Ct Procedures and Imaging Process (2)

UNIT-1
LEARNING OBJECTIVE:
 Patient Preparation for CT
CT scan preparation:
General Instructions
Little preparation is needed for a CT scan. Patients, who do not have congestive heart failure or are not on
dialysis, are asked to drink 64 ounces of water before the exam, especially if the exam is performed with oral
or intravenous contrast. If possible, they should start drinking 12 hours before their scheduled appointment
time.
If patient is receiving IV or contrast, they should not eat or drink 4 hours prior to exam. Patients will be asked
to remove jewelry and other metallic objects that might interfere with the scan. We ask patients to leave
jewelry at home when possible.
Patients who are breastfeeding should be given an opportunity to make an informed decision about whether
to continue breastfeeding after receiving intravascularly administered iodinated contrast media or to
temporarily abstain. A very small percentage of iodinated contrast medium can be excreted into the breast
milk and absorbed by the infant‘s gut. We believe that the available data suggests that is safe for the mother
and infant to continue breastfeeding after receiving such an agent.
The patient can choose to temporarily abstain from breastfeeding for 24 hours with the active expression and
discarding of breast milk from both breast during that period. If so, the patient may wish to use a breast pump
to obtain milk beforehand to use during the 24-hour period following the administration of contrast media.
Please inform the patient of this option when the exam is scheduled.
Patient Screening Prior to Administration of Iodinated Contrast.
Prior to the administration of iodinated contrast, patients are screened for the following:
• Previous reactions to iodinated contrast media
• All severe allergies and reactions (both medications and food)
• History of diabetes, kidney disease, pheochromocytoma, solitary kidney, kidney or other transplant,
or myeloma
• Pregnant or breast-feeding (in women of child-bearing age).
Premedication Instructions for Patients with Contrast Allergies
• Prednisone 50mg po at 13 hours, 7 hours and 1 hour prior to planned administration of intravenous
contrast plus diphenhydramine 50mg po, iv or im at 1 hour prior to planned administration of
intravenous contrast
• Methylprednisolone 32mg po at 12 hours and 2 hours prior to planned administration of contrast plus
diphenhydramine 50 mg po, iv or im at 1 hour prior to the planned administration of contrast
• Hydrocortisone 200mg iv at 5 hours and 1 hour prior to planned administration of intravenous
contrast if patient is unable to take po medications plus diphenhydramine 50 mg po, iv or im at 1 hour
prior to the planned administration of contrast
• Creatinine Testing Prior to Contrast Administration
• Routine creatinine testing prior to contrast administration is not necessary in all patients. The test
should be obtained within 30 days of contrast administration for patients with renal disease, HIV+,
diabetic, hypertensive, over 60 years or on chemotherapy.
Contrast Administration in Patients with Elevated Creatinine
Estimated glomerular filtration rate is a better predicator of renal dysfunction than creatinine alone. The
decision to proceed with contrast administration in patients with an estimated GFR < 30 ml/min/1.732 is a
matter of clinical judgment, based on the individual circumstances of the patient and following consultation
between the radiologist and requesting physician. Strategies to prevent nephropathy in patients with renal
impairment include hydration, reduction of contrast dose, and discontinuation of nephrotoxic drugs. A
critical diagnostic study should not be delayed because of excessive concern regarding possible contrast
nephropathy.
Contrast Administration in Patients with Renal Failure
Patients on dialysis can receive IV contrast, and early post-procedural dialysis is not routinely required.
However, the fact that a patient is on dialysis should not be regarded as automatically allowing the
administration IV contrast. The administration of contrast may jeopardize the return of renal function in
patients who are receiving dialysis for acute renal failure and may further worsen renal function in patients
who still make some urine but receive dialysis intermittently. The volume of IV contrast should also be
considered in patients on dialysis who are at risk for volume overload.
Contrast Administration in Pregnant Patients
The iodine content of contrast media has the potential to cause hypothyroidism in the neonate. Pregnant
women who receive an intravenous iodinated contrast agent are counseled that neonatal thyroid function
should be checked in the first week of life. Informed consent is obtained prior to the administration of
contrast in pregnant patients.
PATIENT PREPRATION FOR CT EXAM:

1. CT Abdomen with Contrast, CT Abdomen/ Pelvis with Contrast, CT Chest/Abdomen with Contrast, CT
Chest/Abdomen Pelvis with Contrast, CT Neck /Chest/Abd Pelvis with Contrast, CT Neck/Chest/Abdomen
Upper with Contrast, CT Pelvis Venogram, CT Pelvis with Contrast.
FOR FOLLOWING EXAM PATIENT PREPRATION IS:
• Arrive 45 minutes prior to your appointment. You may receive oral contrast prior to your exam.
• Length of exam: 20 minutes.
• Food: Do not eat 2 hours prior to your appointment. If you are required to take food with your
medication, a small amount of food is allowed.
• Liquids: Drink at least 1 litre of non-caffeinated clear fluids over the 2 hours prior to your
appointment. A full bladder is not required.
• After Exam: Drink 1 litre of non-caffeinated fluids over the 3 hours following your exam.
• Continue to take your medications as directed and resume your regular diet.
• Diabetic patients: For this fasting exam, to maintain your sugar levels, you are allowed clear fruit
juices up to an hour prior to your appointment.
• If you are on chronic dialysis with fluid intake restrictions, do not follow the drinking instructions
outlined above
• Wear comfortable clothing- no zippers, jewelry or metallic objects in the area to be scanned.
• Island Health is a scent free facility. Do not wear perfume, cologne or any scented products.
• If the patient is a child you may receive additional instructions from the hospital.
2. CT Angiogram, CT Ankle with Contrast CT Chest with Contrast CT Elbow with Contrast CT Extremity
with Contrast CT Facial Bones with Contrast, CT Head & Orbits with Contrast CT Head with Contrast CT
Hip with Contrast CT IAC with Contrast CT Knee with Contrast, CT Lower Extremity Venogram, CT
Nasopharynx & Neck with Contrast, CT Nasopharynx with Contrast, CT Neck &Chest with Contrast CT
Orbit Sella with Contrast CT Shoulder with Contrast, CT Sinus with Contrast, CT Soft Tissue Neck with
Contrast CT Spine Cervical with Contrast CT Spine Lumbar with Contrast CT Spine Thoracic with Contrast
CT Upper Extremity Venogram, CT Vertebroplasty.
FOR FOLLOWING EXAM:
• Arrive 20 minutes prior to your appointment. Length of exam: up to 30 minutes
3. CT Ankle without Contrast CT Body Dual Energy, CT Cardiac Calcium Score CT Chest without Contrast
CT Clavicle without Contrast CT Cystogram, CT Dental CT Elbow, CT Extremity without Contrast CT
Facial Bones without Contrast CT Femur without Contrast, CT Foot without Contrast, CT Forearm without
Contrast CT Hand without Contrast CT Head and Facial Bones CT Head and Sinus CT Head and Spine
Cervical CT Head without Contrast CT Hip without Contrast, CT Humerus without Contrast CT IAC without
Contrast, CT Kidneys Ureters Bladder, CT Knee without Contrast, CT Leg Lengths Scanogram, CT Lower
Extremity Dual Energy, CT Nasopharynx and Neck without Contrast, CT Nasopharynx without Contrast CT
Neck and Chest without Contrast CT Orbit Sella without Contrast, CT Pituitary Fossa, CT Sacrum and
Coccyx, CT Shoulder without Contrast CT SI Joints, CT Sinus without Contrast, CT Soft Tissue Neck
without Contrast CT Spine Cervical and Thoracic, CT Spine Cervical without Contrast CT Spine Lumbar
and SI Joints, CT Spine Lumbar without Contrast CT Spine Post Vertebroplasty, CT Spine Thoracic and
Lumbar, CT Spine Thoracic without Contrast CT Sterno clavicular Joints, CT Tibia/Fibula without Contrast
CT TM Joints, CT Upper Extremity Dual Energy, CT Wrist without Contrast.
FOR FOLLOWINF EXAM PATIENT PREPRATION IS:
• Arrive 20 minutes prior to your appointment. Length of exam: 30 minutes.
4. CT Biopsy, CT Drainage Abdomen/Pelvis CT Drainage Chest, CT Drainage, CT Tumor Ablation
• Arrive 1 hour prior to your appointment. Length of exam: up to 3 hours.
• If you are taking anticoagulants (blood-thinners), anti- inflammatories, or platelet inhibiting
medication such as Aspirin, Coumadin, Ibuprofen or Warfarin, these medications should be discussed
with your ordering physician, as they may need to be stopped 1 week prior to your exam date.
• Within a week of your biopsy date INR-PT blood work must be completed. Contact your ordering
physician for the requisition to have this done.
• If you are on blood thinners, the INR lab work must be done the day prior to your biopsy.
• Do not eat or drink 4 hours prior to your appointment time.
• Continue to take your medications unless otherwise directed. You may have sips of water with
medications.
• Diabetic Patients: For this fasting exam, to maintain your sugar levels, you are allowed clear fruit
• We recommend that you do not drive yourself home. Please arrange for a ride beforehand.
5. CT Cardiac Imaging
• Arrive 30 minutes prior to your appointment.
• Length of exam: 30-90 minutes.
• If you are on chronic dialysis with fluid intake restrictions, do not follow the drinking instructions
outlined above
NOTE: CT SCAN PROTOCOL FOR VARIOUS PROCEDURE WILL BE DISCUSS IN 3RD UNIT.
UNIT-2
LEARNING OBJECTIVE:
 Data Acquiring Concepts
 Slip-Ring Technology
 CT Detector Technology
 Design of a CT Room
Sample Preparation
Strictly speaking, the only preparation that is absolutely necessary for CT scanning is to ensure that the
object fits inside the field of view and that it does not move during the scan. Because the full scan field for
CT is a cylinder (i.e., a stack of circular fields of view), the most efficient geometry to scan is also a cylinder.
Thus, when possible it is often advantageous to have the object take on a cylindrical geometry, either by
using a coring drill or drill press to obtain a cylindrical subset of the material being scanned, or by packing
the object in a cylindrical container with either X-ray-transparent filler or with material of similar density.
For some applications the sample can also be treated to enhance the contrasts that are visible. Examples have
included injecting soils and reservoir rocks with NaI-laced fluids to reveal fluid-flow characteristics
(Wellington and Vinegar, 1987; Withjack, 1988), injecting sandstones with Woods metal to map out the fine-
scale permeability, and soaking samples in water to bring out areas of differing permeability, which can help
to reveal fossils (Zinsmeister and De Nooyer, 1996).
Calibration
Calibrations are necessary to establish the characteristics of the X-ray signal as read by the detectors under
scanning conditions, and to reduce geometrical uncertainties. The latter calibrations vary widely among
scanners; as a rule flexible-geometry scanners such as the ACTIS scanner at UTCT require them, whereas
fixed-geometry scanners geared towards scanning a single object type may not.
The two principal signal calibrations are offset and gain, which determine the detector readings with X-rays
off, and with X-rays on at scanning conditions, respectively. An additional signal calibration, called a wedge,
used on some third-generation systems (including the UTCT ACTIS scanner) consists of acquiring X-rays as
they pass through a calibration material over a 360º rotation. The offset-corrected average detector reading is
then used as the baseline from which all data are subtracted. If the calibration material is air, the wedge is
equivalent to a gain calibration. A typical non-air wedge is a cylinder of material with attenuation properties
similar to those of the scan object. Such a wedge can provide automatic corrections for both beam hardening
and ring artifacts, and can allow utilization of high X-ray intensities that would saturate the detectors during a
typical gain calibration. Although widely employed in medical systems, which use phantoms of water or
water-equivalent plastic to approximate the attenuating properties of tissue, the wedge calibration is
relatively uncommon in industrial systems.
Collection
The principal variables in collection of third-generation CT data are the number of views and the signal-
acquisition time per view. In most cases, rotation is continuous during collection, and each rotation is for a
full 360º, although for some systems smaller rotations may be used. On the UTCT ACTIS scanner, the
number of views used ranges from 600 to 3600 or more. Each view represents a rotational interval equal to
360º divided by the total number of views. The raw data are displayed such that each line contains a single
set of detector readings for a view, and time progresses from top to bottom. This image is called a sinogram,
as any single point in the scanned object corresponds to a sinusoidal curve. Second-generation CT data are
collected at a small number of distinct angular positions (such as 15 or 30), but the progression of relative
object and source-detector position combinations allows these data to complete a fairly continuous sinogram.
Reconstruction
Reconstruction is the mathematical process of converting sinograms into two-dimensional slice images. The
most widespread reconstruction technique is called filtered backprojection, in which the data are first
convolved with a filter and each view is successively superimposed over a square grid at an angle
corresponding to its acquisition angle. The primary convolution filter used at UTCT is the Laks filter
(Ramachandran and Lakshminarayanan, 1970), which is preferred when high-resolution images are desired;
also available is the Shepp-Logan filter (Shepp and Logan, 1974), which is used more frequently in medical
systems and reduces noise at some expense in spatial resolution (ASTM, 1992).
During reconstruction, the raw intensity data in the sinogram are converted to CT numbers or CT values that
have a range determined by the computer system. Most medical and older industrial systems use a 12-bit
scale, in which 4096 values are possible, while most more recent systems use a 16-bit scale, which allows
values to range from 0 to 65535. On most industrial scanners, these values correspond to the grayscale in the
image files created or exported by the systems. Although CT values should map linearly to the effective
attenuation coefficient of the material in each voxel, the absolute correspondence is arbitrary. Medical
systems generally use the Hounsfield Unit (HU), in which air is given a CT number of -1000 and water is
given a value of 0, causing most soft tissues to have values ranging from -100 to 100 and bone to range from
600 to over 2000 (Zatz, 1981). Industrial CT systems are sometimes calibrated so that air has a value of 0,
water of 1000, and aluminum of 2700, so the CT number corresponds roughly with density (Johns and
others, 1993). The calibration of CT values is straightforward for fixed-geometry, single-use systems, but far
less so for systems with flexible geometry and scanning modes, and multiple uses each requiring different
optimization techniques.
Although a link to a reference scale can be useful in some circumstances, the chemical variability of
geological materials and the wide range of scanning conditions used precludes any close correspondence to
density in most cases. Furthermore, because material components can range from air to native metals, a rigid
scale would be counterproductive. Given the finite range of CT values, a single scale may be insufficiently
broad if there are large attenuation contrasts, or needlessly desensitize the system if subtle variations are
being imaged. For geological purposes, it is commonly more desirable to select the reconstruction parameters
to maximize the CT-value contrast for each scanned object. This can be done by assigning arbitrary low and
high values near the limits of the available range to the least and most attenuating features in the scan field.
In general we try to ensure that no CT value is generated beyond either end of the 16-bit range, lest some
dimensional data be lost. For example, the boundary of an object being scanned in air is usually taken to
correspond to the CT-value average between the object and air. If air is assigned to a CT value below zero,
the apparent boundary of the object may shift inward.
CT SCAN DETECTOR:
INTRODUCTION
Signal detectors are a central element in any medical imaging system. In the imaging modalities X-ray, CT,
SPECT and PET the information is carried by ionizing radiation, more precisely X-rays -quanta. The
imaging detectors consist of a multitude of detector channels, for modern X- ray detectors up to several
million picture elements (pixels). In this article, the main emphasis will be on detectors for X-ray and CT.
SPECT and PET will be briefly touched upon in the outlook section at the end of the article.
In general, detectors for X-ray and CT imaging comprise a conversion stage for converting the X-ray quanta
ultimately into electrical signals. The conversion stage is followed by pixel electronics, i.e. the electronic
circuitry belonging exclusively to one detector channel. The pixel electronics are then usually connected to
further circuitry, which is shared by many or all detector channels. The general scheme is shown in Figure 4-
1a.
Figure 4-1. a) General representation of an X-ray or CT detector, b) with indirect conversion.

