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is used as the dummy basic waveform filling up the vacancy. It can be shown easily that the zero vector does not interfere with the functioning of the network. By the application of (1)-(3), the j t h basic waveform stored previously is exchanged for the newly given one. When the previous waveform is the zero vector, the exchange corresponds to the addition of the new waveform; and when the new waveform is the zero vector, the exchange corresponds to the deletion of the previous waveform. Following is the procedure that exchanges the j t h basic waveform. Firstly, the connection of the lines is switched as follows. The feedback lines are disconnected from the outputs. The voltage of the j t h feedback line is set to 1 and other feedback lines to 0. The constant voltage V is set to 2 and is fed only to the resistor T,, connected with the j t h vertical line. Other resistors Tko( kfj) are disconnected from the constant voltage line. Secondly, a new , is supplied to the input lines. Thirdly, the conducwaveform Z tances are modified. The modifications are applied only to the resistors connected with the j t h vertical line or j t h feedback line. The other conductances are fixed. Arrows in Fig. 1 are subjoined only with the resistors that are needed to be modified in this case. (The arrows are actually subjoined with all resistors in order to modify all basic waveforms.) The arrows show that the conductance at the head of an arrow is modified depending on the voltage or conductance at the tail of that arrow. For every i ( i =1;. ., N ) , the conductance S,, is set in proportion to the voltage on the horizontal line (S,, = 4 ) .The conductances T,,, and Tk (k f j ; k = 1,. . ., M ) are determined by the voltage on the vertical lines. Each of these conductances takes the value at which the voltage uk on the vertical line is zero. And the conductances TJk (k f j ; k = 1; . ., M ) are set equal to Tk ( Tk = T k ) .Finally, the conductances are fixed and the connections of the lines are returned to the original state. Equations (1)-(3) can be introduced by the algorithm. Equation (1) is obvious. Equations (2) and (3) are obtained from the equation of the voltage u k . As in [l], the input impedance of the amplifier is assumed equivalent to that of the parallel circuit of the resistor R and capacitor C. Then the voltage uk on the kth vertical line satisfies
N

which integrates the line voltage. It is shown easily that the circuit brings the line voltage to zero. Each control for TJk is same as that for T k J . The proposed algorithm has the following advantages. First, basic waveforms already learned need not be maintained, because these are not needed for learning a new one. Only the new waveform and its basic waveform number are needed. Second, the learning process is completed in a short time, because it does not include repetitive presentation of basic waveforms. Though the algorithm is not applicable to other neural networks [4], it may be utilized in signal decomposition/decision problems.

REFERENCES
[ l ] D. W. Tank and J. J. Hopfield, Simple neural optimization networks: an A/D converter, signal decision circuit, and a linear programming circuit, IEEE Trans. Cmuirs Syst., vol. CAS-33, pp. 533-541, May 1986. [2] D. E. Rumelhart, J. L. McClelland, and the PDP Research Group Eds.. Parallel distributed processing-Explorations in the microstructure of cognition, vol. 1, Foundations. Cambridge, MA: MIT Press, 1986. [3] P. D. Wasserman and T. Schwartz, Neural networks, Part 2: What are they and why is everybody so interested in them now?, IEEE Expert, vol. 3, pp. 10-15, 1988. [4] R. P. Lippmann, An introduction to computing with neural nets, IEEE Acoust. Speech, Signul Processing Mug., pp. 4-22, Apr. 1987.

An Adaptive Weighted Median Filter for Speckle Suppression in Medical Ultrasonic Images
T.LOUPAS, W. N. MCDICKEN, AND P. L. ALLAN
Abstruct-A method for reducing speckle noise in medical ultrasonic images is presented. It is called the adaptive weighted median filter (AWMF) and it is based on the weighted median, which originates from the well-known median filter through the introduction of weight coefficients. By adjusting the weight coefficients and consequently the smoothing characteristics of the filter according to the local statistics around each point of the image, it is possible to suppress noise while edges and other important features are preserved. Application of the filter to several ultrasonic scans has shown that processing improves the detectability of small structures and subtle grey-scale variations without affecting the sharpness or anatomical information of the original image. Comparison with the pure median filter demonstrates the superiority of adaptive techniques over their space-invariant counterparts. Examples of processed images show that the AWMF preserves small details better than other nonlinear space-varying filters which offer equal noise reduction in uniform areas.

