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Medical
Imaging Systems
An Introductory Guide
Lecture Notes in Computer Science 11111
Commenced Publication in 1973
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Gerhard Goos, Juris Hartmanis, and Jan van Leeuwen
Editorial Board
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Lancaster University, Lancaster, UK
Takeo Kanade
Carnegie Mellon University, Pittsburgh, PA, USA
Josef Kittler
University of Surrey, Guildford, UK
Jon M. Kleinberg
Cornell University, Ithaca, NY, USA
Friedemann Mattern
ETH Zurich, Zurich, Switzerland
John C. Mitchell
Stanford University, Stanford, CA, USA
Moni Naor
Weizmann Institute of Science, Rehovot, Israel
C. Pandu Rangan
Indian Institute of Technology Madras, Chennai, India
Bernhard Steffen
TU Dortmund University, Dortmund, Germany
Demetri Terzopoulos
University of California, Los Angeles, CA, USA
Doug Tygar
University of California, Berkeley, CA, USA
Gerhard Weikum
Max Planck Institute for Informatics, Saarbrücken, Germany
More information about this series at http://www.springer.com/series/7412
Andreas Maier Stefan Steidl
•
Vincent Christlein
Joachim Hornegger (Eds.)
Medical
Imaging Systems
An Introductory Guide
Editors
Andreas Maier Vincent Christlein
Lehrstuhl für Mustererkennung Lehrstuhl für Mustererkennung
Friedrich-Alexander-Universität Friedrich-Alexander-Universität
Erlangen-Nürnberg Erlangen-Nürnberg
Erlangen Erlangen
Germany Germany
Stefan Steidl Joachim Hornegger
Lehrstuhl für Mustererkennung Lehrstuhl für Mustererkennung
Friedrich-Alexander-Universität Friedrich-Alexander-Universität
Erlangen-Nürnbergät Erlangen-Nürnbergät
Erlangen Erlangen
Germany Germany
LNCS Sublibrary: SL6 – Image Processing, Computer Vision, Pattern Recognition, and Graphics
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Preface
The present book is the result of four years of work that started in Winter 2014/15 and
was finally concluded in Summer 2018. As such, numerous hours of work went into
this manuscript by several authors, who were all affiliated with the Pattern Recognition
Lab of the Friedrich-Alexander-University Erlangen-Nuremberg. I truly appreciate the
dedication and the hard work of my colleagues that led to this final manuscript and,
although many already left the lab to take positions in academia and industry, they still
supported the finalization of this book.
While major parts of the book were already completed in Winter 2016/17, Springer
gave us the opportunity to rework the book with new concepts like the geek boxes and
new figures in order to adapt the book to a broader audience. With the present concepts,
we hope that the book is suited to early-stage undergraduate students as well as stu-
dents who already completed fundamental math classes and want to deepen their
knowledge on medical imaging. We believe, the time to improve the manuscript was
well spent and the final polish gave rise to a textbook with a coherent story line. In
particular, we break with the historical development of the described imaging devices
and present, e. g., magnetic resonance imaging before computed tomography, although
they were developed in opposite order. A closer look reveals that this change of order is
reasonable for didactical purposes: magnetic resonance imaging relies mainly on the
Fourier transform, while computed tomography requires understanding of the Fourier
slice theorem discovered by Johann Radon. These observations then also mend the
apparent historical disorder, as we celebrate Joseph Fourier’s 250th birthday this year
and celebrated the 100th birthday of the Radon transform last year.
We also tried to find many graphical explanations for many of the mathematical
operations such that the book does not require complete understanding of all mathe-
matical details. Yet, we also offer details and references to further literature in the
previously mentioned geek boxes as students in the later semesters also need to be
familiar with these concepts. In conclusion, we hope that we created a useful textbook
that will be accessible to many readers. In order to improve this ease of access further,
we chose to publish the entire manuscript as open access book under Creative Com-
mons Attribution 4.0 International License. Thus, any information in this book can
shared, copied, adapted, or remixed even for commercial purposes as long as the
original source is appropriately referenced and a link to the license is provided.