In the majority of today‘s detectors for dynamic X-ray imaging and CT imaging, the conversion is indirect
(Figure 4-1b), i.e. the X-rays are first converted into visible light, which is converted further into an
electrical signal by a photosensitive device, usually a photodiode in the case of X-ray and CT. Although the
photodiodes are a part of the overall conversion stage.
There are many design and performance parameters related to imaging detectors. Detection efficiency, spatial
resolution, signal-to-noise ratio, dynamic range and temporal resolution are most important1. This article
cannot cover all these parameters for all key technologies in depths, so only some main relations will be
mentioned.
CONVERSION MATERIALS
Conversion materials should efficiently detect (i.e. absorb) the incoming X-ray quanta and convert them
into light (for scintillating materials) or directly into electrical signals (for direct conversion materials).
The extremely strong influence of the conversion stage on the overall imaging performance makes both
scintillator and direct conversion materials key technology items for imaging detectors. Main characteristics
of conversion materials are:
• Detection efficiency.
• Sensitivity‘, i.e. the light yield for scintillators or the charge yield for direct conversion materials.
• Spatial resolution, often expressed as the Modulation Transfer Function (MTF).
• Temporal resolution.
It is very important to note the difference between detection efficiency and sensitivity. As X-ray and CT
imaging are governed by the noise of the X-ray quantum flux, the detection efficiency should be as high as
possible,e.g. 80% or more of the incoming quanta should be detected. Too low a detection efficiency cannot
be recovered by increasing the sensitivity of the detector.
Scintillators
There are many materials emitting visible light when energy is deposited in the material, e.g. by X-rays or
energetic charged particles. Such materials are known as scintillators. For the efficient detection of X-rays
usually inorganic compounds containing some heavy element are used. Sodium iodide (NaI) or cadmium
tungstate (CdWO4) are well known examples. Extensive overviews have been given by van Eijk2. To
achieve the high detection efficiency at quantum energies of 60 keV or higher, the typical thickness of a
scintillator can range from 0.3 to 2.5 mm for X-ray and CT imaging.
Figure 4-2. Columnar structure of a CsI:Tl scintillator.

X- ray imaging requires a fine spatial resolution of the order of 100 µm at the detector. Cesium iodide (CsI) is
often used for this application, as it can be grown with a columnar structure as shown in Figure 4-2. This
structure limits the lateral spread of the scintillation light, thus helping significantly in achieving an
acceptable spatial resolution. For the use with amorphous silicon photodiodes (see section 3.1), the CsI is
doped with traces of thallium which works as an activator shifting the maximum of the light emission
spectrum into the green region3. The light yield of CsI:Tl is about 60 photons per keV of deposited
energy1,2. CsI:Tl exhibits a significant afterglow of about 1% after 10 ms2,4. However, for X-ray imaging
this is an acceptable value. After strong X-ray illumination the light yield of the CsI:Tl increases slightly, the
effect being known as ‗bright burn‘.
Figure 4-3. Array of CdWO4 crystals for CT imaging.

For CT imaging the requirements on spatial resolution are only of the order of 1 mm at the detector, while the
fast gantry rotation and the large number of projections demand signal integration times as low as 100 µs and
therefore a very good temporal behaviour of the scintillator. Frequently cadmium tungstate (CdWO4) or
gadolinium oxysulfide (GOS, Gd2O2S) are chosen5. CdWO4 has a light yield of 20 photons per keV,
whereas GOS, depending on the doping, reaches 35-60 photons per keV 2. The scintillator crystals are
machined into small pieces of about 2-5 mm³, which are then mounted next to each other with reflective
material between them to avoid lateral cross-talk of the scintillation light between the individual crystals
(Figure 4-3).
Direct conversion materials
Direct conversion materials generate measurable charge signals when absorbing X-ray quanta. Usually these
(between 0.1 and 20 V/µm). For applications in X-ray imaging, several classical photo conducting materials
have been studied,6 such as amorphous selenium7-9 (a-Se) and the polycrystalline materials lead iodide10,
11 (PbI2), lead oxide12-14 (PbO) and mercury iodide11, 15, 16 (HgI2). Some properties of these materials
are listed in Table 4-1. The main advantage of direct conversion materials is their inherently excellent spatial
resolution.
Even for finely spaced pixel electrodes (e.g. 100 µm pitch or below) the charge signal usually remains within
the pixel area in which the X-ray quantum was absorbed. This is due to the relatively high and well-defined
electric fields in the materials and due to a rather small lateral diffusion of the charge carriers. Figure 4-4
shows an X-ray image obtained with a PbO detection layer. Until now, only amorphous selenium is used in
commercial X-ray detectors the other materials still being in their research phases.
Figure 4-4. X-ray image acquired with a PbO detection layer.

A common problem of the amorphous or polycrystalline direct conversion materials is their temporal
behavior. Some materials show strong residual signals, i.e. a decaying surplus dark current after X-ray
illumination, which can be in the range of several percent still 1 s after switching off the X-rays. Amorphous
selenium exhibits a reduced sensitivity (reduced charge yield) after X-ray illumination. This so-called
ghosting effect8 decays even slower, it can be present for minutes. The mechanism of charge trapping cannot
account for all of the observed temporal effects in direct converters. Also charge injection invoked by charge
accumulation layers may often play a role.
There are also crystalline direct conversion materials. Classical examples are silicon and germanium, but
both are not very heavy materials and germanium detectors usually have to be cooled during operation. A
room- temperature detector material receiving much research attention is cadmium zinc telluride (CZT,
roughly Cd0.9Zn0.1Te)17. Some of its properties are also stated in Table 4-1. CZT has a high charge yield of
about 200 e- per keV deposited energy, and its temporal behavior is much better than that of amorphous or
polycrystalline materials. The use of CZT detector crystals is considered for X-ray, CT and also for SPECT.
However, the material is still somewhat expensive and cannot be produced in arbitrary sizes. CZT can also be
operated in counting mode allowing the detection of individual X-ray or quanta.
PHOTODIODES AND PIXEL ELECTRONICS
Flat X-ray detectors based on amorphous silicon
The field of dynamic X-ray imaging detectors has gone through significant technologies change over the last
five years. From the 1970‘s the standard technology were image intensifier systems (II-TV) based on
sizeable vacuum tubes incorporating electron optics, phosphor screens and optical cameras. Roughly from
the year 2000 onwards, flat dynamic X-ray detectors18-21 utilizing amorphous silicon technology have been
introduced for cardiology, neurology, vascular imaging and other applications. Also, for static X-ray
imaging, e.g. in general radiography, the amorphous silicon technology is now frequently employed in new
systems.
The majority of the flat X-ray detectors are based on indirect conversion using CsI:Tl as the scintillation
material, as discussed in section 2.1. The optical light is detected by amorphous silicon photodiodes in the
large area electronics panel22-24. The a-Si photodiodes exhibit only small leakage currents and have their
maximal sensitivity in the green where the CsI:Tl shows its highest light emission. The circuit diagram for an
indirect conversion flat detector pixel is shown in Figure 4-5a. Each pixel has an a-Si thin film transistor
(TFT) as the switching element, allowing a row-wise read-out of the pixel array. The pixel diode and its
associated capacitance are discharged by the light from the scintillator during X-ray illumination. During
read-out an external charge sensitive amplifier (CSA) connected to
the read-out column re-charges the pixel diode to a fixed reverse bias voltage, typically 5 to 10 V. In this
charge read-out configuration, the dominant noise sources are the reset noise of the diode and the noise of the
charge sensitive amplifier. The shot noise of the diode,s leakage current is among the smaller noise
contributions.
In addition to the temporal effects in the scintillator, the amorphous silicon photodiode and the TFT in the
pixel also show temporal effects25-28, namely residual signals, photodiode gain effect (similar to ghosting)
and incomplete read-out. The first two effects are attributed to trapping states in the a-Si. Both can be
reduced by illuminating the a-Si photodiodes with additional light (refresh light).
Figure 4-5. a-Si pixel circuits for (a) indirect and (b) direct conversion.
The introduction of flat X-ray detectors based on a-Si technology on the medical market is very successful.
Compared to the previous II-TV systems, the flat detectors are less bulky, have a distortion-free imaging
geometry and almost completely suppress a long-range blurring effect known as low- frequency drop. For
many applications this opens up a larger usable dynamic range.
The flat detectors based on direct conversion materials also utilize a-Si technology for the large area
substrates. The pixel circuit is very similar, as shown in Figure 4-5b. A collection electrode and a
capacitor on which the charge signals are integrated during X-ray illumination replace the a-Si photodiode.
The read-out operates in a similar way as described for the indirect conversion circuit.
Advanced amorphous silicon flat detectors
After the radical technology switch from image intensifiers to flat X-ray detectors, research and development
in this field are currently concentrating on improving the a-Si based X-ray detectors. Improvement topics are
the signal-to-noise ratio at low X-ray doses, dynamic range and spatial resolution. Also reducing the
production costs and implementing additional functionality within the a-Si technology are natural directions.
One way of improving the signal-to-noise ratio is to enhance the fill factor of the pixel, i.e. the fraction of the
pixel area that is sensitive to light. To this end, several methods to increase the size of the photodiode in the
pixel have been developed, including diode-on-top technologies29, 31 and infinite photodiode layers30. An
increased fill factor also allows to construct detector arrays with smaller pixels and therefore enhanced spatial
resolution. Another way to achieve a higher signal-to-noise ratio would be to amplify the signal already in
the pixel. Several circuits for in-pixel amplifiers have been proposed32-34. Many suffer from some poor
electrical properties of the amorphous silicon TFTs, especially their low charge carrier mobility and the drift
of the threshold voltage over time. In more complex circuits also additional noise sources have to be taken
into account. An example of a pixel circuit with signal amplification is drawn in Figure 4-6. Other advanced
pixel circuit concepts include the integration of sample- and-hold stages or the suppression of the pixel's reset
noise by means of correlated double sampling. Additional functionality can also come in the form of
integrated dose sensing allowing the control of the X-ray generation equipment during the X-ray pulse. One
concept for integrated dose sensing35 avoiding any additional active elements in the pixel is shown in Figure
4-7. The dose sensing information is sensed non-destructively through tiny capacitors Ctap attached to each
pixel node. Using appropriate external electronics this yields coarsely resolved images at a very high rate
(e.g. 10 kHz) from which the information relevant for the dose control can be derived.
Apart from pure a-Si technology, also advanced technology versions or other large area electronics
technologies are investigated. Examples are poly-silicon electronics34, or flexible electronics produced by
inexpensive roll-to-roll processes, including ink jet printing methods and polymer-based electronics36. Also
CMOS array detectors have been proposed which can offer excellent performance37. However, achieving
very large area detectors with sufficient yield may be an issue with this technology.
Figure 4-6. Pixel circuit with signal amplification (source follower).

