PRINCIPLES OF CT

Definition
CAT SCAN = Computed Axial Tomography

Or just CT Scan (Computed Tomography)

► CT makes use of a special x-ray equipment to

obtain image data from different angles around
the body .
► Then uses computer processing of the
information to show a cross-section of body
tissues and organs.

► Like slicing an orange.

INTRODUCTION
In CT scanning.
(a) A transverse slice of the patient which
can be about 10mm thick is produced.
(b) This avoids the superimposition of
adjacent structures that occur in
conventional radiography.
(c) The slice is produced by a narrow fan
beam rotated around the patient which
reduces the amount of scatter produced.
d) The slice is subdivided into a matrix of 512 x
512. volume elements or volumetric pixels
(voxels) each typically 0.5 x 0.5 x 10m.m.

e) The image is reconstructed by a digital computer

as a corresponding matrix of 512 x 512 picture
elements (Pixels).

f) The computer allows the use of windowing to

selectively display a restricted range of tissues.

On account of a,b,c, and f, the contrast

resolution is better than in conventional
radiography.
However on account of d and e the spatial
resolution is less good.
Anatomy of a CT scanner

Gantry

Operator’s
Console

Table
CT Generations
1st generation Scanner
Characteristics…….
- single pencil beam
- single detector
- together translate through
180 steps and
then rotate 1o at a time
through 360o
- Scan time 3 – 5 min/slice
2 nd
Generation Scanner
• Narrow fan beam
• Small curved array of
detector
• Together they translate
and then rotate,
• But requires fewer
angular steps to produce
image
• Reduces scan time to 20
sec/slice
3rd Generation Scanner
• Most commonly used scanner
• Wide fan beam
• Larger curvilinear array of
hundreds of detectors
• Which do not translate but
simply rotate continuously
through 360o around the
patient scan time reduce to
1sec/slice
• Tube and detectors always in a
geometrical relationship
allowing for better pre detector
collimation
• which makes the image subject
to ring artifacts.
4 Generation scanner
th

1. Wide fan beam but only

the tube rotates through
360o around the patient.
2. The detector is a
continuous ring of
thousands of detectors
3. Not faster than 3rd gen
4. But ring artifacts are
avoided
5. Tube closer to patient
than detector
6. Increased radiation doses
to patient
SCANNING THE PATIENT
 A rotating anode with a high heat capacity
produces x-rays. The tube is mounted with its
axis perpendicular to the slice to reduce heat

 The x-rays are collimated as they leave the tube

into a fan beam which just covers the body.

 The emerging rays (transmitted beam) passes

through another set of collimator then falls on a
curvilinear array of detectors.

 These detectors convert the transmitted
beam intensity into a proportional signal
current (pulse). Which is the available
data to provide the image.
 The tube and detectors are mounted on
opposite sides of a ring and they rotate
smoothly around the patient.
CT system - Gantry
PRINCIPLES OF CT IMAGING 1
Pixel / Voxel
512 x 512 Matrix

512

512
Pixel Voxel
ACQUIRING THE DATA
The X ray from the tube is attenuated by the
contents within the Voxel
This attenuated ray then falls on the detector
The detector measures the logarithm of the
intensity of the radiation falling upon it.

The figures are used to Calculate CT

numbers which are then related to the sum
of all the CT numbers of other voxels
How do we Calculate CT Numbers

The linear attenuation coefficient, µt of each tissue pixel is compared to that of water.

CT Number = 1000 (µ t – µw)

µw
Water is used as a reference material because
it’s µ is close to that of soft tissue
it is also a reproducible material for machine calibration.
The multiplier(1000) is used to obtain whole numbers
The CT number(Hounsfield number) ranges from
-1000 in air ,through 0 for water and +1000 in bone.
The ct (hounsfield) number of a body tissue is the attenuation coefficient of
that tissue in relation to the attenuation coefficient of water
 A raysum is the value of the sum of the
voxel CT values along the projection.
51+44+32+45+56+22 = 252

 The CT number of each voxel then

features in several of the ray sums
measured in the entire matrix

 The computer is able to carry out several

arithmetic processes on this data to finally
produce an image on the video display
screen for viewing.
The original
Hounsfield Scale
APPROX. TISSUE NUMERICAL VALUE IN
HOUNSFIELD UNITS

