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Image
receptor
Scatter Breast Lesio
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Simplified computer model of the mammographic image acquisition process:
For the simplified case of monoenergetic x-rays of energy E, the number of x-rays
recorded in a fixed area of the image is proportional to:
T
N B N 0 ( E )e
In the “background”
and:
[ (T t ) ,t ]
N L N 0 ( E )e
The difference in x-ray transmission gives rise to subject contrast which can be
defined as:
NB NL
C0
NB NL
For monoenergetic x-rays and temporarily ignoring scattered radiation
( , )t
1 e
C0 ( , ) t
1 e
For a given image recording system (image receptor) a proper exposure requires a
specific value of x-ray energy transmitted by the breast and incident on the receptor,
i.e. a specific value of NB. The breast entrance skin exposure required to produce an
image is therefore proportional to:
t
N 0 N B ( E )e
What Can Diagnostic Mammography
Show?
Diagnostic mammography may show that an abnormality (lesion) has
a high likelihood of being benign (not cancer). For these, it is
common to ask the woman to return earlier than usual for a recheck,
usually in 6 months. A diagnostic mammogram may show that the
abnormality is not worrisome at all and the woman can then return to
routine yearly screening mammography. In some cases, patients with a
cyst (fluid filled pocket) or other abnormality will also receive
ultrasound imaging to obtain further diagnostic information. Finally,
the diagnostic work-up may suggest that biopsy (tissue sampling) is
needed to tell whether or not the abnormality is cancerous. A
recommendation for biopsy does not necessarily mean that the
abnormality is cancer. About 65% of all breast lesions that are
evaluated with biopsy are found to be benign (non-cancerous) when
evaluated under the microscope.
What Abnormalities Does Mammography Detect and Diagnose?
Mammography alone cannot prove that an abnormal area is cancer although some
abnormalities are very characteristic of malignancy.
If mammography raises a significant suspicion of cancer, tissue must be removed for
examination under the microscope to tell if it is cancer.
This can be done with one of several breast biopsy techniques.
Ductography, also know as a Galactogram, is special type of contrast enhanced mammog
used for imaging the breast ducts. Ductography can aid in diagnosing the cause of an abn
nippledischarge and is valuable in diagnosing intraductal papillomas.
Digital Mammography
One of the most recent advances in x-ray mammography is digital mammography. Digital
(computerized) mammography is similar to standard mammography in that x-rays are use
produce detailed images of the breast. Digital mammography uses essentially the same
mammography system as conventional mammography, but the system is equipped with a
receptor and a computer instead of a film cassette. Several studies have demonstrated th
Mammography is at least as accurate as standard mammography.
Digital spot view mammography allows faster and more accurate stereotactic biopsy. This
in shorter examination times and significantly improved patient comfort and convenience s
the time the patient must remain still is much shorter. With digital spot-view mammography
images are acquired digitally and displayed immediately on the system monitor. Spot-view
systems have been approved by the U.S. Food and Drug Administration (FDA) for use in g
breast biopsy. Traditional stereotactic biopsy requires a mammogram film be exposed, dev
and then reviewed, greatly increasing the time before the breast biopsy can be completed
In addition to spot-view digital mammography, the FDA has recently approved a "full-field"
digital mammography system to screen for and diagnose breast cancer. Currently, only ha
copy printouts of the digital mammographic images maybe used by radiologists. With cont
improvements, the "full-field" mammography systems may eventually replace traditional
mammography.
How Does Digital Mammography Differ From Standard Mammography?
In standard mammography, images are recorded on film using an x-ray cassette. The film
viewed by the radiologist using a "light box" and then stored in a jacket in the facility’s arch
With digital mammography, the breast image is captured using a special electronic
x-ray detector, which converts the image into a digital picture for review on a computer mo
The digital mammogram is then stored on a computer. With digital mammography, the
magnification, orientation, brightness, and contrast of the image may be altered after the e
completed to help the radiologist more clearly see certain areas.
Digital mammography provides many benefits over standard mammography equipment.