Figure 4-7. Diagram illustrating integrated dose sensing.
Detectors for multi-slice CT
In Computed Tomography (CT) the last decade has been dominated by two trends, faster gantry rotation and
more detection slices in the axial direction of the patient (multi-slice CT)38. Both trends led to a dramatic
reduction of the scanning times, shortening a whole-body scan, for example, from about 20 minutes to about
half a minute. At the same time, the spatial resolution was improved, leading to even finer resolved volume
images of the human body and all organs of interest.
The basic construction scheme of a CT detector has stayed roughly the same. The detector elements are
arranged on a ca. 1 m long arc of a circle, sometimes called the ‗detector banana‘. Each detector pixel
consists of a scintillator crystal and a corresponding photodiode. The photodiode is then connected to the
electronics channel, typically comprising an amplifier and an analog-to-digital converter (ADC) optimized
for the CT detector operation.
The photodiodes have evolved from individual diodes or linear arrangements into two-dimensional arrays of
photodiodes. All of these photodiodes are made from crystalline silicon, which has an excellent linearity and
temporal behavior. The illumination is from the front of the photodiode, and the pixel contacts are routed on
that same side to one or two edges of the photodiode array. With the number of axial slices in the CT
exceeding 32, the routing of the many pixel connections to the edges became more and more difficult. This
problem is now addressed using back- illuminated photodiodes, where the routing of the pixel contacts is no
longer needed39,40. The connection from the pixel is made directly to a substrate using modern interconnect
technology.
For the electronics, the increasing number of detector slices led to a strong trend to shrink and integrate the
channel electronics, also in order to decrease cost and power consumption and to minimize the noise by
keeping the distances between the photodiodes and the electronics short. In current CT detectors, the
electronics channels of e.g. 32 pixels fit into an integrated circuit that outputs the digitized data. Also in this
context, high density interconnect technologies such as bump bonding are getting more and more important
in the field of large area radiation detectors.
Advanced technology for CT
Although today,s CT detectors show an excellent performance, some technologies are being investigated for
future CT detectors. One concept brings the integration of the detector one step further by combining the
photodiodes and the channel amplifier in a common CMOS chip41,42. To achieve the necessary dynamic
range of about 17 bit, the amplifier is constructed as an integrator with an automatic gain switch selecting one
of two sensitivities. The pixel electronics is located in areas which are in the shadow of the anti-scatter grid
of the detector. In this way, the electronics are not wasting valuable fill-factor and are shielded from too
much radiation, so that the CMOS pixel electronics is not harmed by the X-rays. Figure 4-8 shows a detector
module with 20 by 20 pixels and a zoom into the pixel area.
Other investigations analyze the use of direct conversion materials also for CT. Due to the required
excellent temporal behaviour (see section 2.1), the known amorphous and polycrystalline direct conversion
materials cannot be used in CT. Only crystalline direct conversion materials are fast enough. Consequently,
materials such as cadmium zinc telluride (CZT, see section 2.2) are regarded as possible candidates for use in
CT detectors. However, some studies analyzing the behaviour of CZT under high X-ray fluxes indicate some
issues with the material.
Figure 4-8. CT Detector module based on integrated CMOS photodiodes and pixel electronics. On the
module, only one of two scintillator arrays is mounted.
The trends towards higher performance and at the same time cost reduction will continue for detectors in X-
ray and CT imaging. In the long run, direct conversion and a further integration of the electronics are
probable directions. Apart from this, also qualitative changes in the functionality of the detectors are
expected, for example moving from integration mode to counting mode detectors. Until now, both X-ray and
CT detectors operate in integration mode, i.e. they sum up the ‗intensity‘ of the measured X-ray flux during
the signal integration time. An alternative approach is to detect and count the X-ray quanta individually, a
mode known as counting operation. Due to the high fluxes that can occur in both X-ray and CT imaging (of
the order of 109 quanta per second per mm² at the detector), counting has so far been considered unfeasible.
However, advances in pixellated counting detectors45, 46 may trigger investigations in this direction.
It is also possible to combine counting and integrating operation, as sketched in Figure 4-9. This would yield
additional information as the counting channel records the number of the detected quanta, whereas the
integrating channel sums up the energies of the detected quanta. Thus the mean energy of the X-ray quanta
can be calculated per detector pixel by simply dividing the integrated signal by the counted signal. The mean
energy is a measure for the beam hardening in the patient and can give some information about the material
composition along the X-ray beam in the patient. With even more complex electronics it may also become
feasible to measure the spectrum of the detected radiation in each pixel. This concept is referred to as spectral
X-ray or CT imaging.
Figure 4-9. Combined counting and integrating detector pixel.
At this point it is interesting to compare the detector technology in X-ray and CT imaging with the methods
used in nuclear medicine, i.e. SPECT and PET imaging. In SPECT and PET it is mandatory to measure the
-quanta to suppress scatter events, so spectral imaging is already a standard in
nuclear medicine. However, the fluxes are much lower (1-100 quanta / s mm² for SPECT and about 100
quanta / s mm² for typical PET applications) which eases the design of the spectrally resolving detector. The
architecture still most commonly used in nuclear medicine comprises scintillator crystals optically connected
to arrays of photomultipliers. The energy of a detected quantum is calculated by summing up the signals
from several adjacent photomultipliers, while the spatial information is retrieved using a centroid calculation.
This is the so-called Anger method already in use since the 1960s for two-dimensional scintigraphy. For
nuclear medicine a technology change towards solid-state detection with indirect conversion or direct
conversion is being contemplated, but most commercial systems still rely on the photomultiplier technology
and discrete electronics. More information about the imaging modalities of nuclear medicine can be found in
Chapter 8 of this volume.
Slip Rings:
A Slip Ring Unit is an electromechanical device which allows the transmission of power and electrical
signals from a stationary to a rotating structure. Slip Rings can be used in any electromechanical system
which requires unrestrained, intermittent or continuous rotation while transmitting power and/or data. It can
improve mechanical performance, simplify system operation and eliminate damage-prone wires
fixed/hanging from moveable joints.
As leading slip ring manufacturers, Trolex Engineering can offer proven slip ring technology, both ATEX
certified and IECEx certified.
Work
The Slip Rings function is to make one or more continuous electrical connections from points in a stationary
unit to points in a rotating section.
You may have heard them called a number of names - rotary electrical interface, collector, swivel, and rotary
joint - however, they are all the same product, and throughout our website, will be referred to as Slip Rings.
They are sometimes referred to as commutator, however commutators are specialised for use on DC motors
and generators. While commutators are segmented, slip rings are continuous.
Transmission of Signals through Slip Rings
A Trolex Slip Ring Unit is as reliable as any other electrical control or monitoring device using well
established and proven designs.
The transmission of signals is not a problem, if circuit characteristics are known we are pleased to consider
the details and where possible provide information relating to similar applications.
The slip ring circuits are of the sliding contact design with a minimum of two-brush contacts/slip ring.
Precious metals are used to improve data transmission of signal circuits.
Types of Signals
Listed below are samples of the type of signals, digital or analogue that have successfully been transmitted
across the rotating interface of our Slip Ring Units.
• Video
• Communications
• Serial Links RS232/RS485
• Superimposed signals onto 1kV power circuits
• Data - PLC 115.2 kBaud (2 x 1,000,000 transmitted and received messages without an error)
• ESD signals
• Fire & Gas
• Fibre optic*: single or multi-mode and 1mm plastics fibre
Testing
All units are tested prior to dispatch, this includes but is not limited to, continuity, insulation resistance,
dielectric strength, torque and rotational tests.
Electrically the circuits are capable of moderate fault levels and surges without detriment. The slip rings,
brush gear and terminal designs are well proven.
Dispatch
A comprehensive Maintenance and Instruction Manual is supplied with each unit and includes a Trolex
Certificate of Conformity and/or Declaration of Incorporation. All Trolex Engineering products are carefully
packaged for protection during transport.
Computed Tomography is an advanced diagnostic imaging procedure where detailed cross-sectional images
of bone, soft tissues and blood vessels can be produced to detect neoplasms, soft tissue lesions, inflammation,
and more. CT scan enables reproduction of recorded images in different planes and even 3 dimensional
images can be viewed easily on a computer screen.
Procedure:
A CT Scan machine consists of an X ray tube and an X ray detector array. It rotates around the patient at a
speed of 120 to 280 rpm.
The X Ray beam is directed across the patient's body and the resultant ray is captured by the array and an
image is created.
The data channels are non-contact based while the power channels are contact based.
slip ring technology is utilized in order to transmit data, current or signals from a stationary surface to a
rotating surface. Data and current transmission is primary in diagnostic technology. The use of slip ring
technology in ct Scans has dramatically improved the accuracy and efficacy of this diagnostic scanning
process. slip ring technology enables production of improved images and better diagnostic functionality of
the machine. Large diameter slip rings are ideal for better working of the computed tomography machines.
The fiber brush variant of slip ring is zero maintenance and accumulates negligible debris so that it works for
a longer time. Moreover, the negligible noise generation helps in quieter and more peaceful operation which
is comforting to the patients. For a high-speed data communication, slip rings with optical components and
coupled capacitors are also available which is an added bonus. The higher circuit densities and the compact
slip ring design helps in more accurate and efficient current and data transmission. The larger bore designs of
the slip ring with inner diameter ranging up to 50 inches further enhance efficacy and accuracy. slip ring in
CT scans has also led to high precision and zero error transmission from the detector array at speeds greater
thab 20 gigabits per second. This is accomplished through optical and capacitive data channels. The
innovative and novel fiber brush technology also enables enhanced power transmission through the sliding
contact area at more than 200 rotations per minute. The non-contacting data channel also helps with lesser
friction.
The two-way communication channels make the machine even more efficient. Diagnostic accuracy is of
paramount importance in CT scan machines and the novel slip ring technology not only enhances the
accuracy but also the longevity of the CT scan equipment. Therefore, you can be ensured of lower
maintenance and higher durability and clearer, higher resolution images that can help detect lesions better.
General recommendations for the design of a radiology room:

The equipment should be positioned so that the primary radiation beam is not directed at the operator‘s
console, windows or doors.
Particular attention must be paid to the shielding of areas where the primary beam will be directed, for
example the wall behind the vertical cassette holder.
1. The floor of the X-ray room must be shielded for the primary radiation beam if there is occupancy in
the room below and the beam is not otherwise attenuated.
2. The operator‘s console area should be located so that: it is adjacent to the staff entrance door; the
operator has a clear panoramic view of the patient and the access doors to the room; and radiation is
scattered at least twice before entering the protective area.
3. The protective screen should be at least 2 m in height and of sufficient width to allow at least two
people stand behind the screen during an exposure.
4. Personal protective equipment (lead aprons, thyroid shields, gonad shields) should be available and
reinforced hangers should be used for the storage of lead aprons.
5. Multilingual pregnancy signs should be displayed in the waiting room and patient cubicles, advising
female patients to declare their known or suspected pregnancy prior to undergoing a radiological
examination.
6. Radiation warning lights should be positioned at all access doors to the room and preferably at eye
level. The light should illuminate during the preparation period (if applicable) and continue for the
duration of the exposure.
7. Radiation warning lights may not be required if the operator can prevent inadvertent access to the
room during exposures (for example if there is only one appropriately positioned door).
8. Appropriately worded radiation warning signs must be posted on access doors to the room.
9. The room layout and shielding design must be reviewed by the RPA each time the equipment or
technology changes.
10. An X-ray room should not be used for more than one radiological procedure at a time, unless
specifically designed for this purpose.
11. The X-ray room should not be a throughway to another room.
12. The design of ancillary facilities such as changing cubicles, toilets and preparation rooms should be
considered.
13. A pragmatic approach to radiation shielding should be considered; it may be more prudent and
possibly more cost effective to specify a consistent level of shielding in all boundaries in the room
rather than specifying different levels of shielding in each boundary.
Design and layout of radiology facilities:
Radiology room types The location, structural design and equipment layout of X-ray rooms must be carefully
considered from a radiation protection perspective. This is easier when X-ray facilities are not designed as
stand-alone rooms and are planned as part of an integrated radiology/imaging department with its supporting
areas and services. Planning the room layouts should start as early as possible in the design process and be
based on inputs from a team including architects, engineers, hospital management, radiologists,
radiographers, the RPA, other consultant medical staff such as cardiologists or vascular surgeons where
relevant, and once identified, the equipment supplier(s). The practical requirements for radiation protection
depend on the clinical functions the room is designed for as well as the workload and adjacent occupancy.
For simplicity, at this point, rooms will be divided into four broad categories: 1) Radiography (e.g. general,
chest, dental, mammography, etc.). 2) Fluoroscopy (e.g. general or interventional applications). 3) Computed
Tomography (CT). 4) Shared function rooms (e.g. operating theatres or emergency departments where
mobile or fixed X-ray equipment may be used). X-ray rooms should be of a size that allows unimpeded
access and ease of movement around the equipment, the patient table and the operator‘s console. The size of
the room will vary greatly depending on the modality and the cost of space. There are no absolute norms, but
it may be helpful to bear in mind some examples from the UK National Health Service which recommends
that general rooms, complex interventional suites and mammography rooms be 33, 50 and 15 m2
respectively (NHS, 2001). General X-ray rooms with ceiling-mounted X-ray tubes must have a minimum
height of 3.1 m between the floor level and the underside of the ceiling support grid (normally concealed by a
suspended ceiling). A conventional ceiling height of 2.4 m should be adequate for dental and dual energy X-
ray absorptiometry (DXA) rooms (NHS, 2001, NHS, 2002).
Radiographic equipment:
Radiography equipment provides a single two-dimensional ‗snap-shot‘ image, which is, essentially, a
partially penetrated projected shadow. Staff are not normally required to be in the vicinity of the patient
during the procedure. These rooms generally include a fixed screen to protect the operator console area. It is
necessary to be able to see and communicate with the patient from this area. In addition, the rooms should be
sufficiently large to reduce radiation intensity at the operator‘s screen and boundaries.
Computed Tomography (CT):
CT allows cross sectional imaging which was traditionally of the single ‗snap-shot‘ form of the head or
body. Modern CT systems produce multiple slices, enable faster three-dimensional imaging, and allow for
real-time tracking of events as in fluoroscopy. These systems have greatly enhanced the clinical value of CT
and also allow for much more rapid patient scanning. For both reasons the workload in CT rooms has
increased and the radiation levels in the vicinity of a CT scanner are possibly higher than for any other
imaging modality. Staff are not generally expected to be in the vicinity of the patient during procedures, so
the mechanisms of radiation protection include the operator screen and the room size approaches already
mentioned. However, the functions accommodated in the operator area are greatly expanded and often
include direction and analysis of the examination by the radiologist as it happens, and observation of the
results by the referring clinical team. Thus the operator‘s cubicle in effect acquires a consultation,
reporting and analysis function and occupies a considerable area. There is normally a panoramic window
and a door from this area to the CT room.
Some general comments on shielding:
From the point of view of providing shielding at the room boundaries, it is important to weigh up whether it
is more economical to maximize space or install more structural shielding. For example, it may be possible to
designate a relatively large space for an X-ray room, and as a result of the increased distances to the
occupants of nearby areas the shielding requirements can be significantly reduced. The cost and practical
implications of distance versus shielding should be considered in optimising the design solution. This will be
considered further in Chapter 5 and may be particularly important with some newer techniques with very
demanding shielding requirements. From the point of view of providing for those who must work within the
controlled or supervised areas that coincide with the room boundaries, there are three approaches to
providing protection that impact on room design or equipment specification. These are:
Fixed screen: This is a screen which attenuates radiation and behind which the operator console and any
other necessary operator control systems (e.g. emergency stop switch) are located. Where the design allows,
the screen should be positioned so that it protects the staff entry door and staff can enter and The Design of
Diagnostic Medical Facilities where Ionising Radiation is used 17 leave the room without risk to themselves
or persons in the corridor outside. Normally the screen is composed of lead and lead glass. It extends to at
least 2 m in height and is of sufficient length to provide full body protection for the operator(s) from scattered
radiation. The screen should allow the operator a panoramic view of the room to include the patient table, the
chest stand (if present) and all doors.
Room size and equipment positioning: Where possible the imaging equipment should be placed in the room
so as to maximise the distance to the more critical boundaries. A room which has considerable space around
the imaging equipment reduces radiation risks by allowing staff to stand well back from the patient except
when they are specifically required to be near. In addition a large room generally increases the distance
between the operator screen and the patient table thereby reducing the radiation intensity in the operator
console area. n Partial body shielding: This is used to protect staff who are required to be near the patient
during X-ray exposures. The shielding may be broadly divided into two types: that used to protect the upper
body and that for the lower body. Upper body shielding is common in interventional rooms; the focus is on
head and neck protection, and particularly on eye shielding. This is normally made of lead glass or lead
acrylic and mounted on the ceiling at the end of a moveable arm. In the case of general fluoroscopy rooms
and some interventional rooms using undercouch tube systems, upper body shielding is provided in the form
of a lead skirt that hangs from the image detector down to the table. Lower body shielding is often provided
for under couch fluoroscopy tubes; this is achieved by means of a lead skirt hanging from the table (the norm
for interventional systems), or lead panels below the screen.
A CT room layout based on the two-corridor model is shown in Fig. 3.8. It is easy to adapt to a single
corridor approach by switching the staff entrance to the opposite wall. CT rooms are generally part of a suite
with patient waiting, changing cubicles, and toilets. As with interventional rooms, large numbers of staff are
frequently involved and need access to the room, the patient and the console area. The console area also often
serves as image processing/reporting/teaching and consultation areas and again this must be borne in mind
when selecting the dose constraints to be used (Section 6.3.5). It normally occupies the length of one wall
with lead glass shielding providing a panoramic view. In addition, it may be expanded to serve two CT
rooms, or a CT and MRI room, one each side of the operator area. An intercom must be used for
communication with the patient as the door between the CT and console area must remain closed during
exposures. Within the CT room, the oblique alignment of the scanner allows observation of the patient from
the operator‘s area for the duration of the examination. It also facilitates easy movement of patients,
wheelchairs, trolleys and staff in the room. Facilities suitable for storage of personal protective equipment
(lead aprons, etc.) should be provided and easily accessed.
There are large variations in the shielding requirements for different CT systems. The increased patient
throughput facilitated by modern multi-slice and spiral CT systems can result in very high levels of scattered
radiation in the room and therefore greater levels of shielding are required.
Unlike interventional rooms the distribution of scattered radiation in the CT room is well defined and fixed,
as the position of the gantry is fixed and the X-ray tube follows the same rotation path for each exposure. Iso
dose curves for each scanner are normally available from the manufacturer and these should be used to
determine shielding requirements taking due account of local technique. As a general guide, the shielding
requirements for new multi-slice CT systems are between 3-4 mm lead (NHS, 2001). However, individual
shielding assessments based on actual workloads, room dimensions and occupancy of adjoining areas are
essential for these facilities and should be undertaken by the RPA.
UNIT-3
LEARNING OBJECTIVE:
 CT Scan of Brain
 CT Scan of Orbit (Plain)
 CT Scan of Temporal Bones
 CT Scan of Para nasal Sinus
 CT Scan of Neck (Plain)
 CT Scan of Chest (Plain)
 CT Scan of H R C T Chest
 CT Scan of Abdomen
A cranial CT scan:
A cranial CT scan is a diagnostic tool used to create detailed pictures of features inside your head, such as
your skull, brain, paranasal sinuses, ventricles, and eye sockets. CT stands for computed tomography, and
this type of scan is also referred to as a CAT scan. A cranial CT scan is known by a variety of names as well,
including brain scan, head scan, skull scan, and sinus scan.
This procedure is noninvasive, meaning it doesn‘t require surgery. It‘s usually suggested to investigate
various symptoms involving the nervous system before turning to invasive procedures.
Indication:
 abnormalities of the bones of your skull
 arteriovenous malformation, or abnormal blood vessels
 atrophy of brain tissue
 birth defects
 brain aneurysm
 hemorrhage, or bleeding, in your brain
 hydrocephalus, or fluid buildup in your skull
 infections or swelling
 injuries to your head, face, or skull
 stroke
 tumors
 fainting
 headache
 seizures, especially if any occurred recently
 sudden behavioral changes or changes in thinking
 hearing loss
 vision loss
 muscle weakness or numbness and tingling
 speech difficulty
 difficulty swallowing
Procedure:
A cranial CT scanner takes a series of X-rays. A computer then puts these X-ray images together to create
detailed pictures of your head. These images help your doctor make a diagnosis. The procedure is usually
done in a hospital or outpatient imaging center. It should take only about 15 minutes to complete the scan.
On the day of the procedure, patient must remove jewelry and other metal objects. They can damage the
scanner and interfere with the X-ray
Patient to be asked to change into a hospital gown. Patient lie on a narrow table either face up or face down,
depending on the reasons for your CT scan.
It‘s very important that patient remain completely still during the exam. Even a little movement can blur the
images.
Some people find the CT scanner stressful or claustrophobic. doctor may suggest a sedative to keep you calm
during the procedure. A sedative will also help keep you still. If child is having the CT scan, their doctor may
recommend a sedative for these same reasons.
The table will slowly slide so that your head is inside the scanner. You may be asked to hold your breath for
a short period. The scanner‘s X-ray beam will rotate around your head, creating a series of images of your
head from different angles. The individual images are called slices. Stacking the slices creates three-
dimensional images.
Images can be seen immediately on a monitor. They will be stored for later viewing and printed. For your
security, the CT scanner has a microphone and speakers for two-way communication with the scanner
operator
Contrast dye helps highlight some areas better on CT images. For example, it can highlight and emphasize
blood vessels, intestines, and other areas. The dye is given through an intravenous line inserted into a vein of
your arm or hand.
Often, images are first taken without contrast, and then again with contrast. However, use of contrast dye
isn‘t always necessary. It depends on what your doctor is looking for.
Doctor may direct you not to eat or drink for several hours before the test if you‘re going to receive contrast
dye. This depends on your particular medical condition. Ask your doctor for specific instructions for your CT
scan.
The scanner table is very narrow. Ask if there is a weight limit for the CT scanner table if you weigh more
than 300 pounds.
Be sure to tell your doctor if you‘re pregnant. X-rays of any kind aren‘t recommended for pregnant women.
Patient will want to be aware of some extra precautions if contrast dye will be used. For example, special
measures must be taken for people on the diabetes medicine metformin (Glucophage). Be sure to let your
doctor know if you take this drug. Also tell your doctor if you‘ve ever suffered an adverse reaction to
contrast dye.
Possible side effects or risks
Side effects and risks for a cranial CT scan involve discomfort, exposure to radiation, and allergic reaction to
the contrast dye. Discuss any concerns with doctor before the test so you can assess the potential risks and
benefits for your medical condition.
Discomfort
The CT scan itself is a painless procedure. Some people feel uncomfortable on the hard table or have
difficulty remaining still. Patient may feel a slight burning when the contrast dye enters your vein. Some
people experience a metal taste in their mouths and a warm sensation throughout their bodies. These
reactions are normal and generally last less than a minute.
Radiation exposure
CT scans expose you to some radiation. Doctors generally agree that the risks are low compared to the
potential risk of not being diagnosed with a dangerous health problem. The risk from a single scan is small,
but it increases if you have many X-rays or CT scans over time. Newer scanners may expose you to less
radiation than older models
Tell your doctor if patient pregnant. doctor may be able to avoid exposing your baby to radiation by using
other tests. These may include a head MRI scan or ultrasound, which don‘t use radiation.
Allergic reaction to contrast
Tell doctor before the scan if patient ever had an allergic reaction to contrast dye.
Contrast dye commonly contains iodine and may cause nausea, vomiting, rash, hives, itching, or sneezing in
people who are allergic to iodine. You may be given steroids or antihistamines to help with these symptoms
before you receive the dye injection. after the test, you may need to drink extra fluids to help flush the iodine
from the body if you have diabetes or kidney disease. In very rare cases, contrast dye can cause anaphylaxis,
a whole-body allergic reaction that can be life-threatening. Notify the scanner operator immediately if you
have trouble breathing
Head
Examples of clinical indications: Without contrast: intracranial hemorrhage, early infarction,
dementia, hydrocephalus, cerebral trauma
Without and with contrast: Mass, lesion, arteriovenous malformation, metastasis, aneurysm, for
symptoms of headache, seizure
Scouts: AP and lateral
Scan type: Axial
Scan plane: Transverse
Start location: Just below skull base
End location: Just above vertex
IV contrast: (if contrast is ordered) 100 mL at 1.0 mL/s. Scan delay = 5 minutes
Oral contrast: None
Reference angle: Angle gantry parallel to supraorbital meatal line (avoid lens of eyes)
DFOV:
SFOV: Head
Algorithm: Standard
Window settings: 140 ww/40 wl posterior fossa; 90 ww/35 wl vertex
16-Detector Protocol 64-Detector Protocol
Gantry rotation time 2.0 s 1.0 s
Acquisition (detector width × 0.625 mm × 16 = 10 mm 0.625 mm × 32 = 20
number of detector rows = mm
coverage)
Reconstruction (slice thickness/interval) 5.0 mm/5 mm (2 images per 5.0 mm/5 mm (4
rotation) images per rotation)
kVp/mA (posterior fossa) 140/150 140/330
kVp/mA (vertex) 120/150 120/330
Reconstruction 2:
Algorithm: Bone
Window setting: 4000 ww/400 wl
Slice thickness/interval 2.5 mm/2.5 mm 2.5 mm/2.5 mm

