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Fundamentals of
Medical Imaging
Third Edition
Paul Suetens
KU Leuven, Belgium
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University Printing House, Cambridge CB2 8BS, United Kingdom
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www.cambridge.org
Information on this title: www.cambridge.org/9781107159785
10.1017/9781316671849
c Paul Suetens 2002, 2009, 2017
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and to the provisions of relevant collective licensing agreements,
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permission of Cambridge University Press.
First published by Cambridge University Press 2002
Second edition 2009
Third edition 2017
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A catalogue record for this publication is available from the British Library.
Library of Congress Cataloging-in-Publication Data
Names: Suetens, Paul.
Title: Fundamentals of medical imaging / Paul Suetens, Katholieke
Universiteit Leuven, Belgium.
Description: [2017 edition]. | Cambridge : Cambridge University
Press, 2017. | Includes bibliographical references and index.
Identifiers: LCCN 2016041204 | ISBN 9781107159785
Subjects: LCSH: Diagnostic imaging – Mathematics. | Medical physics.
Classification: LCC RC78.7.D53 S84 2017 | DDC 616.07/54–dc23
LC record available at https://lccn.loc.gov/2016041204
ISBN 978-1-107-15978-5 Hardback
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Every effort has been made in preparing this book to provide accurate and up-to-date
information that is in accord with accepted standards and practice at the time of publication.
Although case histories are drawn from actual cases, every effort has been made to disguise the
identities of the individuals involved. Nevertheless, the authors, editors, and publishers can make no
warranties that the information contained herein is totally free from error, not least because clinical
standards are constantly changing through research and regulation. The authors, editors, and
publishers therefore disclaim all liability for direct or consequential damages resulting from the use of
material contained in this book. Readers are strongly advised to pay careful attention
to information provided by the manufacturer of any drugs or equipment that they plan to use.
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Contents
Preface ix
Acknowledgments xi
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Contents
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Contents
5.5.3
Energy Resolution 126 6.4.1.2 M-mode 157
5.5.4
Count Rate 126 6.4.1.3 B-mode 157
5.6 Imaging 127 6.4.2 Image Reconstruction 157
5.6.1 Planar Imaging 127 6.4.2.1 Filtering 157
5.6.2 Fourier Reconstruction and Filtered 6.4.2.2 Envelope Detection 157
Backprojection 127 6.4.2.3 Attenuation Correction 158
5.6.3 Iterative Reconstruction 127 6.4.2.4 Log-compression 158
5.6.3.1 Bayesian Approach 128 6.4.2.5 Scan Conversion 158
5.6.3.2 Maximum-likelihood (ML) 128 6.4.3 Acquisition and Reconstruction
5.6.3.3 Maximum-a-posteriori Time 158
Probability (MAP) 129 6.5 Measuring Blood Flow and Tissue
5.6.4 3D Reconstruction 129 Deformation 159
5.6.4.1 Filtered Backprojection 131 6.5.1
Data Acquisition 159
5.6.4.2 ML Reconstruction 131 6.5.2
Reconstruction 160
5.6.4.3 Fourier Rebinning 131 6.5.2.1 Continuous Wave
5.7 Image Quality 131 Doppler 161
5.7.1 Contrast 131 6.5.2.2 Pulsed Wave Doppler 161
5.7.2 Spatial Resolution 131 6.5.2.3 Color Doppler 163
5.7.3 Noise 132 6.5.2.4 Speckle Tracking and
5.7.4 Artifacts 132 Strain 164
5.8 Equipment 134 6.5.2.5 Elasticity Imaging 164
5.8.1 Gamma Camera and SPECT 134 6.5.3 Acquisition and Reconstruction
5.8.2 PET 135 Time 165
5.8.3 Time-of-flight (TOF) PET 137 6.6 Image Quality 166
5.8.4 Hybrid Imaging 138 6.6.1 Spatial Resolution 166
