+ COMPUTED

TOMOGRAPHY
NNNR3054

PHYSICS
&
INSTRUMENTATION
+
Terminology

 Computed tomography (CT) has also been

identified as
 computerized axial tomography (CAT)
 computerized trans axial tomography (CTAT)
 Digital axial tomography (DAT)

 CT results in digital & transverse (axial) image

+
Brief History
 1895: Roentgen discovers x-ray

 1963: Cormack formulates x-ray absorption in tissues

 1972: Hounsfield demonstrates CT

 1979: Hounsfield and Cormack received Nobel Prize

 1983: EBCT demonstrated

 1989: Spiral CT demonstrated

 1991: MSCT introduced

+
+
Test 1
 Which of the following scientists were instrumental
in the initial development of CT?
I. Alan Cormack
II. Raymond Damadian
III. Geodfrey Hounsfield
IV. Paul Leuterbur

A. I, II & III
B. I & III
C. II & IV
D. I, II, III & IV
+
Background

 CTprocess creates cross sectional images

with information collected when an x-ray
beam passes through an area of anatomy
 Eachslice represents a specific plane in the
patient’s body, referred to as the z-axis.
 Thez-axis determines the thickness of the
cross-sectional slice.
+
Background

 Data that form the CT slice are further

sectioned into elements.
 Each 2-D square=pixel (x-axis=width ;y-axis=
height)
 Ifz-axis is taken into consideration, it becomes
a cube=referred to as a voxel
A matrix= grid formed from the rows &
columns of pixel.
+
+
Test 2

How many pixels are contained in a

1,024 matrix image?
A. 1,024
B. 2,048
C. 262,144
D. 1,048,576
+ Beam Attenuation

 X-rayphotons pass through/ absorbed/

scattered by structures in varying amounts,
depending on the average photon energy of
the x-ray beam and the characteristics of the
structure in its path.
 Thedegree to which an x-ray beam is
reduced is referred to as attenuation
+  Objects that have little ability to attenuate the
beam are said to have low attenuation.
 Objects
that have ability to absorb much/all of
the beam are said to have high attenuation.
 Lower attenuation->black/dark gray on image
 Higher attenuation-> white/light gray area
 Numberof photons interact with an object
depends on:
 Thickness
 Density
 Atomic number
+  Amount of x-ray beam that is scattered or
absorbed per unit thickness of absorber is
expressed by linear attenuation
coefficient (µ)
 Differences
in µ among tissues are
responsible for x-ray image contrast
 Todifferentiate object on CT image from
adjacent objects, must be a significant
density difference between the two objects
 Oral
or IV contrast is often used to create a
temporary artificial density difference between
objects
+
 Hounsfield units (HU) quantify the degree
that a structure attenuates an x-ray beam
 HUranging from -1000 for air to +1000 for
dense bone.
 HU measurements are not absolute. A
number of factors can contribute to
inaccurate values including poor equipment
calibration, image artifacts and volume
averaging.
+
+ Tissue HU µ (at 125
kVp)
Dense bone 1000 0.460
Muscle 50 0.231
White matter 45 0.187
Gray matter 40 0.184
Blood 20 0.182
CSF 15 0.181
Water 0 0.180
Fat -100 0.162
Air -1000 0.0003
+
Test 3

An object is slightly less dense than

water. What is the expected
Hounsfield measurement?
A. -940
B. -10
C. 50
D. 850
+
Polychromatic x-ray beam
 X-ray
beam used in CT is polychromatic (varying
energies).

 CT detectors cannot differentiate and adjust for

differences in attenuation that are caused by low energy
photons->artifact

 Artifact->is
an object seen in image but not present in
the object scanned

 Filtering
x-ray beam helps to reduce range of x-ray
energies by eliminating photon with weaker energies
 Filtering reduces artifacts
 Filtering reduces radiation dose to patient
+ Volume averaging

 The process in CT by which different tissue

attenuations are averaged to produce one
less-accurate pixel reading is called volume
averaging or partial volume effect.
 ThickerCT slices increase the likelihood of
missing very small objects
 Thinner slices result in higher radiation dose
+

Theprocess of using raw data to

create an image is called image
reconstruction
 Prospective reconstruction->automatically
produced during scanning
 Retrospective reconstruction->reusing
raw data to generate new image
+
+
Scan modes

