By Dr.

Shravani

Basic principle
The internal structure of an object can be reconstructed from multiple projections of the same. The ray projections are formed by thin cross sections of the scanning part with a narrow x-ray beam The transmitted radiation from this beam is measured by using a sensitive radiation detector. This measured radiation is fed into a computer and analysed by using mathematical algorithms and reconstructed as a tomographic image.

How does CT Work?

X-ray goes through collimator therefore penetrate only an axial

layer of the object,

called

"slice"

 Patient is placed in the center of the measurement field X-ray is passed through the patients slice from many direction along a 360 path The transmitted beams are captured by the detectors which digitizes these signals These digitized signals called raw data are sent to a computer which create the CT image

How is CT Image generated?

The object slice is divided

into small volume

elements called voxels. Each voxel is assigned a value which is dependent

on the average amount of

attenuation

The attenuation values are transferred to the computer where they are coded & used to create a slice image

CT Data Acquisition Components

DATA ACQUISITION
The scanning process begins with data acquisition.

Data Acquisition refers to a method by which the patient is systematically scanned by the X ray tube and detectors to collect enough information for image reconstruction.
A basic data acquisition scheme consists of X ray tube Filters Collimators Detectors

Image reconstruction
The HU of common substances:
Substance Air Fat Water Muscle Contrast Bone HU -1000 -120 0 +40 +130 +400 or more

The pixel itself is displayed according to the mean attenuation

of the tissue(s) that it corresponds to on a scale from +3071 (most attenuating) to -1024 (least attenuating) on the Hounsfield scale Voxel is a volumetric pixel

CT Gantry

CT gantry internal components

1.X-ray tube & collimator
2.Detector assembly 3.Tube controller 4.High freq. generator 5.Onboard computer

6.Stationary computer

X-RAY TUBE
Rotating anode type More heat loading and heat dissipation capabilities Small focal spot size (0.6mm) to improve spatial resolution

FILTERS
Compensation filter is being used To absorb low energy x rays To reduce patient dose To provide a more uniform beam

COLLIMATORS
To decrease scatter radiation To reduce patient dose To improve image quality Collimator width determines the slice thickness

DETECTORS

The detectors gather information by measuring the x-ray transmission through the patient. Two types:

Scintillation crystal detector (Cadmium tungstate+ Si Photodiode)

Can be used in third and fourth generation scanners

Xenon gas ionisation chamber

Can be used in third generation scanners only

Scintillation crystal detector used in I & II gen. CT scanners

When X ray Photons are absorbed by these materials the convert them into light photons and again converted into electric signals by photo multiplier diode.

Scintillation crystal detector used in III and IV gen. CT scanners

First Generation Scanners

Translate - rotate one detector. Total Scan time : 25-30 minutes (5 minutes per section). Uses pencil beam to scan the body. Arc of rotation of the gantry by 1 degree.

Second Generation Scanners

Translate rotate multiple detector (30). Uses fan beam. Multiple detectors are used. Scan time for single section : 10 -90 seconds.

Third Generation Scanners

Rotate rotate type. No linear motion of the Gantry. Multiple detectors are used. Single section Scan time : 4 9 seconds.

Fourth Generation Scanners

Rotate fixed type. Detectors are arranged in fixed circles around the patient and they do not move. Single section Scan time : less then 1 second.

Scan Modes
Spiral (helical) CT Conventional (incremental) CT (helical motion of X-ray tube, (short pause , several minutes) reducing time and radiation exposure)

22

What is Spiral Scan? -- just 4C

Continuously rotating tube/detector system

Continuously generating X-ray

Continuously table feed

Continuously data acquisition

Spiral CT
Newer method

X-ray tube moves continuously with slip-ring technique, the outer fixed detector ring and inner rotating x-ray tube ring having brushes that remain in electrical contact with the inside of outer ring.
X-ray tube moves continuously with patient moving cephalad with constant rate producing a spiral or helix around the patient.

CT SCANNING IN SPIRAL-HELICAL GEOMETRY BASED ON SLIP RING TECHNOLOGY

Slip-ring Technology
Power is transmitted through parallel sets of conductive rings instead of electrical cables.

Continuous Gantry Rotation

Prerequisite for Spiral CT

Non Slip-ring Scanner

Slip-ring Scanner

SPIRAL CT MAJOR STEPS

DATA ACQUSITION-ENTIRE TISSUE IS BEING SCANNED DURING ONE BREATH HOLD IMAGE RECONSTRUCTION-INTERPOLATION USED TO GENERATE SLICES. FILTERED BACK PROJECTION USED TO REDUCE BLURR.

DATA

ACQUSITION

Z-AXIS

Continuous data acquisition

Reconstruction of arbitrary slices (either contiguous or overlapping) within the scanned volume Distance between the slices is called Increment.
B

Volume Data A

During the scanning procedure, the tube is rotating & emitting x-rays at all time. The patient is advanced at a constant speed through the rotating gantry This produced a volume data set from which multiple slices can be reconstructed either in a contiguous or overlapping manner. The images can be produced at any position within the scanned volume A & B

Contiguous Image Reconstruction

Slice Thickness

Increment = Slice Thickness No Overlap No Gaps

Increment

Overlapping Image Reconstruction

Slice Thickness

Overlap

Increment < Slice Thickness Overlap of slices Closer image interval More images created

Increment

Image Reconstruction with Gaps

Slice Thickness

Increment > Slice Thickness Gaps between slices Images are further apart Less images created

Increment

Deep Inspiration

Shallow Inspiration Conventional CT scanning is slow because it requires multiple slice acquisition to cover the volume of interest Despite the fact that scanning are performed with consecutive slices, it is easy to miss small lesion when the patient varies his depth of inspiration from scan to scan. It is also difficult to reduce partial volume effect. In order to do so, the lesion must be captured fully, not partially within the slice. Several overlapping scans may be repeated, with the hope that the patient hold his breath at the same depth each time.

