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Computed Tomography Scan

Computed Tomography is the process of creating transverse, axial, cross-sectional images of
the human body through the basis and measurement of Attenuation.
➢ It is known that the word CT was originally derived from the root words “tomos” –
which means “cut” and “graphia or -graphien” which means to write about.
➢ The orthodox terminology of CT scan was from CAT Scan (Computed Axial
Tomography) as at its earliest generations the CT scanner in the 1970’s can only
generate the Axial images of the human body – hence it is CAT SCAN. It is then, the
development of CT scan generations was set in place – thus the capability of
producing Sagittal, Coronal and Oblique Slices where possible that the term Axial in
the CT scan terminology was then removed.

Attenuation is generally described as the reduction of X-ray Intensity through the process of
Scattering and Absorption as it passes through matter.
➢ Applying this concept in Radiology, the difference in atomic composition (Atomic
Number and Mass) is a major factor for the attenuation of the X-ray Beam – since
the human body is a complex and diverse system the possibility of scattering and
absorption varies.
➢ The variations in the human body accounts for the process known as differential
absorption. Which suggests that different Z number would dictate the differences in
the X-ray attenuation (whether it may or maybe scattering or absorption).
➢ Linear Attenuation Coefficient which the unit of measure for the amount X-ray
intensity is absorbed as it passes through matter.
▪ It is commonly denoted by the Greek Letter (μ) with a unit of 𝒄𝒎−𝟏
▪ This unit is used as another method of measuring Beam Quality
second best to Half Value Layer (HVL).

Hounsfield Units (HU) otherwise known as the “CT numbers”, it is a unit of numerical
measurement that account to the radiodensity of the material based from its Linear
Attenuation Coefficient or simply the ability of the material or tissue to absorb X-ray photons.
➢ That is why the CT numbers are classified into:
o Hyperdense – White Color
o Isodense – Gray Color
o Hypodense – Black Color
➢ REMEMBER that the basis for the Hounsfield Units is from the X-ray absorbing
power of water (Linear Attenuation Coefficient).

The Hounsfield Units are the numerical measurement of Radiodensity based from the Remnant
Radiation (otherwise known as Exit Radiation) are the X-ray photons that were transmitted
from the body and then intercepted by the RADIATION DETECTORS.
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General Process in CT scan can be done in 3 steps:

Step 1: Data Acquisition

This is done through the use

of X-ray Tube, Collimators, X- Step 2: Image
ray Detectors, and DAS Reconstruction

This is done through the

use of Computer and
Step 3: Image Display, Manipulation,
Algorithms
Storage & Communication.

The Goals of Computed Tomography

1. To overcome Superimposition of Anatomy
2. To record and measure small differences in Tissues
3. To improve Contrast

What is the difference of CT scan, MRI, and Conventional Radiography?

Computed Tomography Scan Magnetic Resonance Imaging Conventional
Radiography
Uses X-ray photons and X-ray Uses Radiofrequencies and Uses X-ray Photons and
detectors to form cross sectional Magnets to form images. Image Receptors to
images (slices). obtain images.
No scattered Radiation
Presence of Scattered Radiation Produces 2-Dimensional
- Remedied using a fine Soft Tissue/ Organ Imaging Image of Anatomy.
collimation.
Superior Contrast Resolution Presence of Scattered
For Bone and Soft Tissue above all imaging modalities Radiation.
imaging - Remedied
Uses Gradient Coils to generate through Grid, Air
Second Best in Contrast different views of the body. Gap Technique,
Resolution Technical Factor
Manipulation.
Uses Reconstruction Algorithm
to generate different views of
body.
(Best Example is the use of MPR
– Multiplanar Reformation)

Exhibits the Uncoupling Effect

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Historical Development of Computed Tomography Scanners

➢ Dr. Godfrey Newbold Hounsfield is the Father of Computed Tomography. He is a

biomedical engineer who worked towards the development of CT scanners.
➢ Allan McLeod Cormack is the co-inventor of Dr. Hounsfield who developed the
necessary calculation for the image reconstruction and translation of CT raw data
into a readable CT image.
The joint work of Dr. Hounsfield and Cormack earned them the Nobel Prize for Medicine and
Physiology in 1979.

➢ 1st Generation which is known in the following names: MARK 1; Brain Tissue
Scanner; EMI Scanner.
o TRANSLATE/ROTATION
o Inventor/s: Godfrey Hounsfield & Allan Cormack
▪ It was 1st installed at ATKINSON MORLEY HOSPITAL in the United
Kingdom.
▪ Take Note: 180 translations are needed for the completion of an
image sequence.
o X-ray Tube: Pencil Beam
o X-ray Detector: 1-3 x-ray detectors are used and arranged in a Linear
Fashion.
o Scan Time: 3-5 minutes per translation.
o Its application is only limited to Neurologic Imaging.
▪ This generation has a standard 80x80 matrix size.
➢ 2 Generation which is known to be the ACTAS (Automated Computerized
nd

Transverse Axial Scanner)

o TRANSLATE-ROTATE
o Invertor/s: Dr. Robert S. Ledley
o X-ray tube: Narrow Fan Beam
o X-ray Detectors: this generation of CT scanners have 5-30 detectors that is
arranged in a Linear Fashion which can facilitate a 10-degree
rotation/translation which would only require 18 translations to complete a
slice.
o Scan Time: 20 seconds to 3.5 minutes.
▪ Although this generation has a main disadvantage of having high
scattered radiation – due to the x-ray tube design of a Narrow Fan
Beam which has characteristic wide beam divergence. Alongside the
increased scattered radiation, a combination of a wide beam
divergence and a linear array of X-ray tube detectors would create a
region of Penumbra.
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▪ The solution to the scattered radiation and region of penumbra is

the use of a Bowtie Filter.
➢ 3 Generation
rd

o ROTATE-ROTATE
o X-ray tube: Wide Fan Beam which is mainly controls the beam divergence to
conform with the curvilinear array of detector configuration.
o X-ray Detectors – uses 750 – 1000 detectors that is arranged in a Curvilinear
Fashion to conform with the curvature of the beam divergence and human
anatomy.
▪ This diminished the region of penumbra from the 2nd Generation.
▪ The control of Scattered Radiation is through the use of Thin
Tungsten Septa.
o Scan Time: 0.35 seconds – 10 seconds per slice.
o Disadvantage: This generation has one main draw back – a misalignment of
the x-ray detectors can cause the development of RING ARTIFACT which is
formed in the center of the image.
➢ 4th Generation
o ROTATE-STATIONARY
o X-ray Tube: Wide Fan Beam
o X-ray Detectors: This generation of CT scanners used a Stationary X-ray
Detector Ring which solves the problem of the 3rd Generation CT Scanner
for the existence of Ring Artifacts.
▪ The use of Thin Tungsten Septa is still in place to reject the Scattered
Radiation.
o Scan Time: less than 1 second per slice.
o Disadvantage: The Radiation Dose has dramatically increased due to the
short SID of the X-ray Tube to the Patient.
➢ 5 Generation aka. Electron Beam CT scanner (EBCT) and Heart Scanner
th