These benefits include:
• faster image acquisition
• shorter exam time
• easier image storage
• physician manipulation of breast images for more accurate
detection of breast cancer
• transmittal of images over phone lines or a computer network for remote consultati
other physicians
Digital mammography has the potential to significantly reduce the amount of time required
acquire a mammogram from 10 to 15 minutes to less than a minute. This will provide a sh
more comfortable exam for the woman and possibly allow mammography facilities to cond
more mammograms in a day. Digital images can also be manipulated to correct for under
over exposure. If under or over exposure occurs with a standard film-based mammograph
System women have to undergo a repeat mammogram before leaving the facility.
Many radiologists support digital mammography as an effective tool to
screen for breast cancer.
The contrast resolution of these devices is inherently better, "In addition, the extra features
digital mammography will ultimately provide, such as telemammography, tomosynthesis, a
computer-aided diagnosis will prove invaluable to patients and their doctors,”
Telemammography (also called teleradiology) allows radiologists to share digital images vi
phone or network connection for remote consultation with other physicians;
tomosynthesis allows radiologists to add or subtract digital mammography images using a
computer workstation for enhanced diagnostic capability. Computer-aided detection (CAD)
was approved by the FDA in June 1999. CAD helps radiologists more accurately
detect breast cancer by marking suspicious areas on digitized mammograms.
The FDA has approved the first "full-field" digital mammography scanner to screen for and
diagnose breast cancer in February 2000. Before applying for FDA certification, data was
gathered from 662 patients at four institutions: the University of Colorado, the University
of Massachusetts Medical Center, Massachusetts General Hospital, and the Hospital of the
University of Pennsylvania. The data compared hard copies of digital breast images on film
conventional mammography films finding that digital mammography is as effective at detec
breast cancer as standard film mammograms. A separate study revealed that the digital
mammography scanner showed a slight advantage in the visibility of breast tissue at the sk
Disadvantages to Digital Mammography
While digital mammography is quite promising, it still has additional hurdles to undergo b
it replaces conventional mammography. Digital mammography must:
provide higher detail resolution (as standard mammography does)
become less expensive (currently several times more costly than
conventional mammography)
provide a method to efficiently compare digital mammogram
images with existing mammography films on computer monitors
Standard mammography using film cassettes has the benefit of providing very high deta
resolution (image sharpness), which is especially useful for imaging microcalcifications
(tiny calcium deposits) and very small abnormalities that may indicate early breast
cancer. While full-field digital mammography may lack the spatial resolution of film, clinic
trials have shown digital mammography to be at least equivalent to standard film screeni
mammography. This is because digital mammography has the benefit of providing impro
contrast resolution, which may make abnormalities easier to see. Various manufacturers
trying to develop digital mammography systems with detail resolution equivalent to
standard film mammography while also providing the benefits of digital mammography n
above.
The high cost of digital mammography is a major obstacle. Digital mammography system
costs roughly four to five times as much as standard mammography equipment. Standar
mammography systemsare currently installed in over 10,000 locations across the United
It may take years for this current equipment to be updated or replaced
and for digital mammography to become widespread after its approval
by the FDA.
Benign lesion - Fibroadenoma
Computerized Tomography
Translate – rotate
movement
Single detector
4th generation CT Fan beam, stationary detectors.
Stationary Detectors
(600-4800)
Fifth generation CT
(Image data are acquired in as little as 50 mSEC).
DAS
Detector ring
Gun
Patient table
Electron
beam
Target rings
CT (by Picker)
Spiral scan
Colonoscopy with spiral CT
Example of cross-sections through several parts of the body:
skull, thorax, and abdomen,
Starts with the assumption that the absorbing medium is uniformly distributed.
with several intensity profile we get a star-like reconstructed image.
By increasing the number of angles, the intensity in the center decreases and we
back projected image but less sharp.
Instead of showing one attenuation pixel,
The neighboring pixels are visible in the reconstructed image as well.
This blurring is corrected with filtering techniques.
Some Mathematics:
t y
s
(x,y)
x
p( t , ) c z
f ( x , y ) ds
The relationship between the source position (x,y) the projection angle and
position of the detection on the 1D detector array is given by:
t y cos x sin
In 2D tomographic imaging, The 1D detector rotates around the object.
The goal of image reconstruction is to solve the inverse Radon
transform.
