Introduction to Computed Tomography (CT)

● Computed Tomography (CT) is an advanced medical imaging technique that uses X-

rays to create detailed cross-sectional images of the body.It allows for visualization of
internal structures with high resolution, aiding in accurate diagnosis and treatment
planning.
● CT scanners rotate around the patient, capturing multiple images from different
angles.
● These images are processed by computers to produce 2D slices or 3D
reconstructions.CT is faster and more precise than traditional X-rays, making it ideal
for emergency and routine evaluations. It is widely used in detecting trauma, tumors,
infections, and vascular conditions. CT has become a cornerstone in modern
diagnostic radiology due to its speed, clarity, and diagnostic accuracy.
 History of Computed Tomography

● Computed Tomography (CT) was invented by Sir Godfrey Hounsfield and Dr. Allan
Cormack in the early 1970s.
● The first successful CT scan of a human brain was performed in 1971.
● In 1979, Hounsfield and Cormack were awarded the Nobel Prize in Physiology or
Medicine.
● Early CT scanners could only image the head and required several hours to
reconstruct images.
● Technological advances in the 1980s introduced whole-body scanning and faster
image processing.
● The development of spiral (helical) CT in the 1990s revolutionized imaging speed
and resolution.
● Today, multi-slice CT scanners provide high-speed, high-resolution imaging for a
wide range of clinical applications.
 Basic Principle of Computed Tomography

● CT works on the principle of X-ray attenuation as it passes through different tissues

in the body.
● An X-ray tube rotates around the patient, emitting beams that pass through the body
at various angles.
● Detectors on the opposite side capture the attenuated X-rays after they pass through
tissues.
● Each tissue absorbs X-rays differently based on its density and composition.
● These variations are measured and converted into electrical signals by the detectors.
● A computer processes these signals to reconstruct cross-sectional images (slices) of
the body.
● The images represent varying densities in shades of gray, helping to distinguish
normal and abnormal structures.
 Components of Computed Tomography

1. X-ray Tube – Produces the X-rays that pass through the patient’s body.

2. Detectors – Capture the attenuated X-rays after they pass through the body and
convert them into electrical signals.

3. Gantry – The rotating frame that houses the X-ray tube and detectors; allows
movement around the patient.

4. Patient Table (Couch) – A motorized table that moves the patient through the gantry
during scanning.
5. Control Console – Operated by the radiologic technologist to set scan parameters
and monitor the procedure.

6. Computer System – Processes raw data from detectors and reconstructs it into
cross-sectional images.

7. Display Monitor – Displays the reconstructed images for interpretation by

radiologists.
 Working Mechanism of CT

CT works by using X-rays to take detailed pictures of the inside of the body. The patient lies
on a table that slowly moves through a large circular machine called a gantry. Inside the
gantry, an X-ray tube rotates around the patient, sending X-rays through the body from
different angles. These X-rays are picked up by detectors on the other side, which measure
how much of the X-rays are absorbed by different tissues. The information is sent to a
computer, which processes it and creates cross-sectional images or “slices” of the body.
These images help doctors see bones, organs, and other structures clearly. CT scans are
fast, accurate, and useful for diagnosing many conditions.

Scanning Modes in CT

CT scanners use different scanning modes depending on the clinical need and the type of
CT machine. The main scanning modes are:
1. Axial (Sequential) Mode – The scanner takes one slice at a time. The table moves
step-by-step after each scan. It gives high-quality images but takes longer.

2. Spiral (Helical) Mode – The X-ray tube rotates continuously while the table moves
through the gantry. This creates a spiral path of data, allowing faster scanning and
covering more area in less time.

3. High-Resolution Mode – Used for very detailed images of small structures like the
lungs, using thin slices.

4. Dynamic (Cine) Mode – Takes repeated images over time, often used to study
moving organs like the heart or during contrast studies.