(
i=l

-k)

+ kO(

k)

+
k=l

kk(

Vk-

uk)

duk uk =c-+-. dt R

(4)

Applying the above algorithm, one can reduce (4) to (2) when k = j , and to (3) when k # j. It is also valuable to consider the case in which S ,, ( i = 1,. . ., N ) is not overridden by the new value but shifts a little from its old value. In this case, the network may respond to the average of the new waveform and old one. 111. DISCUSSION The simulation studies showed that the state of the network sometimes falls into the local minimum of the energy function. The global minimum was not always obtained. It may be a shortcoming of the network, but may be overcome by means of the simulated annealing technique which was used in neural network researches [2],[3]. The resistors in the network may be realized by voltage-con,, is controlled in proportrolled resistors. Each conductance for S tion to the line voltage. Each conductance for TJP and TkJ is controlled in proportion to the output of an invertmg integrator

I. INTRODUCTION Since the advent of real-time ultrasonic imaging, ultrasound is being used at an ever increasing rate and has been established as one of the most important techniques in the field of medical diagnostic technology. Image quality is of central importance to the success of an ultrasonic examination. However, ultrasonic
Manuscript received October 5 , 1987; revised March 30, 1988. This work was supported in part by the Scottish Home and Health Office. T. Loupass work was supported by the State Scholarship Foundation of Greece and by the British Council. This paper was recommended by Associate Editor H. Gharavi. T. Loupas and W. N. McDicken are with the Department of Medical Physincs and Medical Engineering, University of Edinburgh, Edinburgh EH3 9YW, United Kingdom. P. L. Allan is with the Department of Medical Radiology, University of Edinburgh, Edinburgh EH3 9YW, United Kingdom. IEEE Log Number 8824586.

OO98-4094/89/01OO-0129$01 .OO 01989 IEEE

130 images suffer from a type of acoustic noise called speckle [l], which represents one of the major sources of image quality degradation. Ultrasonic speckle, like similar phenomena encountered in laser and microwave radar imaging, is an interference effect caused by the scattering of the ultrasonic beam from microscopic tissue inhomogeneities [2]. The resulting granular pattern does not correspond to the actual tissue microstructure. On the contrary, speckle tends to mask the presence of low-contrast lesions and reduces the ability of a human observer to resolve fine detail [3]. Hence, speckle suppression by means of digital image processing should improve image quality and possibly the diagnostic potential of medical ultrasound. Ultrasonic scans represent a very difficult and demanding application area for noise reduction algorithms because, although they are heavily corrupted by noise, they possess sharp contrast which should be retained. In addition, they contain a variety of features which should also be preserved. These include bright large-scale interfaces between organs such as liver and diaphragm, structures such as small blood vessels with dimensions comparable to the average speckle size and, more importantly, boundaries between areas of slightly different grey-scale level which enable the physician to detect abnormalities such as tumors. Linear filters are not suitable for this type of images because they introduce severe blurring and loss of diagnostically significant information. The inadequacy of linear filtering techniques has long been recognized by the image processing community. In order to overcome their limitations, several nonlinear algorithms have been introduced with the well-known median filter [4] probably the most popular among them. The median filter has been widely applied in image processing, including medical imaging [5], [6], because of its edge preserving properties and simplicity of implementation. Recently, considerable effort has been devoted in developing more general families of nonlinear order statistics filters [7]-[lo] with some very interesting results. In this paper, a new nonlinear space-varying filter called the adaptive weighted median filter (AWMF) is presented. The weighted median, which is the basic estimation unit of the filter, is introduced in Section I1 together with a brief discussion on the effect of the weight coefficients on the weighted medians performance. Section I11 introduces the idea of adjusting the weight coefficients according to the local statistics of the image in order to achieve maximum noise reduction in uniform areas but also preserve resolvable structures. Comparisons with other nonlinear filters based on the median are presented in Section IV. Although the effectiveness of the AWMF is demonstrated only by applying it to ultrasonic scans, this approach could be useful for any type of speckle suppression problem where signal preservation is very important, provided that a single quantity which characterizes the statistical properties of speckle can be found. For example, the ratio of the local standard deviation to the local mean could be chosen to characterize laser speckle because it is independent of the signal intensity [ll].
11. THEWEIGHTED MEDIAN

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Fig. 1.
\

family of linear weight coefficients with variable slope a

For the sake of simplicity the filters examined in this section are one-dimensional. The weighted median of a sequence { X, } is defined as the pure median of the extended sequence formed by taking each term X,, w, times, where { w,} are the corresponding weight coefficients [14]. For example, if w1= 2, w, = 3, w3= 2, the weighted median of the sequence { X I , X,, X3 } is given by

