10/28/2013

1
Image Characteristics and Quality
Rena Widita
Medical Imaging
A window into the human body
Major Issues
No image window reveals everything
Different medical imaging methods reveals
different characteristics of the human body
Medical Imaging Process
The objective: to make the object or condition within the patients body visible to
the observer
Most medical imaging systems have a
considerable number of variables that must be
selected by the operator:
Intensifying screens in radiography
Transducers in sonography
Coils in MRI
Most variables are adjustable physical
quantities associated with the imaging
process:
Kilovoltage in radiography
Gain in sonography
Echo time in MRI
The value selected will determine the quality
of the image and the visibility of the specific
body features
10/28/2013
2
The ability of an observer to detect signs of a
pathologic process depends on a combination
of 3 major factors:
Image quality
Viewing conditions
Observer performance characteristics
IMAGE QUALITY
The quality of a medical image is determined
by
Imaging method
The characteristics of the equipment
Image variables selected by the operator
Image quality is a composite of 5 factors
Contrast
Blur
Noise
Artifacts
Distortion
Image Contrast
If contrast is adequate, the object will be visible
Contrast means difference
Contrast can be in the form of different
Shades of gray
Light intensities
Colors
10/28/2013
3
Contrast sensitivity
When imaging system has a relatively
low contrast sensitivity, only objects
with a high concentration of iodine (high
object contrast) will be visible in the
image
The circular objects are the same size
but are filled with different
concentrations of iodine contrast
medium
When imaging system has a high contrast sensitivity, the lower
contrast objects will also be visible
Contrast sensitivity relates to the
systems ability to translate
physical object contrast into
image contrast
Contrast sensitivity is the characteristic of the imaging system to increase or decrease
sensitivity and allow us to see objects in the body (see the curtain)
A system with low contrast sensitivity allows us to visualize only objects with
relatively high inherent physical contrast
Blur and Visibility of Detail
Objects range from large organs and bones to
small structural features
Each imaging method has a limit as to the
smallest object that can be imaged and thus on
visibility detail
Visibility of detail is limited because all imaging
methods introduce blurring into the process
The effect of image blur is to reduce the contrast
and visibility of small objects or detail
The various objects in the body in
terms of both physical contrast
and size
The boundary between visible and
invisible objects is determined by
the contrast sensitivity of the
imaging system
It has little effect on the visibility of large objects but it reduces the contrast and
visibility of small objects
When blur is present, and it always is, the curtain of invisibility covers small
objects and image detail
The image compares the approximate blur values for medical imaging methods
Noise
Image noise, sometimes referred to as image
mottle, gives an image a textured or grainy
appearance
The source and amount of image noise
depend on the imaging method
10/28/2013
4
Consider the effect of image noise on visibility
The general effect of increasing image noise is to lower the curtain and reduce object
visibility
In most medical imaging situations the effect of noise is most significant on the low-
contrast objects that are already close to the visibility threshold.
Artifacts
Another problem is that most imaging methods
can create image features that do not represent a
body structure or object artifacts
In many situations an artifact does not
significantly affect object visibility and diagnostic
accuracy
But artifacts can obscure a part of an image or
may be interpreted as an anatomical feature
A variety of factors associated with each imaging
method can cause image artifacts.
Distortion
A medical image should not only make
internal body objects visible, but should give
an accurate impression of their size, shape,
and relative positions
An imaging procedure can, however, introduce
distortion of these three factors.
Compromises
An imaging procedure should be set up to
produce adequate image quality and visibility
without excessive patient exposure or imaging
time
In many situations, if a variable is changed to
improve one characteristic of image quality, such
as noise, it often adversely affects another
characteristic, such as blur and visibility of detail
An imaging procedure must be selected
according to the specific requirements of the
clinical examination.
TISSUE CHARACTERISTICS AND IMAGE
VIEWS
A combination of two factors makes each
imaging method unique (produce the various
shades of gray)
Tissue characteristics that are visible in the
image
The viewing perspective
10/28/2013
5
Many pathologic conditions produce a change
in a physical characteristic that can be imaged
by one method but not another
Imaging methods create images that show the
body from one of two perspectives, through
either projection or tomographic imaging.
There are advantages and disadvantages to
each
projection imaging (radiography and
fluoroscopy)
images are formed by projecting an x-ray beam through the
patient's body and casting shadows onto an appropriate receptor
that converts the invisible x-ray image into a visible light image
The gamma camera records a projection image that represents the
distribution of radioactive material in the body.
The primary advantage of this type of image is that a large volume
of the patient's body can be viewed with one image.
A disadvantage is that structures and objects are often
superimposed so that the image of one might interfere with the
visibility of another.
Projection imaging produces spatial distortion that is generally not
a major problem in most clinical applications.
Tomographic imaging
produces images of selected planes or slices of tissue in
the patient's body
The general advantage of a tomographic image is the
increased visibility of objects within the imaged plane
One factor that contributes to this is the absence of
overlying objects
The major disadvantage is that only a small slice of a
patient's body can be visualized with one image
most tomographic procedures usually require many
images to survey an entire organ system or body
cavity.