Partial Volume Effect

Standard CT / Slice Imaging

Misregistration due to different

respiratory levels between slices Unable to reconstruct images at arbitrary position

Slice imaging is slow

Why do we need spiral/helical CT scan

It eliminates respiratory misregistration and motion artifacts by rapid acquisition in a single breath-hold. Produces overlapping images without additional radiation. From single helical CT scan data, multiple, overlapping axial sections can be retrospectively reconstructed. Multidimensional imaging is possible 2D / 3D reformations with maximum longitudinal resolution optimizing image quality.

SPIRAL CT MODES
SINGLE SLICE

SPIRAL CT MODES
MULTI - SLICE

Conventional CT
Alternate translation & xray exposure is done. Each rotation of x-ray tube generates data of a transaxial image Prospective selection of slice positioning and spacing

Spiral CT

Both are done simultaneously Each rotation yields data Specific to an angled plane of section. From this, by interpolation, transaxial image is reconstructed.

Done retrospectively .

Protocol factors of spiral CT scan

Slice thickness / Collimation:

5 to 8mm for abdomen scan. 7 to 10 mm for chest scan. 5 mm for neck scan. 2 to 3 mm to scan small structures like lung nodules, smaller blood vessels. It affects effective slice thickness of reconstructed transaxial scan and its longitudinal resolution.

Advantages of spiral over conventional CT

Shorter scanning time Reconstruction along z axis with overlapping of successive images leading to detection of small lesions Fewer motion artifacts 3D reconstruction of image

Applications:
CT angiography. Cardiac CT with gating to freeze cardiac motion. Coronary artery imaging including calcium scoring. Tumor permeability studies. Functional and perfusion imaging. In Emergency acute abdomen cases.

Despite high heart rate of 90 bmp, motion free visualization of the coronary arteries.

Hepatic Laceration & Adrenal hematoma due to abdominal trauma

Fig: A Fig: B

Hepatic focal fibrosis misdiagnosed as hepatocellular carcinoma. Axial helical CT images obtained during hepatic arterial and portal venous phases reveal multiple round, hypo attenuating areas (arrows) in right and left liver lobes. This finding simulated hypo vascular mass and was originally misdiagnosed as possible tumour.

ARTIFACTS IN COMPUTED TOMOGRAPHY

ARTIFACT
Any discrepancy between the CT numbers represented in the image and the expected CT number based on the linear attenuation coefficient

PATIENT INDUCED ARTIFACTS

Motion Beam Hardening Metal Artifact Out Of Field Artifact

MOTION ARTIFACT CAUSED BY:

Voluntary motion. Involuntary motion.

It produces ghosting effect object Ct image appears as if composed of Superimposed images

MOTION

MOTION

MOTION

MOTION

REMEDY:
VOLUNTARY MOTION: Explanation Of The Procedure And Good Communication With A Patient. INVOLUNTARY MOTION: Short Scan Time.

BEAM HARDENING
It occurs when the average energy of an x-ray beam passing through the patient increases. Beam is hardened high energy photons are attenuated less by the tissue. As a result, they are pass through the patient and reach the detectors. This artifact is also called cupping artifact because the hardening is most pronounced in the center and less at the periphery. It resembles a cup.

COMMON AREAS OF MANIFESTATION:

Skull Petrous Pyramids Upper Chest And Shoulders Hips

BEAM HARDENING

BEAM HARDENING - CONTRAST

BEAM HARDENING

REMEDY
INCREASE kvp Decrease slice thickness Increase filtration bowtie filter

METAL ARTIFACT
Manifest itself as star streaking artifact. Its caused by presence of metallic objects inside or outside the patient. Metallic object absorbs the photons causing an incomplete profile

METAL ARTIFACT

REMEDY Removal of external metallic objects

OUT OF FIELD ARTIFACT

Patient is not entirely enclosed in the scanning field of view. Patients body can obstruct detectors. In addition, patient tissue outside the sfov will further harden the x-ray beam. Artifact appears as streaks and shading.

OUT OF FIELD ARTIFACT

OUT OF FIELD ARTIFACT

OUT OF FIELD ARTIFACT

REMEDY:
Selection of larger sfov Taping patient tissue Raising patients arms above their head on the scan of chest and abdomen

RING

RING

REMEDY Detector calibration Detector replacement

TUBE ARCING
Tungsten vapor from anode and cathode intercepts the projectile electrons intended for collisions with the target. Crackling sound!!!!

TUBE ARCING

REMEDY
GAS BURNOFF TUBE REPLACEMENT

LINE IN TOPOGRAM
BAD DETECTOR CAUSES CONTINUOUS LINE ON THE TOPOGRAM

REMEDY: DETECTOR REPLACEMENT

STAIRCASE
Improper selection of slice thickness and slice incrementation when generation mpr and 3-d images

REMEDY
THIN SLICE USE 50% OVERLAP ON RECON SLICE INCREMENTATION

Thank You