COMPUTED

TOMOGRAPHY
Merrill’s V. 3: Ch. 31
&
Bushong Ch. 23
No other development in x-ray imaging over
the past 50 years has been as significant !
Snook transformer

Coolidge hot-cathode
x-ray tube

Potter-Bucky
diaphragm
Image-intensifier tube Wow… look
at that image
quality & detail
Tidak ada Trafo snook
perkembangan lain Coolidge tabung
dalam pencitraan sinar-X katoda
sinar-X selama 50 panas
tahun terakhir yang Diafragma
signifikan!
Potter-Bucky
Tabung penguat
gambar
 FUNDAMENTALS
CREATING A CROSS-SECTIONAL
TOMOGRAPHIC PLANE OF ANY BODY
PART
A PATIENT IS SCANNED BY AN X-RAY
TUBE ROTATING AROUND THE BODY
A DETECTOR ASSEMBLY MEASURES
THE RADITION EXITING THE PATIENT.
 DASAR-DASAR
MENCIPTAKAN BIDANG LINTAS
TOMOGRAFI BAGIAN TUBUH APA PUN
PASIEN DIPINDAI OLEH X-RAY TUBE
BERPUTAR DI SELURUH TUBUH
RAKITAN DETEKTOR MENGUKUR
RADISI YANG KELUAR DARI PASIEN.
 Equipment
arrangement
Tomo = image // to long axis of the body
CT = image is transverse to the body
In its simplest form, a CT imaging system consists
of a finely collimated x-ray beam and a single
detector.

both moving
synchronously
in a translate
rotate mode.
Translation
= one rotation of
source and
detector
 DASAR-DASAR
Sumber RADIASI adalah : DATA UTAMA
DATA UTAMA DIKUMPULKAN OLEH
DETEKTOR
KOMPUTER memproses data gambar
dengan cara MENGHITUNG DATA
terpilih secara ALGORITMA selanjutnya
di bentuk GAMBAR
PRESELECTED ALGORITHM
 GAMBAR
SETIAP GAMBAR DITAMPILKAN DALAM
BENTUK AXIAL
PADA AWAL GAMBAR DITAMPILKAN
PADA CATHODE RAY TUBE (CRT)
ATAU LCD
Cathode Ray Tube (CRT): is an air evacuated glass envelope
containing an e- gun and a fluorescent screen. When e- hit
the fluorescent screen light is emitted
LCD
 CT
Conventional Radiographs: Frequently
body structures are superimposed

In CT: A tightly collimated x-ray beam is

directed thought the patient from different
angles – “cross sectional image”
Essentially eliminating superimposition of
body structures
 CT
Claim to fame:

Exceptional Contrast Resolution

Contrast resolution = differentiation of
densities, capable of differentiating among
tissues with similar densities
The contrast of an object is expressed relative to
its surrounding background.
That is what determines its visibility .
 CT
Due to the reduction in amount of
scattered radiation
 Reducing over lapping structures and 2
collimators
Digitized image: because of this numerous
image manipulation techniques can be
used to enhance and optimize the
diagnostic information.
Window/Level, Axial, Sagittal, Coronal
CT Collimation
CT vs CAT
 Historical Development
CT was first demonstrated successfully in
1970. Dedicated to head CT only
Dr. Godfrey Hounsfield (Engineer)
Allan Macleod Cormack (Nuclear
Physicist)

Nobel Prize in medicine and physiology in

1979
First full-scale commercial unit
Installed in 1971
Physicians recognized its value for
providing diagnostic neurologic information
U.S.– June 1973 at the Mayo Clinic (MN)
& General Hospital (MA)
These early units were also dedicated
head CT scanners.
 Early CAT scanners
Hounsfield’s discovery parallels Rontgen’s
discover of x-rays

Early CAT scans required nine days to

produce a single section image
 Whole-body scanners
1974 – Dr. Robert S. Ledley of
Georgetown University Medical Center,
developed the first whole-body scanner

Many different companies began

manufacturing scanners.
 Generations
First Generation Scanners
 Translation/Rotation
 Tube produced a finely collimated beam or
pencil beam
 1 to 3 detectors were placed opposite the
tube for radiation detection
 4.5 minutes to gather enough information for
one slice
 Tube was only able to rotate 180 degrees
 Second Generation
Fan-shaped x-ray beam
30 or more detectors
20 seconds per slice or 10 minutes for a
40 slice exam
180 degree rotation
Long data reconstruction time
 Third Generation
Fan-shaped x-ray beam
960 detectors opposite the x-ray tube
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
3 generation configuration
rd
 Fourth Generation
Developed in 1980’s
Fixed ring of as many as 4800 detectors,
completely surrounding the patient, Rotate
only movement
Rotating x-ray tube provides short bursts
of radiation
Detectors collect the remnant radiation to
reconstruct into an image
1 minute for multiple slices
4th generation
configuration
Fifth Generation
EBCT
 Modern Scanners
No longer categorize into Generations
Contemporary CT scanners are either
third or fourth generation designs
Scanners are categorized by tube and
detector movement
Slip Ring Technology: connects generator
with tube (no cables)
Slip Rings
 Technical Aspects
Optimum imaging: patient/area of interest
and gantry are perpendicular to each other
Tube rotates around the patient, irradiating
the area of interest.
Detectors measure the transmitted x-ray
values, covert them in to an electric signal,
and relay the signal to the computer.
 Raw Data
The remnant radiation that is converted
into an electrical signal values are called
projections, scan profiles or raw data.
Raw data is collected and digitized.
This process assigns a whole number to
each signal.
The value assigned is directly proportional
to the strength of the signal.
Tube Interactions
 Digital Image
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
 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.
 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 +14,000 for dense bone
 Only – CT # in the body are Fat, Lung & Air
 Displaying the image
On the CRT or LCD, 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
 System Components
Computer, Gantry &Table & Operator’s
Console

