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Fundamentals of Medical Imaging Second Edition

Fundamentalsof Medical Imaging Second Edition Paul Suetens Katholieke Universiteit Leuven

CAMBRIDGE UNIVERSITY PRESS Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo, Delhi, Dubai, Tokyo Cambridge University Press The Edinburgh Building, Cambridge CB2 8RU, UK Published in the United States of America by Cambridge University Press, New York www.cambridge.org Information on this title: www.cambridge.org/9780521519151 © First edition © Cambridge University Press 2002 Second edition © P. Suetens 2009 This publication is in copyright. Subject to statutory exception and to the provision of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published in print format 2009 ISBN-13 978-0-511-59640-7 eBook (NetLibrary) ISBN-13 978-0-521-51915-1 Hardback Cambridge University Press has no responsibility for the persistence or accuracy of urls for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Every effort has been made in preparing this publication to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this publication. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use.

Contents page vii Preface Acknowledgments ix 1 Introduction to digital image 1 processing Digital images Image quality Basic image operations 1 2 4 16 14 14 2 Radiography Introduction X-rays 14 Interaction with matter X-ray detectors 17 Dual-energy imaging Image quality Equipment Clinical use Biologic effects and safety Future expectations 32 24 25 23 21 27 59 3 X-ray computed tomography 34 35 33 Introduction X-ray detectors in CT Imaging Cardiac CT 46 Dual-energy CT Image quality Equipment Clinical use Biologic effects and safety Future expectations 63 53 58 49 48 4 Magnetic resonance imaging 64 Introduction Physics of the transmitted signal Interaction with tissue 68 Signal detection and detector Imaging 72 71 33 64 64 90 Image quality Equipment Clinical use Biologic effects and safety 104 Future expectations 95 98 102 5 Nuclear medicine imaging 105 Introduction Radionuclides Interaction of γ-photons and particles 105 105 with matter 108 116 108 Data acquisition Imaging 111 Image quality Equipment Clinical use Biologic effects and safety Future expectations 125 117 122 6 Ultrasound imaging 128 Introduction Physics of acoustic waves Generation and detection of 128 ultrasound 137 145 141 138 Gray scale imaging Doppler imaging Image quality Equipment Clinical use Biologic effects and safety Future expectations 156 149 152 124 128 155 7 Medical image analysis 159 159 Introduction Manual analysis Automated analysis Computational strategies for automated 160 160 medical image analysis 166 Pixel classiﬁcation 163

Contents Geometric model matching using a transformation matrix 170 Flexible geometric model matching Validation Future expectations 189 186 8 Visualization for diagnosis and therapy Introduction 2D visualization 3D rendering 190 190 192 192 175 205 Virtual reality User interaction Intraoperative navigation 214 Augmented reality Future expectations 218 207 208 Appendix A: Linear system theory Appendix B: Exercises Bibliography 248 Index 232 246 219 vi

Preface This book explains the applied mathematical and physical principles of medical imaging and image pro- cessing. It gives a complete survey, accompanied by more than 300 illustrations in color, of how medical images are obtained and how they can be used for diagnosis, therapy, and surgery. It has been written principally as a course text on medical imaging intended for graduate and ﬁnal-year undergraduate students with a background in physics, mathematics, or engineering. However, I have made an effort to make the textbook readable for biomedical scientists and medical practitioners as well by delet- ing unnecessary mathematical details, without giving up the depth needed for physicists and engineers. Mathematical proofs are highlighted in separate para- graphs and can be skipped without hampering a ﬂuent reading of the text. Although a large proportion of the book covers the physical principles of imaging modalities, the emphasis is always on how the image is computed. Equipment design, clinical considerations, and diag- nosis are treated in less detail. Premature techniques or topics under investigation have been omitted. Presently, books on medical imaging fall into two groups, neither of which is suitable for this read- ership. The ﬁrst group is the larger and comprises books directed primarily at the less numerate pro- fessions such as physicians, surgeons, and radiologic technicians. These books cover the physics and mathe- matics of all the major medical imaging modalities, but mostly in a superﬁcial way. They do not allow any real understanding of these imaging modalities. The sec- ond group comprises books suitable for professional medical physicists or researchers with expertise in the ﬁeld. Although these books have a numerate approach, they tend to cover the topics too deeply for the beginner and to have a narrower scope than this book. The text reﬂects what I teach in class, but there is somewhat more material than I can cover in a module of 30 contact hours. This means that there is scope for the stronger student to read around the subject and also makes the book a useful purchase for those going on to do research. In Chapter 1, an introduction to digital image pro- cessing is given. It summarizes the jargon used by the digital image community, the components deﬁn- ing image quality, and basic image operations used to process digital images. The theory of linear sys- tems, described in Chapter 2 of the ﬁrst edition, has been moved to an appendix. It is too high-level for the medical reader and a signiﬁcant part of the engi- neering readers of the previous edition considered it as redundant. However, many students in physics or engineering are not familiar with linear system theory and will welcome this appendix. Chapters 2–6 explain how medical images are obtained. The most important imaging modalities today are discussed: radiography, computed tomogra- phy, magnetic resonance imaging, nuclear medicine imaging, and ultrasonic imaging. Each chapter includes (1) a short history of the imaging modality, (2) the theory of the physics of the signal and its inter- action with tissue, (3) the image formation or recon- struction process, (4) a discussion of the image quality, (5) the different types of equipment in use today, (6) examples of the clinical use of the modality, (7) a brief description of the biologic effects and safety issues, and (8) some future expectations. The imaging modalities have made an impressive evolution in a short time with respect to quality, size and applicability. This part of the book provides up-to-date information about these systems. Chapters 7 and 8 deal with image analysis and visualization for diagnosis, therapy and surgery once images are available. Medical images can, for example, be analyzed to obtain quantitative data, or they can be displayed in three dimensions and actively used to guide a surgical intervention. Most courses sepa- rate the imaging theory from the postprocessing, but I strongly believe that they should be taken together

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