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Chapter

Research in Medical Imaging

Using Image Processing
Techniques
Yousif Mohamed Y. Abdallah and Tariq Alqahtani

Abstract

Medical imaging is the procedure used to attain images of the body parts for
medical uses in order to identify or study diseases. There are millions of imaging
procedures done every week worldwide. Medical imaging is developing rapidly due
to developments in image processing techniques including image recognition, anal-
ysis, and enhancement. Image processing increases the percentage and amount of
detected tissues. This chapter presents the application of both simple and sophisti-
cated image analysis techniques in the medical imaging field. This chapter also
summarizes how to exemplify image interpretation challenges using different
image processing algorithms such as k-means, ROI-based segmentation, and water-
shed techniques.

Keywords: medical, imaging, image processing technique

1. Introduction

Medical imaging is the process of producing visible images of inner structures of

the body for scientific and medicinal study and treatment as well as a visible view of
the function of interior tissues. This process pursues the disorder identification and
management. This process creates data bank of regular structure and function of the
organs to make it easy to recognize the anomalies. This process includes both
organic and radiological imaging which used electromagnetic energies (X-rays and
gamma), sonography, magnetic, scopes, and thermal and isotope imaging. There
are many other technologies used to record information about the location and
function of the body. Those techniques have many limitations compared to those
modulates which produce images. Annually billions of images have been done
globally for different diagnostic purposes. About half of them use ionizing and
nonionizing radiation modulates [1]. Medical imaging produces the images of the
internal structures of the body without invasive procedures. Those images were
produced using fast processors and due to conversion of the energies arithmetically
and logically to signals [2]. Those signals later are converted to digital images. Those
signals represent the different types of tissues inside the body.
The digital images play a necessary role on a daily basis. The medical imaging
processing refers to handling images by using the computer. This processing
includes many types of techniques and operations such as image gaining, storage,
presentation, and communication. The image is a function that signifies a measure

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Medical Imaging - Principles and Applications

of characteristics such as illumination or color a viewed sight. The digital images

have several benefits such as faster and cheap processing cost, easy storing and
communication, immediate quality assessment, multiple copying with reserving the
quality, fast and cheap reproduction, and adaptable manipulation. The disadvan-
tages of digital images are exploitation copyright, inability to resize with preserving
the quality, the need of large-capacity memory, and the need of faster processor for
manipulation [3].
An image processing technique is the usage of computer to manipulate the
digital image. This technique has many benefits such as elasticity, adaptability, data
storing, and communication. With the growth of different image resizing tech-
niques, the images can be kept efficiently. This technique has many sets of rules to
perform into the images synchronously. The 2D and 3D images can be processed in
multiple dimensions. The image processing techniques were founded in the 1960s.
Those techniques were used for different fields such as Space, clinical purposes,
arts, and TV image improvement. In the 1970s with the development of computer
system, the cost of image processing became less and faster. In the 2000s, the image
processing became quicker, inexpensive, and simpler [4].
The human visual system is one of the most complex schemes that ever existed.
This system allows living beings to organize and understand the many complex
elements in their external environment. The visual system comprises of the eye that
transmutes light into neural signals and the related parts of the brain that process
those signals and excerpt essential data. The human eye is bilateral cylinder struc-
tures that are located anteriorly in the skull. The eyes are 2.5 cm in both crosswise
and lengthwise diameters. In the middle of the eyeball, there is a blackened struc-
ture called the pupil. This system permits the light to cross the eye. This system
narrows when exposed to a heavier light source. This reduces the light to the retina
and enhances the visual process. There are many muscles surrounding the eye and
that control the widening of the pupil. The eye always has some supporting struc-
tures called the sclera. The lens is a ligamentous part located behind the cornea. The

Figure 1.
The eyeball.

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shape of the lens changes continuously due to muscle contraction [4, 5]. Figure 1
shows the cross-sectional view of the eyeball.
The light concentrates into the middle part of the eye and focuses from the
cornea and lens on retinae. The fovea emphases the image into the retina. Finally,
the brain forms the details and colors using its perception through multiple pro-
cesses.

2. Classification of digital images

The digital images have two main types of images. Raster image is described as a
four-sided arrangement of frequently sampled values known as pixels. The digital
images are usually inaccessible images and involve multifaceted color difference.
The digital images have fixed resolution due to their pixels size. The digital images
lose their quality in the resizing process due to some missing data. The digital
images are used mainly in photography images because of their good color shades.
The image-gaining instrument controls the resolution. The digital images include
many formats such as BMP (Windows bitmap), TIFF (Tag Interleave Format), PCX
(Paintbrush), PNG (Portable Network Graphics), etc. [6, 7].
A vector is described as a wrinkled and a bent object that is defined precisely by
the computer. The vector has many qualities such as line width, dimension, and
hue. The vectors are easily scalable images and can be reproduced in different
magnitudes without change in its quality. The vectors are suitable for design, line
painting, and diagrams.

