BME481 MEDICAL IMAGING

Dr. Betül Polat Budak BME481 Medical Imaging 1

 Lecture Contents:
• Introduction to Medical Imaging concepts
• Biomedical images: signals to pictures I: Ionizing Radiation
• Biomedical images: signals to pictures II: Non-ionizing Radiation
• Image quality
• Projection Radiography: X-rays
• Projection Radiography: CT
• Nuclear Imaging: Planar Scintigraphy
• Nuclear Imaging: PET and SPECT
• Ultrasound Imaging
• Magnetic Resonance Imaging
• Advanced and combined Techiques
• Wrap up and Closing remarks

Dr. Betül Polat Budak BME481 Medical Imaging 2

 Lecture 5

Projection Radiography: X-rays

Dr. Betül Polat Budak BME481 Medical Imaging 3

 Lecture 5 Part II
Projection Radiography: X-rays Contents
5.1 Introduction
5.2 Instrumentation
5.2.1 X-Ray Tubes
5.2.2 Filtration and Restriction
5.2.3 Compensation Filters and
Contrast Agents
5.2.4 Grids, Airgaps, and Scanning
Slits
5.2.5 Film-Screen Detectors,
5.2.6 X-Ray Image Intensifiers
5.2.7 Digital Radiography
5.3 Image Formation
5.3.1 Basic Imaging Equation
5.3.2 Geometric Effects
Inverse Square Law, Obliquity, Beam
Divergence and Flat Detector, Anode
Heel Effect, Path Length, Depth-
Dependent Magnification, Imaging
Equation with Geometric Effect
5.3.3 Blurring Effects
5.3.4 Film Characteristics
5.4 Noise and Scattering
5.4.1 Signal-to-Noise Ratio
5.4.2 Quantum Efficiency and
Detective Quantum Efficiency
5.4.3 Compton Scattering

Dr. Betül Polat Budak BME481 Medical Imaging 4

 Basic Imaging Equation

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 Basic Imaging Equation
• The x-ray tube emits a burst of x-rays that, after filtration and
restriction, are incident upon the patient.
• These x-rays are then attenuated as they pass through the body in a
spatial pattern that depends on the linear attenuation coefficient
distribution in the body.

• Length of the line segment is r = r(x, y), where it is made explicit that
the length of the line depends on the position (x, y).
• S0(E) is the spectrum of the incident x-rays.
• Any photon ‘‘surviving’’ its passage through the body then hits the
detector apparatus and is absorbed by the detector.

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 Geometric Effects

• Radiography is the production of a two-dimensional image from a

three-dimensional object, the patient
• X-ray images are created from a diverging beam of x-rays.
• This divergence produces a number of undesirable effects that arise
from geometric considerations.

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 Geometry of Projection Radiography
• The source of radiation in the x-ray tube is
a small spot, and x-rays that are produced
in the x-ray tube diverge as they travel
away from this spot. Because of beam
divergence, the collimated x-ray beam
becomes larger in area and less intense
with increasing distance from the source.
Consequently, x-ray radiography results in
some magnification of the object being
radiographed.
The geometry of beam divergence is shown. The object is
positioned a distance a from the x-ray source, and the
detector is positioned a distance (a + b) from the source.
From the principle of similar triangles, Magnification can be
defined simply as
𝐿image 𝑎 + 𝑏
𝑚= =
𝐿𝑜𝑏𝑗𝑒𝑐𝑡 𝑎

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 Geometry of Projection Radiography
• The magnification will always be greater than 1.0 but approaches 1.0
when a relatively flat object (such as a hand in radiography) is
positioned in contact with the detector, where b < 0. The
magnification factor changes slightly for each plane perpendicular to
the x-ray beam axis in the patient, and thus different anatomical
structures are magnified differently.