The solution is the reconstructed image estimate of the object distribution f(x,y)
p , ( t , ) ct I 0 exp[ z
( x , y )ds]
Where:
j - the jth projection angle.
m - number of projection views.
- The angular spacing between adjacent projections.
Filtering can be implemented in 2 ways, in the spatial domain, the filter operation
equivalent to to convolving the measured projection data using a special convolv
function h(t)
p, (t , ) p(t , ) h(t )
1 ||0.5
rect ()= {
0 ||>0.5
The rectangular function rect() when the absolute value of is less than the
Nyquist frequency at 0.5 cycles per pixel.
Additional smoothing function may be applied for noisy data.
Attenuation coefficients of several tissues expressed
in Hounsfield units.
Magnetic resonance imaging (MRI)
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Magnetic resonance imaging exploits the existence of induced nuclear magnetism in the
patient. Magnets with an odd number of photons or neutrons possess a weak but observable
nuclear magnetic moment. Most commonly photons (H) are imaged, although
(13C, Phosphorous (P) sodium (Na) and Fluorine (F) are also of significant interest.
The nuclear moments are normally randomly oriented, but they align when placed in a strong
magnetic field (typically 0.2-1.5 T).
The NMR signal from a human is due predominantly to water protons. Since these
protons exists in identical magnetic environments, they all resonate at the same frequency.
Hence the NMR signal is simply proportional to the volume of the water. The key innovation
for MRI is to impose spatial variation on the magnetic field to distinguish spins by their
location. Applying a magnetic field gradient causes each region of the volume to oscillate at
a distinct frequency.
The primary contrast mechanisms exploit relaxation of the magnetization are T1 and T2.
Spin-lattice relaxation T1: The exponential rate constant describing the decay of the z
component of magnetization towards the equilibrium magnetization. Typical values in the
body are between 300 and 3000 ms.
Spin-Spin relaxation T2: The exponential rate contrast describing the decay of the transverse
components of magnetization (Mx and My).
MR images provide excellent contrast between various forms of soft tissues. For patients
who have no ferromagnetic foreign bodies within them, MRI scanning appears to be
perfectly safe and can be repeated as often as necessary without danger. The NMR signal is
also not blocked by air like US and there is no need for radioactive tracers as in the case of
nuclear medicine scanning. Typical imaging studies range from 1 to 10 minutes but new fast
imaging techniques acquire images in less than 50 msec.
MRI by Picker
Spinal cord Brain section
Functional MRI
fMRI is a technique that images intrinsic blood signal change with magnetic
Resonance imagers.
Changes in neuronal activity are accompanied by focal changes in cerebral
blood flow (CBF), blood volume (CBV), blood oxygenation and metabolism. These
physiological changes can be used to produce functional maps of mental operations.
There are two basic techniques used:
1 Saturation or inversion of incoming blood signal to quantify
absolute blood flow.
By focusing on blood flow change and not steady state flow, it is possible to
image brain visual functions associated with quantitative perfusion change.
At this way common baseline artifact can be subtracted.
Measuring changes in blood oxygenation during neuronal activity.
The study of changes in blood flow is done also with injection of contrast agents
(i.e. gadolinium-DTPA).
Two relaxation rates are measured in fMRI T1 and T2* (represents the rate of decay of
MRI signal due to magnetic field in-homogeneities and changes in used to measure
blood oxygenation change.
T2* changes reflect the interplay between changes in cerebral blood flow, volume and
oxygenation. As hemoglobin becomes deoxygenated, it becomes more paramagnetic
than the surrounding tissue and thus creates a magnetically inhomogeneous
A functional map (in color) in the cerebellum during performance of a cognitive peg-
board puzzle task, overlaid on a T2*-weighted axial image in gray scale. The dentate
nuclei appear as dark crescent shapes at the middle of the cerebellum due to iron
deposits. fMRI images were acquired by conventional T2*-weighted FLASH techniques
with a spatial resolution of 1.25x1.25x8 mm3 and a temporal resolution of 8 seconds.