5.8.4.1 PET-CT and SPECT-CT 138 6.6.1.1 Axial Resolution 167
5.8.4.2 PET-MRI 139 6.6.1.2 Lateral and Elevation
5.9 Clinical Use 140 Resolution 167
5.10 Biological Effects and Safety 144 6.6.2 Noise 168
5.11 Future Expectations 144 6.6.3 Image Contrast 168
6.6.4 Artifacts 168
6.6.4.1 Side Lobes 168
6 Ultrasound Imaging 147
6.6.4.2 Reverberations 169
6.1 Introduction 147
6.6.4.3 Aliasing 169
6.2 Physics of Acoustic Waves 147
6.2.1 What Are Ultrasonic Waves? 147
6.7 Equipment 170
6.7.1 One-dimensional Array
6.2.2 Generation of Ultrasonic Waves 148
Transducers 171
6.2.3 Wave Propagation in Homogeneous
6.7.2 Transducers for 3D Imaging 173
Media 148
6.8 Clinical Use 174
6.2.3.1 Linear Wave Equation 148
6.8.1 Structural Imaging 174
6.2.3.2 Interference 149
6.8.2 Blood Flow and Tissue Deformation
6.2.3.3 Attenuation 151
Mapping 176
6.2.3.4 Nonlinearity and Higher
6.8.3 Contrast Echography 177
Harmonics 151
6.2.4 Wave Propagation in Inhomogeneous
6.9 Biological Effects and Safety 177
6.10 Future Expectations 178
Media 152
6.2.4.1 Reflection and Refraction 153
6.2.4.2 Scattering 154
6.2.5 Wave Propagation and Motion: The 7 Medical Image Computing 184
Doppler Effect 154 7.1 Introduction 184
6.3 Generation and Detection of 7.2 Interactive Methods 185
Ultrasound 156 7.3 Automated Image Computing 185
6.4 Obtaining Spatial Information 156 7.3.1 Complexity of the Image Data 185
6.4.1 Data Acquisition 156 7.3.2 Complexity of the Model or vii
6.4.1.1 A-mode 156 Prototype 186
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Contents
7.3.2.1 Multimodal Analysis 186 8 Visualization for Diagnosis and Therapy 221
7.3.2.2 Multitemporal Analysis 187 8.1 Introduction 221
7.4 Computational Strategies for Automated 8.2 2D Visualization 223
Medical Image Computing 188 8.3 3D Rendering 223
7.4.1 Building a Model or Prototype 188 8.3.1 Surface Rendering 225
7.4.2 Model-to-data Tuning 188 8.3.1.1 Surface Geometry 225
7.4.3 Low-level Methods 189 8.3.1.2 Illumination and Shading 226
7.4.4 Model-based Methods 189 8.3.2 Volume Rendering 229
7.4.4.1 Data 8.3.2.1 Position-Independent Transfer
Classification/Regression 189 Functions 230
7.4.4.2 Model Fitting 191 8.3.2.2 Position-Dependent Transfer
7.5 Data Classification/Regression 192 Functions 230
7.5.1 Pixel Labeling 192 8.4 Virtual Reality 233
7.5.1.1 Supervised Learning 192 8.5 User Interaction 234
7.5.1.2 Unsupervised Learning 193 8.6 Intraoperative Navigation 234
7.5.1.3 Spatial Dependency 194 8.6.1 Finding the Coordinates in the Surgery
7.5.2 Pattern Recognition 195 Space 236
7.6 Model Fitting 198 8.6.2 Calculating the Geometric
7.6.1 Model Fitting Using a Transformation Transformation 238
Matrix 200 8.7 Augmented Reality 242
7.6.1.1 Fitting Image Patterns 201 8.8 Future Expectations 245
7.6.1.2 Fitting Shapes 203
7.6.2 Flexible Model Fitting 205
7.6.2.1 Fitting Flexible Image
Patterns 206
7.6.2.2 Fitting Flexible Shapes 208 Further Reading 249
7.6.2.3 Fitting Flexible Image Patterns Index 251
and Flexible Shapes 216
7.7 Hybrid Strategies 216
7.8 Validation 217
7.9 Future Expectations 218
viii
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Preface
This book explains the applied mathematical and deeply for the beginner and have a narrower scope
physical principles of medical imaging and image than this book.
computing. It gives a complete survey of how med- The text reflects what I teach in class, but there is
ical images are obtained and how they can be used more material than I can explain in a module of 30
for diagnosis, therapy, and surgery. It is accompa- contact hours. This means that there is scope for the
nied by about 400 color illustrations and 80 video stronger student to read around the subject and also
clips.1 makes the book a useful purchase for those going on
It has been written principally as a course text to do research.