2 System Theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
2.1 Signals and Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2.1.1 Signals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2.1.2 Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
2.2 Convolution and Correlation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
2.2.1 Complex Numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
2.2.2 Convolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
2.2.3 Correlation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
2.3 Fourier Transform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
2.3.1 Types of Fourier Transforms . . . . . . . . . . . . . . . . . . . . . . . 22
2.3.2 Convolution Theorem & Properties . . . . . . . . . . . . . . . . . 25
2.4 Discrete System Theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
2.4.1 Motivation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
2.4.2 Sampling Theorem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
2.4.3 Noise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
2.5 Examples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
3 Image Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
3.1 Images and Histograms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
3.1.1 Images as Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
3.1.2 Histograms of Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
3.2 Image Enhancement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
3.2.1 Window and Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
3.2.2 Gamma Correction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
3.2.3 Histogram Equalization . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
3.3 Edge Detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
3.4 Image Filtering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
3.4.1 Filtering – Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
3.4.2 Linear Shift-invariant Filters in Image Processing . . . . . 44
3.4.3 Nonlinear Filters – the Median Filter . . . . . . . . . . . . . . . 47
3.5 Morphological Operators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
3.6 Image Segmentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
4 Contents
4 Endoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
4.1 Minimally Invasive Surgery and Open Surgery . . . . . . . . . . . . . 57
4.2 Minimally Invasive Abdominal Surgery . . . . . . . . . . . . . . . . . . . . 58
4.3 Assistance Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
4.4 Range Imaging in Abdominal Surgery . . . . . . . . . . . . . . . . . . . . . 63
4.4.1 Stereo Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
4.4.2 Structured Light . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
4.4.3 Time-of-Flight (TOF) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
5 Microscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
5.1 Image Formation in a Thin Lens . . . . . . . . . . . . . . . . . . . . . . . . . 70
5.2 Compound Microscope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
5.3 Bright Field Microscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
5.4 Fluorescence Microscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
5.5 Phase Contrast Microscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
5.6 Quantitative Phase Microscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
5.7 Limitation of Light Microscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
5.8 Beyond Light Microscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
5.9 Light Microscopy Beyond the Diffraction Limit . . . . . . . . . . . . . 88
11 Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
11.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
11.2 Physics of Sound Waves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238
11.2.1 Sound Waves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238
11.2.2 Sound Wave Characteristics at Boundaries . . . . . . . . . . 239
11.2.3 Attenuation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242
11.3 Image Acquisition for Diagnostics . . . . . . . . . . . . . . . . . . . . . . . . 243
11.3.1 Transducers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
11.3.2 Piezoelectric Effect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
11.3.3 Spatial Resolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244
11.3.4 Imaging Modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
11.4 Safety Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
Acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
Author Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
Chapter 1
Introduction
covers the basics of image processing and explains how different image trans-
formations such as edge detection and blurring are implemented as image
filters using convolution.
The following chapters cover examples for imaging devices using stan-
dard optics. In this book, endoscopy and microscopy are discussed as typical
modalities of this genre. Endoscopes, see Chap. 4, were among the first med-
ical imaging devices that were used. Images can be acquired by using long
and flexible optical fibers that are able to transport visible light through the
body of a patient.
Microscopes also use visible light. However, tissue samples or cells have to
be extracted from the body first, e. g., in a biopsy. Then the microscope’s op-
tics are used to acquire images at high magnifications that allow the imaging
of individual cells and even smaller structures. Microscopes and the principles
of optics are described in Chap. 5.
Magnetic resonance imaging (MRI), see Chap. 6 uses electromagnetic
waves to excite water atoms inside the human body. Once the excitation
is stopped, the atoms return to their normal state and by doing so emit
the same electromagnetic radio wave that was used to excite them. This ef-
fect is called nuclear magnetic resonance. Using this effect, an MRI image is
obtained. Fig. 1.1 shows a state-of-the-art MR scanner.