Older CT systems operated in a

‘step-and shoot’ fashion.
Inthe 1990s-> helical scanning
(uninterrupted imaging)
Helicalscanners were further
improved to multiple rows of
detector
+
Image planes

Based on the body being viewed in the

anatomic position
 Anterior
 Posterior
 Inferior
 Superior
 Lateral
 Medial
 Proximal
 Distal
+
Body planes :
Planes parallel to the floor-
>horizontal/axial
Planes perpendicular to the floor ->
longitudinal/ vertical
Coronal-> divides body into ant &
posterior
Sagittal-> divides body into left and
right
Oblique planes?
+
Overview of CT operation

 X-rayphotons are created when a

substance is bombarded by fast-moving
electrons.
 Hightube voltage (kV) is used to make
electrons move quickly. This propels the
electrons from the x-ray tube filament to the
anode.
 Theanode area where the electrons strike
and x-ray beam produced is the focal spot.
+
 Thequantity of electrons propelled is
controlled by tube current (mAs)
 Theintensity of the x-ray beam is controlled
by the kVp
 Thevast majority of the kinetic energy of
the projectile electrons is converted to
thermal energy.
 The ability of tube to withstand heat is
called heat capacity.
 The ability of tube to rid itself of heat is
called heat dissipation.
+
Overview of CT operation (cont.)

Detectors record the number of x-

ray photons that pass through the
patient.
Each detector cell is sampled many
times per second by the data
acquisition system (DAS)
The digital data from DAS are then
transmitted to the CPU
+
Overview of CT operation (cont.)
 The reconstruction process takes the individual
views and reconstructs the densities within the
slice.

 Digitizeddata are then sent to a display processor

that converts them into shades of gray that can be
displayed on a monitor.

 TheCT process:
 Phase 1: data acquisition (get data)
 Phase 2: image reconstruction (use data)
 Phase 3: image display (show data)
+
+
Test 4
 Whichof the following is a function of Data
Acquisition System (DAS)?
I. Amplify the detected signal
II. Convert the detected signal to analog form
III. Transmit the detected signal to the computer
IV. Post-process the detected signal

A. I, II & III
B. I & III
C. II & IV
D. IV
E. I, II, III & IV
+
Data acquisition
Phase I
+
Data acquisition
Dataare acquired when x-ray
pass through a patient to strike a
detector and are recorded.
Themajor components used for
data acquisition are those
contained in:
The gantry
The patient table
+
CT Gantry
+ Gantry specification
 Components are mounted in the gantry on a
rotating scan frame.

 Gantriesvary in total size as well as in the diameter

of the aperture ranging from 70-90 cm.

 The gantry can be tilted to adjust the scan plane.

 Earlyscanners used cables to rotate in one

direction and then stop to change the direction and
rotates in the opposite direction.

 Thedevelopment in the slip rings permits the

gantry frame to rotate continuously, making helical
scan method possible.
+
+
+ CT gantry
 Generator
+
 Highfrequency generators are used in CT and
located within the gantry.

 Producing high voltage and transmit it to x-ray tube.

 Powercapacity is in kilowatts (kW). It determines the

range of exposure technique available.

 Generatorsproduced high kV to increase intensity of

x-ray beam. This increases penetrating ability of the
beam.

 HighkV allows low mA setting->reduces heat load

on x-ray tube

 Coolingmechanisms housed within the gantry help

to reduce temperature fluctuations.
+
+
X-ray source
 The x-ray tubes used in CT are modification
of a standard rotating anode tube.
 CTtubes often contain more than 1 size focal
spot. Small focal spots improve spatial
resolution but it concentrate heat onto a
small portion of the anode.
 Anode heat capacity is measured in million
heat units (MHU).
 Anode heat dissipation rate is measured in
thousand heat units (KHU)
+ Filtration
 Filtersare used to shape the x-ray beam. They
reduce radiation dose and help to reduce image
artifact.

 Filteringthe x-ray beam helps to reduce the range

of x-ray energies that reach the patient by removing
the lower energy x-rays.

 Different
filters are used when scanning specific
body region.

 Bowtie filters are often used to scan the body.

 Thesereduce the beam intensity at the periphery of

the beam, corresponding to the thinner areas of a
patient’s anatomy.
+
+
Collimators
 Collimators restrict the x-ray beam and reduce
scatter radiation.

