UNIT-II

Tomography
 COMPUTED TOMOGRAPHY(CT)

Godfrey Newbold Hounsfield

A Multi slice CT Scanner: Philips ‘Brilliance’

64 channel thin slice
 Early Attempts at CT

• Gabriel Frank: 1940 Patent: described CT principles using

optical back projection reconstruction (but no filter)

• Takahashi (Japan, ‘40s, published 1956): describes

equipment to image slices by backprojection
• Tetel’baum et al (Russia, 1957): Accurate formulation of
inverse Radon Transform; TV-based reconstruct
• Kuhl & Edwards: (1963): cross-sectional images by back-
projecting transmission data on oscilloscope
• Alan Cormack: built simple CT to measure densities for
radiotherapy. Shared Nobel Prize.
 HISTORY OF CT SCAN

• Originally known as "EMI SCAN" as the first CAT scanner, a device

which revolutionised medical imaging developed in early 1970s, at
EMI Central Research Laboratories in UK by Godfrey Newbold
Hounsfield and Allan McCormack in 1972 (They shared the 1979 Nobel
Prize)
• CT stands for Computerized Tomography
• Sometimes referred to as CAT(Computed Axial Tomography), or CT Scan
or Body Section Roentgenography.
• The word "tomography" is derived from greek tomos (section or slice)
and graphein (to write).
• Utilizes X-Rays and computers for cross sectional slice of the body
• Each picture is like a slice from a loaf of bread, showing both the outline
and internal structure
• The scan provides highly detailed images of all parts of the body (soft
tissue, bone, organs, etc)
 HISTORY OF CT SCAN (CONTD)..

• CT was originally proposed and used as an extension of the basic X-

ray: doctors wanted to see inside the head, but standard X-ray
techniques could not penetrate the dense skull while distinguishing
soft tissues
• The first scanners could only do one slice at a time and each slice
took 4 minutes to complete
• By 1976, whole body scanners were developed
• Today’s machines can acquire a slice in less than half a second (.1
second for the GE top-end multislice LightSpeed Pro16 with Xtream)
• Advancements still occurring through new technology
HISTORY OF CT SCAN (CONTD)..

A present-day scan,
Circa 1975, in the early
showing a six-fold increase
days of the CT scan.
in detail
(images courtesy Siemens Medical Systems and Imaginis.com)
HISTORY OF CT SCAN (CONTD)..

Original "Siretom"

                                          
dedicated head
CT scanner, circa
1974
 HISTORY OF CT SCAN (CONTD)..

Specifications First CT (circa 1970) Modern CT Scanner

(2001)

Time to acquire one 4-5 minutes 0.5 seconds

CT image

Pixel size 3 mm x 3 mm 0.5 mm x 0.5 mm

Number of pixels in an 64,000 256,000

image

Table Data: http://www.physicscentral.com/action/action-02-3.html

TRADITIONAL X-RAYS

• X-rays pass through the body and

project a shadow of the contents
of the body onto the detectors,
which record this projection in
various shades of gray
• Only reveals bones clearly, while
soft tissue just appears black
• Three-dimensional body parts are
projected onto two-dimensional
film, losing valuable information
PROJECTION IMAGES:
The creation of a two-dimensional image “shadow” of the
three dimensional body. X-ray are transmitted through a patient,
creating a radiograph.
 Limitations of Radiography

• Inefficient x-ray absorption: typically ~25% for par speed

cassette (prior to rare earth technology)
• High Scatter-to-Primary Ratios: may have >50% scatter at
receptor with large beams even with high ratio grid
• Receptor Contrast vs latitude: required film dynamic range
limits film contrast
• Superposition/Conspicuity: overlapping structures with 3D
anatomy rendered on 2D image
 IMPROVEMENTS OVER X-RAYS

• Provides 3D images
and cross-sectional
views instead of basic
2D images
• CT Scans can show
soft tissue as well as
bone, allowing
physicians to detect problems such as cancerous tumors
• Extremely helpful in determining organ anatomy, especially following
trauma
• Can determine tissue density difference of less than 1% while X-rays can
allow determine tissue density difference of 5%
Conventional vs Axial Tomography

Conventional Cut

CT Axial Cut
 CT IMAGES

Normal Abdominal CT.

