Definition

CT imaging equipment includes conventional, spiral, multi-slice, and electron-beam computed

tomography full-body scanners, which use x rays to acquire cross-sectional images and computer
workstations to reconstruct acquired image data for display on a viewing monitor or printed on film.
Also referred to as computeried axial tomography !CAT" scanning equipment.
Purpose
Computed tomography is an x-ray imaging modality used for a variety of clinical applications. CT
imaging equipment is used for spine and head imaging, gastrointestinal imaging, vascular imaging
!e.g., signs of stroke, detection of blood clots", cancer staging and radiotherapy treatment
planning, screening for cancers and heart disease, rapid imaging of trauma and pediatric patients,
measuring bone mineral density for diagnosing osteoporosis, imaging of musculoskeletal disorders,
detection of signs of infectious disease, and guidance of certain interventional procedures !e.g.,
biopsies". CT is the preferred imaging exam for diagnosing several types of cancers. CT scanners
are also used to perform noninvasive angiographic imaging to assess the large blood vessels.
Three-dimensional !#-$" image reconstruction, a feature available on many CT scanners, allows
surgical procedure simulation and planning, postoperative evaluation, #-$ angiography, and
virtual colonoscopy. %ecause computed tomography can clearly image soft tissue, bones,
the lungs, and blood vessels, and can be used to diagnose so many diseases and conditions, CT
scanners are often considered the backbone of a radiology department, and large hospitals may
have multiple scanners to meet imaging demand. %ecause CT scanners are valuable in aiding in the
evaluation of trauma and other emergency medical conditions, hospitals with large emergency
volumes and ma&or trauma centers may have a CT scanner located in and dedicated to the
emergency department.
'ome types of CT scanners !electron-beam and multislice, see below" have begun to be used for
whole- body scanning for preventive screening purposes( that is, asymptomatic individuals can have
a full-body scan to see if heart disease, cancer, or other conditions are present. This application is
primarily offered by independent imaging centers and is not reimbursed by insurance companies.
Description
)n general, a computed tomography scanner consists of a gantry, an x-ray system, a patient table,
and a computer workstation. The gantry is a large square unit with an opening in the center through
which the patient is moved during the scan. The gantry contains the x-ray system, which includes an
x-ray tube, detectors, x-ray beam collimators, circuitry, and an x-ray generator. )n some older CT
scanners, the x-ray generator may be separate from the gantry. The patient table is designed for
both vertical and horiontal motion to accommodate various types of patient positions during the
scan.
$uring a CT scan, the x-ray generator supplies power to the x-ray tube. * rays are produced by the
x-ray tube and emitted as it is rotated around the patient. The x rays pass through the patient+s body
to the detectors, which, depending on the CT scanner type and model, may consist of xenon gas
ioniation chambers or solid- state crystals !such as cesium-iodide or cadmium- tungstate". $uring
each rotation, the detector produces electrical signals, which are generated after exposure to the x
rays. These electrical signals are transferred to the computer, processed, and reconstructed into
images using preprogrammed algorithms. ,ach rotation of the xray tube and detectors is
reconstructed into an image that is referred to as a slice. The slice represents a cross-section of
anatomical detail, and allows the inside of anatomical structures to be visualied, which is not
possible with general radiography. Collimators are located near the x-ray tube and at each detector
to minimie scatter radiation and to properly define the x-ray beam for the scan. The height of the
collimators determines the slice thickness.
There are several types of CT scanners currently in use that differ in configuration and scanning
features. Conventional CT scanners, which were introduced in the -./0s, have cables attached to a
detector array, and therefore, at the end of one x-ray tube rotation, the assembly must reverse to
avoid tangling the cables. Conventional scanners, then, have the slowest scanning speed. 'piral CT
scanners, also called helical or volumetric scanners, have a slip-ring configuration that allows
continuous one-way rotation. )n spiral scanning, the patient table is moved through the gantry while
the x-ray tube and detector rotate in a spiral around the patient. 'canning speed is faster, thinner
slices are acquired, and shorter patient breathholds are required than for conventional CT. 'piral CT
scanners were introduced in -.1., and have since been considered a revolutionary advance in CT
imaging due to the improvements in scanning speed and image quality that were possible compared
to conventional CT scanners.
2ultislice scanners, which were introduced in -..1 and are considered the next revolution in CT
imaging, have multiple rows of detectors that allow acquisition of multiple image slices during one x-
ray tube rotation. $epending on the model and manufacturer, a multislice scanner may be up to
eight times faster than a single-slice spiral scanner, and slices half as thin as those acquired on a
spiral scanner are attainable. 2ultislice technology was still under development as of 300-.