o STATIONARY-STATIONARY
o Inventor: Andrew Castagnini
o X-ray Tube: Electron Gun Beam
▪ This X-ray tube uses an energy that operates at a max of 130
kilovoltage.
▪ The Electron Beam will energize the Stationary Tungsten Rings that
will generate the X-ray Photons during exposure – the stationary
tungsten rings are composed of 4 Tungsten Rings.
o X-ray Detectors: this generation of CT scanners uses a Stationary Detector
Rings – mainly comprising of 4 X-ray detector rings.
▪ Advantage: among all of the CT scanner Generation, the EBCT has the
BEST TEMPORAL RESOLUTION.
o Scan Time: 50-100ms
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➢ 6th Generation aka. Dual Source CT Scanner (DSCT)

o SPIRAL/ HELICAL GEOMETRY
o Inventor/s: William Kalender and Kazuhiro Katada
o X-ray Tube: Dual X-ray Tube
o X-ray Detectors: Dual Curvilinear Array of X-ray tube detectors that are both
aligned to the X-ray Tube.
▪ Due to the Dual Source Capability of this generation Spiral/ Helical
Mode was already utilized – this simply means that the table
movement and X-ray tube gantry rotation can already be performed
at the same time.
• This action simultaneous action of the X-ray tube is made
possible through the use of Slip Ring Technology which allows
interruptible flow of electricity to the X-ray tube during
continuous scanning.
• This enables the TABLE PITCH.
▪ Note: Table Pitch is the term used for the Patient Table movement.
▪ Note: Excels in Multiplanar Reformation.
➢ 7th Generation aka. Multi-Slice CT scanners and Turbo Charged Spiral CT.
o X-ray Tube: Cone Beam which has a characteristic beam divergence that is
able to cover a large number of X-ray Detectors.
o X-ray Detectors: Flat Panel Detector that has a minimum number of 16
detector arrays with the highest at 1152 detector arrays.
o Advantage: the ability of the scanner to cover a large amount of anatomy in
the shortest period of time – overcoming Motion Artifact.
o Disadvantage: Expensive Cost of the machine.

Computed Tomography Instrumentation and Physics

System Components:
The Computed Tomography scanners have 4 main components:
1. CT Gantry
2. Patient Table
3. Computer
4. Control Console

CT Gantry is the largest component of the CT scanner which has an opening that is called as the
Aperture; the aperture has a circular opening that is measured to be 28 (71.2 cm) inches in
total diameter.
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➢ The gantry has a capability to tilt/ change direction according to the selection of the
Radiologic Technologist – it is said that the Gantry can be tilted from 15 – 30
degrees.
a. Laser Localizers – these are lasers that are used for localizing body landmarks during
the scanning of the patient.
b. Isocenter is the middle/ central region inside the aperture; it a place where dose is
equal in all directions.
o If in case the patient is not placed in the Isocenter: there would be image cut off,
unequal distribution of radiation, formation of noise.
c. X-ray Tube of CT Scanners have higher specifications in comparison with the X-ray tubes
that are normally seen in Conventional Radiography.
o The X-ray tube uses a target material - Rhenium Tungsten to increase the
efficiency and boiling point of the tungsten which have a boiling point of 3410
degree Celsius. Having the Anode construction to be a Rotating Anode that is
effective in Heat Dissipation.
o The Filament also uses an alloy of Thoriated Tungsten to enhance the efficiency
of Thermionic Emission.
Computed Tomography X-ray Tube Conventional Radiography X-ray Tube

Straton is the X-ray tube that is dedicated Coolidge is the X-ray tube that is
for CT Scanners. dedicated to Conventional X-ray Machine.

**High Heat Loading Capacity which is **Low Heat Loading Capacity in

measured in 6 – 8 mega heat units comparison to a CT Scanner which is at 1
(MHU). mega heat units (MHU).

**Current Rating: 300 mA

**Current Rating: 200 – 800 mA **Kilovoltage Rating: 120 KVp
**Kilovoltage Rating: 100 – 140 KVp
**Bevel Angle: 5 – 20 degrees
**Bevel Angle: 12 degrees which
decreases the Effective Focal Spot hence
achieving a Smaller Focal Spot which
helps in improving Spatial Resolution.
- The Bevel Angle reduces the
Anode Heel Effect.
o The smaller bevel angle is designed to utilize the Line Focus Principle
(Goetze Principle) which posits that the steeper the bevel angle the smaller
the Effective Focal Spot Size (FSS) – translating to High Spatial Resolution.
d. High Voltage Generators are used to supply the X-ray Tube with the require kilovoltage
of energy.
o There are two types of generators that are used in CT Scanners:
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▪ Three Phase – Twelve Pulse Generators – it is capable of producing

4% voltage ripple and 96% voltage efficiency; this type of generators
is bulky and usually positioned outside the CT Gantry as a “Stand-
alone design”.
• Obsolete – no longer used in CT scanners.
▪ High Frequency – is capable of producing less than 1% of the voltage
ripple having a 99% voltage efficiency. It is designed as a compact
generator that can be placed inside the CT Gantry.
e. Data Acquisition System (DAS) is the part of the CT Scanners that collects the raw
electrical signals from the X-ray Detectors and converts it into a Signal Data for image
reconstruction and processing.
o The part of the Data-Acquisition System that performs this task is called the
Analog-to-Digital Converter (ADC).
f. Collimators are the used to control the area/ field size of the Effective X-ray Beam.
Although in Computed Tomography, there are two levels of collimation to ensure that
amount of low energy X-ray photons and Scattered Radiation is decreased into a
minimum. Hence making CT a modality that uses “Finely Collimated X-ray Beam”.
➢ The levels of Collimation are the following:
o Pre-Patient Collimation – these are collimators that are placed/
incorporated in the X-ray tube which restricts the amount of Useful Beam
reaching the patient.
o Post-Patient Collimation (aka. Pre-Detector Collimation) – these are
collimators that are placed beneath the patient which restricts the amount
of Remnant Radiation reaching the X-ray Detectors.
Note! – the pre-patient and post-patient collimators should be in the same size. If in
case these scenarios happen:
Pre-Patient is High; Post-Patient is Low this will result into increased radiation
dose.
Pre-Patient is Low; Post-Patient is High this will result into noise formation and
photon starvation artifact.
Additional Note: Post-Patient Collimation Controls the Slice Thickness
g. X-ray Detectors are the component of the CT Gantry which collects the Remnant
Radiation that exits the patient’s body.
There are 2 types of X-ray Detectors according to their material:
1. Gas Filled Detectors uses Noble/Inert gases (particularly Xenon Gas) to generate
electronic signals through a direct process of conversion through Ionization of Xenon
Gas particles.
➢ The Ionization event will directly produce an Ion Pair – Cation & Anion will then be
collected and measured by the Electronic Diodes
ADVANTAGE: Gas Filled Detectors have excellent Stability, Dynamic Range, No
Afterglow, Response Time.
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DISADVANTAGE: it has Poor Detector Efficiency Rate (60-80%) which is caused by the
construction of the Front Window that acts an attenuating barrier with the incoming
X-ray photons and Aluminum Casing that keeps the pressurized Xenon Gas, further
attenuate the X-ray photons before it even causes an Ionization event with the
pressurized gas inside.
2. Scintillation Detectors (aka. Solid State Detectors) uses Photoreactive crystals to
generate light signals through an indirect process of conversion through Excitation of
photoreactive crystals.
➢ The Excitation even will directly produce light signals that is equivalent to the
intensity of the ionizing radiation. These light signals will be collected by the
Photodiode for it to be converted into Electronic Signals.
The following are the list of Photoreactive Crystals:
➢ Bismuth Germanate Oxide (BGO) – mostly used detector for PET Scanners.
➢ Cadmium Tungstate (CdWO4) – “Most Preferred” Photoreactive Crystal used as a
Detector for CT Scanners
➢ Cesium Iodide (CsI) – mostly used as a material for Image Intensifier in Fluoroscopy.
➢ Sodium Iodide (NaI) – obsolete photoreactive crystal in CT; but widely used in Gamma
Cameras in Nuclear Medicine.
ADVANTANGE: it is widely chosen over a Gas Filled Detector due to it 100% Absorption
Rate.
DISADVANTAGE: it is susceptible to afterglow due to low response time; this is
alongside the hygroscopic property of photoreactive crystals which they have high
affinity to water and moisture.
o This is why there CT Scanners have dehumidifier inside the CT scan room.

