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 Andreas Maier · Stefan Steidl
Vincent Christlein
Joachim Hornegger (Eds.)
Tutorial
LNCS 11111

Medical
Imaging Systems
An Introductory Guide
Lecture Notes in Computer Science 11111
Commenced Publication in 1973
Founding and Former Series Editors:
Gerhard Goos, Juris Hartmanis, and Jan van Leeuwen

Editorial Board
David Hutchison
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

ISSN 0302-9743 ISSN 1611-3349 (electronic)

Lecture Notes in Computer Science
ISBN 978-3-319-96519-2 ISBN 978-3-319-96520-8 (eBook)
https://doi.org/10.1007/978-3-319-96520-8

Library of Congress Control Number: 2018948380

LNCS Sublibrary: SL6 – Image Processing, Computer Vision, Pattern Recognition, and Graphics

© The Editor(s) (if applicable) and The Author(s) 2018. This book is an open access publication.
Open Access This book 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
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The publisher, the authors and the editors are safe to assume that the advice and information in this book are
believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors
give a warranty, express or implied, with respect to the material contained herein or for any errors or
omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in
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permission.

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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.

June 2018 Andreas Maier

Contents
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

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

6 Magnetic Resonance Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

6.1 Nuclear Magnetic Resonance (NMR) . . . . . . . . . . . . . . . . . . . . . . 91
6.1.1 Genesis of the Resonance Effect . . . . . . . . . . . . . . . . . . . . 91
6.1.2 Relaxation and Contrasts . . . . . . . . . . . . . . . . . . . . . . . . . . 95
6.2 Principles of Magnetic Resonance Imaging . . . . . . . . . . . . . . . . . 100
6.2.1 Slice Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
6.2.2 Spatial Encoding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
6.2.3 k-space . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
6.2.4 Slice-selective vs. Volume-selective 3-D Imaging . . . . . . 105
6.3 Pulse Sequences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
6.3.1 Spin Echo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
6.3.2 Gradient Echo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
6.4 Advanced Topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
6.4.1 Parallel Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
6.4.2 Spectrally Selective Excitation . . . . . . . . . . . . . . . . . . . . . 114
6.4.3 Non-contrast Angiography . . . . . . . . . . . . . . . . . . . . . . . . . 115
6.4.4 The BOLD Effect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117

7 X-ray Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119

7.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
7.1.1 Definition of X-rays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
7.1.2 History and Present . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
7.2 X-ray Generation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Contents 5

7.3 X-ray Matter Interaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125

7.3.1 Absorption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
7.3.2 Photoelectric Effect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
7.3.3 Compton Scattering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
7.3.4 Rayleigh scattering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
7.4 X-ray Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
7.4.1 Image Intensifiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
7.4.2 Flat Panel Detectors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
7.4.3 Sources of Noise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
7.5 X-ray Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
7.5.1 Radiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
7.5.2 Fluoroscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
7.5.3 Digital Subtraction Angiography . . . . . . . . . . . . . . . . . . . 143

8 Computed Tomography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147

8.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
8.1.1 Motivation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
8.1.2 Brief History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
8.2 Mathematical Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
8.2.1 Radon Transform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
8.2.2 Fourier Slice Theorem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
8.3 Image Reconstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
8.3.1 Analytic Reconstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
8.3.2 Algebraic Reconstruction . . . . . . . . . . . . . . . . . . . . . . . . . . 161
8.3.3 Acquisition Geometries . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
8.4 Practical Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
8.4.1 Spatial Resolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
8.4.2 Noise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
8.4.3 Image Artifacts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
8.5 X-ray Attenuation with Polychromatic Attenuation . . . . . . . . . 176
8.5.1 Mono- vs. Polychromatic Attenuation . . . . . . . . . . . . . . . 176
8.5.2 Single, Dual, and Spectral CT . . . . . . . . . . . . . . . . . . . . . 179
8.5.3 Beam Hardening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
8.6 Spectral CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
8.6.1 Different Spectral CT Measurements . . . . . . . . . . . . . . . . 182
8.6.2 Basis Material Decomposition . . . . . . . . . . . . . . . . . . . . . . 186

9 X-ray Phase Contrast:

Research on a Future Imaging Modality . . . . . . . . . . . . . . . . . . 191
9.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
9.2 Talbot-Lau Interferometer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
9.2.1 Talbot-Lau Interferometer Setup . . . . . . . . . . . . . . . . . . . 195
9.2.2 Phase Stepping and Reconstruction . . . . . . . . . . . . . . . . . 197
9.3 Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
9.4 Research Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
6 Contents

10 Emission Tomography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207

10.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
10.2 Physics of Emission Tomography . . . . . . . . . . . . . . . . . . . . . . . . . 208
10.2.1 Photon Emission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
10.2.2 Photon Interactions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
10.3 Acquisition Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
10.3.1 SPECT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
10.3.2 PET . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
10.4 Reconstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
10.4.1 Filtered Back-Projection . . . . . . . . . . . . . . . . . . . . . . . . . . 219
10.4.2 Iterative Reconstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . 220
10.4.3 Quantitative Reconstructions . . . . . . . . . . . . . . . . . . . . . . 222
10.4.4 Practical Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
10.5 Clinical Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
10.5.1 Diagnostics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
10.5.2 Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
10.6 Hybrid Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
10.6.1 Clinical Need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
10.6.2 Advent und Acceptance of Hybrid Scanners . . . . . . . . . . 231
10.6.3 Further Benefits of Hybrid Imaging . . . . . . . . . . . . . . . . . 232

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

12 Optical Coherence Tomography . . . . . . . . . . . . . . . . . . . . . . . . . . . 251

12.1 Working Principle of OCT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
12.1.1 Michelson Interferometer . . . . . . . . . . . . . . . . . . . . . . . . . . 253
12.1.2 Coherence Length . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
12.2 Time Domain OCT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254
12.3 Fourier Domain OCT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256
12.4 OCT Angiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256
12.5 Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257

Acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
Author Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
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