COMPUTED

TOMOGRAPHY
MANUAL
2019/2020

ATTENTIONS
THE MATERIAL IN
THIS PRACTICAL
MANUAL MAYBE A
SUBJECT TO
CHANGE
THROUGH THE
COURSE PLEASE
PAY ATTENTION TO
YOUR TEACHER
GUIDES.

This manual reviewed by:

 Inaya Medical Collage

Department of Radiological Science

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Lab Title

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*By signing above you attest that you have contributed to this
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submission is your own work.
Content
Lab No Lab Subject

Lab No1 Introduction

Lab No2 Type of machine and software

Lab No3 CT component

Lab No4 Image quality & Display

Lab No5 Radiation Dose

Lab No6 Dose Vs Image Quality

Lab No7 Imaging with contrast media

Lab No8 Application of CT (Industrial CT)

Lab No9 Application of CT (SPECT & PET)

Lab No10 Potable CT

Lab No11 Revision

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Lab Instructors

 Leave your work station clean and in good order before leaving the

laboratory.

 Follow all instructions given by your teacher.

 Learn how to transport all materials and equipment safely.

 No eating or drinking in the lab at any time!

 Please MAKE sure all your assignments are corrected and signed.

 The logbook worth 10 mark!

 Make sure to submitted the logbook before the final practical exam.

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 M
Introduction to CT

o1 Pre lab

1.1 This is an introductory lab, print this document please.

2 Objective

2.1 To be familiar with a CT machine.

2.2 To Identify the difference between CT image & conventional radiology image.

3 Subject

3.1 CT produces data that can be manipulated in order to demonstrate various bodily
structures based on their ability to absorb the X-ray beam.

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Although, historically, the images generated were in the axial or transverse plane,
perpendicular to the long axis of the body, modern scanners allow this volume of
data to be reformatted in various planes or even as volumetric (3D)
representations of structures.

4 CT VS conventional radiology
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 4.1 CT VS conventional radiology compression table

CT X-ray

if
i
Fast, detailed image in 3D. Fast, cheap , 2D image.
Require high radiation dose. Relatively low radiation dose
a
Detect solid tumors in abdomen & Diagnose bones better.
chest.
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 5 Common use of CT procedure

5.1 Used to examine patients with injuries from trauma such as a motor vehicle accident.

5.2 Performed on patients with acute symptoms such as chest or abdominal pain or
difficulty breathing.

5.3 Detecting cancers in the chest, abdomen and pelvis, such as lymphoma and cancers
of the lung, liver, kidney, ovary and pancreas. allows a physician to confirm the presence

E
of a tumor, measure its size, identify its precise location and determine the extent of its
involvement with other nearby tissue.

5.4 Detection, diagnosis and treatment of vascular diseases that can lead to stroke,
kidney failure or even death. CT is commonly used to assess for pulmonary embolism (a
blood clot in the lung vessels) as well as for aortic aneurysms.

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 Type of MAchine & SoftwAre

1 Pre lab

1.1 Prepare of a discussion in different type of CT generation & modality.

2 Objective

2.1 To be illustrate the difference between CT modalities and software.

3 Subject

3.1 Spinning tube, commonly called spiral CT, or helical CT is an imaging technique
in which an entire X-ray tube is spun around the central axis of the area being
scanned.
These are the dominant type of scanners on the market because they have been
manufactured longer and offer lower cost of production and purchase. The main
limitation is the bulk and inertia of the equipment (X-ray tube assembly and
detector array on the opposite side of the circle) which limits the speed at which
the equipment can spin.

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3.2 Electron beam tomography (EBT) is a specific form of CT in which a large enough
X-ray tube is constructed so that only the path of the electrons, travelling between
the cathode and anode of the X-ray tube, are spun using deflection coils. It is
advantage much faster, allowing for less blurry imaging of moving structures, such
as the heart and arteries. Only one manufacturer (Imatron, later acquired by
General Electric) ever produced scanners of this design.

4 CT software
4.1 Machine control software often consists of multiple functional blocks that work
together to control machine processes. These may include:

a) User interface: Nearly all software packages include a UI for user manipulation of
processes.
b) Machine setup: This function allows the operator to set up or calibrate the
machine.
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 A c) Auditing and reporting: A data acquisition system provides an audit trail and a
means for creating reports based on collected data.
d) Diagnostics: This function allows for machine fault detection and correction.
O
ahem s of wet E3

o o o o

o o
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 User input parameters

‒ Patient Phantom type.

