COMPUTED TOMOGRAPHY

DEFINITION BRIEF HISTORY

COMPUTED TOMOGRAPHY 1930’S – ALLESANDRO VALLEBONA

 Creation of a cross-sectional tomographic  Proposed a method to represent a single
section of the body with a rotating fan beam, slice of the body on the radiographic film
a detector array and computed (TOPOGRAPHY)
reconstruction
 Other Names: Computed Axial 1970 – GODFREY NEWBOID HOUNSFIELD
Tomography (CAT), Computed Transaxial  First demonstrated the CT technique
Tomography (CTAT), Computed
Reconstruction Tomography (CRT), Digital 1972-1974
Axial Tomography (DAT), Body Section  First clinical CT scanners were installed
Roentgenography
 Greek Word: “Tomos” = slice/section; 1979
“Graphia” = describing  Hounsfield & Allan Mcleod Cormack
shared the Nobel Prize in Physics
CT SCANNER
 Consists of an x-ray source emitting finely 1980
collimated x-ray beam and a single detector  CT scan machine became widely available
both moving synchronously in a translate or
rotate mode or a combination of both EMI SCANNER
 1st CT scan machine
 180 translation/1o rotation
INTRODUCTION
ACTA
COMPUTERS  1st CT system that could make images of any
 Used Binary System part of the body
 Did not require water tank
BINARY DIGIT/BIT
 Can code for 2 values or 2 shades of gray
which correspond to white and black PRINCIPLES OF OPERATION
 8 bits=1 byte
 2 bytes=1 word CONVENTIONAL/AXIAL TOMOGRAPHY
 16 bits=1 word  Plane of the image is parallel to the long
axis of the body
STORAGE REQUIREMNENT  Produces sagittal and coronal images
 Kilobytes, megabytes, gigabyte or terabytes
COMPUTED TOMOGRAPHY
 Plane of image is perpendicular to the long
axis of the body
 Produces a transverse image
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 COMPUTED TOMOGRAPHY

CT IMAGE 2ND GENERATION

 A transaxial/transverse image  Has a narrow fan beam and multiple
detectors
TRANSLATION/SWEEP
 It refers to movement of source-detector 3RD GENERATION
assembly across the patient  Has a wide fan beam
 Results in a projection
 Projection: represents the attenuation 4TH GENERATION
pattern of patient profile  Equipped with a detector ring
 Detector signal: has a dynamic range of 12
bits (4096 gray levels) 5TH GENERATION
 The electron beam tomography CT
PROJECTION
 An intensity profile 6TH GENERATION
 The helical (or spiral) CT scanner
ALGORITHM
 Computer-adapted mathematical calculation 7TH GENERATION
applied to raw date during image  The multi-detector row CT.
reconstruction
SEVEN GENERATIONS
RECONSTRUCTION
 Creation of an image from date FIRST GENERATION
 A demonstration project
RECONSTRUCTION TIME  Characteristic: translate/rotate (Bushong )
 Time needed for the computer to present a or rotate/translate (Reveldez)
digital image after an examination has been  X-ray Beam Shape: pencil beam
computed  Detector: single detector
 Time between the end of imaging and the  Imaging Time: 5-minute imaging time
appearance of an image
SECOND GENERATION
 Characteristic: translate/rotate (Bushong )
GENERATIONS OF COMPUTED or rotate/translate (Reveldez)
TOMOGRAPHY  X-ray Beam Shape: narrow fan beam
 Detector: multiple detector (5-30)
GENERATION OVERVIEW  Imaging Time: 30 seconds
 Advantage: speed
1ST GENERATION o Rationale: consist of multiple
 Has a pencil beam and one detector detectors
 Disadvantages:
o Increased scattered radiation

