Paper Presentation on Image Processing in Health Care (Magnetic Resonance Images(M.R.

I Scan))

By: P. Fakruddin IV C.S.E fakhruddin.p2@gmail.com Ph:9700054435 K. Revana Suresh IV C.S.E revana.suresh91@gmail.com Ph:9989793953

Of
BRINDAVAN INSTITUTE OF TECHNOLOGY & SCIENCE
PEDDATEKUR, KURNOOL

CONTENTS:

INTRODUCTION BACKGROUND EXPERIMENTAL METHOD FIELD OBSERVATIONS REQUIREMENTS COMPUTATIONAL CHOICES CONCLUSION

Abstract:
Medical image analysis is shifting from current film-oriented light screen environments to computer environments that involve viewing and analyzing large sets of images on a computer screen. Magnetic Resonance Imaging (MRI) studies, in particular, can involve many images. This paper examines how best to meet the needs of radiologists in a computational environment. To this end, a field study was conducted to observe radiologists interactions during MRI analysis in the traditional light screen environment. Key issues uncovered involve control over focus and context, dynamic grouping of images and retrieval of images and image groups. To address the problem of focus and context, existing layout adjustment and magnification techniques are explored to provide the most appropriate solution Our interest is in combining the methodologies of human computer interaction studies with computational presentation possibilities to design a visual environment for the crucial field of medical image analysis.

INTRODUCTION:
Magnetic resonance imaging (MRI), or nuclear magnetic resonance imaging (NMRI), is primarily a medical imaging technique most commonly used in radiology to visualize the structure and function of the body. It provides detailed images of the body in any plane. MRI provides much greater contrast between the different soft tissues of the body than computed tomography (CT) does, making it especially useful in neurological (brain), musculoskeletal, cardiovascular imaging. Unlike CT, it uses no ionizing radiation, but uses a powerful magnetic field to align the nuclear magnetization fields of are (usually) used to hydrogen atoms in water in the body. Radiofrequency systematically alter the alignment of this magnetization, causing the hydrogen nuclei to produce a rotating magnetic field detectable by the scanner. This signal can be manipulated by additional magnetic fields to build up enough information to construct an image of the body. MRI is a relatively new technology, which has been in use for little more than 30 years. The first MR Image was

published in 1973 and the first study performed on a human took place on July 3, 1977. Magnetic resonance imaging was developed from knowledge gained in the study of nuclear magnetic resonance. In its early years the technique was referred to as nuclear magnetic resonance imaging (NMRI). However, as the word nuclear was associated in the public mind with ionizing radiation exposure it is generally now referred to simply as MRI. Scientists still use the term NMRI when discussing non-medical devices operating on the same principles. The term Magnetic Resonance Tomography (MRT) is also sometimes used. One of the contributors to modern MRI, Paul Lauterbur, originally named the technique zeugmatography, a Greek term meaning "that which is used for joining" The term referred to the interaction between the static, radiofrequency, and gradient magnetic fields necessary to create an image, but this term was not adopted

BACKGROUND:
The traditional technology for displaying MRI images is the use of a large light screen panel (Figure 1). The panel used in the current study, consists of two visible 58 above 58 area is large enough to display eight MRI films 14 images depending on image size and shape. Images are logically grouped into volume sets and of different planar set orientation contrast. Each where 17 each film measures and contains 15 to 20 screens the 38 other each to measuring Figure1:Lightscreen displaying MRI images form a 19 . These are positioned one display area. This total

EXPERIMENTAL METHOD
A field study was conducted at

Vancouver General Hospital to understand the MRI analysis process. Informal observations of radiologists interacting in a traditional filmoriented environment were gathered were using gathered researcher fieldnotes. Observations during five one to two hour diagnostic teaching sessions involving both intern and staff radiologists. These sessions provide diagnosis for current MRI cases while at the same time providing a learning experience for intern radiologists. They progress very much like a non-teaching diagnostic situation, except are slower and there is more talking. They are exceptionally well suited to the observation task as the slower pace and helpful commentary

contains a number of sequential slices that combine to make the volume. These sets are distinguished by planar orientation (i.e. axial, saggital, coronal) or by tissue contrast. Contrast sets are determined at data acquisition time and differ This in grey scale in representations. difference

contrast is an important factor in the identification of healthy and unhealthy tissue.