 Reducingthe scatter improves contrast resolution

and decreases patient dose.

 Sourcecollimators affect slice thickness by

narrowing or widening the x-ray beam.

 Because they act on the x-ray before it passes

through the patient, they are also called pre-
patient collimators.
+  Some CT systems used pre-detector
collimation.
 This act on x-ray after it has emerged from
the patient and before it strikes the
detector.
 Sometimes, it is called ‘post-patient
collimators’.
 The purpose is to prevent scattered
radiation from reaching the detectors
+
+ Detectors
 Detectorscollect information regarding the degree
to which each anatomic structure attenuates the x-
ray beam.

A detector array comprises detector elements

situated in an arc or a ring, each of which measures
the intensity of transmitted x-ray radiation along a
beam projected from the x-ray source to that
particular detector element.

 Thenumber of detector cells that collect data is

controlled by the selection of scan field size.

 Detectorscan be made from different substances,

each with their own advantages and disadvantages
+
Detectors
+  The optimal characteristic of a detector are:
 High detector efficiency-ability to capture
transmitted photons and change them to
electronic signals.
 Low or no afterglow
 High scatter suppression
 High stability

 Detector efficiency is dependent on the

stopping power of the detector material,
scintillator or charge collection (xenon
types) efficiency, geometry efficiency and
scatter rejection.
+  The geometric efficiency refers to the amount
of space occupied by the detector collimator
plates relative to the surface area of the
detector.
 Capture efficiency refers to the ability with
which the detector obtains x-ray beams that
have passed through the patient.
 Absorption efficiency refers to the number of
photons absorbed by the detector and is
dependent on the physical properties of the
detector face.
 Response time is the time required for the
signal from the detector to return to zero so that
it is ready to detect another x-ray event.
+  The dynamic range is the ratio of the
maximum signal measure to the minimum
signal the detector can measure.
 Detectors can be made from a solid-state crystal
or from xenon gas-filled chambers. All new
detectors are of the solid-state crystal variety.
 Xenon gas detectors are much less efficient than
solid-state detectors. However, they are less
expensive to produce, somewhat easier to
calibrate and are highly stable.
+  Solid-state detectors are also called scintillation
detectors because they use crystal that fluoresces
when struck by an x-ray photon.
 A photodiode transforms the light energy into
electrical energy.

 Solid-state
detectors are very efficient, absorption
nearly 100%.

 Older solid-state detectors produced a brief

afterglow.

 Solid-state detectors are more sensitive to

fluctuation in temperature and moisture than the
gas variety.
+  The size, shape and placement of the
detector elements affect the amount of
scatter radiation that is recorded.
 Detector spacing is measured from the
middle of one detector to the middle of the
neighboring detector. It accounts for
spacing bar placed between each
detector element.
 The size of detector opening is called the
aperture.
 A small detector is important for good
spatial resolution and scatter rejection.
+
+Detector Electronics

 Thedata acquisition system (DAS)

measures the number of photons that strike
the detector, converts the information to a
digital signal, and sends the signal to the
computer.
 TheDAS is positioned in the gantry, near the
detectors.
 To
be useful for the CT system computer, the
analog signals from the detector must be
converted into a digital format
+
+
 Thistask is accomplished by the analog-to-
digital converter (ADC).
 Detectors are sampled many times, as many
as 1000 times per second by the DAS.
 The number of samples taken per second
is known as the sampling rate, sample rate
or sampling frequency.
 Image artifacts can occur if the sampling
rate is too low.
+ Patient table
 Theprocess of moving the table by a specific
measure is called incrementation, feed, step, or
index.

 Helical
CT table incrementation is measured in mm/s
because the table moves continuously throughout the
data acquisition.

 The degree to which the table can move horizontally

is called the scannable range.

 An anatomic landmark is chosen when a patient is

first positioned within the gantry and the table
position is manually set to zero.

 This is referred to as referencing the table.

+

CT table
+
Scanner Generations
+
1st generation of CT
 Finelycollimated x-ray beam (pencil beam) was
used in 1st generation CT imagers.

 Single radiation detector

 Translate-rotate motion

 180translations with 1° rotation between

translations

 Single image projection per translation.

