Overview

In this module, we shall be looking into the principles of operation and how Computer Tomography
works. Computed tomography (CT) is one of the most widely used imaging modalities to diagnose
various diseases in the clinical field.

At the end of this module, you will: Learning Outcomes

1. Understand how Computed Tomography works;

2. Reflect on how important Computed Tomography is;
3. Discuss the proper way of demonstrating the principles of operation.

The computed tomography (CT) Learning

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system isand Self-Assessment
revolutionary. No ordinary image receptor, such as
screen film or an imageintensifier tube, is involved. A collimated x-ray beam is directed on the patient,
and the attenuated image-forming x-radiation is measured by a detector whose response is transmitted
to a computer. After the signal from the detector is analyzed, the computer reconstructs the image and
displays the image on a monitor. Computer reconstruction of the cross-sectional anatomy is
accomplished with mathematical equations (algorithms) adapted for computer processing. Helical CT,
which has emerged as a new and improved diagnostic tool, provides improved imaging of anatomy
compromised by respiratory motion. Helical CT is particularly good for the chest, abdomen, and pelvis,
and it has the capability to perform conventional transverse imaging for regions of the body where
motion is not a problem, such as the head, spine, and extremities. This chapter introduces the physical
principles of multi-slice helical CT. Special imaging system design features and image characteristics are
reviewed

The components necessary to construct a computed tomography (CT) imaging system were available to
medical physicists 20 years before Godfrey Hounsfield first demonstrated the technique in 1970.
Hounsfield was a physicist and engineer with EMI, Ltd., the British company most famous for recording
the Beatles, and both he and his company justifiably have received high acclaim.

Alan Cormack, a Tufts University medical physicist, shared the 1979 Nobel Prize in physics with
Hounsfield. Cormack had earlier developed the mathematics used to reconstruct CT images.

The CT imaging system is an invaluable radiologic diagnostic tool. Its development and introduction into
radiologic practice have assumed an importance comparable with the Snook interrupter less
transformer, the Coolidge hot-cathode x-ray tube, the Potter-Bucky diaphragm, and the image-
intensifier tube. No other development in x-ray imaging over the past 50 years has been as significant.

PRINCIPLES OF OPERATION

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 When the abdomen is imaged with conventional radiographic techniques, the image is created directly
on the screen-film image receptor and is low in contrast, principally because of Compton scatter
radiation. The intensity of scatter radiation is high because of the large area x-ray beam. The image is
also degraded because of superimposition all of the anatomical structures in the abdomen. For better
visualization of an abdominal structure, such as the kidneys, conventional tomography can be used
(Figure 28-1).

CT is based on the fundamental principle that the density of the tissue passed by the x-ray beam can be
measured from the calculation of the attenuation coefficient. Using this principle, CT allows the
reconstruction of the density of the body, by two-dimensional section perpendicular to the axis of the
acquisition system.

The CT x-ray tube (typically with energy levels between 20 and 150 keV), emits
N photons (monochromatic) per unit of time. The emitted x-rays form a beam which passes through the
layer of biological material of thickness Δx. A detector placed at the exit of the sample, measures N + ΔN
photons, ΔN smaller than 0. Attenuation values of the x-ray beam are recorded and data used to build a
3D representation of the scanned object/tissue.

There are basically two processes of the absorption: the photoelectric effect and the Compton effect.
This phenomenon is represented by a single coefficient, mju.
In the particular case of the CT, the emitter of x-rays rotates around the patient and the detector, placed
in diametrically opposite side, picks up the image of a body section (beam and detector move in
synchrony).

Unlike x-ray radiography, the detectors of the CT scanner do not produce an image. They measure the
transmission of a thin beam (1-10 mm) of x-rays through a full scan of the body. The image of that

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section is taken from different angles, and this allows to retrieve the information on the depth (in the
third dimension).

In order to obtain tomographic images of the patient from the data in "raw" scan, the computer uses
complex mathematical algorithms for image reconstruction.
If the x-ray at the exit of the tube is made monochromatic or quasi-monochromatic with the proper
filter, one can calculate the attenuation coefficient corresponding to the volume of irradiated tissue by
the application of the general formula of absorption of the x-rays in the field (see Figure 1).
The outgoing intensity I(x) of the beam of photons measured will depend on the location. In fact, I(x) is
smaller where the body is more radiopaque.

Hounsfield chose a scale that affects the four basic densities, with the following values:
air = -1000 HU (Hounsfield units)
fat = -60 to -120 HU
water = 0 HU
compact bone = +1000 HU

The image of the section of the object irradiated by the x-ray is reconstructed from a large number of
measurements of attenuation coefficient. It gathers together all the data coming from the elementary
volumes of material through the detectors. Using the computer, it presents the elementary surfaces of
the reconstructed image from a projection of the data matrix reconstruction, the tone depending on the
attenuation coefficients.

The image by the CT scanner is a digital image and consists of a square matrix of elements (pixel), each
of which represents a voxel (volume element) of the tissue of the patient.
In conclusion, a measurement made by a detector CT is proportional to the sum of the attenuation
coefficients.

The typical CT image is composed of 512 rows, each of 512 pixels, i.e., a square matrix of 512 x 512 =
262,144 pixels (one for each voxel). In the process of the image, the value of the attenuated coefficient
for each voxel corresponding to this pixel needs to be calculated.

Each image point is surrounded by a halo-shaped star that degrades the contrast and blurs the boundary
of the object. To avoid this, the method of filtered back projection is used. The action of the filter
function is such that the negative value created is the filtered projection, when projected backwards, is
removed, and an image is produced, which is the accurate representation of the original object.
The CT scan deals with the attenuation of the x-rays during the passage through the body segment.
However, several features distinguish it from conventional radiology: the image is reconstructed from a
large number of measurements of attenuation coefficient.

