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Enhancing Image Quality Using Advanced Signal Processing Techniques

LISA SMITH ANDREA PERRON ANGELA PERSICO ELENA STRAVINSKAS DARRIN COURNOYEA, BSC, RDMS, RVT, CRGS, CRVS

The main expectation of a sonographer is to obtain images of diagnostic quality. This requires the fundamental knowledge of spatial, contrast, and temporal resolution. To help determine which of these parameters needs to be optimized, one needs a well-defined clinical approach. Once satisfactory imaging is achieved, advanced signal processing tools can then be applied to further enhance image quality beyond that of good acoustic windows and tissue paths. Spatial compounding and tissue harmonic imaging are two commonly used tools that have significant clinical relevance in diagnostic sonography. These tools have their own unique applications and benefits, as well as limitations. When used correctly, they have shown to significantly improve image quality, allowing for the possibility of increased accuracy and an improvement in diagnostic confidence. Key words: spatial compounding, tissue harmonics, spatial resolution, contrast resolution

From Mohawk-McMaster Institute for Applied Health Sciences, Hamilton, Ontario, Canada. The first four authors of this article are senior level sonography students from the Medical Radiation Sciences Program at Mohawk College and McMaster University. Correspondence: Lisa Smith, 98 Daffodil Crescent, Ancaster, Ontario L9K 1E2. E-mail: SMITHL9@MCMASTER.CA. DOI: 10.1177/8756479308315231

Sonographers today are expected to recognize specific pathological conditions rather than just acknowledge that an abnormality exists. In doing so, it is crucial that they understand how to manipulate signal processing controls to optimize spatial, contrast, and temporal resolution. Once optimal imaging is achieved, advanced tools can then be applied to further improve resolution. Spatial compounding and tissue harmonic imaging are two advanced tools that will be explored. However, a basic understanding of the fundamentals behind resolution is crucial before a complete understanding of these tools can be obtained. Spatial, contrast, and temporal resolution are the three main forms of resolution. Spatial resolution can be described as the systems ability to

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detect and display structures that are located in close proximity. There are three components of spatial resolution: axial, lateral, and elevational resolution. Axial resolution distinguishes reflections along the sound beam axis and is mainly dependent on the spatial pulse length. High-frequency and short pulses of sound provide optimal axial resolution. Lateral resolution is the ability to resolve two structures as separate entities that are positioned perpendicular to the beam axis in the plane of the image. The ability to detect small objects improves as the width of each scan line decreases. Lateral resolution is best in the focal zone where beam width is narrowest. Elevational or slice thickness is the dimension of the beam perpendicular to the image plane. Depending on the thickness of the beam, this resolution can be subject to the partial volume artifact. Next, contrast resolution is the difference in brightness between regions of the displayed image. It is determined by differences in signal intensity, with increasing differences resulting in enhanced contrast. Conversely, contrast resolution is decreased as the number of shades of gray available for display is increased. This form of resolution can be broken down into two categories: intrinsic and extrinsic contrast. Intrinsic contrast is determined by differences in brightness between the target and background and is defined by the bit depth.1 Extrinsic contrast is controlled by gray-scale maps that are applied during postprocessing.1 Last, temporal resolution is the systems ability to accurately depict the movement of structures. Several frames must be acquired sequentially in time to visualize this movement. The more image frames displayed, the smoother the motion will appear.1 It is important to note that all of these parameters are interdependent. Therefore, modifying one to enhance image quality can often result in the degradation of another.1 For this reason, the identification of the clinical question is crucial. The scope of the examination will determine which parameters need to be optimized. For example, spatial resolution is of greatest importance when measuring nuchal translucencies, whereas contrast resolution must be optimized to visualize liver metastases. Therefore, it is evident that the use of

diagnostic sonography is highly dependent on the effective management of image quality. Spatial compounding and tissue harmonics are two types of advanced signal processing techniques that have proven to contribute to the overall success of the examination. This article explores the physics behind each tool, highlighting the advantages, limitations, and typical uses of each. With sufficient training and education, sonographers will be able to better appreciate the added value that becomes available when these advanced signal processing tools are used appropriately. Ultimately, this article demonstrates that spatial compounding and tissue harmonic imaging provide the opportunity to choose varying levels of resolution required to optimize the visualization of specific anatomy or pathologies.