IMAGE VIEWING CONDITIONS
Our ability to see a specific object or feature in an
image depends on the conditions under which we
view the image
Assume a circular object located within
a larger background area.
The ability of an observer to detect the
object depends on a combination of
factors
Object contrast and size
Background
Brightness (luminance) and
structure (texture)
Glare produced by other light
sources
Distance between the image and the
observer
The time available to search for the
object.
Object Contrast
The ability to see or detect an object is influenced
by the contrast between the object and its
background
There is not a specific threshold contrast at which
the object suddenly becomes visible
The accuracy of seeing or detecting a specific
object increases with contrast
When viewer contrast sensitivity is low, an object
must have a relatively high contrast to be visible.
10/28/2013
6
The degree of contrast required depends on
conditions that alter the contrast sensitivity of
the observer:
background brightness
object size
viewing distance
glare
background structure.
Background Brightness
vision is not equally sensitive at all brightness levels
The ability to detect objects generally increases with
increasing background brightness or image illumination
To be detected in areas of low brightness, an object
must be large and have a relatively high level of
contrast with respect to its background
Viewbox luminance (brightness) can have a significant
effect on the visibility of objects within an image. For
general image viewing, viewboxes should have a
luminance of at least 1,500 nits. A brighter viewbox of
at least 3,500 nits is recommended for mammography
Object Size
The relationship between the degree of contrast
required for detectability and for background
brightness is influenced by the size of the object. Small
objects require either a higher level of contrast or
increased background brightness to be detected.
The detectability of an object is more closely related
to the angle it forms in the visual field. The angle is the
ratio of object diameter to the distance between image
and observer. In principle, a small object will have the
same detectability at close range as a larger object
viewed at a greater distance.
Viewing Distance
The relationship between visibility and
viewing distance is affected by several factors.
When the viewing distance is reduced, an
object creates a larger angle and is generally
easier to see. However, the eye does not focus
and exhibit maximum contrast sensitivity at
close range. Therefore, the relationship
between detectability and viewing distance
generally peaks at a distance of approximately
2 ft.
Glare
Glare is produced by bright areas or light sources in the
field of view and has several undesirable effects. One effect
is to reduce the perceived contrast of the objects viewed.
When light from the glare-producing source enters the eye,
some of it is scattered over other areas within the visual
field. This in turn reduces contrast sensitivity. The extent to
which it is reduced depends on the brightness and size of
the glare source and its proximity to the object viewed.
Glare is a major problem when some of the bright
viewbox area is not covered by the film. Visibility is
improved by masking when viewing small films as in
mammography.
Background Structure
The structure or texture of an object's
background has a significant effect on its
visibility. A smooth background produces
maximum visibility; visibility of low contrast
objects is often reduced because of the
texture of surrounding tissues or image noise.
10/28/2013
7
OBSERVER PERFORMANCE
In many situations, the presence of a specific
object or sign is not obvious but requires
establishment by a trained observer.
The criteria used to establish the presence of a
specific sign often vary among observers.
Individual observers also use different criteria,
often influenced by the clinical significance of
a specific observation.
Sensitivity and Specificity
a specific pathologic condition is present in
some and absent in
True and False Decisions
The diagnoses derived from the imaging procedure divide the cases into
four categories, as shown in the image below: true positives, true
negatives, false positives, and false negatives.
In the ideal situation, there are only true positives and true negatives.
This would be a diagnostic process with 100% accuracy.
False negatives and false positives occur for a
number of reasons, including inherent
limitations of a specific imaging method,
selection of inappropriate imaging factors,
poor viewing conditions, and the performance
of the observer (radiologist).
ROC Curves
In general, if an observer is aggressive in
trying to increase the number of true positives
(sensitivity), the number of false negatives
(decreased specificity) also increases.
The relationship between sensitivity and
specificity for a specific diagnostic test
(including observer performance) can be
described by a graph known as a receiver
operating characteristic (ROC) curve.
The ideal diagnostic test produces
100% sensitivity and 100% specificity
as shown.
If a diagnostic procedure has no
predictive value, and the diagnosis is
obtained by a random selection
process, the relationship between
sensitivity and specificity is linear.
The observer determines the actual
operating point along this line. Since
this particular diagnostic procedure is
providing no useful information, an
attempt to increase the sensitivity by
calling a greater number of positives
will produce a proportionate decrease
in the specificity.
10/28/2013
8
Human Operating Point
The relationship between sensitivity and specificity for
most medical imaging procedures is between the ideal
and no predictive value. The ROC curve shown below is
typical.
The characteristics of the imaging method and the
quality of the resulting image determine the shape of
the curve and the relationship between sensitivity and
specificity for a specific pathological condition.
The criteria used by the observer to make the diagnosis
determine the point on the curve that produces the
actual sensitivity and specificity values.