2005 Mindy Horrow, MD

Multi-slice CT
Principles and Perspectives
Mindy M. Horrow, MD, FACR
Director of Body Imaging
Albert Einstein Medical Center

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Before CT

Entire areas of body inaccessible to

radiography (brain, retroperitoneum,
etc.)
Some useful diagnostic procedures
were either potentially harmful or
considerably uncomfortable
(exploratory laparotomy,
pneumoencephalography)

Principles of CT

Radiographic tube emits x-rays while

rotating axially around patient
Array of detectors on opposite side of
patient detects x-rays transmitted
through patient
Computer algorithms use digitized data
from detectors to create axial
tomographic images of body.
CT = tomography + algorithms + high
speed digital computers

Principles of CT

Tomography- CT actually eliminates

unwanted material, outside of scan plane
instead of just blurring it (1921conventional tomography)
Reconstruction algorithms- Fast Fourier
Transformation: allows mapping of
function of space into a function of
frequency using the theorem that any
function can be decoded into a sum of
sine and cosine functions (described by
Fourier in 1811)

Development of Workable CT
Scanner

1963- Cormack in S. Africa develops

algorithm for accurate reconstruction of
images from radiographic projections
1971- Hounsfield, a computer engineer in
England produces first working CT scanner
used clinically on patients. Produced 70
head CTs in 6 mos, at 4 min per slice,
recorded on magnetic tape with two days
reconstruction time per case.
Cormack and Hounsfield awarded Nobel
Prize in medicine and physiology in 1979

Sir Godfrey Hounsfield with a

prototype CT scanner in 1974

Head CT circa 1975 with 128 x 128 matrix

Radiology: Volume 119, 1976

Davis, Taveras, New, et al. Diagnosis of Epidermoid

Tumor by Computed Tomography
Hahn, et al The Normal Range and position of the Pineal
Gland on Computed Tomography
Huckman, Ramsey, et al. Computed Tomography in the
Diagnosis of Pseudotumor Cerebri
Messina, Potts, et al. Computed Tomography: Evaluation
of the Posterior Third Ventricle
OConnor, et al. Computed Tomography in a Community
Hospital
Sagel, Stanley, Evens. Early Clinical Experience with
Motionless Whole Body Computed Tomography

Sagel, Stanley, Levitt, et al.

Computed Tomography of the
Kidney Radiology 124:359-370, 1977

Computed tomography is an extremely

accurate method of obtaining more definitive
diagnostic information about a renal mass
discovered on a urogram. Benign renal cysts
are readily distinguished from solid renal
neoplasms, and CT is often valuable in
characterizing possible juxtarenal masses.
The cause of a nonfunctioning kidney(s) on a
urogram can often be discerned, and
hydronephrosis is easily detected.

Proliferation of CT

By 1976, 3 years after Hounsfields

publications, 22 companies were
manufacturing CT scanners
By 1979 1000 scanners were operating in
50 countries
Competition produced rapid
technological sophistication
Introduction of fan beam-scanning
decreased scan time from 300 sec to 2
sec per slice in 4 years

Conventional CT scanners

Employ fan of x-ray beams and a large

detector array
3 types of gantries: translate-rotate,
rotate-rotate, rotate-stationary
Involves alternating patient translation
and x-ray exposure
Each rotation of x-ray tube generates data
from which a corresponding axial image
is reconstructed

Helical (spiral) CT

Simultaneous patient translation and x-ray

scanning generates volume of data
X-ray beam traces a helix of raw data from which
axial images must be generated
Each rotation generates data specific to an
angled plane of section
To create true axial image, data points above and
below desired section must be interpolated to
estimate value in axial plane
Thus, interval between reconstructed transsexual
images can be chosen retrospectively

Technological considerations of
helical CT

Slip-ring technology (no electrical cables

connecting gantry to ground) allows
source detector assembly to rotate
continuously. Previously, frequent, abrupt
changes between scans were necessary to
permit winding and unwinding of cables
More robust x-ray tubes and generators
were developed to allow high tube current
for prolonged duration. Also needed to be
lightweight enough to be mounted in slip
ring gantry