Intuitively, it is expected that as more emphasis is placed on the central weights the ability of the weighted median to suppress noise decreases but also the signal preservation increases. This is a very useful characteristic because it allows the design of a space-varying filter which combines median-type properties with adjustable smoothing. One way of achieving this is to choose a family of weights which decrease as we move away from the center of the window and the rate of decrease is controlled by the local image content. This is the main idea behind the adaptive weighted median. Families of weights which have been proposed for the design of digital FIR filters using the window method [15] are suitable for this type of application. Since the families we have experimented with (generalized Hamming, Kaiser, etc.) have comparable performance, the simplest and computationally more efficient of all has been chosen. This is a family of linear weights with variable slope a. For a 2K + 1-point window, the weight coefficient w, at point i is given by
W,= [ wK+ -

K + 1- ill.

(2)

The weighted median is a general class of median-type filters, of which the pure median is a special case. This type of filter has been applied to astronomical images for object removal, with the weight coefficients chosen so that specified desirable features are preserved [12]. More recently, a 3-by-3 weighted median filter capable of real-time operation has been developed for impulse suppression in FM satellite TV signals [13].

The symbol [XI denotes the nearest integer to x if x is positive, or zero if x is negative. The pure median corresponds to a = 0 with all the weights equal to For the following applications a window size of 2 K + 1= 9 has been used. Fig. 1 displays the weights for three values of a. Some of the first- and second-order probability density functions (PDFs) of the weighted median have been derived in [16]. The resulting expressions tend to be very long and cumbersome so they will not be repeated here. However, they will be used to give an insight to the effects of the weights on the weighted medians smoothing characteristics. It must be noted that due to the nonlinear nature of the weighted median the curves shown in Figs. 2-4 are only valid for the specific input distributions mentioned in the text.

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The variance u k M of the weighted median when the input is a constant signal corrupted by noise gives an indication of the filters ability to suppress noise in uniform areas. By using the probability density function f W M ( x ) of the weighted median when the input is a constant signal m corrupted by white additive noise having a symmetric PDF, the theoretical output variance ukMthcan be calculated from

0.30-

(3)
The variance ukMth is plotted in Fig. 2 as a solid curve for the case of Gaussian noise with mean 0 and variance 1. From [14], an approximate expression for the variance ukMapof the weighted median is given in terms of the approximate variance of the pure median ugMapby
0.15

SLOPE a

which suggests that the variance of the weighted median is proportional to the ratio p, defined as

Fig. 2. Output variance of the weighted median (solid curve) and p (broken curve) as a function of the slope a of the weight coefficients. The input is white Gaussian noise with mean 0 and variance 1

p takes values between 1/(2K + 1) if all the weights are equal, and 1 if only one weight has a nonzero value. p is also plotted in Fig. 2 as a broken curve. Comparison between the two curves shows that the theoretical variance is indeed proportional to p for small values of a. The agreement deteriorates after the point a = 4 because the assumption made in the derivation of (4) that none of the weights wf is considerably larger than the rest is no longer valid. It is well known that median-type filters preserve ideal edges. However, in the presence of noise they do introduce edge distortion although this is smaller than the distortion introduced by linear filters [17]. As a quantitative index of the weighted medians performance in edge preservation when noise is present the mean square error MSE has been used. Let us consider an ideal edge of heights h , , h , , with the transition occurring at point M and corrupted by white additive noise. Since for a filter size of 2 K + 1 the window encounters the edge 2 K times, the total MSE is defined from [17] as
M+K-1

.
\

SLOPE a

Fig. 3. Total MSE introduced by the weighted median (solid curve) and l/p (broken curve) as a function of the slope a of the weight coefficients. The input sequence is an ideal edge corrupted by white additive Gaussian noise with mean 0 and variance 1.