Level of Liver and Spleen Level of Kidneys
 Principle of CT
• A narrow x-ray beam is scanned across a patient in synchrony with a radiation
detector on the opposite side of the patient.
• If the beam is mono energetic, the transmission of x-rays through the patient is

I=Ioe-µx
• If the x-ray beam is intercepted by two regions with attentuation coefficients µ 1
and µ2 and thickness x1 and x2, the x-ray transmission is

I=Ioe-µ1x1+µ2x2
• If many(n) regions with different linear attentuation coefficients occur along the
path of x-rays, the trransmission is

I=Ioe-∑i=1to n µixi
CT - BLOCK DIAGRAM

Diagram showing relationship of x-ray tube,

patient, detector, and image reconstruction
computer and display monitor
 CT SCAN METHODOLOGY

•X-ray tube and detectors rotate around the patient, with the axis of rotation running
from the patient’s head to toe
•Detectors measure the average linear attenuation coefficient, µ, between the tube and
detectors
•Attenuation coefficient reflects the degree to which the X-ray intensity is reduced by
the material it passes through
•2D measurement are taken in a helical manner all around the patient
•Attenuation data is summed up from thousands of angles used in a process called
reconstruction
•Contrast dye is sometimes used to make the internal organs more visible in the image
 CT SCAN METHODOLOGY (CONTD)..
Radiation detection system is composed of detection elements, such as scintillating
crystals and photodiodes
•Data acquisition system measures the radiation data transmitted through the object
and digitizes it so the computer system can read it
•Computer reconstructs the image from raw scan data then a picture is created by a
cathode ray tube
•Computer allows the technologist to shade, rotate, correlate and measure the
organs in the image
•Bone appears white; gases and liquids are black; tissues are gray
•Measurements taken in Hounsfield units (Hu), calibrated universally with air at
-1000 Hu and water at 0 Hu (other typical values include fat ~-50 Hu, muscle ~40
Hu, and bone ~1000 Hu)
•The same study data can show bone structure or soft tissue detail, simply by
altering the window and leveling (ie, which Hu range will the 0-255 greyscale
values will correspond to)
 CT MACHINE-BASIC COMPONENTS
•
A CT scanner looks like a big, square doughnut.
• The patient aperture (opening) is 60 cm to 70 cm (24" to
28") in diameter.
• Inside the covers of the CT scanner is a rotating frame
which has an x-ray tube mounted on one side and the
banana shaped detector mounted on the opposite side.
• A fan beam of x-ray is created as the rotating frame spins
the x-ray tube and detector around the patient .

   
Outside view of modern CT
• Each time the x-ray tube and detector make a 360 degree, system showing the patient table
and CT scanning patient aperture
an image or "slice" has been acquired and during which
the detector takes numerous snapshots called profiles
(about 1,000 profiles) of the attenuated x-ray beam are
sampled.
                                                                                                                                                                                                                
• Each profile reconstructed           
(or "back projected") by a
dedicated computer into a two-dimensional image of the
"slice" that was scanned.
• A workstation with dedicated controls allows the
technologist to control and monitor the exam.
• The CT gantry and table have multiple microprocessors Inside view of modern CT system, the x-
ray tube is on the top at the 1 o'clock
that control the rotation of the gantry, movement of the position and the arc-shaped CT detector
is on the bottom at the 7 o'clock
table (up/down and in/out), tilting of the gantry for angled position. The frame holding the x-ray
images, and other functions such as turning the x-ray tube and detector rotate around the
patient as the data is gathered.
beam on an off.
The three standard orientations of slice (or tomographic)
images
Axial,
Transaxial, Coronal
Transverse Frontal Sagittal

Oblique Slice: an orientation not corresponding to one of the

Standard slice orientation.
 CT SCANNER

– Generator
• High frequency, 30 - 70 kW
– X Ray tube
• Rotating anode, high thermal capacity: 3-7
MHU
• Dual focal spot sizes: about 0.8 and 1.4
– Gantry
• Aperture: > 70 cm of diameter
• Detectors: gas or solid state; > 600 detectors
• Scanning time: <1 s, 1 - 4 s
• Slice thickness: 1 - 10 mm
• Spiral scanning: up to 1400 mm
 IMAGE PROCESSING

• Reconstruction time:
• 0.5 - 5 s/slice
• Reconstruction matrix: 256x256 –
1024x1024
• Reconstruction algorithms:
• Bone, Standard, High resolution, etc
• Special image processing software:
• 3D reconstruction
• Angio CT with MIP
• Virtual endoscopy
• CT fluoroscopy
 WHAT TYPICALLY GETS SCANNED

• brain and spinal abnormalities

• brain tumors and strokes
• sinusitis
• aortic aneurysms and other blood vessels
• hemorrhage
• chest infections
• diseases of organs such as the liver, kidneys, and lymph nodes in the
abdomen.
• quickly identify injuries to the lungs, heart and vessels, liver, spleen,
kidneys, bowel or other internal organs in cases of trauma.
• guide biopsies and other procedures such as abscess drainages and
minimally invasive tumor treatments.
• plan for and assess the results of surgery, such as organ transplants or
gastric bypass.
• stage, plan and properly administer radiation treatments for tumors as well
as monitor response to chemotherapy.
• measure bone mineral density for the detection of osteoporosis.
 A LOOK INSIDE A ROTATE/ROTATE CT

Detector
Array X Ray
and Tube
Collimator
 CT- SCANNING SYSTEM

• First Generation-Parallel Beam Geometry.