X-ray imaging devices, see Chap. 7, use light of very high energy. However,
the light is no longer visible for the human eye. The higher energy of the light
allows for a deeper penetration of the body. Due to different absorption rates
of X-rays, different body tissues can be distinguished on X-ray images. Tissues
with high X-ray absorption, e. g., bones, become visible as bright structures
in X-ray projection images. Today, X-rays are among the most widely spread
1 Introduction 9
Figure 1.1: MRI is based on nuclear magnetic resonance which does not
involve ionizing radiation. For this reason MRI is often used in pediatric
applications. Image courtesy of Siemens Healthineers AG.
Figure 1.2: X-ray projection images are one of the most wide-spread imaging
modalities. Image courtesy of Siemens Healthineers AG.
10 1 Introduction
Figure 1.3: Modern CT systems allow even scanning of the beating heart.
Image courtesy of Siemens Healthineers AG.
Figure 1.4: An X-ray dark-field setup can be used to reconstruct the ori-
entation of fibers that are smaller than the detector resolution. The image
on the left shows the reconstructed fiber orientation in different layers of a
peanut. The image on the right shows a microscopic visualization of the waist
of the peanut (picture courtesy of ECAP Erlangen).
Open Access This chapter is licensed under the terms of the Creative Commons
Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/),
which permits use, sharing, adaptation, distribution and reproduction in any medium
or format, as long as you give appropriate credit to the original author(s) and the
source, provide a link to the Creative Commons license and indicate if changes were
made.
The images or other third party material in this chapter are included in the chapter’s
Creative Commons license, unless indicated otherwise in a credit line to the material. If
material is not included in the chapter’s Creative Commons license and your intended
use is not permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder.
Chapter 2
System Theory
In the digital age, any medical image needs to be transformed from contin-
uous domain to discrete domain (i. e. 1’s and 0’s) in order to be represented
in a computer. To do so, we have to understand what a continuous and a
discrete signal is. Both of them are handled by systems which will also
be introduced in this chapter. Another fundamental concept is the Fourier
transform as it allows us to represent any time domain signal in frequency
space. In particular, we will find that both representations – time domain
and frequency domain – are equivalent and can be converted into each other.
Having found this important relationship, we can then determine conditions
which will guarantee that also conversion from continuous to discrete domain
and vice versa is possible without loss of information. On the way, we will
introduce several other important concepts that will also find repeated use
later in this book.
2.1.1 Signals
Figure 2.1: A system H{.} with the input signal f (t) and the output signal
g(t).
2.1.2 Systems
for the shift τ . This means that shifting the signal by τ followed by
processing with the system is identical to processing the signal with
the system followed by a shift with τ .
before the input actually arrives in the system. This is especially important
for signals with time as the independent parameter. However, non-causal
systems do not pose a problem for the independent parameter space, e. g.,
image filters that use information from the left and right of a pixel. Geek
Box 2.3 presents examples for the combination of different system properties.
Linear shift-invariant systems are important in practice and have conve-
nient properties and a rich theory. For linear shift-invariant systems, the ab-
stract operator H{·} can be described completely using the impulse response
h (t) (cf. Sec. 2.2.2) or transfer function H (ξ) (cf. Sec. 2.3.2). The impulse
response is combined with the signal by the operation of convolution. This is
sufficient to describe all linear shift-invariant systems.
2.2 Convolution and Correlation 17
a = Re (z) (2.6)
b = Im (z) . (2.7)
a = A cos φ
b = A sin φ
polar coordinates consists of magnitude A and angle φ (cf. Geek Box 2.4). For
system theory, an important property of complex numbers is Euler’s formula
Using this relation, a complex sum of sine and cosine can be expressed con-
veniently using a single exponential function. This leads directly to the ex-
ponential notation of complex numbers z = Aeiφ . We will use the complex
numbers and different notations in Sec. 2.3.
2.2 Convolution and Correlation 19
Description Equation
2.2.2 Convolution
1.4
Input signal f (t)
1.2 Impulse response h(t)
1.0 Output signal g(t)
0.8
0.6
0.4
0.2
0.0
−1 0 1 2 3 4
For the definition of the square function, the Heaviside step function
is useful to shorten the notation
(
0, if t < 0
H (t) = .
