COMPUTED TOMOGRAPHY

What is CT SCAN????
 WHAT IS CT????

• A method of examining body organs by scanning

them with X rays and using a computer to construct a
series of cross-sectional scans along a single axis

• Acquiring and reconstructing, thin cross section on

the basis of measurement of attenuation
 CONTD….

 Computed tomography (CT) is a medical imaging

method employing tomography
 The word "TOMOGRAPHY" is derived from the
Greek tomos (slice) and graphein (to write).
 A large series of two-dimensional X-ray images
(slices) of the inside of an object are taken around a
single axis of rotation
 Digital geometry processing is used to generate three-
dimensional images of the object from those slices.
history
 History

 The first commercially viable CT scanner was

invented by Sir Godfrey Hounsfield in 1972.
 Received Nobel Prize in Medicine
Prototype CT scanner
 First CT

• The "EMI-SCANNER“
• Limited to brain
• Images from these scans took 2.5 hours to be
processed by algebraic reconstruction techniques on a
large computer
• A single photomultiplier detector, and operated on the
translate/rotate principle
Historic EMI Scanner
GOALS OF CT SCAN
 Goals of CT

• To overcome superimposition of structures

• To improve contrast
• To measure small differences in tissue contrast

CT came to solve the problems of tomography and

conventional radiography, image reconstruction from
projections
 Solution

• Transmitting a collimated beam through a cross

section of the body
• Detectors, measuring small differences in tissue
contrast
• Computer that allows data manipulation and
reconstruction
EQUIPMENT
 Basic CT scanner components

•Gantry
•X-Ray Tube
•Detector
•Control Console
Modern CT scanner
 Label

1. gantry aperture microphone

2. sagittal laser alignment light
3. patient guide lights
4. x-ray exposure indicator light
5. emergency stop buttons
6. gantry control panels
7. external laser alignment lights
8. patient couch
9. ECG gating monitor
 Gantry

• CT X-ray tube
• High voltage generator
• Detector array
• Data acquistion system
• Slip ring
CT Gantry –Internal structure
 Label

1. x-ray tube
2. filters, collimator, and reference detector
3. internal projector
4. x-ray tube heat exchanger (oil cooler)
5. high voltage generator
6. direct drive gantry motor
7. rotation control unit
8. data acquisition system
9. detectors
10. slip rings
 Detector Elements

Capture energy that has not been attenuated by the

patient
 Control console

• Set scan parameters

– kVp, mA, scan time, reconstruction filter, etc.
• Set scan mode
– Digital radiograph, axial or volume
• Houses reconstructor
• Review and archive images
• Post-processing
CT --- BASIC
PRINCIPLES…
 Understanding Basic factors

 Absorption :-stopping Scattered x-rays

of x-rays with transfer
of energy
 Scatter:- deflection of x-
rays
 Incident Intensity :- No. Transmitted
of x-ray photons falling X-ray beam
Incident x-
on an object
ray beam
 Transmitted Intensity:-
No. of photons passing
through
 Attenuation
More dense
material Less
transmitted
 The reduction of the x-rays
beam intensity on
passing through the
material due to More
transmitted
absorption plus scatter
x-rays
 The degree of
attenuation is obtained
by measuring and
Less dense
comparing the incident
material
and transmitted
intensities
Applications of X-ray attenuation &
detection

 Conventional X-ray (Radiography)

 Conventional Tomography
 Computed Tomography
 Conventional Tomography
 The source and detector
moves
 Produces Images of
coronal or sagittal
sections (cuts) of areas
of interest
 Eliminates the
superimposition of
structures above and
below
 BASIC PRINCIPLE OF CT
• When radiation passes through an objects, some of it
is absorbed and some is scattered Attenuation
measurements is the basis of CT imaging
• Radiation passes through each section in a specific
way (depending on the tissue
properties/characteristics) onto a detector that sends
signal to a computer for processing
CT – schematic view
 CT Scan
X-ray tube

 CT scan produces axial

sections/cuts /Slices
 The CT image is
recorded through a
SCAN.

