Abstract:Background and objective: High-resolution radiographic images play a pivotal role in the early diagnosis and treatment of skeletal muscle-related diseases. It is promising to enhance image quality by introducing single-image super-resolution (SISR) model into the radiology image field. However, the conventional image pipeline, which can learn a mixed mapping between SR and denoising from the color space and inter-pixel patterns, poses a particular challenge for radiographic images with limited pattern features. To address this issue, this paper introduces a novel approach: Orientation Operator Transformer - $O^{2}$former. Methods: We incorporate an orientation operator in the encoder to enhance sensitivity to denoising mapping and to integrate orientation prior. Furthermore, we propose a multi-scale feature fusion strategy to amalgamate features captured by different receptive fields with the directional prior, thereby providing a more effective latent representation for the decoder. Based on these innovative components, we propose a transformer-based SISR model, i.e., $O^{2}$former, specifically designed for radiographic images. Results: The experimental results demonstrate that our method achieves the best or second-best performance in the objective metrics compared with the competitors at $\times 4$ upsampling factor. For qualitative, more objective details are observed to be recovered. Conclusions: In this study, we propose a novel framework called $O^{2}$former for radiological image super-resolution tasks, which improves the reconstruction model's performance by introducing an orientation operator and multi-scale feature fusion strategy. Our approach is promising to further promote the radiographic image enhancement field.