‒ Standard scan protocols from a
dropdown Combo box.
‒ Type of scanner.
‒ BTF type.
‒ Collimation for the scanner.
‒ Z-overscanning.
‒ kVp for the scanner.
‒ mAs.
‒ Pitch.
‒ CTDIw.

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 CT Components

guntery
o
1 Pre lab

1.1 Prepare of a discussion & brain storming for CT components.

2 Objective

2.1 To be illustrate & demonstrate the external and internal components of CT.

3 Subject

 A CT system consists of an X-ray source‚ a rotary table, an X-ray detector and a

data.

3.1 CT X-ray tube

The gantry – a circular, rotating frame with an X-ray tube mounted on one side and
a detector on the opposite side. A fan-shaped beam of X-rays is created as the rotating
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frame spins the X-ray tube and detector around the patient. X-ray tube can stand heat.

3.2 CT Detector
An X-ray detector is used to measure the transmission of the X-rays through the
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object along the different ray paths. The purpose of the detector is to convert the
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 incident X-ray flux into an electrical signal, scintillation counters detectors are used in
CT.

3.3 CT Table
When scanning, the part is mounted on the rotary table. System axis misalignment

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can introduce artefacts in the scanned data. The ideal system geometry is shown in Figure
the central ray intersect the center of the detector (point O); the rotation axis is
perpendicular to the mid-plane and the mid-plane cuts the detector in the central row.
450 Pounds (204 Kg) Distributed Weight Limit. Schnabel Range: Coverage From Head

if
To Thigh (162 Cm).
fiber

FIE
Gantry Aperture (70 cm
diameter).
Microphone.
Sagittal laser Alignment
Light.
Patient guide lights.
X-ray exposure indicator
light.
70 LM Emergency stop buttons.
Gantry control panels.
External laser alignment
lights.
Patient Couch.
10.Monitor.

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CT Gantry External View
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C t
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 Odegrees).
Gantry Tilt (+/-30

O Laser
on/off.
Alignment Lights

G Couch in/out.
Free (manual) Couch
OMovement.
O Zero Couch Position.
Couch up/down.
O Home Button (couch out &
O
down).

Gantry tilt.
Use of bolsters. Gantry-
needle alignment. a, b Range
of gantry angulation, which is
±30° on most scanners. Spine
curvature and spatial
orientation can be modified
using bolsters and wedges.
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 X-Ray Tube.
Filters.
Collimator.
X-Ray tube heat exchanger (Oil Cooler).
its
High Voltage Generator (0-75 kV)
i
Direct Drive Gantry Motor.
Rotation Control Unit.
Y
Data Acquisition System (DAS).
Detectors.
Slip Rings.
A
Detector Temperature Controller
High Voltage Generator (75-150 kV).
Power Unit (AC to DC).
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 Comment & Feedback

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 IMAge QUAlity & DisplAy

1 Pre lab

1.1 Review image formation and reconstruction form lecture3 & 4.

2 Objective

2.1 To be illustrate & demonstrate image quality & display using CT simulator.

3 Subject

3D displays represent a scan volume in a single image which has generally been
manipulated to enhance a specific characteristic. This can only be done successfully when
one high-contrast structure (like the skeleton) is to be displayed.

3.1 Scanning parameter

A. mA.
B. Kvp.
C. Scan time.
D. FOV.
E. Pitch.
F. Slice thickness.
G. Reconstruction algorithm.

3.2 Computed Tomography (CT) Volumetric Rendering Techniques such as:

1/ Shaded Surface Displays (SSD).
2/ Minimum Intensity Projection (MinIP).
3/ Maximum Intensity Projections (MIP).
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 4/ Volume Rendering (VR).
5/ Perspective Volume Renderings Technique (pVRT), or Virtual Endoscopy (VE).
6/ Curved Plane Reconstructions.

(A) Coronal Multiplanar volume rendering (B) minimum intensity projection

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 (A) Maximum Intensity Projection.
(B) Volume Rendered, Images of the Abdomen.

Virtual Endoscopy
(VE)
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 Dental CT reconstructions. By drawing a manual trace on an axial CT scan (A), it is
possible to obtain shaded surfaced display volume rendered (B), curved Multiplanar
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reconstruction.
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 4 Multiplanar reconstruction and projections

Multiplanar reconstruction (MPR) is the creation of slices in more anatomical planes than
the one (usually transverse) used for initial tomography acquisition. It can be used for
thin slices as well as projections. Multiplanar reconstruction is feasible because
contemporary CT scanners offer isotropic or near isotropic resolution.
MPR is frequently used for examining the spine. Axial images through the spine will only
show one vertebral body at a time and cannot reliably show the intervertebral discs. By
reformatting the volume, it becomes much easier to visualise the position of one vertebral
body in relation to the others.

