm, the wavelength in the body is about 1 mm.
However, the transmission coefficient through 25 cm of tissue at this wavelength is only about 1022 .
Consequently, direct absorption of EM waves up to microwave frequencies is not very useful for medical imaging.
At wavelengths in the X-ray region (1-50 pm, corresponding to photon energies of 25 keV - 1 MeV), attenuation is reasonable.
Also, in this region wavelengths are much shorter than typical image resolutions of 0.1 mm - 10 mm, which ensures that
diffraction will not distort the imaging system and that all rays travel in straight lines. (Making a lens to focus X-rays is hard.)
At -ray wavelengths (< 1 pm) the body is essentially transparent, providing no contrast and, therefore, no possibility of high

c J. Fessler, August 2, 2009, 21:21 (student version)

1.6

quality transmission imaging.

Radiographic imaging, including conventional shadowgrams, fluoroscopy, and CT scans, is fundamentally transmission imaging. Contrast in these images is provided by the differential absorption of X-rays among different tissues. These images display
anatomy, often to exquisite detail.
Nuclear imaging
In nuclear imaging, biologically important chemicals are labeled with radioactive materials, where the specific labeled compound
is chosen depending on the disease or physiological process of interest. Through nuclear decays, high energy -rays are emitted
and detected. Depending on the photon energy, a great many of the photons are absorbed or scattered in the tissue, a process
called attenuation. Because of this attenuation, and because of the high (relative to X-ray) energies, a relatively smaller number
of photons are available for detection at the same patient dose. Consequently, the counting statistics are poor, resulting in noisy
images with unspectacular resolution.
Although the images are of poor quality, nuclear imaging is very useful clinically. Because of the lower attenuation than at
X-ray energies, very small concentrations are required to get useful information. (High sensitivity.)
Images can be disease specific. This can greatly reduce clinical ambiguity in interpreting images.
Newer imaging methods such as Position Emission Tomography (PET), use more of the available photons resulting in higher
resolution images and lower doses of radioactive label.
Nuclear magnetic resonance imaging (NMR) or MRI
All nuclei with an odd number of nucleons possess a magnetic moment. In the presence of a large static magnetic field, the
nuclear moment can be detected by exciting the system with a radio frequency (RF) magnetic field.
The frequency of the RF excitation is chosen to match a resonance condition determined by the Larmor frequency 0 = H,
where is a nuclei specific gyromagnetic ratio and H is the applied magnetic field strength.
The gyromagnetic ratio of each nuclei, as well as several time constants controlling the return to thermodynamic equilibrium
after RF excitation, are determined primarily by the local electronic (i.e., chemical) environment. Thus, the details of the nuclear
magnetic resonance are dominated by the chemical properties of tissue. Thus NMR measurements of tissue are primarily related
to biochemical properties.
Because of its inherent sensitivity and natural abundance, proton NMR (i.e., H1 ) dominates medical imaging applications.
To a lesser extent, other biologically important nuclei have been studied (e.g., P31 , C13 ). Detailed characteristics of the resonance
associated with these nuclei, as well as H1 resonances of non-water protons, can often be linked to metabolic processes. Such
detailed biochemical studies are based on spectroscopic information contained in the NMR signal, and therefore, are often
referred to as NMR spectroscopy.
Imaging is performed by spatially altering the magnetic resonance conditions using spatially variant magnetic fields.
Thus, imaging is performed through the induction of local interactions rather than the propagation of a directed energy source.
Exquisite anatomical pictures can be obtained from proton MRI.
Some biochemical information can be obtained directly from proton MR images.
Detailed biochemical information can be obtained from MR spectroscopy but with poor spatial resolution.
Ultrasound imaging
In the frequency range from 1-10 MHz at wavelengths from 1.5 to 0.15 mm, sound waves can propagate over significant distances
in tissue. Local inhomogeneities in tissue mechanical properties cause weak reflected waves that can be detected. The arrival time
of such echoes after launching a short acoustic pulse determines the range of the reflector, i.e., Vs t = 2R.
Ultrasound images are constructed from the strength of reflected acoustic waves, where the range (or depth) of the reflecting
source is determined simply by timing.
Because of the relatively small sound velocity in tissue (1.5 mm/sec or 1.5106 mm/sec), precise range measurements can be
obtained from simple timing measurements.
Thus, ultrasound images fundamentally display local, microscopic mechanical properties of tissue.
Lateral resolution in ultrasound images is determined primarily by diffraction. In fact, most imaging systems work near the
diffraction limit. Thus acoustic lens design is critically important for ultrasound imagers.
Acoustic lenses can be synthesized electronically using phased array transducers (i.e., sampled apertures).
Using phased arrays, directed beams of ultrasound can be generated at electronic rates. Thus, ultrasound imagers are inherently
real time.