Dr. Betül Polat Budak BME481 Medical Imaging 9

 Geometric Effects: Inverse Square Law
• The distance of separation is proportional by the inverse square to
intensity.
• The inverse square law states that the net flux of photons (i.e., photons
per unit area) decreases as 1/r2, where r is the distance from the x-ray
origin.

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 Geometric Effects: Inverse Square Law

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 Geometric Effects: Obliquity
• Obliquity is a second factor that acts to decrease the beam intensity
away from the detector origin.
• The obliquity effect is caused by the detector surface not being
orthogonal to the direction of x-ray propagation (except at the detector
origin).
• X-rays passing through a
unit area orthogonal to the
direction of x-ray
propagation pass through a
larger area on the detector.
• Thus, the x-ray flux is lower,
which directly results in a
lower measured x-ray
intensity on the detector
surface.

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 Geometric Effects: Obliquity
• Area A orthogonal to the
direction of x-ray
propagation, the
projected area on the
detector is
Ad = A/ cos θ.
• Obliquity is

The effect of obliquity on spot size.

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 Geometric Effects: Beam Divergence and
Flat Detector
• The effects of beam divergence and the flat detector act
together to reduce intensity at the detector plane in two
ways:
(1) reduction in beam intensity due to the inverse square law effect
(2) reduction in beam intensity due to obliquity

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 Geometric Effects: Anode Heel Effect
• The reason for the anode heel effect is due to the geometry of the anode.
• Beam intensity is higher in the cathode direction; the variation can be as
much as 45 percent intensity variation in the cathode to anode direction.
• The anode heel effect can be compensated by using an x-ray filter that is
thicker in the cathode direction than in the anode direction.

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 Geometric Effects: Path Length

Imaging a uniform slab.

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 Geometric Effects: Path Length
• Consider imaging a slab of material with a constant linear attenuation
coefficient μ and thickness L arranged parallel to the plane of the
detector.
• Assume a monoenergetic x-ray spectrum for the present analysis.
• The central ray of the x-ray beam encounters a net path length L through
the object.
• Thus, the x-ray intensity at (x, y) = (0, 0) will be where is
the intensity of the beam that would be present at the detector origin if
the slab were not present.
• The x-rays propagating toward the detector point (x, y), however,
experience a different path length through the slab. Path length is
defined by:

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 Geometric Effects: Path Length
• Since L‘ > L more x-rays will be attenuated along this line than along
the central path, and the x-ray intensity at the detector will be smaller.
the intensity is

• If the inverse square law and obliquity

are included, then the intensity is:

Dr. Betül Polat Budak BME481 Medical Imaging 18

 Geometric Effects: Depth-Dependent
Magnification
• Another consequence of divergent x-rays is object magnification,
which is specifically called depth-dependent magnification in
radiography.

• Object of height w, will always

appear larger on the detector
than it is in reality.
• The height of the object on
the detector is different
depending on the position of
the object in the field-of-view.

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 Geometric Effects: Depth-Dependent
Magnification
• Using the concept of similar triangles, it is easy to show that when the
object is at position z, its height wz on the detector will be:

• From this, we see that the

magnification M(z) is given by:

• The magnification is a function

of z, which is why this
magnification is referred to as
depth-dependent.

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 Geometric Effects: Depth-Dependent
Magnification
• There are three important consequences of depth-dependent
magnification.
• First, two objects within the body of the same size may appear to have
different sizes on the radiograph. Thus, judgments about relative sizes
of anatomical features must be made with caution and knowledge.
• Second, anatomical features studied longitudinally—that is, using
radiographs of the same patient taken over several months or years—
can only be compared in size if the same radiographic conditions and
patient positioning is used.
• Third, the boundaries of a single object can be blurred simply because
the ‘‘front’’ of the object is closer to the radiograph than its ‘‘back.’’
This effect, which might be called depth-dependent blurring

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 Blurring Effects
• Divergent rays will blur edges of objects that are thick in the range
direction.
• Extended sources and the detector thickness also blur objects.