► 200 – 1000 Bone

► 80 – 200 Calcification
► 55 – 75 Hemorrhage
► 35 – 45 Grey matter
► 22 – 32 White matter
► 12 – 18 Brain edema
► 0 – 10 CSF
► 0 Water
► - 100 Fat
► - 1000 Air
Windowing
 Although the scanner can distinguish
2000 different CT numbers,
 The eye however cannot distinguish as
many different shades of grey on the
screen.
 Usually there are about 14 shades of
grey.
 There is a need to choose a window,
which just embraces all the tissues of
interest
 only these areas are displayed as the available shades of
grey
 while CT numbers outside this window are undifferentiated
and are displayed either as black or white.
 The window level represents the CT No closest to your area
of interest
 while the window width is a range of CT numbers an image
contains, with the window level as its median.
 Wide window is best used in areas of acute differing
attenuation values e.g lungs where air and vessels sit side by
side
 Narrow window are excellent when examining areas of
similar attenuation, for example soft tissue.
Window Width and Level

CT numbers above window width range are

displayed as white.

CT numbers below window width range are

displayed as black.

To calculate the hennof CT numbers displayed

divide the window level e.g 200 by 2 = 100 then
add the resulting value 100 to the level =300, to
determine the upper CT number and subtract the
same value from the level 200= 100 to determine
the lower value which becomes 100..
Center value = window level =100

Window width = 500

Upper value = window level(100) +
window width (250) =350
2

Lower value = window level (100) – window

width (250) =150
2
Other Features Of CT Scan
 Partial volume effect

 Beam Hardening
The use of High KV (typically 120KV)
reduces:
-Patients dose
-Beam hardening by the patients
-the efficiency of the detector
-The contrast of the image
Beam hardening….
- It however increases scatter
-necessitating collimation in front of the
detectors.
This beam hardening effect results in the CT
Number of each kind of tissue decreasing along
the path of the ray
but the reconstruction process assumes the CT
numbers to be constant.
This beam hardening effect is
accommodated by the computer using a Beam hardening
algorithm.
Recently improved beam hardening algorithms have
allowed
- lighter filtration
- greater tube output
- and a shorter scan time.
- Also to compensate for diminishing patient thickness
toward the edges of the fan beam a bow tie filter is used
which is thicker along the two parallel edges than the
center.
The bowtie filter
minimizes
surface dose up to 50%
and reduces X-ray
scattering effects.
1974 CT image resolution

1994 CT image resolution

Two dimensional reformatting
 A series of axial slices can be reconstructed and
displayed in various planes.
 Sagittal-produces an anterior-posterior view
 Coronal –produces a left-to-right view
 Oblique –produces a view along a desired plane

Usually the image quality of the reconstructed reformats are dependent

on the thickness and no of the axial image.
Axial image and sagittal reformat
Slip ring Technology
 If the tube KV is supplied by high tension (HT) cables
 Then the gantry ring has to reverse direction after each
360o rotation
 Faster continuous rotation of the tube is achieved in
modern scanners
 By using high voltage generators operating at high
frequency, light and compact mounted on the rotating
gantry ring itself and supplies power through slip rings.
 The tube then rotates in one direction indefinitely
therefore making helical scanning possible.
Spiral/ Helical Scanning

Characteristics
- the couch moves continuously at a steady
speed
- The tube and detectors make a number of
revolutions around the patient
- The tube receives power supply through
slip rings
- The detectors send their signals by radio
Spiral scanning
Spiral scanning
Pitch
This is defined as the distance in ( mm) moved by
the table per 3600 rotation divided by the slice
thickness also in (mm)
• Increasing the table speed, is like stretching the
spring.
• Therefore if the pitch increases
– it speeds up scanning
- Reduces dose
- But resolution may be lost
Above a pitch of 2:1 there are gaps in the volume
being scanned and artifacts may arise
Pitch Definition
Patient Table dist per 360° rotation, in relation to the slice thickness

Gantry Rotation

Table distance
Example:
Table dist = 20 mm
Slice thick. = 10 mm
Pitch =20/10 =2
Note the following:
Rotation of tube per sec (rotation/sec)
e.g 1 rotation/sec
Couch moves ; 10mm/sec
Slice thickness; 10mm
Pitch is 10mm / 10mm 1:1
- Data is acquired in the form of a continuous
ribbon of contiguous slices
- Each ribbon slanted like the turns of a spiral ring
- Data is reconstructed as a series of vertical slices
5 Generation Scanner
th

