Professional Documents
Culture Documents
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 1
The Discovery of X-Rays...
a German scientist,
discovered x-rays...
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 2
Look Inside The Human Body...
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 3
CT Broke the Barrier...
In 1972,
two scientists -
Hounsfield and Ambrose-
presented the first
clinical CT image ...
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 4
The Human Body Slice by Slice...
So we could
see
tomographic anatomy
&
density differences
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 6
The First Siemens CT Scanner...
Console
Computer
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 9
What Does a CT Look Like?
From the inside...
Tube
♣ Tube
♣ Detector
♣ DAS*
DAS
Detector
Data
Data acquisition
acquisition
Recon
Recon && postprocessing
postprocessing
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 11
Image Generation - The “Slice”
X-rays pass through a collimator therefore only
penetrating an axial layer of the object, called
a "slice"
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 12
Image Generation - The “Voxel”
The slice is artificially
divided into small volume
elements called "voxels"
with a square base,
inside which the
attenuation is measured
as a constant value.
And in plane, the picture
elements are called “pixels”
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 13
Image Generation - The “Matrix”
The attenuation of radiation values is measured,
encoded and transferred to a computer.
35 36 34 39 33
31 34 33 35 32
31 78 80 85 90
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 14
CT Image Generation - A/D/A*
The numerical matrix is converted into a black and
white image in a corresponding gray scale.
35 36 34 39 33
31 34 33 35 32
31 78 80 85 90
CT Image Quality
Contrast Detectability
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 16
Spatial Resolution...
The ability to resolve High Contrast Objects,
(also called “High Contrast Resolution”)
Image display
Scan time
Operating mode
Algorithm
Slice thickness
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 18
Contrast Detectability...
When Small Contrast Differences are crucial
(also called “Low Contrast Resolution”)
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 19
Noise?
Noise is superimposed on the image and results in
a "grainy" impression, as is the case with poor TV
reception.
206 mA 60 mA
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 20
Noise...
Image “noise” is determined by the number of
x-ray quanta that reach the detector and then
contribute to the image. It depends on:
Noise
Image display
mAs
Operating mode
kV
Slice thickness
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 21
Artifacts...
The various structures or patterns that appear in a
CT image, but are not found in the original object.
Artifacts
They depend on: ...
Scan time Patient
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 22
Influences on CT Image Quality?
CT Image Quality
Patient
System
User
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 23
System Efficiency...
100 mAs 100 mAs
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 24
mAs...
Tube current and scan time, determine dose.
Noise
high Rule
Ruleofofthumb:
thumb:
The noise 1
Thehigher
higherthe
thedose,
dose,
the dose
thelower
lowerthe
thenoise.
noise.
low
mAs
low high
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 25
mAs...
Low mAs High mAs
Image 1: Image 2:
Low mAs value - 4 times the mAs value-
high noise level half the noise level
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 26
Recommendations for mAs...
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 27
Tube Voltage - kV
The dose level, depends very strongly on the
voltage applied to the tube.
kV
kV Relative
Relativedose
dose
Water
140
140 100%
100%
20 cm 120
120 58%
58%
80
80 12%
12%
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 28
Tube Voltage - kV
The higher the voltage, the more the radiation
spectrum is shifted to a higher energy level,
resulting in decreased radiation attenuation. This
is most noticeable in bone and contrast media.
140 kV 80 kV
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 29
Algorithms...
... provide the recipe for mathematical image
calculation
Image definition
Sharp ULTRA HIGH
HIGH
STANDARD
SOFT
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 31
Algorithms
Soft Algorithm HighRes Algorithm
high noise
AA thin
thin slice
slice poorer contrast resolution
means:
means: better edge definition
no partial volume artifacts
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 34
Slice Thickness...
slice thickness 1/2 no. of x-ray quanta 50% noise level 1.4
High
High
Low Low
1 2 3 5 10 mm 1 2 3 5 10 mm
Slice thickness Slice thickness
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 35
Slice Thickness...
3 mm Slice 10 mm Slice
400%
Rule
Ruleofofthumb:
thumb:
300% The
Thenoise
noiselevel
leveldoubles
doublesfor
forevery
every88cm
cm
increase
increaseininpatient
patientdiameter.
diameter.
200%
100%
30 34 38 42 46 cm
Patient diameter
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 38
Patient Size...
An attenuation by a factor of 2 results from
each 4 cm increase in patient thickness, thus
increasing the pixel noise.
45 cm 28.8 cm
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 39
Image Display - Windowing
3000
Blood Liver
60 Tumor
Spleen Kidneys Heart
Bone Pancreas Bladder
40 Adrenal
Intestine
Gland
Water
0
Rule
Ruleofofthumb:
thumb:
-100
Mamma The
TheCT CTvalue
valueof
ofwater
waterisis00and
and
air
air-1000.
-1000.The
Therelative
relativevalues
valuesofof
-200
Fat
the
theother
othertissues
tissuesare
arecalculated
calculated
-900 Air Lung relative
relativeto
tothat
thatof
ofwater
water
-1000
Window Window
width W center C
0
Black
-1000 CT Windowing
Window width (W): the density range represented within the gray scale.