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 Blurring Effects

(a) Ideal field of view and object

projection (with magnification).
(b) Penumbra at edges of field of view
due to extended source.
(c) Blurred object edges due to extended
source.

Dr. Betül Polat Budak BME481 Medical Imaging 23

 Lecture 5 Part II
Projection Radiography: X-rays Contents
5.1 Introduction
5.2 Instrumentation
5.2.1 X-Ray Tubes
5.2.2 Filtration and Restriction
5.2.3 Compensation Filters and
Contrast Agents
5.2.4 Grids, Airgaps, and Scanning
Slits
5.2.5 Film-Screen Detectors,
5.2.6 X-Ray Image Intensifiers
5.2.7 Digital Radiography
5.3 Image Formation
5.3.1 Basic Imaging Equation
5.3.2 Geometric Effects
Inverse Square Law, Obliquity, Beam
Divergence and Flat Detector, Anode
Heel Effect, Path Length, Depth-
Dependent Magnification, Imaging
Equation with Geometric Effect
5.3.3 Blurring Effects
5.3.4 Film Characteristics
5.4 Noise and Scattering
5.4.1 Signal-to-Noise Ratio
5.4.2 Quantum Efficiency and
Detective Quantum Efficiency
5.4.3 Compton Scattering

Dr. Betül Polat Budak BME481 Medical Imaging 24

 Noise and Scattering
• Until now, we have only considered the effects of the x-ray source and
the composition of the object.
• The detector does not reproduce the incident intensity distribution as
is.
• Furthermore, x-rays arrive in discrete packets of energy (quanta or
photons). The discrete nature of their arrival can lead to fluctuations in
the image.
• In the following sections, we discuss some of the additional factors
introduced by x-ray physics and the image recorder.

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 Visualization of noise:

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 Signal-to-Noise Ratio
• We assume that the number of x-rays incident across a patient is a
constant.
• In fact, the formation of x-rays occurs randomly in both space and
time.
• As a result, a measurement of the number of x-rays that pass through
a small region is a random variable.
• By making repeated measurements, one can estimate the average
(mean) and variance (standard deviation squared). The underlying
statistical process of x-ray generation is Poisson distributed.

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 Signal-to-Noise Ratio

• Ib be the background intensity

• It be the object (target) intensity on the detector plane,
It > Ib
• Local Contrast:

• Because the x-rays arrive in

discrete quanta (photons), there
will be random fluctuations in
the number of photons arriving
in each small area of the
detector, leading to noise.

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 Signal-to-Noise Ratio
• We can quantify the effect of noise on image formation using the
concept of SNR.
• The higher the SNR, the less evident will be the granularity in the
image resulting from this quantum effect.
• The ‘‘signal’’ is It − Ib, the difference between the target intensity and
the background intensity.
• The noise is caused by quantum-related fluctuations in the
background, and it can be characterized by a standard deviation σb.

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 Signal-to-Noise Ratio
• Suppose that all photons arriving at the detector have the same
energy, hν, which might be called the effective energy.
• The intensity is related to the number of photons by:

where A is a small area on the detector and t is the duration of

the x-ray burst.
• The number of photons N is a Poisson random variable, and in the
background, we can denote the average number of photons per burst
per area A as Nb:

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 Signal-to-Noise Ratio
• Also, the variance of the number of photons per burst per area A in the
background is given by:

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 Signal-to-Noise Ratio
• In order to improve the visibility of a particular structure in a
radiograph, it is necessary to either increase the contrast of the
structure (C) or to increase the number of photons used in the
visualization or analysis (or both).

• The contrast of the structure might be improved by changing the

energy of the x-rays or by using a contrast agent or dual-energy
techniques.
• The number of photons might be increased by several methods: by
increasing the filament current, the duration of the x-ray pulse, or the
energy of the x-rays (which would then penetrate the body better), or
by using larger area elements (pixels) or a more efficient detector.

