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Medical Imaging
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Textbook and Materials
Rafael C. Gonzalez, Richard E. Woods,
Techniques “Digital Image Processing”, 2nd Edition,
Pearson Education, 2003
Digital Image Processing by Jayaraman,
Veerakumar, 2012
Khandpur R.S, Handbook of Biomedical
Instrumentation, 3/e, Tata McGraw
Hill,New Delhi, 2014
Dr. K. Adalarasu
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Reference
William K. Pratt, “Digital Image Processing” ,
John Willey ,2001
Steve Webb, The physics of medical imaging,
Adam Hilger, Bristol, England, Philadelphia, Radio Isotope
USA, 1988
Jain A.K., “Fundamentals of Digital Image
Imaging
Processing”, PHI, 1995.

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Radio Isotopes in Medical Diagnosis Radio Isotopes in Medical Diagnosis
 Used in medicine both for therapeutic as well as  Detector
diagnostic applications  Amount of radioactivity can be measured within parts of
organs as well as within the whole organ
 Diagnostic practice
 Small amounts of radioactive chemicals, called ‘tracers’ (or  Measurement of the uptake of radioactive iodine by
radio-pharmaceuticals), the thyroid gland
 Injected into an arm vein or administered through ingestion or  Rate of uptake of iodine by the thyroid
inhalation
 Greatly increased in patients with disease characterized
 Amount of radioactivity at different points within the by increased production of thyroid hormone
patient’s body, or in body fluids (hyperthyroidism)
 Then examined by radiation detectors  Disease that led to nervousness, tremor, weight loss
and, in extreme cases, even death

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Radio Isotopes in Medical Diagnosis Radio Isotopes in Medical Diagnosis
 Decreased iodine uptake (hypothyroidism) by the  Radio-nuclide imaging depends on
thyroid  Obtaining a suitable distribution of the radio-nuclide in the
 Had symptoms and signs of diminished thyroid function patient
 Thyroid gland continues to be the organ most  Radio-nuclide is labelled to a compound
frequently examined by nuclear medicine  Which will be taken up or metabolized in some way by the
 Imaging of organ functions is carried out non- human tissue to be studied
invasively  Patient receives the material, usually by intravenous
 Nuclear medical examination approach is primarily injection
function-oriented  After a suitable delay, which may be minutes or hours to
 Vital processes such as blood circulation, metabolism and  Allow uptake in the target tissues and clearance from the
vitality of organs and tumours can be displayed as blood, imaging can commence
functional images  Each taking 2–10 minutes

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Radio Isotopes in Medical Diagnosis

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Radio Isotopes in Medical Diagnosis
Dynamic studies can be performed with the  Tecnetium-99m (Tc-99m) - radio-nuclide used to
gamma camera  Examine the brain, liver, lungs, bones, thyroid, kidney and
heart
Moment of injection and capturing frames of the
data either photographically or digitally  Tecnetium-99m (Tc-99m)
 Metastable nuclear isomer of technetium-99 (itself an
At times ranging from minutes down to fractions of isotope of technetium), symbolized as 99m Tc
a second  That is used in tens of millions of medical diagnostic procedures
Data can produce useful information on organ annually

function, blood flow, clearance rates, etc  Emits readily detectable gamma rays with a photon
energy of 140 keV (these 8.8 pm photons are about the
same wavelength as emitted by conventional X-ray
diagnostic equipment)
 Half-life for gamma emission is 6.0058 hours
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Radio Isotopes in Medical Diagnosis
 TC-99m cannot be coupled with all required
biologically active substances
 So that with this radio-nuclide the spectrum of radio-
pharmaceuticals for examinations of the organ metabolism Radiation Detectors
is limited
 Iodine-123 labelled substances
 Which are used in many clinical examinations
 Iodine-123 (123I or I-123)
 Half-life is 13.22 hours
 Predominant energy of 159 keV (this is the gamma
primarily used for imaging)

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Radiation Detectors Radiation Detectors
Depending upon the radiation emitted by the
radio isotope of the radiopharmaceutical Ionization chamber
A suitable detector is selected and operated under Geiger Muller Counter
optimum conditions
Proportional Counter
Radiation falls on a photographic plate
Semiconductor detectors
It would cause darkening when developed after
exposure Solid state detectors
Photographic method is useful for measuring the
total exposure to radiation of workers

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Ionization Chamber Ionization Chamber