,lectron-beam CT scanners, also called ultrafast CT scanners, use a different scanning technology
than other CT scanners, where x-ray tube rotation is mechanical. ,lectron-beam CT scanners have
no moving parts, which makes such a fast scanning speed possible. An electron gun produces a
focused electron beam that generates a rotating x-ray fan beam after being steered along tungsten
target rings. 'can times are approximately ten times faster than multislice scanners because only
the electron beam moves during scanning. ,lectron beam CT scan- ners were introduced in the mid-
-.10s and were designed for cardiac imaging and imaging of other moving structures !e.g., lungs,
colon" due to their fast scanning speed.
CT imaging equipment is often supplied with image archiving devices !e.g., compact disk &ukebox,
tape drive", image hard copy devices !e.g., x-ray film processor, laser imager", and networking
capabilities, depending on the needs of the facility. %ecause CT is a digital modality, CT scanners
are frequently networked with other digital equipment, such as ultrasound and magnetic resonance
imaging !24)" systems, to facilitate comparison of images on viewing monitors.
)n small hospitals or hospitals in rural areas, a CT scanner may not be installed( rather, a mobile CT
scanning service may be contracted. A spiral CT scanner is installed in a specially designed trailer,
which is driven to the hospital contracting the service. 5rescheduled CT scans are then performed
for the day or days the scanner is available at the hospital. 6bviously, mobile CT only
accommodates imaging in cases where the exam is not urgent.
Operation
After the technologist properly preps and positions the patient on the scanning table, the technologist
goes to the ad&acent control room and begins the scan using the control computer workstation.
7sually, the computer has preprogrammed scanning protocols for common types of scans !e.g.,
abdomen and pelvis, chest, head" and some computers allow customied scan protocols to be
entered. $uring scanning, the technologist instructs the patient via an intercom system regarding
breathholds and positioning. The controlling computer automatically moves the patient table
according to the scanning parameters selected. The scan itself may only take five to -8 minutes, but
total examination time may be up to #0 minutes, since the patient must be prepped and positioned.
9hen the examination is completed, the technologist processes the image data using the computer
workstation. $epending on the facility, images may be sent to an x-ray film processor or laser imager
to be printed as hard copy and taken to a reading room, or they may be put on a
Computed tomography (CT) equipment uses x rays to obtain cross-sectional images of soft tissues of the body !5ete
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computer diskette or transferred via a digital image management system !picture archiving and
communication system" for interpretation on a viewing monitor.
%efore the patient is moved off the table, the radiologic technologist should review the acquired
images to be sure they are of sufficient diagnostic quality. 2otion artifacts, which are streaks, blurs,
or other inconsistencies in the image, may occur if the patient moves during the scan or when
imaging moving structures !e.g., heart, lungs". $ecreasing the acquired image slice thickness,
changing the timing of the contrast material in&ection, and shortening the patient+s breathhold time
can help reduce the occurrence of motion artifacts.
The radiologic technologist should choose the scanning protocol that will provide optimal image
quality with minimal radiation dose. Typical radiation doses for a CT scan are approximately equal to
the amount of natural background radiation the average person is exposed to over a year. The
patient radiation dose from a CT scan is slightly higher than that of a typical x-ray procedure. ;ewer
multislice scanners may deliver a significantly higher radiation dose than single-slice spiral scanners(
this higher dose is of special concern for pediatric patients. The American 'ociety of 4adiologic
Technologists !A'4T" has issued a statement regarding scanning protocols for pediatric scanning
and recommends that specific scanning protocols be developed for pediatric patients and that CT
equipment manufacturers develop a range of suggested parameters for pediatric patients based on
weight. )n addition, A'4T encourages technologists to be aware of radiation doses for their pediatric
cases by using radiation shielding when necessary, ad&usting patient positioning, using special dose
filters, and increasing the pitch ratio !the table speed per gantry rotation" on spiral scans.
!aintenance
$ue to its high cost !<800,000 to over <-,000,000" and technical sophistication, CT imaging
equipment is usually purchased with a service contract from the manufacturer or third party service
provider that covers x-ray tube and other parts replacement and emergency service repair. The
facility+s biomedical engineering department and medical physicist may also conduct annual
preventive maintenance checks, as well as monthly calibration, image quality testing, and radiation
dose monitoring.
" technologist stays at computer controls #hile the patient is scanned #ith CT equipment !Custom 2edical 'tock
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A comprehensive quality control program that includes evaluation of image resolution, patient
radiation dose, accuracy, image processing, patient table movement, and other overall system
performance and image quality features should be followed. The radiologic tech- nologist may be
required to assist engineering staff with maintenance checks and service repairs.
2ost CT manufacturers offer remote diagnostic features on their equipment that facilitate repair of
system problems. Communication via modem and telephone with service personnel and diagnostic
software allows, for example, ordering of replacement parts, downloading of software to fix a
problem, or immediate notification of an operational problem to repair personnel.