Detector
 Slice / Cut

 The cross sectional

portion of the body
which is scanned for the
production of CT image
is called a slice.
 The slice has width and
therefore volume.
 The width is determined
by the width of the x-
ray beam
HOW DOES CT SCAN WORK???
The formation of CT image by CT scanner
involves three steps:
1. data acquisition
2. image reconstruction
3. image display, manipulation, storage, and
recording.
 Data Acquisition
• Collection of x ray transmission measurements
– After passing through patient they fall onto detectors
– Detector measures the attenuation value
• Reconstruct an image, enough data needed
(transmission measurements)
 Contd…
• A fan beam of x-ray is created as the rotating frame
spins the x-ray tube and detector around the patient.
• Each time the x-ray tube and detector make a 360o
rotation, an image or "slice" has been acquired. This
"slice" is collimated (focused) to a thickness between
1 mm and 10 mm using lead shutters in front of the x-
ray tube and x-ray detector.
• As the x-ray tube and detector make this 360 o
rotation, the detector takes numerous
snapshots (called profiles) of the attenuated x-
ray beam. Typically, in one 360o lap, about
1,000 profiles are sampled.
• Each profile is then backwards reconstructed
(or "back projected") by a dedicated computer
into a two-dimensional image of the "slice"
that was scanned.
 Image Reconstruction

• After enough transmission measurements (detector)

sent to the computer for processing
• Computer (uses mathematical techniques to
reconstruct the CT image)
• Reconstruction algorithms (example: algebraic
reconstruction technique)
• Need: minicomputer and microprocessors for
performing the function/ or array processors for
calculations.
 Image Display/Manipulation

• After image reconstruction

• Image displayed on monitor which is part of console
• Manipulation: transverse axial images can be
reformatted into coronal , sagital, and paraxial
sections./ and three dimensional processing
CT--- SCANNING METHODS
 Scanning methods

• Conventional CT
– Axial (Start/stop)
• Volumetric CT
– Helical or spiral CT (Continuous acquisition)
 Axial CT
•X-ray tube and detector
rotate 360°
•Patient table is stationary
–With X-ray’s “on”
•Produces one cross-
sectional image
•Once this is complete
patient is moved to next
position
–Process starts again at the
beginning
 VOLUMETRIC CT

X-ray tube and detector rotate 360°

•Patient table moves continuously
–With X-ray’s “on”
•Produces a helix of image information
–This is reconstructed into 30 to 1000 images
How ct is performed???

????
• The technologist begins by positioning patient on the
CT examination table, usually lying flat on back or
less commonly, on one side or on stomach.
• Straps and pillows may be used to help you maintain
the correct position and to hold still during the exam.
• Depending on the part of the body being scanned,
patient may be asked to keep hands over head.
• If contrast material is used, it will be swallowed,
injected through an intravenous line (IV) or
administered by enema, depending on the type of
examination.
• Next, the table will move quickly through the
scanner to determine the correct starting position for
the scans.
• Then, the table will move slowly through the machine
as the actual CT scanning is performed.
• Depending on the type of CT scan, the machine may
make several passes.
• Patient may be asked to hold breath during the
scanning.
• Any motion, whether breathing or body movements,
can lead to artifacts on the images. This is similar to
the blurring seen on a photograph taken of a moving
object.
• When the examination is completed, you will be
asked to wait until the technologist verifies that the
images are of high enough quality for accurate
interpretation.
• The CT examination is usually completed within 30
minutes. The portion requiring intravenous contrast
injection usually lasts only 10 to 30 seconds.
CT INTERPRETATION
The amount of attenuation is determined by the density
of the imaged tissue, and they are individually assigned
a Hounsfield Unit or CT Number.
• High density tissue (such as bone) absorbs the
radiation to a greater degree, and a reduced amount is
detected by the scanner on the opposite side of the
body
• Low density tissue (such as the lungs), absorbs the
radiation to a lesser degree, and there is a greater
signal detected by the scanner.
Hounsfield chose a scale that affects the
four basic densities, with the following
values:
• Air = -1000
• Fat = -60 to -120
• Water = 0
• Compact bone = +1000
Fat

Muscle
Air

Bone
 How to see soft tissues with CT
scans
• In a normal X-ray picture, most soft tissue doesn't
show up clearly. To focus in on organs, or to examine
the blood vessels that make up the circulatory system,
we must introduce contrast media into the body.
 CONTRAST ENHANCED CT

Depending on the structure being imaged, CT scans can

be used with and/or without contrast. The introduction
of an intravenous contrast into the bloodstream can be
used for a variety of diagnostic purposes, for example:
• Used to visualize the cardiovascular system (e.g.
investigating for suspected aneurysms, dissections, or
atherosclerotic diseases).
• Used to identify whether a tumour is malignant.
Oral contrast can also be administered if investigation
is required of the digestive system. (Crohn’s disease,
bowel obstruction, diverticulitis, appendicits).
CT PLANES
 ORIENTATION

• When interpreting at CT scan, it is important to

determine the orientation. Images are most commonly
presented in the transverse plane, and are orientated
so that we are looking up the body from the patient’s
toes.
• A helpful way to get your bearings is the
acronym RALP. Starting at the 9 o’clock
position and moving clockwise in 90 degree
intervals, we are looking at
the Right, Anterior, Left
A and Posterior aspects

of the patient.

