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(Radiographics. 2002;22:993-1002.)
© RSNA, 2002

infoRAD

Image Editing with Adobe Photoshop 6.01

Ronald D. Caruso, MD and Gregory C. Postel, MD

1 From the Department of Radiology, University of Louisville School of Medicine, 530 S Jackson St, Louisville, KY 40202. Received October 31, 2001; revision requested February 13, 2002 and received March 12; accepted March 28. Address correspondence to R.D.C. (e-mail: rcaruso@louisville.edu).


   Abstract
Top
 Abstract
Introduction
 System Requirements and...
 Basic Desktop
 Image File Size and...
 Basic Editing Functions
 Final Thoughts
 References
 
The authors introduce Photoshop 6.0 for radiologists and demonstrate basic techniques of editing gray-scale cross-sectional images intended for publication and for incorporation into computerized presentations. For basic editing of gray-scale cross-sectional images, the Tools palette and the History/Actions palette pair should be displayed. The History palette may be used to undo a step or series of steps. The Actions palette is a menu of user-defined macros that save time by automating an action or series of actions. Converting an image to 8-bit gray scale is the first editing function. Cropping is the next action. Both decrease file size. Use of the smallest file size necessary for the purpose at hand is recommended. Final file size for gray-scale cross-sectional neuroradiologic images (8-bit, single-layer TIFF [tagged image file format] at 300 pixels per inch) intended for publication varies from about 700 Kbytes to 3 Mbytes. Final file size for incorporation into computerized presentations is about 10–100 Kbytes (8-bit, single-layer, gray-scale, high-quality JPEG [Joint Photographic Experts Group]), depending on source and intended use. Editing and annotating images before they are inserted into presentation software is highly recommended, both for convenience and flexibility. Radiologists should find that image editing can be carried out very rapidly once the basic steps are learned and automated.

© RSNA, 2002

Index Terms: Images, hard copy • Images, processing


   Introduction
Top
 Abstract
 Introduction
System Requirements and...
 Basic Desktop
 Image File Size and...
 Basic Editing Functions
 Final Thoughts
 References
 
Adobe Photoshop 6.0 (Adobe Systems, San Jose, Calif) is an excellent tool for editing and annotating radiologic images intended for presentation or publication. The 400-page manual distributed with the program, however, is oriented to commercial color users (1) and the operations most useful to radiologists are not emphasized. This article introduces the software to radiologists and demonstrates basic techniques of editing gray-scale cross-sectional images. We first cover basic concepts, such as the Adobe desktop, image acquisition, file types, and use of the Actions and History palettes. We then demonstrate basic editing functions.


   System Requirements and Orientation
Top
 Abstract
 Introduction
 System Requirements and...
Basic Desktop
 Image File Size and...
 Basic Editing Functions
 Final Thoughts
 References
 
A modern computer with at least the amount of memory recommended by Adobe is necessary. We employ 256 Mbytes of random access memory. A good video card is also useful. The purchase price for an academic version of the program is approximately $275. The retail version costs about $600. Upgrades for either version are about $150. The software is available for both Microsoft Windows 9X (Redmond, Wash) and Macintosh (Apple \E Computer, Cupertino, Calif) operating systems (the latter version uses the same instruction manual [1]). Program installation is straightforward. The manual may be consulted if necessary.

In this article, a basic knowledge of Microsoft Windows is presumed. Capitalization or italics have been used herein for menu items, shortcut keys, and similar items. On the Adobe desktop, shortcut keys are underlined in menus or appear as a key combination after a menu item. For Tools, shortcut keys are in parentheses after the tool name, a convention we also follow in the text. Tools shortcut keys, which are capitalized by Adobe, are case insensitive; a small letter will do. Holding the cursor over an icon will reveal its identity.


   Basic Desktop
Top
 Abstract
 Introduction
 System Requirements and...
 Basic Desktop
Image File Size and...
 Basic Editing Functions
 Final Thoughts
 References
 
On opening the program, the user may display various palettes. For basic editing of black-and-white cross-sectional images, we display the Tools palette and the History/Actions palette pair. If they are not displayed, select the Window menu located at the top of the program desktop and choose them from the drop-down list. The desktop can be extensively customized as desired.