Criterion for Selecting an X-ray Detector

There are 5 criterion one should look at when selecting an appropriate X-ray Detector:
1. Detector Efficiency – is the ability of the X-ray detector to detect, capture, and convert
X-ray Photons into quantifiable Electronic Signals.
a. Absorption Efficiency - Is the ability of a detector to effectively absorb the X-ray
Photons.
b. Capture Efficiency – is the ability of the detector to effectively obtain/collect
remnant radiation exiting from the patient.
c. Conversion Efficiency – is the ability of the detector to effectively convert all of
the absorbed X-ray photon into Electronic Signals.
2. No Afterglow there should be no persistence of light emission after stimulation.
3. Dynamic Range is the ability to measure and discriminate between the smallest to
largest signal with precision.
4. Stability is the ability of the X-ray detector to develop a steady response.
5. Response Time is the ability of the X-ray detector to detect and recover from an X-ray
event leading to another. (Ability to detect and recover – hence prevents overlapping of
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X-ray Photon events – remember when X-ray events are overlapping this leads to
Afterglow event).

Patient Couch/ Table function is to carry the patient during the scanning process, places the
patient in the Isocenter of the Aperture.
o The material used in the Patient Table should be low atomic number; low
attenuating material such as Wood and Carbon Fiber which can carry a weight
limit of at least 220lbs.
The Table Movement in CT terms are called as Table Increments/ Indexing which is
used for the older generations of CT Scanners (from 1st to 5th Generation). While the
Table Pitch is an exclusive term that should be used for the newer generations of CT
Scanners (6th and 7th Generation).
NOTE: the Table Indexing/ Pitch is one of the Primary Controller of Slice Thickness.

**Scannable Range is the degree the patient table can move horizontally.

Table Pitch Table Increments/ Indexing

The movement of the Patient Couch The movement of the Patient couch
towards the aperture are simultaneous towards the aperture is done in
with the X-ray Tube Rotation. succession with the X-ray Tube
Rotation.

**Table Pitch is also defined as ratio of table speed/feed to slice thickness. This can be
expressed using the equation below:
𝑻𝒂𝒃𝒍𝒆 𝑰𝒏𝒅𝒆𝒙𝒊𝒏𝒈
Table Pitch =
𝑺𝒍𝒊𝒄𝒆 𝑻𝒉𝒊𝒄𝒌𝒏𝒆𝒔𝒔

Table Pitch is given in ratio values, it can be interpreted as table movement (number of increments)
indicating distance of slice thickness per gantry rotation.

Example: if the Ratio value given is 2:1, this simply means that table has moved twice (2x) in a single
gantry rotation.
➢ Table Pitch value indicates the speed of indexing/ table feed.
o If the Pitch is > 1 (greater) – the speed of indexing is fast.
▪ This is prone to image blurring
▪ A fast table speed is very useful in covering a large amount of Anatomy
when scanning hence favorable for CT contrast and angiography studies.
o If the Pitch is <1 (less than) – the speed of indexing is slow.
▪ This yields for high spatial resolution but in the cost of high patient
radiation dose.

NOTE: the most ideal value of table pitch should always be equal to 1 – 1.5.
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Computer serves as the link between the Radiologic Technologist and CT components.
➢ The computer in aiding data acquisition, image reconstruction, display and post
processing.
Storage – the modern storage of all digital is through the Picture Archiving and
Communication System.
- it uses a file extension known as .dicom (Digital Communications in Medicine) other file
extension is .hl7 (Health Level 7).

Control Console is a CT component where the Radiologic Technologist can control and monitor
scan parameters.

Methods of Data Acquisition

Localizer Scan/ Preliminary Scan

- these is a scout image that is taken by the Radiologic Technologist to use as a guide for
CT planning.
o It is also used to check for patient positioning (ensuring Isocenter Positioning)
and designation of DFOV.
**Otherwise known as the Topogram, Surview, Scanogram, Preview.

Two Modes of CT scan operation

Sequential Scanning Mode Helical/ Spiral Mode

(Aka. Step-and-Shoot) (Aka. Volumetric Mode)

Often referred to as Step-and-Shoot Often referred to as Volumetric Scanning

Scanning Mode due to manner of acquiring Mode due to the ability of this scanning type
data; for every single table increment/ feed to cover a large amount of scannable range
in the CT aperture, the X-ray Tube must in a single breath hold for the patient.
complete a full rotation.
This is made possible through the use of Slip
The movement of table towards the CT Ring Technology.
aperture is called the Table Increment/
Feed. Table Pitch is exclusive into this type of
scanning mode.
This mode directly produces Axial CT images
that is Perpendicular to the Z-axis and This mode of scanning generated slices that
Parallel with other slices. are angled/ slightly tilted (similar to the
shape of a spring); this leaves a space in the
ADVANTAGE: elimination of image blur. acquisition rendering to a missing data
scan.
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DISADVANTAGE: prolongs scan time, This is solved through the use of

cannot cater examinations that requires Interpolation Algorithm.
fast data acquisition, prone to
misregistration artifact. ADVANTAGE: reduced motion artifacts and
scanning time, improved image resolution
Although this solution for prolonged Scan for Contrast Media studies.
and Misregistration artifact is solved
through the use of Clustering Technique is DISADVANTAGE: High Radiation Dose
where the RT will group the sequential
scans into “cluster” or “groups” into a Its clinical application is through CT Contrast
single breath hold. and Angiography studies.

Its clinical application is through CT guided

Biopsy.