c J. Fessler, August 2, 2009, 21:21 (student version)

1.7

Modality comparison
Radiographic and nuclear imaging use ionizing radiation, where EM absorption is directly related to ionization.
MRI and ultrasound imaging use non-ionizing radiation of such low intensities that these systems can be considered completely
non-invasive. (Although RF heating can be a safety concern.)
Radiographic images exhibit the best spatial resolution for most general applications, but information is primarily anatomic.
Nuclear images exhibit the poorest spatial resolution but can often provide very specific functional information.
MR images exhibit good spatial resolution, where image contrast can provide some chemical information.
Ultrasound images exhibit good spatial resolution, but with poor contrast. Real-time aspects are important for imaging dynamic organs, such as the heart. Also, specific disease states that are associated with large changes in microscopic mechanical
properties are easily detected.
In general, the specific medical imaging application determines the modality. The best choices change with time as modalities
improve, but, generally, no single modality is optimal for all imaging applications.

Other modalities
This course will focus on the large scale medical imaging modalities that are used daily for human imaging in hospitals. These
systems have spatial resolutions ranging from roughly 1 mm to 10 mm.
Other large scale imaging modalities include the following.
electrical impedance imaging [25],
magnetoencephalography (MEG) imaging [26]
proton computed tomography [2729]
neutron imaging [30]
infrared (thermal) emission, etc.
microwave imaging [31]
There is growing interest in the medical imaging community in systems that can image at much smaller scales, well below 1 mm.
These systems are useful for basic science and drug development research, often using small animals. There are many similarities
between the image formation methods and image processing techniques used for all such systems. Examples include the following.
light microscopy
confocal microscopy
fluorescence microscopy
multi-photon microscopy
thermal microscopy
stimulated emission depletion microscopy
differential-interference-contrast microscopy
phase-contrast microscopy
optical coherence tomography (OCT)
ultrashort light pulses
endoscopic imaging [32]
electron microscopy
scanning electron microscopy (SEM)
tunneling electron microscopy (TEM)
cryo electron microscopy
force microscopy
atomic force microscopy (AFM)
magnetic resonance force microscopy (MRFM)
One major biological imaging challenge is visualizing a virus that is typically about 100 nm across. One approach under investigation is stochastic optical reconstruction microscopy (STORM) [33, 34].
An intriguing hybrid modality is photo-acoustic tomography, or more generally thermoacoustic imaging, where external EM
radiation sources cause tissue heating and thus expansion that creates a propagating acoustic wave that can be recorded by external
acoustic transducers [35]. The advantage of using acoustic sensors rather than optical sensing is that acoustic scattering is about
100 times smaller than optical scattering. Like most things in medical imaging, the basic principles date back to famous scientists;

c J. Fessler, August 2, 2009, 21:21 (student version)

1.8

in 1880 Alexander Graham Bell reported that an intermittent beam of sunlight on a rubber sheet. could create an audible sound.

But first we start with the tools...

c J. Fessler, August 2, 2009, 21:21 (student version)

1.9

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