 When an atom is ionized  Chamber which is filled with gas and is provided with
 It forms an ion pair
two electrodes
 If the electrons are attracted towards a positively  Very high insulation resistance used as the insulation
charged electrode between the inner and outer electrodes of the ion
chamber
 Positive ions to a negatively charged electrode, a
 Polytetrafluoroethylene
current would flow in an external circuit
 Potential difference of a few hundred volts is applied
 Principle of the ionizing chamber
between the two electrodes
 Magnitude of the current would be proportional to the
amount of radioactivity present between the electrodes  Radioactive source is placed inside or very dose to
the chamber

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Ionization Chamber Ionization Chamber
 Charged particles moving through the gas undergo  Current 10–10 A or less
inelastic collisions to form ion pairs  Measured by using a very high input impedance
 Electrodes is sufficiently high to collect all the ion voltmetre
pairs
 Chamber current will then be proportional to the
amount of radioactivity in the sample
 Ionization chambers are operated
 Counting mode
 They respond separately to each ionizing current
 Integrating mode
 Collection of ionization current over a relatively long period

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Ionization Chamber
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Scintillation Detector
 100,000 ion pairs produced  Scintillator
 Single alpha particle  Crystalline substance which produces minute flashes of
 Traversing approximately 1 cm in air light in the visible or near ultraviolet range
 Would be around 3 x10–14 coulomb  When it absorbs ionizing radiation

 Average charge is made to pass through a resistance  Number of fluorescent photons is proportional to the
of 3 x 1010 Ω in 1s energy of the radioactive particle
 Difference of approximately 1 mV potential would develop  Flashes occur
across the high resistance  Due to the recombination and de-excitation of ions
 Voltage is a function of the rate of ionization in the  Excited atoms produced along the path of the radiation
chamber  Light flashes are of very short duration
 Portable ionization chambers are also used to  Detected by using a photo-multiplier tube
monitor personnel radiation doses
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Scintillation Detector Scintillation Detector
 Which produces a pulse for each particle  Scintillating material which is generally used as
 Scintillation counter gamma ray detector
 Scintillator along with the photo-multiplier tube  A crystal of sodium iodide activated with about 0.5%
 Gamma radiations cannot be detected directly in a of thallium iodide
scintillating material  Counting beta particles
 Because gamma rays possess no charge or mass  Scintillator crystals of anthracene are employed
 Gamma ray energy must be converted into kinetic  Detector must be able to absorb a high proportion of
energy of electrons present in the scintillating the incident radiation
material  Convert this energy rapidly into suitable electronic signals
 Conversion power will be proportional to the number of  Thallium-activated sodium-iodide NaI(TI)
electrons (electron density) available for interaction with the
gamma rays
scintillation crystal is used in all commercial
cameras
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Scintillation Detector Semiconductor Detectors

Conversion efficiency  Detectors can be made very small and robust
Ratio of light output to incident photon energy  Silicon and germanium crystals
Typically 10% for 140 keV radiation  Counting alpha and beta particles
 On absorption of radiation in the crystal
40 keV gamma ray absorbed in the crystal
 Electrons and positive holes are formed
Produces about 4200 light photons  Which move towards opposite electrodes under the
In the blue-green region of the spectrum where each influence of applied potential
light photon has an energy of around 3 eV
 Resulting current is proportional to the energy of the
Decay time of this light flash ionizing radiation
Half-life of approximately 0.2 ms
Sufficiently fast for most clinical applications

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Semiconductor Detectors Solid State Detectors
Advantage
 Miniature form and can be utilized as in-vivo probes
Low energy (3 to 3.5 eV) required to produce an for clinical and experimental applications in medicine
electron-hole pair relative to that of a gas (30 to 35
 Silicon and cadmium telluride detectors (1 mm
eV to produce one ion pair)
diameter)
Or scintillation detector (200 to 300 eV to produce one
 Which can be encapsulated
photoelectron)
 Used as catheter tubes for studying blood circulation and
Operate lithium-drifted silicon or germanium regional pulmonary functions
detectors at a low temperature (at the liquid
 Detectors are highly sensitive to gamma rays
nitrogen boiling point of 77°K) in order to reduce
because of the high atomic number of cadmium (48)
the leakage current
and telluride (52)

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Pulse Height Analyser
 Radioactivity measurements
 Individual particles are detected as single electrical
impulses in the detector

Pulse Height Analyser  Measurement of pulse height is thus a useful tool for
energy determination
 To sort out the pulses of different amplitudes and to
count them
 Electronic circuits are employed
 Instrument which accomplishes this is called a ‘pulse
height analyser
 Analysers are either single or multiple-channel instruments