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 COMPUTED TOMOGRAPHY

o Increased radiation intensity toward
the edges of the beam
 Compensation: used of bow-
tie filter
 Bow-tie Filter: equalize the radiation
intensity that reaches the detector array
THIRD GENERATION
 Characteristic: rotate/rotate
 X-ray Beam Shape: wide fan beam
 Detector: curvilinear detector array (30)
 Imaging Time: <1 second
 Advantages:
o Better x-ray beam collimation
o Decreased scattered radiation
o Good image reconstruction
 Disadvantage: ring artifacts
o Compensation: software connected
image reconstruction algorithm
NOTE: Third generation designs have the
advantage that thin tungsten SEPTA can be place
between each detector in the array and focused on
the x-ray source to REJECT SCATTERED
RADIATION
rotation of the x-ray source, proving a self-
calibrating system. Third generation system are
calibrated only once every few hours.
FIFTH GENERATION (early 1980’s)
 Electron beam CT
 Ultrafast CT scanner
 X-ray tube rotation is mechanical
 No moving parts
 Electron Gun: produces a focused electron
beam that generates a rotating x-ray fan
beam after being steered along tungsten
target rings
SIXTH GENERATION (early 1990’s)
 Helical/Spiral CT
 Volumetric scanners
 Introduced by Will Kalender and Kazuhiro
Katada
 Uses slip ring technology
 Excels in 3D multiplanar reformation
 Slip Ring: electromechanical device that
conduct electricity and electric signals
through rings and brushes across a rotating
surface onto a fixed surface

FOURTH GENERATION SEVENTH GENERATION

 Characteristic: rotate/stationary  64-Slice CT
 X-ray Beam Shape: wide fan beam  Multiple detector array
 Detector: fixed circular detector array IMAGING SYSTEM DESIGN
(4000) with detector ring
 Imaging Time: <1 second 3 MAJOR COMPONENTS
 Advantage: no ring artifacts 1.) Gantry
 Disadvantage: 2.) Operating Console
o Increased patient dose 3.) Computer
o High cost
GANTRY
NOTE: The detectors are no longer coupled to the  Largest component
x-ray source and hence cannot make used of
focused SEPTA to reject scattered radiation.
However, detectors are calibrated twice during each
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 COMPUTED TOMOGRAPHY

 Subsystems: x-ray tube, detector array, high and change them to electronic
voltage generator, patient couch and signals
mechanical support o Low or no after glow
 A brief, persistent flash of
X-RAY TUBE scintillation that must be
 Special requirements: taken into account &
o Power capacity: must be high subtracted before image
 >120 kVp reconstruction
 400 mA o High scatter suppression
o High speed rotors: for heat o High stability
dissipation  Allows a system to be used
o Anode heat capacity: 7 MHU without interruption of
(Spiral CT) frequent calibration
o Heat storage capacity: 8 MHU o Types:
o Anode cooling rates: 1MHU/min o Gas-filled detector – previously used
o Focal spot size: small o Scintillation & solid-state detectors –
 Takenote: CT scanners recently used
designed for high spatial o Gas detector:
resolution imaging not for o Basis: ionization of gas
direct projection imaging o Three types:
o Limiting characteristics:  Ionization chamber
 Focal spot design: must be  Proportional counter
robust or strong  Geiger-Muller counter
 Heat dissipation o Characteristics:
o X-ray tube life: approx. 5000  Excellent stability
exposures (Conventional CT)  Large dynamic range
 Focal-Spot Cooling Algorithms:  Low quantum efficiency
o Design to predict the focal spot o Scintillation detector:
thermal state o Characteristic: high x-ray detection
o To adjust the mA setting accordingly efficiency (90%)
 Reduces patient dose
DETECTORY ARRAY  Allows faster imaging time
o The entire collection of detectors  Improves image quality
o Group of detectors o Crystals used: Sodium iodide
o The image receptor in CT o Replaced by:
o Detector: absorbs radiation and converts it  Bismuth germinate (BGO)
to electrical signal  Cesium iodide (CsI)
o Optimal Characteristics: o Current crystal of choice:
o High detector efficiency  Cadmium tungstate (CdWO4)
 The ability of the detector to  Special ceramics
capture transmitted photons
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 COMPUTED TOMOGRAPHY