total MSE =
1-M-K M+K-1

E { ( y, - s,)}

J(x-s,)fwM(x;i)dx

(6)

r=M-K

where filter output when the window is centered at position i, s, signal value at that point before noise was added, f w M ( x ;i) PDF of the weighted median at position i when the input is an ideal edge corrupted by white additive noise. The total MSE is plotted as a solid curve in Fig. 3 for the case of Gaussian noise with mean 0, variance 1, and edge heights h, = 0, h , = 5. The broken curve represents the inverse quantity of (59, l/p = [CW,]~/[CW?]. Again there is a close agreement between the two curves up to a value of a = 4. Figs. 2 and 3 follow a similar pattern. For weights relatively close to the central value (slope values a = 0 to 2) the filter Y,

behaves almost as a pure median, offering maximum noise suppression in uniform areas but also introducing maximum distortion to edges corrupted by noise. However as the slope a increases, i.e., the weights fall more rapidly as we move away from the center of the window, signal preservation improves at the expense of the ability to reduce noise. Signal preservation is proportional and noise reduction is inversely proportional to p provided that the weights do not have significantly different values. The ability of the ratio p to describe the weighted medians performance improves as the filter window becomes larger. By calculating the Fourier transform of the autocorrelation of the output when the input is a constant signal corrupted by white additive noise, the power spectrum of the weighted median has been obtained for slope values a = 0, 3, and 6 (Fig. 4). This figure illustrates how the slope a modifies the low-pass characteristics of the weighted median. As the slope increases the bandwidth becomes wider while both ripple and attenuation in the stopband zone are reduced. It is interesting to note the similarity between this behaviour and that of the weighted average filters.

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G a w

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-5 O

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0.10

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0.30

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30

BO

BO

NORMALISED FREQUENCY

MEAN GREY-SCALE LEVEL

Fig. 5 .

Fig. 4. Normalized power spectrum of the weighted median for three different sets of weight coefficients. The input is a constant signal plus white additive Gaussian noise (quantized to 32 levels).

Standard deviation vs. the mean of ultrasonic speckle noise

111. THEADAPTIVE WEIGHTED MEDIAN FILTER

It has been stated already in Section I that a noise smoothing algorithm applied to ultrasonic scans must satisfy several diverse and conflicting requirements. A space-invariant filter which performs the same type of operation to every pixel of an image cannot satisfy all requirements simultaneously. This is true even in the case of nonlinear edge-preserving filters because signal preservation deteriorates rapidly as the window size increases to provide adequate noise reduction. Clearly what is needed is a space-varying algorithm which takes into account the local image content. Local statistics have been widely used to describe the image content in space-varying filtering applications [18]. The statistics of ultrasonic speckle have been studied along similiar lines as laser and synthetic aperture radar speckle [19]. It has been found that the envelope-detected signal has Rayleigh distribution with mean proportional to the standard deviation. This implies that speckle could be modelled as multiplicative noise. However, the signal processing stages inside the scanner (logarithmic compression, low-pass filtering, interpolation) modify the statistics of the original signal. By taking into account these factors we have arrived at the graph of the standard deviation versus the mean of speckle shown in Fig. 5. The solid curve has been obtained by modeling the signal processing stages mentioned above. The points represent experimental measurements from scans of objects which have acoustic properties similar to those of soft tissue (tissue mimicking phantoms). From this figure it is evident that speckle is no longer multiplicative in the sense that the mean is proportional to the variance rather than the standard deviation. Therefore, if x denotes the true signal, n is a noise term which is independent of x and has mean 0 and y is the observed signal, the following signal-dependent noise model can be used:

The adaptive weighted median (AWM) takes advantage of the fact that the ratio u/m can characterize the local image content by performing space-varying weighted median filtering with the weight coefficients adjusted according to the local statistics of the image by using the formula
w(i,j )
=

[ w( K +1, K + 1 ) - cdo/rn]

where
c m , U

[XI

scaling constant, the local mean and variance inside the 2K +1 by 2 K + 1 window, distance of the point ( 2 , j ) from the centre of the window ( K 1, K + l), defined as in (2).

=x

+ x1l2n.

( 7)

Assuming that a uniform area is scanned, i.e., x = m is constant, it can be easily proven from (7) that the variance U of the observed signal is U = mu:, where U,? is the noise variance. The curve of Fig. 5 establishes the expected values of u/m for uniform areas of speckle.

Equation (8) is the 2-D equivalent of the weight equation (2) with the product c d / m corresponding to the slope a. In Section I1 it has been demonstrated that the selection of the weight coefficients represents a trade-off between noise reduction and signal preservation. For uniform areas where intensity fluctuations are due to noise, the local mean and variance follow the curve of Fig. 5. The constant c has been chosen so that in this case the slope cu/m has a low value. Hence, maximum noise reduction is performed. However when the filter window includes a resolvable structure or a boundary between two regions of different greyscale level, the local variance is larger than that expected from a uniform area having the same local mean. Consequently, the slope increases and fine image detail can be preserved. The AWMF parameters have been selected experimentally in terms of the clinical quality of the processed image. In the following applications the window size, which determines the maximum noise reduction, is 9 by 9. The scaling constant c and the central weight w( K + 1, K l),which determine the filters ability to preserve image detail are equal to 20 and 99, respectively. Experience has shown that the values chosen give satisfactory results with a variety of images from different patients and scanners. The images of Fig. 6, which display part of the liver and portal vein, are used to demonstrate the AWM filters ability to preserve not only bright edges but also subtle grey-scale variations. Fig. 6(a) is a magnified region taken from a 576X530X&bit ultrasonic scan and Fig. 6(b) is the same region taken from the