Window 1
0
Black
Window 2
-1000 CT Windowing
This is used for the display of two tissue types
differing greatly in their density values, such as
the lung & the mediastinum.
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 44
Double Window Technique*
To see both
lungs and
mediastinum
within image
simutanously
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 47
Review vs. Magnification
Reviewed Magnified
Review: Magnification:
A zoom reconstruction from a purely optical
raw data to enhance magnification of image
sharpness of details data which may result in
blurred appearance
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 48
Image Artifacts - Origins
Image Artifacts
...
Operator
Motion error
Metal Technical
defects
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 49
Image Artifacts - Appearance
Image artifacts
Streak Cupping
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 50
Motion Artifact & Scan Time
Motion artifacts
Severe
Rule
Ruleof ofthumb:
thumb:
The
Theshorter
shorterthe
thescan
scantime,
time,the
the
less
lesslikely
likelymotion
motionartifacts
artifactsare
are
occur.
occur.
Moderate
Scan time (s)
Short Long
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 51
Motion Artifact & Correction
Motion artifacts can be compensated for by
the Motion Correction Algorithm (MCA)
5 mm
That is because the
very dense structures
(bones) are only
partially included in the
slice, resulting in high
contrast errors.
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 54
Partial Volume Effect
5 mm 2 mm
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 56
Beam Hardening Effect
The x-ray photons emitted from the x-ray tube do
not all have the same energy. As they penetrate
the irradiated object, the spectrum is shifted to
higher energies - called “beam hardening”. In the
image, streak artifacts or the so-called “cupping
effect” can be seen.
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 57
Beam Hardening & Correction
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 58
Beam Hardening & Correction
The “cupping” effect can be compensated for
by means of “beam hardening correction”
w/o correction w/ correction
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 60
Adaptive Filter
For a non-circular object, x-ray attenuation is
greater along the long axis than along the short
axis, therefore directional noise is seen.
w/o A.F. w/ A.F.
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 61
Artifacts & Corrections
The reasons for artifacts are quite diverse. What
we do is to perform corresponding corrections in
order to avoid them. But sometimes artifacts can
not be compensated for completely.
Nothing is perfect...
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 63
Clinical Requirements...
CT is really great!
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 64
Conventional CT...
Standard Scan:
- Longer cycle time I.S.D* I.S.D
- but instant display
Dynamic Scan:
- Fast acquisition
- but delayed display
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 67
Problems of Conventional CT...
Partial Volume Effect and slice location cause
misregistration and/or misdiagnosis
Best
case
Worst
case
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 68
Location Was the Problem...
One mouse...
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 69
Problems of Conventional CT...
l Scan influenced by respiration
l Image can’t be reconstructed anywhere as desired
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 71
Conventional vs. Spiral CT ...
2D Slice 3D Volume
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 72
The 4 “C”s?
Continuously rotating tube/detector system
Continuous radiation
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 73
Spiral CT...
“You said that images will contain artifacts if there
is any motion during the scan, but a spiral scan is
performed during constant table movement!”
Spiral Algorithms
WIDE, SLIM & SLIM 2
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 74
Wide (360°) Algorithm
2 x 360° (2 full rotations) data acquisition is used
for 1 image reconstruction. Both are measured data.
measured
data
table position
slice
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 75
Slim/Slim 2 (180°) Algorithm
2 x 180° (2 half rotations) data acquisitions are
used for 1 image reconstruction. Measured data
are weighted for Slim, and interpolated for Slim 2.
measured
data
complementary
data
table position
slice
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 76
Different Interpolations?
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 77
Effective Slice Thickness (FWHM*)
Slice Thickness (relative) 3.5
3
2.5
WIDE
2
1.5 SLIM
1
0.5
0
0 0.5 1 1.5 2 2.5 3
Pitch
WIDE makes FWHM wider, while SLIM/SLIM 2 keep
FWHM narrow.
* Full Width Half Maximum
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 78
Noise Amplitudes
Compared with Sequence scans, WIDE gives less noise, and
SLIM/SLIM 2 give more. But for all of them, noise amplitude
does not depend on pitch.
1 SEQ.
0.8 WIDE
0.6
0.4
0.2
0
0 0.5 1 1.5 2 2.5 3
Pitch
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 79
Noise Amplitudes
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 80
Which Algorithm to Choose?
Slim: use it with HighRes algorithm when only
spatial resolution is most important (e.g. bone and
lung study)
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 81
Spiral Parameters
Pitch:
Table feed per rotation divided by slice thickness
Increment = 3 mm
Increment = 5 mm
Increment = 10 mm
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 84
Why Perform Spiral CT?
u Fast scanning of large anatomical volumes
u Gapless data acquisition during one breathhold
u Optimum utilization of contrast medium
u Retrospective reconstruction with arbitrary slice
increments
Source: CTC/CTM
© Siemens AG, 1998
Medical Engineering Group, Computed Tomography
CT Basics 86