COMPUTED TOMOGRAPHY

Merrills V. 3: Ch. 31 & Bushong Ch. 23

No other development in x-ray imaging over the past 50 years has been as significant !
Snook transformer Coolidge hot-cathode x-ray tube Potter-Bucky diaphragm Image-intensifier tube

Wow look at that image quality & detail

FUNDAMENTALS
CREATING A CROSS-SECTIONAL TOMOGRAPHIC PLANE OF ANY BODY PART A PATIENT IS SCANNED BY AN X-RAY TUBE ROTATING AROUND THE BODY A DETECTOR ASSEMBLY MEASURES THE RADITION EXITING THE PATIENT.

Equipment arrangement

Tomo = image // to long axis of the body CT = image is transverse to the body

In its simplest form, a CT imaging system consists of a finely collimated x-ray beam and a single detector.

both moving synchronously in a translate rotate mode. Translation = one rotation of source and detector

FUNDAMENTALS
EXITING RADIATION: PRIMARY DATA PRIMARY DATA IS COLLECT BY DETECTORS THE COMPUTER COMPILES AND CALCULATES THE DATA BASED ON PRESELECTED ALGORITHM AND AN IMAGE IS FORMED

PRESELECTED ALGORITHM

IMAGE
EACH IMAGE IS DISPLAYED IN AN AXIAL FORM INITALLY THE IMAGES ARE DISPLAYED ON A CATHODE RAY TUBE (CRT) OR LCD

Cathode Ray Tube (CRT): is an air evacuated glass envelope containing an e- gun and a fluorescent screen. When e- hit the fluorescent screen light is emitted

LCD

CT
Conventional Radiographs: Frequently body structures are superimposed In CT: A tightly collimated x-ray beam is directed thought the patient from different angles cross sectional image Essentially eliminating superimposition of body structures

CT
Claim to fame: Exceptional Contrast Resolution

Contrast resolution = differentiation of densities, capable of differentiating among tissues with similar densities

The contrast of an object is expressed relative to its surrounding background. That is what determines its visibility.

CT
Due to the reduction in amount of scattered radiation

Reducing over lapping structures and 2 collimators

Digitized image: because of this numerous image manipulation techniques can be used to enhance and optimize the diagnostic information. Window/Level, Axial, Sagittal, Coronal

CT Collimation

CT vs CAT

Historical Development
CT was first demonstrated successfully in 1970. Dedicated to head CT only Dr. Godfrey Hounsfield (Engineer) Allan Macleod Cormack (Nuclear Physicist)

Nobel Prize in medicine and physiology in 1979

First full-scale commercial unit

Installed in 1971 Physicians recognized its value for providing diagnostic neurologic information U.S. June 1973 at the Mayo Clinic (MN) & General Hospital (MA) These early units were also dedicated head CT scanners.

Early CAT scanners

Hounsfields discovery parallels Rontgens discover of x-rays Early CAT scans required nine days to produce a single section image

Whole-body scanners
1974 Dr. Robert S. Ledley of Georgetown University Medical Center, developed the first whole-body scanner Many different companies began manufacturing scanners.

Generations
First Generation Scanners

Translation/Rotation Tube produced a finely collimated beam or pencil beam 1 to 3 detectors were placed opposite the tube for radiation detection 4.5 minutes to gather enough information for one slice Tube was only able to rotate 180 degrees

Second Generation
Fan-shaped x-ray beam 30 or more detectors 20 seconds per slice or 10 minutes for a 40 slice exam 180 degree rotation Long data reconstruction time

Third Generation
Fan-shaped x-ray beam 960 detectors opposite the x-ray tube Complete 360 degree rotation Rotate/Rotate movement One rotation = one slice Second data acquisition could be made as the tube and detectors move in the opposite direction. Time reduced to 1 sec per slice

3rd generation configuration

Fourth Generation
Developed in 1980s Fixed ring of as many as 4800 detectors, completely surrounding the patient, Rotate only movement Rotating x-ray tube provides short bursts of radiation Detectors collect the remnant radiation to reconstruct into an image 1 minute for multiple slices

4th generation configuration

Fifth Generation EBCT

Modern Scanners
No longer categorize into Generations Contemporary CT scanners are either third or fourth generation designs Scanners are categorized by tube and detector movement Slip Ring Technology: connects generator with tube (no cables)

Slip Rings

Technical Aspects
Optimum imaging: patient/area of interest and gantry are perpendicular to each other Tube rotates around the patient, irradiating the area of interest. Detectors measure the transmitted x-ray values, covert them in to an electric signal, and relay the signal to the computer.

Raw Data
The remnant radiation that is converted into an electrical signal values are called projections, scan profiles or raw data. Raw data is collected and digitized. This process assigns a whole number to each signal. The value assigned is directly proportional to the strength of the signal.

Tube Interactions

Digital Image
Array of numbers arranged in a grid of rows and columns called a matrix. Single square, or picture element, with in the matrix is called a pixel. Slice thickness gives the pixel and added dimension called the volume element, or voxel

Voxel
Each pixel in the image corresponds to the volume of tissue in the body section being imaged. The voxel volume is a product of the pixel area and slice thickness

Hounsfield units
Each pixel within the matrix is assigned a number that is related to the linear attenuation coefficient of the tissue within each voxel

These are CT numbers or Hounsfield units.

