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American Journal of  Medical 
Science and Innovation (AJMSI) 

Analysis of  Window Width Variations on MSCT Stonegraphy Anatomic Image
Information at Sanjiwani Hospital of  Gianyar Regency

I Made Dwi Gunawan1*, Anak Agung Aris Diartama1, I Made Adhi Mahendrayana1, Putu Irma Wulandari1

Volume 2 Issue 2, Year 2023
ISSN: 2836-8509 (Online)

DOI: https://doi.org/10.54536/ajmsi.v2i2.2076
https://journals.e-palli.com/home/index.php/ajmsi

Article Information ABSTRACT

Received: September 04, 2023
Accepted: September 30, 2023
Published: October 09, 2023

Parameters in MSCT can affect image contrast and brightness are values of  Window width 
and window level. window width will affect the contrast of  the image. where the higher 
the value of  window width used, the image contrast will decrease, where is the selection of  
the value of  window width which can improve the quality of  MSCT images and provide 
better diagnostic information. The purpose of  this research is to determine the effect of  
window width variation on anatomy image information and determine the most optimal 
window width value MSCT Stonegraphy examination. This research is a quantitative with 
an experimental approach. The data obtained was then analyzed by kappa test to assess the 
reliability of  the respondents, from the results of  the respondents then the statistical test 
used was the Friedman test. Statistical test results p value <0.05. This research has the effect 
of  changing values window width. anatomical image information with value of  window 
width 250 showed optimal results for assessing the urinary tract on Stonegraphy MSCT. 
In this study there is the effect of  variation window width significant to the Stonegraphic 
MSCT anatomical image information.

Keywords
MSCT, Stonegraphy, Window 
Width

1 ATRO Bali, Indonesia
* Corresponding author’s e-mail: oguna919@gmail.com

INTRODUCTION
Multislice Computed Tomography (MSCT) stonography 
is an examination of  the urinary tract without using oral 
or intravenous contrast media. MSCT Stonegraphy is one 
of  the examination techniques used to view and diagnose 
urinary tract abnormalities, namely hydronephrosis, 
urolithiasis, nephrolithiasis, so MSCT Stonegraphy is used as 
a substitute for IVU (intravenous urography) examinations, 
because it cannot provide qualitative diagnostics.
All aspects related to the accuracy of  displaying organ 
structures and tissues in images are included in image 
quality. Factors that influence image quality include 
spatial resolution, contrast resolution, noise, and artifacts. 
To obtain an optimal image, an image display with clear 
contrast is required. Parameters in MSCT that can affect 
image contrast and brightness are the window width and 
window level values (Bontrager & Lampignano, 2014)
To modify the grayscale on MSCT, a process called 
windowing is used, by setting the CT window width 
and window level values. The window width level will 
affect the image contrast, where the higher the window 
width value used, the image contrast will decrease, 
where selecting the appropriate window width value can 
improve the quality of  the MSCT image and provide 
better diagnostic information (Singh, 2020).
A wider Window Width (2000 HU) will display a larger 
CT number range, so that changes from dark to light areas 
will occur over a wider area (Nadya, 2021). Therefore, 
using a wide Window Width will show all the different 
CT number values, so that soft tissue is not clearly visible. 
On the other hand, a narrow Window Width is very good 
for displaying similar anatomical structures such as soft 
tissue (Nadya, 2021).

The protocol used in the MSCT Stonegraphy examination, 
namely the MSCT Abdomen protocol, includes kV, mAs, 
Slice, Slice Thickness, Pitch, FOV, Range, Reconstruction 
Algorithm and Window Widht and Window Level (Singh, 
2020), and uses soft tissue windowing (Soomro, Ather , & 
Salam, 2016). The Window Widht setting is between 50 to 
350 HU, to distinguish networks that have almost the same 
density (Nadya, 2021), while according to Seeram (2022), 
use a Window Width of  350-600 HU to see different soft 
tissue network structures with the same density.
From data obtained at the Radiology Installation at 
Sanjiwani Hospital, Gianyar, there are approximately 40 
patients undergoing MSCT Stonegraphy examinations a 
month. The MSCT Stonegraphy examination at Sanjiwani 
Hospital Gianyar is one of  the most frequent types of  
examination every month, with various diagnoses, such 
as Urolithiasis, kidney stones, Hydronephrosis, and UVJ 
stones. The management of  MSCT Stonegraphy at 
the Sanjiwani Hospital Gianyar installation uses a plain 
MSCT Abdomen protocol with a Window Width of  
300 HU. Based on the explanation above, the author is 
interested in conducting research on optimizing Window 
Width in MSCT Stonegraphy examinations. The aim of  
this research is to determine the effect of  variations in 
window width on anatomical image information and to 
determine the optimal value of  window width on MSCT 
Stonegrafi anatomical image information.