o Photodiode: converts light into electrical  Value <1: non ideal detector system
signal o Result: increased in patient dose to
o Characteristics: maintain image quality
 Small,
 Cheap CAPTURE EFFICIENCY
 Does not require power  Refers to the ability with which the detector
supply obtains photons that have passed through the
patient
THREE IMPORTANT FACTORS
CONTRIBUTING TO DETECTOR ABSORPTION EFFICIENCY
EFFICIENCY  Refers to the number of photons absorbed
by the detector
1.) GEOMETRIC EFFICIENCY  Depends on: physical properties of the
 The area of the detectors sensitive to detector face
radiation as a fraction of the total exposed o Thickness
area o Material
 The amount of space occupied by the
detector collimator plates relative to the RESPONSE TIME
surface area of the detector  The time required for the signal from the
2.) QUANTUM EFFICIENCY detector to return to zero after stimulation of
 The fraction of incident x-rays on the the detector by x-ray radiation so that it is
detector that are absorbed and contribute to ready to detect another x-ray event
the measured signal  A function of the detector design

3.) CONVERSION EFFICIENCY DYNAMIC RANGE

 The ability to accurately convert absorbed x-  The ratio of the maximum signal measured
ray signal to electrical signal to the minimum signal the detectors can
measure
OVERALL/DOSE EFFICIENCY
 The product of geometric, quantum and DATA ACQUISITON SYSTEM (DAS)
conversion efficiency  Computer-controlled electronic amplifier
 The product of the following factors and switching device
o Stopping power of the detector  Where signal from each radiation detector is
material connected
o Scintillator efficiency (in solid-state  Consists of:
types) o Preamplifier
o Charge collection efficiency (in o Integrator
xenon types) o Multiplexer
o Geometric efficiency o Logarithmic
o Scatter rejection o Amplifier
 Normal value: b/n 0.45-0.85 o Analog-to-digital converter
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 COMPUTED TOMOGRAPHY

 Patient dose
HIGH VOLTAGE GENERATOR  Predetector/Post Patient Collimator
o High frequency power o Restricts the x-ray beam viewed by
o High voltage step-up transformer the detector array
o Power: 50 kW o Purpose:
o Accommodates higher x-ray tube rotor  To decrease scattered
speeds radiation
o Accommodates instantaneous power surges  To improved contrast
characteristic of pulsed system o Determines:
 Slice thickness
PATIENT COUCH  Sensitivity profile
o Supports the patient comfortably
o Construction: low-Z material (Carbon OPERATING CONSOLE
fiber)  Contains meters and controls
o Rationale: it does not interfere with o For selection of proper imaging
x-ray beam transmission & patient technique factors
imaging o For proper mechanical movement of
o Features: should be the gantry and patient couch
o Smoothly and accurately motor o For the use of computer commands
driven  Allow image reconstruction
 Rationale: precise and transfer
positioning is possible  2-3 operating consoles
o Capable of automatic indexing o 2 for CT radiologic technologists
 Rationale: operator does not  1st: To operate imaging
have to enter the room system
between each scan  2nd: to post-process images
for filming and filing
COLLIMATION o 1 for physician
 Restricts the volume of tissue irradiated  To view the images
 Purpose:  To manipulate contrast, size
o Reduces patient dose & general visual appearance
o Improved image contrast  Accepts the reconstructed
 Types: post patient & prepatient collimator image from operator’s
 Prepatient Collimator console
o Limits the area of the patient that  Displays reconstructed image
intercepts the useful beam for viewing and diagnosis
o Mounted on the x-ray tube housing  Two monitors:
or adjacent to it o 1st: provided for operator
o Purpose: to decrease patient dose  To annotate patient data on
o Determines: the image (e.g. hospital
 Dose profile
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 COMPUTED TOMOGRAPHY
identification, name, patient
number, age, gender)
 To provide identification for
each image (e.g. number,
technique, couch position)
nd
o 2 : allows the operator to view the
resulting image before transferring it
to hard copy or physician’s viewing
console
 Technique factors:
o kVp: <120
o mA: 400 (maximum)
 varied according to
 patient thickness to reduce
patient dose
o Slice thickness: 0.5-5 mm
 Physician’s work station: allows the
physician
o To call up any previous image
o To manipulate image to optimize
diagnostic information
 Scan time: length of time required per scan
COMPUTER
 Unique subsystem of the CT imaging system
 Microprocessor & primary memory: heart
of the computer
o Determine reconstruction time
 Array processors:
o Mostly used in CT instead of
microprocessors
o Rationale:
 Does many calculations
 Faster than microprocessors
(<1 sec reconstruction time)
 Computer memories: ROM & RAM
 Random access memory: temporary
memory that stores information while
software is used
 Read only memory: for storage data only
and cannot be overwritten
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 Central Processing Unit (CPU): performs
calculations and logical operations under
control of software instruction
o Heart of the computer
 Special requirements:
o Controlled environment
o Relative Humidity: <30%
o Temperature: <20oC
o High humidity and temperature:
contribute to computer failure
SLIP-RING TECHNOLOGY
 Slip ring: electromechanical device that
conducts electricity and electrical signals
through rings and brushes
o Allows the gantry to rotate
continuously without interruption
o Made MSCT possible
 Brushes: transmit power to the gantry
components
o Composition: silver graphite alloy
 Used as sliding contact
o Replacement of brushes:
 Every year
 During preventive
maintenance
IMAGE CHARACTERISTICS
IMAGING MATRIX
 Layout of cells in rows and columns
 Original EMI: 80x80 matrix
o 6000 cells of information
 Current system: 512x512 matrix
o 262,144 cells of information
 Pixel: a picture element
o Each cell of information
o Two-dimensional
 Pixel Size = FOV ÷ matrix size
 COMPUTED TOMOGRAPHY