Types of CT Scanners according to their Detector Arrays:

Single Detector CT scanners (SDCT) Multi-detector CT scanner (MDCT)

Uses a single row of X-ray Detectors to Uses multiple rows of X-ray Detectors to
acquire images. acquire images – also known as Flat Panel
Detectors.
This is exclusive to the older generations of
CT Scanners – 3rd and 4th Generation. This is exclusive to 7th Generation CT
Scanners who are capable of producing 16,
The Slice Thickness is controlled by the 32, 64 or even higher number of CT slice in a
Collimator Assembly. single Gantry Rotation.

The Slice Thickness is controlled by the

Detector Element Size and Table Pitch.

Other type of CT Scanner is the Dual Source CT Scanner (DSCT) this type of CT scanners utilizes
two X-ray Tubes with a Single Row of X-ray Detector Element.
- This is exclusive to 6th Generation of CT Scanner; which is advantageous – the dual
source X-ray tube will provide a higher detail due to the dual energy source.
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X-ray Tube

Image Acquisition and Formation

Pre-Patient Collimator
in Computed Tomography
Human Body

Pre-Detector Collimator
CT Image Data
Remnant Radiation
(Measurement Data)

X R D T R

DAS Pre-Processing:
(Analog-to-Digital Conversion) (Raw Data)

Reconstruction
Computer Fourier Convolution Filtered CT Data Algorithm
Transform
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Image Reconstruction
The Ray, Ray Sum, View, Attenuation Profiles (aka. Scan Profiles, Projection Profiles)
1. Ray/s are the pathway of the X-ray Photon from the X-ray Tube towards the detector.
2. Ray Sum is the detection of the individual rays and measurement of X-ray beam
attenuation.
3. View is the complete set/ grouping of Ray Sum.
4. Attenuation Profile – is the way the CT system profiles/classifies the characteristics of
each ray sum and the correlate its position to the position of the ray.

Rays

Finished Image

Ray Sum
and View

Attenuation Profiles

Successive Summation of Attenuation Profiles is done

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Until it forms a visible image that can be interpreted.

There are four types of CT Data that is processed during image reconstruction:

Measurement Data Raw Data Filtered Data Image Data

Type of CT data that Type of CT data that Type of CT data that Type of CT data that
is derived by the has undergone pre- has undergone has undergone
measurement of the processing by the Convolution/ image processing
Remnant Radiation Data Acquisition Filtering. technique through
from the patient’s System. the use of Image
body. Reconstruction
Algorithms.

Reconstruction Algorithms
1. Back Projection (aka. Summation Method)
Is a computer algorithm that is used to reconstruct CT images through the combination
(summation) of scan profiles from the patients in a 360-degree perspective as the X-ray Tube
completes a single rotation per table increment.
Disadvantage: formation of the Star Pattern Artifact.
2. Filtered Back Projection (aka. Summation Method)
Is an improvement of the Back Projection Method which has the capability to eliminate
the Star Patter Artifact through the use of Fourier Transformation and Convolution Filters.
➢ Fourier Transformation – is a mathematical technique that was developed by Jean-
Baptiste-Joseph Fourier. It is widely used in Digital Signal Processing (DSP), the
collected signals are transformed through the decomposition (separation) of bundled
signals into its individual components; it can also be used to map/locate each
individual signal for image processing and reconstruction.
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A. Discrete Fourier Transform (DFT) is used for finite range of signals that is used to
digitize frequency signals.
B. Fast Fourier Transform (FFT) is a variation of Fourier Transform which can cover
a wide range of frequency signals and digitize all of these analog signals faster
than DFT.
➢ FFT’s are also used in Ultrasonography particularly in Doppler Mode.
Application of FT is very evident with the Convolution of Frequency Signals when using a
Filtered Back Projection algorithm which uses a filter to create an image that is pleasing/ in line
with the clinical question for the improvement of either Contrast/ Spatial Resolution.
➢ Convolution Filters (aka. Kernels) is a computer algorithm that is used to suppress
“filter” individual digital signals such as High/ Low Frequency signals to improve the
image quality of the CT image.

High Frequency Kernels Low Frequency Kernels

(Low Pass Filter) (High Pass Filters)
This type of Convolution Kernel will only This type of Convolution Kernel will only
filter all the High Frequency Signals and let filter all the Low Frequency Signals and let
all the Low Frequency Signals to be all the High Frequency Signals to be
processed and transformed into a CT processed and transformed into a CT
image. image.

The resultant CT image has a High Contrast The resultant CT image has a High Spatial
Resolution – this process of increasing Resolution which is very ideal for Small
Contrast Resolution is known to be Structure Imaging.
“Smoothing” which is very ideal for Organ
Imaging. Characterized by High Noise and Low
Contrast Resolution.
Characterized by Low Noise Image and Low
Spatial Resolution.

3. Iterative Reconstruction (aka. Adaptive Statistical Reconstruction Algorithm) is a

reconstruction algorithm which reconstructs CT images through an assumed image and
raw data from the scan profiles; it is then compared with the original mage; the
differences between the actual and calculated projection are then use to update the
image for improved quality and suppression of image noise.
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o An increase in the
Number of Iterations;
Improved image
quality; increased
reconstruction time.

Post – Processing Techniques

Image Reformation
(Aka. Image Rendering) is a process of generating images in a plane or orientation (3-
Dimensional, Sagittal, Coronal, and Oblique Views) that is sourced from a prospective image
data (Axial images).
1. Shaded Surface Display (SSD) is a 3-dimensional image rendering technique that selects
pixels and voxels values that are fit to the preselected value range that representative to
the anatomy of interest – the selected pixel and voxels values are going to represent
and form a surface image while the rest of the pixel and voxels values that are not used
will be invisible.
o Only demonstrates specific anatomy of interest and its surface – best used for
Solid Structures such as Bones, Solid Masses/Tumors.
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2. Volume Rendering Technique (VRT) is a 3 – dimensional image rendering technique that

uses all of the available pixel and voxel values (no loss of CT data) to form a volumetric
image that exactly shows the different anatomy and their relationship.
o Special Application of VRT is the “Endoluminal Imaging” which is the ability of
the CT software to generate a 3-dimensional image of hollow organs (such as
Colon and Bronchi) and look inside it.
o This ability to look inside the organ is called as “Flying Through” visualization.

Volume Rendered Images Endoluminal Image – Virtual

Colonoscopy

3. Multiplanar Reformation (MPR) is a 2-Dimensional image rendering technique that

enables a CT image to be reformatted into Sagittal, Coronal, and Oblique Views through
the combination of Axial CT Image data.
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4. Maximum Intensity Projections (MIP) is an image rendering technique which uses voxel
and pixel that contains High Intensity Projection data to form 2-dimensional images - a
good image rendering technique when evaluating bones and contrast filled structures
(Angiography Studies).