Each color represents a 1% increment, starting at 1%. R, right cerebellum; L, left
cerebellum. A left-handed subject used the left hand to perform the task. Bilateral
activation in the dentate nuclei and cerebellar cortex was observed. The activated area
in the dentate nuclei during performance of pegboard puzzle was 3-4 times greater than
that seen during the visually guided peg movements. (see details in Kim et al., 1994b).
Whole brain functional imaging study during a visuo-motor error detection and correction task.
Functional images were acquired by the multi-slice single-shot EPI imaging technique with
spatial resolution of 3.1x3.1x5 and temporal resolution of 3.5 seconds. The skull and associated
muscles were eliminated by image segmentation. The 3-D image constructed from multi-slice
images was rendered by Voxel View program (Vital Images, Fairfield, Iowa).The task was to
move a cursor from the central start box onto a square target by moving a joystick. Eight targets
were arranged circumferentially at 450 angles and displaced radially at 200 around a central start
box. Activation (in color) is observed at various brain areas. Top image displays the brain as a
3-D solid object so that only the cortical surface is seen. In the bottom image, a posterior section
was removed at the level of the associative visual cortex to display activation not visible from the
surface (Kindly provided by Jutta Ellermann, Jeol Seagal, and Timothy Ebner).
Open MRI units
Nuclear Imaging
Collimator
Electronics NaI(Ti)
crystal
PMT
Y
Counts/pixel
X
The most important tool in nuclear medicine is the scintillation camera (anger
camera) based on a large area (~40 cm in diameter) NaI(Tl) crystal.When a
photon hits and interact with the crystal, the scintillation generated and detected
by the area of PMTs. An electronic circuit evaluates the relative signals from the
PMTs and determines the location of the signal.
Performance characteristics of Nuclear
Imaging Systems
Spatial resolution - A measure for the degree of detail the final
reconstructed image provides and hence the size of lesions that m
potentially be detected. In other words: how fine the details are that
be separated.
Some of the events are lost because the system is still processing
previous event (dead time).
Signal to Noise ratio (SNR) - The relative strength of the informatio
and the noise. If the lesion is small compared with the spatial resol
the contrast is reduced because the high lesion activity blurred int
neighborhood by the detector response.
P(r,)
In 2-D tomographic imaging, the 1D detector array rotates around
the object distribution f(x,y) and collects projection data from various
projection angles . The integral transform of the object distribution
to its projections is given by:
z
z
p(t , ) ce ( x, y)ds
In SPECT attenuation coefficient is not so important, so it can
be considered as constant in the body region under inspection.
z
l(x,y) is the pathlength between the point (x,y) and the edge of the
attenuator (or patient’s body) along the direction of the projection
ray.
The image reconstruction problem is further complicated by the non
stationary properties of the collimator detector and scatter response
functions and their dependence on the size and composition of the
patient’s body.
Brain and Liver Tomographic
Reconstruction and 3D Rendering
Positron emission tomography
PET enables physicians to assess chemical or physiological changes
related to metabolism. Since the origins of many diseases are
biochemical in nature, these functional changes often predate or exceed
structural change in tissue or organs. PET imaging utilizes a variety of
radiopharmaceuticals, called "tracers," to obtain images. PET tracers
mimic the natural sugars, water, proteins, and oxygen found in our
bodies. These tracers are injected into a patient and collect in various
tissues and organs. The PET system takes a time-exposure of the tracer
and generates a "photo" of cellular biological activities. PET images
can be used to measure many processes, including sugar metabolism,
blood flow and perfusion, receptor-ligand binding rates, oxygen
utilization and a long list of other vital physiological activities.
PET TRACER PRODUCTION SYSTEMS
EtOOC N O NH COOEt
99mTc
S S
Scintillator
Tungsten
septum
Resolution factors are:
Calibration data
Sinogram
Correction data
Reconstruction Counts/ray
Image
Whole body PET
Study for cardiomyopathy
SA reconstructed slices
Measurements:
• Blood volumes
• Oxygen consumption
• Perfusion
• Glucose consumption
Ultrasound Imaging
Ultrasound operates much the same as sonar, using high-frequency sound waves as its
imaging source. Ultrasound is the reflection of a sound wave as it collides with the
anatomy being studied. The resulting pattern of that reflection is converted into
diagnostic information via a hand-held transducer passed over the area being imaged.
