Image Editing Using IrfanView

Download of this freeware program from Irfanview.

Image01.jpg (28771 bytes) You can either open an existing file from the Irfanview program or right click on the image you wish to edit, and select copy. This copies the image to the image clipboard. Then in IrfanView, use the Edit/Paste menu item or Control V to paste the image into the editor.
Image03.gif (32296 bytes) The initial task is to improve the brightness and contrast so one can see something of the clinical problem. Open Image Menu and select Enhance Colors
Image04.jpg (75747 bytes) Initially the Enhance Colors control box shows the thumbnails of the original and new images the same. Note also that Brightness and Contrast control sliders are at zero and the Gamma correction at 1.00. Saturation and colour balance controls are not used in Xray editing as you end up in Grayscale, monochrome.

The original images, seen at upper left is not changed until the OK or Apply to Original button is clicked.

Image05.jpg (74145 bytes) Increasing the brightness to +60 in this image makes more of the detail of the 1sr ray metatarsophalangeal joint appear but there is little contrast between the bone and soft tissues.
Image06.jpg (36428 bytes) With a bit more adjustment of brightness and contrast the image is improved further.
Image07.jpg (74139 bytes) A small adjustment to Gamma correction. This is mainly a control for colour rendition but it does have an effect on monochrome contrast as well.
Image08.jpg (75310 bytes) Click the Apply to Original button and the original is changed so you can see it full sized. Note you can use the Undo button on the Toolbar if you don't like the effect.
Image09.gif (34123 bytes) Convert the image to Greyscale using the Image menu / Convert to Greyscale item. In addition to improving the way the image looks this conversion makes a big difference to the size of the image.
Image10.jpg (27041 bytes)  Image11.gif (29352 bytes) Although the image is quite small overall there many areas that convey no useful clinical information, including the fingers of someone who is holding the child's foot. It increases the size of the file for no purpose. These areas should be cropped out.

The area to be retained is outined by dragging the cursor diagnonally across the valuable parts of the image. Detailed adjustments can then be made placing the cursor on one margin of the selected area and dragging the margin one way or the other. Once the area has been selected to your satisfaction you can crop it.

Image12.gif (7155 bytes)   Usually the image is still too big at this stage in editing. This one was (IMO) too small so I elected to enlarge it. You could lose some information doing this so it is not normally a good thing to do. The controls for increasing or decreasing the size of the image are opened from the Image Menu / Resize/Resample.

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Image13.gif (15468 bytes) A normal computer screen window is 1024 X 800 pixels so a good size for an Xray image is about 600 max width or 600 max height, or less. I usually use Pixels for sizing an image I am sending over the net and cms for images I am editing to print. Make sure the Preserve Aspect Ratio box is checked before you alter the dimensions
image14.jpg (7875 bytes)  Image01.jpg (28771 bytes) The fully edited picture compared to the original.

It is still not adequate for offering a clinical opinion. A better Xray in the first place would help, but it would also have helped to overexpose by 2 stops for such an underpenetrated film.

All images can be improved by editing. Before you send one think back to your fiercest professor and ask yourself what he/she would say if you displayed an image of this quality at a clinical teaching session.

best.jpg (5099 bytes) Using the more elaborate controls of Lview and cropping tighter, this version is a lttle better but is beginning to show pixelation owing to the extent of the manipulation. The message is that you must start with a good image; if you have one you can and should improve it by editing it, but there is a point beyond which you cannot go.