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LO

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(b)
Fig. 6. Part of an ultrasonic scan of the liver (L) and portal vein (PV). (a) Original. (b) Adaptive weighted median 9 by 9. The images have been magnified from 64 x 64 to 256 x 256

Fig. 7. (a) Ratio a 2 / m along column 23 of the original image of Fig. 6(a). calculated using a 9 by 9 window. (b) Corres onding values for the ratlo p of the AWMF. (c) The 9 by 9 variance along column 23 of the processed image of Fig. 6(b), normalized by the variance a calculated along the same column of the original image.

processed scan. Comparisons between the two images shows that speckle has been almost totally eliminated and the visibility of the hypoechoic area above the portal vein has been greatly enhanced in the processed image. Some quantitative data about the AWM filters operation, calculated from Fig. 6 along the columns indicated by the white markers and using 9 by 9 windows, are presented in Fig. 7. The ratio u/m of the local variance to the local mean of the original image is plotted in Fig. 7(a) and its effect on the weight coefficients of the AWMF can be seen in Fig. 7(b) which plots the quantity p = [ X w 2 ( i ,j ) ] / [ C w ( i ,j ) ] , already defined in (5) for the 1-D case. Finally, the noise reduction acheved can be seen from Fig. 7(c) which plots the ratio uiWM/u2of the local variance of the processed over the local variance of the original image. The three graphs follow similar patterns with high values of u2/m, which imply the presence of an edge or resolvable structure, resulting in less noise reduction. Also, p is approximately proportional to the variance uiWM, something observed in Section I1 for the 1-D case. The AWMF possesses certain advantages. The use of local statistics enables space-varying processing to be performed which takes into account the local image content. The median-type nature of the filter guarantees good signal preservation even in regions of subtle grey-scale variations, like the hypoechoic area of Fig. 6(a) and 6(b). In addition, the weighted median is more suitable than the pure median for a space-varying application because it offers more flexibility. The smoothing characteristics of the pure median can only be controlled by its window size. On the contrary, it has been shown in [20]that for a given window length the weighted median acts in a very large (but finite) way on the data, depending on the selection of the weight coefficients. The method for finding the AWM at a particular point involves a three-step procedure. First, the local statistics of the terms inside the window and the weight coefficients are calculated. Next, the grey-level histogram H ( I ) , I = 1,. . . , (maximum

grey level), of the minimum square window which includes all the nonzero weight coefficients is formed by examining the grey level x , , of each pixel ( 2 , j ) and incrementing H(x,,) by the corresponding weight coefficient. Finally, the weighted median is determined as the smallest grey level y,, which satisfies
VWM

H(I)2 ( c w ( r n . n ) + 1 ) / 2
/=1

( 9)

where Z w ( m , n ) is the sum of the weight coefficients.

IV. COMPARISONS The AWMF was compared with three more nonlinear filters. The task of comparing different algorithms can be very difficult, especially when real instead of simulated images are to be processed, because there is not an objective way of selecting the parameters such as window size, thresholds etc. of the algorithms involved. The approach followed here was to process speckle images obtained from tissue mimicking phantoms which do not contain any resolvable structures and choose the parameters which offered equal noise reduction. Fig. 8(a) is a scan of the liver, gallbladder and the hepatic vein. The 64 X 64 area enclosed by the white square has been magnified and is displayed as a 128 x 128 image at the top left part of Fig. 8(a). The vertical profile of the intensities along the column indicated by the markers above and below the square is displayed at the top-right part of the image. The processed images of Fig. 8 are also displayed following the same format. Processing by the AWMF results in Fig. 8(b). Comparison with Fig. 8(a) shows that speckle has been suppressed to a great extent in the processed image while the edges are as sharp as in the original and all the important features have been preserved. Also. processing seems to improve the resolution of small structures, like the portal tracts and small blood vessels in the left part of the scan, which

