Radiation Protection in Digital Radiology: Digital Radiographic Image Processing

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 over- and
under-exposure, producing a consistent
appearance
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Incorrect exposure factor selection in
screen-film radiography
Overexposed Underexposed
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DR compensates for incorrect exposure
factor selection
Overexposed Underexposed
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The raw DR image has low contrast
• DR has an extremely wide latitude, which implies low

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

A, with good contrast
• B is air # pixels
A B
• C is scatter contribution - C
D
only outside collimators
Exposure (or greyscale)
• D is scatter contribution -only
image of anatomy outside
collimated area, barium, or Region of clinical interest
lead
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Increased mAs shifts the Greyscale
Histogram
# pixels
A B
D C
Region of clinical interest
• Changing mAs does not affect subject contrast, as long as the

dynamic range is not exceeded
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Increased kVp squeezes the Greyscale
Histogram
# pixels
A B
C
D
Region of clinical interest
• Higher kVp => less subject contrast
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Primary job of image processing: identify values of
interest and maximize their contrast.
contrast
• Detection of collimator boundaries or anatomy,
“exposure recognition”
• Window width and window level are adjusted
relative to greyscale histogram
• Density is thus also adjusted
• This is “acquisition processing”
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Did we skip a step?
• How did we assure that the response of the

detector was uniform over the entire field of
view?
• “Pre-acquisition processing”, or “preprocessing”,
corrects for detector imperfections and variable
response.
• Some include auto-ranging in preprocessing.
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Detector characteristic function for CR
3 10000
2.5
1000 Film/screen
Intensity (rel)
Density (OD)
2 Histogram
1.5 100 w/contrast
PSL
1 Adjust WW
10
0.5
0 1
0.1 1 10 100 1000
Air KERMA (µGy)
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Raw data Raw, ranged data
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“Matched latitude” is another feature of
histogram re-scaling
3 10000
2.5
1000
Intensity (rel)
Histogram 1
Density (OD)
2
Histogram 2
1.5 100 Adjust WW 1
1 Adjust WW 2
10
0.5
0 1
0.1 1 10 100 1000
Air KERMA (µGy)
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Code values can be remapped in more
complex ways to modify contrast
• Modifying contrast is the secondary role for image

processing
• Contrast is compromised for some values of interest in
order to enhance contrast in others
• “post-acquisition processing”
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There are many brand-names for post-
acquisition processing
• Look-up-table (LUT, Gradation Processing)

• Unsharp Mask (Frequency Processing)
• Multi-frequency Processing (Musica®)
• Multi-Objective Frequency Processing
• Dynamic Range Control
• Tomographic Artifact Suppression
• Energy Subtraction (Dual Energy)
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Code values can be remapped to a non-linear
function
• This function might have lower contrast for lighter and
darker features with higher contrast for values in the
middle range, to achieve a film-like appearance.
• Code values within the values of interest are translated
by means of a Look-up Table (LUT).
• This is “Gradation Processing”,
“Sensitometry”, and “grey-scale rendition”
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Raw, ranged data Gradation-processed data
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The DR image has limited sharpness
• Sharpness is limited by pixel dimensions

• The smallest feature that can be resolved by CR is a “line
pair” represented by one “dark” pixel next to a “light”
pixel.
• Maximum spatial resolution is the sampling rate (pixels
per mm) divided by 2 (pixels per line pair)
• This is also called the “Nyquist Frequency” or “Nyquist
Limit”
• A large format cassette with 2000 pixels along the 35 cm
dimension would have about 6 pixels per mm and a
maximum spatial resolution of 3 lp/mm
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Practical resolution is less than the Nyquist
frequency
• Factors besides sampling
compromise sharpness
• X-ray focal spot dimensions
• Blur in Indirect DR and CR
• Optical and mechanical imprecision in
IDR and CR
• Afterglow in fast-scan dimension in
CR
• Limit of resolution is where
Modulation Transfer Function
(MTF) has decreased to 10%
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Enhancing sharpness:
sharpness a secondary purpose
of image processing
• If one can selectively increase the contrast of

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

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

g – blu
Ori
Orig + Diff
Difference image Sharpened image

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Musica® Edge Contrast
• Raw image is decomposed into sub-bands, each representing an octave
of spatial frequencies.
• Adding all sub-bands together would reconstitute the original
image
• The contrast of features in each sub-band is modified according to a
function.
• The degree of enhancement is controlled by the value of a single
parameter.
• Differential enhancement is controlled by a second parameter
value.
• The modified sub-bands are added back together to create a modified
image.
• Extra enhancement of high frequency sub-bands emphasizes edges
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Raw, ranged data Gradation-processed data
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Musica® Processed data Gradation-processed data
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blurred
Dynamic
Range
Control ) Blurred image
Original image r ed
f( b l ur
(actually a form
of “contrast
enhancement”)
Orig + f(blurred)
DRC image
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Dual Energy Subtraction Imaging: Uses low energy
image and high energy image …
• Two images are acquired

