SPATIAL RESEARCH

METHODS
The methods of spatial research
include linear and computed
tomography, panoramic
tomography, panoramic
zonografiya .

Linear tomography is a method

of layer-by-layer X-ray examination, Researched
in which an image of an organ is
plane
obtained at a given depth. The
effect of tomography is achieved
due to the continuous synchronous
movement in opposite directions of
the X-ray tube and the film
cassette along parallel planes
along a stationary object at an
angle of up to 30-50° . With this
displacement, all points tube- Pic.12: Linear tomography (scheme), where A is an x-ray tube, B is a patient in
cassette located outside the center which points 2 and 1 are examined, C is an x-ray table deck with a cassette receiver
of rotation are fuzzy, smeared, and and x-ray film. When the X-ray tube is rocked (30-50°), the P-film and images of
the points located at the level of points 2 and 1 move, while the position of point 1 on the film does not change, and
the center of rotation are depicted the image of point 2 moves from one end of the film to the other, thereby achieving
most clearly (Pic. 12). its “smearing” effect, and point 1 is clearly depicted.
The thickness of the studied layer depends on the amplitude of the rotation of the
system the larger the amplitude, the smaller the thickness of the resulting slice. With
an amplitude of 30-50 ° , it is 2-3 mm. Linear tomography is widely used to study the
respiratory organs, the cardiovascular system, the abdominal organs, the osteoarticular
apparatus, as a cheaper alternative to computed tomography.

If a small displacement angle is set (8-10°), then images of a “thicker” layer are
obtained. This type of linear tomography is called linear zonography – a layer-by-layer
study with a system rotation amplitude of 8-10 °. Cut thickness – 10-12 mm,
tomographic step – 1-2 cm.

Panoramic sonography is a layer-by-layer study of the facial skull using a special

panoramic device, when turned on, the x-ray tube moves around the facial region of the
head, in this case, the image of the object is recorded by a narrow X-ray beam on a
cassette with a film curved according to the shape of the face (upper and lower jaws,
pyramids of the temporal bones, upper cervical vertebrae).
X-ray computed tomography
Fundamentals of the method of X-ray computed tomography were developed by South African
mathematician Alan McCormack. At Horte Schuur Hospital in Cape Town, he got the idea to
improve the technology brain research. In 1963 he published an article with mathematical
calculations, which made it possible to reconstruct the image after scanning it with a narrow
beam of x-rays. Having studied these materials, a group of engineers from the English firm of
electric musical instruments EMI, led by Godfrey Hounsfield, began to create a computer
tomograph for brain research (that is why the first CT systems were called EMI scanners). After
7 years in 1972, for the first time in clinical practice, a study of the brain was performed using
CT. It was the possibility of studying brain structures that cannot be visualized with
conventional radiography that was first used with the help of CT. The study of other organs and
systems began somewhat later. But already from this moment, the rapid development of the
CT method begins. Leading medical technology firms begin to work in this area and establish
the production of computed tomographs as early as 1973. In 1975, CT was created to study the
whole body. Godfrey Hounsfield and Alan McCormack were awarded the Nobel Prize in Medicine
in 1979 for the development of the CT method.
X-ray computed tomography (CT) can be defined as an X-ray examination in which
the image of the layer of the object under study is obtained by computer processing the
results of multiple transillumination of the layer by a narrow beam of x-ray radiation,
when the x-ray tube moves in a circle. Passing through the tissues of the examined
patient, X-ray radiation is attenuated according to the density and atomic composition of
the tissues. In this case, the X-ray beam is fixed by a special system of detectors, which
convert radiation energy into electrical signals (according to the principle of digital
radiology). The image obtained during CT is initially digital. An x-ray tube, rotating
around the patient, with the help of a narrow beam of x-rays, shines through (scans) his
body at different angles , going through a full 360° rotation. By the end of the
revolution, signals from all detectors are entered into the computer memory, then a flat
image is created using computer processing – a slice. After receiving one cut is
transferred to the next one, for which the patient table advances by 0.3-10 mm (by a
“step”), depending on the objectives of the study. It takes a certain amount of time (5-
15 seconds) to move the table for the next scan. Therefore, the CT data systems are
also called «step by step» (Pic. 13).
Pic.13: Scheme of X-ray computed tomography, where 1 is an X-ray tube, 2 is a
narrow beam of X-rays, 3 is the object of study, 4 is a row of detectors.
Sections of the cut that attenuate X-rays appear bright, while sections that transmit X-rays appear dark
(similar to the principle of conventional radiography). The CT software also allows you to make large-
scale measurements of the received image, highlight areas of interest, etc., i.e. Full image post-
processing, characteristic of digital technologies. But of particular importance is the possibility of
obtaining a quantitative characteristic of tissue density, which is measured in arbitrary units – Hounsfield
units HU (in honor of Godfrey Hounsfield, the first creator of the CT). The zero mark is taken as the
density of water – 0 HU. Air density is -1000 UH, bone density +1000 HU. The remaining tissues of the
human body occupy intermediate values. Since all density zones cannot be simultaneously displayed on
the display, during the examination, the doctor selects a certain range on the Hounsfield scale, the so-
called «window». A «window» is selected depending on the planned area of ​examination and the
expected pathology.