Orbits
Examples of clinical indications: Without contrast: trauma, foreign body
With contrast: intraorbital masses, thyroid ophthalmopathy, inflammation, infection
GROUP 1.
Scan type: Axial
Start location: Just below orbital floor
End location: Just above orbital roof
IV contrast (if contrast is ordered): 100 mL at 1.0 mL/s. Split bolus—two 50-mL injections.
Two-minute delay between injections; scans initiated once second injection is complete.
Oral contrast: None
Reference angle: Angle gantry parallel to infraorbital meatal line
DFOV: 16 cm
SFOV: Head
Algorithm: Soft
Window settings: 350 ww/50 wl
16-Detector Protocol 64-Detector
Protocol
Acquisition (detector width × number of 0.625 mm × 16 = 10 0.625 mm × 32 =
detector rows) = coverage mm 20 mm
Reconstruction (slice thickness/interval) 2.5 mm/2.5 mm (4 2.5 mm/2.5 mm
images per (8 images per
rotation) rotation)
kVp/mA 120/200 120/200
Reconstruction 2:
Algorithm: Bone
DFOV: 16 cm
Slice thickness/interval 2.5 mm/2.5 mm 2.5 mm/2.5 mm
GROUP 2.
Scout: Lateral
Scan type: Axial
Scan plane: Coronal
Start location: Mid sphenoid sinus
End location: Anterior frontal sinus
Reference angle: Angle gantry perpendicular to the infraorbital meatal line
DFOV: 16
SFOV: Head
Algorithm: Soft
Protocol
Acquisition (detector width × number of 0.625 mm × 16 = 10 0.625 mm × 32 =
detector rows) = coverage mm 20 mm
Reconstruction (slice thickness/interval) 2.5 mm/2.5 mm (4 2.5 mm/2.5 mm
images per (8 images per
rotation) rotation)
kVp/mA 140/200 140/200
Neck (Soft Tissue)

Examples of clinical indications: Neck mass, vascular abnormality
(If patient has metal dental work, split scan into two groups and angle to reduce artifact)
Scan type: Helical
Start location: Mid orbit
End location: Clavicular heads
IV contrast: 125 mL at 1.5 mL/s. Split bolus—1st injection 50 mL, 2-minute delay; 2nd injection
75 mL, scans initiated 25 seconds after the start of the second injection.
Oral contrast: None
Reference angle: Angle gantry parallel to hard palate
DFOV: 18 cm
SFOV: Large body
Algorithm: Standard
Protocol
Acquisition (detector width × number of 0.625 mm × 16 = 10 mm 0.625 mm ×
detector rows) = coverage 32 = 20 mm
Reconstruction (slice thickness/interval) 2.5 mm /1.25 mm 2.5 mm/1.25
mm
Pitch 0.562 0.531
kVp/auto mA 120/150–800 120/150–800
Reconstruction 2:
Algorithm: Bone
DFOV: 18 cm
Slice thickness/interval 2.5 mm/1.25 mm 2.5 mm/1.25
mm
Reconstruction 3: From just below mandible to clavicular heads
Algorithm: Bone
DFOV: 30
Slice thickness/interval 2.5 mm/1.25 mm 2.5 mm/1.25
mm
Sinus Screen
Sinus screening is intended as an inexpensive, accurate, and low radiation dose method for
confirming the presence of inflammatory sinonasal disease. If confirmed and the patient will
then have endoscopic sinus surgery, the coronal images provide a “road map” for the surgeon.
Examples of clinical indications: Recurrent or chronic sinusitis
Scout: Lateral
Scan type: Axial
Scan plane: Coronal
Start location: Mid sella
End location: Through frontal sinus
IV contrast: None
Oral contrast: None
Reference angle: Angle gantry perpendicular to the orbital meatal line

DFOV: 16 cm
SFOV: Head
Algorithm: Standard
Protocol
Scan Type Helical Axial
Acquisition (detector width × number of 0.625 mm × 16 =10 mm 0.625 mm ×
detector rows) = coverage 32 = 20 mm
Temporal Bones
Examples of clinical indications: Without contrast: cholesteatoma, inflammatory disease,
fractures, evaluate implants With contrast: IAC tumor, hearing loss, acoustic neuroma,
Schwannoma
GROUP 1.
Scan type: Axial
Start location: Just below the mastoid process
End location: Just above petrous ridge (include entire mastoid, internal auditory canal, and
external auditory canal)
IV contrast: (if contrast is ordered) 100 mL at 1.0 mL/s. Scan delay = when all contrast is
administered
Oral contrast: None
Reference angle: Angle gantry parallel to infraorbital meatal line (be sure patient‘s head is straight
and not rotated in the head holder)
DFOV:
SFOV: Head
Algorithm: Bone
Window settings: 4000 ww/ 400 wl
Protocol
Acquisition (detector width × number of 0.625 mm × 16 =10 mm 0.625 mm × 32
detector rows = coverage) = 20 mm
Reconstruction (slice thickness/interval) 0.625 mm/0.625 mm (16 0.625