Discussion
Both spatial compounding and tissue harmonic imaging are valuable tools for visualizing a wide variety of structures with greater detail and accuracy. They have provided sonography with further diagnostic relevance and an advanced role in diagnostic imaging departments. Of course, this high level of image quality is dependent on the sonographer, making it crucial that he or she fully understands how these processing tools work, along with their appropriate applications. Although they provide many similar benefits, they differ drastically in their methodology. The physics behind each method, along with their added benefits and limitations, will be discussed.
SPATIAL COMPOUNDING

Spatial compounding is an image averaging processing technique that increases contrast resolution and the signal-to-noise ratio. In this method, the beam is steered in multiple directions, and the angle dependency characteristic of speckle (noise) is decreased. Speckle is random in its location and differs in each frame, allowing it to be effectively reduced with the averaging process. Essentially, signals that do not remain constant in location from frame to frame are removed from the image, and true tissue reflections that remain relatively consistent are not. Displayed images are an integration of

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FIGURE 1. In spatial compounding, the beam is actively steered in three directions. These frames are then averaged to produce an image that is a combination of the three frames. New images are consistently being updated. Image taken with permission from Hedrick et al.1

several frames acquired over time at various steered angles (see Figure 1). All subsequent images being displayed are constantly refreshed with a single new frame, not an entire new set of frames. Therefore, a completely new image is never generated, minimizing the reduction in frame rate.
BENEFITS

Normal and abnormal anatomy of abdominal and pelvic soft tissue organs, as well as superficial structures, can be better visualized with the use of

spatial compounding. This is due to the increase in contrast resolution and adjacent tissue border delineation (Figure 2). Lateral border visualization is enhanced because multiple angles of insonation increase the number of specular reflectors perpendicular to the beam (Figure 3). The echotexture of homogeneous organs also appears smoother because speckle is reduced. Furthermore, spatial compounding has been found to be a useful tool aiding in the detection of the pancreatic and bile ducts.2 The increase in contrast resolution and structural continuity of the ducts allows for more

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FIGURE 2. Using conventional sonography in image A, the endometrium is not as clearly depicted as seen in image B with spatial compounding. The borders of the endometrium are now clearly distinct, and accurate caliper placement can be achieved.

(Figures 4 and 5). One study came to the conclusion that thyroid nodules can be best visualized using spatial compounding because of freedom from artifacts and increased nodule conspicuity.3 Limitations. As with many imaging tools, some limitations to spatial compounding do exist. The acquisition of several frames from multiple angles creates the potential for decreased temporal resolution and thus motion blurring. This is because a short amount of time is required for older frames to be averaged with the most recent frames. This reduction in temporal resolution will degrade the quality of images with fast-moving structures, such as the fetal heart, which is one application where spatial compounding should not be applied. Another limitation results from the multiple-angle acquisition technique and the compounding of the images. Posterior shadowing and enhancement appear less prominent and display a pyramidal shape (Figure 3). This may reduce the diagnostic effectiveness of this tool, as shadowing and enhancement are characteristic of certain pathologies, such as renal stones or cysts in the breast. Therefore, spatial compounding should be used with discretion, to provide appropriate comparisons of varying tissue characteristics.

FIGURE 3. Conventional imaging (A) does not provide perpendicular specular reflections of lateral borders. Spatial compoundings ability to insonate structures from multiple angles increases lateral border continuity and overall improved visualization. Image taken with permission from Rumack et al.4

accurate caliper placement. This may also apply to the visualization and measurement of the nuchal translucency of a fetus. Another area that benefits from the use of spatial compounding is the imaging of cystic structures. Reverberation and noise can be decreased, and the differentiation between a simple cyst and complex cyst can be achieved

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FIGURE 4. Bladder and ovary with conventional sonography (image A) shows poorly defined bladder walls and echoed-filled follicles. Image B was taken with spatial compounding and displays echo-free prominent follicles and well-defined bladder and ovarian borders.

FIGURE 5. Spatial compounding seen in image A offers increased nodule conspicuity over conventional sonography seen in image B. TISSUE HARMONIC IMAGING

selectively process only the second-order harmonic frequencies because they maintain sufficient received signal amplitudes required for image production. It is important to note that the harmonic frequency is generated in the tissue and thus only travels a one-way path back to the transducer. This single path reduces the amount of distortion from the subcutaneous fat layer that occurs on the way into the patient. Tissue harmonic imaging also significantly reduces artifacts, such as clutter, grating lobes, and side lobes, that are forms of noise generated at the fundamental frequency. Lateral resolution is also improved because the harmonic frequency beam width is narrower than that of the fundamental frequency. Benefits. The main parameter that is optimized with tissue harmonic imaging is contrast resolution. This can be useful when imaging low-contrast lesions and cystic structures because an increase in contrast can have a profound impact on the diagnosis. Harmonic imaging has demonstrated the ability to improve detection of low-contrast lesions, particularly in the liver.5 This can be greatly appreciated in cases of metastases or inconspicuous lesions (Figure 6). In addition, fluid-filled structures can be depicted with fewer internal artifactual echoes that may inhibit adequate visualization. This is evident in many gallbladder abnormalities and free fluid in the pelvis