R L

P
CT WINDOWS
• Three basic windows
– Soft tissue window (brain,neck, mediastinum,
abdomen/pelvis, musculoskeletal)
– Lung window
– Bone window
Mediastinal window Lung window Bone window
Soft tissue window Bone window
Bone window Soft tissue window
3D CT
CT anatomy
 Approach to Cross sectional
imaging
• Type of study?
– CT/MRI
• Region?
– Brain, neck chest, abdomen, upper/lower limbs
• Window???
– Bone/ soft tissue/lung
• Plane ???
– Sagittal/ coronal/ axial
• Pathology ….
 CT terminology
Hypodense Hyperdense
(less attenuation) (more attenuation)

•
indications of ct
 CT Brain

• Headache
• Trauma
• Vertigo/Dizziness
• Syncope
• Hydrocephalus
• Intracranial Hemorrhage
• Memory/ Concentration Problems
• Seizure / fits
• Brain tumour
• Brain abscess
 CT PARANASAL SINUSES

• Sinusitis
• Tumors
 CT NECK

• Lymphadenopathy
• Swelling
• Abscess/ Infection
• Palpable Lump/ Lesion
• Tumor
• Oral Cancer
• Foreign body
 CT CHEST

• Mass/ Tumor
• lymphadenopathy
• Shortness of breath/ Dyspnea
• Pulmonary Embolus
• Trauma
• Lung Metastases
 CT abdomen pelvis
• Liver mass • Appendicitis
• Renal mass
• Pancreatic/GB mass
• Renal calculi
• Urinay bladder mass
• Trauma
• Lymphadenopathy
• Abscess/ infection
• Pancreatitis
• Staging of tumors
 MUSCULOSKELETAL CT

• Trauma
• Bone Tumor
cases
 3D
AXIAL

CORONAL
SAGITTAL
Brain tumor
Skull fracture
Liver carcinoma
Fractures
Bone tumor
Ct--- risks vs benefits
 Benefits

1. CT scanning is painless, noninvasive and

accurate.
2. A major advantage of CT is its ability to image
bone, soft tissue and blood vessels all at the same
time.
3. Unlike conventional x-rays, CT scanning provides
very detailed images of many types of tissue as
well as the lungs, bones, and blood vessels.
4. CT examinations are fast and simple; in emergency
cases, they can reveal internal injuries and bleeding
quickly enough to help save lives.
5. CT has been shown to be a cost-effective imaging
tool for a wide range of clinical problems.
6. CT is less sensitive to patient movement than MRI.
7. CT can be performed if you have an implanted
medical device of any kind, unlike MRI.
8. X-rays used in CT scans should have no immediate
side effects.
• CT imaging is a good tool for guiding minimally
invasive procedures such as needle biopsies and
needle aspirations of many areas of the body,
particularly lungs, abdomen, pelvis and bones.
• A diagnosis determined by CT scanning may
eliminate the need for exploratory surgery and
surgical biopsy.
• No radiation remains in a patient's body after a CT
examination.
 RISKS

• There is no conclusive evidence that radiation at

small amounts delivered by a CT scan causes
cancer.
• CT scanning is, in general, not recommended for
pregnant women unless medically necessary because
of potential risk to the fetus in the womb.
• The risk of serious allergic reaction to contrast
materials that contain iodine is extremely rare
• Because children are more sensitive to radiation, they
should have a CT exam only if it is essential for
making a diagnosis and should not have repeated CT
exams unless absolutely necessary. CT scans in
children should always be done with low-dose
technique.
Contraindications of ct
NO ABSOLUTE CONTRAINDICATION
Comparison with other modalities
 CT (CT abdo X-ray (CXR
Ultraso
Factor used as MRI used as
und
example) example)

5-10
Duration 3-7 minutes 30-45 min 2-3 min
minutes

Cost Cheaper Expensive Cheap Cheap

Dimensio
3 3 2 2
ns

Soft Excellent
Poor detail Poor detail Poor detail
tissue detail

Bone Excellent detail Poor detail Excellent detail Poor detail

Radiation 10mSv None 0.15mSv None

 CT vs MRI

• CT Scans are usually cheaper

• CT Scans are typically better at showing bones
than MRI, but less effective at showing the soft
tissue
• CT scans take around 5 minutes, MRI’s usually
take 30 minutes
• CT scans can be harmful to the patient, while
MRI’s have no known biohazards
• Both used for detecting cancer
 Limitations

• In order for better clarity, more exposure to

radiation is necessary
• Human error in reading scans
• Not very good at depicting soft tissue
• In order to change the image plane you have to
move the patient, unlike with MRI.
THANKYOU