images per rotation) mm/0.625
mm (32
images per
rotation)
kVp/mA 140/170 140/170
Reconstruction 2:
Algorithm: Bone
GROUP 2.
Scout: Lateral
ABDOMINAL CT:
An abdominal CT scan helps doctor see the organs, blood vessels, and bones in your abdominal cavity. The
multiple images provided give your doctor many different views of your body.
Indication:
 abdominal pain
 a mass in your abdomen that you can feel
 kidney stones (to check for size and location of the stones)
 unexplained weight loss
 infections, such as appendicitis
 to check for intestinal obstruction
 inflammation of the intestines, such as Crohn‘s disease
 injuries following trauma
 recent cancer diagnosis
 CT scan vs.
Doctor will probably ask fast (not eat) for two to four hours before the scan. Patient may be asked to stop
taking certain medications before your test.
Patient should wear loose, comfortable clothing because patient need to lie down on a procedure table.
patient may also be given a hospital gown to wear. You‘ll be instructed to remove items such as:
 eyeglasses
 jewelry, including body piercings
 hair clips
 dentures
 hearing aids
 bras with metal underwire
Depending on the reason why patient are getting a CT scan, that may need to drink a large glass of oral
contrast. This is a liquid that contains either barium or a substance called Gastrografin (diatrizoate
meglumine and diatrizoate sodium liquid).
Barium and Gastrografin are both chemicals that help doctors get better images of your stomach and bowels.
Barium has a chalky taste and texture. Patient likely wait between 60 and 90 minutes after drinking the
contrast for it to move through your body.
Before going into your CT scan, tell doctor if Patient are allergic to barium, iodine, or any kind of contrast
dye (be sure to tell your doctor and the X-ray staff) have diabetes (fasting may lower blood sugar levels) are
pregnant
About contrast and allergies
In addition to barium, doctor may want you to have intravenous (IV) contrast dye to highlight blood vessels,
organs, and other structures. This will likely be an iodine-based dye.
If patient have an iodine allergy or have had a reaction to IV contrast dye in the past, you can still have a CT
scan with IV contrast. This is because modern IV contrast dye is less likely to cause a reaction than older
versions of iodine-based contrast dyes.
Also, if patient have iodine sensitivity, your healthcare provider can premedicate you with steroids to reduce
the risk of a reaction.
All the same, be sure to tell your doctor and the technician about any contrast allergies you have.
Procedure:
A typical abdominal CT scan takes from 10 to 30 minutes. It‘s performed in a hospital‘s radiology
department or a clinic that specializes in diagnostic procedures.
Once patient dressed in your hospital gown, a CT technician will have patient lie down on the procedure
table. Depending on the reason for patient scan, patient may be hooked up to an IV so that contrast dye can
be put into your veins. probably feel a warm sensation throughout your body when the dye is infused into
your veins.
The technician may require you to lie in a specific position during the test. They may use pillows or straps to
make sure patient stay in the right position long enough to get a good quality image. You may also have to
hold your breath briefly during parts of the scan.
Using a remote control from a separate room, the technician will move the table into the CT machine, which
looks like a giant doughnut made of plastic and metal. You‘ll most likely go through the machine several
times.
After a round of scans, you may be required to wait while the technician reviews the images to make sure
they‘re clear enough for your doctor to read
The side effect:
The side effects of an abdominal CT scan are most often caused by a reaction to any contrast used. In most
cases, they‘re mild. However, if they become more severe, you should call your doctor right away.
Side effects of barium contrast can include:
 abdominal cramping
 diarrhea
 nausea or vomiting
 constipation
Side effects of iodine contrast can include:
 skin rash or hives
 itching
 headache
If you‘re given either type of contrast and have severe symptoms, call your doctor or go to the emergency
room right away. These symptoms include:
1. trouble breathing
2. rapid heart rate
3. swelling of your throat or other body part
After an abdominal CT scan
After your abdominal CT scan, can likely return to your regular daily activities.
Results for an abdominal CT scan typically take one day to process. doctor will schedule a follow-up
appointment to discuss your results. If results are abnormal, it could be for several reasons. The test could
have found problems, such as:
 kidney problems like kidney stones or infection
 liver problems like alcohol-related liver disease
 Crohn‘s disease
 abdominal aortic aneurysm
 cancer, such as in the colon or pancreas
With an abnormal result, your doctor will likely schedule you for more testing to find out more about the
problem. When they have all the information they need, your doctor will discuss your treatment options with
you. Together, you can create a plan to manage or treat your condition
Chest CT scan:
Computed tomography (CT) scans provide greater clarity than regular x-rays and are used to further examine
abnormalities found on chest x-rays. They may be used for detection and evaluation of various disease and
conditions in the chest, e.g., tumor, inflammatory disease, vascular disease, congenital abnormalities, trauma
and hemoptysis.
INDICATIONS FOR CHEST CT:
For annual lung cancer screening:
The use of low-dose, non-contrast spiral (helical) multi-detector CT imaging as an annual screening
technique for lung cancer is considered medically necessary when used to screen for lung cancer for certain
high-risk individuals when ALL of the following criteria are met:
 Individual is between 55-80 years of age; AND
 There is at least a 30 pack-year history of cigarette smoking; AND
 If the individual is a former smoker, that individual had quit smoking within the previous 15 years.
 No current symptoms suggestive of possible underlying lung cancer. The use of CT scanning as a
screening technique for lung cancer in individuals is considered not medically necessary when the
above criteria are not met and for all other indications.
For evaluation of known tumor, cancer or mass:
 Initial evaluation of diagnosed cancer.
 Evaluation of known tumor or cancer for patient undergoing active treatment with most recent
follow-up study > 2 months (documentation to include but not limited to type/timing/duration of
recent treatment).
 Evaluation of known tumor or cancer or history of prior cancer presenting with new signs (i.e.,
physical, laboratory, or imaging findings) or new symptoms.
 Cancer surveillance excluding small cell lung cancer: Every six (6) months for the first two (2) years
then annually thereafter.
 Cancer surveillance – small cell lung cancer: Up to every 3 months for the first two years then
annually thereafter.
Evaluation of suspicious mass/tumor (unconfirmed cancer diagnosis):
 Initial evaluation of suspicious mass/tumor found on an imaging study and needing clarification or
found by physical exam and remains non-diagnostic after x-ray or ultrasound is completed.
 Known distant cancer with suspected chest/lung metastasis based on a sign, symptom, imaging study
or abnormal lab value.
 For the follow-up evaluation of a nodule with a previous CT (follow-up intervals approximately 3, 6,
12 and 24 months).
Other indications for Chest CT:
 Pre-operative evaluation.
 For further evaluation after abnormal imaging within past 30 - 60 days and with no improvement on
x-ray, (not indicated with known rib fractures).
 For evaluation of persistent unresolved cough with at least four weeks duration, unresponsive medical
treatment and chest x-ray has been performed
 For evaluation of other chest or thorax adenopathy.
 Evaluation of pneumothorax.
 For evaluation of vocal cord paralysis.
 For suspected thymoma with myasthenia gravis.
Preparation:
should not eat any solid food four (4) hours before your exam. however, drink clear liquids, including water,
tea, clear gelatin, lemon-lime soda, orange or grape punch (not juice) and broth. doctor may also have other
instructions for you. If any medications, take them prior to your test with a small sip of water. doctor may
have other specific instructions for you. Please bring your medication list with you to your exam. If you are
50 or older, have diabetes, high blood pressure, kidney disease or have undergone an exam within the
previous seven days where contrast material (x-ray dye) was injected into your body, you will need to have a
blood test before this procedure to check for kidney function.
Procedure:
An IV may be started in the vein of your arm if x-ray dye will be used for the exam (this is determined by
your physician and also by the reason for the exam). Patient may be asked to undress and wear a hospital
gown for the images. Patient will lie on your back on a table with your arms above your head. The table will
be moved into the CT machine or scanner where the images will be taken. Except for the movement of the
table, patient should not feel anything. Patient must remain as still as possible during this procedure, and
patient will be asked to hold breath for 10 to 15 seconds as each scan is taken. It's important to do this for
each scan. It is during this time that an x-ray dye may be injected through the IV. Patient may feel warm and
flushed for a few minutes, which is very normal. However, if patient should feely itchy, short of breath or
uncomfortable, please tell the CT technologist.
After the Exam:
 may go back to your regular diet after the exam, unless otherwise directed by doctor.
 If received the x-ray dye through an IV, should drink plenty of fluids along with resuming a regular diet.
The dye will go out through urine and will not be able to see it.
HRCT:( High-resolution computed tomography)
High-resolution computed tomography (HRCT) imaging of the lungs is well-established for diagnosing and
managing many pulmonary diseases [1-7]. Optimal methods of acquisition and interpretation of HRCT
images require knowledge of anatomy and pathophysiology [8], as well as familiarity with the basic physics
and techniques of computed tomography. This parameter outlines the principles for performing high-quality
HRCT of the lungs.
HRCT is the use of thin-section CT images (0.625-mm to 1.5-mm slice thickness) with a high spatial
frequency reconstruction algorithm, to detect and characterize diseases that affect the pulmonary parenchyma
and small airways [9]. Following the development and widespread availability of multidetector CT (MDCT)
scanners capable of acquiring near-isotropic data throughout the entire thorax in a single breath-hold, 2
general approaches are available for acquiring HRCT images [10-14]. The first and more traditional method
entails obtaining axial HRCT images spaced at 10-mm to 20-mm intervals throughout the lungs. The second
method uses the ability of MDCT scanners to provide volumetric single breath-hold datasets allowing
spaced, contiguous, and/or overlapping HRCT images to be reconstructed. With MDCT, the volumetric data
enables multiplanar thin-section HRCT reconstruction, which facilitates evaluation of the distribution of
diffuse lung disease [15,16] and the application of postprocessing techniques such as maximum intensity
projection (MIP), minimum intensity projection (minIP), and software that uses volumetric data for
quantification of features in the lungs and airways
Optimal performance of HRCT studies requires familiarity with the advantages and disadvantages of each
HRCT method, with the choice between these approaches reflecting available equipment, clinical
indication(s), and radiation dose considerations. With both methods, image data are routinely acquired at
suspended full inspiration with patients in the supine position. Additional options, useful in many cases,
include obtaining inspiratory prone images to differentiate posterior lung disease from dependent atelectasis
and end-expiratory images to evaluate for air trapping
The main objective of HRCT is to detect, characterize, and determine the extent of diseases that involve the
lung parenchyma and airways
The indications for the use of HRCT of the lungs include, but are not limited to, the following
1. Evaluation of known or clinically suspected diffuse lung disease that is incompletely evaluated on
standard chest CT or chest x-ray or that which is chest x-ray occult 2. Evaluation of suspected small
airway disease 3. Quantification of the extent of diffuse lung disease for evaluating effectiveness of
treatment 4. Guidance in selection of the most appropriate site for biopsy of diffuse lung disease.
2. Contraindications There are no absolute contraindications to HRCT of the lungs. As with any imaging
procedure, the benefits and risks should be considered prior to thoracic CT performance.
SPECIFICATIONS AND PERFORMANCE OF THE EXAMINATION
A. Written Request for the Examination
The written or electronic request for a HRCT of the lungs should provide sufficient information to
demonstrate the medical necessity of the examination and allow for its proper performance and
interpretation. Documentation that satisfies medical necessity includes 1) signs and symptoms and/or 2)
relevant history (including known diagnoses). Additional information regarding the specific reason for
the examination or a provisional diagnosis would be helpful and may at times be needed to allow for the
proper performance and interpretation of the examination. The request for the examination must be
originated by a physician or other appropriately licensed health care provider. The accompanying
clinical information should be provided by a physician or other appropriately licensed health care
provider familiar with the patient‘s clinical problem or question and consistent with the state scope of
practice requirements. (ACR Resolution 35, adopted in 2006)
B. Technical Parameters Although many of the operations of a CT scanner are automated, a number of
technical parameters remain operator-dependent. As these factors can significantly affect the
diagnostic value of the HRCT examination it is necessary for the supervising physician to be familiar
with the following:
1. Radiation exposure factors (mAs, KvP)
2. Collimation
3. Display section thickness for Multidetector systems
4. Table increment or pitch and gantry rotation time and table speed
5. Matrix size, scan field of view, and reconstruction field of view
6. Window settings (width and center)
7. Reconstruction algorithm, filter or kernel 8. Image reconstruction interval or increment
8. Detector configuration for multidetector systems
9. Automatic exposure control (angular and longitudinal tube current modulation) and image quality
reference parameter
10. Radiation dose report
11. Reformatted images (multiplanar (MPR), curvilinear, MIP, and minIP) and 3-D surface or
volumerendered (VR) and image plane (axial, coronal, sagittal)
12. Reconstruction techniques such as filtered back projection or iterative reconstruction
13. Axial or helical mode of the CT scanner.
Protocols should be prepared according to the specific medical indication.
Technique should be selected that provide image quality consistent with the diagnostic needs of the
examination at acceptably low radiation dose levels to the patient. When volumetric HRCT data are acquired,
utilization of the multiplanar capabilities is encouraged to facilitate assessment of disease distribution and
morphology. For each indication, the protocol should include at least the following:
a. Tube potential and tube current appropriate to patient size. Typically, this entails use of 120 (kVp)
and approximately ≤240 mAs. Use of lower tube potentials (eg, 100 kVp) and tube-current settings is
encouraged, especially for younger patients or those who may need serial imaging. In this case, using
similar technical parameters for each study facilitates direct comparison between studies and is of
particular value if quantitative CT measurements are employed.
b. Utilization of techniques available to minimize dose (eg, tube current modulation) is encouraged.
c. Proper supine and/or prone patient positioning with optimal breathing instructions
d. State of respiration (inspiration and/or expiration), with appropriate breathing instructions; Expiratory
images are typically acquired at end-expiration.
e. Table speed for volumetric HRCT to enable single-breath-hold acquisition, when possible
f. Axial (incremental HRCT) or helical (volumetric HRCT) modes of data acquisition. Acquiring
exploratory and/or prone sequence images in a helical fashion is discouraged. For those sequences,
axial acquisition with nonirradiated increments of 10–20 mm or more is preferable.
g. Gantry rotation: ≤1 second
h. Reconstructed image thickness (≤ 1.5 mm for axial CT, ≤1.5 mm nominal slice thickness for helical
CT)
i. Moderately high-spatial-frequency reconstruction algorithm, such as a bone algorithm for lung
images
j. Proper patient positioning (positioning the patient at isocenter to minimize radiation dose and
optimize image quality) k. Superior and inferior extent of the region of interest to be imaged, typically
from the lung apices to the costophrenic sulci. For additional series such as prone or expiratory HRCT
imaging, shorter z-axis coverage and/or greater increment between imaging locations is encouraged to
decrease patient radiation exposure.
k. When possible, scan field of view should be selected appropriate to patient size at time of image.
l. Reconstructed field of view limited to the lungs adjusted for small, medium, and large patients to
optimize spatial resolution for each patient
m. Plane, thickness, and interval for reconstructions or reformats (eg, coronal, sagittal, oblique MPRs
and MIPs) from volumetric HRCT data to be sent to the picture archiving and communications
system (PACS) or reconstruction directly at the PACS workstation
UNIT-4
LEARNING OBJECTIVE:
 IMAGE RECONSTRUCTION
Over the past two decades, rapid system and hardware development of x-ray computed tomography (CT)
technologies has been accompanied by equally exciting advances in image reconstruction algorithms. The
algorithmic development can generally be classified into three major areas: analytical reconstruction, model-
based iterative reconstruction, and application-specific reconstruction. Given the limited scope of this
chapter, it is nearly impossible to cover every important development in this field; it is equally difficult to
provide sufficient breadth and depth on each selected topic. As a compromise, we have decided, for a
selected few topic, to provide sufficient high-level technical descriptions and to discuss their advantages and
applications.
Introduction
Evolution and innovation in CT image reconstruction are often driven by advances in CT system designs,
which in turn are driven by clinical demands. From a historical perspective, for example, the fan-beam axial
filtered back-projection (FBP) algorithm was the dominant mode of image reconstruction for CT for decades
until the introduction of helical or spiral CT, which forced the development of new reconstruction algorithms
to compensate for helically-induced motion artifacts. The development of the helical scanner itself, on the
other hand, was driven by the clinical desire to cover an entire human organ in a single breath-hold. The fan-
beam helical algorithm was later replaced by the cone-beam FBP, necessitated by the introduction of the
multi-slice scanner; while the multi-slice scanner itself was born to meet the clinical need for routinely
achieving isotropic spatial resolution. With the huge success of CT as a diagnostic imaging modality,
increased public awareness of CT-induced radiation, and the need to reduce the associated risks, inspired the
development of low-dose clinical protocols and techniques which, in turn, accelerated the recent
development of statistical iterative reconstruction.
Besides application-specific reconstruction techniques, image reconstruction for x-ray CT can be generally
classified into two major categories: analytical reconstruction and iterative reconstruction. The analytical
reconstruction approaches, in general, try to formulate the solution in a closed-form equation. Iterative
reconstruction tries to formulate the final result as the solution either to a set of equations or the solution of
an optimization problem, which is solved in an iterative fashion (the focus of this paper is more on the
iterative solution of an optimization problem). Naturally, there are pros and cons with each approach. As a
general rule of thumb, analytical reconstruction is considered computationally more efficient while iterative
reconstruction can improve image quality. It should be pointed out that many reconstruction algorithms do
not fall into these two categories in the strict sense. These algorithms can be generally classified as hybrid
algorithms that leverage advanced signal-processing, image-processing, and analytical reconstruction
approaches. Given the limited scope of this chapter, discussions on these algorithms are omitted.
Analytical Reconstruction
Cone-Beam Step-and-Shoot Reconstruction
The concept of ―cone-beam CT‖ is not as clearly defined as one may think. In the early days of multi-slice
CT development, there was little doubt that a 4-slice scanner should be called a multi-slice CT or multi-row
CT, and not a cone-beam CT. As the number of slices and the z-coverage increase, the angle, θ, formed by
two planes defined by the first and the last detector rows (Fig. 1) increases, and it becomes increasingly
difficult to decide where to draw the line between a multi-slice scanner and a cone-beam scanner.
Figure 1 Illustration of cone-beam geometry