Tissue harmonic imaging is a technique that uses the harmonic frequency of the sound wave to improve contrast resolution by reducing noise and artifacts. Sound waves propagate in a nonlinear fashion, with the compression phase moving faster than the rarefaction phase. This results in the distortion of the wave as it travels through a medium and a change in frequency that generates harmonics of the fundamental wave. The harmonic frequencies generated are integer multiples of the fundamental frequency (2, 3, 4, etc.) and are often called second-, third-, and fourth-order harmonics. Sonography systems today

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FIGURE 6. Conventional imaging (A) of a liver hemangioma could be easily missed because of the lack of contrast resolution. Harmonic imaging (B) provides increased contrast resolution between the hemangioma and liver parenchyma, and consequently, this lesion becomes more readily identifiable.

FIGURE 7. Image A with conventional sonographic imaging and image B with harmonic imaging depicting the improved contrast resolution and enhanced posterior shadowing of a gallbladder stone.

(Figures 7 and 8). Harmonic imaging was also found to be superior when scanning obese patients and patients with poor acoustic windows.6 Low-contrast organs, such as the pancreas, can benefit from an

increase in contrast to better delineate their tissue borders from surrounding structures. Last, the increase in attenuation resulting from harmonic frequencies actually enhances posterior shadowing

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FIGURE 8. Using conventional sonography, the free fluid (arrow) in the posterior cul-de-sac contains artifactual internal echoes (A). Harmonic imaging (B) eliminates this artifact.

FIGURE 9. Shorter pulse lengths preserve axial resolution but allow fundamental and harmonic frequency overlap, minimizing the reduction of noise and clutter (A). Elongating the pulse length separates the fundamental and harmonic frequency but at the cost of axial resolution (B). Image taken with permission from Miele.7

(Figure 7). This is opposite to the effect of spatial compounding. Limitations. Although tissue harmonic imaging is excellent at improving contrast resolution, it can have a detrimental effect on spatial resolution, particularly axial resolution. The basis of this limitation lies in

the fact that modern sonography units use broad bandwidth transducers that generate shorter pulse lengths. Although shorter pulse lengths are best for achieving optimal axial resolution, the broad bandwidth transducer creates an overlap of the fundamental and harmonic frequencies (Figure 9A). This overlap hinders the effectiveness of harmonic

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TABLE 1. Summary of Tissue Harmonic and Spatial Compounding Advantages and Disadvantages Benefits/Advantages Spatial compounding Improved contrast resolution Increased signal-to-noise ratio Reduced speckle Reduction in specular reflection-related artifacts Improved conspicuity Improved structural continuity Improved visualization of smooth echotexture of homogeneous organs Improved contrast resolution Harmonic imaging Improved lateral resolution Reduction in reverberation artifact at superficial depths Reduction in artifactual information and noise (clutter, grating lobes, side lobes) Improved detection of low-contrast lesions Enhancement of posterior shadowing due to increased attenuation Disadvantages Less prominent posterior shadowing (pyramidal) and enhancement Decreased temporal resolution Potential for motion blurring

Decreased frame rate Decreased temporal resolution Decreased spatial resolution (but can be corrected with pulse inversion technique) Impaired visualization of homogeneous organs/parenchyma Harmonic frequency is depth dependent

FIGURE 10. Conventional sonography of this bicornuate uterus (A) lacks clear definition and contrast to effectively display the borders of the separated endometrium. In image B, using both spatial compounding and harmonics simultaneously, the image is smoother, and the borders of the endometrium are now well visualized.

imaging by limiting the reduction of noise and clutter.7 The solution to this limitation is a method called harmonic filtering. This method works by extending the pulse length and narrowing the bandwidth, thus separating the fundamental and harmonic frequencies. This allows the transducer to listen for the harmonic frequencies independently. However, this results in degradation in axial resolution because of the increased spatial pulse length (Figure 9B). Fortunately, a technique called pulse inversion makes use of the

nonlinear propagation nature of sound waves to retain shorter pulse lengths and preserve axial resolution. In pulse inversion, two pulses with short pulse lengths are sent down each scan line. The second pulse is sent 180 degrees out of phase from the first pulse. The returning fundamental frequencies will cancel because of deconstructive interference, and the harmonic frequencies will constructively interfere when summed together. This results in harmonic signals with increased amplitude and maintained

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FIGURE 11. Example of the increased contrast and artifact reduction of a gallbladder with a small polyp (arrow) using harmonic and spatial compounding imaging simultaneously (B). Image A is harmonic imaging only.

spatial resolution. Nevertheless, sending out an extra pulse per scan line does decrease the frame rate and temporal resolution. Table 1 provides a summary of the advantages and limitations to both spatial compounding and tissue harmonic imaging.
SIMULTANEOUS IMAGING WITH SPATIAL COMPOUNDING AND TISSUE HARMONICS