5 CT image quality
• Image quality in CT as in all medical imaging, depends on 4 basic factors: Image
Contrast, Spatial Resolution, Image Noise, and Artifacts.
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 5.1 CT Image Contrast
CT image contrast depends on Subject Contrast and Display Contrast. CT Display
Contrast is arbitrary (depending only on the window level and width selected). CT
Subject Contrast is determined by Differential Attenuation that is, differences in X-Ray
Attenuation by Absorption or Scattering in different types of tissue and thus resulting in
differences in the Intensity of the X-Rays ultimately reaching the Detectors.

5.2 CT Spatial Resolution

Spatial resolution in CT is the ability to distinguish small, closely spaced objects
on an image. Motion introduce blurring, although the more important effect of motion
is the potential creation of artifacts. Matrix Size and Pixel Size, (A bigger matrix brings
better resolution).

5.3 Image Noise

CT image noise is this associated with the number of x-rays contributing to each
detector measurement. X-ray Tube Amperage: Changing the mA value changes
the beam intensity—and thus the number of x-rays—proportionally. Scan
(Rotation) Time: Changing the scan time changes the duration of each
measurement—and thus the number of detected x-rays—proportionally.

5.4 Image Artifacts

Artifacts may be defined as any structure that is seen on an image but is not
representative of the actual Anatomy.
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 Most types of CT artifacts fall into 1 of 3 categories:
1/ Shading Artifacts.
2/ Ring Artifacts.
3/ Streak Artifacts.
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 Comment & Feedback

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 Dose versus IMAge QUAlity

1 Pre lab

1.1 Review the last lab and radiation dose effect, units & biological effect.

2 Objective

2.1 To be able to explain the effect of radiation dose in CT image quality.

3 Subject

Reduce the radiation dose during CT examinations without compromising the

image quality is important. In general, higher radiation doses result in higher-resolution
images, while lower doses lead to increased image noise and unsharp images. However,
increased dosage raises the adverse side effects, including the risk of radiation-induced
cancer – a four-phase abdominal CT gives the same radiation dose as 300 chest X-rays.
Reduction method:
1. New software technology can significantly reduce the required radiation dose.
(e.g., iterative Sparse Asymptotic Minimum Variance).
2. Individualize the examination and adjust the radiation dose to the body type and
body organ examined.
3. Prior to every CT examination, evaluate the appropriateness of the exam whether
it is motivated or if another type of examination is more suitable.
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 Comment & Feedback

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 IMAging with coNTRASt MEDIA

1 Pre lab

1.1 Be prepare to discusses type of contrast media & patient reaction to contrast
media.

2 Objective

2.1 To be able to image with contrast media.

3 Subject

Contrast media used for X-ray CT, as well as for plain film X-ray, are called radio-
contrasts (iodine-based). This is useful to highlight structures such as blood vessels that
otherwise would be difficult to delineate from their surroundings. Using contrast
material can also help to obtain functional information about tissues. Often, images are
taken both with and without radiocontrast.

4 Contrast type

4.1 Oral Contrast Materials

Barium-sulfate contrast materials that are swallowed or administered by mouth
(orally) are used to enhance x-ray and CT images of the gastrointestinal (GI) tract,
including:
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  pharynx
 esophagus
 stomach
 the small intestine
 the large intestine (colon)
In some situations, iodine-based contrast materials are substituted for barium-sulfate
contrast materials for oral administration.

4.2 Rectal Contrast Materials

Barium-sulfate contrast materials that are administered by enema (rectally) are
used to enhance x-ray and CT images of the lower gastrointestinal (GI) tract (colon and
rectum).

4.3 Intravenous Contrast Materials

Iodine-based and Gadolinium-based Iodine-based contrast materials injected
into a vein (intravenously) are used to enhance x-ray and CT images. Gadolinium injected
into a vein (intravenously) is used to enhance MR images. Typically, they
are used to enhance the:
internal organs, including the heart, lungs, liver, adrenal glands, kidneys, pancreas,
gallbladder, spleen, uterus, and bladder gastrointestinal tract, including the stomach,
small intestine and large intestine arteries and veins of the body, including vessels in the
brain, neck, chest, abdomen, pelvis and legs soft tissues of the body, including the
muscles, fat and skin brain breast.