The step-and-shoot cone-beam (SSCB) acquisition refers to the data collection process in which the source
trajectory forms a single circle. During the data acquisition, a patient remains stationary while the x-ray
source and detector rotate about the patient. The advantage of SSCB is its simplicity and robustness,
especially when data collection needs to be synchronized with a physiological signal, such as an EKG. If the
anticipated data acquisition is not aligned with the desired physiological state, as in the case of arrhythmia in
coronary artery imaging, the CT system can simply wait for the next physiological cycle to collect the
desired data. This acquisition results in a significant reduction in radiation dose compared with low pitch
helical acquisitions. When the z-coverage is sufficiently large, the entire organ, such as a heart or a brain, can
be covered during a single gantry rotation to further minimize the probability of motion.
The inherent drawback of the SSCB is its incomplete sampling since the data acquisition does not satisfy the
necessary condition for exact reconstruction. This data incompleteness can be viewed in terms of Radon
space or in terms of the local Fourier transform of a given image voxel. In the case of the SSCB acquisition,
image artifacts arise from three major causes: missing frequencies, frequencies mishandled during the
reconstruction, and axial truncation. Missing frequencies (Fig. 2a, low in-plane and high in z spatial
frequencies) refers to the fact that there is a small void region in the three-dimensional Fourier space of the
collected data for all image locations off the central slice, and increasingly for more distant slices.
Mishandled frequencies (Fig. 2a, shaded region) refer to the issue of improper handling of the redundant
information in the Fourier space. Axial truncation (Fig. 2b) is caused by the geometry of cone beam
sampling, in which the object is not completely contained in the cone beam sampling area over all views.
Figure 3b, c depict coronal images of a CD-phantom (similar to a Defrise phantom) scanned in helical and
SSCB modes, respectively. Since parallel CDs are placed horizontally with air gaps in between, the
corresponding coronal image should exhibit a pattern similar to Venetian blinds. The image formed with the
SSCB mode clearly shows deficiencies for areas away from the detector center-plane.
Sampling challenges for step-and-shoot cone beam geometry illustration of missing frequencies and
mishandled data in Fourier space (a) and axial truncation (b)
Reformatted images of a CD-phantom. a Phantom. b Coronal image of helical scan. c Coronal image of a
single step-and-shoot scan
When the cone angle is moderate, various approximate reconstruction algorithms have been shown to
effectively produce clinically acceptable images. One of the most commonly used reconstruction algorithm is
the Feldkamp–Davis–Kress (FDK) reconstruction. This algorithm differs from the conventional fan-beam
reconstruction in replacing the two-dimensional back-projection with a three-dimensional back-projection to
mimic the x-ray path as it traverses the object, and in including a cosine weighting in the cone direction to
account for path length differences of oblique rays [6]. Extensions from the FDK algorithm have been
introduced to solve one of the three major issues with reconstruction from an arc trajectory.
Several solutions to the first problem of the missing data have been proposed. These algorithms generally
compensate for the missing information by approximating it via frequency-domain interpolation or two-pass
corrections to estimate the missing frequencies, and are often sufficient to provide clinically acceptable
image quality. An example of such a correction is shown in Fig. 4.
Reformatted images of simulated chest phantom reconstruction, where the vertical axis is orthogonal to the
scan plane. a FDK reconstruction. b Two-pass reconstruction to compensate for missing frequencies shown
in Fig. 2a
The second issue of proper weighting of the collected data is important in the case of a short scan acquisition
where all measured frequency values are not measured the same number of times. One solution to this
problem is the application of an exact image reconstruction framework using arc-based cone-beam
reconstruction with equal weighting (ACE). The ACE algorithm (Fig. 5) equally weights the measured
frequencies by introducing non-horizontal filtering lines in the detector, and applies to any length of arc. In
the case of the full scan, the algorithm is equivalent to the FDK algorithm [6] plus Hu‘s correction [12] based
on the derivative along the z direction in the detector. Another approximation, based on an exact framework,
for the circular trajectory utilizes the back-projection filtration (BPF) framework [13–15] where the data is
differentiated, back-projected, and filtered along approximate filtering lines [16]. A study compared these
algorithms for circular short-scan data and showed that the ACE method provides visually superior image
quality to other algorithms.
Slices through the Shepp Logan phantom with window parameters of. Note the improvement in the soft
tissue away from the central slice as well as the reduction in streaky cone-beam artifacts (arrows) which are
due to improper weighting. The vertical direction in these images is the z direction, which is orthogonal to
the plane of the source trajectory
The third problem of axial data truncation has been handled by the selective use of measured projection data
in the corner region to avoid relying too heavily on extrapolated data. This has been accomplished by
weighting conjugate rays differently based on their cone-angle or by essentially using multiple rotated short
scan reconstructions in the corner region.
Further reduction of artifacts can be achieved with modified data acquisition trajectories. Several modified
trajectories, such as circle-plus-arc, circle-plus-line, dual-circle, or saddle trajectories (Fig. 6; [21–28]) try to
resolve the first problem listed above (missing frequency data). In Fig. 7, a phantom known to demonstrate
such a problem is shown for just a single-circle trajectory on the left and a dual-circle trajectory on the right.
Although these ‗circle plus‘ trajectories meet the conditions for mathematically exact reconstruction,
utilization of these trajectories in a real clinical environment still faces significant challenges because of
many practical considerations: large mass of a CT gantry, high gantry rotation speed, and desire to minimize
overall data acquisition time.
Alternative source trajectories to enable complete sampling: circle-plus-line (a), circle-plus-arc (b), dual-
circle (c), and saddle (d)
An example of exact reconstruction from the source trajectory of two concentric circles. On the left is the
contribution to the final image from the horizontal circle only. In the center, is contribution from the vertical
circle only and the sum is on the right. Reprinted from, with permission
Another relatively recent discovery is the fact that, in order to reconstruct a given region of interest (ROI),
one does not need 180° plus the fan angle of the system. The 2D sufficiency condition is similar to Tuy‘s
condition [4] for 3D exact reconstruction, in that any line which can be drawn through the ROI must intersect
the source trajectory at least once. This condition can be exploited to reduce the temporal window of
acquisition for off-center ROI imaging.
Multi-Slice Helical Reconstruction
Since the introduction of helical scanning over two decades ago, significant research efforts have been
devoted to the subject of cone-beam helical reconstruction, and the majority of the clinical protocols have
switched from step-and-shoot to helical mode. In the helical mode of data acquisition, the table is indexed
along the z-axis while the gantry rotates about the patient to collect projection measurements.
Approaches to analytic helical cone beam reconstruction can be generally divided into two major categories:
exact reconstruction methods and approximate reconstruction methods. The exact reconstruction methods, as
the name implies, try to derive analytical solutions that match the scanned object in mathematical precision if
the input projections are the true line integrals [32]. One of the most exciting developments in the past few
years is the development of exact FBP algorithms as first developed by Katsevich .This algorithm falls into
the category of FBP with a shift-invariant one-dimensional filter, and the flow of this reconstruction
algorithm is similar to that of the fan-beam FBP. Since its invention, many new algorithms have been
proposed and developed to allow more general trajectories, more efficient use of the projection samples, and
region-of-interest reconstruction. The advantage of these algorithms is of course their mathematical
exactness. However, to date, these algorithms have yet to be implemented widely in commercial products,
mainly due to their noise properties, limited robustness to patient motion, and lack of flexibility. For
example, in a cardiac acquisition, a half-scan is typically used to improve the temporal resolution. In clinical
practice, a sub-volume of the heart (in z) needs to be reconstructed for each half-scan acquisition to keep the
overall acquisition time to a minimum. This is difficult to achieve with the exact reconstruction algorithms.
The second algorithm category is the approximate reconstruction approaches derived from the original FDK
algorithm [40–48]. Each projection is weighted, filtered on a row-by-row basis, and back-projected three-
dimensionally into the object space. Although these algorithms are approximate in nature, they do offer
distinct advantages, such as volume reconstruction in a single half-scan acquisition. Because of their
flexibility, their ability to intrinsically handle data from long objects and their computational efficiency, the
approximate reconstruction algorithms are still the dominant force behind most commercial CT
reconstruction engines.
It should be pointed out that the non-exact algorithms often borrow techniques developed in the exact
reconstruction algorithms. For example, the Katsevich algorithm performs the projection filtration along a set
of κ-curves (instead of row-by-row) as shown in Fig. 8, and each filtered ―virtual row‖ falls along a tangent
to the helix. The same approach can be incorporated into the approximate reconstruction to significantly
improve image quality. Figure 9 shows a computer simulated phantom with (1) an approximate algorithm
with tangential filtering [47] and (2) the Katsevich algorithm: comparable image quality between the exact
and approximate reconstruction algorithms can be observed.
An example of the κ-curves used in the filtering operation of the Katsevich algorithm (helical pitch 87/64)
Simulated body phantom with 64 × 0.625 mm detector configuration and 63/64 helical pitch. a Modified
FDK algorithm with tangential filtering and 3D weighting. b Katsevich reconstruction algorithm.
Iterative Reconstruction
Over the years, many algorithmic approaches have been proposed to reduce image artifacts and noise during
the image generation process. Noise and artifact reductions are necessary steps toward dose reduction in CT.
The recent burst of research activities in iterative reconstruction can also be credited to the increased
awareness of the radiation dose generated by a CT scan, and advancements in reconstruction hardware
capability.
The use of an iterative reconstruction to solve the inverse problem of x-ray computed tomography has a long
history. As a matter of fact, reconstruction of the very first clinical image utilized an iterative technique
called algebraic reconstruction technique (ART) to invert a large matrix. Although the objective of ART at
the time was to find a solution to a complicated inverse problem and did not involve complex modeling of
the CT system, it nonetheless demonstrated the efficacy of IR techniques for x-ray CT.
If we look beyond the CT reconstruction, statistical IR has been used extensively in single photon emission
computed tomography (SPECT) and positron emission tomography (PET) to combat photon starvation issues
and to show great benefits in noise reduction and improved accuracy in the reconstructed images. Although
the success of IR in SPECT and PET seemingly implies a straightforward transfer of such technology to CT,
reality has shown that such a transition has been met with great challenges due to the significant differences
between the modalities. First, in x-ray CT, pre-processing and calibration steps are numerous and critical to
the production of CT images, and these correction steps significantly change the statistical properties of the
measured projection samples. If proper modeling is not performed, the desired noise or dose reduction is
difficult to achieve. Second, spatial resolution is much higher in x-ray CT than either SPECT or PET.
Achieving high spatial resolution in IR requires carefully modeling the optics of the system as well as using
an ―edge-preserving‖ regularization design to control image properties and avoid needless sacrifice of spatial
resolution for noise reduction. Third, due to the large amount of data and complexity of the inverse CT
problem and associated models, IR calls for the design of robust and stable converged results by carefully
crafting an optimization cost function, the solution of which is performed iteratively and typically demands
long reconstruction time. This has prevented wide application of IR in clinical practice until recent
advancements in computer hardware and fast algorithms.
Unlike the analytical reconstruction algorithms where each projection sample is weighted, filtered, and back-
projected to formulate an image, iterative reconstruction arrives at the final solution in an iterative manner:
the initial reconstructed images are refined and modified iteratively until certain criteria are met. The criteria
are written in the form of a cost function to be minimized, which measures the fit of the image to the data
according to a model of the imaging system. However, the enormous size of the optimization problem as well
as the complexity of the model makes it difficult to solve, and the cost function needs to be minimized
iteratively. Each iteration typically involves the forward- and back-projection of an intermediate image
volume. The forward-projection step simulates the x-ray interactions with the ―object‖ (the
intermediate images) and produces a set of synthesized projections. The synthesized projections are
compared against the real projection measurements collected by the CT scanner according to a statistical
metric, and the differences between the two are attributed to the ―error‖ or ―bias‖ in the
intermediately estimated image volume. The error is then used to update the intermediate image volume to
reduce the discrepancy between the image and the acquired data. The new intermediate image is then
forward-projected again in the next iteration, and, provided the choice of an adequate cost function and a
globally convergent optimization algorithm, the image volume will converge to an estimate near the
minimizer of the cost function after several iterations.
In the context of this chapter, due to limited space, we consider only statistical IR as defined in an
optimization sense, whereby the reconstructed result is achieved by minimizing a cost function that
determines the desired characteristics of the final image estimate as it relates to the measurement data, and
the iterative approach mostly determines the speed of the convergence to that solution. Other IR formulations
exist, which do not always provide the same properties of predictable convergence and stable results.
Advantages and Requirements
To understand the advantages of a model-based iterative reconstruction (MBIR) over other approaches, let us
examine a typical CT system and the assumptions being made to derive the FBP algorithm, or analytical
reconstruction algorithms in general. Figure 10 depicts a schematic diagram of a CT scanner with
intentionally enlarged x-ray source, detector, and image voxel for easier illustration. In the derivation of an
FBP algorithm, a series of assumptions are made regarding the physical dimension of the x-ray focal spot, the
detector cell, and the image voxels in order to make the mathematics manageable. Specifically, the size of the