Figure 1 shows the authors’ basic program desktop with a single image open; two or more can be opened during active editing. The open image takes up most of the active image window, with the gray borders demarcating the margins of the window. The Tools palette is positioned between the image and the History/Actions palette pair. One can display either the History palette or the Actions palette by toggling between the two; that is, by selecting, at the top of the palette, the one that is hidden. (Your displayed Actions palette may have a different appearance, since users can customize their own palettes.)



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  		Figure 1.  The Adobe Photoshop desktop, with an image opened and ready to be edited and with the Tools palette and History/Actions palette pair displayed at the far right. Arrow = Crop tool, arrowhead = instructions for use of the selected tool (Crop in this view).

 
Figures 2 and 3 are close-ups of the Tools and Actions palettes, respectively. In the Tools palette, the Foreground Color is important for several operations; the overlapping Background Color is also useful. If your colors are not as shown, select the small Default icon, located just below the Foreground Color. The Switch icon (double-headed curved arrow just above the Background Color) reverses the two colors. The Crop tool is the active tool; it is highlighted in white. The same icon appears at the upper left of the desktop and instructions in the use of the tool are at the bottom of the desktop (Fig 1). (An image must be open for the instructions to appear.) Although the cursor is not visible in Figure 1, which is a "print screen" captured image of the desktop, the cursor takes the form of the Crop tool and should be visible on your desktop if you have selected it and have placed the cursor over an open image. If the Crop tool is not the active tool, it may be activated by selecting its icon or by entering its shortcut key, C (case insensitive), on the keyboard. Other tools are opened in turn by selecting the appropriate icons or keyboard shortcuts.



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  		Figure 2.  Tools palette. The letters shown are shortcut keys on the keyboard. The Crop tool is highlighted in white because it is the active tool. Arrow = Background Color, arrowhead = Foreground Color, B = Paintbrush tool, C = Crop tool, L = Lasso tool, M = Rectangular Marquee tool.

 


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  		Figure 3.  Actions palette. The palette is shown in Button mode, and the colored buttons will activate custom macros for various editing tasks. The arrowhead icon (*) at the top right is used to toggle the Actions palette to List mode. The paired History palette is selected by clicking on the History tab (arrow).

 
In the Actions palette, the colored buttons are some of the authors’ custom macros. Selecting a button will carry out its programmed action.


   Image File Size and Type
Top
 Abstract
 Introduction
 System Requirements and...
 Basic Desktop
 Image File Size and...
Basic Editing Functions
 Final Thoughts
 References
 
Size and type of the image file depend on the source and intended use of the image. Common sources of images include picture archiving and communication systems (PACS), teleradiology systems, digital scanners, and digital cameras. Main uses of images are publication and computerized presentations such as those created with PowerPoint (Microsoft) or for the World Wide Web. Editing and annotating images before they are inserted into presentation software is highly recommended, both for convenience and flexibility.

