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You can install the free Ghostscript and Ghostview programs. After you open the PDF in Ghostview, you can export as any kind of bitmap format (BMP,GIF,TIFF,PNG,...), and even choose the dots per inch resolution to match that of your printout (to preserve scale)
I would recommend to avoid lossy formats like JPG.
You also may need to install the auxiliary "pstoedit" program. http://pages.cs.wisc.edu/~ghost/
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Another feature of Acrobat Pro -- if the images in the PDF are bitmapped, then you can click "export all images" and choose a lossless format such as TIFF or PNG. The output files will usually be pixel-perfect, without any resizing or resampling.