x-ray focal spot is assumed to be infinitely small and therefore can be approximated as a point source.
Although the detector-cell spacing is correctly considered in the derivation of the reconstruction filters, the
shape and dimension of each detector cell are ignored, and all x-ray photon interactions are assumed to take
place at a point located at the geometric center of the detector cell. Similarly, the image voxel‘s shape and
size are ignored and only the geometric center of the voxel is considered. These assumptions lead to the
formation of a single pencil beam representing the line integral of the attenuation coefficients along the path
which connects the x-ray source and a detector cell. In addition, each of the projection measurements is
assumed to be accurate and is not influenced by the fluctuation induced by photon statistics or electronics
noise.
Schematic diagram of CT system
The CT system model traditionally used by analytical algorithms clearly does not represent physical reality.
For most clinical CT scanners, typical focal spot size is about 1 mm × 1 mm and detector cell spacing is
slightly larger than 1 mm with an active area of 80–90 % of the spacing. The image voxel is normally
modeled as rectangular in shape with its dimensions determined by the reconstruction field-of-view (FOV)
and slice thickness (Due to limited scope, other image voxel shapes, such as a blob, will not be discussed).
For example, for a 512 × 512 matrix size image representing a 50 cm FOV and 5 mm slice thickness, the
reconstructed pixel is 0.98 mm × 0.98 mm × 5 mm in x, y, and z. Because each projection sample is acquired
over a finite sampling duration (less than a millisecond on modern scanners) with limited x-ray flux, each
measurement at a detector cell has finite photon statistics. The statistical fluctuation is further complicated by
the fact that the electronics used in the data acquisition system has an inherent noise floor which contributes
to the overall noise in the measurement. There is little doubt that the simplifications made in the derivation of
an FBP should have an impact on reconstructed image quality.
MBIR Algorithms
One way of incorporating an accurate system model while overcoming the mathematical intractability of an
analytical reconstruction is to use a technique called model-based iterative reconstruction, MBIR. In 1982, by
incorporating only the noise properties of emission tomography, an expectation–maximization algorithm
(EM) was proposed for SPECT and was published in a classic paper .The development of IR techniques for
x-ray computed tomography, however, started a few years later due to its technical complexities and the
perception that less benefit was possible than in emission CT.
The accuracy of modeling is critical to the quality of the MBIR reconstruction. There are three main key
models in the IR algorithm: the forward model, the noise model, and the image model. The forward model
accounts for the system optics and all geometry-related effects. An accurate system model is necessary to
ensure that modeling errors do not grow during the iterative convergence process to form artifacts in the
reconstructed images One example of an accurate forward model is casting of multiple pencil-rays through
the x-ray focal spot, the image voxel, and the detector cell. These pencil-beams mimic different x-ray photon
paths going through the object, and the complicated CT optics is approximated by a weighted summation of
many simplistic line integral models One strategy to ensure an unbiased coverage of different points on the
focal spot, different locations on a detector cell, and different sub-regions inside an image pixel is to sub-
divide the focal spot, detector cell, and pixel into equal-sized small elements. Needless to say, this process is
time consuming.
An alternative approach is to model the ―shadow‖ cast by each image voxel onto the detector and rely on
point-response functions to perform the optics modeling, as shown in Fig. 12 In this approach, only one ray
is cast between the center of the focal spot and the center of the image voxel to locate the point of
intersection on the detector, and a response function is used to distribute the contribution of the image voxel
to different detector cells during the forward-projection process. The response function is non-stationery and
changes with the voxel location to account for different magnifications and orientations. Compared to the ray
casting approach, this method is computationally more efficient, and can introduce advanced system
modeling such as detector effective area, cross-talk, or focal spot energy distribution.
Note that accurate system modeling implies accounting for spatially-varying behavior where the projection of
an image voxel onto the detector depends on its shape and position relative to the x-ray source, contrary to
simplistic models used in FBP-type reconstruction. Using this accurate system model, it is also important that
the forward- and back-projection operators remain adjoint to each other in order to prevent the propagation of
errors in the reconstruction.
The modeling of noise distributions in the projections is not as straightforward as one may think, complicated
by the fact that the CT projection measurement undergoes complicated pre-processing and calibration
processes prior to its use in the reconstruction. Although the original x-ray photon statistics follow
approximately the Poisson distribution (approximation due to the poly-energetic x-ray source used in CT),
the projection data after the calibration process no longer exhibits this behavior. The same complication
applies to the electronic noise after the pre-processing steps. If a simplistic model is used to approximate the
statistical properties, suboptimal results are likely to result. It should be pointed out that the level of bias or
error introduced by the simplified model increases with the reduction of the x-ray flux received at the
detector, and the image quality degradation increases as a result. This is undesirable when considering the
fact that one of the major driving-forces behind MBIR is dose reduction, which leads naturally to a reduced
x-ray flux on the detector.
Once the projection noise is properly modeled, the philosophy behind MBIR is to treat each projection
sample differentially based on its estimated noise variance. In general, a higher confidence is placed on
samples with high signal-to-noise ratio (SNR) and lower weights are placed on samples with low SNR. This
is in direct contrast to the noise treatment in analytical reconstruction where all samples are treated equally
from a statistical point of view.
The image model is somewhat more subjective. The general approach is to model the image volumes as
Markov random fields, which results in a cost function term that penalizes noise-induced intensity
fluctuations in the neighborhood of a voxel. By carefully examining the human anatomy, one naturally
concludes that the attenuation characteristics of a voxel-size element inside the human body are not
completely isolated from or independent of the surrounding elements. Therefore, if a voxel CT number is far
from its neighbors, it should be penalized and modified. The term used to enforce such conditions in the cost
function is often called the regularization term in IR.
Although the concept looks simply, several challenges need to be addressed in the design of the
regularization term. The differentiation of the noise from the real structures in the image can be quite
difficult, since real object structures are often buried in the noise and there is little prior information available
about the object itself. The general approach taken by researchers is to construct an ―edge-preserving
prior‖ that preserves structural edges. Another challenge is to maintain the uniform image quality across the
volume. In CT reconstruction, the noise distribution in the image varies as a function of local attenuation;
highly attenuated regions tend to have higher noise. Therefore, it requires a spatially varying design of the
regularization term to achieve uniform image resolution and noise behavior [80]. Another difficulty is to
properly balance the regularization and data likelihood terms in the cost function to achieve the desired IQ:
designing for robust IQ behavior across a range of clinical scenarios without end-user interaction can pose a
significant challenge.
The MBIR cost function typically incorporates all the models discussed above. High spatial resolution is
usually a direct result of an accurate forward model combined with appropriate regularization. For
demonstration, Fig. 13a, b depict a clinical example of standard FBP and MBIR reconstructions of the same
projection data. The MBIR image exhibits not only significantly reduced noise but also much improved
spatial resolution as demonstrated by the visibility of fine anatomical structures.
figure13
Example of coronal images reconstructed with a FBP and b MBIR
It is clear from the discussion that fully modeled IR is more computationally intensive than analytical
reconstruction methods. Although it provides superb image quality in terms of spatial resolution, noise
reduction, and artifact correction, the time delay in the image generation process is not negligible. In today‘s
clinical environment, ―real time‖ image reconstruction is often demanded and the CT operator expects
all images will become available shortly after the completion of the data acquisition.
Extensive research has been conducted over the years to speed-up IR algorithms. Fast hardware
implementation, distributed parallel processing, and efficient algorithm convergence properties are equally
important to achieve this goal. To speed up convergence, one approach is to improve the update strategy at
each iteration. There are two types of update strategies: global updates, or local updates. Algorithms using
the global update strategy update the entire image volume at once. These algorithms are relatively easy to
parallelize. However, since the inverse problem is typically ill-conditioned based on the large number of
unknowns relative to the measurements and the range of data statistics, simple global update algorithms such
as gradient descent and conjugate gradient tend to require a large number of iterations to converge.
Therefore, various acceleration techniques such as preconditioner-based methods and ordered-subset (OS)
methods [75] have been proposed to accelerate the convergence of global update algorithms. The OS
algorithms perform their updates based on a subset of the projection data: at each iteration, image updates
start with one subset of the data, and rotate around all consecutive subsets until all projection data are used.
Today, this acceleration technique is used extensively in commercial PET and SPECT scanners.
Contrary to global updates, local updates focus on updating a single voxel or a subset of voxels at a time.
These voxels are selected according to a pattern, possibly random, and their modifications are estimated
based on all projection data. After the first set of voxels is updated, another set is selected and updated in
sequential fashion. An example of such algorithm is the iterative-coordinate-descent (ICD) algorithm]. If we
define the single update of all voxels in the image as one full-iteration, the local update strategy generally
takes only a few iterations to reach acceptable convergence. The convergence speed can be further improved
by exploring the flexibility to update certain pixels more frequently than others in the so-called non-
homogeneous update strategy
From an implementation point of view, however, it can be difficult to parallelize a local update algorithm to
run on a large number of threads to take full advantage of massive parallel computer architectures. The
global update strategy seems to be just the opposite: it is easier to parallelize, but typically needs a larger
number of iterations to reach convergence. Historically, the computational complexity of MBIR was one of
the most important factors that prevented its application to CT. Although the same issue is still present today,
the magnitude of the obstacle has been significantly reduced. With renewed research interests, this issue is
likely to be resolved in the near future with the combination of advanced computer architectures and
improved algorithm efficiency. It needs to be stated that the investigation of MBIR for CT is still in its
infancy and new clinical applications of MBIR are likely to be discovered.
Artifacts:
Artifacts are commonly encountered in clinical computed tomography (CT), and may obscure or simulate
pathology. There are many different types of CT artifacts, including noise, beam hardening, scatter, pseudo
enhancement, motion, cone beam, helical, ring, and metal artifacts. We review the cause and appearance of
each type of artifact, correct some popular misconceptions, and describe modern techniques for artifact
reduction. Noise can be reduced using iterative reconstruction or by combining data from multiple scans.
This enables lower radiation dose and higher resolution scans. Metal artifacts can also be reduced using
iterative reconstruction, resulting in more accurate diagnosis. Dual and multi-energy (photon counting) CT
can reduce beam hardening and provide better tissue contrast. Methods for reducing noise and out-of-field
artifacts may enable ultra-high resolution limited-field-of-view imaging of tumors and other structures.
Ring artifact:
• Ring artifact is caused by a miscalibrated or defective detector element, which results in rings centered on
the center of rotation. This can often be fixed by recalibrating the detector.
Noise:
• Poisson noise is due to the statistical error of low photon counts, and results in random thin bright and
dark streaks that appear preferentially along the direction of greatest attenuation. This can be reduced
using iterative reconstruction, or by combining data from multiple scans. Noise reduction techniques
enable diagnostic scans at a much lower radiation dose.
• With iterative reconstruction, low dose results in decreased resolution, with only a slight increase in
noise. Model-based iterative reconstruction (MBIR), for example, attempts to smooth out the noise
while preserving edges, resulting in a plastic appearance, where there are small clusters of pixels with
similar Hounsfield units.
Beam hardening and scatter:
• Beam hardening and scatter both produce dark streaks between two high attenuation objects (such as
metal or bone), with surrounding bright streaks. These can be reduced using iterative reconstruction.
Dual energy CT reduces beam hardening, but not scatter.
• Beam hardening and scatter also cause pseudo enhancement of renal cysts.
Metal artifact:
• Metal streak artifacts are caused by multiple mechanisms, including beam hardening, scatter, Poisson
noise, motion, and edge effects. The Metal Deletion Technique (MDT) is an iterative technique that
reduces artifacts due to all of these mechanisms. In some cases, the improved image quality can
change the diagnosis.
Out of field “artifact”:
• Out of field ―artifacts‖ are due to a suboptimal reconstruction algorithm, and can be fixed
using a better algorithm. Images can then be acquired using a field of view that is much smaller than
the object being scanned, thus reducing the radiation dose.
• Higher resolution scanners will likely require iterative reconstruction or limited field of view scans to
reduce the radiation dose required to achieve an acceptable level of noise.

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UNIT-1

PATIENT PREPRATION FOR CT EXAM:

Figure 4-1. a) General representation of an X-ray or CT detector, b) with indirect conversion.

Figure 4-2. Columnar structure of a CsI:Tl scintillator.

Figure 4-3. Array of CdWO4 crystals for CT imaging.

Figure 4-4. X-ray image acquired with a PbO detection layer.

Figure 4-6. Pixel circuit with signal amplification (source follower).

General recommendations for the design of a radiology room:

Slice thickness/interval 2.5 mm/2.5 mm 2.5 mm/2.5 mm

Neck (Soft Tissue)

Reference angle: Angle gantry perpendicular to the orbital meatal line

Reconstruction (slice thickness/interval) 0.625 mm/0.625 mm (16 0.625

Figure 1 Illustration of cone-beam geometry

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