• Second Generation-Fan Beam,Multiple Detectors.
• Third Generation-Fan Beam,Rotating Detectors.
• Fourth Generation-Fan beam,Fixed Detectors.
• Fifth Generation-Scanning Electron Beam.
• Spiral/Helical Scanning
 FIRST GENERATION CT
• To Acquire a projection (X-ray)
translation and rotation motion is used

• Translate x-ray pencil beam and

detector across body and record
output(eg.160 measurements)

• Translational scanning seperated by 1

degree increments repeated thro arc of
180 degree.

• Assemble all the projections.

• Typical scan time of 5 minutes.

• Limited only to brain studies.

Pixels
and
Voxel
s
1st Generation Data
Collection
Hounsfield’s CT Formulation
• Measurement
Ni written as
sum of
attenuation of
pixel along
path

• Solve
simultan-eous
equations from
data at many
positions and
angles
 Second generation scanners
• Fan shaped beams where introduced so that multiple measures are made
simultaneously
• Fan-shaped beam & increased number of detectors permitted scanning and
rotation with fewer linear movements (eg. 30 degree fan beam and 10
degree angular increments.)
• Improved image quality by reducing the effects of motion
• Loss of collimation increased the amount of scatter detected = major
disadvantage
• Long data reconstruction time.
• Scan time – 20 to 60 seconds
– Reasonable breath holds
– Exams of whole body now possible
 Third Generation
• Wider fan-shaped beam
• Curved array of 250 - 750 detectors to
achieve a single projection
• Beam was wide enough to include entire
body in a single exposure
• 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
• Dynamic scanning – 4 scans per minute
THIRD GENERATION CT (Contd..)
FOURTH GENERATION CT
 Fourth generation CT

• Single-projection fan-shaped beam

• 600-2000 stationary detectors in a 360° ring

• Wider range of scan arcs possible with scan times from

0.5 – 10 seconds

• Some are capable of scan rates of 15 scans per minute

• Limiting factor = interscan time & computer processing

time
1ST, 2ND, 3RD, & 4TH GENERATION

One detector Multiple detectors

Translation-rotation Translation-rotation
Parallel-beam Small fan-beam

1st Generation 2nd

Generation
Detector ring
Multiple detectors Source-rotation
Translation-rotation Large fan-beam
Large fan-beam

4th
3d Generation Generation
YUMC RIRS
 FIFTH GENERATION CT SCANNER
(OR) ULTRA FAST CT SCANNER
• ELECTRON BEAM COMPUTED
TOMOGRAPHY or CARDIAC
CINE
– X-ray tube is replaced with an
electron gun
– Deflection coil to direct electron
beam around an anode ring
• Uses an electron beam accelerated by
130-140KV instead of x-ray tube.
• Focal point is Electromagnetically
focused around the patient,deflected
over target in 50 ms scan times.
• Used in cardiac examinations.
• 4 anode rings, 2 detector rings,8
contiguous slices,8x8 mm scanned
area.
• Heartscan by Imatron EBCT
 SPIRAL (HELICAL) CT

WILLI KALENDER Developed Spiral CT in 1989

 SPIRAL (HELICAL) CT

• Referred to as Helix, volume or 3 D CT Scanning.

• If the X Ray tube can rotate constantly, the patient can then be moved
continuously through the beam, making the examination much faster
• For helical scanners to work, the X Ray tube must rotate continuously
• This is obviously not possible with a cable combining all electrical sources
and signals
• A self lubrication “Slip Ring” is used to supply power and to collect the
signals
 HELICAL SCAN PRINCIPLE

• Scanning Geometry

X Ray beam

Direction of patient
movement

• Continuous Data Acquisition and Table Feed

• Helical (spiral) Scanners
– Slip ring technology
– Current and voltage supplied while the tube is in continuous motion around the gantry
• Table is moved slowly during exposure while tube is in continuous rotation.
• Scanning motion has a set circular diameter (helix)
• Much shorter scan time = 30-40 seconds for entire abdomen
– Less contrast is needed
• Entire exam can be completed in 1 breath hold
– Eliminates overlaps & variations in inspirations
– Reduces possibility of motion artifacts

• Primary disadvantage: a full 360 set of data is not acquired for each section
– The patient is continually advanced through the gantry during exposure
– Sectional image is created from computer reconstructions
 A LOOK INSIDE A SLIP RING CT

Note:
X Ray how most
Tube of the
electronics
is
placed on
the rotating
Detector gantry
Array

Slip Ring
SPIRAL (HELICAL) CT

• A pitch of 1 yields
contiguous spiral.