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Pulse Height Analyser Pulse Height Analyser
 Output pulses from the photo-multiplier are amplified
in a high input impedance low-noise pre-amplifier
 Amplified pulses are fed into a linear amplifier of
sufficient gain to produce output pulses in the
amplitude range of 0–100 V
 Pulses are then given to two discriminator circuits
 Schmitt trigger circuit
 Which can be set to reject any signal below a certain voltage
 Required for excluding scattered radiation and
amplifier noise

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Pulse Height Analyser Pulse Height Analyser
 Upper discriminator circuit  Anti-coincidence circuit
 Rejects all but signal 3  Output pulse when there is an impulse in only one of the
 Lower discriminator circuit input channels
 Rejects signal 1 only  Cancels all the pulses which trigger both the Schmitt
triggers
 Transmits signals 2 and 3
 Only signal reaching the counter is the one lying in
 Two discriminator circuits give out pulses of
the window of the pulse height analyser
constant amplitude
 Window can be manually or automatically adjusted to
 Pulses with amplitudes between the two triggering
cover the entire voltage range with a width of 5–10 V
levels are counted
 Difference in two levels is called the window width, the
 Scaler and counter
channel width or the acceptance slit  Scaling unit counts down the pulses from the analyser
 So that they are digitally displayed

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Pulse Height Analyser

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 A decade system of counting is employed, which

displays units, tens, hundreds
 Multi-channel pulse height analysers are often used
to measure a spectrum of nuclear energies Uptake Monitoring
Equipment
 May contain several separate channels
 Schmitt trigger discriminators are adjusted to be
triggered by pulses of successively longer amplitude
 Simultaneous counting and recording of an entire spectrum
 Parallel array of discriminators is generally used
 Provided the number of channels is ten or less

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Uptake Monitoring Equipment Uptake Monitoring Equipment
 Medical investigations depends  Fraction of the chemical present in the organ at any
 On obtaining a suitable distribution of the radio-nuclide in time
the patient  Would indicate the functional status or what is called
 Achieved by administering a suitable chemical the uptake of the organ
substance tagged with a radio-nuclide  Gamma energy range for uptake monitoring studies
 Emitting gamma radiations is from 100 keV to 500 keV
 Gamma ray gets transmitted through the body  NaI (TI) scintillation crystal for detection of gamma
tissues rays
 An external monitoring system can be used to detect  Photo-multiplier which converts the scintillations into an
them electrical signal
 Provide the measurement of the chemical substance

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Uptake Monitoring Equipment Uptake Monitoring Equipment
 Output from the photo-multiplier is given to a
 Pre-amplifier followed
 By a pulse shaping circuit
 A pulse height analyser
 Output of the analyser drives a counter/timer
 Which displays the information on a digital counter and a
strip chart recorder
 Vital component in the system is the collimator
 Simple collimator
 Consists of a single tapered hole in a cylindrical lead block

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Uptake Monitoring Equipment

 Sides of the lead block must be sufficiently thick to
absorb the majority of the gamma rays impinging
obliquely
 Detector must be surrounded by an adequate Radio-isotope Rectilinear
thickness of lead to effectively shield it from all
gamma rays except those entering through the Scanner
aperture
 Shielded and collimated detector is called a probe
 Probe is mounted on an adjustable support allowing it to
be appropriately positioned in relation to the patient

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Radio-isotope Rectilinear Scanner Radio-isotope Rectilinear Scanner
 Distribution of radioactive material within an organ or  Scanner is a moving detector imaging system
part of the body is studied by using radio-isotope  Heart of the system is the detector-collimator
rectilinear scanners assembly
 Rectilinear scanner is a device for imaging the  Detector
distribution of radioactive material within the body  Three or five inch diameter NaI crystal
 Situated behind a focusing collimator
 Travel in a regular scanning pattern back and forth
across the area of interest
 Detected and amplified signals can be plotted to
give a picture or contour map of radioactivity within
the organ

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Radio-isotope Rectilinear Scanner Radio-isotope Rectilinear Scanner
 Detector-collimator assembly
 Photo-multiplier
 Pre-amplifier are housed in a single unit
 Which is attached to a motor-driven device
 Single probe scanner makes use of one detector
that scans the area of interest
 Dual probe scanners that have two synchronously
moving
 Axially opposite detectors with the patient between
the two detectors

