High quality

digital
radiographic

Index
terms:
Radiography
digital

Improved
and

detection

#{188}?

of low-contrast

preliminary

Masamitsu

clinical

Ishida,

Paul H.

images:

Frank,

objects

studies

M.Sc.t

M.D.

I-

-(p

op
Orth

Kunio

Doi,

James

L. Lehr,

Ph.D.

M.D.

Ae

The

visibility

unsharp

ofdetail

masking,

in a variety

appears

to be improved

a technique

of digital

that

imaging

may

by the use of digital

have

beneficial

application

systems.

THIS EXHIBIT,
A SELECTION
OF THE
BADIATION
PHYSICS PANEL, WAS DISPLAYED
AT THE
68Th
SCIENTIFIC
ASSEMBLY
AND
MEETING

ANNUAL

OF THE

OF NORTH
28-DECEMBER
3,
NOIS.

RADIOLOGICAL

AMERICA,
NOVEMBER
1982, CHICAGO,
ILLI-

SOCIETY

Introduction
The

major

at an accurate
quired

for

accurate

radiographic
From

tories

the Kurt

Rossmann

for Radiologic

Image

Labora-

Research,

Department
of Radiology,
versity
of Chicago,
Chicago,
t Presently,
Fuji Photo

Ltd., Technology
Miyanodai

migun,

Development

Kaiseimachi,

Kanagawa
Address

Doi,

Ph.D.,

University

59th

Street,
*

Volume

Center,

Ashigaraka-

258,

reprint

The

Grant

The UniIllinois.
Film Co.,

Department

to Kunio

of Radiology,

of Chicago,

Chicago,

Supported
CA 24806.

3, Number

950

in part

by

whether
We
system

June

1983

For

of superior

in

systems

are

have
with

is used

is to assist

improved

quality

have

an

design

of
quality

high

a high

task

it is important

to provide

contrast,

resolution,

high

re-

the production
of such images
among
these parameters
is
radiographic

digital

investigate

the

in radiographic
and

in arriving

imaging

systems,

or digital.

a high

we can

input,

improved

radiologist

is a fundamental

detection,

that

conventional

developed
which

techniques
as

the

the

of abnormalities

image

effect

imaging
quality

processing

of physical

systems.

digital

and

simulation

parameters

and

A conventional

film

image

image

radiograph

is produced

as

the

output.
In this paper,
the

potential

diographs

imaging

detection

diagnosis.

involved
the

patterns
USPHS

The

images

necessarily

East

IL 60637

in radiographic

and low noise. It is equally

important,
however,
that
require
no increase
in patient
exposure.
A compromise

processing

Japan.

requests

goal

diagnosis.

RadioGraphics

we demonstrate

can be improved
use

without

of these

any

with

that
digital

techniques

increase

the detectability
image
to improve

in patient

of low-contrast

processing
diagnostic

techniques.
certainty

radiographic
We also show
in clinical

ra-

exposure.

325

Digital

radiographic

Ishida

images

Digital
Image
and Simulation

WRITE

Figure 1
Schematic
diagram
of the digital
image
processing
and simulation
system.
An original
radiograph
mounted
on the transparent
read
drum is scanned,
and the image signals are digitized
by an analog-todigital converter.
After digital image
processing,
the image data are converted
back to analog
signals
by a
digital-to-analog
converter.
Finally, a
photographic
film is exposed
to a
glow tube, the light output of which is
modulated
by the processed
image
signals. This system
is a powerful
research tool for studies of the potential
of digital radiography,
because
many
parameters
can be varied
independently over a wide range.

Processing
System

READ

DRUM

et at

DRUM

LIGHT

SOURCE

OO[1
DISK

Figure2
Specifications
for the digital
image
processing
system.
The important
features
of the system
include:
(1)
high density
and high spatial resolution, (2) the production
of hard
radiographs
as the output,
(3) a large
image format,
and (4) real-time,
online operation
for overall
contrast
manipulation
and /or unsharp
mask
filtering

326

SCANNER
MAXIMUM
DRUM

SIZE

SPEED

DENSITY

RANGE

GRAYLEVELS

DRIVES

FLOPPY
DISK

MAGNETIC
TAPE

PRINTER
KEYBOARD

SYSTEM
35.6

COMPUTER

CM X 35.6

3.0

R.P.S.

0.0

3.2

CM

O.D.