$ealth care team roles
A radiologic technologist trained in computed tomography positions the patient on the table,
administers any contrast material !intravenously, oral, or by enema", and operates the CT scanner
and computer workstation. %efore administering any contrast material, the technologist will screen
the patient for any allergies to medications or iodine and take a medical history to determine
whether the patient has any medical condition !e.g., diabetes, asthma, heart disease, kidney or
thyroid problems" that may interfere with CT imaging or indicate a higher risk of reaction to the
contrast material. )n addition, the technologist will ask female patients whether there is a possibility
of pregnancy. The technologist will position lead aprons on appropriate areas of the patient to
minimie unnecessary radiation exposure and provide lead aprons and other shielding for any
individuals who must remain in the scan room !e.g., parents with children, staff monitoring a critical
patient".
$uring the CT scan, the technologist controls the imaging scan parameters using the computer
workstation, and communicates instructions to the patient via an intercom system. The technologist
is responsible for acquiring the requested images and ensuring that they are of diagnostic quality. A
radiologist will interpret the CT images and compile a report that is sent to the requesting physician.
$epending on the condition of the patient, other clinical staff may be present during the CT scan.
%ecause CT is frequently used for trauma imaging, emergency medicine staff !nurses,emergency
medical technicians" may be required to transport and monitor the patient.
Training
4adiologic technologist education programs include specialied training on CT principles of
operation, radiation dose, patient positioning and anatomy, and CT imaging techniques. 'pecific
training for a particular CT scan- ner is provided by the manufacturer upon installation and:or a
workshop at the manufacturer facility. 7sually, training for technologists and physicians is included in
the cost of the CT system and consists of three to four days of technical and clinical instruction. The
manufacturer often provides follow-up on-site visits after installation.
%&' T&(!)
"ngiographymaging of the blood vessels of the body conventionally performed using an x-ray
system and invasive catheteriation, but that is performed on some CT scanners as a noninvasive
alternative, since only an intravenous in&ection of contrast material is required.
Contrast material chemical mixture in&ected intravenously, swallowed, or administered by enema
before and:or during a CT scan to enhance imaging of the area of interest.
Digital image management system* picture archiving and communication systemystems of
computer networking that allow exchange of images over the network or )nternet, archiving of
images for on-line access, and viewing of patient images and other data on a display monitor. These
may encompass &ust the radiology department or an entire facility. CT scanners are frequently
networked as part of these larger systems.
+antryhe large square unit that houses the xray system and related components and has an
opening in the center through which the patient table is moved.
,aser imager device that uses laser technology to produce hard copies of CT images( used instead
of an x-ray film processor.
(esources
-OO%)
4obb, 4ichard A. Biomedical Imaging, Visualization, and Analysis. ;ew =ork> ?. 9iley @ 'ons, -....
P&(.OD.C",)
Aunderman, 4.%. B5hysics of 'piral CT.B Applied Radiology !2arch -..C, 'upplement"> -#C.
Darvey, $an. B5reventive CT 'creening> Dealth %oon or %aneEB Radiology Today 3, no. C !2arch
-3, 300-"> 1---.
;apel, 'andy. B$esign> 5rimer on 2ultislice CT 'canner Technology.B Diagnostic
Imaging,;ovember -... 'upplement. FFa
hrefGBhttp>::www.dimag.com:dbHarea:archives:-...:..--mnapel.1-
..di-.htmlBIhttp>::www.dimag.com:dbHarea:archives:-...:..--mnapel.1-..d... I.
O(+"/.0"T.O/)
American College of 4adiology. -1.- 5reston 9hite $rive, 4eston, JA 30-.--K#./. !100"33/-8KC#.
FFa hrefGBhttp>::www.acr.orgBIhttp>::www.acr.orgI.
American 4egistry of 4adiologic Technologists. -388 ;orthland $rive. 't. 5aul, 2; 88-30---88
!C8-" C1/-00K1. FFa hrefGBhttp>::www.arrt.orgBIhttp>::www.arrt.orgI.
American 'ociety of 4adiologic Technologists !A'4T". -8000 Central Avenue ',, Albuquerque, ;2
1/-3#-3//1. !100" KKK-3//1. FFa hrefGBhttp>::www.asrt.orgBIhttp>::www.asrt.orgI.
4adiological 'ociety of ;orth America. FFa hrefGBhttp>::www.rsna.orgBIhttp>::www.rsna.orgI.
OT$&(
Computed Tomography !CT" 'canning of the %ody. FFa
hrefGBhttp>::www.radiologyinfo.org:content:ctHofHtheHbody.htmBIhttp>::www.radiologyinfo.org:content
:ctHofHtheHbody.htmI.
CT Technology, ,xpanded Applications %lossom. FFa
hrefGBhttp>::www.medscape.com:medscape:cno:3000:4';AC2,:'tory.cfmE
storyHidG-1K1BIhttp>::www.medscape.com:medscape:cno:3000:4';AC2,:'tory.cfm... I.
?ennifer ,. 'isk, 2.A.