Imaging simultaneously with these advanced signal processing tools has also been found to increase overall image quality and lesion conspicuity of certain abdominal and pelvic pathology8 (Figure 10). This is especially true for cystic structures where a high degree of contrast and artifact reduction is favored (Figure 11). It is important for sonographers to be aware of which settings to use for specific applications to obtain the highest degree of diagnostic images.

image quality and emphasize the vital role that sonographers play in contributing to the diagnostic process. It is crucial for sonographers to obtain proper training and education to be able to correctly apply these tools. With a thorough understanding of their benefits and limitations, image quality can be significantly improved. Thus, the appropriate incorporation of spatial compounding and tissue harmonic imaging into specific examinations can enhance the diagnostic reliability of sonography.

References
1. Hedrick W, Hykes D, Starchman D: Ultrasound Physics and Instrumentation. 4th ed. St. Louis, MO, Mosby, 2005. 2. Rickes S, Bohm J, Malfertheiner P: SonoCT improves on conventional ultrasound in the visualization of the pancreatic and bile duct: a pilot study. J Gastroenterol Hepatol 2006;21:552555. 3. Shapiro RS, Simpson WL, Rausch DL, Yeh H-C: Compound spatial sonography of the thyroid gland: evaluation of freedom from artifacts and of nodule conspicuity. Am J Roentol 2006;177:11951198. 4. Rumack C, Wilson S, Charboneau JW: Diagnostic Ultrasound. 3rd ed. St. Louis, MO, Mosby, 2005.

Summary
The advanced signal processing techniques discussed in this article clearly exhibit improvements in

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5. Sodhi KS, Sidhu R, Gulati M, Saxena A, Suri S, Chawla Y: Role of tissue harmonic imaging in focal hepatic lesions: comparison with conventional sonography. J Gastroenterol Hepatol 2005;20:14881493. 6. Choudhry S, Gorman B, Charboneau JW, et al: Comparison of tissue harmonic imaging with conventional US in abdominal disease. Radiographics 2000;20:11271135.

7. Miele FR: Ultrasound Physics and Instrumentation. 4th ed. Forney, TX, Pegasus Lectures, 2006. 8. Oktar O, Yurel C, Ozdemir H, Uluturk A, Isik S: Comparison of conventional sonography, real-time compound sonography, tissue harmonic sonography, and tissue harmonic compound sonography of abdominal and pelvic lesions. Am J Roentol 2003;181:13411347.

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SDMS-JDMS CME TEST

Article: Enhancing Image Quality Using Advanced Signal Processing Techniques Authors: Lisa Smith Andrea Perron Angela Persico Elena Stravinskas Darrin Cournoyea, BSc, RDMS, RVT, CRGS, CRVS Category: Physics Credit: 1.0 CME Objectives: After studying the article titled Enhancing Image Quality Using Advanced Signal Processing Techniques, you will be able to: 1. Define spatial, contrast, and temporal resolution. 2. Discuss optimization of controls for image enhancement. 3. Describe spatial compounding and tissue harmonic imaging. 5. The ability to accurately depict the movement of structures is a. Tissue harmonics b. Temporal resolution c. Axial resolution d. Intrinsic contrast 6. When measuring nuchal translucencies, to obtain greater detail and accuracy, which type of resolution is most important? a. Spatial resolution b. Lateral resolution c. Axial resolution d. Temporal resolution 7. To better delineate the pancreatic tissue and the bile ducts, which technique is most useful? a. Tissue harmonics b. Temporal resolution c. Spatial compounding d. Contrast resolution 8. Which technique is used to improve the detection of lowcontrast lesions in the liver? a. Contrast resolution b. Harmonic filtering c. Tissue harmonics d. Temporal resolution 9. Tissue harmonic imaging is excellent at improving which resolution? a. Axial b. Lateral c. Contrast d. Temporal 10. Broad bandwidth transducers generate which of the following? a. Shorter pulse lengths b. Tighter axial resolution c. Improved lateral resolution d. Long pulse lengths

1. The three components of spatial resolution include all the following except a. Axial resolution b. Lateral resolution c. Contrast resolution d. Elevational resolution 2. The ability to resolve two structures as separate entities that are positioned perpendicular to the beam axis in the plane of the image is a. Focal zone resolution b. Lateral resolution c. Spatial resolution d. Tissue harmonic resolution 3. The slice thickness is the dimension of the beam perpendicular to the image plane, also known as a. Axial resolution b. Lateral resolution c. Elevational resolution d. Beam width resolution 4. The difference in brightness between regions of the displayed image is a. Contrast resolution b. Gray-scale resolution c. Tissue harmonics d. Temporal resolution