on medical imaging intended for graduate and final- In Chapter 1, an introduction to digital image pro-
year undergraduate students with a background in cessing is given. It summarizes the jargon used by
physics, mathematics, or engineering. However, I the digital image community, the components defin-
have made an effort to make the textbook readable ing image quality, and basic image operations used to
for biomedical scientists and medical practitioners by process digital images.
avoiding unnecessary maths, without giving up the Chapters 2–6 explain how medical images are
depth needed for physicists and engineers. Mathe- acquired. The most important imaging modalities
matical proofs and details are highlighted in separate today are discussed: radiography, computed tomogra-
paragraphs and can be skipped without hampering a phy, magnetic resonance imaging, nuclear medicine
fluent reading of the text. imaging, and ultrasonic imaging. Each chapter
Although a large proportion of the book cov- includes (1) a short history of the imaging modal-
ers the physical principles of imaging modalities, the ity, (2) the theory of the physics of the signal and its
emphasis is always on how the image is computed. interaction with tissue, (3) the image formation or
Equipment design, clinical considerations, and diag- reconstruction process, (4) a discussion of the image
nosis are treated in less detail. Premature techniques quality, (5) the different types of equipment in use
or topics under investigation have been omitted. today, (6) examples of the clinical use of the modal-
Presently, books on medical imaging fall into two ity, (7) a brief description of the biological effects
groups, neither of which is suitable for this read- and safety issues, and (8) some future expectations.
ership. The first group is the larger and comprises The imaging modalities have made an impressive
books directed primarily at the less numerate pro- and never-ending evolution in the last decades with
fessions such as physicians, surgeons, and radiologic respect to image quality, patient safety, tissue differ-
technicians. These books cover the physics and math- entiation, and applicability. Today, medical imaging
ematics of all the major medical imaging modalities, plays a role in early patient diagnosis, individual ther-
but mostly in a superficial way. They do not allow apy planning, population screening, therapy outcome
a thorough understanding of the imaging modali- assessment and prediction, evidence-based medicine,
ties. The second group comprises books suitable for and translational pre-clinical and clinical research.
professional medical physicists or researchers with This part of the book provides up-to-date information
expertise in the field. Although these books have a about these systems.
numerate approach, they tend to cover the topics too Chapters 7 and 8 deal with computational analysis
and visualization of medical images. Medical images
can, for example, be analyzed to obtain quantitative
data, or they can be displayed in three dimensions
ix
1 www.cambridge.org/9781107159785
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Preface
and used to plan and guide a surgical interven- Medical imaging and image computing are rapidly
tion. Most courses separate the imaging theory from evolving fields and this edition has been updated with
the postprocessing, but I strongly believe that they the latest developments in the field.
should be taken together because these topics are inte-
grated. The interest in clinical practice goes beyond – New sections include recent X-ray detector tech-
the production and qualitative diagnosis of two- nology; photon counting CT; dynamic (cardiac,
dimensional images, and the demand for structured perfusion) CT; multi-energy CT; parallel MR
reporting, calculating quantitative information, and imaging; phase-based (susceptibility weighted,
therapy preparatory image computing increases. chemical shift) MRI; arterial spin labeled perfusion
Medical imaging and image processing can also be MRI; magnetic particle imaging; functional CT,
approached from the perspective of information and MRI, and ultrasound imaging; time-of-flight PET;
communication and the supporting technology, such hybrid imaging (PET-CT, SPECT-CT, PET-MRI);
as hospital information systems, the electronic patient speckle tracking echography and tissue deforma-
record, and PACS (picture archiving and communi- tion mapping; acoustic shear waves and elasticity
cation systems). However, this focus would put the imaging; harmonic ultrasound imaging; and trans-
emphasis on informatics, such as databases, network- ducers for 3D ultrasound imaging.
ing, internet technology, and information security, – Needless to say that the sections on current equip-
which is not the purpose of this book. ment, their clinical use and biological impact, and
Two appendices are provided online.2 The first the expected developments in the domain are up to
is about linear system theory, which is used both in date in this edition.