Caruso et al (2) previously described their experiences with megapixel digital cameras, which the authors still use for digitizing hard copy. In general, the authors acquire tagged image file format (TIFF) images at 300 pixels per inch for publication and Joint Photographic Experts Group (JPEG) images at much lower resolution for computerized presentations. Recently, our department acquired a complete PACS system (NT Dominator; DR Systems, San Diego, Calif) and we began downloading TIFF and JPEG images from the PACS workstations directly to floppy and zip disks. The resulting 300-pixels-per-inch TIFF images are of relatively small file size (typically 64–256 Kbytes) and are the same file size as the identical downloaded DICOM (Digital Imaging and Communications in Medicine) image after the latter has been converted from its native 16-bit architecture (65,000 shades of gray) to 8-bit architecture (256 shades of gray). The DICOM images are of lower resolution, but proportionately larger image size. The JPEG image files, downloaded at maximum quality setting, are significantly smaller. We have evaluated computed tomographic (CT) and magnetic resonance (MR) neuroradiologic images downloaded from this system in the available file formats (DICOM at both 16 bit and 8 bit, TIFF, and JPEG), both printed at high resolution and opened side by side on the Adobe desktop after required editing adjustments. We can discern no significant differences on the monitor or in the printed images among these formats. TIFF and JPEG images can be downloaded as single images from the workstation after cropping, magnifying, windowing, simple annotation, and other operations, but DICOM images must be downloaded as native files in a more cumbersome fashion and must be renamed to be opened. (A new version of our PACS software may address this.) To open DICOM images, Photoshop requires the addition of a plug-in, a small software program that can be downloaded from the Internet. The authors, in their informal evaluations, employed DICOMaccess (DesAcc, Chicago, Ill; about $350). Freeware plug-ins have also recently become available. In some settings, PACS or teleradiology systems may export images of lesser quality because compression algorithms were used. In such circumstances, it may be prudent to acquire native DICOM images if there is convenient access to single image files. DICOM files can be converted to TIFF or JPEG in Photoshop.

Final file size for gray-scale cross-sectional neuroradiologic images (8-bit, single-layer TIFF at 300 pixels per inch) intended for publication varies from about 700 Kbytes to 3 Mbytes. For instance, RadioGraphics specifies that computer images be 3 inches or 6.25 inches wide (not including the width of the borders), with most of those printed being the smaller width. Accordingly, the height of each image will determine its file size. The coronal head image in Figure 1 has a greater height (3.4 inches ) than width (3 inches), resulting in a file size of about 900 Kbytes. A sagittal head image would have a lesser height than width, with a file size of about 700 Kbytes. RadioGraphics and most other journals will also accept photographic prints. A common print size, 5 x 7 inches with white borders, has a file size of about 3 Mbytes (same file parameters as above). The white borders waste substantial file space, greatest for very narrow images. Final file size for incorporation into computerized presentations is about 10–100 Kbytes (8-bit, single-layer, gray-scale, high-quality JPEG), depending on source and intended use.

The preceding guidelines will serve as a point of departure. Some individuals may prefer to use other formats or parameters. Many combinations of imaging equipment, hardware, software, and use exist. Moreover, two individuals may have widely different results with exactly the same images, equipment, and software because of the multiple possible input and output variables. For these reasons, each radiologist should evaluate his or her own acquired images and final products (as printed, displayed, or projected) to determine the parameters that work best. Although visual examination is usually sufficient, the Image Mode drop-down menu and the Image Size and Canvas Size dialog boxes (discussed later) can be used to view the numerical parameters of an image.

The figures used in this article are, of necessity, relatively low-resolution 72-pixels-per-inch captured "print screen" files of the program desktop.


   Basic Editing Functions
Top
 Abstract
 Introduction
 System Requirements and...
 Basic Desktop
 Image File Size and...
 Basic Editing Functions
Final Thoughts
 References
 
Opening the Image and Gray-scale Conversion
Converting an image to 8-bit gray scale, if appropriate, is the first editing function. This step markedly reduces the file size, since color image files (which are three or four channels) are at least three times greater than the file size of gray-scale images, and 16-bits-per-channel images are at least two times greater than the file size of 8-bits-per-channel images. Visual inspection will not reveal these parameters.

To determine if conversion is necessary, open an image by selecting the File menu (upper left of the program desktop), selecting Open, and locating the desired file by browsing, similar to opening any file in Windows. If no suitable image is available, open a color image from the Adobe Sample file. The color status of the image is usually displayed in its title at the top of the image window. The opened image in Figure 4 is a three-channel RGB (red-green-blue) image file. Many digital cameras save all files, even those optimized for black and white, in RGB format. Now select the Image menu and choose Mode. The status of the image will be displayed by two check marks in the drop-down menu. If your image is not Grayscale and 8/bits/Channel, select these (in turn) to carry out the conversion(s). If a dialog box opens, indicate OK. The image will now be shown in gray scale, and its file size will have been reduced substantially. The new file size will be displayed near the bottom left of the desktop. (It may be possible to alter the settings in your scanner software or Photoshop such that future images are acquired as desired. For instance, DICOMaccess can be set to open native 16-bit DICOM images in Photoshop as 8-bit images, saving an editing step. Adobe plug-ins are configured by using the Help menu).