clarifies the activities

and thought

processes of the team. Question and answer sessions were also conducted with the radiologists in order to better understand the nature of the images and diagnostic process. Paul Lauterbur (born 1929), Urbana, Illinois, USA, discovered the possibility to create a two-dimensional picture by introducing gradients in the magnetic field. By analysis of the characteristics of the emitted radio waves, he could determine their origin. This made it possible to build up two-dimensional pictures of structures that could not be visualized with other methods. Peter Mansfield (born 1933), MRI is used for imaging of all organs in the body. Magnetic resonance imaging, MRI, is now a routine method within medical diagnostics. Worldwide, more than 60 million investigations with MRI are performed each year, and the method is still in rapid development. MRI is often superior to other imaging techniques and has significantly improved diagnostics in many diseases. MRI has replaced several invasive modes of examination and thereby reduced the risk and discomfort for many patients. Nuclei of hydrogen atoms Water constitutes about two thirds of the human body weight, and this high water content applicable explains to why magnetic There are resonance imaging has become widely medicine. differences in water content among Nottingham, England, further developed the utilization of gradients in the magnetic field. He showed how the signals could be mathematically analysed, which made it possible to develop a useful imaging technique. Mansfield also showed how extremely fast imaging could be achievable. This became technically possible within medicine a decade later.

tissues and organs. In many diseases the pathological process results in changes of the water content, and this is reflected in the MR image. Water is a molecule composed of hydrogen and oxygen atoms. The nuclei of the hydrogen atoms are able to act as microscopic compass needles. When the body is exposed to a strong magnetic field, the nuclei of the hydrogen atoms are directed into order stand "at attention". When submitted to pulses of radio waves, the energy content of the nuclei changes. After the pulse, a resonance wave is emitted when the nuclei return to their previous state. The small differences in the oscillations of the nuclei are detected. By advanced computer processing, it is possible to build up a three-dimensional image that reflects the chemical structure of the tissue, including differences in the water content and in movements of the water molecules. This results in a very detailed image of tissues and organs in the investigated area of the body. In this manner, pathological changes can be documented.

Films are arranged according to logical groupings where appropriate and individual preference otherwise. Arrangement of the films cannot accommodate all aspects of the analyses and in a typical session there is a great deal of physical movement. The radiologists will stand up, sit down, and move to the left or to the right of the screen in order to focus on specific images or image groups. Pointing or sweeping hand motions are also used and can indicate areas of interest. Often radiologists point at one or more images for a prolonged period, marking them for comparison purposes or future reference. Films are sometimes moved to different locations or removed entirely, to obtain better grouping and context. At times an entire film may be extracted from the light screen and held up to the light by hand for closer viewing. In this manner, each session appears to progress in a similar fashion, with the frequency of movements varying from one radiologist to the other. The pattern of observations and comparisons made in each session, however, is unique and dependent on both the radiologist and the particular case.

FIELD OBSERVATIONS

Especially valuable for examination of the brain and the spinal cord Today, MRI is used to examine almost all organs of the body. The technique is especially valuable for detailed imaging of the brain and the spinal cord. Nearly all brain disorders lead to alterations in water content, which is reflected in the MRI picture. A difference in water content of less than a percent is enough to detect a pathological change. In multiple sclerosis, examination with MRI is superior for diagnosis and follow-up of the disease. The symptoms associated with multiple sclerosis are caused by local inflammation in the brain and the spinal cord. With MRI, it is possible to see where in the nervous system the inflammation is localized, how intense it is, and also how it is influenced by treatment. Examination with MRI is especially valuable for detailed imaging of the brain and the spinal cord. Another example is prolonged lower back pain, leading to great suffering for the patient and to high costs for the society. It is important to be able to differentiate between muscle pain and pain caused by pressure on a nerve or the spinal cord. MRI examinations have been able to replace previous methods which were unpleasant for the patient. With MRI, it is possible to see if a disc herniation is pressing on a nerve and to determine if an operation is necessary. Important preoperative tool Since MRI yields detailed three-

dimensional images, it is possible to get distinct information on where a lesion is localized. Such information is valuable before surgery. For instance, in certain

microsurgical

brain

operations,

the

MRI

can

replace

previously and

used

surgeon can operate with guidance from the MRI results. The images are detailed enough to allow placement of electrodes in central brain nuclei in order to treat severe pain or to treat movement disorders in Parkinson's disease. Improved diagnostics in cancer MRI examinations are very important in diagnosis, treatment and follow-up of cancer. The images can exactly reveal the limits of a tumour, which contributes to more precise surgery and radiation therapy. Before surgery, it is important to know whether the tumour has infiltrated the surrounding tissue. MRI can more exactly than other methods differentiate between tissues and thereby contribute to improved surgery. MRI has also improved the possibilities to ascertain the stage of a tumour, and this is important for the choice of treatment. cancer regional affected. Reduced suffering for patients For example, MRI can determine how deep in the tissue a colon has infiltrated lymph nodes and whether have been

invasive

examinations

thereby

reduce the suffering for many patients. One example is investigation of the pancreatic and bile ducts with contrast media injection via an endoscope. This can in some cases lead to serious complications. Today, corresponding information can be obtained by MRI. Diagnostic arthroscopy (examination

with an optic instrument inserted into the joint) can be replaced by MRI. In the knee, it is possible to perform detailed MRI studies of the joint cartilage and the cruciate ligaments. Since no invasive instrument is needed in MRI, the risk of infection is eliminated.