Before the data are presented on the screen, the conventional rescaling was made into CT numbers,
expressed in Hounsfield Units (HU), as mentioned before. CT numbers based on measurements with the
EMI scanner invented by Sir Godfrey Hounsfield 6, a Nobel prize winner for his work in 1979, related the
linear attenuation coefficient of a localised region with the attenuation coefficient of water, the
multiplication factor of 1000 is used for CT number integers. So, the signal transmitted by the detector
is processed by the PC in the form of the digital information, the CT image reconstruction.

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 SELF-ASSESSMENT QUESTIONS

5 points

What developments do you see in diagnosing various diseases in the clinical field using in Computed/
Computerized Tomography? How do you see our world without this advanced technology?

(Minimum of 3 sentences Maximum of 5 sentences). Make it clear and concise.

END OF THE LESSON ASSESSMENT

Instructions: Read each question carefully and choose the correct answer.
Part 1: Multiple Choice

1. Which of the following statements regarding different CT scanner generations are correctly
paired?
a. 1st generation scanners are often referred to as a rotate-translate scanner
b. 3rd generation scanners are often referred to as a rotate-stationary scanner
c. 4th generation scanners are often referred to as a rotate-rotate scanner
d. 4th generation scanners are the most popular scanners in current use

2. In CT scan, Hounsfield units depends on:

a. electron density
b. mass density
c. effective atomic number
d. linear attenuation coefficient

3. Which unit of radiation is a measurement of absorbed dose and has been replaced by the gray
(Gy)?
a. rad
b. sem
c. cm
d. C/kg

4. Typically how many energy levels does the CT x-ray tube have that emits
N photons (monochromatic) per unit of time?
a. Between 60 and 250 keV
b. Between 20 and 150 keV
c. Between 40 and 150 keV
d. Between -20 and -150 keV

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 5. It describes the amount of radiation absorbed by person.
a. Radioactivity
b. Exposure
c. Absorbed dose
d. Effective dose

Instructions: Identify what is being asked. Write your answer on the blank.
Part 2: Enumeration

1. is a digital image and consists of a square matrix of elements

(pixel), each of which represents a voxel (volume element) of the tissue of the patient.
2. is a medical imaging technique used in radiology to obtain
detailed internal images of the body noninvasively for diagnostic purposes
3. The personnel that perform CT scans are called or
.
4. The unit used for effective dose is or .
5. A is directed on the patient, and the attenuated image-forming
x-radiation is measured by a detector whose response is transmitted to a computer.

6. The is a digital image and consists of a square matrix of elements

(pixel), each of which represents a voxel (volume element) of the tissue of the patient.
7. describes the amount of radiation traveling through the air. Many
types of radiation monitors measure exposure. The units for exposure are the
coulomb/kilogram (C/kg, international unit) and the roentgen (R, U.S. unit).

8. There are basically two processes of the absorption: the and

the .
9. Computer reconstruction of the cross-sectional anatomy is accomplished with mathematical
equations adapted for computer processing.
10. The CT scan deals with the attenuation of the x-rays during the passage through the
.

Key points

A CT scan or computed tomography scan is a medical imaging technique used in radiology to obtain
detailed internal images of the body noninvasively for diagnostic purposes. The personnel that perform
CT scans are called radiographers or radiology technologists.

Beam collimators are 'beam direction' devices used in the x-ray tube housing, along with an
arrangement of mirrors and lights, in such a way that the light and x-ray fields match each other. They
allow different projections of x-ray fields.

Helical CT scanners have a gantry that rotates continuously in the same direction. During scanning,
data acquisition is combined with continuous movement of the patient through the gantry. The path of
the X-rays can be described as a spiral or helix, hence the name helical or spiral CT.

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 Radioactivity refers to the amount of ionizing radiation released by a material. Whether it emits alpha
or beta particles, gamma rays, x-rays, or neutrons, a quantity of radioactive material is expressed in
terms of its radioactivity (or simply its activity). This represents how many atoms in the material decay in
a given time period. The units of measurement for radioactivity are the Becquerel (Bq, international
unit) and the curie (Ci, U.S. unit).

Exposure describes the amount of radiation traveling through the air. Many types of radiation
monitors measure exposure. The units for exposure are the coulomb/kilogram (C/kg, international unit)
and the roentgen (R, U.S. unit).

Absorbed dose describes the amount of radiation absorbed by an object or person. The unit for
absorbed dose is the gray (Gy, international unit) or the rad (U.S. unit). One gray is equal to 100 rads.

Effective dose describes the amount of radiation absorbed by person, adjusted to account for the type
of radiation received and the effect on particular organs. The unit used for effective dose is sievert (Sv,
international unit) or rem (U.S. unit).

References

Goldman LW. Principles of CT: Multislice CT. Journal of Nuclear Medicine Technology. Vol. 36, No.2, 2008

Lazic J, Sobic V, Cikaric S. et al.Radiologija (Radiology – Unviersity Manual), Medicinska Knjiga, Belgrade
1997

Sprawls P. The Physical Principles of Medical Imaging, 2nd Ed. 1995, Medical Physics Pub. (Madison, Wis)
Semnic R. CT Toraksa i Abdomena, Institut za Onkologiju Vojvodine, Sremska Kamenica, Grpah Style, Novi
Sad 2005

Stankovic JB, Milosevic NT. Osnovi radioloske fizike (Basic Principles of Radiological Physics), PTT,
Belgrade, 2007

Thomas AMK, Banerjee AK, Busch U. Classic Papers in Modern Diagnostic Radiology. (2004) ISBN:
9783540219279

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