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  		Figure 4.  Desktop with a color image open and displaying the Tools palette and the Actions palette in Button mode. At this point, the user can either begin the editing process (with gray-scale conversion being the first step) or create new macros or actions.

 
The size of the viewed image can be altered by first resizing the window containing the image. With the cursor placed at a corner or side, drag the corner or side (depress the left mouse key while moving the cursor) to enlarge the window and then hold down the Control key while repeatedly depressing the + key (or - key) until the desired image size is reached. The middle mouse wheel may also be employed. A larger image is helpful in editing, particularly spot editing such as blackening any unwanted annotations. Adjustment of final image size will be covered later.

Creating Macros: Using the Actions Palette
Macros, called Actions by Adobe, save time by automating an action or series of actions. Creation and recording of a simple macro will be illustrated by automating the previously described conversion of a color image to a gray-scale image. First, open a color image and display the Actions palette in Button mode as shown in Figure 4. (If your screen has opened with the palette in List mode [Fig 5], continue reading without performing the next operation.) The prerecorded actions shown in Figures 3 and 4, each with its ownbutton, are some of those used by the authors. Now select the arrowhead icon at the top (Fig 3) to toggle to the List mode. Near the bottom of the resulting drop-down list, assuming the palette is in the Button mode shown, Button mode should be checked. De-select it (click on it to unselect it) to enter the List (Edit/Record Action) mode (Fig 5). The previously recorded actions shown could be edited or deleted at this point if desired.



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  		Figure 5.  Actions palette. The palette is shown in List (Edit/Record Action) mode. To begin creating a macro or action, select the Create a New Action icon (arrow) at the bottom of the palette. * = arrowhead icon for toggling to Button mode, arrowhead = Stop Playing/Recording button.

 
To begin creating the macro or action, select the Create a New Action icon at the bottom of the palette (Fig 5). In the New Action dialog box that appears (Fig 6), name the macro "Grayscale from Color." If desired, assign it a color or function key and then select Record. Repeat the steps given in the preceding section to convert the color image file to a gray-scale file by using the Image menu. After the image converts to gray scale, return to the Actions palette and select the Stop Playing/Recording button to terminate the macro. Convert the Actions palette back to Button mode by again selecting the triangle at the upper right and then selecting the unchecked Button mode. The new action will be displayed as a button. Next time, it will be necessary to select only the button to perform the action.



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  		Figure 6.  New Action dialog box. To name a new macro or action, type the name in the box and assign it a color or keyboard function key.

 
Most of the actions shown in Figure 3 are simple macros, carried out fully as the button is depressed. Some actions require a pause, such as those that require the user to enter information that is not identical each time into a dialog box. For instance, the authors’ Auto Level action in Figure 3 is set to pause with the Levels dialog box still open (see the Leveling section). By incorporating a pause, the user has the option of making adjustments before selecting OK. See the program manual for details on creating pauses in macros by using what Adobe calls Modal Controls. The Batch command (which can be reached by selecting Automate from the File menu) can provide further automation. For instance, all images in a folder can be altered simultaneously.

Reversing Changes: Using the History Palette
The History palette may be used to undo a step or series of steps. It is very helpful in editing. To observe its function, shift the Actions palette to the History palette by selecting it at the top of the palette. As shown in Figure 7, two buttons, signifying the last two steps we have taken, are displayed beneath the image file name in the palette. The final action—in this example, the gray-scale conversion—is selected by default. To undo the conversion to gray scale, simply select the Open button or the file name button; the image will again be in color. In a similar way, most editing changes (eg, size change, crop, filter, or annotation placement) can be undone by reverting to an earlier History level, as long as the image has not been resaved. Selecting Undo from the Edit menu also usually reverses the most recent change. As a last resort, the file can simply be closed without resaving it and then reopened.