LITERATURE REVIEW
Computed Tomography (CT)
CT Scan is a supporting tool for making a diagnosis that 
uses a combination of  X-rays and a computerized system 
to obtain sliced images of  various pieces of  human body 



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objects. Data processing with a computerized system to 
produce a cross-sectional view of  the image and can also 
display a three-dimensional image of  the internal organs 
and structure of  the body can also help diagnose the 
internal body in normal or abnormal conditions, CT-
Scans are also used in accurate treatment procedures for 
assists in instrument placement or patient care.
Computed Tomography (CT-Scan) consists of  3 (three) 
main components: Gantry, computer, and operator 
console. Computed Tomography (CT-Scan) uses the 
main principle, namely the rotation of  the x-ray tube 
and emitting x-rays continuously, followed by movement 
of  the patient’s table, so that there are multislices in one 
patient movement.

The X-ray radiation beam will experience an exponential 
decrease in intensity with the thickness of  the object 
it passes through. The decrease in the intensity of  
the radiation beam occurs as a result of  the radiation 
interaction process in the form of  absorption or 
scattering, the probability of  which occurs is determined 
by the type of  object and the radiation emitted. To get an 
image of  an object in Computed Tomography (CT-Scan), 
the radiation beam produced by a radiation source will go 
towards an object from various angles. Scattered radiation 
will be detected by the detector system to be stored and 
collected as input data which is then processed using a 
computerized system to produce images using a method 
called reconstruction.

Figure 1: Working System of  MSCT

Parameter Computed Tomography (CT-Scan)
According to Bontrager (2018), the quality of  the image 
produced by MSCT is an important factor in displaying 
a good image, thus allowing the clinical aspects of  the 
image to be used to make a diagnosis. When using 
Multislice CT, there are several parameters that must be 
considered to control optimal image output. Multislice 
CT parameters are as follows:

Range
Range is the result of  combining a number of  slice 
thicknesses. Range is used to produce different slice 
thicknesses in one examination area.

Slice Thickness
Slice Thickness is the thickness of  the cut or slice of  
the object being examined, also expressed in millimeters 
(mm).

Exposure Factor
Exposure factors are factors that influence tube voltage 
(kV), tube current (mA) and time (s). The amount of  
tube voltage can be selected automatically for each 
inspection

Field of  View (FOV)
FOV is the diameter of  the image to be reconstructed 
between 200-300mm

Gantry Tilt
Gantry tilt is the formation of  an angle between the 
vertical plane and the gantry (X-ray tube with sectors). 
The angle range is between -30° to +30°. Gantry angles 
function for diagnostic purposes in each case.

Matrix Reconstruction
Matrix reconstruction is a series of  rows and columns 
of  picture elements (pixels) in the image reconstruction 
process. Generally the matrix used is 512 x 512 in size.

Reconstruction Algorithms/ Kernel Filters
Reconstruction Algorithms are mathematical procedures 
used in reconstructing images. The appearance and 
characteristics of  the Computed Tomography image 
depend on the strength of  the algorithm chosen.

Window Width
Window width refers to the computed tomography 
(CT) values converted to gray levels for display on a 



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TV monitor. After the image is processed through 
matrix reconstruction and algorithms, the results will be 
converted into a numerical value called the CT Number. 
This CT number is measured in Hounsfield Units (HU), 
where bone has a HU value of  around +1000 to +3000 
and air has a HU value of  around -1000. Tissue or other 
substances have different HU values depending on their 
density. As a result, bones will appear as white and air 
will appear as black on the monitor. Tissue and other 
substances will be displayed as different levels of  gray 
called Gray Scale. However, if  iodine is used as a contrast 
medium, blood that initially appears as gray levels may 
appear as white (7). A narrower window width can increase 
greater detail in anatomical image quality, for example the 
use of  a narrow window width (70 HU) in head MSCT 
examinations in cases of  non-hemorrhagic stroke.
According to Seeram (2022), the correct use of  window 
width is 400HU - 2000HU to cover different tissues, for 
example tissue in parts of  the body, namely the abdomen, 
using a window width of  350 HU to 600 HU in order to 
differentiate fat, fluid and muscle.
According to Buzug 2008, to show the condition of  the 
bones using a window width of  1500HU and to show 
soft tissue using a window width of  350HU, visible on 
abdominal examination. Differences in spine density can 
only be seen in the bone window because the window 
width is wide, but cannot show soft tissue. Soft tissues 
such as the liver and kidneys can be differentiated quite 
well in a narrow window width with a value of  +225HU, 
whereas according to R. Bruening et.al the Ct Scan 
examination to show the kidneys uses a window width of  
420 to get maximum results on the kidney organs.