Since the introduction of CT technologies into clinical practice (since the early 1970s), their development
has gone through several stages, which are called generations. Each new generation had more detectors,
thereby reducing the time of research. The researchers were constantly working on the technical
improvement of the devices, which consisted in the desire to reduce the duration of the study.

In the 1990s, a new type of scanner was developed which was called spiral CT (SCT) . In SCT, an x-ray
tube with detectors constantly rotates around a continuously moving table with a patient. This made it
possible not only to reduce the study time, but also to eliminate the limitations of the «step by step»
method – skipping sections that «did not fall into the cut», as well as areas that were skipped due to
different depths of breath holding by the patient (pic. 14).
 Pic.14: Scheme of spiral computed tomography

A special computer program allows you to reconstruct the obtained data in any plane or reproduce
a three-dimensional image of an organ or a group of organs. SCT allows you to significantly speed
up the scanning process, and, accordingly, reduce the examination time, reduce radiation exposure
and obtain better reconstruction of images both in different planes and in 3D reconstruction.
In 1998, multislpiral CT (MSCT) appeared , when systems were created with not one (as in SCT), but 4
rows of digital detectors. Subsequently, MSCT with 16 rows were created, and in 2003 – the number of
rows reached 64. In 2007 MSCT appeared with 256 and 320 rows of detector elements. On such
tomographs, you can get hundreds and thousands of tomograms in just a few seconds with a slice
thickness of 0.5-0.6 mm. In addition to reducing examination time and improving image quality, it was
possible to study coronary vessels and heart cavities using MSCT.
To improve the differentiation of organs from each other, normal and pathological structures, contrast
enhancement techniques are used in CT, most often, with the use of iodine-containing contrast agents.
The main route of administration of the contrast agent is intravenous. A contrast study with CT allows you
to clarify the nature of the detected pathological changes, including with high diagnostic efficiency to
indicate the presence of tumors against the background of the surrounding soft tissues, as well as to
visualize changes that are not detected in a conventional or «native» study. Intravenous opacification can
be performed in two ways: «manual» intravenous opacification and bolus opacification. In the first
method, the contrast is introduced manually by an X-ray laboratory assistant or a procedural nurse, the
time of administration and speed is not regulated, the study begins after the introduction of a contrast
agent. This method is used on «slow» (step-by-step) devices, in MSCT, the “manual” administration of a
contrast agent no longer corresponds to the significantly increased capabilities of the method. With bolus
contrast enhancement, the contrast agent is injected intravenously with a syringe-injector with installed
the rate and time of delivery of the substance. The goal of the bolus contrast amplification is to delimit
the phases of contrast enhancement
Advantages of CT over traditional radiography:

1. The image of the organs is not superimposed on each other (there is no summation effect);
2. Information about the internal structure of the studied part of the body can be presented in three-
dimensional form based on the results of summing up a series of thin sections of the studied area (eliminating
the shortcomings of a planar image);
3. CT is more sensitive to tissue density: X-ray can display tissues with a difference in tissue density of at least
10%, with CT – 1% or less;
4. Ability to process and adjust the image after scanning is completed (post-processing): brightness
adjustment, contrast, scaling, grayscale adjustment – adjusting the window (windowing) for better
visualization of the anatomy of interest.

The disadvantages of RCT include:

1. Relatively high (compared to X-ray) radiation exposure to the patient – this circumstance dictates the strict
need to use CT only for strict indications (pregnant women are contraindicated);
2. The appearance of artifacts from dense structures, especially metal ones – joint prostheses, foreign bodies,
etc.
3. Relatively low soft tissue contrast resolution.