 Voxel: a volume element Blood 20

o The tissue volume CSF 15
 Voxel (mm3) = pixel size (mm2) x slice Water 0
thickness (mm) Fat -100
Lungs -200
 CT number/Hounsfield unit: the numeric
Air -1000
information contained in each pixel
 Matrix: rows and columns of pixels
displayed on a digital image
IMAGE RECONSTRUCTION
 Field of view (FOV): the diameter of image
reconstruction
FILTER BACK PROJECTION
o FOV increased, fixed matrix size
 Process by which an image is acquired
 Result: increase/larger pixel
during CT and stored in computer memory
size
is reconstructed
o Fixed FOV, increase matrix size
 Filter: refers to mathematical function
 Result: decrease/smaller
pixel size
MULTIPLANAR REFORMATION (MPR)
 A method for generating coronal, sagittal, or
oblique images from the original axial image
data
CT NUMBER/HOUNSFIELD UNIT (HU)
 MSCT: excels in 3D MPR
 Used to assess the nature of tissue
 3D MPR Algorithm: most frequently used
 HU: scale of CT number
 Range: -1000 – +3000
THREE 3D MPR ALGORITHMS
 Formula: CT Number = k (µt-µw/ µw)
o k: constant that determines the scale
1.) MAXIMUM INTENSITY PROJECTION
factor for the range of CT number
(MIP)
o µt: attenuation coefficient of the
 Reconstruct an image by selecting the
tissue in the pixel under analysis
highest value pixels along the arbitrary line
o µw: x-ray attenuation coefficient of
 Widely used in CT Angiography
water
2.) SHADED SURFACE DISPLAY (SSD)
 Computer-aided technique that identifies
CT NUMBER FOR VARIOUS TISSUES
narrow range of values as belonging to the
APPROXIMATE CT
TISSUES object to be imaged
NUMBER
Dense bone 3000 3.) SHADED VOLUME DISPLAY (SVD)
Bone 1000  Very sensitive to the operator-selected pixel
Liver 40-60 range
Muscle 50  Previously: applied to bone imaging
White matter 45  Recently: applied to virtual colonoscopy
Gray matter 40
Kidney 30
IMAGE QUALITY
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 COMPUTED TOMOGRAPHY