3. Applications of digital image processing

The digital image processing has many applications in the medical field such as:

3.1 Medicine

In medicine, many techniques are used such as segmentation and texture analy-
sis, which is used for cancer and other disorder identifications. Image registering
and fusion methods are widely used nowadays specially in new modalities such as
PET-CT and PET-MRI. In the field of bioinformatics, telemedicine and the
formatless compression techniques are used to communicate the image remotely
[1–5].

3.2 Forensics

The common techniques used in this field are edge detection, pattern matching,
denoising, security, and biometric purposes such as identity, face, and fingerprint
documentation. Forensics is based on the database information about the individ-
uals. Forensics matches the input data (fingerprint, eye, photo, etc.) with the
database to define the person identity [2].

4. Medical imaging systems

Medical imaging systems use the signals received from the patient to produce
images. Medical imaging systems use both ionizing and nonionizing sources.

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Medical Imaging - Principles and Applications

4.1 X-ray imaging systems

Since the discovery of X-rays by the German scientist Roentgen, X-rays have
been used to image the body parts for diagnostic purposes. In X-ray tube, the
electrons are produced in cathode through a thermal emission process and are
accelerated through a potential difference of 50–150 KV. The electrons hit the anode
to produce the X-rays. Only 1% of this energy is converted to X-rays, and the
remaining amount is changed to heat (Figure 2) [3].
In the X-ray machines, the images are produced in 2D plans of the examined
part of the body. The fluoroscopy system is used to scan the moving organs. The
acquired images can be displayed, stored, and communicated through different
machines. Computed radiography (CT) uses image receptor to produce the image.
X-rays accompany a screen covered with a storage phosphor device. The mammog-
raphy imaging is used to differentiate between the breast tissues and different
diseases. Mammography imaging uses lower energy compared with bony structure
imaging. The range of potential difference used is 15–40 kV (Figure 3) [2–16].

4.2 Computed tomography (CT)

In this modality, the images are produced in multiple dimensions rather than the
conventional radiography. CT scanner produces multiple slices of the body tissues
in different directions. In CT scanner, the patient is placed inside its aperture and
scanned by a rotating X-ray tube in all directions (Figure 4) [6].

4.3 Nuclear medicine

This imaging modality uses the radioisotopes to produce images about the func-
tions of the different structures such as the heart, kidney, and liver. The radioiso-
topes are labeled by pharmaceutical materials to be guided to the certain organs.
The patient’s emitted photons are received in the detectors and convert into signals.
Those signals are converted to interpretable digital images. There are many types of
nuclear medicine scanning modalities such as planar, tomographic, and positron
emissions. The planar emission produces 2D images. Both of the tomographic and
the positron emissions produce 3D images (Figure 5) [5].

Figure 2.
X-rays tube.

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Research in Medical Imaging Using Image Processing Techniques
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Figure 3.
Mammography image.

Figure 4.
CT scanner.

4.4 Ultrasound

Ultrasound is a technique, which uses high-frequency sound waves to produce

images of the internal structure of the body from the returned echoes. Ultrasound is
similar to the location determination technique, which is used by some animals like
bats and whales in the nature. Ultrasound is transmitted in high-frequency pulses
into the body using a transducer as those waves travel through the body tissues.

5
Medical Imaging - Principles and Applications

Some of those waves are absorbed and some reflect back. The reflected waves are
received by the transducer and converted into electric signals. Those electric signals
are converted into digital ones and pass through the computer system. The com-
puter system uses the arithmetic and logic calculation to form the 2D image of the
scanned structures. In the ultrasonic system, thousands of pulses are sent per each
millisecond. There are many imaging techniques used to enhance the ultrasound
images (Figure 6) [1–6].

Figure 5.
Nuclear medicine imaging.

Figure 6.
Ultrasound imaging diagram.

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5. Fundamentals of digital image processing

The images are classified according to different qualities such as illumination,

contrast, entropy, and signal-to-noise ratio. The histogram is the simplest image
processing technique. The image display does not change the image quality. The
grayscale histogram considers the basic type of the images that are used to evaluate
and to improve the images. The histogram is a scheme showing the pixels’ values
and not their locations. The gray-level histogram shows whether an image is gener-
ally shady or bright (Figure 5). The mean pixel value is obtained from the histo-
gram by summing the produced pixel values and consistent bin altitude and
dividing by the entire number of pixels [7, 8]. Histogram equalization is used to
compare many images acquired on definite bases. The technique works by changing
the histogram to become smooth, identical, and balanced (Figure 7).
The mean value of central pixel intensity is designated to the ideal brightness.
Any intensity above or below makes the image darker or brighter. Signal-to-noise
ratio (SNR) of an image is used to associate the level of the anticipated signal to the
level of the contextual signal. Signal-to-noise ratio (SNR) is defined as the ratio of
signal intensity to noise intensity. Signal-to-noise ratio (SNR) calculates from the
image in an up-front method. The mean intensity of the image is expressed as the
square of the mean of the pixel value (Eq. (1)).
Psignal
SNR ¼ (1)
Pnoise
where p is the average power.