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 Signal-to-Noise Ratio
• We can express the SNR in more detail.
• SNR is proportional to the number of photons per unit area of
detector, if we increase the unit area we also increase the number of
photons.

Where ɸ is the number of photons per Roentgen per cm2,

A is the unit area,
R is the body’s radiation exposure in Roentgens,
t is the fraction of photons transmitted through the body,
η is the detector efficiency.

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 Quantum Efficiency and Detective
Quantum Efficiency
• In projection radiography, x-rays that are not stopped by the body
should be detected.
• Quantum efficiency (QE) is the probability that a single photon
incident upon the detector will be detected; it is a basic property of
any x-ray detector.
• Detective quantum efficiency (DQE), is a way to characterize the
performance of a detector that has a direct relation to the SNR of the
images it produces. DQE) considers the transformation of SNR from a
detector’s input to its output:

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 Compton Scattering
• An incoming photon ejects an outer shell electron, yielding a
Compton electron
• The incident photon loses its energy and changes its direction (Not
completely absorbed by the atom!)
• The scattered photon is called Compton photon

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 Compton Scattering
• Compton scattering decreases image quality.
• The reason for this is that Compton photons are deflected from their
ideal straight-line path, and some are detected in locations away from
the correct, straight-line location.
• This produces two unwanted results: a decrease in image contrast and
a decrease in SNR.

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 Compton Scattering: Effect on Image
Contrast
• Compton scatter adds a constant intensity Is to both target and
background intensity, yielding a new contrast:

(local contrast)

• Therefore, the effect of scatter is to reduce contrast by the factor 1/(1

+ Is/Ib). The ratio Is/Ib is called scatter-to-primary ratio; clearly, it
should be kept as small as possible in order to preserve contrast

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 Compton Scattering: Signal-to-Noise
Ratio with Scatter

Compton-free derivation

• Ns stands for the number of Compton scattered photons per burst per area A
on the detector, and the symbol C is the underlying contrast (not the
Compton scatter-reduced contrast)

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 Compton Scattering: Signal-to-Noise
Ratio with Scatter
• The SNR with Compton scattering is related to the SNR without
Compton scattering is:

• Thus, in addition to the loss in contrast, there is an additional loss of

in SNR due to the effects of Compton scattering.

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 Summary and Key Concepts
• 1. Projection radiography produces radiographs, which are 2-D
projections of 3-D objects.
• 2. A projection radiography system consists of an x-ray tube, devices
for beam filtration and restriction, compensation filters, grids, and a
film-screen or digital detector.
• 3. The basic imaging equation describes the energy- and material-
dependent attenuation of the x-ray beam produced by the system as it
passes through the patient.
• 4. The basic imaging equation must be modified by several geometric
effects, including the inverse square law, obliquity, beam divergence,
anode heel effect, path length, and depth-dependent magnification.

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 Summary and Key Concepts
• 5. The film-screen detector produces an optical image on film; the
degree of film blackening—the optical density—depends on film
exposure in a nonlinear way characterized by the H&D curve.
• 6. Digital detectors convert x-rays by direct or indirect means to
electronic signals that can be read directly into a computer and
viewed on a computer display.
• 7. Noise arising from the random nature of x-ray production and
transmission reduces an image’s SNR, and thus the detective quantum
efficiency of the system.
• 8. Acceptance of Compton scattered photons reduces both image
contrast and SNR.

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 Sources
• Medical Imaging For Health Professionals: Technologies And Clinical
Applications, First Edition. Edited By Raymond M. Reilly. © 2019 John
Wiley & Sons, Inc. Published 2019 By John Wiley & Sons, Inc
• Prince And Links, Medical Imaging Signals And Systems
• Fundamental Mathematics And Physics Of Medical Imaging
• Introduction To The Science Of Medical Imaging
• Introduction To Medical Imaging, Physics, Engineering And Clinical
Applications

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