5. Minimum Intensity Projections (MinIP) is an image rendering technique which uses

voxel and pixel that contains Low Intensity Projection data to form 2-dimensional
images - a good image rendering technique when evaluating soft tissue with low
attenuation such as bronchial tree.
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Image Quality and Display

Computed Tomography Image Characteristics
The Computed Tomography image is composed of the following elements:
1. Pixel (aka. Picture Element) – is the To calculate for the Size of each pixel:
representative of individual Hounsfield Units
which is a two-dimensional representation of 𝑫𝒊𝒔𝒑𝒍𝒂𝒚 𝑭𝑶𝑽
𝑷𝒊𝒙𝒆𝒍 𝑺𝒊𝒛𝒆 =
the whole CT image that is confined in a 𝑴𝒂𝒕𝒓𝒊𝒙 𝑺𝒊𝒛𝒆
Matrix – arranged in rows and columns.
Each Pixel that can be assigned as Black (Hypodense), Gray (Isodense), and White
(Hyperdense) – depending on the Hounsfield Unit that is assigned.
The Hounsfield Units are based on the Linear Attenuation Coefficient of X-ray photons in
Water which has a constant value of 0.
**If a material has an assigned Hounsfield Unit greater than the value of Zero it is known to be
denser than Water, therefore appearing as White (Hyperdense).
**If a material has an assigned Hounsfield Unit greater than the value of Zero it is known to be
less dense than Water, therefore appearing as Black (Hyperdense).
**If a material has an assigned Hounsfield Unit equal/ almost equal than the value of Zero it is
known to be same density with Water, therefore appearing as Gray (Isodense).
Take note of the following Hounsfield Units:
o Bone = +1000
o Air = -1000
o Water = 0
**Remember: As the PIXEL SIZE increases the image quality is degraded – the image will
appear more “Pixelated” and if the PIXEL Size decreases the image quality will be improve –
this will appear “sharper”.

Large Pixel Size Medium Pixel Size Small Pixel Size

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2. Voxel (aka. Volume Element) is the tissue volume of the CT image. It is directly affected
by the slice thickness.
An Isotropic Voxel is the ideal type of
voxel which is shaped as a Cube. This
indicates that are loss of CT data due to
the volume averaging by increasing slice
thickness.
A Voxel’s volume can be calculated
through the use of this equation below:
𝑽𝒐𝒙𝒆𝒍 = (𝑷𝒊𝒙𝒆𝒍 𝑺𝒊𝒛𝒆)(𝑺𝒍𝒊𝒄𝒌 𝑻𝒉𝒊𝒄𝒌𝒏𝒆𝒔𝒔)

**Unit of Voxel is 𝒎𝒎𝟑

➢ Slice Thickness is a scan parameter that is otherwise known as the Z-axis or Slice
Sensitivity Profile; this indicates the size of the voxel.
▪ The slice thickness is controlled by TABLE PITCH
▪ Slice Thickness controls the
SPATIAL RESOLUTION of the
finished CT data.
3. Image Matrix is the grid that is formed by the
columns and rows of Pixels.
o Standard Matrix Size: 512 x 512
**Remember as the Image Matrix increases – the
Pixel Size decreases this will result into good quality
image but when the Image Matrix decreases – the
Pixel Size increases this will result into poor image
quality.
4. Field of View (aka. FOV) is the maximum diameter of the area of the scanned object
that is represented by the reconstructed image.

Scan Field of View (SFOV) Display Field of View (DFOV)

(Aka. Calibration Field of View) (Aka. Zoom or Target)

Determines the area of the gantry which the Determines the amount of raw data
raw data is acquired. that is going to be used for
reconstructing an image.

The DFOV can influence the image

quality of the finished CT image data in
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Simply the area of the Aperture that is the computer during the post-
scanned – from the Isocenter extending from processing stage:
the distant edge of region of interest.
PIXEL and MATRIX SIZE.

Its other function entails the “zoom

feature” if the Technologist would like
to focus on a certain region of interest
the DFOV can be used.

CT Image without a change in DFOV

SFOV also controls the amount of the Flat

Panel Detectors that would be activated for
data acquisition.

CT image with a “Zoomed” DFOV for

specifically imaging the Lumbar Spine.

Although this is selected by the CT Scanner

System when the Technologist selects what
type of examination will be performed.
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NOTE: the Largest SFOV that could be selected

50 cm. The succeeding measurements above
50cm gives an unstable Hounsfield Unit value.

Small SFOV: 25cm used for Head, Neck,

Extremities Scanning

Medium SFOV: 35cm used for Thoracic

Scanning

Large SFOV: 42-50cm used for Abdominal

Scanning.

REMEMBER: DFOV cannot be bigger than SFOV – because the SFOV is the basis and control
for acquiring the raw data before it is transformed into an image data. While the DFOV
only controls the finished image data – This means DFOV is dependent on SFOV.
5. Window Setting (aka. Gray Level Mapping) is a post processing technique which adjusts
or maps the different shades of gray.

Window Width Window Level

(Aka. Window Center)
Determines the quantity of shades of Selects the Hounsfield Unit values that
gray that will be included in an image are displayed as shades of gray.
display.
Midpoint value for the shades of gray.
Primarily Controls Contrast.
Primarily controls Brightness of the
This setting controls the Scale of image.
Contrast:

Narrow Width means that few shades of

gray will be included in a CT image.
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Wide Width means that many shades of

gray will be included in a CT image.

6. Uncoupling Effect & CT Dose Index (CTDI)

The Uncoupling Effect is a phenomenon by which the amount of radiation exposure is no
longer related to the perceived image quality. Which is very evident in Digital Imaging
systems such as Computed Tomography, Computed Radiography, and Digital Radiography
– unlike in Conventional Film-Screen Radiography, hence the term “Uncoupled”.

➢ Computed Tomography Dose Index (CTDI) is a

measurement of radiation dose in single CT scan
procedure.
o This is measure through the use of Pencil
Ionization Chamber (aka. Pen Dosimeters)

Quality Control and Quality Assurance in CT scan

RESOLUTION:
Spatial Resolution is the ability of the imaging system to resolve small objects that are laying
very close together as separate objects.
It is expressed as line pair/cm (lp/cm).

High Spatial Low Spatial

Resolution Resolution
Image Image
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Parameters Results in:

Increasing Pixel Size Decreases Spatial Resolution
(Increase in pixel size; will increase the volume averaging
of the attenuation profiles (scan profiles) into a less
accurate pixel therefore degrading Spatial Resolution)
Increasing Voxel Size Decreases Spatial Resolution
(Increase in voxel size; will increase the volume averaging
of the attenuation profiles (scan profiles) into a less
accurate voxel therefore degrading Spatial Resolution)
Increase Matrix Size Increases Spatial Resolution
(Increase in Matrix Size; will increase the number of Pixel
in FOV)
Results in Longer Reconstruction Time
Increase Slice Thickness Decreases Spatial Resolution
(Increasing Slice thickness will result into volume
averaging)
Increase Focal Spot Size Decrease Spatial Resolution
(Larger FSS will degrade spatial resolution due to the
increase of Penumbra around the object)

Increase FOV Decrease Spatial Resolution

(Increasing FOV will degrade because of the insufficient
number of Pixels to fit a bigger FOV, hence increasing FOV
stretches the Pixel Size).
Increase Post Patient Increase Spatial Resolution
Collimation (Increasing Post-Patient Collimation eliminates scattered
radiation and controller of slice thickness).