image reconstruction and in image analysis. Students – The whole chapter on medical image analysis has
in physics or engineering who are not familiar with been totally revised and a new section on pattern
linear system theory will welcome this appendix. The recognition has been added.
second appendix provides a list of exercises for self- – The list of exercises for self-assessment has dou-
assessment. It is a collection of exam questions of the bled.
previous years. The questionnaire follows the order – As compared to the previous edition, the large
of the chapters and concludes with a set of miscella- majority of images have been renewed and many
neous questions that require insight into the matter of them are augmented with video clips.
of multiple chapters. – Finally, many minor changes resulted from sugges-
In the bibliography, references to untreated top- tions and comments from researchers, clinicians,
ics can be found, as well as more specialized works and students.
on a particular subdomain and some other generic – Some mathematical proofs and details are high-
textbooks related to the field of medical imaging and lighted in separate blue boxes and can be skipped
image processing. without hampering a fluent reading of the text.
x
2 www.cambridge.org/9781107159785
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Acknowledgments
My colleagues of the Medical Imaging Research Cen- Marshall, Johan Michiels, Luc Mortelmans, Johan
ter have directly and indirectly contributed to the Nuyts, Raymond Oyen, Efstathios Pagourelias, João
production of this book. This facility is quite a unique Pedrosa, Ronald Peeters, David Robben, Kevin and
place in the center of the University Hospital where Kristin Suetens, Stefan Sunaert, Johan Van Cley-
engineers, physicists, computer scientists, bioscien- nenbreugel, Koen Vande Velde, Dirk Vandermeulen,
tists, and medical doctors collaborate in an inter- Jens-Uwe Voigt, and Guozhi Zhang. They provided
disciplinary team. Research is focused on clinically me with pieces of text, relevant clinical images, and
relevant questions. This then explains the emphasis important literature; and I had indispensable discus-
in this book, which is on recent imaging technology sions with them concerning content and structure.
used in clinical practice. I would like to express my sincere gratitude to
The following colleagues and former colleagues Walter Coudyzer for his assistance in collecting radi-
contributed to the content of this and the previ- ological data. Finally, I am particularly grateful to
ous editions of the book: Matthew Bickell, Hilde Dominique Delaere, who assisted me with the fig-
Bosmans, Daan Christiaens, Stijn De Buck, Fred- ures, illustrations, and animations, consistency check-
erik De Keyzer, Bruno De Man, Christophe Deroose, ing, and the webpages associated with this textbook.
Jan D’hooge, Steven Dymarkowski, Hendra Hudyana, Thanks to his degree in biomedical engineering, he
Dirk Loeckx, Frederik Maes, Guy Marchal, Nicholas also made several improvements to the content.
xi
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Chapter
Introduction to Digital Image Processing
1
1.1 Digital Images
Visible light is essentially electromagnetic radiation
with wavelengths between 400 and 700 nm. Each
wavelength corresponds to a different color. On the
other hand, a particular color does not necessarily
correspond to a single wavelength. Purple light, for
example, is a combination of red and blue light. In
general, a color is characterized by a spectrum of
different wavelengths.
(a) (b)
The human retina contains three types of pho-
Figure 1.1 Color mixing: (a) additive color mixing (b) subtractive
toreceptor cone cells, which transform the incident color mixing.
light with different color filters. Because there are
three types of cone receptors, three numbers are nec- (see Figure 1.1(b)). Nevertheless, in print applications
essary and sufficient to describe any perceptible color. black ink is typically added as a separate fourth basic
Hence, it is possible to produce an arbitrary color color for a variety of practical and quality reasons.
by superimposing appropriate amounts of three pri- Black is abbreviated to “K,” yielding the CMYK color
mary colors, each with its specific spectral curve. In model.
an additive color reproduction system, such as a color Note that equal distances in physical intensity are
monitor, these three primaries are red, green, and blue not perceived as equal distances in brightness. Inten-
light. The color is then specified by the amounts of sity levels should rather be spaced logarithmically
red, green, and blue (RGB). Equal amounts of red, instead of linearly to achieve equal steps in perceived
green, and blue yield white (see Figure 1.1(a)). Ideal brightness. Hue refers to the dominant wavelength in
white light has a flat spectrum in which all wave- the spectrum and represents the different colors. Sat-
lengths are present. In practice, white light sources uration describes the amount of white light present in
approximate this property. In a subtractive color the spectrum. If no white light is present, the satura-
reproduction system, such as printing or painting, tion is 100%. Saturation distinguishes colorful tones
these three primaries typically are cyan, magenta, and from pastel tones at the same hue. In the color cone
yellow (CMY). Cyan is the color of a material, seen of Figure 1.2, equal distances between colors by no
in white light, that absorbs red and reflects green and means correspond to equal perceptual differences.