SIGNAL/NOISE

at

SYSTEM

c.p.u.
MAIN

024,256

EXT.
MEMORY

NOVA
MEMORY

MAGNETIC

I 28

TAPE

1600/800

DISKDRIVE
DO.O

SAMPLINGRASTER

20,

APERTURES

5O,IOO,2OOM

10, 5 PIX./MM

RadioGraphics

FLOPPY

4X
KB

DISK

.26MB

PRINTER

60

Char/sec

EXTERNALMEMORY

384

KB

June

BPI

2X25MB

1983

Volume

3, Number

Ishida

Digital

et at

3.0

images

U
U)
U)
U
0
0

radiographic

2.0

\REVERSAL
Figure 3
Image processing
techniques
available in the system include gray-scale
manipulation,
which may be applied
to recovery
of under- or overexposed
radiographs,
as well as reversal.

RECOVER

UNDER-

EXPOSE

IMAGE

RECOVER
OVER- EXPOSED
IMAGE

a.
U-

1.0

>-

IU)

z
U

/
0.0

1.0

2.0

3.0

DENSITY OF ORIGINAL IMAGE

[p(XY)=Do

(X,Y)+

2.0

PROCESSED

U
0
4
U-

1.5

(DpI

I-.

Ui
I-

IMAGE

K *[Do(X,Y)-Dus(X,Y)]

,
1.0

ORONAL

-----

MAGE(Do)

0
0

Ui

o.5Is),/:LE\%N

Ui
U-

0.01

0.1

SPATIAL

Volume

3, Number

June

FREQUENCY

1983

RadioGraphics

Figure 4
For local
enhancement
of radiographic
images, linear unsharp
mask
filtering
is employed.
K is a weighting
factor that determines
the magnitude
of enhancement.
The size of the unsharp mask determines
the spatial
frequency
range
within
which
the
frequency
content
of the image
is
enhanced
most strongly.
Specifically,
the smaller the mask size, the higher
the spatial
frequency
range that is
most enhanced.

(CYCLES/MM)

327

Digital

radiographic

images

Ishida

Digital

D(X,Y)=D0(X,Y)

linear

technique

helps

to reduce

the

noisy appearance
of processed
images when a large weighting
factor is
desired
for an increased
enhancement.

(see next page for Figure

Processing

and Simulation
UNSHARP
MASKING, System

NON-LINEAR

Figure 5
Nonlinear
unsharp
mask filtering
is
also implemented
with the system.
The weighting
factor
K is a function
of the local density
in the original
image. The frequency
content
of the
nonlinearly
enhanced
radiograph
will
be relatively
low in low-density
areas
and
high
in high-density
areas.
Therefore,
quantum
noise
is suppressed
in the low-density
areas of
the nonlinearly
enhanced
radiograph
without
impairing
the advantages
of
the unsharp
mask filtering.
This non-

Image

et at

+ Kn[Do(X,Y)]*[Do(X,Y)Dus(X,Y)1

4
NON

LINEAR

UNSHARP

MASKING

a:
LINEAR

UNSHARP

MASKING

0
4

2
II
0
U

.0

3.0

DENSITY,

D0(X,Y)

Detection

Studies

6)

z
0

Figure 7
Receiver
operating
characteristic
(ROC) curves for detection
of 5 mm
low-contrast
disk patterns
in radiographs
made
with
the X-Omatic
Regular/XRP
system,
with and without digital
image
processing.
The
ROC curves were determined
with 5
rating

categories.

It is apparent

detectability
is significantly
by the use of unsharp
tering.

that

C)

4
L.

0.6

Ui

>
0.4

a.
Ui

I-.