Window Levels
Window level is the middle value of  the window used 
for image display. This value can be selected and depends 
on the weakening characteristics of  the structure of  
the object being examined. Window level determines 
the density of  the image to be produced (7). Using the 
correct window level will produce good anatomical image 
quality, which is indicated by clear boundaries between 
different tissues. When examining a Thorax CT scan for 
lung window conditions, using a window level of  -450 is 
better in displaying anatomical image quality.

a) Computed Tomography (CT-Scan) Image Quality
b) According to Nagel, the factors that influence image 

quality are spatial resolution, contrast resolution, noise 
and artifacts.

Spatial Resolution
Spatial Resolution is to distinguish small objects with 
different densities from the same background.

Contrast Resolution
Contrast resolution is to differentiate organs with very 
small differences in density which are influenced by object 
size, exposure factors, slice thickness, and reconstruction 
algorithms/kernel filters.

Noise
Noise is the fluctuation (standard deviation) of  the 
attenuation value in a homogeneous tissue or material.

METHODOLOGY
This research is quantitative research with an experimental 
approach. The resulting data is on an ordinal scale, so a 
descriptive test is carried out to group the data followed 
by a kappa test to assess the reliability of  the respondents. 
From the respondents’ results, the statistical test used 
is the Friedman test, if  the p value is <0.05 then Ho is 
rejected and Ha is accepted, meaning that there is an 
influence of  window width variations on the MSCT 
Stonegrafi anatomical image information. 

RESULTS AND DISCUSSION
Based on data obtained from MSCT Stonegraphy 
patients at the Radiology Installation at Sanjiwani 
Hospital, Gianyar, the examination was carried out using 
the Siemens Somatom Definition AS 64 Slice MSCT tool 
using varying window width values, namely 250, 300, 350, 
400. Data from this study were obtained from 15 patients 
as a research sample, so that 60 image results were 
obtained. From the slices obtained, the slice that most 
clearly shows the kidneys, ureters, urinary bladder and 
pathology in one image is selected. Then the assessment 
of  anatomical information is obtained by giving an 
assessment score of  1 to 3.

Table 1: Results of  Kappa test.
Value Approximate 

Significance
Measure of  Agreement Kappa .881 .000
N of  Valid Cases 15

Table 1 shows that the kappa test above means that the 
level of  reliability between the two respondents is strong, 
(strong agreement) namely 0.881.
Analysis of  window width variations in anatomical image 
information during the MSCT Stonegraphy examination at 
the Radiology Installation at Sanjiwani Hospital, Gianyar.
Data was obtained from 2 questionnaires that were 
distributed to radiologists. Because the data is ordinal 
in nature, the data is then processed using the Friedman 
Test, where the results are obtained according to Table 2.
Based on Table 2, the results of  the Friedman test regarding 
window width variations in the MSCT Stonegraphy 
examination of  anatomical image information shows a 
p value of  0.000 (p value <0.05) which means that Ho is 
rejected and Ha is accepted.

Table 2: Results of  Friedman test.
N p value Results
Window width variation 
analysis of  MSCT 
Stonegraphy anatomical 
image information

0.000 P value <0.05 
Ho Rejected 
Ha Accepted



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The results of  this research are related to research 
conducted by Muhammad Izzudin et al. (2020) which 
shows the results of  Asymo. Sig is smaller than 0.05 (p 
value <0.05), which means there is a difference in changes 
in window width variations, which can also be interpreted 
as meaning that changes in window width have an effect 
on image information.
According to Buzug (2008), to show the condition of  the 
bones using a window width of  1500HU and to show 
soft tissue using a window width of  350HU, visible on 
abdominal examination. Differences in spine density can 
only be seen in the bone window because the window 
width is wide, but cannot show soft tissue. Soft tissues 
such as liver and kidneys can be differentiated quite well 
in a narrow window width with a value of  +225HU.
The results of  this research are also supported by the 
results of  the author’s observations while conducting 
research at the Radiology Installation at Sanjiwani 
Hospital, Gianyar, namely, on the radiologist’s advice, the 
radiographer changed the window width conditions to 
between 250 and above to obtain optimal image results 
according to the needs for diagnosing patients.