Computer – provides the link between the

CT technologist and the other components
of the imaging system
 Computer
The computer has four basic functions:
 Control of data acquisition
 Image reconstruction
 Storage of image data
 Image display
 Array Processor
Raw Data is sent to the array processor

Array processor only performs algorithm

calculations.
 Applies desired filters to raw data.
 Gantry
Gantry is a circular device that houses the
Data Acquisition system (DAS) = Tube,
Detectors, Filters, Collimators & Analog-to
–Digital Converter (ADC)
 Gantry
Can be tilted forward or backward up to 30
degrees to compensate for body part
angulation.

The opening within the center of the gantry

is termed the aperture
 CT Tubes
X-ray tube for CT is similar in design to the
conventional radiography tube, but is
specially designed to handle and dissipate
excessive heat units – much higher heat
loading

Ceramic target backing

 Decreases tube
weight
especially for spiral computed
tomography
 Detectors
Function as image receptors for remnant
radiation, then converts the measurement
into an electrical signal proportional to the
radiation intensity.

Two basic detector types are used:

Scintillation (solid state) and Ionization
(xenon gas) detectors.
 Detectors
Scintillation photodiodes convert light into
electronic signal.
 Approximately 90% of the x-rays incident on
the detectors are absorbed and contribute to
output signal.
Gas Detectors: small chambers filled with xenon or
xenon-krypton mixture
 Approximately 45% x-rays incident on the detectors

are absorbed and contribute to output signal.

 Manufactures no longer use gas detectors
 Detectors
Used to record photon activity

Materials include: cadmium tungstate,

cesium iodide, gadolinium or yttrium
 Table
Automated device linked to the computer
and gantry
Designed to move in increments after
every scan according to the technologists
scan program.
Accurate and reliable table movements is
vital to image quality and accuracy
CT tables have max weight limits
 Operator’s Console
Where the technologist controls the
scanner
Keyboard, graphic monitor, CRT
 Display Monitor
For the CT image to be displayed on a
CRT monitor in a recognizable form, the
digital CT data must be converted into a
gray-scale image

Each digital CT number is the matrix is

converted into an analog voltage
 Image Display
The brightness value of the gray-scale
image correspond to the pixels and CT
numbers of the digital data they represent

Because the image is digital image

manipulation can be performed
 FOV

The field of view determines the

amount of data to be displayed on
the monitor
 Image manipulation
Most common: windowing or gray-level
mapping

This technique allows the technologist to

alter the contrast of the displayed image
by adjusting the window width and window
level.
 Windowing
Window width: is the range of CT numbers
that are used to map signals into shades
of gray
 Wide/Narrow or Long/Short

Window level: determines the midpoint of

the range of gray levels to be displayed
 Darker or Lighter
Window Width
Window Level
 Image manipulation
Multiplanar reconstruction or MPR

Ability to reconstruct axial images into

coronal, sagittal or oblique body planes
Transverse images can be reconstructed at
any plane along the z-axis.
 Diagnostic Applications
Most common procedures: head, chest,
abdomen, pelvis
CT is the exam of choice for head trauma
CT can evaluate the CNS for infarctions,
hemorrhage, disk herniation, craniofacial
and spinal fractures, tumors and other
cancers
Biopsy & Abscess Drainages
 CT examinations
CT demonstrates abnormalities such as
metastatic lesions, aneurysms,
abscesses, and fluid collections from
infection or trauma

Interventional procedures: abscess

drainage, tissue biopsy, cyst aspiration
 CT Angiography
CTA: Uses three dimensional (3D)
imaging techniques to evaluate the
vascular system
Advantages over conventional angio:
 Image reconstruction without the use of more
patient exposure to radiation or IV contrast
 Overlying structures can be eliminated (post
processing)
 Does not require an arterial puncture
 Contrast Media
Is used in most CT imaging to distinguish
normal anatomy from pathology
 Iodine based IV contrast, similar to the IVU
 Oral/Rectal contrast
 2% Barium mixture is used
 Iodinated oral contrast can be used
(Hypaque) Gastrographen must be at 1.5% to
3% concentration to prevent contrast artifacts
What are factors that affect
image quality?
Factors Affecting Image Quality
Four main factors contributing to image
quality are: Spatial resolution, Contrast
resolution, Noise, and Artifacts

Diagnostic imaging has superior spatial

resolution compared to CT
 How do we measure spatial resolution?
 What is the range for plane films?
 Image Resolution –
(how sharply is the image seen)
CR & DR CR 2 - 5 lp/mm
4000 x 4000 RAD 3-6 lp/mm
image only as good a
monitor* DR 3 - 5 lp/mm
CT lp/cm
525 vs 1000 line IMAGE APPEARS
more pixels = more SHARPER BECAUSE
memory needed to store CONTRAST CAN BE
resolution dependent on ADJUSTED BY THE
pixel size
COMPUTER –
(DIFFERENCES IN
DENSITY)
Technologist Determines Image
Quality Factors

The technologist choice of slice thickness,

focal spot size, display FOV, technique
selection, pitch and reconstruction
algorithm will effect the resultant image
quality
 Contrast
Resolution
• Removal of
superimposed
anatomy
• Very fine x-ray
beam
• Double
collimation
 Review/Questions
What does the window width control for
image display?

Oral contrast used for CT? What

concentration?