10. Grayscale Window

10.1. Grayscale Window Width and Level

Windowing controls how image voxel values are mapped onto grayscale levels when a digital image is displayed. Windowing allows the viewer to adjust image brightness and contrast and may help to emphasize specific image structures.

Windowing is critical for CT images, where the grayscale values reflect a range of CT numbers expressed in Hounsfield units (HU). The Hounsfield scale (Fig. 10.1) is obtained using a linear transformation of the X-ray attenuation coefficients for each voxel (\mu_{voxel}) into units where the radiodensity of water (at standard temperature and pressure) is zero and the radiodensity of air is equal to –1000 HU:

(10.1)HU &= K \times \frac{(\mu_{voxel} - \mu_{water})}{(\mu_{water} - \mu_{air})}

Here K is an integer coefficient equal to 1000 (or 1024 in some CT systems), and \mu_{water} and \mu_{air} are the attenuation coefficients of water and air.

Typical Hounsfield units

Fig. 10.1 Typical CT numbers (Hounsfield units) for various tissues.

The CT numbers in medical images typically range between –1000 HU for air to over +1000 HU for dense bone. Computer displays are usually capable of showing 256 grayscale values, and human eye can distinguish even fewer levels. The full range of 2000 HU distributed over 200 gray levels would lead to each level representing 10 HU. The differences between important image structures can be emphasized through windowing, or selecting the range of values (window width, W) and the center value (window level, L) to be mapped onto grayscale.

For example, abdominal organs are often viewed in a narrow window centered at a low, positive value in order to highlight the differences between tissues with closely spaced CT numbers (Fig. 10.2).

Narrow soft tissue window

Fig. 10.2 A narrow window (L: 50; W: 200) for abdominal organs, with typical ranges of CT numbers shown by red bars.

The window width, or the range of CT numbers in the image, changes the image contrast. Increasing the width decreases contrast, and narrowing the window increases contrast. The window level, or the CT number at the center of the window, changes the image brightness. Increasing the window level decreases brightness.

For a given window level and width, the window limits, the upper limit (UL) corresponding to white and the lower limit (LL) corresponding to black grayscale value, are determined as follows: UL = L + W/2; LL = L – W/2.

10.2. Adjusting Window Width/Level in FireVoxel

In FireVoxel, windowing can be quickly and interactively adjusted using the Change Width/Level tool, best suited for adjusting the grayscale window of CT images.

Alternatively, ViewFilter option on the Layer Control panel enables precise control of window level and width for all images, including real-valued images displayed as color maps.

Both these methods can be used for windowing CT images loaded as real-valued volumes (in HU, without conversion) or converted to unsigned integer intensity values (see Load > CT data conversion).

For converted images, the window level (L) and width (W) in ViewFilter are shown as converted values. For example, if the conversion from voxel Hounsfield units (voxel_HU) to voxel intensity (voxel_intensity) is given by voxel_intensity = voxel_HU + 1024, then the window level of the intensity image is L(intensity) = L(HU) + 1024, and W(intensity)=W(HU).

Another method for selecting the window level and width is via the main menu command Volume > Window Level setting > Optimal for All (or Optimal for current timepoint). This method helps the user to quickly adjust the grayscale window to view a given dataset. Note that these commands select the window center and width automatically and do not target a specific tissue.

10.3. Change Width/Level (Toolbar)

FireVoxel’s Change Width/Level toolbar tool window_level_icon is intended primarily for adjusting the grayscale window for integer images in the active layer. However, the tool will also act on real-valued images displayed as color maps, but may not be optimal for this purpose. For adjusting width/center of colormaps see Layer Control Panel > ViewFilter.

To launch the tool, click the toolbar icon (cursor becomes black/white circle). To exit, press Esc.

To use, click and drag the mouse across the image, horizontally or vertically.

To increase the window width, drag the mouse horizontally to the right. To decrease the window width, drag the mouse to the left.

To increase the window center, drag the mouse vertically up. To decrease the window, drag the mouse down.

10.4. Tissue-Specific Windows

Windowing helps to highlight specific organs or tissues in a medical image. Wide window (400-2000 HU) is suitable for displaying images with widely varying attenuation values, such as the lungs or bones adjacent to air and blood vessels. Narrow window (50-350 HU) is more suitable for displaying soft tissues. Typical tissue-specific windows (width/level combinations, HU) set using ViewFilter for CT images converted to unsigned integer volumes, may be as follows:

Lung window: L: –600 HU W:1600 HU (Fig. 10.3)

Bone window: L:500 HU W:2000 HU (Fig. 10.4)

Soft tissue window: L:50 HU W:400 HU (Fig. 10.5)

CT lung window

Fig. 10.3 CT image converted to intensity and displayed in lung window set in ViewFilter.

CT bone window

Fig. 10.4 CT image converted to intensity and displayed in bone window set in ViewFilter.

CT soft tissue window

Fig. 10.5 CT image converted to intensity and displayed in soft tissue window set in ViewFilter.