The Most Optimal Window Width Value to Obtain 
Good Anatomical Image Information During the 
MSCT Stonegraphy Examination at the Radiology 
Installation at Sanjiwani Hospital of  Gianyar Regency
Data was obtained from a questionnaire distributed to two 
radiologists as respondents to determine the most optimal 
window width value to obtain good image information. 
Then the data is input using statistics according to the 
questionnaire data that has been selected.

the optimal window width value for showing the anatomy 
of  the urinary tract is 300. According to Buzug (2008), 
Differences in spine density can only be seen in the bone 
window because the window width is wide, but cannot 
show soft tissue. Soft tissues such as liver and kidneys 
can be differentiated quite well in a narrow window width 
with a value of  +225HU.

CONCLUSIONS
The results of  the research show that there is a significant 
influence of  window width variations on the anatomical 
image information of  MSCT Stonegrafi. The most 
optimal variation in window width values for obtaining 
anatomical image information shows a mean rank of  7.23 
with a window width value of  250. This value is able to 
display the anatomy of  the urinary tract clearly and clearly.
The window width selection for the MSCT Stonegraphy 
examination is recommended to use a window width of  
250. Each hospital has a different window width value 
in order to obtain optimal results for confirming the 
diagnosis. Future research can further vary the window 
width in the MSCT Stonegraphy examination, and so that 
each anatomy is assessed.

REFERENCES  
Bontrager, K.L., Lampignano, J.P. (2014). Handbook of  

Radiographic Positioning and Techniques. Journal of  
Chemical Information and Modeling. 

Buzug, T.M. (2018). Computed Tomography (Frim 
Photon Statistics to Modern Cone-Beam CT). 
Germany: Springer.

Drake, R.L., Vogl, W., Mitchell, A.W.M. (2016). Gray Basic 
Anatomy. Second Edition. Elsevier, Piladelphia.

Izzudin, M., Sukmaningtyas H., Sulaksono, N. (2021). 
Analisis Variasi Window Width Terhadap Informasi 
Citra Anatomi MSCT Stonegrafi. JRI (Jurnal Radiogr 
Indones, 4(2), 99–105. 

Nadya, N.S. (2021). Prosedur Pemeriksaan CT Scan 
Urografi Dengan Klinis Batu Saluran Kemih di 
Instalasi Radiologi RS Awal Bros Panam. Karya Tulis 
Ilmiah. STIKES Awal Bros Pekanbaru, 6-7.

O’Connor, O.J., Maher, M.M. (2010). CT Urography. Am 
J Roentgenol, 195(5):320–4. 

Romans, L.E. (2011) Computed Tomography for 
technologists A Comprehensive Text. Philadelphia, 
Pennsylvania. 317-33.

Seeram, E. (2022). Computed Tomography: Physical Principles, 
Patient Care, Clinical Applications, and Quality Control. 
Fifth Edition. Elsevier.

Singh, V. (2020). General Anatomy with Sistemic Anatomy 
Radiological Anatomy Medical Genetics. Third Edition. 
206-7.

Watson. (2018). Chapman & Nakielny’s Guide to Radiological 
Procedures. seventh Edition. 132-3.

Yuliana. (2017). Diktat Urinary Tract. Bagian Anatomi 
Fakultas Kedokteran Universitas Udayana Denpasar, 
8-12.

Table 3: Mean Rank.
Mean Rank
R1_250 7.17 R1_250 7.23
R2_300 4.10 R2_300 4.47
R3_350 3.57 R3_350 3.13
R4_400 2.93 R4_400 3.40

Based on Table 3, the mean rank results regarding the 
optimal window width value show that the window width 
value of  250 has the largest mean rank value, namely 7.17 
and 7.23.
The results obtained can be interpreted as meaning that 
this research can make the window width value of  250 the 
optimal variation to show a good anatomical image in the 
MSCT Stonegraphy examination. Apart from being based 
on statistical test results, based on direct observation by 
the two respondents, namely radiology specialists, they 
stated that a window width value of  250 could show clear 
anatomy of  the urinary tract.
The results of  this research are also supported by other 
similar research conducted by Izzudin et al. (2020) 
regarding analysis of  window width variations on MSCT 
Stonegraphy anatomical image information showing that 


