COMPUTED TOMOGRAPHY (CT)

It uses X-rays (Ionising radiation). The patient lies on table which moves into the gantry and the X-ray
tube rotates 360◦ around the patient. The table continuously moving in helical CT. Move-scan –
move- scan (Single slice). The x-ray beam (fan beam) is attenuated by the patient and then collected
by multiple detectors (detector array) which is opposite the tube within the gantry.

The x-rays collected by the detector are registered as a linear attenuation coefficient. Detectors emit
light in response to the amount of dose received (scintillations). Light is converted to electronic
signal = image data. Data is then reconstructed into images into any plane.
• Iterative
• Filtered back

RECONSTRUCTION METHODS
There are 2 reconstruction methods: Iterative or Filtered back.

Low-dose head CT protocols using filtered back-projection are susceptible to increased noise and
decreased image quality. Iterative reconstruction noise suppression allows the use of lower-dose
techniques with maintained image quality. So, using iterative reconstruction allows lower dose
scanning.

MDCT SPIRAL (HELICAL) SCANNING

Spiral/helical scanning is characterized by

continuous gantry rotation and continuous data
acquisition while the patient table is moving at
constant speed.
Advantages:
1. Minimize motion artifacts.
2. Reduced patient dose.
3. Improved spatial resolution in z- axis.
4. Enhanced multi-planar or 3D rendering.
PITCH
It is the movement of table per gantry rotation (table travel per rotation).
HOUNSFIELD UNITS
CT NUMBER is assigned based on the calculation of linear absorption co-efficient of the tissue
compared with water.

• All appear white

• Bone
• Blood
• Contrast (iodine)
• But have different HU
• Bone = 800
• Blood = 50
Contrast (iodine) = 300

WINDOW LEVEL AND WINDOW WIDTH

• Select a window setting (Window level – WL) to represent the centre density of the tissues of
interest
• The width of the window (Window width - WW) influences the contrast of the image
• The narrower the window, the greater the contrast across inherently low contrast tissue
areas
SAME DATA WITH DIFFERENT WW AND WL

WL -593 WW 529 WL –12 WW 400

CT CONTRAST MEDIA
CT uses Iodine based contrast agents. It is a clear fluid with high viscosity. It is kept warm to make it
runnier, making it easier to inject. It is usually pump injected, not by hand.

It has a high atomic number attenuates x-rays more. It shows as white on the image and can be
given orally – GI tract or intravenously – cardiovascular. Typically, 50ml per scan.

Contrast media are good highlighting tumours. They can also blockage in blood vessels. However,
there are also disadvantages.

• IV contrast Risks
• Allergy
• Mild reactions – eg urticaria (hives)
• Severe reactions – Anaphylaxis
• Kidney damage
• Patient with already poor kidney function
• eGFR scores
Identify Patients at increased risk from contrast administration:
• Previous contrast reaction
• Renal problems – eGFR check
• Asthma
• Diabetes
• Metformin therapy
• Other cases- pregnancy, lactation, hyperthyroidism, interleukin- 2 treatment.
CT DOSE
• Computed Tomography Dose Index (CTDIvol) standardized parameter to measure Scanner
Radiation Output (mGy)
• Dose Length Product (DLP) = CTDIvol x L (scan length)
• Helps to calculate patient dose

DISADVANTAGES OF CT
- High Ionising radiation
o CT abdomen/pelvis gives10mSv and equates to 4.5 years worth of background
radiation
- Potential nephrotoxicity from iodinated contrast agents
- Inability to differentiate between residual tumour or fibrosis and a recurrence after
radiotherapy or chemotherapy.
- Sometimes unable to visualize the tumour or to detect certain anatomical structures
- Metal implants can produce too much artefact
- Software can reduce this Eg iMAR (Siemens)

ADVANTAGES OF CT
1- Short scan times
2- Phased scanning
3- Isotropic data sets
4- Excellent contrast resolution
5- Excellent at producing hi-resolution images of structures with high inherent contrast i.e.
lungs and bones

COMMON APPLICATIONS OF CT
• Head scan
• Trauma, Stroke, tumour
• Trauma – Chest/abdo/pelvis
• Cancer detection, staging, follow up
• CT Pulmonary Angiogram (CTPA)
• Pulmonary emboli (PE’s) (“gated”)
• Fracture detection & surgical planning
• Cardiac scan (“gated”)
• CT colons