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(e)
Fig 8
Ultrasoiu \can of the lner (L),gailbladder I(%) and the hepahc win (hv) (a) Ongind (b)Adlrrpti\e ueightd medun V 1% 9 ( c i Sepatdhle median o f 5 pomti (d) Vanablelength rrretlian 9 bv 9 ( e ) T3W MTM 7 h\ 7

were previously obscured by speckle. Fig. X(c) is obtained by processing the original scan with a separable median of 5 points (first along the vertical and then along the horizontal direction) which was preferred instead of the 2-D median because in some cases it offers better signal preservation [21]. This figure demonstrates the inadequacy of space-invariant filters. Despite the fact that a small window of 5 points was chosen. there is considerable

loss of image detail and also insufficient noise suppression, &\ it can be seen by coinpmng Fig X(b) and (c). An additional disadvantage is that the processed scan has a \em blotchy appearance. A 7 - or 9-point mindow uhicb offers cmnparable noise reduction to that of the AWMF introduces severe blurnng and

results In an image uhere almost all diagnostic inforniation i s lost. A5 a computationally len demanding aiternativo to the

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AWMF the original scan has been processed by a variable-length median filter (Fig. S(d)). This is a 2-D median filter with a window size 2 N + 1 by 2N + 1 calculated at each point from the formula

V. CONCLUSION
The flexibility offered by the W M s through the selection of the appropriate weight coefficients can make the use of mediantype filters more efficient and better suited to particular applications. The AWM filter for speckle suppression in medical ultrasonic images demonstrates this. The filter combines the edge-preserving properties of the W M s with the space-varying implementation based on the local image characteristics to reduce significantly the speckle with negligible loss of genuine image detail. The examples shown above indicate that processing improves the detectability of subtle grey-scale variations and small structures within the parenchyma of an organ, and seems to enhance the information content of an image.
ACKNOWLEDGMENT

N
where 2K

[ K( 1- c u 2 / m > ]

+ 1 by 2 K + 1

m , U
C

I.[

maximum window size, mean and variance of the terms inside the 2 K + 1 b y 2 K + 1 window, scaling constant, defined as in (2).

The parameters chosen for this filter were 2 K + 1= 9 and c = 0.30. Fig. S(b) and S(d) exhibit similar appearance, something not very surprising since both filters use the same local statistics criterion. However the variable-length median is not able to perform fine adjustments to its smoothing characteristics because it can only offer a few distinct modes of action (5 in this case: from window size 9 by 9 to 1 by 1). This inflexibility, which results in smearing of fine details such as the branch of the hepatic vein indicated by the arrow, restricts the diagnostic quality of the processed image. The result of processing the original scan by the double-window modified trimmed mean (DW MTM) filter is shown in Fig. S(e). This is an adaptive nonlinear filter which can be implemented without having to calculate the local statistics at each point of the image and has been found to perform better than other generalized median filters [SI. The DW MTM filter involves a two-step procedure. First, the median m,, of a small window centered at pixel ( 2 , j ) is found and used as an initial estimate of the true signal value. Then, a better estimate is obtained by averaging all the terms inside a larger window which lie within the interval [m,, - q, m,, + q]. The threshold q is related to the noise variance and in general it is signal-dependent and determined by the type of noise degradation [22]. For the noise model assumed here (7), q is given by

The authors would like to thank the referees for providing constructive comments and suggestions.
REFERENCES
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q = c { m,, } 1
The filter parameters chosen were: median window 3-by-3, mean window 7-by-7, c = 2. The DW MTM has a satisfactory performance as it can be seen from Fig. Se. Speckle has been reduced substantially and the overall appearance of the scan is much cleaner. However, comparison between Fig. S(b) and (e) shows that the DW MTM filter has an inferior performance in signal preservation than the AWMF. For example, the visibility of small structures such as the portal tracts and blood vessels in the left part of Fig. S(e) has been reduced. This happens because even the use of a small 3-by-3 window for calculating the median m,, can cause loss of image detail. Also, the averaging operation performed during the second phase of DW MTM filtering can introduce a degree of blurring, something which can be appreciated better by comparing the magnified regions of Fig. S(b) and (9. As far as computational complexity is concerned the AWMF is the least efficient of the filters compared here. The average CPU times on a MicorVax I1 were: separable median-15 s, DW MTM-100 s, variable-length median-110 s, AWMF-230 s. However, this is not regarded as a serious disadvantage for an off-line application such as ours. A clinical trial involving seventy five patients is in progress to evaluate the clinical usefulness of this technique