Contrast Resolution is the ability of the imaging system to resolve/ differentiate between
objects that have the same densities as their background.

High Contrast
Low Contrast
Resolution
Resolution
Image
Image
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Parameters Results in
Increase Noise Decreases Contrast Resolution
(Increasing noise degrades the Contrast
Resolution of the image due to the loss/
fluctuation of pixel values due to
insufficient detected photons).
Increasing Slice Thickness Increases Contrast Resolution
(Increasing Slice Thickness increases the
voxel size which in turn increases the
detected X-ray photons)
Increasing Pixel Size Increases Contrast Resolution
(Increasing Pixel Size will increase the
detected photons).
Increasing Voxel Size Increases Contrast Resolution
(Increasing Slice Thickness increases the
voxel size which in turn increases the
detected X-ray photons)
Increasing Matrix Size Decrease in Contrast Resolution
(Increasing Matrix Size means that the sizes
of pixel are decreasing thus the noise
increases due to the number of rows and
columns that needs to filled with
insufficient number of photons).
Increase mAs Increase in Contrast Resolution
(Increasing mAs will entail increased
number of X-ray photons which fills the
Matrix).
Increasing kvp Decreases Contrast Resolution
(Increasing Kvp will entail a Higher
Scattered Radiation that leads to Noise
Formation and Long Scale of Contrast)

Increase Contrast Resolution

(Increasing Kvp will entail a Harden Beam;
thus, increasing the production of High
Energy Photons and readily attenuated Low
Energy Photons.
Increase Post Patient Collimation Increase Contrast Resolution
(Increasing Post-Patient Collimation
eliminates scattered radiation).

Increasing Patient Thickness Decrease Contrast Resolution

(Increasing Patient Thickness will only
contributed to increase Attenuation of X-
ray Beam and Scattered Radiation).
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CT imaging Artifacts:

Artifact Type Cause and Appearance Solutions

Photon Starvation Occurs when there is an
insufficient amount of X-ray Increase in mA, kvp
Patient based Artifact photons that reaches the X-
ray Detectors. Increase Slice thickness

Appears as noise/ streaks in Iterative Reconstruction

Highly Attenuating Structures
such as Bone, Metal.
Metallic Artifact Occurs when there’s a Remove the metal in the
presence of Metal in the SFOV.
Patient Based Artifact SFOV which attenuates the X-
ray Beam. Increase kvp; mAs

Appears as Star Streak/ Star Wider Window Width.

Burst.
Motion Artifact **Proper patient instruction
(Aka. Ghosting Artifact) Occurs when there’s an for the control of Voluntary
uncontrolled voluntary and motion
Patient Based Artifact involuntary motion that was
exhibited by the patient. **Immobilization

Appears as SHADING, **ECG - Cardiac Gating

GHOSTING or BLURRING. Techniques

Tube Arcing Occurs when there’s an

(Aka. High voltage Arcing) undesired surge of electrical
current in the X-ray tube Tube Replacement
Scanner based Artifacts causing a short circuit
(Arcing).

It is caused by Tungsten
Vaporization; Presence of
Gas in the X-ray tube
Envelope.

Appears as Single-Multiple
Streaks in the CT image.
Ring Artifact Occurs when there’s a
misalignment of the X-ray Calibration of X-ray
Scanner Based Artifact Detectors. Detectors by the Service
Engineers.
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Appears as Concentric Rings

centered on the DFOV.
Partial Volume Artifact Occurs when the dense
objects lie at the edge of the
(Physics Based Artifact) Field-of-View. Reducing Slice Thickness.

Occurs when increasing Slice

Thickness over a region of
Anatomy that is small.
(Ex. Posterior Cranial Fossa)

This causes the data

attenuation profile to
contained within a Voxel;
which produces less accurate
representation of image due
to the confinement of more
than one data attenuation
profile inside the voxel.

Beam Hardening Occurs when a

“Polychromatic Beam”
(Physics Based Artifact) experiences attenuation from Use of Filters, Calibration
the organ that is being Correction, and Beam
imaged; hence “Hardening” Hardening Software.
the beam.

The organ acts as though it is

a filter; absorbing low energy
photons.
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Clinical Applications of Computed Tomography

CONTRAST MEDIA
➢ Positive Contrast Media – appears as White due to High Attenuation capabilities of
these substances.
o Barium Sulphate
o Iodinated Contrast Media
➢ Negative Contrast Media – appears as Black due to Low Attenuation capabilities of
these substances.
o Air – Carbon Dioxide or Room Air
CONTRAST MEDIA DELIVERY TECHNIQUES & SCAN DELAY METHODS:
➢ There are 2 CM delivery techniques:
o Drip infusion Method uses the force of gravity to deliver the contrast to the
patient with use of elevated IV line.
▪ Take note this technique doesn’t produce a “Peak Contrast”
enhancement because of the slow contrast media introduction rate
into the body.
o Bolus Technique is a method that delivers Contrast Media in a Rapid
Injection Rate which can be achieved by:
▪ Mechanical Injector (Power Injector)
▪ Hand Bolus Injection
➢ There are 2 methods of Scan Delay
o Test Bolus - method of administering CM of 10-20mL via IV line; to
determine the length of time from the injection of CM to Peak
Enhancement in the Organs.
o Bolus Tracking (aka. Automated Triggering; Bolus Triggering) – is a method
using a bolus of Contrast Media to start a Scan; this technique uses low-
radiation dose scans to monitor (known as the Monitor Scans) the progress
of contrast enhancement in the body.
PHASES OF CONTRAST ENHANCEMENT AND CONTRAST EXAMINATION TYPES
➢ Arterial Phase (aka. Bolus Phase) is the first phase of the Contrast Media Flow; no
contrast media is seen at this phase of the CM flow.
o 20 -30 seconds is the theoretical average time for the Arterial Phase.
➢ Venous Phase (aka. Non-Equilibrium Phase) occurs when the Contrast Media has
already been administered through the patient; scanning should be performed at
an average time of 60 post-injection.
o Venous Phase is the second phase of the CM Flow
o It has a Theoretical Average Time of 60-70 seconds.
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➢ Delayed Phase (aka. Equilibrium Phase) is the last phase of the Contrast media
enhancement; it is where the contrast media has already been completely drained
from the organ.
PATIENT CONSIDERATIONS
The following list should be considered when a patient is required to undergo a CT scan
procedure that entails the administration of IV contrast, Biopsies, and Fluid Drainage:
1. Laboratory Examination:
a. Creatinine and Blood Urea Nitrogen (BUN) – are the laboratory examination
that tests the Renal Function of an individual – particularly for examinations
with IV contrast
b. Prothrombin Time (PT) and Partial Thrombin Time (PTT) – are set of laboratory
examination that tests for blood coagulation ability of an individual –
particularly for CT Guided Biopsies and Fluid Drainage.
2. Patient History – the Radiologic Technologist should be well of the following:
a. History of Asthma – considered as a risk factor for adverse reaction to IV
contrast administration knowing that Asthmatic are 5x more prone in
comparison to healthy individual.
b. History of Allergy with Food, Medications, and other substances – this is one of
the factors that increases the risk of developing adverse reaction with IV
Contrast Media administration.
c. Patients with Diabetes Mellitus (Type II) in Metformin Therapy – this increases
the risk of adverse reaction of IV Contrast with Metformin which may lead to
Lactic Acidosis or in patient who are diagnosed with Diabetes alone with
controlled blood sugar to develop a condition of Contrast Induced Nephropathy
(CIN) due to IV contrast media administration.
▪ Metformin should be WITHELD FOR 2 days; 1 day before the
examination and 1 day after the examination.
3. Use of Pre-medications – is a technique that is used to decrease the incidence of any
allergic reaction with IV Contrast Administration this is done through the combination
of Steroids (Corticosteroids) and (Antihistamines – e.g., Benadryl). The administration
of these drugs is done before the administration of