• A pitch of 2 yields an
extended spiral.

• A pitch of ½ yields an
overlapping spiral.
 SPIRAL (HELICAL) CT vs. CONVENTIONALCT

• Fasterimage acquisition
• Quicker responsd to contrast medium
• Fewer motion artifactrs
• Improved two-axis resolution
• Physiological imaging
• Improved coronal, sagittal, and 3D imaging
• Less partial volume artifact.
• Ability to set pitch at less than 1.0 and produce oversampling of areas of interest
• Image reconstruction can be set for smaller section thicknesses than those that were
acquired.
• Increasing pitch value permits a greater field of view to be imaged in a shorter
time.
• Using the smallest detector size combined with a pitch of less than 1 increases
resolution in the z plane
SINGLE-SLICE VS. MULTI-SLICE
DETECTORS
SINGLE-SLICE CT

1sec/revolution
HELICAL MULTI-SLICE CT
16 SLICES

0.4 sec/revolution
1.25 slice thickness
1000 images/whole body study
 7th Generation(Multi slice)

• Single slice CT scanners: • Multi Slice CT scanners:

• Section thickness
determined by collimator • Section thickness is
size determined by the width of
the detector
– Resolution is determined
by the width of the
detector
MSCT
 MSCT

• Because these bands of detectors operate simultaneously – a single beam

exposure can produce multiple sets of image receptor data.
• When combined with helical scanning:
Total exam time is dramatically reduced
(chest or abd procedure: 15-20 sec).
• Section thickness determined by collimator size in single slice.
• Section thickness is determined by the width of the detector and resolution
determined by width of detector in multi slice detector.
 7th Generation

• MSCT:
– More efficient
– Reduces patient exposure
– Increases image resolution
– Allows post-acquisition reconstruction at new levels…
 7th

• Example:
– 20 mm collimated beam width can expose an array
of four 5 mm detector bands – the dataset from this
exposure can be displayed as:
• Four 5 mm sections
• Two 10 mm sections
• One 20 mm section
• Any other combination = unlimited choices for Dr
 SPIRAL CT AND SPIRAL MULTISLICE CT

Advantages: Contd..
 Ability to Image Larger volume of tissue in a relatively short time
 Dose Saving:
 reduction of single scan repetition
 use of pitch > 1
 No data missing as in the case of inter-slice interval
 Shorter examination time:
 to acquire data during a single breath-holding period avoiding respiratory
disturbances
 disturbances due to involuntary movements such as peristalsis and
cardiovascular action are reduced .
• Single-slice detectors-Slow exam times
• Multi-slice detectors-Much quicker exam times
• Up to 4 slices in 0.5 seconds
• Soon to be 8 or even 16 detectors
 HELICAL MULTI-SLICE CT

Solid State Detectors

Ultra Fast Ceramics

- Improved Temporal Resolution

- Improved Axial Resolution
- Wider Anatomical Coverage
HELICAL MULTI-SLICE CT
CARDIAC IMAGING
 PIXEL and VOXEL

• 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.

• 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.
• 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

+1,000 for dense bone
– Only – CT # in the body are Fat, Lung & Air
 CT Numbers: Hounsfield
Units

Example 1: voxel contains water (up= uw):

CT# = 1000 x (uw - uw)/ uw = 0

Example: voxel contains air (up≈ 0):

CT# = 1000 x (0 - uw)/ uw = 1000 x (-1) = -1000
• On the CRT, 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
 Benefits

• CT scanning is painless, noninvasive and accurate.

• A major advantage of CT is its ability to image bone, soft tissue and blood
vessels all at the same time.

• Unlike conventional x-rays, CT scanning provides very detailed images of

many types of tissue as well as the lungs, bones, and blood vessels.

• CT examinations are fast and simple; in emergency cases, they can reveal
internal injuries and bleeding quickly enough to help save lives.

• CT has been shown to be a cost-effective imaging tool for a wide range of

clinical problems.

• CT is less sensitive to patient movement than MRI.

• CT can be performed if you have an implanted medical device of any kind,
unlike MRI.

• CT imaging provides real-time imaging, making it a good tool for guiding

minimally invasive procedures such as needle biopsies and
needle aspirations of many areas of the body, particularly the lungs,
abdomen, pelvis and bones.

• A diagnosis determined by CT scanning may eliminate the need for

exploratory surgery and surgical biopsy.

• No radiation remains in a patient's body after a CT examination.

• X-rays used in CT scans usually have no side effects.

 Limitations of CT

• Soft-tissue details in areas such as the brain,

internal pelvic organs, knee or shoulder can be
more readily and clearly seen with
magnetic resonance imaging (MRI). The exam
is not generally indicated for pregnant women.