improved
mask
filFALSE

328

RadioGraphics

POSITIVE

FRACTION

June

1983

Volume

3, Number

Ishida

Volume

et al

Digital

Figure

6B

Figure

6C

3, Number

radiographic

images

Figures 6A, B & C

Comparison
of original and processed
images
containing
low-contrast
radiographic
patterns
of circular
disks
5 mm in diameter.
The original image
(A) at three
different
background
densities
(0.5, 1.0, and 1.5) was obtamed
by exposure
of X0matic#{174}
Regular
screens
(Eastman
Kodak
Co.) with XRP film. The processed
images were enhanced
by two types
of image processing
techniques:
(B)
windowing,
or overall
contrast
enhancement
by a factor of 4, in which
the average density of the processed
image in the center was kept equal to
that of the original
image at 1 .0; and
(C)
linear unsharp
mask filtering
with
a mask size of 12 mm and a weighting
factor of 3.0. Note that the windowing
technique
cannot
reproduce
the
whole density
range because
of the
limited
dynamic
range of the display
system.
The unsharp
masking
technique,
however,
increases
only the
local contrast,
so that a wide range of
background
densities
can be reproduced. Therefore,
unsharp
mask filtering is superior
to windowing
when
applied
to clinical
images.
It should
also be noted that, although
the processed
images
appear
to be noisy,
the circular
disks are easily detected
in the center image of (B) and in each
image of (C).

June

1983

RadioGraphics

329

Digital

radiographic

images

Ishida

Clinical
A preliminary
image

processing

grams,

used

compared
techniques

Figure

330

8A

was

angiograms,

gastrointestinal

was

clinical

Studies

evaluation
performed

as well
radiographs.

et at

of high-quality

digital

on mammograms,
as chest

An

and

unsharp

tomo-

double-contrast

masking

technique

for clinical

radiographs

because

of its advantages

to overall
as shown

contrast
in Figure

enhancement
6.

or windowing

i#{149}#{149}

Figure

8B

RadioGraphics

June

1983

Volume

3, Number

Ishida

et at

Digital

Clinical

Figure

Figures

8A, B & C
chest

image

and nonlinear

(A), and

(C) unsharp

of lung

details

Volume

3, Number

June

the

1983

Studies

linearly

processed

RadioGraphics

processed

masking

in the

and (C). In low-density

areas,
are absorbed,
the nonlinearly
than

images

8C

Original
visibility

radiographic

images

techniques

high-density

areas

obtained

with

with

linear

a 6 mm mask.

is enhanced

in both

(B)

The
(B)

however,
where relatively
few x-ray quanta
processed
image appears
to be less noisy
image.

331

Digital

radiographic

images

Ishida

Clinical

Figures 9A & B
Comparison
of an angiogram
obtamed with a conventional
film subtraction
technique
(A) and a digitally
processed
image (B) that was made
by density
reversal
and high-frequency
enhancement
of the angiogram without
subtraction.
Although
the

overall

appearance

of

the

Figure

9A

Figure

9B

et at

Studies

two

images is similar,
the clarity of blood
vessels in the filtered
image seems to
indicate
the potential
utility of highfrequency
filtering
for improvement
of angiographic
images.

332

RadioGraphics

June

1983

Volume

3, Number

Ishida

et al

Digital

Clinical

Figure

Figure

manipulation

abdominal

and unsharp

vides
much
more
requiring
another

3, Number

June

1983

lOB

1OA & B

An underexposed

Volume

images

Studies

1OA

Figures

radiographic

detail
patient

RadioGraphics

angiogram

mask

(A) is restored

filtering.

in the paravertebral
exposure.

The restored
venous

by overall

image
plexus,

density

(B) prowithout

333

Digital

radiographic

Ishida

images

Clinical

Figure

Studies

ilA

Figure

11B

Figures llA & B

(A) Original mammogram.
by the use of an unsharp

The processed
mammogram
(B) is enhanced
mask 3 mm in size. Multiple small calcifications,

which

of breast

are characteristic

are seen much

more

clearly

et al

carcinoma,

in the processed

and

soft

image

tissue

than

structures

in the original

mammogram.

334

RadioGraphics

June

1983

Volume

3, Number

Ishida

et al

Digital

Clinical

Figure

images

Studies

Figure

12A

radiographic

l2B

Figures l2A & B

Unprocessed
(A) and processed
(B) radiographs
of a patient with mild,
active
ulcerative
colitis.
The disease
is present
distal to the distal
transverse
colon. The processed
radiograph
shows the en face appearance
of mucosal
ulcerations
more clearly than the nonprocessed
radiograph.
The most proximal
area of disease,
characterized
by mucosal nodularity
in the transverse
colon,
is seen more readily
in the
processed
image.

Volume

3, Number

May

1983

RadioGraphics

335

Digital

radiographic

Ishida

images

Clinical

Figure

13A

Figure

13B

Figures

et al

Studies

13A & B

The original
image
(A) is a 1 mm polytomographic
slice through
a temporal bone. The processed
image (B) shows the bone detail much
better
than does the original
tomogram.
This is due to relative
suppression
of
low frequencies,
which
tends
to remove
the tomographic
blur, thereby
improving
the detail
visibility
of the tomographic
image
in the focal
plane.