4.4 Microbubble Contrast Materials

Microbubble contrast materials are tiny bubbles of an injectable gas held in a

supporting shell. They are extremely small -smaller than a red blood cell- It is a useful
option for patients with kidney failure or allergies to MRI and/or computed tomography
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(CT) contrast material.

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 Comment & Feedback

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 AppliCAtion of CT
IndustrIAL CT

1 Pre lab

1.1 Be prepare by studying and reviewing other modalities engaged with CT.

2 Objective

2.1 To illustrate and demonstrate other application of CT scan such as industrial CT.

3 Subject
The main difference in the setup of industrial and medical CT systems is that in
the case of industrial CT, the object rotates on a rotary table and the X-ray source is
steady, whereas in medical CT, the X-ray sources rotate and the object (a human body in
the most cases) is lying on a table/bed which is steady.
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 Because industrial CT systems image only non-living objects, they can be designed to take
advantage of the fact that the items being studied do not move and are not harmed by X-
rays.
They employ the following optimizations:
1. Use of higher-energy X-rays.
2. Use of smaller X-ray focal spot sizes.
3. Use of finer X-ray detectors.
4. Use of longer integration times.

4 Uses of industrial CT

1. Reverse engineering – the process of taking measurements of an existing part or

object, then creating an exact CAD replica. This technology is extremely useful
when you have a manufactured part or object, but not the original prints or design
data.
2. Non-contact measurement – the process of capturing the geometry of existing
objects through the use of laser emitting camera-like 3D scanners.
3. Contact measurement – a method of collecting single points relative to each other.
There is a wide range of solutions for contact measurement and generally two types
of systems solutions are used with portable CMMs: 1) For capturing localized or
small volume information, digitizing or articulating arms are used, 2) For larger
volumetric projects, optical solutions including laser trackers and photogrammetry
units.
4. Long range scanning – for a detailed 360° 3D snapshot of a structure, bridge, plot
of land, plant or process operation with millimeter accuracy.
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 5. Art forgeries – a bit unusual for what is thought to be an industrial product, but
hundreds of art museums, dealers and auction houses use scanning each year to
validate works of art, as well as the structural integrity of sculpture.
6. Model to manufacture processing – here again, artists will often have their models,
whether fashioned or human, scanned for dimension prior to casting a statue in
bronze or producing a high-fashion line of clothing.
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 Comment & Feedback
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 APPLICATion of CT
SPECT/CT
PET /CT

1 Pre lab

1.1 Be prepare by studying and reviewing other modalities engaged with CT.

2 Objective

2.1 To illustrate and demonstrate other application of CT scan such as SPECT/ CT

& PET /CT.

3 Subject
3.1 SPECT /CT
SPECT-CT is where two different types of scans are taken and the images or
pictures from each are fused or merged together. The fused scan can provide more
precise information about how different parts of the body function and more clearly
identify problems such as tumours (lumps) or Alzheimer’s disease, etc.
The X-ray machine from the CT scanner rotates much faster than the gamma camera, so
the CT part of the study takes less time than the SPECT study. Combining the
information from a nuclear medicine SPECT study and a CT study allows the information
about function from the nuclear medicine study to be easily combined with the
information about how the body structure “looks” in the CT study.
It takes 30-40 minutes to obtain the SPECT and CT images.
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 3.2 PET /CT
Nuclear medicine images can be superimposed with computed tomography (CT)
to produce special views, a practice known as image fusion or co-registration. These
views allow the information from two different exams to be correlated and interpreted
on one image, leading to more precise information and accurate diagnoses. In addition,
positron emission tomography/computed tomography (PET/CT) units that are able to
perform both imaging exams at the same time.
A PET scan measures important body functions, such as blood flow, oxygen use, and
sugar (glucose) metabolism, to help doctors evaluate how well organs and tissues are
functioning.
CT imaging uses special x-ray equipment, and in some cases a contrast material, to
produce multiple images or pictures of the inside of the body. CT imaging provides
excellent anatomic information.
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 Comment & Feedback
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 PortAble CT

1 Pre lab

1.1 Be prepare to discusses type of contrast media & patient reaction to contrast
media.

2 Objective

2.1 To be able to image with contrast media.

3 Subject
Portable CT technology provides a better way to obtain diagnostic imaging in
the critical care patient population.1–6 Imaging of these patients is considered valuable
enough to warrant the increase in both cost and risk associated with their transport.
abdominal imaging on portable CT has shown significant diagnostic limitations, a CT head
examination performed on transportable equipment has proved quite useful.
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 A is stander CT , B is portable CT
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 Comment & Feedback
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