Comparison of single slice and

multi-slice CT

Detector configuration
Reconstructions
Detector design
Definition of pitch
Pitch and image quality
Spatial resolution

Configuration of detectors

SS- long, narrow array with length

of single detector aligned in z axis
MS- detector array segmented in z
axis, a mosaic
Allows for simultaneous acquisition of
multiple images in scan plane with ONE
rotation

Mosaic Detector

Diode

FET Switching Array

16 cells in Z direction
--each cell 1.25 mm (in Z)
16 cells (Z) x 912 cells (transverse) = 14592 total cells
Signal collected from 4 channels/2 flex connectors

Reconstructions

SS- reconstruct images of SAME thickness

with different image indexing (table
increment intervals)
MS- acquire 3D raw data that are
contiguous in space. Therefore can
reconstruct images at various thicknesses
AND at different intervals

If image index < image thickness, results in

overlapping slices
Must have raw data available for any type of
reconstruction

Multi-slice detector design

(GE 4 slice scanner)

16 equal elements in z axis, 20mm

maximum collimator width *
Can acquire 1, 2, or 4 images per rotation
For example: with collimator at 10mm can
make 4 images @ 2.5mm, 2 images @
5mm or 1 image @ 10mm
Thinnest slice thickness that can be
reconstructed depends entirely on
combination of slice thickness and table
speed
* A single 1.25 detector is made of two .63 detectors

Axial Configurations
4 x 2.5 mm
Diode

FET Switching Array

4 signals collected from eight 1.25 mm detectors with 2 detectors contributing to each signal
2.5 mm is the minimum slice thickness because two 1.25 mm detectors are combined per signal
Cells can be combined to form 4 slices @ 2.5 mm each or 2 slices @ 5 mm each or 1 slice @ 10 mm

4i mode = each set of

2 cells becomes a slice
@ 2.5 mm each

2i mode = 2 sets
(of 2 cells each) are
combined to form
2 slices @ 5 mm each

1
1i mode = 4 sets
(of 2 cells each) are
combined to form
1 slice @ 10 mm

Pitch
SS = table travel per rotation
image thickness
If table travel > slice thickness, pitch > 1

MS = table travel per rotation

total active detector width*
* = x-ray beam collimation

SS

MS

Table travel/ rotation =

7.5mm

Table travel/ rotation =

7.5mm

Image thickness = 5mm

Four Images with

thickness = 2.5mm

Pitch = 7.5 = 1.5

5.0

Pitch = 7.5 = .75

(4 x 2.5)

GE Definition of Pitch

Table travel per rotation =

single image slice thickness
(High quality mode)

7.5 = 3
2.5

i.e.. When 4 images are acquired per tube

rotation, associated table travel is 3
times image width

GE Definition of Pitch

Table travel per rotation =

15 = 6
single image slice thickness 2.5
(High speed mode)

i.e.. When 4 images are acquired per tube

rotation, associated table travel is 6
times image width

Pitch and Image Quality

SS- Image quality decreases as

pitch increases

MS- GE scanners have unique

property of forming images with
particularly good quality at 2
specific pitch values, HQ and HS

Pitch and Noise

To reconstruct image, projections must be

collected over 180 gantry rotation and fan angle
of x-ray beam (45 ), about 2/3 of spiral
Since reconstruction algorithms need fixed
number of projections to make image and since
pitch only affects how these projections are
distributed in spiral, not the number of projections,
pitch does not affect noise
No difference between SS and MS

Image Quality: Contrast

Resolution

Ability of imaging system to detect a

single structure that varies only slightly
from its surroundings
Related to noise AND pitch
Less noise, fewer distractions, increased
ability to perceive low density object
Contrast resolution in x-y plane as pitch
for SSCT but does NOT change for MSCT

Contrast Resolution

SS- pitch causes broadening of slice-sensitivity

profile. Scanner needs to have enough
projections to reconstruct slice and is forced to
seek them outside of specific z axis. Some
projections may not pass through object in
question and results in under-sampling which
blurs object

Contrast Resolution

MS- pitch does not broaden SSP

because at least one of multiple rows of
detectors passes into x-y plane
containing object in question. Because
of multiple detectors, highly unlikely that
projections distant from imaging plane
will be needed.