blue, and can thus be obtained by additive mixing The Commission Internationale de l’Eclairage (CIE)
of equal amounts of green and blue light. Similarly, has defined perceptually more uniform color spaces
magenta is the result of the absorption of green light like L∗ u∗ v∗ and L∗ a∗ b∗ . A discussion of pros and cons
and consists of equal amounts of red and blue light, of different color spaces is beyond the scope of this
and yellow is the result of the absorption of blue textbook.
and consists of equal amounts of red and green light. While chromatic light needs three descriptors or
Therefore, painting a white wall with a mixture of numbers to characterize its color, achromatic light, as
cyan and magenta yields a blue color; using cyan and produced by a black-and-white monitor, has only one
yellow gives green, and yellow with magenta gives descriptor, its brightness or gray value. Achromatic
red. Mixing yellow, cyan, and magenta paint pro- light is light with a saturation of 0%. It contains only 1
duces black (i.e., only absorption and no reflection) white light.
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Chapter 1: Introduction to Digital Image Processing
Given a set of possible gray levels or colors and subsequent values are not distinguishable anymore on
a (rectangular) grid, a digital image attributes a gray the display. One way to overcome this problem is by
value (i.e., brightness) or a color (i.e., hue, saturation, expanding a small gray value interval into a larger one
and brightness) to each of the grid points or pixels. In with a suitable gray value transformation, as discussed
a digital image, the gray levels are integers. Although in Section 1.3.1 below.
brightness values are continuous in real life, in a dig- In the process of digital imaging, the continuous
ital image we have only a limited number of gray looking world has to be captured onto the finite num-
levels at our disposal. The conversion from analog ber of pixels of the image grid. The conversion from a
samples to discrete-valued samples is called quanti- continuous function to a discrete function, retaining
zation. Figure 1.3 shows the same image using two only the values at the grid points, is called sampling
different quantizations. When too few gray values are and is discussed in detail in Appendix A.
used, contouring appears. The image is reduced to Much information about an image is contained in
an artificial looking height map. In order not to lose its histogram. The histogram h of an image is a prob-
information by quantizing the detected signal, many ability distribution on the set of possible gray levels.
more gray values are needed than what is strictly The probability of a gray value v is given by its relative
necessary to avoid contouring artifacts. Most digi- frequency in the image, that is,
tal medical images today use 4096 gray values (12
Number of pixels having gray value v
bpp). The problem with so many gray values is that h(v) = . (1.1)
Total number of pixels
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Chapter 1: Introduction to Digital Image Processing
|OTF|
1
lp/mm
(a) (b)
Figure 1.5 (a) Point spread function (PSF). (b) Corresponding
modulation transfer function (MTF). The MTF is the amplitude of the
optical transfer function (OTF), which is the Fourier transform (FT) of
the PSF.
and phase shift of a sinusoidal target as a function of Artifacts are artificial image features such as dust
frequency. The modulation transfer function (MTF) or scratches in photographs. Examples in medical
is the amplitude (i.e., MTF = |OTF|) and the phase images are metal streak artifacts in computed tomog-
transfer function (PTF) is the phase component of the raphy (CT) images and geometric distortions in mag-
OTF. For small amplitudes, the lines may no longer netic resonance (MR) images. Artifacts may also
be distinguishable. An indication of the resolution is be introduced by digital image processing, such as
the number of line pairs per millimeter (lp/mm) at a edge enhancement. Because artifacts may hamper
specified small amplitude (e.g., 10%). the diagnosis or yield incorrect measurements, it is
As explained in Appendix A, the OTF is the
Fourier transform (FT) of the PSF or LSF. ∗ The noise amplitude as a function of spatial frequency
Contrast is the difference in signal intensity of can be calculated from the square root of the noise power
adjacent regions of the image. The contrast is defined spectrum (NPS), also called the Wiener spectrum, which is
by (1) the imaging process, such as the source inten- the Fourier transform of the autocorrelation of a flat-field 3
sity and the absorption efficiency or sensitivity of the image.