CT Imaging of the Head

➢ HEAD CT Imaging
The Head CT Imaging protocols suggests that the laser localizer should be placed
at the level of the Orbitomeatal Line (OML) during the image planning. As the rules and
regulations for Radiation Safety has been updated – the use Supra-Orbitomeatal Line
(SOML) aka. Glabella-meatal Line (GML) was set into place in order to reduce the
radiation dose to the Lens of the Eyes when undergoing a Cranial CT imaging.
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➢ Kothari Method and 3D volume pixel Method – these are the methods of measuring brain
bleeds in patients suffering from Intracranial Hemorrhage (especially CVA’s) but limited in
measuring brains bleeds that are near to Bone Structures, Axonal Injuries, Cerebellar and
Pontine Bleeds.

Note: Intracranial Hemorrhage (ICH) undergoes changes in appearance in CT Image due to

complex factors that involves blood clotting and CSF mixing

Brain Perfusion Studies is a CT imaging protocol that is used to tissue viability of patient who
had suffered a Cerebrovascular Accident (CVA) or most commonly known as “Stroke” –
especially useful identifying areas in the Brain tissue that are considered as:
➢ “Non-salvageable” or “Neuronal death” – which is collectively called as “Core
Infarcts”- these are areas of the brain which have occluded blood supply due to the
presence of embolus or thrombus.
➢ “Ischemic penumbra” – these are areas of the brain which have partial occlusion of
blood supply due to the presence of embolus or thrombus.

This can be identified through the use of the following parameters:

➢ Regional Cerebral Blood Flow – measurement of total amount of blood volume moving
through an image voxel in a given unit of time.
➢ Regional Cerebral Blood Volume – measurement of the total amount of blood volume
in an image voxel – blood in tissues and blood vessels.
➢ Mean Transit Time – measurement of average transit time of CM infused blood
perfusing through a volume of brain tissue.

Take Note:
Core Infarcts – Decreased in both CBV and CBF with an Increase in MTT.
Ischemic Penumbra – Increased MTT, preserved CBV; decreased CBF.
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To better identify and visualize the relevance of MTT, CBV, and CBF. A color-coded software is
used by modern CT scanners to demonstrate the mismatch of CBF, CBV and MTT mismatch
values.

Arrows – representing decreased CBF Arrows – representing increased MTT

CT Imaging of the Thoracic Cavity

In general, the Thorax has the highest intrinsic contrast in comparison to any body part
in the human body. This is because of the inherent differences in the attenuation values of the
neighboring structures in the Thoracic cavity – bones, muscles, body organs (lungs and heart)
and blood vessels. Due to this characteristic – it is seldom that the scanning of the Thoracic
Cavity includes IV Contrast.

➢ AIRWAYS (Trachea and the Bronchial Tree)

o The scanning technique for Respiratory Airways to perform imaging in both
Inspiration and Expiration this is to differentiate the respiratory organs with
and without an extrinsic contrast (AIR).
o By performing this the assessment of the Airway opening is possible – making
CT a valuable modality for assessing Tracheal Narrowing due to neoplastic
(tumor growth) or past history of Endotracheal Tube.
▪ Post processing techniques such as Volume Rendering Technique (VRT) is
an algorithm that is designed to perform the Virtual Bronchoscopy.
➢ LUNG PARENCHYMA
o The Lung Parenchyma is imaged through a CT imaging protocol known as the
High-Resolution Computed Tomography (HRCT).
▪ The High-Resolution CT imaging protocol is used to diagnose diffuse
pathologies that exists in the lung parenchyma:
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• Diffuse Pathologies typically include – Pulmonary Tuberculosis,

Emphysema, Lung Nodules, Cystic Fibrosis.
o This imaging protocol is performed by following these operating procedures:
▪ Thin Slice thickness this increases the spatial resolution of the image that
will be taken.
▪ Fast Acquisition – the faster the acquisition the lesser the chances of
occurring misregistration artifact.
▪ Small DFOV – a smaller DFOV will increase the spatial resolution.
o Alongside the aforementioned protocols the following position should be taken
into consideration:
▪ There are HRCT are performed with the use of these CT scanning modes:
• Axial Scanning Mode
o The CT scanner acquires images in an incremental manner
which have an interval of 10mm in between z-slices.
o ADVANTAGE: It has less radiation exposure to the patient,
increased spatial resolution due to fast acquisition hence
preventing misregistration artifact.
o DISADVANTAGE: Technologist should remember that this
cannot be used for cases which the patient has diffuse
pathologic lesions in the lung parenchyma. As this may
cause the imaging to miss out some of the pathologies
that should be included in between intervals – causes
misdiagnosis.
• Helical/ Spiral Mode (aka. Volumetric Scanning Protocol)
o This scanning protocol entirely replaced the Axial
Scanning Method which has its main ADVANTAGE: to
cover the whole lung volume without missing any region
of the lungs which is hence very ideal for diagnosis of
diffuse and focal lung parenchymal pathologies.
▪ This method is also capable of 3D reconstruction
with the use of Min IP and Max IP which makes the
Airway 3D reconstruction possible alongside with
the HRCT 3D Reconstruction.
o DISADVANTAGE: the increased Radiation Dosage due to
Helical Scanning.

Patient Position
Prone Supine
Used to differentiate pathologies in Anterior The standard position for CT imaging.
and Posterior areas of the Thorax that could
be missed in a Supine Position Scan due to
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the influence of gravity to lung expansion,

gas volume, and blood pooling.

Ex. Atelectasis that could be located in the

dependent region of the Thorax (side
touching the CT couch).