5.1 Image enhancement

Image enhancement is a technique used to improve the image quality and per-
ceptibility by using computer-aided software. This technique includes both objec-
tive and subjective enhancements. This technique includes points and local
operations. The local operations depend on the district input pixel values. Image
enhancement has two types: spatial and transform domain techniques. The spatial
techniques work directly on the pixel level, while the transform technique works on
Fourier and later on the spatial technique (see Figures 8 and 9) [9].

5.2 Image segmentation

Image segmentation is a technique of segregating the image into many parts. The
basic aim of this segregation is to make the images easy to analyze and interpret

Figure 7.
Sagittal MRI image of a head had enhanced using (i) image adjustment, (ii) histogram equalization, and (iii)
adaptive histogram equalization [8].

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Medical Imaging - Principles and Applications

Figure 8.
Edge-aware local contrast manipulation of thyroid scan images (a), (b) edge threshold, (c) original image and
(d) reduced contrast 0.5 [12].

with preserving the quality. This technique is also used to trace the objects’ borders
within the images. This technique labels the pixels according to their intensity and
characteristics. Those parts represent the entire original image and acquire its char-
acteristics such as intensity and similarity. The image segmentation technique is
used to create 3D contour of the body for clinical purposes. Segmentation is used in
machine perception, malignant disease analysis, tissue volumes, anatomical and
functional analyses, 3D-rendered technique, virtual reality visualization and anom-
aly analysis, and object definition and detection (Figure 10) [12–14].
Image segmentation is divided into kinds: (i) local segmentation and (ii) global
segmentation. The local segmentation works particularly in one subdivision of the
image. This technique has a fewer number of pixels compared to the global type.
The global segmentation works in the whole image as one unit. This technique has
more pixels to manipulate. Segmentation can be divided into methods:

1. region method;

2. boundary method; and

3. Edge method [14].

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Research in Medical Imaging Using Image Processing Techniques
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Figure 9.
Edge-aware local contrast manipulation of leukemia cell images (a) and (c) original image, (b) Edge
threshold, and (d) Reduced contrast 0.5 [13].

Figure 10.
Segmentation process of (a) thyroid gland and heart [3].

5.3 Image segmentation based on thresholding

Thresholding segmentation depends on the threshold value to convert the gray

color-based image into black and white [4]. There are many other techniques
applied in radiology in order to rebuild or reslice the images such as Otsu’s and
k-means techniques [5, 6]. Threshold method is useful for establishing the borders
of solid objects in a dark background. Threshold techniques need presence of

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Medical Imaging - Principles and Applications

differences between the object’s and background’s intensities. There are three types
of thresholding methods. Those methods include global, adaptive, and histogram-
built selection threshold. The global threshold is broader and used for all segmenta-
tion techniques. The global threshold (θ) calculates using binarization procedure as
in the following equation (Eq. (2)):

1 if f ðm; nÞ ≥ θ


f ðxÞ ¼ (2)
0

The adaptive or fixed threshold segments image faster if the region of

interest contains unique intensity and is different from the background. The
disadvantage of this method is its simplicity and inability to process the
multichannel images [15].

5.4 Image segmentation based on edge detection

Edge detection is a segmentation technique that uses border recognition of

strictly linked objects or regions. This technique identifies the discontinuity of the
objects. This technique is used mainly in image study and to recognize the parts of
image where a huge variation in intensity arises.

5.5 Some types of edge detection

5.5.1 Roberts kernel

Roberts kernel is a technique used for determining the difference between two
close pixels. Precisely it is called forward differences. This technique can find the
edges in high noised images; it is calculated using first-order fractional derivative
and cross-gradient operator (Eqs. (3) and (4)) (Figure 11) [21].

∂f
¼ f ði; jÞ f ði þ 1; j þ 1Þ (3)
∂x
∂f
¼ f ði þ 1; jÞ f ði; j þ 1Þ (4)
∂x
The fractional derivative can be applied into two 2  2 matrices. In this situation,
Roberts masks are calculated as in Eq. (5):

1 0 0 1
   
Gx ¼ and Gy ¼ (5)
0 1 1 0

5.5.2 Prewitt kernel

This technique is based on the idea of central difference. This technique is better
than Roberts operator (Figure 11). Assume that matric has arrangement of pixels
[i, j] as in Eq. (6):
2 3
a0 a1 a2
4 a7 ½i; jŠ a3 5 (6)
6 7

a6 a5 a4

The fractional derivative of Prewitt operator is computed as in Eq. (7):