Z axis resolution

SS- increased
pitch decreases z
axis resolution

SS- increased
pitch decreases
radiation dose

Dose

MS- increased
pitch has little
effect on z axis
resolution

MS increased
pitch, machine
compensates with
increased mA and
dose does not
change

Dose-Pitch Relationship

For SS, if pitch>1, dose decreases

pitch<1, dose increases

For MS, if pitch>1, dose similar

pitch<1, dose similar
When pitch is<1 in MSCT, images are
interleaved, with reconstructed slices
using information from surrounding slices,
allowing a decrease in technical factors

Reconstruction Algorithms

SS and MS are similar

First step done by machine, z axis
interpolator works on raw data to weight
projections nearest the slice location most
heavily
Second step selected by user: for soft
tissue images, want to suppress noise and
increase low contrast sensitivity. For bone
want higher contrast.

Protocols for MSCT

Image thickness, detector configuration,

collimation, table speed, interval,
reconstruction algorithms

IV contrast parameters

Length of acquisition

Technique: kV, mA, sec

Reconstruction algorithm

FOV- for scan, for display

Problems/Pitfalls in
Protocol Design

Timing of bolus and data acquisition

Preset filming
Pseudo-enhancement
Venous artifacts
Increasing numbers of tiny lesions

Timing

Routine chest protocol with 20 cm

coverage, table speed 11.25
mm/rotation, takes 14 sec for entire
scan at 0.8 sec/slice
Using 40 sec prep delay
If injection rate is 2cc/sec, use 108 cc
If injection rate is 2.5, use 128 cc

Filming
Because of high levels of vascular
enhancement, classic soft tissue
windows will not be appropriate
for all organs. Lesions may be
obscured in organs that enhance
brightly such as kidney and
arteries (pulmonary emboli,
dissection flaps)

Other issues

Pseudo-enhancement of renal cysts

surrounded by parenchyma becomes a
greater problem because of higher levels
of renal enhancement
Increasing numbers of tiny lesions in lung,
liver, etc. Are these metastases?
Venous artifacts, which simulate thrombus
become more obvious and frequent

Can I reconstruct thinner slices

than those printed on image?

PE protocol 2.50mm/7.50 1.5:1

Image 2.5mm thickness
Table speed = 7.5 mm/rotation
Pitch = 1.5:1 (HS mode)

7.5 1.5 = 5mm collimation

With 4 slices per rotation, detector size must
be 1.25mm and therefore this is thinnest slice
thickness that one can reconstruct

16 slice scanner

Routinely 360 rotation in 0.5 sec (798 data points)

Can go to 0.4 sec rotation for cardiac scanning

For larger patients, increase rotation time

Using the large-large FOV, each pixel is 1mm in

x-y plane. Thus each vowel is 1 x1 x1mm =
ISOTROPIC SCANNING
Can also achieve isotropic scanning with small
FOV (head, neck, extremity) in which each voxel is
0.5mm

16 slice scanner

Helical pitch = table distance per

rotation / slice thickness
15mm / 1mm = 15

Beam pitch = helical pitch / image

thickness
15 / 16 = 0.938

16 slice scanner

Prospective Gating: 0.4 sec gantry speed.

Machine counts 5 cycles, calculates R-R
interval, takes 0.25 sec scan, ending prior
to beginning of next R wave. Requires
heart rate < 80 bpm. Table moves during
next R-R interval. Each scan covers 4
images @ 3mm thickness.
Retrospective gating = gated
reconstruction. Helical acquisition with
ECG over raw data. When ECG is at a
given point, take data at that time to make
image.