1, otherwise
Z ∞
f (t)δ(t − T ) dt = f (T ).
−∞
With the sifting property, the element at t = T can be selected from the
function, which is equivalent to sampling the function at that time point.
The sift property is useful for convolution of an arbitrary function and the
Dirac function.
Z ∞
f (t) ∗ δ(t − T ) = f (τ )δ(t − T − τ ) dτ = f (t − T ) (2.11)
−∞
Figure 2.2: Graphical representation of the Dirac function δ(t). The arrow
symbolizes infinity.
Figure 2.3: Laboratory sifters are used to remove undesired parts from
discrete signals. Sequences of Dirac pulses can be applied in a similar way.
Image courtesy of BMK Wikimedia.
2.2.3 Correlation
Here, we use x̄, ȳ, σx , and σy to denote the respective mean values and
standard deviations. If we assume the standard deviations to be equal
to 1 and the means equal to 0, we arrive at the following equation:
X
r(x, y) = x n · yn
n
0.8 1.75
Fourier coefficients of f(t) Coeff. at 1/2 Original signal f(t) Frequs. 0, 1/2
0.7 Coefficient at 0 (offset) Coeff. at 3/2 1.50 Frequency 0 (offset) Frequs. 0, 1/2, 3/2
0.6 1.25
0.5 1.00
0.4 0.75
0.3 0.50
0.2 0.25
0.1 0.00
0.0 0.25
3 2 1 0 1 2 3 3 2 1 0 1 2 3
(a) Fourier coefficients, weights of trigono- (b) Periodic signal and approximations us-
metric functions approximating the signal ing different numbers of Fourier coefficients
f (t)
f (t) = A · cos(2πξt + ϕ) A, ϕ ∈ R
= a · cos(2πξt) + b · sin(2πξt) a, b ∈ R
= c · e2πiξt + c̄ · e−2πiξt c∈C
In Geek Box 2.7, we show how the parameters a, b, and c are related to A
and ϕ.
A Fourier series (cf. Geek Box 2.8) is used to represent a continuous
signal using only discrete frequencies. As such a Fourier series is able to ap-
proximate any signal as a superposition of sine and cosine waves. Fig. 2.4(b)
shows a rectangular signal of time. The absolute values of its Fourier coeffi-
cients are depicted in Fig. 2.4(a). As can be seen in Fig. 2.4(a), the Fourier
coefficients decrease as the frequency increases. It is therefore possible to ap-
proximate the signal by setting the coefficients to 0 for all high frequencies.
Fig. 2.4(b) includes the approximations for three different choices of sets of
frequencies.
The Fourier series, which works on periodic signals, can be extended to
aperiodic signals by increasing the period length to infinity. The resulting
transform is called continuous Fourier transform (or simply Fourier trans-
form, cf. Geek Box 2.9). Fig. 2.5(b) shows the Fourier transform of a rectan-
gular function, which is identical to the Fourier coefficients at the respective
frequencies up to scaling (see Fig. 2.5(a)).
The counter part to the Fourier series for cases in which time domain is
discrete and the frequency domain is continuous is called the discrete time
Fourier transform (cf. Geek Box 2.10). It forms a step towards the dis-
crete Fourier transform (cf. Geek Box 2.11) which allows us to perform
all previous operations also in a digital signal processing system. In discrete
space, we can interpret the Fourier transform simply as a matrix multiplica-
tion with a complex matrix F
2.3 Fourier Transform 25
Table 2.2: Fourier transforms of popular functions. Here we use the defini-
tion sinc(x) = sin(πx)
πx . Note that a convolution of two rectangular functions
yields a triangular function as F [rect(t) ∗ rect(t)] = sinc2 (ξ).
k = Fn (2.14)
where the signal n and the discrete spectrum k are vectors of complex values.
The inverse operation is then readily found as
n = FHk (2.15)
F{f ∗ g} = F · G (2.24)
F{f · g} = F ∗ G (2.25)
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