336

RadioGraphics

June

1983

Volume

3, Number

Ishida

et at

Digital

Clinical

radiographic

Images

Studies

..

. .

.4;

Figure

14A
Figure

Figures

l4B

14A & B

In an intravenous

cholangiogram,

the

extrahepatic

and

cystic

ducts

are

barely visible in the original image (A), but are clearly shown in the processed image (B). The image processing
parameters
used for this lowcontrast
radiograph
are the same as those used in the detection
studies
(a 12 mm mask and K = 3.0).

Volume

3, Number

May

1983

RadioGraphics

337

Digital

radiographic

Ishida

images

et al

Conclusions
This

digital

is a useful
cessing

image

toot

for

techniques

processing

and

investigating
on

the

both

basic

clinical
images.
The detectability
radiographic
patterns
has been
unsharp
vantage

simulation

effect

hancement,

system
image

pro-

contrast

studies

and

original

of

detection

a unique
contrast

image.

unsharp

of great
systems

aden-

masking

maintaining
The visibility

in conventional
radiographs
the use of digital
unsharp

of simulated
low-contrast
increased
significantly
by

mask filtering.
This technique
has
compared
to windowing
or overall

because
while

increases

the

the wide dynamic

range
of lesions and anatomic
also appears
masking.
This

advantage
when applied
such as digital
fluoroscopy.

local
of the
details

to be improved
technique
may

to other

forms

by
be

of digital

Readings
1. Ishida

M, Kato

processing

H, Doi

system.

K, Frank

Proc

2. Schreiber
WF: Wirephoto
1970; 2:117-121.
3. Green

DM,
York,

New

Swets
1973.

We are grateful
M.D.,

M. Carlin

and

Y. Kodera

Lu,

Grays

points

are

well-taken

and

theory

Ph.D.,
and

for observing

Response

Dr.

improvement

radiographs

percent

pulse

of peak,

equipment.

effective

kilovoltage

three-phase,
can provide

is 49

there

is no question

tubes

with

be a 0.6/1.2
radiologists

percent

for

the

For

smallest

most
with

have

Grays

single

twelve
converted

heavy

degree

phase,

and

J Pattern

psychophysics.

E. Duda,

for their

discussions

Krieger

M.D.,

and

Recognition

Publishing

Heber

Co.,

MacMahon,

with us; and to Y. Higashida,

images.

letter,

(Page

324)

speeds

fourth

of 200-400

which

produce

one-half

to one-

of the heat

smaller

into the x-ray tube. With less heat loading,

spots
can be used. But, I would
question
the
speed rotation
of the anode.
The wear factor

focal

need

for

high

for

that

high

capacity

speed

rotation

for generators

is not warranted

and

less than

if necessary,

should

500

mA

be auto-

matic.

duty
focal

target.

image

the
range

concerning
spots

should

tube

In these
combinations

I think

x-ray

radiographic

the appropriate

to film-screen

radiographic

on the bearings
of the x-ray tube at high speed
rotation
is
about nine times normal
speed. Prolonged
use of high speed
rotation
can lead to shortened
tube life. I am of the opinion

six

63

in this

digital

masking.

relative

Unfor-

exposure

phase

point

appropriate

applications,

three

Exposures
change.

second

that

for

kilovoltage

six pulse equipment.

a significant
contrast
to Dr.

obtained.

90

a 70 peak

In response

tubes,

338

about

For

and

the simulated

tunatety,
radiologic
technologists
are taught
to convert
from
single phase
to three phase techniques
by simply
dividing
mAs in half which
disregards
the change
in beam quality.
The effective
kilovoltage
for single phase is approximately
70

by unsharp

Eugene

to Dr. Grays

correct.

of a new

347:(42-48).

detection

to Chien-Tai
ctinical

Development

1982;

quality

JA: Signal

for supplying

PH:

SPIE

of

days

be

that

Dr. Grays

need

for considerable

chase

of x-ray

thought

comments

further

to be given

illustrate

before

the

the
pur-

generators.

would
most
with

Thomas
Professor

T. Thompson,
of Radiology

RadioGraphics

M.D.

June

1983

Volume

3, Number