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

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Conventional vs. DES images
Where is the lesion? Is it calcified?
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Sufficient x-rays must reach the detector to
produce the radiographic image.
• At the same dose, the smaller the pixel size, the fewer x-
rays in each pixel, and the worse the noise.
• Larger the pixel size, worse the sharpness.
Air KERMA Photons Noise

(µGy) /100 m X100 m (%)
0.9 133 8.6
0.09 13 27.4
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IAEA 9 µGy 34
IAEA 3 µGy 35
IAEA 0.9 µGy 36
Post-acquisition processing can reduce noise.
noise
(generic term is “noise reduction”)
• Because noise is considered as high frequency variation,

attenuating high spatial frequencies can reduce noise.
• This is effectively a “high pass filter”
• Unsharp Mask can do this
• Musica® Noise Reduction can do this
• This also attenuates small clinical features!
• Corollary is that, enhancing small features also
enhances noise!
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Optimization in DR imaging cannot ignore
patient dose!
• In order to make a diagnostic radiographic image, a
sufficient number of x-rays must reach the detector.
• Unfortunately, the x-rays must pass through the patient
to reach the detector.
• The ALARA Principle dictates that the examination
should be performed with the lowest reasonable dose to
the patient.
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Acquisition processing involves
assumptions:
• Radiographic technique
• Composition of anatomic region imaged
• Use of collimation
Images with very different greyscale histograms

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Post-acquisition processing is controlled by
exam-specific parameters
• There are literally thousands of permutations of

allowable parameter settings.
• Extreme values can have dramatic effects on the
image.
• There is no general agreement on the optimum
values for the parameters.
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Auxiliary purpose of image processing:
improve usability
• Imprint demographic overlays
• Add annotations
• Apply borders or shadow masks
• Flip and rotate
• Increase magnification
• Conjoin images
• Scoliosis
• Full leg
• Modify sequence of views
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Conjoined images: early vs. modern
Note: Better contrast

different matching
contrast
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Inappropriate roles for image processing
• Compensate for inappropriate

radiographic technique
• Compensate for poor
calibration of acquisition and
display
• Deletion of non-diagnostic
images
Recovery of non-diagnostic
images to prevent re-exposure
is last resort, not routine
activity!
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Bad practice still translates into bad images.
Automation has not been invented

to correct for
• patient motion
• poor inspiration
• bad positioning
• improper collimation
• incorrect alignment of x-ray beam
and grid
• wrong exam performed
• wrong patient examined
• double-exposure.
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Radiographers need to recognize image artefacts ...
• … and take appropriate action

when artefacts occur.
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Conclusions:
• DR image quality can be described in conventional

terms.
• DR image processing has three purposes:
• Identify values of interest and maximize their contrast
• Modify contrast within values of interest
• Improve usability of the image
• Image quality cannot be optimized without considering
patient dose.
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Answer True or False
• Acquired images from DR system are

independent of display
• DR has wide latitude
• Spatial resolution of DR images are limited by
pixel dimensions
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Answer True or False
• True. Acquisition is independent from display, code

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

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

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

Digital Radiographic Image Processing

• List three main purposes of digital image

• Density can be modified.

Result of 20 years of development!

• Density function inherently nice.

Result of 110 years of development!

• Acquisition is independent from display

• DR has an extremely wide latitude, which implies low

• Goal is to represent anatomy,

Exposure (or greyscale)

Region of clinical interest

• Changing mAs does not affect subject contrast, as long as the

Region of clinical interest

• Higher kVp => less subject contrast

• How did we assure that the response of the

• Modifying contrast is the secondary role for image

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

• Sharpness is limited by pixel dimensions

• If one can selectively increase the contrast of

• Start with original image

Original image r re d Blurred image

Difference image Sharpened image

• Two images are acquired

Bone only image Soft tissue only image

Where is the lesion? Is it calcified?

Air KERMA Photons Noise

0.9 133 8.6

• Because noise is considered as high frequency variation,

Images with very different greyscale histograms

• There are literally thousands of permutations of

Note: Better contrast

• Compensate for inappropriate

Automation has not been invented

• … and take appropriate action

• DR image quality can be described in conventional

• Acquired images from DR system are

• True. Acquisition is independent from display, code

• Flynn MJ Processing digital radiographs of specific body parts. Advances in

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

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