REQUIREMENTS
It is apparent from observations and discussions that all images are scanned at least once and several subgroups of images are singled out for simultaneous viewing or comparison purposes. As sub-groups may involve some of the same images, it is not possible to permanently position the films so that the components of each subgroup are close together. Radiologists typically solve this problem through physical

movement or by reorganization of the films, obtaining multiple groupings of images as required. Although this method appears cumbersome, it allows radiologists complete control and flexibility with regard to which images they view up close, which images they view as a group and which image sets they scan as a whole. Further radiologists individual examination in and a of list the of observations and comments from the resulted actions associated

Focus and Context: Ability to view one or more images up close without losing or over lapping the remaining images in the group. Present individual image detail and related contextual images at the same time. The first two categories, Grouping and Retrieval, are beyond the scope of this paper not covered here. The rest of the paper addresses the third, Focus and Context, requirement.

COMPUTATIONAL CHOICES
Research in computational presentation is examined in order to find an appropriate approach for medical imaging presentation that fulfills the focus and context requirement. The traditional light screen provides a large and flexible display space, while the computer screen limits the number of images that can be displayed effectively. Depending on the computer screen size, once the number of displayed images exceeds some maximum, the image size must be decreased and detail is lost. Current systems rely on standard zooming and panning techniques in combination with large and, often multiple computer screens. Magnifying one image using standard zoom can recapture detail but

requirements. Although many of these overlap, in general three main categories of requirements emerged: Grouping: Ability to dynamically group desired images together for simultaneous viewing and comparison. Provide flexible user control over the location and visibility of the groups on the screen. Retrieval: Ability to locate and relocate both stored and visible images as well as stored and user determined groups of images. Provide visual clues and representations of available images and image groups in order to facilitate retrieval.

sacrifices available postpones between

context. computer the presenting

Increasing display detail

the space

tolerated. In other words, the aspect ratio of the image must be maintained throughout any layout adjustments. Finally, the comparison aspect of the analysis task indicates that selection of more that one image, creating multiple focal views, is also important. Due to the sensitive nature of this task, it is further important that the focal images are presented with equal scale. A great variety of distortion presentation techniques exist, varying from the single focal Bifocal Display [9] to powerful multi-focal presentations such as 3DPS [2] and Non-linear views as in [3] (for surveys see [4,6]). However, the orthogonality requirement greatly reduces this list. Early orthogonal approaches [5,7] had to be eliminated because they cause information distortion in the rows and columns that

inevitable

conflict and

maintaining context but does not resolve it. Furthermore, large or multiple screens are expensive and often not an option for smaller hospitals or for use in remote consultation. This problem indicates a need for a versatile strategy layout that and makes magnification

maximum use of screen real estate and provides for both image detail and group context. To our knowledge, research in focus and context magnification techniques (also called fisheye and distortion) has not yet been applied to medical imaging presentation. We examine research in this area for a technique that suits the data involved in the current task. There are several visual requirements originating from the nature of the data and the MRI analysis task. Though each image in itself represents medical data, the presentation problem requires laying out images as discrete objects. Also, while it is useful to provide magnification of the images, no distortion other than scaling can be

hold focal points and thus would distort the images themselves. The Zoom family [1] introduces smooth interview transitions which also aid in preservation of the mental map but allows a more loose interpretation of orthogonality than would be ideal in this case. The SHriMP[10] approach comes the closest to fitting the observed requirements.

proposed In

and order

alternative to

resulting the

layouts suggested. determine feasibility of the proposed solution, further user studies must be performed. A comparison study of the proposed alternative layouts will form the basis of one of these. Further work is also Figure 6: MR images, Constrained Areas. CONCLUSION Providing radiologists with functionality to support interactions similar to those currently utilized in the light screen environment will help ensure a more seamless transition to computerized medical image analysis. Three separate areas have been identified as general requirements that must be met in order to provide the radiologists with the same control as they are accustomed to with the light screen: retrieval, grouping and focus and context. Of these, the focus and context requirement was further examined. It was hypothesized that layout and fisheye magnification techniques would be better applied to this problem than traditional zooming, panning techniques. A solution was [1] L. Bartram, A. Ho , J. Dill and F. Henigman. The Continuous Zoom: A Contstrained Fisheye Technique for Viewing and Navigating Large Information Spaces., ACM Press, UIST'95: Proceedings of the ACM Symposium on User Interface Software and Technology, 1995, 207 - 216. [2] M. S. T. Carpendale, D. J. For Cowperthwaite and F. D. Fracchia. 3Dimensional Pliable Surfaces: Effective Presentation of Visual Information. ACM Press, Proceedings of the ACM Symposium on User Interface, 1995. required to integrate retrieval and grouping techniques in order to satisfy the remaining general requirements

REFERENCES