Hounsfield units
Defined: A relative comparison of x-ray attenuation of a voxel of tissue to an equal volume of water. Water is used because it is in abundance in the body and has a uniform density Water is assigned an arbitrary value of 0

CT numbers
Tissue denser than water are given positive CT numbers Tissue with less density than water are assigned negative CT numbers The scale of CT numbers ranges from -1000 for air to +14,000 for dense bone

Only CT # in the body are Fat, Lung & Air

Displaying the image

On the CRT or LCD, each pixel within the image is assigned a level of gray The gray level assigned to each pixel corresponds to the CT number or Hounsfield units for that pixel

System Components
Computer, Gantry &Table & Operators Console Computer provides the link between the CT technologist and the other components of the imaging system

Computer
The computer has four basic functions:

Control of data acquisition Image reconstruction Storage of image data Image display

Array Processor
Raw Data is sent to the array processor Array processor only performs algorithm calculations.

Applies desired filters to raw data.

Gantry
Gantry is a circular device that houses the Data Acquisition system (DAS) = Tube, Detectors, Filters, Collimators & Analog-to Digital Converter (ADC)

Gantry
Can be tilted forward or backward up to 30 degrees to compensate for body part angulation. The opening within the center of the gantry is termed the aperture

CT Tubes
X-ray tube for CT is similar in design to the conventional radiography tube, but is specially designed to handle and dissipate excessive heat units much higher heat loading Ceramic target backing

Decreases tube weight

especially for spiral computed tomography

Detectors
Function as image receptors for remnant radiation, then converts the measurement into an electrical signal proportional to the radiation intensity. Two basic detector types are used: Scintillation (solid state) and Ionization (xenon gas) detectors.

Detectors
Scintillation photodiodes convert light into electronic signal.

Approximately 90% of the x-rays incident on the detectors are absorbed and contribute to output signal.

Gas Detectors: small chambers filled with xenon or xenon-krypton mixture Approximately 45% x-rays incident on the detectors are absorbed and contribute to output signal. Manufactures no longer use gas detectors

Detectors
Used to record photon activity Materials include: cadmium tungstate, cesium iodide, gadolinium or yttrium

Table
Automated device linked to the computer and gantry Designed to move in increments after every scan according to the technologists scan program. Accurate and reliable table movements is vital to image quality and accuracy CT tables have max weight limits

Operators Console
Where the technologist controls the scanner Keyboard, graphic monitor, CRT

Display Monitor
For the CT image to be displayed on a CRT monitor in a recognizable form, the digital CT data must be converted into a gray-scale image Each digital CT number is the matrix is converted into an analog voltage

Image Display
The brightness value of the gray-scale image correspond to the pixels and CT numbers of the digital data they represent Because the image is digital image manipulation can be performed

FOV

The field of view determines the amount of data to be displayed on the monitor

Image manipulation
Most common: windowing or gray-level mapping This technique allows the technologist to alter the contrast of the displayed image by adjusting the window width and window level.

Windowing
Window width: is the range of CT numbers that are used to map signals into shades of gray

Wide/Narrow or Long/Short

Window level: determines the midpoint of the range of gray levels to be displayed

Darker or Lighter

Window Width

Window Level

Image manipulation
Multiplanar reconstruction or MPR Ability to reconstruct axial images into coronal, sagittal or oblique body planes

Transverse images can be reconstructed at any plane along the z-axis.

Diagnostic Applications
Most common procedures: head, chest, abdomen, pelvis CT is the exam of choice for head trauma CT can evaluate the CNS for infarctions, hemorrhage, disk herniation, craniofacial and spinal fractures, tumors and other cancers

Biopsy & Abscess Drainages

CT examinations
CT demonstrates abnormalities such as metastatic lesions, aneurysms, abscesses, and fluid collections from infection or trauma Interventional procedures: abscess drainage, tissue biopsy, cyst aspiration

CT Angiography
CTA: Uses three dimensional (3D) imaging techniques to evaluate the vascular system Advantages over conventional angio:

Image reconstruction without the use of more patient exposure to radiation or IV contrast Overlying structures can be eliminated (post processing) Does not require an arterial puncture

Contrast Media
Is used in most CT imaging to distinguish normal anatomy from pathology

Iodine based IV contrast, similar to the IVU Oral/Rectal contrast 2% Barium mixture is used Iodinated oral contrast can be used (Hypaque) Gastrographen must be at 1.5% to 3% concentration to prevent contrast artifacts

What are factors that affect image quality?

Factors Affecting Image Quality

Four main factors contributing to image quality are: Spatial resolution, Contrast resolution, Noise, and Artifacts Diagnostic imaging has superior spatial resolution compared to CT

How do we measure spatial resolution? What is the range for plane films?

Image Resolution
(how sharply is the image seen)
CR & DR 4000 x 4000 image only as good a monitor* CR 2 - 5 lp/mm RAD 3-6 lp/mm DR 3 - 5 lp/mm CT lp/cm IMAGE APPEARS SHARPER BECAUSE CONTRAST CAN BE ADJUSTED BY THE COMPUTER (DIFFERENCES IN DENSITY)

525 vs 1000 line more pixels = more memory needed to store resolution dependent on pixel size

Technologist Determines Image Quality Factors

The technologist choice of slice thickness, focal spot size, display FOV, technique selection, pitch and reconstruction algorithm will effect the resultant image quality

Contrast Resolution
Removal of superimposed anatomy Very fine x-ray beam Double collimation

Review/Questions
What does the window width control for image display?

Oral contrast used for CT? concentration?

What