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Radio-isotope Rectilinear Scanner Radio-isotope Rectilinear Scanner
 Scanning can be linear or one-dimensional  Photographic recorder
 In the whole body counting applications  Light flashes can be photographed on a film
 Detector is moved continuously over the body and the  Face of a cathode ray tube
counts are integrated over the entire scan
 Dot recorder is most commonly used
 Recording may be done either by
 Photographic recorder or by dot recorders

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Radio-isotope Rectilinear Scanner Radio-isotope Rectilinear Scanner
 It produces a map of the distribution of activity within
Scaling factor of 16
the area of interest by recording dots or slit-like
marks on paper Every 16 counts arriving at the input of the
scaling circuit from the pulse height analyser
 Dot recording mechanism consists of an electrically
heated stylus to burn a small spot on a sheet of One dot appears on the paper
electrically conducting paper Reduction in counting rate is necessary
 Each time a pulse passes through the stylus Because extremely high counting rates will drive
 Pulses to the stylus are delivered from the pulse the stylus wild
height analyser Count-rate metre
 After scaling down the counts by an adjustable scaling
factor from 1 to 256 Display or record the average count rate

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Radio-isotope Rectilinear Scanner
Some scanners make use of colour printing
Maximum count rate is first established
Divided into six ranges
Each being associated with a different colour print Gamma Camera
Coloured map showing the distribution of the
isotope is built up

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Gamma Camera Gamma Camera
 Used to produce images of the radiation generated
by radio-pharmaceuticals within a patient’s body in Gamma camera was developed by Anger
order (1958)
 To examine organ anatomy and function, and to visualize Large circular area of thin scintillation crystal
bone abnormalities An array of closely packed photo-multiplier tubes
 Stationary gamma camera systems to amplify
 Whole-body images (single head-to-toe skeletal profiles) Locate the gamma ray interactions in the crystal
 Tomographic images (cross-sectional slices of the body
To display the scintillations instantly on a cathode
acquired at various angles around the patient and
displayed as a computer-reconstructed image) ray tube
Study the rapidly changing distribution of activity

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Gamma Camera Gamma Camera
 Modern-day gamma cameras constitute extremely  When a photon of the radiation leaves the patient’s
complex electronic equipment body
 Detector  It passes through the collimator
 Collimator, crystal  Interacts with a crystal
 Photo-multiplier tubes  Wherein its energy is converted into light

 Position localization circuitry  Light from the crystal is received by photo-multiplier tubes
 Camera Electronics – includes  Converted into an electrical signal
 Correction circuitry  Electrical signal passes through the position
 Energy analysis circuitry localization circuitry
 Counting circuit  Whose output consists of X and Y positional signals, and
a Z or energy signal
 Image display
 Image recording device
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Gamma Camera Gamma Camera
 Special correction circuits
 Which compensate for errors in the detection and
localization of photon
 Z or energy signal is then analysed in the pulse
height analyser circuit
 To determine if the detected photon is within a user-
specified energy range
 If it is registered in the counter
 X and Y signals are then sent to an image recording
device
 Where they are used to position the beam of a cathode ray
tube

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Gamma Camera Gamma Camera
 Z pulse then turns the beam on Collimator
 Causing a bright dot to appear at a location on the face of Heavy metal absorber such as lead, with some
the CRT corresponding to the location in the crystal
where the photon deposited its energy
tungsten or platinum parts
 Hundreds of thousands of photons leave the Basic types of collimators used in conventional
patient’s body and strike crystal gamma camera imaging
 Each causing a black spot to be formed on the film Pinhole
 Collimator is used to selectively absorb unwanted Parallel-hole
radiation Diverging
 Only photons traveling along the desired path are allowed
to pass through to the detector
Converging

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Gamma Camera
Crystal of up to 500 mm diameter
Typically 6.4 mm or 9.6 mm thick with an array of
61, 75 or 93 photo-multiplier tubes
Number of gamma rays received by any region
Multicrystal Gamma
of the crystal is directly proportional to the
amount of nuclide located directly below the Camera
region
Polaroid camera is mounted on the
oscilloscope for photographing the build-up of
about 50,000 dots on the screen

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Multicrystal Gamma Camera Multicrystal Gamma Camera
 Major limitation in using a scintillation camera for  Z-pulse analyser accepts only those events which
rapid dynamic studies is the counting losses that fall within the selected window
occur at the high count rates  Two pulses occurring within a short span of each
 Actual count rate is always greater than the other are piled up and the resulting summation
registered count rate that passes the window of the pulse is rejected
analyser  Because its amplitude exceeds the upper window level
 Scintillation  Results in the loss of two valid pulses
 Output of all photomultipliers is summed to give a Z-signal  With subsequent total count loss
 Proportional to the total amount of light emitted during the  Principle of operation differs slightly for multi-crystal
scintillation cameras