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Chapter 1: Introduction to Digital Image Processing
important to avoid them or at least understand their transformation is a function g that transforms each
origin. gray level I(i, j) to another value I (i, j) independent
In the following chapters, image resolution, con- of the position (i, j). Hence, for all pixels (i, j)
trast, noise, and artifacts are discussed for each of the
imaging modalities. I (i, j) = g(I(i, j)). (1.2)
White
Black
Black White
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Chapter 1: Introduction to Digital Image Processing
A particular and popular transformation is the This operation can be applied to CT images for the
window/level operation (see Figure 1.7(a)). In this segmentation of bony structures, which can subse-
operation, an interval or window is selected, deter- quently be visualized in three dimensions or printed
mined by the window center or level l and the window with a 3D printer.
width w. Explicitly
1000 1000
0 0
0 1000 2000 3000 4000 0 1000 2000 3000 4000
(a) (b)
# pixels
White
Black
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Chapter 1: Introduction to Digital Image Processing
(a) (b)
(c) (d)
Figure 1.9 Magnetic resonance image of a slice through the spine. Example of averaging to increase the CNR. (a) This image was obtained
with a T1 -weighted turboSE sequence (see Section 4.5.8.2). (b) Same slice as in (a), obtained by repeating the sequence five times followed
by averaging. (c) Image obtained with a T2 -weighted turboSE sequence. (d) Averaged image of five subsequent T2 -weighted sequences.
(Courtesy of the Department of Radiology.)
images by averaging the different channels indepen- in the blood vessels and one without a contrast agent.
dently like gray level images. Subtraction can be Subtraction of these two images yields a pure image
used to get rid of the background in two similar of the blood vessels because the subtraction deletes
images. For example, in subtraction angiography, two the other anatomical features. Figure 1.10 shows an
6 images are made, one with a contrast agent injected example.
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Chapter 1: Introduction to Digital Image Processing
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Chapter 1: Introduction to Digital Image Processing
⎞ ⎛
⎛ ⎞⎛ ⎞ For a linear shift-invariant transformation L (see also
x a11 a12 a13 tx x Eq. A.31),
⎜ y ⎟ ⎜ a21 a22 a23 ty ⎟ ⎜y ⎟
general affine⎜ ⎟ ⎜
⎝ z ⎠ = ⎝ a31
⎟⎜ ⎟.
a32 a33 tz ⎠ ⎝ z ⎠ L(I)(i, j) = I(k, l)L(δ)(i − k, j − l)
1 0 0 0 1 1 k,l
(1.10) = I(k, l)f (i − k, j − l)
k,l
While most medical images are three dimensional,
= f (k, l)I(i − k, j − l)
interventional imaging is often still two dimensional.
k,l
To map 3D image data onto a 2D plane, a projective
= f ∗ I(i, j), (1.14)
transformation is needed. Assuming a pinhole cam-
era, such as an X-ray tube, with focal point (0, 0, 0), where f is called the kernel or filter, and the linear
any projection line through (x, y, z) intersects the pro- transformation on the digital image I is the discrete
jection plane z = f in the point (xp , yp ) as follows convolution with its kernel f = L(δ).
In practice, the flipped kernel h defined as h(i, j) =
x z f (−i, −j) is usually used. Hence, Eq.(1.14) can be
=
xp f rewritten as
y z (1.11)
= . L(I)(i, j) = f ∗ I(i, j)
yp f
= f (k, l)I(i − k, j − l)
This projection can be written in matrix form as k,l
follows: = h(k, l)I(i + k, j + l)
⎛ ⎞ k,l
⎛ ⎞ ⎛ ⎞ x
λ.xp f 0 0 0 ⎜ ⎟ = h • I(i, j), (1.15)
⎝ λ.yp ⎠ = ⎝ 0 f 0 0 ⎠ ⎜ y ⎟ (1.12)
⎝ z ⎠ where h • I is the cross-correlation of h and I. If the
λ 0 0 1 0
1 filter is symmetric, which is often the case, cross-
correlation and convolution are identical.