5. Dual-Energy Mode – Uses two different X-ray energies to help differentiate materials
like calcium, iodine, or soft tissue.
 Image Formation:

In CT, image formation starts when the X-ray tube rotates around the patient and sends X-
rays through the body. Different tissues absorb X-rays differently based on their density. The
detectors measure how much radiation passes through and convert this data into electrical
signals. These signals are sent to a computer, which uses mathematical formulas (called
reconstruction algorithms) to create cross-sectional images or “slices” of the body. Each
image slice is made up of tiny squares called pixels, and each pixel represents a specific
tissue density using Hounsfield Units (HU).
 Image Display:

The reconstructed images are displayed on a monitor as grayscale pictures. Dense

structures like bones appear white, soft tissues appear gray, and air appears black. The
images can be viewed in different planes (axial, sagittal, coronal) or combined to form 3D
views. Radiologists can adjust contrast, brightness (windowing), and zoom to better analyze
specific areas. These images are saved in a digital format and can be printed or stored for
future reference

Post-Processing Techniques in CT

Post-processing techniques in CT are used to improve, analyze, or manipulate the raw

images after they are acquired. These techniques help radiologists get more detailed and
accurate information. Some common post-processing methods include:
1. Multiplanar Reconstruction (MPR): Converts axial images into other views like
sagittal, coronal, or oblique planes for better visualization.

2. Maximum Intensity Projection (MIP): Shows only the brightest (most dense) pixels,
useful for viewing blood vessels and contrast-filled structures.

3. Minimum Intensity Projection (MinIP): Displays the darkest pixels, ideal for visualizing
airways or low-density structures.

4. Volume Rendering (VR): Creates a 3D image from the CT data, useful for surgical
planning and anatomical overview.
 Anatomy and Associated Organs in CT Abdomen

CT of the abdomen helps visualize the internal structures and organs located between the
chest and pelvis. It provides detailed cross-sectional images of the following major
anatomical parts:

1. Liver – Largest solid organ in the abdomen, located in the right upper quadrant;
involved in metabolism and detoxification.

2. Gallbladder and Biliary System – Located under the liver; stores bile and includes
bile ducts.

3. Pancreas – Lies behind the stomach; plays a role in digestion and blood sugar
control.
4. Spleen – Located in the left upper abdomen; filters blood and helps fight infection.

5. Kidneys and Ureters – Bean-shaped organs on both sides of the spine; filter blood
and produce urine.

6. Adrenal Glands – Sit on top of each kidney; produce hormones like adrenaline and
cortisol.

7. Stomach and Intestines (Small and Large Bowel) – Involved in digestion and
absorption of food.
 Indications for CT Abdomen

1. To find the cause of stomach pain.

2. To check for injury after an accident.

3. To look for tumors or lumps.

4. To find infections or swelling inside the belly.

5. To check for kidney stones.

6. To find problems like appendicitis or pancreatitis.

7. To see why someone is losing weight or feeling unwell.

8. To follow up after surgery or treatment.

9. To help guide a biopsy or surgery.

10. To check blood vessels in the abdomen.

 Contraindications for CT Abdomen

1. Pregnancy (especially first trimester)

2. Severe allergy to iodinated contrast

3. Severe kidney failure

4. Severe claustrophobia

5. Unstable or critically ill patients

6. Inability to cooperate or stay still

 Patient Preparation for CT Abdomen

1. Fasting for 4–6 hours before the scan.

2. Informing the doctor about allergies, especially to contrast dye.

3. Drinking oral contrast if prescribed to highlight the intestines.

4. Removing any metal objects or jewelry.

5. Wearing comfortable, loose clothing or hospital gown.

6. Informing the technologist about pregnancy or medical conditions.

7. Staying still and following breathing instructions during the scan.

 Contrast Media in CT Abdomen

1. Purpose: Enhances visibility of blood vessels, organs, and abnormal tissues.

2. Types:

○ Oral contrast: Taken by mouth to highlight the gastrointestinal tract.