5 min imaging time

 Head Imager only

+ 1 st generation
+
2nd generation of CT

 Fan-shaped x-ray beam

 Multiple radiation detectors-a detector array

 Translate-rotate motion

 Usually 18 translations with 10° rotation between

translations.

 Multiple image projections or detectors per

translation

 Approximately 30s imaging time.

+
2nd generation
+ 3 rd generation of CT

 Eliminates the lateral movement of the tube-detector system.

 This was the so-called fan-beam or continuous rotation

scanner.

 By using fan-beam, the projection of x-ray beam is in the

shape of a fan with an angular spread of between 40° and 55°,
enough to encompass the whole of the test object.

 Time to acquire a reconstructed image was reduced to about 5

seconds.

 Scanners of this generation are examples of the

implementation of the fan-beam projection system in its purest
form.

 In this scanner generation, after all the projections have been

made for the first image, the table moves and the whole
procedure is repeated for the next cross-section of the body
+
3rd generation
+ 4 th generation of CT

 Thefourth generation of scanners was introduced in

1978 which differed slightly from the third
generation.

 In
the earlier designs, the detector array moved
around the test object together with the X-ray tube.

 Rotation of the array was eliminated by arranging it

on a stationary ring with a radius larger than the
radius of the circle described by the tube.

 Thefourth generation scanner also known as the

rotate-fixed scanner; which the x-ray tube rotates
around the object being scanned while the arrays of
detectors are fixed.
+
 In order to maintain an adequate resolution of the
radiation intensity measurements, the number of
detectors in the array was increased and now ranged
from 600 to 5,000 detector elements.
 The time taken to obtain one image using this design
however was still about 5 seconds (Fishman and Jeffrey
1995).
 However, there are some limitations in fourth generation
scanners including the size and geometric dose
efficiency.
 Since the x-ray tube rotating inside the detector ring, a
large ring diameter of 170-180 cm is required in order to
ensure acceptable tube-skin distances.
 Other than high cost is needed to fill up the ring with
detectors (>1200 detectors), scattered radiation is the
main concern with this scanner generation.
+
4th generation
+
Spiral CT scanners
+
Single-slice CT
 Developed in 1989, based on 3rd generation of CT

 The projection system moved in a spiral around the patient which

was called ‘single-slice spiral computed tomography’.

 In the initial phases of the development of spiral CT, the scanners

used a detector array in shape of an arc of a circle

 The device was called a single-slice spiral computed tomography

scanner or SSCT.

 The single-slice spiral CT works with a rotation of the tube around

the patient combined with a smooth displacement of the patient
through the gantry (Goldman 2008).
+
4-slice CT
 In
1998, 4-slice CT scanner was introduced by
several manufacturers

 Fourdetector ‘rows’ corresponding to the 4

simultaneously collected slices fed data into 4
parallel data ‘channels’, so that these 4-slice
scanners were said to possess 4 data channels.

 Advantages of MSCT include substantially shorter

acquisition times, retrospective creation of thinner or
thicker sections from the same raw data, and
improved three-dimensional rendering with
diminished helical artefacts (Costello 1996).
+ 4-slice CT scanner
+  For example, the SOMATOM Volume Zoom with a
500 ms rotation time and the simultaneous
acquisition of 4 slices offers an eight-fold increase
of performance compared to previous 1s, single-
slice scanning.
 Four-slice
scanners are the basic system for
coronary CT angiography examination.
 With only 250 mm of temporal resolution and gantry
rotation of 500 ms made a longer time coronary
scan which allows continuous acquisition of data
with 4 parallel detectors.
 Inaddition to smaller scan coverage of 4 × 1.0 mm,
resulting in long breath-hold between 30 and 40
seconds which leads to breathing and motion
artefacts
+ 16-slice CT
 The installation of MSCT scanners providing 16 data channels
for 16 simultaneously acquired slices began in 2002 (Goldman
2008).

 In addition to simultaneously acquiring up to 16 slices, the

detector arrays associated with 16-slice scanners were
redesigned to allow thinner slices to be obtained as well.

 16-slice scanners have a slightly better spatial resolution and

faster gantry rotation (420 ms) compared to that 4-slice CT
(Kopp et al. 2002).

