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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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.)

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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 R ontgen 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 purication work. After an initial urry of activity in the early 20th century culminating in the invention of the rst 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 Hounseld), 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. Identication of new modalities e.g., photo-acoustic imaging, or major variants of old modalities, e.g., Doppler ultrasound. Today, medical imaging is a vibrant eld where innovative researchers continually discover new ways to improve image quality and explore novel techniques.

Course philosophy Medical imaging is a very interdisciplinary eld, 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 identied. 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.

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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 gure 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 Human Interface

Digital Conversion

Image Formation

Display

Digital Processing

Digital Storage

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

Input Image
f (x, y ) f (x, y, z )

System Function
S

Output Image
g (x, y ) g (x, y, z )

Design Parameters

g = S [f ]

Input Image

Raw Data Instrument Image Formation

Output Image

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

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

Design Parameters

Design Parameters

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 specics 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.

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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 (Reection 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 10
0

10

10

10

Transmission

10

Transmission Diagnostic Xrays

10

10

10

10

10

1.5 T MRI H O 2 63 MHz = TV 3

10

10

10
4

10

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10 10 Wavelength [Angstroms]

10

10 10 Wavelength [meters]

The gure above, adapted from [1, Fig. 1.1], graphs the transmission coefcient 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 gure. 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 coefcient 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

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quality transmission imaging. Radiographic imaging, including conventional shadowgrams, uoroscopy, 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 specic 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 specic. 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 eld, the nuclear moment can be detected by exciting the system with a radio frequency (RF) magnetic eld. The frequency of the RF excitation is chosen to match a resonance condition determined by the Larmor frequency 0 = H , where is a nuclei specic gyromagnetic ratio and H is the applied magnetic eld 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 elds. 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 signicant distances in tissue. Local inhomogeneities in tissue mechanical properties cause weak reected waves that can be detected. The arrival time of such echoes after launching a short acoustic pulse determines the range of the reector, i.e., Vs t = 2R. Ultrasound images are constructed from the strength of reected acoustic waves, where the range (or depth) of the reecting 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.

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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 specic 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, specic disease states that are associated with large changes in microscopic mechanical properties are easily detected. In general, the specic 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 uorescence 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;

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

But rst we start with the tools...

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