MSCT
Examples of Unique
Protocols

Lung

Abnormal CXR- survey exam with 5mm sections,

but choose detector set of 4 1.25mm so that
retrospective thin slices through a small nodule
can be obtained without re-imaging
Airway disease- single breath hold with 1 or
1.25mm collimation. Evaluate trachea with
overlapping 3-5mm sections, use 1mm sections to
assess small airways. Combine inspiratory &
expiratory views for physiologic evaluation, air
trapping
PE- 1.25- 2.5mm, HS mode scan average thorax in
10-12 sec. Use bolus tracking. Helpful to view as
reconstructions.

Abdomen

Porta hepatis- because of complicated

anatomy & oblique orientation, 3mm
sections recon w 50% overlap curved
or coronal reformats
Liver and pancreas- multiple phases in
single breath holds
Kidneys- 3D reconstructions similar to
IVU and angiography

Musculoskeletal System

0.5mm slice thickness can result in

isotropic data set such that x-, y- and zaxes are equal in size (Will be standard
on 8 and 16 slice scanners)
Trauma- if scanning chest, abdomen,
pelvis can change FOV, recon to thinner
slices, change to bone algorithm and do
2D and 3D recons to review spine,
without re-imaging as spine protocol

Head and Neck

Elimination of direct coronal imaging

Reformats can avoid artifacts from teeth
3D displays for trauma and congenital
anomalies
3D reformats can provide endoscopic
views of larynx, hypopharynx and to
calculate tumor volumes
Angiographic and perfusion studies

Post Processing Applications

Huge numbers of images can be generated

from original data set and reformatted in
different planes, surface displays,
angiographic techniques, virtual endoscopy
Issues of how to view and store images

QUIZ

1. For SSCT with image thickness

of 2.5 mm and table speed of 4.0
mm/rotation, the pitch =
__________

2. For MSCT with tech requesting 4

slices with 3.75 mm thickness and
table speed of 11.25 mm/rotation,
pitch = ________________

a.
b.
c.
d.

SSCT
MSCT
both
neither

3. Re-indexing, or creating overlapping slices is

possible on
4. Reconstruction images to different slice
thicknesses is possible on
5. X-Y axis resolution (image quality) does not
change significantly with higher pitch on

a. SSCT
b. MSCT
c. both
d. neither

6. Noise increases with increasing pitch on

7. As pitch increases, > 1, the radiation dose to
the patient decreases on
8. The reconstruction algorithm involves 2
steps, the z axis interpolator and application of
specific algorithms such as smooth, standard,
bone, etc on

1. For SSCT with image thickness of 2.5

mm and table speed of 4.0 mm/rotation,
the pitch = 1.6

2. For MSCT with tech requesting 4

slices with 3.75 mm thickness and table
speed of 11.25 mm/rotation, pitch = 0.75

a.
b.
c.
d.

SSCT
MSCT
both
neither

3. Re-indexing, or creating overlapping slices is

possible on c
4. Reconstruction images to different slice
thicknesses is possible on b
5. X-Y axis resolution (image quality) does not
change significantly with higher pitch on b

a.
b.
c.
d.

SSCT
MSCT
both
neither

6. Noise increases with increasing pitch on d

7. As pitch increases, > 1, the radiation dose to
the patient decreases on a
8. The reconstruction algorithm involves 2
steps, the z axis interpolator and application of
specific algorithms such as smooth, standard,
bone, etc on c

References

Brink JA, Heiken JP, et al. Helical CT:

Principles and Technical Considerations.
Radiographics 1994; 14:887-893
Friedland GW and Thurber BD. The Birth
of CT. AJR; 167: 1365-1370
Silverman PM. multi-slice Computed
Tomography- A Practical Approach to
Clinical Protocols. Lippincott Williams &
Wilkins, 2002; Chapter 1: 1-29
Thanks to GE for providing images

The End