with λ being an arbitrary value. A cross-correlation of an image I(i, j) with a ker-
Using homogeneous coordinates, the above geo- nel h has the following physical meaning. The kernel
metric transformations can all be represented by h is used as an image template or mask that is shifted
matrices. In some cases, however, it can be necessary across the image. For every image pixel (i, j), the tem-
to use more flexible transformations. For example, plate pixel h(0, 0), which typically lies in the center of
the superposition of images in dynamic or follow-up the mask, is superimposed onto this pixel (i, j), and
studies may be hampered by patient movement and the values of the template and image that correspond
tissue deformation; the spatial alignment of images to the same positions are multiplied. Next, all these
of different patients in population studies has to values are summed. A cross-correlation emphasizes
cope with intra-patient shape variability; and unde- patterns in the image similar to the template.
sired deviations of the magnetic field in magnetic Often local filters with only a few pixels in diam-
resonance imaging (see p. 107) can cause complex eter are used. A simple example is the 3 × 3 mask
geometric distortions. with values 1/9 at each position (Figure 1.11). This
filter performs an averaging on the image, making it
smoother and removing some noise. The filter gives
1.3.4 Filters the same weight to the center pixel as to its neigh-
bors. A softer way of smoothing the image is to give
1.3.4.1 Linear Filters
a high weight to the center pixel and less weight to
From linear system theory (see Eq. A.22), we know
pixels further away from the central pixel. A suitable
that an image I(i, j) can be written as follows:
filter for this operation is a sampled Gaussian kernel
2
I(i, j) = I(k, l)δ(i − k, j − l). (1.13) 1 −r
8 g(r) = exp r = (i, j). (1.16)
k,l 2π σ 2 2σ 2
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Chapter 1: Introduction to Digital Image Processing
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Chapter 1: Introduction to Digital Image Processing
z
1 0 −1
z
Sobel 2 0 −2
x x 1 0 −1
y y
1 1 1
(a) (b)
average − δ 1 −8 1
z
x 1 1 1
y
z
x
Note that if we compute the convolution of an
y
image with a filter, it is necessary to extend the image
at its boundaries because pixels lying outside the
image will be addressed by the convolution algorithm.
(c) (d) This is best done in a smooth way, for example, by
Figure 1.13 (a) A Gaussian function. (b) Derivative of the repeating the boundary pixels. If not, artifacts appear
Gaussian in the x-direction. (c) Derivative of the Gaussian in the at the boundaries after the convolution.
y-direction. (d) Laplacian of the Gaussian.
As an application of linear filtering, let us dis-
cuss edge enhancement using unsharp masking. Fig-
ure 1.14 shows an example. As already mentioned, a
Approximating this partial derivate as low-pass filter g can be used to split an image I into
two parts: a smooth part g ∗ I and the remaining high-
∂g(r) g(r, kσ ) − g(r, σ ) frequency part I − g ∗ I, containing the edges in the
≈ , (1.21)
∂σ kσ − σ image or image details. Hence
g(r, kσ ) − g(r, σ ) ≈ (k − 1)σ ∇ 2 g(r). (1.22) Note that I − g ∗ I is a crude approximation of the
Laplacian of I. Unsharp masking enhances the image
Popular derivative filters are the Sobel operator details by emphasizing the high-frequency part and
for the first derivative, and the average − δ for the assigning it a higher weight. For some α > 0, the
10
Laplacian, which use integer filter elements: output image I is then given by
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Chapter 1: Introduction to Digital Image Processing
(a) (b)
(c) (d)
(a) (b)
(c) (d)
11
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Chapter 1: Introduction to Digital Image Processing
(a) (b)
(c) (d)
Figure 1.16 The effect of the filter size in unsharp masking. (a) Original image (2880×2880 pixels). Unsharp masking (α = 2) using a
Gaussian smoothing filter with σ (b) 1.5 mm, (c) 5 mm, and (d) 15 mm. Image (b) shows enhanced fine details. In image (d) large-scale
variations, which correspond to the lungs and the mediastinum, are enhanced, while most of the small details are suppressed. Image (c)
shows a case somewhere between (b) and (d).
12
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DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI
I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.