SPATIAL FREQUENCY
FIVE PRINCIPAL CHARACTERISTICS OF  Used to describe CT spatial resolution
CT IMAGE  Low SF: represents large objects
1.) Spatial resolution  High SF: represents small objects
2.) Contrast resolution
3.) Noise EDGE RESPONSE FUNCTION (ERF)
4.) Linearity  Mathematical expression of the ability of the
5.) Uniformity CT scanner to reproduced a high-contrast
edge with accuracy
SPATIAL RESOLUTION
 Ability to image small object that have high MODULATION TRANSFER FUNCTION
subject contrast (MTF)
 Expressed in: linepairs/millimeter (lp/mm)  Mathematical expression for measuring
 A function of pixel size resolution
 Takenote: SR for a CT image is limited to  The ratio of the image to the object as a
the size of the pixel function of spatial frequency
 Image reconstruction and postprocessing  Used to describe CT spatial resolution
tasks: powerful way to affect SR  MTF = 1: faithfully represents the object
 Formula: SR (cm) = ½ {1/SF (lp/cm)}  MTF = 0: image is blank and contain no
information
FACTORS AFFECTING/INFLUENCING  MTF = intermediate values: intermediate
SPATIAL RESOLUTION levels of fidelity
1.) Pixel size
2.) Slice thickness CHARACTERISTICS OF CT IMAGING
3.) Voxel size SYSTEM CONTRIBUTING TO IMAGE
4.) Design of prepatient and predetector collimators DEGRADATION
5.) Detector size 1.) Collimation
2.) Detector size and concentration
EFFECT IN SPATIAL 3.) Mechanical/electrical gantry control
FACTORS
RESOLUTION 4.) Reconstruction algorithm
Thick slice thickness Poor SR
Thin slice thickness Better SR
IMAGE FIDELITY
Large pixel size Poor SR
 Measured by determining the optical density
Small pixel size Better SR
Large voxel size Poor SR along the axis of the image
Small voxel size Better SR
Large detector size Poor SR LIMITING RESOLUTION
Small detector size Better SR  Spatial frequency at MTF equal to 0.1

LINE PAIR IMPORTANT MEASURES OF IMAGING

 One bar and its interspace of equal width SYSTEM PERFORMANCE
1.) Artifacts generation
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 COMPUTED TOMOGRAPHY

2.) Contrast resolution Equal 0

3.) Spatial resolution Large variation High
Small variation Low
CONTRAST RESOLUTION
 The ability to distinguish one soft tissue FACTORS AFFECTING NOISE
from another without regard for size or 1.) kVp and filtration
shape 2.) Pixel size
 Takenote: CR is superior to CT 3.) Slice thickness
o Rationale: better x-ray beam 4.) Detector efficiency
collimation 5.) Patient dose – primary control of noise
 Ability to image low-contrast objects:
o Limited by: LINEARITY
 Size and uniformity of the  Describes the amount to which the CT
object number of a material is exactly proportional
 Noise of the system to the density of this material (in Hounsfield
units)
X-RAY ABSORPTION IN TISSUE  Evaluation test: five-pin performance test
 Determined by the mass density of the body object
part  Frequency: daily
 Characterized by x-ray linear attenuation UNIFORMITY
coefficient  The consistency of the CT numbers of an
image of a homogeneous material across the
X-RAY LINEAR ATTENUATION scan field
COEFFICIENT
 A function of x-ray energy and atomic SPATIAL UNIFORMITY
number of the tissue  Constancy of pixel values in all region of the
reconstructed image
NOISE  Evaluation test: plotting the CT number in
 The percentage standard deviation of a histogram/line graph
large number of pixels obtained from a  Acceptable value: +/- 2 mean value
water bath image (Standard Deviation)
 The variation in CT number above or below
the average values
 Appears as graininess MULTISLICE SPIRAL CT IMAGING
 Takenote: the resolution of low-contrast PRINCIPLES
objects is limited by the noise of the CT
imaging system ADVANTAGE OF MSCT
o Evaluation test: 20-cm water bath  Increases the volume of tissue that can be
o Frequency: daily imaged at a given time