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Multicrystal Gamma Camera Multicrystal Gamma Camera
 Rectangular array of many small crystal detectors If two or more events interact at the same time
 Each surrounded by reflective or shielding material to in different crystals
minimize scattering
Both events are discarded
 Modified parallel-hole collimator
This is not possible with a mono-crystal
 Bisecting lead septa within the hole of each detector
 Used to increase sensitivity while maintaining overall
system
spatial resolution Computerized multi-crystal gamma camera
 Multi-crystal data accumulation matrix system can accumulate high count rates
 Every gamma event coming from the patient and (200,000 Hz)
interacting in any crystal
At rapid time intervals (20 s) making possible both
 Detected as a separate event at a unique location
clinical and research applications

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Multicrystal Gamma Camera Multicrystal Gamma Camera
 Detector system of this camera consists of 294
discrete crystals arranged in 14 rows and 21 columns
 Each column and row is optically coupled by a lucite
light guide to a photo-multiplier tube
 35 photo-multiplier tubes
 Pulses from 35 pre-amplifiers and amplifiers serving
photo-multiplier tubes pass to 35 low-discriminators
 Which eliminate events observed simultaneously in
adjacent crystals
 Row and column photo-tube are uniquely identified

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Multicrystal Gamma Camera Multicrystal Gamma Camera
 Scintillations occur in the front part of the detector  Movable bed which performs a scanning motion is
 Thin crystals provide better resolution by bringing the light used
flashes closer to the PMTs
 To improve spatial resolution in static imaging
 Crystals of such units are 9.5 mm thick and 28 to 61 measurements
cm in diameter  Bed motion permits each detector crystal to scan a
 Rectangular crystals are of similar thickness and range from square area within 1.11 cm sides in 16 programmed
20 X 20 cm to 46 X 66 cm
movements of 2.78 mm each
 Random-access, solid-state buffer memory
 Bed motion cannot be used during a dynamic study
 Valid events are stored
 Spatial resolution may be somewhat less in these studies
 Information representing data from the entire detector
assembly passes into the memory of the computer

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Multicrystal Gamma Camera

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Multicrystal Gamma Camera
 Light pipe array that is required to localize each event must  Y-co-ordinates are obtained by gathering the 11 rods
transmit as much light as possible in order to optimize the to a 2-inch diameter multiplier photo-tube
energy resolution of the system  Y-co-ordinates for the entire array require 14 groups of rods
gathered
 X-co-ordinates are derived from 21 spatulas that are
shaped and bent to fit on to the end of 2-inch diameter
photo-tubes
 Main advantage of the addressing scheme is that
 Detection and positioning are made independent
 Disadvantage of the light-pipe scheme is that
 Light is attenuated in the light guides
 Leading to a degradation of the gamma ray energy
resolution
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Multicrystal Gamma Camera Multicrystal Gamma Camera
 System ensures that only events that occur in one
and only one detector at the correct energy range
will be stored in the memory
 Modern gamma camera employs a crystal of up to
500 mm diameter
 Typically 6.4 mm or 9.6 mm thick
 With an array of 61,75 or 93 photo-multiplier tubes
 Prime general purpose instrument for radio-nuclide
imaging in routine nuclear medicine investigations

2 X 2 crystal array

KA – MIT – Unit III – March, 2018, Sastra, Deemed University KA – MIT – Unit III – March, 2018, Sastra, Deemed University

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 4/10/2018

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Multicrystal Gamma Camera Multicrystal Gamma Camera

 New solid-state detectors constructed of cadmium  Image output
zinc telluride (CZT) are under development to  Either black and white laser printers with a resolution of at
replace the crystal/PMT structure currently used least 1200 dpi (dots per inch)
 These solid-state CZT detectors would be used to  Colour printers (thermal transfer) or X-ray film printers are
used
directly convert gamma rays to electrical pulses
 Use of dry laser images is preferred in nuclear medicine in
 Requirements for the computer system used with modern cameras
gamma camera are speed and stability in acquisition
 Gantry and the table are operated by
of the data
microprocessor-controlled motors
 Modern camera computers are at least 64 Mbytes
RAM, 20” Monitor with a resolution of at least 1024 X
786 for 256 colours, at least 2 Gbytes hard disk and
network connection
KA – MIT – Unit III – March, 2018, Sastra, Deemed University KA – MIT – Unit III – March, 2018, Sastra, Deemed University

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