First utilized some 50 years ago, this medical technology's non-radioactive nature has
made it the modality of choice for ob-gyn procedures; in fact, it is most commonly
associated with fetal imaging. Advances in ultrasound technology have resulted in
applications that extend far beyond fetal imaging to include cardiac, vascular and
breast imaging, as well as cyst identification and guidance of a variety of surgical
and other therapeutic procedures.
Ultrasound
examination
Micro-convex: 6.5MHz
For transvaginal and
transrectal studies
Ultrasound transducers generate acoustic waves by converting magnetic, thermal, or
electric energy into mechanical energy. The most efficient technique for medical
ultrasound uses the piezoelectric effect. Applying stress on a crystal creates electrical
potential and vise versa. The transducer developed when linear arrays were developed.
To implement real time imaging, rapid steer of the acoustic beam is needed. Linear
sequential arrays were designed to electronically focus the beam in a rectangular image
region. Linear phased area transducers were designed to electronically steer and focus
the beam at high speed in a sector image format.
The standard material fot medical ultrasound for many years is the ferroelectric ceramic
lead-zirconate-titanate (PZT) it has a high electromechanical conversion efficiency and
low intrinsic losses. The properties of the PZT can be adjusted by modifying the ratio of
zirconium to titanium and introducing small amounts of other substances, such as
Tantalum. PZT is mechanically strong and can operate at temperatures up to 1000 C
and it’s stable for a long period of time. The disadvantage is high acoustic impedance
(Z=30 Mrayls) compared with body tissue (1.5 Mrayls). This is compensated with
acoustic matching layers. Other materials are used as well (i.e. PVDF-Polyvinylidene
difluoride).
Array transducers use the same principal as acoustic lenses to focus an acoustic beam.
In both cases variable delays are applied across the transducer aperture.
Focusing and steering is done by delayed excitation signals as follows:
Transmit focus
Excitation signals
The acoustic signal from all elements reach the focal point at the same time. According
to Huygens principle the net acoustic signal is the sum of all signals. For receiving an
ultrasound echo, the phase array works in reverse. The echo from a receive focus is
incident on each array element at a different time interval. The received signals are
electronically delayed so that the delayed add in phase for an echo originating at the
focal point.
In the receive mode, the focal point can be dynamically adjusted so that it coincides with
the range of returning echoes. After transmission of acoustic pulse, the initial echoes
return from targets near the transducer. Therefore, the scanner focuses the phase array
on these targets, located at the first focus. As echoes return from from more distance
targets, the scanner focuses at a greater depth. Focal zones are established with adequate
depth of field so targets are always in focus to receive. This process is called dynamic
receive focusing.
f1
f2
time time
Arrays can be configured as :
Linear sequential array (~512 elements)
Curvilinear (convex) arrays.
Linear phased arrays.
1.5D arrays
2D arrays.
Linear
phased
Linear
Backin
g
2D array
S (t ) T (t ) B(t ) A(t ) (t )
Where:
B-mode (2-D) - The current display mode of choice. This is produced by sweeping the
transducer from side to side and displaying the strength of the returned echoes as bright
spots in their geometrically correct direction and distance.
M-mode - Followed A mode by recording the strength of the echoes as dark spots on
moving light sensitive paper. Object that move, such as the heart cause standard patters
of motion to be displayed. And a lot of diagnostic information such as valve closure
rates, whether valves opened and closed completely, and wall thickness could be
obtained from this mode.
Transducer Ribs
Chest wall
M-line
Transducer
Skin surface
Layers of intervening
tissue
Vessel
Blood flow
Reflection of sound waves depend on the acoustic impedance which are defined by
its density and the velocity of sound in the medium.
Acoustic impedances differences are very small between soft tissues.
Echofarnaceuticals (US Cas) have been proposed to increase acoustic impedance
differences at tissue interfaces. Secondly to increase the respective echo intensities.
The most effective principle by far that has emerged is the diffraction of ultrasonic
waves on gas bubbles (microbubble containing solutions ) and colloidal, sometimes
temperature dependent diphasic systems.
Ultrasound contrast agents