CT techniques and actual

trends
 CT history
• CT was invented in 1972 by British
engineer Godfrey Hounsfield of EMI
Laboratories, England.
• Original "Siretom" dedicated head CT
scanner
 l’evoluzione della radiologia
• 1895 Wilhelm Conrad
Rontgen scopre i raggi X
• 1930 stratigrafia
(Vallebona)
• 1950 radioscopia con
amplificatore di brillanza
• 1972 nasce la TC
(Tomografia
Computerizzata)
• 1981 nasce la RM
(Risonanza Magnetica)
Sir Godfrey N. Hounsfield, 1919–2004
 Scanner anni ‘70

Matrice: 128 x 128

Circa 8 minuti per Livelli: 8 gray level
Spessore: 10-13 mm
immagine Ricostruzione: nottetempo
 Oggi

150 immagini al secondo Matrice: 1024 x1024

Tempo rot: 0.4 sec
Livelli: 12 bit (4096 livelli)
Spessore: < 0.4 mm
Ricostruzione: 6 img/sec
 Velocità di acquisizione
• Mille volte più veloce rispetto al 1972

1972 1977 1982 1987 1992 1997 2002 2007

 CT history
• Different CT generations

– 3th generation 4th generation

 X-ray Tube – Historical Limitation

• Heat generation - inefficiency

• Large number of images per study
– DRR quality
– Target delineation
• Rapid study acquisition time
– Spatial and temporal integrity
– Motion artifacts
• Large heat anode storage ability (MHU):
– 5+ MHU tubes
• Fast anode cooling rate (MHU/min)
 Image Generation:
Single Slice
One Rotation - One Image
 CT scanner – Single and
multi-slice scanning
• Wider collimator widths
• Post patient collimation
• Multiple area detectors
– 1992 - Elscint CT Twin - first CT scanner
capable of simultaneously acquiring more
than one transaxial slice
– 1998 – Four major manufacturers
introduce scanners capable of scanning 4
slices simultaneously
• Today - 64+ slice scanners
commercially available
 Multislice CT

One Rotation – Multiple Images

 CT scanner – Multi-slice scanning
• Faster scan times
– 4 slice scanner example (8 times faster):
• multi: 0.5 sec/rotation and 4 slices/rotation
• single: 1 sec/rotation and 1 slice/rotation
• Lower tube heat loading
– Longer volume covered per rotation
• Improved temporal resolution
– Faster scan times
• Improved spatial resolution
– Thinner slices
• Decreased image noise
– More mA available
 CT scanner – Multi-slice scanning
Monster Tubes necessity
• HUGE capacity x-ray tubes now
available
– Standard on some 64-channel scanners
– Optional on some 16-channel scanners
– At 120 kVp, max tube current 800 mA
 Image Quality
• Everything else being equal, thinner slices produce better
images
• Balance between large amounts of data and image quality

5mm Slices 3mm 0.8mm

 Image Quality
• Everything else being equal, thinner slices produce better
images
• Balance between large amounts of data and image quality

5mm Slices 3mm 0.8mm

 Image Quality

800 Images – 0.8 mm slice thickness

Image Quality
 Image Reconstruction
• Voxel:
– Volume element representing the slice
thickness or depth of the image.
– 3 Dimensional
•X
z
•Y X

•Z y
 Isotropic Imaging
• Square isotropic voxels X = Y = Z
• Sub-millimeter slice thickness
• Multi Planar Reconstruction
– Sagittal
– Coronal X z

• Multi Planar Contouring y

 Isotropic Resolution
• Multi-planar
reconstruction
– Axial
– Sagittal
– Coronal
• Resolution the same in
all three planes
• It does not matter
which plane is used for
contouring
Isotropic Resolution
 Data Issues

• Image viewing speed

• Network Traffic
• Archiving
• Dose calculation
• Need tools to allow use of data
without compromise
 Multi-slice CT - Speed
• Single slice scanner – 30 seconds
• Multi slice scanner – 2 to 4 seconds
• Dynamic CT
• 4D CT
• Cardiac gating
Multi-slice CT - Dynamic CT

Approximately – 7000 images

 Multi-slice CT- mAs

• mAs – proportional to number of photons

• Number of photons affects noise (image
quality)
• Single slice scanner – 150 to 300 mAs
• Multi slice scanner – up to 2000 mAs
• Increasing mAs increases patient dose
from a CT scan
• Increase in dose is a significant concern in
diagnostic scanning
 Contrast Resolution
• A measure of a • Soft tissue contrast
scanners sensitivity, • Affects ability to
or the ability to • contour structures
discriminate small
changes in density
Contrast Resolution
 Radiation Dose
• An infinite number of x-rays would
result in a perfect (ideal) image
– Unrealistic (too bad)
• Must balance need for image quality
(risk) with the medical benefit
• Becoming a hot-button issue
• Requires education of ordering
physicians
Abdomen/Pelvis CT protocol: 120kV, 280-300 mA
1 sec/rotation, pitch = 1, image thickness = 5 mm

