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Ctscanfinal2 160709063902
Ctscanfinal2 160709063902
Scintillation Detectors
Coupled optically to photodiode
Materials Used
I. Sodium Iodide
II. Bismuth Germanium Oxide
III. Cesium Iodide
IV. Cadmium Tungstate
Gas Filled Detectors
Materials Used
Xenon
Krypton
Xenon + Krypton
Have high atomic number, are inert, and display minimal afterglow. The gas is
contained under high pressure in the detector array.
Since 90% of 50 is 45, the output is same. The overall efficiency of both the
detectors is same
Data Acquisition System
The DAS consists of the following parts
X-ray photons come on the dectector
The detector detects the intensity in form of current.
The current is converted into voltage.
The analog integrator removes spikes.
The analog signal is converted into digital form.
This signal can now be processed and reconstructed
in the computer.
Current to Analog to
Pre Analog
Detector Voltage Digital Computer
Amplifier Integrator
Convertor Convertor
Image Reconstruction
• After enough transmission measurements (detector)
• Sent to the computer for processing
• A software called Fourier Slice Transform is used.
• More than 250,000 reconstruction algorithms are used
(example: algebraic reconstruction technique) to
compute the image.
Operating Console
It is master control center of the CT scanner.
It is used to input all of the factors related to taking a scan.
Typically, this console is made up of a computer, a
keyboard, and multiple monitors.
Often there are two different control consoles, one used
by the CAT scanner operator, and the other used by the
physician.
GENERATIONS OF CT
• FIRST-GENERATION EMI CT SCANNER
• FOURTH-GENERATION CT SCANNERS
• Fast imaging
• X-ray source is not an X-ray tube rather a focused,
steered, and micro wave- acclerated electron beam
incident on a tungsten target.
• Scan time : <50 ms
• Principally applied to cardiac imaging
SIXTH GENERATION OF CT
• Helical CT scanners acquire data while the table is
moving
• Mostly used nowadays
SEVENTH GENERATION OF CT
Multidetector /Multislice /Multirow CT
• Most recent advancement,
introduced in 1998.
• This uses usually 64-128
adjacent multiple detector
arrays in conjunction with a
helical CT scanner , the
collimator spacing is wider and
more of the x-rays that are
produced by the tube are used
in producing image data.
• Scanning time: 0.25 second
Mathematical principle of CT scan
• Mathematical principles of CT were first developed in 1917 by
Radon
• ”Proved that an image of an unknown object could be
produced if one had an infinite number of projections through
the object.”
• The internal structure of an object can be reconstructed from
multiple projections of the object.
• Plain film imaging reduces the 3D patient anatomy to a 2D
projection image
• Density at a given point on an image represents the x-ray
attenuation properties within the patient along a line
between the x-ray focal spot and the point on the detector
corresponding to the point on the image
Tomographic acquisition
Single transmission measurement through the patient made
by a single detector at a given moment in time is called a ray
A series of rays that pass through the patient at the same
orientation is called a projection or view
Two projection geometries have been used in CT imaging:
Parallel beam geometry with all rays in a projection parallel to one
another
Fan beam geometry, in which the rays at a given projection angle
diverge
Purpose of CT scanner hardware is to acquire a large number
of transmission measurements through the patient at different
positions
Single CT image may involve approximately 800 rays taken at
1,000 different projection angles
Before the acquisition of the next slice, the table that the
patient lies on is moved slightly in the cranial-caudal direction
(the “z-axis” of the scanner
IMAGE RECONSTRUCTION
The photon recorded by the detectors
represent a composite of absorption
characteristics of all elements of the
patient in the path of x-ray beam.
Computer algorithms use these photon
count to construct one or more digital
cross-sectional image.
The X-ray beam attenuation is collected
in a grid like pattern called matrix.
These cross sectional image of the body
is divided into tiny blocks called as
VOXEL (VOlume Element){3D}.
Each square of image matrix is called as
Pixel{2D}.
Image are typically 512 x 512 or 1024 x
1024 pixels.
CT THEORY
Composition and thickness of voxel along with quality of beam
determine the degree of attenuation.
Attenuation is followed by Lambert's law of absorption.
So for a single block of homogeneous tissue and monochromatic
beam of x–ray
N = N0e-µx
since e is natural log, N0 is initial photon, N is transmitted
photon, x is thickness of slab
2.Iterative methods
It start with assumption that all point in matrix have same value and it was compared with measured
value and make correction until Values come with in acceptable range.
It is used instead of filtered back-projection to reduce noise from images. This technique allows the use of
low-dose protocols yet still produces images with comparable or better image qualit
3.Analytical methods
Most commonly used now.
It start with assumption that all point in matrix have same valueAnd it was compared with measured value
and make correction until Values come with in acceptable range
Fig: Image reconstruction.