The High-Resolution CT scanning are performed in the following set of protocols:

1. HRCT scanning are done in Caudo-Cranial Fashion – meaning that the foot goes first and
head follows with the arms are laid upwards.
o The Caudo-Cranial position ensures that the motion artifact could be avoided
because the base of the lungs acquires more motion during a respiratory cycle
in comparison to the apices.
2. HRCT scanning are done in series of scanning having the patient positioned in Prone
and Supine.
3. HRCT scanning always performed at Full Inspiration but if a differential diagnosis is
needed – a Expiratory Scan is performed.
Full Inspiration vs. Full Expiration
Full Inspiration Full Expiration

This is used for HRCT for maximizing This is used only when there is a need for
contrast enhancement with the use of comparison (depending on clinical
AIR. This is also to ensure that the lung is question). As Expiratory Scan are useful
at its full capacity. in detecting the areas of the lungs that
does not empty air (air trapping); which
is common for Bronchiectasis and Cystic
Fibrosis.

CHEST CT ANGIOGRAM
A routine Chest CT Angio is a useful tool in diagnosing Pulmonary Embolism in a non-
invasive manner. This is because the traditional route of diagnosis is usually performed with
the use of Pulmonary Angiography procedures.
Other options may include the use of V/Q Scintigraphy.

CARDIAC CT IMAGING
Cardiac CT imaging is definitely one of the difficult organs in the body to obtain CT
images due to the rapid involuntary movements that is caused by Heart Contractions. To be able
to obtain high quality CT images of the Heart the following are used:
Techniques for Cardiac CT Imaging
Pharmacologic Control This uses a pharmacologic agent: Beta-Blockers which has a
mechanism of action to slow down the heart of the patient to
less than 65 – 70 bpm.
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(The slow heart rate enables the CT scanner to keep up with

the heart contractions).

Pharmacologic Agent: Metoprolol Tartrate

Route of Administration can be done through in combination

or stand-alone Intravenous (IV) Oral administration.

Oral – 1 hour Post administration

IV – 5 – 10 minutes Post administration

While the dosage of the drugs will strictly depend in the

Physician’s order.

Disadvantage: Allergic Reaction to medications, Bradycardia

etc.

ECG-Gated Imaging Prospective ECG Gated CT imaging

Aka. Sequential/ Cine Mode
This is a CT imaging
protocol which utilizes an Uses an Axial/ Sequential Scanning Mode – the image
Electrocardiogram (ECG) to acquisition is typically triggered at the R-wave segment of the
track phases of the Cardiac ECG reading.
Cycle with the least cardiac
motion. Meaning to say that only a small/ finite portion of the Cardiac
Cycle is being scanned to reconstruct a CT image of the heart.
The phase of the Cardiac
Cycle with the least Cardiac
Motion is at End Diastole Advantage: It has a significant low radiation dose when
(Relaxation – Filling Phase) acquiring CT images of the Heart.
or End Systole (Contraction
– Pumping Phase) Disadvantage: This method of Cardiac Imaging is very
susceptible to motion and misregistration artifacts which may
occur if the patient has a history of Cardiac Dysrhythmias.

To initiate a Prospective Scan:

**Identify the R-wave in the ECG Reading.

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**Place and measure a Delay Time – it is controlled by the

Technologist and reproduce this in succession until the

targeted anatomic interest is covered.

**Initiate Scanning in between the S-T segment (this area of

the Cardiac Cycle is marked as the Ventricular Relaxation
phase) – synchronizing the scanning with the Heartbeat of
the patient that is within the R-R Interval (One complete
Cardiac Cycle).
**The finished CT images in the Prospective ECG-Gated
Scanning are reconstructed at the desired phase of the
Cardiac Cycle.

Retrospective ECG Gated CT imaging

Aka. Dynamic/ Cine Loop

Uses a Helical/ Volumetric Scanning Mode to acquire the CT

image/s of the Heart.
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This protocol work by a continuous Helical Scanning of the

Heart throughout the entire Cardiac Cycle and only select the
specific images that has a least Cardiac Motion.

The Helical data acquisition of an entire cardiac cycle enables

the collected data to be manipulated and presented in a Cine
Loop (Dynamic Image) which is sometimes called as 4-
dimensional imaging of the Heart.

Disadvantage: High Patient Dose although this can be resolved

through the use of ECG-Pulsed Tube Current Modulation

ECG-Pulsed Tube Current Modulation is a dose reduction

technique developed by CT manufacturers which reduces the
tube current (mAs) during a Helical data acquisition at the
Cardiac Systolic Phase of the Cardiac Cycle.

Cardiac Calcium Scoring

This an CT imaging technique that is used to measure blood vessel narrowing of the
Coronary Arteries due to Atherosclerotic build-up of fat, plaque, and even Calcium for patients
that are diagnosed with a coronary artery disease (CAD) that are asymptomatic.
This diagnostic examination is very useful in predicting a likelihood of cardiovascular
events especially with individuals without any apparent symptoms and also a screening
examination for patients with high risk factors.
- The amount of Calcification that can be detected in the scan is expressed as Calcium
Score.
Methods of Calcium Scoring
Agatston Method Calcium Volume Score Calcium Mass Score
This method of Coronary This method of CAC Score is a This method of CAC Score is a
Artery Calcium Score (CAC) is breakthrough from Agatston breakthrough of limitations
only applicable with the 5th from Calcium Volume Score.
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Generation CT Scanners – and designed to work for

EBCT. MDCT scanners.
This method measures
This method measures This method measures calcium contents in the
calcium contents in the calcium contents in the Coronary Arteries similar to
arteries based on the density arteries through calcium area Bone Densitometry – which
and extent of Calcium (space occupancy) or volume bases its measurements of
Deposits. inside the blood vessel. Calcium deposits on X-ray
attenuation.
It has a limitation due to
varying patient body size and It has the ability to calculate
CT Scanner which will not the concentration and mass
reflect the actual Calcium of Calcium Plaques.
Score; it is also affected by
Volume Averaging Artifacts.

PET/CT AND HYBRID IMAGING

Is a hybrid fusion imaging technique which utilizes the CT scan in its ability to produce image of
detailed anatomy and utilize Nuclear Medicine to demonstrate the physiologic function of the
organ.

F-18 – Fluorodeoxyglucose (FDG) Scan

Is a scanning technique that uses Hybrid Fusion imaging of CT scan and Nuclear Medicine to
form an image display that constitutes a detailed anatomy and physiology of an Organ. The
main use of F-18 FDG Scan is for Cancer Metastasis detection.
➢ Uses a Radiopharmaceutical called Flourine-18; Fluorodeoxyglucose (aka.
Radioactive Sugar).
➢ The use of Radioactive Sugar is used to detect metastatic spread of Cancer Cells
throughout the body – through an accumulation of F-18 radiopharmaceutical in a
form of Unilateral Hotspots; these hotspots represent areas of the body with High
Consumption of the Radioactive Sugar in comparison to Healthy Normal Cells
around it with an EXCEPTION TO THE FOLLOWING ORGANS – Brain, Liver, Urinary
Bladder.
➢ A complimentary CT image is fused to Gamma Camera Image to further delineate
a clearer picture of anatomy and areas marked with Hot Spots (High Sugar
Uptake).

Lecture Material Created By: Niňo Timothy A. Garcia, R.R.T.

References:
➢ Radiographic Positioning and Procedures Vol. 3; 10 th Edition.
➢ Roman’s Book for Computed Tomography