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  		Figure 7.  History palette. The last action, conversion to gray scale, is active by default. To undo an editing change, select an earlier History level (as long as the file has not been resaved).

 
Rotating
Images are occasionally not positioned properly. Use of one or more of the Rotate Canvas commands from the Image menu permits alignment. The Flip Horizontal and Arbitrary commands are most frequently used.

Cropping
Cropping is the next action. Since data from outside the crop zone are discarded, cropping decreases the image file size. With an image open, select the Crop tool from the Tools palette. The cursor will now display the Crop symbol when it is placed over an image. Place the cursor in the image near one corner of the intended crop margin and drag it (ie, move it while holding down the left mouse button) to the opposite corner. The area outside the rectangle will be cropped when the Enter key is pressed.

Figure 8 shows an opened image with a crop field. Dragging the cursor from a point within the crop field will allow movement of the whole rectangle; dragging a side or corner box will permit adjustment of the sides. Once the crop is correct, press the Enter key. The new file size will be displayed.



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  		Figure 8.  Desktop with an open image to be cropped. The lighter rectangle within the image is the crop field. The History palette, displayed on the right, will indicate the crop when the user completes it.

 
Leveling
Contrast and brightness are most easily adjusted by going to the Image menu, selecting Adjust, and then selecting Levels. The Levels dialog box is shown in Figure 9. (If preferred, Contrast and Brightness can be selected instead from the Adjust menu.) In the Levels dialog box, check Preview and select Auto Level. If the change is acceptable, indicate OK. Further adjustment may be needed. In that case, dragging the central triangle under the histogram to the left or right usually suffices. Select OK when done. For quality MR and CT neuroradiologic images, usually little change is necessary. Some other images, particularly radiographs of the chest, may require manual adjustment, with use of all three triangles.



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  		Figure 9.  Levels dialog box. To adjust the contrast and brightness, the radiologist usually uses the Auto button as a point of departure. Manual adjustment may be carried out by using the three arrowheads under the histogram.

 
Blackening Unwanted Annotations
Eliminating annotations may be necessary if unwanted labeling or other superfluous data are present outside the image or region of interest; this is usually done for digitized hard-copy images. More advanced techniques are available if scratches or other imperfections are present inside the image. To change the color of an area, one can use Fill from the Edit menu or one or more of these tools from the Tools palette: Paintbrush (B), Eraser (E), Airbrush (J), or Magic Wand (W). For color work, one can use the Color Picker box, which is accessed by selecting either the Foreground Color or Background Color from the Tools palette. For more advanced editing, the Eyedropper tool (I) can be used to set the Foreground Color to match any existing color in the image (such as a gray background). Use of Fill and Paintbrush are described herein.

The Fill command can be carried out with either the Rectangular Marquee tool for defining a rectangular area or the Lasso tool for defining an irregular region. First, open an image and from the Tools palette select the Rectangular Marquee tool (M). Place the cursor in the image and drag it to form a box around an area to be blackened, similar to defining a crop field. Select the Edit menu and choose Fill. In the Fill dialog box (Fig 10), enter the settings shown (Black, Normal, and 100%; notice the other color options). Then choose OK and click in the image outside the area just blackened. Other areas may be blackened in the same way. If the area to be filled is not rectangular, the Lasso tool (L) may be used to trace around the margins of the area by placing the cursor at a point on the periphery of the intended area and dragging it around the area. The Fill command is then used as described.



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  		Figure 10.  Fill dialog box for blackening an unwanted annotation.

 
In some instances, it is useful to paint an area with the Paintbrush tool. The color used is set by the Foreground Color. From the Tools palette, set the Foreground Color to black and select the Paintbrush tool (B). An options strip now opens at the top left of the desktop. From that strip, select the small downward arrowhead icon to the right of Brush. From the drop-down box that appears, choose 19. Then set Mode to Normal and Opacity to 100%. Now click on the image to blacken any area, dragging the cursor as a brush. Other "brush" sizes may be chosen.