PIXEL VALUE NOISE

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 COMPUTED TOMOGRAPHY

o Rationale: it has the ability to image  Z-axis location and

a larger volume of tissue in a single
breath-hold
 Helpful in:
o CT Angiography
o Radiation therapy treatment
o Imaging uncooperative patients
INTERPOLATION ALGORITHMS
 A special computer program
 1st interpolation algorithm: used 360o
linear interpolation
o Disadvantage: caused prominent
blurring of the reconstructed image
 Solution for blurring: 180o linear
interpolation
o Results:
 Improved Z-axis resolution
 Improved sagittal and coronal
reformatted views
o It allows imaging at a pitch <1
 Interpolation:
o Estimation of value between two
known values
o A mathematical method of creating
missing data
 Extrapolation: estimation of value beyond
the range of known values
 Data interpolation: performed
interpolation algorithm
PITCH/SPIRAL PITCH
 The relationship between patient couch
movement and x-ray beam width
 Spiral Pitch Ratio:
o PITCH = Couch movement each
360o ÷ Beam width
 MSCT Pitch: 1
o Rationale:
 Multiple slices are obtained
reconstruction width can be
selected after imaging
 CTA Pitch: <1:1
 Pitch >1:1:
o Decreases Z-axis resolution
o Rationale: a wide section sensitivity
profile
VOLUME IMAGING
 Formula:
o TISSUE IMAGED = Beam width x
Pitch x Imaging time
 For 360o gantry rotation/sec
o TISSUE IMAGED = (Beam width
x Pitch x Imaging time) ÷ gantry
rotation
 If gantry rotation is not
360o/sec
SENSITIVITY PROFILE
 Full Width at Half Maximum (FWHM):
o The width of sensitivity profile at
one half of its maximum value
 If MSCT pitch=1:1:
o Sensitivity profile: 10% wider than
conventional CT
by  If MSCT pitch=2:1:
o Sensitivity profile: 40% wider than
conventional CT
IMAGING TECHNIQUES
TWO PRINCIPAL DISTINGUISHING
FEATURES OF MSCT
1.) Several parallel detector arrays
2.) Quickly energizing
MULTISLICE DETECTOR ARRAY
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 COMPUTED TOMOGRAPHY

 Early 1990’s: initial demonstration of dual- Improved lesion -Reconstructs at

slice imaging detection arbitrary z-axis intervals
 Recently: 320 slice imaging -Reconstructs at
overlapping z-axis
 Wider slice imaging: Reduced partial
interval
o Better contrast resolution (at same volume
-Reconstructs small than
mA setting) image interval
 Rationale: detected signal is -Date obtained during
larger peak of enhancement
Optimized IV contrast
o Slight decrease in spatial resolution -Reduces volume of
 Rationale: increased voxel contrast agent
size Multiplanar images -Higher quality
improved reconstruction
 Smaller detector size: better spatial
resolution
FEATURES OF MSCT
DUAL SOURCE MSCT
LIMITATIONS RATIONALE
 Has two x-ray tubes & two detector arrays -bigger x-ray tubes
 Principal advantage: speed Increased image noise
needed
 Imaging time: 80 ms Reduced z-axis
-increases with pitch
resolution
DATA ACQUISITION RATE Increased processing -more data, more images
time needed
 Slice Acquisition Rate (SAR): one measure
of the efficiency of the MSCT imaging
system
 Formula:
COMPUTED TOMOGRAPHY QUALITY
o SAR = Slice acquired/360o ÷
CONTROL
Rotation time
NOISE AND UNIFORMITY
Z-AXIS COVERAGE (Z)
 Assessment test: 20-cm water bath
 Formulas:
 Frequency: weekly
o Z = (N/R) x W x T x B
 Acceptable tolerance:
o Z = SAR x W x T x B
o Water: w/in +/- HU of 0
 N: number of slice acquired
o Uniformity: not > +/- 10 HU from
 R: rotation time
center of periphery
 W: slice width
 Assessment in quantitative CT: the
 T: time
following should be changed
 B: pitch o CT scan parameters
o Slice thickness
FEATURES OF MSCT o Reconstruction diameter
ADVANTAGES RATIONALE o Reconstruction algorithm
-Removes respiratory
No motion artifacts
misregistration
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 COMPUTED TOMOGRAPHY