• A:Assume four volumes with differing linear attenuation coefficients (µ). A beam entering the
object with N0 photons is reduced in intensity by object. The intensity of the remnant beam is
measured by the detector array. The value of each cell in the object can be determined by
solving four (or more) independent simultaneous equations. Such a brute-force approach is
computationally intensive, and in practice much faster algorithms are used to reconstruct
images.
• B:This task is conceptually similar to sudoku problems in that the exposure to the detector is
known, and the filtered back-projection algorithms estimate the exposure intensity at each
voxel.
•
CT Tomographic images
• For image display, each pixel is
assigned a CT number representing
tissue density.
• CT numbers, aka Hounsfield
units (HU), in honor of the inventor
Hounsfield, range from −1000 to
+1000, each corresponding to a
different level of beam attenuation.
• Most monitors may display only 256
gray-scales and the human eye can
perceive only 64 shades of gray.
Multiplanar Reformatted Imaging
• Data from a single CT imaging procedure, consisting of either multiple
contiguous or one helical scan, can be viewed as images in the axial,
coronal, or sagittal planes or in any arbitrary plane depending on the
diagnostic task; this is referred to as multiplanar reformatted
imaging
• Have the capability of viewing normal anatomy or pathologic
processes simultaneously in three orthogonal planes often facilitates
radiographic interpretation
• These are two-dimensional and require a certain degree of mental
integration by the viewer for interpretation.
• This limitation is overcomed by computer programs that reformat
data acquired from axial CT scans into three-dimensional images.
• Three-dimensional reformatting requires that each original voxel,
shaped as a rectangular solid, be dimensionally altered into multiple
cuboidal voxels. This process, called interpolation, creates sets of
evenly spaced cuboidal voxels (cuberilles) that occupy the same
volume as the original voxel.
Fig: Three-dimensional rendering. Three-dimensional images can be reconstructed from the cuberilles, thresholded for
bone (left) or soft tissue (right), oriented in any arbitrary direction, and made to appear to have depth by highlighting
structures near the front and shadowing structures near the back. This patient has hemifacial microsomia and
demonstrates incomplete development of the left frontal, sphenoid, temporal maxillary, zygomatic, and mandibular
bones. Note also the reduced size of the left orbit, depression of the tip of the nose, missing and incompletely erupted
left maxillary teeth, deviation of the right mandible to the left, sunken left midface, and malformation of the left ear.
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
• Bone appears white; gases and liquids are black; tissues are gray
• Measurements taken in Hounsfield units (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)
Scanning methods
1. Digital projection
1. AP, PA, Lat or Oblique projection
2. Surview, Scanogram
2. Conventional CT
1. Axial -Start/stop
3. Volumetric CT
1. Helical or spiral CT - Continuous acquisition
Digital Projection
X-ray tube and detector remain stationary .Patient
table moves continuously with X-rays “on” Produces an
image covering a range of anatomy similar to a
conventional X-ray image, e.g. flat plate of the
abdomen .Image used to determine scan location.
Volume CT
X-ray tube and detector rotate 360°. Patient table
moves continuously with X-ray’s “on” Produces a helix
of image information. This is reconstructed into 30 to
1000 images .
Principles of CT Interpretation
CT interpretation is based on an organized and
comprehensive approach.
CT images are viewed in sequential anatomic order,
examining each slice with reference to slices above and
below.
This image analysis is made dramatically easier by viewing CT
images on a PACS workstation.
The interpreting physician can scroll up and down the stacked
image display.
The radiologist must seek to develop a three-dimensional
concept of the anatomy and pathology displayed. This
analysis is fostered by the availability of image
reconstructions in coronal and sagittal as well as axial planes.
Must be interpreted with reference to the scan parameters,
slice thickness and spacing, administration of contrast, timing
of scanning relative to contrast enhancement, and presence
of artifacts.
In these images, bone is white or light grey, soft
tissue is medium gray, and air is dark grey to black.
Axial images are oriented so that the observer is
looking at the patient from below.
The patient’s right side is oriented on the left side of
the image.
PACS workstation viewing of digital images allows the
interpreter to actively manipulate the image, magnify,
change image brightness and contrast, measure
attenuation, and create oblique and three-
dimensional image reconstructions to optimize
interpretation.
Artifacts
Artifacts refer to components of the image that do not faithfully
reproduce actual anatomic structures because of distortion,
addition, or deletion of information.
Partial volume artifacts/volume averaging:
when a voxel contains tissues of different densities the resulting CT
number for that voxel is an intermediate value that does not
represent either tissue. The resulting image may be a blurring of
the junction of the tissue or a loss of part of a thin cortical layer of
bone
Beam hardening artifact
Results from greater attenuation(absorption) of low-energy x-ray
photons as they pass through tissue. Mean energy of the x-ray
beam is increased (the beam is “hardened”), resulting in less
attenuation at the end of the beam than at its beginning. Beam-
hardening errors are seen as areas or streaks of low density as
darkening in middle of an axial slice.