○ Intravenous (IV) contrast: Injected into a vein to show blood flow and organ
details.

3. Common agents: Iodine-based contrast is most commonly used.

4. Precautions: Check kidney function before IV contrast; avoid in severe allergies.

5. Side effects: Mild reactions like nausea or warmth; rare severe allergic reactions.

6. Hydration: Patients are advised to drink plenty of fluids after the scan to flush out
contrast.
 Scan Range in CT Abdomen

1. From the diaphragm (bottom of the chest) to the pelvic brim.

2. Includes the entire liver, spleen, pancreas, kidneys, adrenal glands, stomach,
intestines, and major blood vessels.

3. Sometimes extends into the lower chest to include the lung bases.

4. May include the pelvis if pelvic organs need evaluation.

5. Adjusted based on clinical indication and area of interest.

Pathological Conditions Evaluated by CT Abdomen

1. Tumors and cancers (e.g., liver, pancreas, kidneys)

2. Inflammatory diseases (e.g., appendicitis, pancreatitis, diverticulitis)

3. Infections and abscesses

4. Trauma-related injuries (e.g., organ lacerations, bleeding)

5. Kidney stones and urinary tract obstruction

6. Vascular conditions (e.g., aneurysms, thrombosis)

7. Bowel obstructions and perforations

8. Cysts and benign masses

9. Liver diseases (e.g., cirrhosis, fatty liver)

10. Enlarged lymph nodes and metastatic disease

 Clinical Finding

Case study: 1

Name- Jasdeep kaur Age - 45Y/F

History of- Severe Abdomen pain, Abdominal discomfort and intermittent flank pain for the
past 10 days. No history of fever, vomiting, or urinary symptoms. No prior surgical history.

Scan done - NCCT abdomen

Impression- Suprarenal glands appear normal in shape, outline attenuation values.

No obvious area of abnormal attenuation seen on both sides. Right Kidney is enlarged in
size & is normal in shape & position. Perirenal inflammation is seen.
2.

Name- Manvi Verma Age- 41/F

H/O- Recurrent lower abdominal pain, dysuria, and occasional hematuria for the past two
weeks. The patient has a history of urinary tract infections but no prior kidney issues.

Scan done- CT KUB

Impression- Evidence of a 5mm non-obstructing renal stone in the left kidney, located in the
renal pelvis. Mild left-sided hydronephrosis is noted, likely due to the stone. No signs of
urinary tract obstruction or infection are observed. The bladder appears normal, with no
evidence of masses or significant pathology.
 Advantages of CT Abdomen

1. Fast and accurate imaging.

2. Provides detailed cross-sectional views of organs.

3. Detects a wide range of diseases and conditions.

4. Useful in emergencies (e.g., trauma, bleeding).

5. Can guide biopsies and surgeries.

6. 3D reconstruction is possible.

Limitations of CT Abdomen

1. Involves exposure to ionizing radiation.

2. May require contrast, which can cause allergies or affect kidneys.

3. Not ideal for pregnant women.

4. Limited in detecting small or early-stage soft tissue abnormalities.

5. Higher cost compared to some other imaging methods.

 Radiation Dose Management in CT Abdomen

1. Use of ALARA Principle – Keep radiation “As Low As Reasonably Achievable.”

2. Proper Justification – Perform CT only when clinically necessary.

3. Optimization of Scan Parameters – Adjust mA, kVp, and scan length to minimize
dose.

4. Use of Automatic Exposure Control (AEC) – Machine adjusts dose based on patient
size.

5. Limiting Scan Range – Scan only the area of clinical interest.

6. Avoiding Repeat Scans – Review previous imaging before doing new scans.

7. Use of Shielding – When appropriate, use lead shields to protect sensitive organs.

8. Pediatric Dose Adjustments – Use child-specific protocols to reduce radiation