I am working on binary segmentation of ultrasound images, i.e. from a noisy (mostly speckle noise, I would say) ultrasound image I want to obtain a black and white image. 

For finding the global pixel intensity threshold I'm using Otsu's method, which works reasonably well. 

Now my question is, what image (pre-) processing steps would one perform on an ultrasound image prior to finding the intensity threshold via, e.g. Otsu's method. 

Is Gaussian blurring, median filtering etc. a good idea or does it destroy the pixel intensity histogram? What is the common work flow or image processing pipeline prior to image segmentation? 

Thanks a lot for your insights (I'm new to image processing)

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