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Research in Medical Imaging Using Image Processing Techniques
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Gx ¼ ð a2 þ ca3 þ a4 Þ ð a0 þ ca7 þ a6 Þ (7)

where c is constant and expresses the pixels closed to the center of the image. Gx
and Gy are the calculations at [i, j]. When c equals 1, the Prewitt operator is
calculated as in Figure 10 and Eq. (8) [15, 16]:
2 3 2 3
1 1 1 1 0 1
Gx ¼ 4 0 0 0 5 and Gy ¼ 4 1 0 1 5 (8)
6 7 6 7

1 1 1 1 0 1

5.5.3 Sobel kernel

This technique can be dependent on the central difference which tends toward
the central pixels in average. This technique can be expressed as 3  3 matric to the
first derivative of Gaussian kernel. This technique is calculated as shown in
Eqs. (9)–(12) [20–22]:

Gx ¼ ð a2 þ 2a3 þ a4 Þ ð a0 þ 2a7 þ a6 Þ (9)

and

Gy ¼ ð a6 þ 2a5 þ a4 Þ ð a0 þ 2a1 þ a2 Þ (10)

The Sobel masks are the following:

2 3 2 3
1 2 1 1 0 1
Gx ¼ 4 0 0 0 5 and Gy ¼ 4 2 0 25 (11)
6 7 6 7

1 1 1 1 0 1

The Sobel is better than Prewitt in noise reduction [18]. This technique is used in
the functional imaging modality such as nuclear medicine. In the study of red blood
cell images, the unraveling of strictly neighboring cells is considered difficult issues
due to the background noise. This affects the interpreting processes and makes
them difficult to diagnose by the physician. Segmentation can solve such problems
and identify those red cells easily (see Figure 12) [17].

Figure 11.
Prewitt edge detection technique, (a) gradient magnitude, and (b) gradient direction.

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Medical Imaging - Principles and Applications

Figure 12.
Red blood cell segmentation using edge detection: (a) original image and (b) Sobel and (c) Prewitt techniques.

Figure 13.
k-means segmentation technique of nuclear medicine images.

5.6 k-means segmentation

k-means cluster is a technique of vector and signal valuations. This technique

subdivides the image into n parts and into k clusters in which each observation fits
to a cluster with a similar mean. k-means clustering tends to find clusters of com-
parable spatial extent. Given a set of comments (x1, x2, …, xn), where each com-
ment is a d-dimensional actual vector, k-means clustering aims to subdivide the n
observations into k (≤ n) sets S = {S1, S2, …, Sk} so as to minimize the within-cluster
sum of squares (Eqs. (12) and (13)) [16].

k k
arg minS ∑ ∑ kx μi k2 ¼ arg minS ∑ jSi VarSi (12)
i¼1 x ∈ Si i¼1

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where μi is the mean of points in Si.

k 1
arg minS ∑ ∑ kx yk2 (13)
i 1 2jSi j x1y ∈ Si

k-means technique can be applied in large databases because of its simplicity.

This technique is used in economical, stargazing, cultivation, and computer per-
ception (Figure 13) [17–19].

6. Conclusion

Images are the method of expression of the data in pictographic form. Images
consist of various small elements called pixels. Each pixel has a specific position and
value. Geometric image signifies an image arithmetically with geometrical primi-
tives such as lines. Each image is saved in a specific file format, which consists
of two parts, the heading and the data. Imaging processing techniques is a group of
approaches that are used for handling the images by computer. The objective of
segmentation is the partition of the images into important portions. Local segmen-
tation deals with the partition of the images into small parts within the images.
Global segmentation deals with the assembly of those partitions. Image segmenta-
tion works in three methods, which are region, border, and edge. Region method is
used to examine images and region class of neighboring pixels. Thresholding
segmentation uses the histogram and threshold value of pixels. Image edge tech-
niques are used to analyze the images at borders or discontinuing. Those techniques
include Roberts, Prewitt, Sobel, and Frei-Chen.

Acknowledgements

The authors are thankful to the Deanship of Scientific Research, at Majmaah

University, for funding this research.

Conflict of interest

There are no conflicts of interest.

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Medical Imaging - Principles and Applications

Author details

Yousif Mohamed Y. Abdallah1* and Tariq Alqahtani2

1 Radiological Science and Medical Imaging Department, College of Applied

Medical Science, Majmaah University, Majmaah, Saudi Arabia

2 Medical Equipments Technology Department, College of Applied Medical

Science, Majmaah University, Majmaah, Saudi Arabia

*Address all correspondence to: [email protected]

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms
of the Creative Commons Attribution License (http://creativecommons.org/licenses/
by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.

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Research in Medical Imaging Using Image Processing Techniques
DOI: http://dx.doi.org/10.5772/intechopen.84360

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