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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
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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
Chapter 1

Introduction

Author: Andreas Maier

The design and manufacturing of modern medical devices requires knowl-

edge of several disciplines, ranging from physics, over material science, to
computer science. Thus, designing a single lecture as an introduction to med-
ical engineering faces a lot of challenges. Nonetheless, the manuscript Medi-
cal Imaging Systems – An Introductory Guide aims at being a complete and
comprehensive introduction to this field for students in the early semesters.
Medical imaging devices are by now an integral part of modern medicine,
and have probably already been encountered by all students in their personal
life.
This book does not simply summarize the content of the lecture held in
Erlangen. Instead, it should be understood as additional material to gain a
better understanding of the theory that is covered in the lecture. To give a
complete introduction, the lecture notes also cover basic math and physics
that are required to understand the underlying principles of the imaging
devices. However, we try to limit this to the very basics. Obviously, this
is not sufficient to describe everything in the appropriate level of detail. For
this reason, we introduced geek boxes (cf. Geek Box 1.1) that contain optional
additional background information. This concept will be used in all chapters
of the book which are summarised in the following sections.
Chap. 2 and 3 of this book cover an introduction to signal and image pro-
cessing. Chap. 2 introduces the concepts of filtering, convolution, and Fourier
transforms for 1-D signals, all of which are fundamental tools that are later
on used across the entire book. We try to explain why these concepts are
required and as most image processing is digital also emphasize the discrete
algorithmic counter parts. At the beginning of Chap. 3, the transition to im-
ages is made, and therefore also the transition from 1-D to 2-D. The chapter

c The Author(s) 2018

A. Maier et al. (Eds.): Medical Imaging Systems, LNCS 11111, pp. 7–12, 2018.
https://doi.org/10.1007/978-3-319-96520-8_1
8 1 Introduction

Geek Box 1.1: Geek Boxes

We designed the manuscript to be readable from the first semester

on. However, we felt that we need to demonstrate that there is much
more depth that we could go into. In order not to confuse a less
experienced reader, we omitted most equations and math from the
main text and relocated them to geek boxes that go into more detail
and give references to further reading. In addition, we also refresh
concepts that are already known to most readers. Nonetheless, the
important concepts are already mentioned in the main text. This way,
the reader can return to this book at a time when these concepts are
introduced, e. g., in more advanced math courses seemingly unrelated
to medical imaging. As such this book can be read twice: once omitting
all geek boxes to get an overview on the field and a second time with
a more throrough focus on the mathematical details.

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.

medical imaging technologies. An example for an X-ray imaging device is

shown in Fig. 1.2.
Computed tomography (CT) uses X-rays to reconstruct slice and volume
data as described in Chap. 8. The total absorption along the path of an X-ray
through the body is actually given by the sum of absorptions by tissues with
different absorption characteristics along its path. Thus, a measurement of
the absorptions of X-rays from different directions allows for a reconstruction
of slice images through the patient’s body. In doing so, much better contrast
between types of soft tissue is obtained. One is even able to differentiate
between different tissue types such as brain and brain tumor. Once several
slices are combined, the entire volume can be reconstructed by stacking the
slices, which is then referred to as a 3-D image. Fig. 1.3 shows a state-of-the-
art CT system with a gantry that rotates at 4 Hz.
X-rays essentially are electromagnetic waves that can be described by their
amplitude, wavelength, and phase. Phase contrast imaging exploits the effect
that an X-ray passing through tissue is not only influenced by absorption,
but that also the phase of the electromagnetic wave is shifted. Chap. 9 shows
that the phase shift of X-rays can be used to visualize the tissue the X-
rays have passed. Today, phase contrast imaging is not yet used in clinical
practice. In fact, due to the high requirements on the type of irradiation, such
images often require a synchrotron as the source of the radiation. However,
new developments in research now allow to generate phase contrast images
using a normal clinical X-ray tube, which renders the application clinically
feasible. At present, technical limitations allow only the scanning of small
specimen such as peanuts and the mechanical design is still challenging. First
image results indicate that the modality might be of high clinical relevance.
Fig. 1.4 shows the reconstruction of peanut fibers that are in the range of
1 Introduction 11

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).

Figure 1.5: Modern SPECT/CT systems combine different modalities to

achieve multi-modal imaging. Image courtesy of Siemens Healthineers AG.

several micrometers. Phase contrast allows for a reconstruction of these fibers,

although the resolution of the used imaging device based on the absorption
of X-rays was only 0.1 mm.
Emission tomography, described in Chap. 10, is used for imaging different
bodily functions. It uses tracers, which are molecules that are marked with
radioactive atoms. For example one can introduce a radioactive atom into a
sugar molecule. When this tracer is consumed by the body it will follow the
normal metabolism, and its path through the body can be followed. While
sugar consumption is normal in certain parts of the body such as the muscles
or the brain, tumors also require a lot of sugar for their growth. Thus, emis-
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