LINEARITY  Intended slice thickness of <5 mm: 0.5

 Assessment test: five-pin insert mm acceptable tolerance
performance
 Frequency: semiannually COUCH INCREMENTATION
 Analysis: should show relationship b/n the  Assessment test: noting the position of the
HU and electron density couch with tape measure & straightedge on
 Acceptable tolerance: the couch rails
o Correlation coefficient: at least  Frequency: monthly
0.96% or 2 standard deviation  Acceptable tolerance: w/in +/- 2 mm
 Assessment in quantitative CT: requires
precise determination of the value of tissue LASER LOCALIZER
in HU  For patient positioning
 Assessment test: specially designed test
GAMMEX 464 objects
 CT test object  Frequency: semiannually
 Used to evaluate noise, spatial and contrast
resolution, linearity and uniformity PATIENT DOSE
 Specified as CT dose index (CTDI)
SPATIAL RESOLUTION  High resolution: high patient dose
 Most important component of QC program  Monitored by: specially designed pencil
 Assessment test: imaging a wire/edge/hole ionization chamber/TLD
array/bar pattern  Frequency: semiannually
 Frequency: semiannually  Acceptable tolerance:
 Acceptable tolerance: w/in manufacture’s o Fixed technique: patient dose not
specifications vary from > +/- 10%
 Should follow replacement of the tube
CONTRAST RESOLUTION
 Assessment test: low-contrast test objects
with built-in analytic schemes CT SCAN ARTIFACTS
 Frequency: semiannually
 Acceptable tolerance: ARTIFACTS
o CT resolving power: should be 5  Systematic discrepancy in CT numbers/HU
mm objects at 0.5% contrast  Unintended optical density on a radiograph
 More common in CT than in conventional
radiographs
SLICE THICKNESS/SENSITIVITY PROFILE
 Types:
 Assessment test: ramp, a spiral or a step o Streaking - due to an inconsistency
wedged (specially designed test objects) in a single measurement
 Frequency: semiannually o Shading – due to a group of
 Acceptable tolerance: w/in 1 mm of the channels or views deviating
intended slice thickness gradually from the true measurement

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 COMPUTED TOMOGRAPHY

o Rings – due to errors in an Patient positioning

individual detector calibration Gantry tilting
o Distortion – due to helical Appropriate FOV selection
reconstruction Appropriate bowtie filter
 Four categories: Most commonly
Bone and metal implants
o Physics-based artifacts occur
 Caused: physical processes
involved in the acquisition of CUPPING ARTIFACT
CT data Beam is hardened more
o Patient-based artifacts in the middle portion of
 Caused: Description
an object than those in
 Patient movement the edges
 Presence of metallic Caused Beam hardening
materials The middle of the
o Scanner-based artifacts, Effect image appear darker
 Caused: imperfections in than the periphery
scanner function Beam hardening
o Helical and multisection artifacts Avoidance
correction
 Caused: image
reconstruction process.