• How does the a. CT ~ chest x-ray

radiation dose from b. CT ~ 10 chest x-
this study compare rays
to the radiation c. CT between 10-
dose from a chest 100 chest x-rays
x-ray?
d. CT between 100-
250 chest x-rays
e. CT ~ 500 chest
xrays
Abdomen/Pelvis CT protocol: 120kV, 280-300 mA
1 sec/rotation, pitch = 1, image thickness = 5 mm

• How does the a. CT ~ chest x-ray

radiation dose from b. CT ~ 10 chest x-
this study compare rays
to the radiation c. CT between 10-
dose from a chest 100 chest x-rays
x-ray?
d. CT between 100-
250 chest x-rays
e. CT ~ 500 chest
xrays
Abdomen/Pelvis CT protocol: 120kV, 280-300 mA
1 sec/rotation, pitch = 1, image thickness = 5 mm

• How does the Radiologists’ Answers!!!

radiation dose from
this study compare • CT ~ chest x-ray 5%
to the radiation • CT ~ 10 chest x-rays 56%
dose from a chest • CT between 10-100 chest x-
x-ray? rays 15%
• CT between 100-250 chest
x-rays 13%
• CT ~ 500 chest xrays 10%

Lee CI, et.al., Radiology 2004; 231:393-398

 Risk from CT Scan???
• 4% risk of fatal cancer from 1 Sv radiation*
• Abd/pelvis exam ~ 10 mSv (or 0.01 Sv)
• Would require ~ 100 Abd/pelvis CT exams to
reach 1 Sv target
• At ~ 100 Abd/pelvis CT exams risk of fatal cancer
induction is 4 in 100
• But some time interval & healing between 100
Abd/pelvis CT exams…

• *BEIR V, 1990.
 Actual & future trends
• Cardiac CT

• Large Aperture Gantry; Table Wt.

Capacity

• CT Perfusion
 1994 2000 2002 2004

EBT (3mm) 4 slice (1.25mm) 16 slice (0.75mm) 64 slice (0.6mm)

96-99% negative predictive value for
detection of coronary stenoses

Mollet et al, JACC 2005

Morgan-Hughes et al, Heart 2005
Kuettner et al, JACC 2005
Achenbach et al, Eur Heart J 2005
Hoffmann et al, JAMA 2005
Raff et al, JACC 2005
Leschke et al, Eur Heart J 2005
Leber et al, JACC 2005
Mollet et al, Circulation 2005
 Exclusion of CAD

Cardiac CT Conventional Angiogram

96-100% sensitivity for
bypass graft occlusion

Nieman et al, Radiology 2003

Schlosser et al, JACC 2004,
Martuscelli et al, Circulation 2004
Chiurlia et al, AJC 2005
 RCA Proximal Occlusion

Vessel details distal to complete

occlusion are available in postprocessed
images
 Coronary Angiogram (CAG)
vs.
Cardiac Multirow Detector CT
(MDCT)

1. Diffuse Coronary Calcification: CAG > MDCT

2. Fast heart rate: CAG > MDCT
3. Stent evaluation: CAG > MDCT
4. Diffuse CAD & plaque burden: MDCT > CAG
5. Distal to occlusion: MDCT > CAG
Limited spatial and temporal
resolution as compared to
- cardiac cath
- size and speed of coronary
arteries
 Limitations:
• Motion artifacts -> heart rate ->
temporal res.
• Spatial resolution -> radiation
• Several heart beats -> arhythmias
 Future Paths:
• > 64 slices:
– Shorter breathhold
• >> 64 slices:
– One heart beat (120 mm)?
• < 0.5 mm slices: spatial resolution
– >>radiation!
• Faster rotation:
– better temporal resolution
 Future Paths:
• Better temporal resolution
• => Prospective triggering
• => Less radiation
• => Thinner slices?
 We will see:
• Up to 256-slice scanners
• Faster temporal resolution
• Better software
 ?
1995 2005

10 years 10 years
 Actual & future trends
Big Bore Size

70 cm Bore Opening 85 cm Bore Opening

CT scanner – Bore size

Patient Size
CT Perfusion
 Baseline

1° treatment cycle

2° treatment cycle
 CT perfusion metrics
• Tumor size (cm3)
• Perfusion (ml / 100 g / min)
• Time-density curves & maps
– Peak enhancement relative to pre-
contrast value
– TTP = time to peak
– MTT = mean transit time
– Regional blood volume
– Regional blood flow