- multiple x-ray tubes

- Multiple stationery detector rings
- which allow multiple slices to be scanned
simultaneously.
- Reducing scan time to 50 – 100
microseconds
- An asset in cardiac imaging and imaging in
patients when voluntary breath holding is
impossible
From 1 slice to 4, 16, & 32 slices
per rotation
From slice to volume
- When slice thickness is 1mm, interpolation
allows slices to be imaged at any level and
with varying increments.
- Compared with sequential or step & shoot
CT scanning where the tube reverses and
the patient couch is indexed between
slices with separate breath holds
- spiral scanning allows volume imaging &
has the following advantages.
Advantages Spiral CT
- It is faster
- Allows use of smaller volume of contrast
medium
- It overcomes the problem of slice to slice
misregistration
- Especially in the region of the the
diaphragm with variations in inspiration
between the separate breath holds
needed in sequential scanning
Advantages Contd…….
- It reduces partial volume artefarcts since
the reconstructed slices can be
incremented in small steps
- Resolution of axial image is better
- Multiplanar reformation is improved
- 3D imaging is possible
Disadvantages
As there is no cooling periods between
Slice acquisitions; the heat load of the tube is
high
- though a high capacity tube and sensitive
detectors are used a lower mA must be
employed to reduce patient dose
- Noise is greater
- There may be some loss of spatial resolution
due to the interpolation process
What is 3D imaging?
3D Imaging

Allows user to extract a region or
anatomical feature
from a data set (referred to as volume
segmentation)
and display the result as one or more 3D
objects.

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3D Parameters
Thresholding
- Extracts a range of voxels which represent a specific tissue o
object
Scalpel
- Allows user to define a volume or region of interest
Rendering modes
- Define how the 3D object will be displayed these include
i. Surface shading
Treats a 3D object as if it were fully opaque
ii. Projection shading made up of (Mip, Min,Raysum, Avg, Int
- It Treats a 3D object as if it were translucent. User can ch
how the voxel values in the 3D object are displayed.
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3D Imaging


MIP (Maximum Intensity Projection)
- The pixel value is the maximum voxel value along
the projection.


HD MIP (High Definition Maximum Intensity
Projection)
- Same 51as 44MIP,
32 45except
58 22 the image
58 definition is greater.

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3D Imaging

MinIP (Minimum Intensity Projection)
- The pixel value is the minimum voxel value along the
projection.
51 44 32 45 58 22 22


RaySum
- The pixel value is the sum of the voxel values along the
projection. Result is similar to conventional radiography.
51 44 32 45 58 22 252

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3D Imaging

Integral
- The pixel value is the sum of the voxel values along a shallow depth
below the displayed surface. Different from surface shading in
in two respects: it shows objects just below the surface of the
object, but does not use shading based on reflected light.
22
20 65 45 110 50 70 252
51 44 32 45 58 22
22
20 65 45 110 50 70

Average
- The pixel value is the average of the voxel values along the projection.
( sum of the voxel values divided by the number of voxels)

51 44 32 45 58 22 42

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3D Images
Surface HD MIP MIP

Raysum Integral MinIp

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Artifacts
- Motion
- cardiac, respiratory and patient movements
Streak artifact
(black and white bands) from high attenuation
objects.
-objects like neurosurgical clips, dental amalgam
and shrapnels/missiles give star artifacts which
may obscure area of interest.
This effect is accentuated by motion
Detector malfunction
In the 3rd generation scanner – a small
imbalance in the sensitivity of the
scintillation detector can produce ring
artifacts.
The problem is reduced by frequent
recalibration of the detectors and is less
noticeable with gas detectors which are
more easily matched.
Artifacts from beam hardening as previously
described resulting in CT numbers being lower
in the center of the patient than both peripheral
margins is usually corrected by a beam
hardening algorithm or a bow-tie filter
Geometrical artifacts
- Because of the diverging beam CT slices are
narrower at the center than at the edge
- In consequence there may be an overlap at the
edges or an unscanned region at the center
Aliasing
– A sharp and high contrast boundary (as at a
bone edge) may produce a number of
parallel streaky artifacts nearby in the image
- Partial volume
- Artifacts from an atypical or non
representative average voxel attenuation.
3 components
A) Computer Console. B) Table. C) Gantry