PHYSICS-BASED ARTIFACTS STREAK AND DARK BAND ARTIFACTS

 Beam hardening artifact Description
Appear between two
o Cupping artifact dense objects
o Streak artifact Metals (bullets,
 Partial volume pacemaker, dental
 Photon starvation fillings)
 Undersampling Caused Beam hardening
Poisson noise
BEAM-HARDENING ARTIFACT Patient motion
Edge effects
Increased mean energy of
Description the x-ray beam when it High CT number on the
Effect
passes through object image
Polychromatic nature of the Beam hardening
Caused Avoidance
x-ray beam correction
Cupping artifact Bony regions of the
Appearance of dark bands Most commonly occur body
or streak Used of contrast media
Effect
(b/n metal or bone)
Pseeudoenhancement of PARTIAL VOLUME ARTIFACTS
renal cysts Distortion of signal
BUILT-IN FEATURES: Description intensity from an
Filtration anatomy
Calibration correction Anatomy that doesn’t lie
Avoidance
Beam hardening correction Caused totally within the slice
software thickness
BY OPERATOR:
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 COMPUTED TOMOGRAPHY

Averaging the linear

attenuation coefficient in METAL ARTIFACTS
Effect a voxel that is Presence of metal object
heterogenous in Caused
in the scan field
composition Incomplete attenuation
Thin slice selection Effect profile
Avoidance
Thin slice incrementation Severe streaking artifacts
Most critical region Posterior cranial fossa Asked patient to remove
metallic objects
PHOTON STARVATION ARTIFACTS Use gantry angulation
Potential source of Avoidance
Description (for nonremovable items)
streaking artifacts Increased kVp
High x-ray attenuation Thin slice thickness
Caused Highly attenuating
structures
MOTION ARTIFACTS
Insufficient x-ray Patient motion
photons reaching the Caused
Effect (involuntary & voluntary)
detector
Effect Misregistration artifacts
Very noise projections
By the operator:
Increase tube current
Use of positioning aids
Use of adaptive
Immobilization
Avoidance filtration
Sedation (infant)
Automatic tube current
Short scan time
modulation
Instruct patient to hold
Avoidance
UNDER SAMPLING ARTIFACTS breath
By built-in features:
Two large an interval
Description Overscan & underscan
between projections
modes
Misregistration by the
Software correction
computer of information
Caused Cardiac gating
relating to sharp edges
and small objects
View aliasing (fine INCOMPLETE PROJECTION
stripes appearance) Presence of anatomy
Effect lying outside the scan
Ray aliasing (stripes Description
appearance) field produces severe
For view aliasing: artifacts
Slower rotation speed Portion of anatomy lies
Caused
Avoidance For ray aliasing: outside the field of view
Quarter-detector shift Incomplete information
Flying focal spot of the anatomy by the
Effect computer
Generation of streaking
PATIENT-BASED ARTIFACTS and shading artifacts
 Metallic materials Position patient so that
 Patient motion Avoidance no parts lying outside
 Incomplete projection the scan field
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 COMPUTED TOMOGRAPHY

sagittal reformats seen

with helical and
SCANNER-BASED ARTIFACTS multidetector row CT
 Ring artifacts Increased number of
section acquired per
RING ARTIFACTS rotation
Caused
Artifacts seen in third Wider collimation
Description Increase number of
generation CT scanner
Faulty detector detector rows
Caused Detector out of Artifacts similar to those
Effect
calibration caused by partial volume
Consistently erroneous Employing cone beam
Avoidance
reading at each angular reconstruction
Effect
position
Circular artifact ZEBRA ARTIFACTS
Detector calibration Periodic stripes of more
Selecting correct scan or less noise at the image
Avoidance FOV Description periphery seen on
(by using calibration coronal or sagittal
date) reformats
HELICAL AND MULTISECTION CT Caused Helical interpolation
ARTIFACTS Alternating high and low
 Cone beam effect (Helical) Effect
noise on image
 Stair-step artifacts (MSCT) Employing cone beam
Avoidance
 Zebra or windmill artifacts (MSCT) reconstruction

CONE BEAM EFFECT

The x-ray beam becomes -THE END-
Description cone-shaped rather than “There are no secrets to success. It is the result of
fan-shaped
preparation, hard work learning from failure”
Increased number of
05/29/14
section acquired per
rotation
Caused
Wider collimation
Increase number of
detector rows
Fundamental deficit in
Effect
the acquired data
To acquire a more
complete data set
Avoidance
Employing cone beam
reconstruction

STAIR STEP ARTIFACTS

Description Serrations on coronal or
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