 The major advantage of 16-slice scanners over 4-slice CT is

the larger coverage (16 × 0.75 mm vs 4 × 1.0 mm), resulting in
significantly shorter breath hold and less motion artefacts.
+
16-slice CT scanner
+
64-slice CT
 The 64-slice CT was first introduced with a single x-
ray source mounted opposite to a 64-detector-array
in the gantry unit and then developed with dual x-
ray source (DSCT).

 Thex-ray tube and detector array system rotates

around the patient to generate tomographic
images. To reconstruct a transverse CT image, the
gantry requires a rotation of approximately 180°.

 DSCT using two X-ray sources and two detectors at

the same time: double temporal resolution, double
speed, and twice the power, while lowering dose
even further.
+ SINGLE SOURCE VS DUAL SOURCE
+
64-slice CT (SSCT)
+
64-slice CT (DSCT)
+
 Another potential advantage of dual-source CT is
tissue characterization with both detector systems
operating at different tube voltage which known as
dual-energy CT.

 Although this has not been clinically realized to date,

two x-ray beams of different energy spectra in
theory could better demonstrate varying attenuation
characteristics of different tissues (Ruzsics et al.
2008; Rybicki et al. 2008).

 In this approach the temporal resolution is

sacrificed, and scanning requires a larger number of
slabs.
+ DUAL ENERGY
+ 128 & 256-slice CT

 In
late 2007, Philips introduced the 128-slice
MDCT (Brilliance iCT; Philips Healthcare,
Cleveland, OH), a 128 × 0.625-mm detector
row system with dual focal spot positions to
double the number of slices within the 8-cm
(width) z-axis gantry coverage.
 ProspectivelyECG-gated cardiac CT
typically covers the entire heart in two axial
acquisitions over three heartbeats.
+
128-slice CT scanner
+
256-slice CT scanner
+  Second generation of 128-slice CT was
introduced with dual-source which uses two
x-ray tubes with opposing 64 detector
arrays mounted 90° from each other.
 However, the volume coverage remains the
same; for example, a 128-detector row
scanner with two alternating z-focal spot
positions can be referred to as 256-slice CT.
 Itis important to specify the number of
detector rows in z-axis, with or without
alternating focal spot positions, and single
versus dual source.
+
320-slice CT
 Thishardware (Aquilion One Dynamic Volume CT;
Toshiba) currently has the largest z-axis detector
coverage. It was released shortly after experiments with
a 256-detector row MDCT prototype.

 Each
detector element is 0.5 mm wide, yielding a
maximum of 16-cm z-axis coverage.

 Thisconfiguration allows three-dimensional volumetric

entire heart imaging during the diastole of one R-R
interval.
+
320-slice CT scanner
+ 640-slice CT scanner

 The Aquilion One Vision Edition is equipped with a

gantry rotation of 0.275 seconds, a 100 kw generator
and 320 detector rows (640 unique slices) covering
16 cm in a single rotation, with the industry’s thinnest
slices at 500 microns (0.5 mm).

 The system can accommodate larger patients with

its 78 cm bore and fast rotation, including bariatric
and patients with high heart rates.

 AquilionOne Vision Edition also includes Toshiba’s

third-generation iterative dose reconstruction
software 3-D, which incorporates significant system
enhancements by reducing radiation dose
compared with conventional scanning.
+
640-slice CT scanner
+  The system was cleared by the U.S. Food and Drug
Administration (FDA) in September 2012 and
currently has one install in the United States at the
National Institutes of Health (NIH).

 Studies there on CT angiography found coronary

scans could be completed in 0.0137 seconds and
with less than 1 mSv of dose for an average sized
patient.

 This
less-than-a-second scan time allows for single-
beat cardiac cycle scans.

 The 16 cm coverage area also means one scan can

acquire the whole volume of the heart, so no image
stitching is required.

 The couch has a 660 lb capacity.

+
References

 Henwood, S. 2008. Clinical CT Techniques and Practice.

Cambridge: Cambridge University Press.

 Romans. L.E. 2011. Computed Tomography for Technologists.

Philadelphia: Lippincott Williams & Wilkins.

 Schoenhagen, P., Stillman, A.E. & Hallibutron, S.S. 2006.

Cardiac CT Made Easy: An Introduction to Cardiovascular
Multidetector Computed Tomography. Florida: Taylor and
Fracis.

 Bushong S.C. 2000.Computed Tomography: Essentials of

Medical Imaging Series. Berkeley: McGraw-Hill Companies