Motion artifact
Results when structures move to different positions during
image acquisition. Motion is demonstrated in the image as
prominent streaks from high- to low-density interfaces or as
blurred or duplicated images
Metal Streak artifacts:
Occurs due to near complete absorption of x-ray photons
by metallic restorations. Appears as opaque streak in
occlusal plane.
Ring artifacts
Ring artifacts are seen as high- or low-density circular
rings in the image.
Ionic -- LOCM
a) Loxaglate ( hexabrix ) 490 Barium compound contrast
1. Baritop 100 ( 100% all part of GIT )
2. EPI -C ( 150% large bowel )
None Ionic – LOCM 3. E-Z HD ( 250 % esophagus ,
I. Iopamidole ( Niopam , Isovue ) stomach and duodenum )
470
4. E-Z paque ( 100% small bowel
II. Iohexol ( Ominpaque )
“ 5. Polibar ( 115% large bowel )
III. Iomeprol ( Iomeron ) 6. Polibar rapid ( 100% large bowel )
“ 7. Water -soluble 20 ml {Urograffin 150 ,
IV. Ioversol ( Optiray ) gastromiro }
“ 8. Barium suspension – low density ( 2%
V. Iopromide ( Ultravist ) w/v
“
• Once the iodine/barium contrast has been injected into the
blood stream, it circulates through the heart and passes
into the arteries, through the body's capillaries and then
into the veins and back to the heart.
• As CT images are being acquired, the CT's x-ray beam is
attenuated (weakened) as they pass through the blood
vessels and organs flush with the contrast. This causes the
blood vessels and organs filled with the contrast to
"enhance" and show up as white areas on the x-ray or CT
images. The kidneys and liver eliminate the contrast from
the blood.
Appear as localized,
expansile degenerative
area having a fluid
density throughout the
lesion. Do not show
contrast enhancement in
contrast aided imaging
(except Aneurysmal Fig: Axial CT images of a
Bone Cyst) keratocystic odontogenic tumor
in the mandible
ODONTOGENIC TUMOURS
• Ameloblastomas-bicortical expansion,
thinning and breach of bony walls,
extension of tumor into adjacent soft tissue
spaces. Focal cystic degenerations
commonly seen in multi-locular lesions.
• Plexiform ameloblastomas have high
contrast enhancement due to high
vascularity.
• Cystic ameloblastomas show a
predominant fluid density.
• Malignant ameloblastomas have a grossly
destructive pattern.
• Focal hyper dense areas suggesting
calcifications maybe noticeable in Pindborg
tumour.
MALIGNANCIES
Seen as focal high contrast
enhancement areas. Invasive lesions
show no/minimal expansion.
Demarcation from surrounding soft
tissue is difficult without contrast
aided imaging. Reparative lesions like
central giant cell granulomas also
manifest as destructive, contrast Fig: Osteosarcoma of jaw in
enhancing lesions showing minimal CT
or no expansile pattern.
Fibro-osseous lesions
CT pattern depends on the
maturative stage of lesion.
Cemental lesions are
distinguished based on the
continuity of the lesions with
the roots of the tooth and
the periodontal ligament
space, separating the lesion
Fig: Fibrous dysplasia of the mandible
from the bony alveolus.
MAXILLARY LESIONS
Maxillary lesions share
similar pictures in
contrast to mandibular
lesions which make this
difficult to distinguish
them.
Significantly greater
tumor extent is
demonstrated by CT than
by conventional Fig: Swelling in the left maxillary sinus diagnosed
methods. with Brown tumor
TMJ
CT helps identify the bony
changes in the TMJ like
destruction of the condylar
head, wearing of articular
elements, traumatic lesions
within and outside the
capsule.
Advantageous over
arthrography as it is a painless
Figure 2: Coronal CT scan view showing
procedure with superior obliteration of left interarticular space of
resolution. TMJ.
CONCLUSION
CT scan is a complex but effective imaging system that
has a variety of clinical indications directly related to the
diagnosis and treatment of oral and maxillofacial
abnormalities.
CT scan has made a major impact on the practice of
dentistry, particularly in oral and maxillofacial diagnosis,
surgery and management of a wide variety of oral lesions.
Advances in computer softwares already allow 3 D
visualization and conclusion of anatomy and pathology,
but further improvement in clinical performance is
expected.
References
• Oral radiology, 1st south asian edition, white and pharoah
• Oral radiology, 6e, White and Pharoah
• Fundamentals of Diagnostic Radiology, 4e, Brant, William and Helms
• Handbook of biomedical Instrumentation, R S khandpur
• Lippincott Radiology
• Computed Tomography - Special Applications Edited by Dr. Luca Saba
• ww.contempclindent.org/article.asp
• serc.carleton.edu/research_education/geochemsheets/techniques/CT.
html
• http://pocketdentistry.com/
• http://arcadiacachamber.org/hospitals-ct-scanner-state-of-art/