Applying Filters
Application of filters is seldom necessary for editing cross-sectional images. Most commonly, filters are used for images scanned from textbooks or for damaged films or slides. Commonly employed filters include Dust and Scratches, Despeckle, Blur, Gaussian Blur, Sharpen, Unsharp Mask, and Sharpen Edges. When needed, they can found by selecting the Filter menu and choosing the desired filter. Some practice and trial and error are necessary, and the History palette is useful here.

Sizing and Printing Final Images
As discussed, adjustment of image size and pixel number depends on the intended use of the image and is limited by the resolution and other interrelated parameters of the acquired image. It requires some experience and trial and error. From the Image menu, select Image Size to open the Image Size dialog box (Fig 11). The parameters of the image should now be ascertained. Note the Pixel Dimensions, Document Size, and Resolution. A resolution of 300 pixels per inch should be selected for printing or publication (assuming the image was acquired with sufficient resolution), and significantly less resolution is employed for most other purposes. Use of the smallest file size necessary for the purpose at hand is recommended (see Image File Size and Type section).



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  		Figure 11.  Image Size dialog box for adjusting image parameters.

 
The options Constrain Proportions (mandatory for radiologic images) and Bicubic Resample Image should be selected as shown in Figure 11. If prints are required, they can be sized as desired. To size an image as a 5 x 7-inch print with a 0.25-inch white border on the smaller side, set the Width and Height to the largest size possible such that the shorter dimension is no more than 4.5 inches and the longer dimension is no more than 6.5 inches. This is shown in Figure 11. Click OK when done. Return to the Image menu and select Canvas Size and set that to 5 x 7 inches (or 7 x 5 inches) as shown in Figure 12, making sure that the Background Color is first set to white if necessary. The Anchor should be set as shown in Figure 12. The Anchor can be altered for special bordering projects, such as a poster.



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  		Figure 12.  Canvas Size dialog box for applying borders.

 
Printing of images can be automated in many ways (see the Automate dialog box selected from the File menu), including multiple identical images on the same sheet. Use of a good ink-jet photo printer and quality glossy photographic paper should yield quality prints. Use the black or black-and-white setting, rather than color, if available.

Saving Image Files
Figure 13 shows the Save As dialog box, accessed from the File menu. Files can be saved in any of the formats listed under the Format drop-down list. When saving a TIFF or other uncompressed image to JPEG, which is a compressed format, the JPEG Options dialog box will open (Fig 14). A Quality must be selected, and radiologists should choose from 8 to 12 for typical purposes. Compression is least, and the file size the greatest, at 12. Repeated saving of JPEG files during image editing should be avoided.



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  		Figure 13.  Save As dialog box for saving files.

 


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  		Figure 14.  JPEG Options dialog box.

 

   Final Thoughts
Top
 Abstract
 Introduction
 System Requirements and...
 Basic Desktop
 Image File Size and...
 Basic Editing Functions
 Final Thoughts
References
 
The authors learned most of the above steps through trial and error. We hope the above tutorial will speed the learning curve for you. You will find that image editing can be carried out very rapidly once the basic steps are learned and automated.


   Footnotes
 
Abbreviations: DICOM = Digital Imaging and Communications in Medicine, JPEG = Joint Photographic Experts Group, PACS = picture archiving and communication systems, TIFF = tagged image file format

See also the article by Corl et al (pp 981–992) in this issue.


   References
Top
 Abstract
 Introduction
 System Requirements and...
 Basic Desktop
 Image File Size and...
 Basic Editing Functions
 Final Thoughts
 References
 

  1. Adobe Systems. Adobe Photoshop 6.0 user guide San Jose, Calif: Adobe Systems, 2000.
  2. Caruso RD, Postel GC, McDonald CS, Aronson BA, Christensen JD. Software annotated, digitally photographed and printed MR images: suitability for publication. Acad Radiol 2002; 9:346-351.[CrossRef][Medline]

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RadioGraphics 2002 22: 981-992. [Abstract] [Full Text] [PDF]



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