Computed Tomography

Dr Huma
Introduction
Computed Tomography

▪ A computerized tomography (CT) scan

combines a series of X-Ray images taken
from different body angles around your
body and uses computer processing to
create cross-sectional images of the bones,
blood vessels and soft tissues inside your
body.
Basic Principles

▪ CT refers to a computerized x-ray imaging procedure in which a

narrow beam of x-rays is aimed at a patient and quickly rotated
around the body, producing signals that are processed by the
machine’s computer to generate cross-sectional images, or “slices.”
▪ These slices are called tomographic images and can give a clinician
more detailed information than conventional x-rays.
▪ Once a number of successive slices are collected by the machine’s
computer, they can be digitally “stacked” together to form a three-
dimensional (3D) image of the patient.
CONT.

▪ that allows for easier identification of basic structures as well as

possible tumors or abnormalities.
Parts of a CT Scanner

▪ The CT system consists of:

▪ A computer work station for operation of the scanner
▪ Image processing computers
▪ Electronic cabinets
▪ Gantry
▪ Patient table
Composition of Gantry

▪ The gantry houses the key components of the scanner.

▪ X-Ray Tubes
▪ Generator
▪ Filters
▪ Collimators
▪ Detectors
X-Ray tubes

▪ The radiation source for CT would supply a monochromatic x-ray beam

(i.e., one made up of photons all having the same wavelength) with
advantage that image reconstruction is simpler and more accurate.
▪ Earlier models used oil-cooled, fixed-anode, relatively large (2 X 16
mm) focal spot tubes at energies of about 120 kV (constant potential)
and 30mA
▪ The beam was heavily filtered to remove low energy photons and to
increase the mean energy of the radiation.
▪ New fan beam units have a diagnostic type x-ray tube with a rotating
anode and a much smaller focal point around(0.6mm).
Cont.

▪ These tubes have large heat loading and heat dissipation capabilities
to withstand the very high heat loads generated when multiple slices
are acquired in rapid sequence
GENERATOR

 High frequency generator which is;

☻Small
☻Compact
▪ More efficient than conventional generators
▪ Provides power ranging from 20-100kw
FILTERS

▪ They serve a dual purpose:

▪ Filtration removes long wavelength x-rays as do not play a role in CT
image formation and add to patient dose.
▪ Filtration shapes the energy distribution across the beam to produce
a uniform beam.
COLLIMATORS

▪ X-ray beam collimated at two points, one close to the x-ray tube and
the other at the detector(s) with perfect alignment.
▪ Each detector has its own collimator.
▪ Collimator at the detector controls scatter radiation.
▪ The collimators also regulate the thickness of the tomographic slice.
▪ Pixel size is determined by the computer program not by the
computer.
DETECTORS

▪ Two types of detectors are used

Scintillation Detectors
Gas Filled Detectors
Scintillation Detectors; These are the materials that will produce light
(scintillate) when ionizing radiation reacts with them. The combination
of a scintillation crystal and the light detector is called a scintillation
detector.
Data Acquisition System

▪ X-ray photons come on the detector.

▪ The detector detects the intensity in form of current.
▪ The current is converted into voltage.
▪ The analog integrator removes spikes.
▪ The analog signal is converted into digital form.
▪ This signal can now be processed and reconstructed
Image Reconstruction

▪ After enough transmission measurements (detector) Sent to the

computer for processing.
▪ A software called Fourier Slice Transform is used.
▪ More than 250,000 reconstruction algorithms are used:(example:
algebraic reconstruction technique) to compute the image.
Operating Console

▪ It is master control center of the CT scanner.

▪ It is used to input all of the factors related to taking a scan.
▪ Typically, this console is made up of a computer, a keyboard, and
multiple monitors.
▪ Often there are two different control consoles, one use by the CAT
scanner operator, and the other used by the physician.
What is a CT contrast agent?

▪ As with all x-rays, dense structures within the body—such as bone—

are easily imaged, whereas soft tissues vary in their ability to stop x-
rays and therefore may be faint or difficult to see.
▪ For this reason, contrast agents have been developed that are highly
visible in an x-ray or CT scan and are safe to use in patients.
▪ Contrast agents contain substances that can stop x-rays and are
therefore more visible on an x-ray image. 
▪ For example, to examine the circulatory system, an intravenous
(IV) contrast agent based on iodine is injected into the bloodstream
to help illuminate blood vessels.
Cont.
▪ This type of test is used to look for possible obstructions in blood
vessels, including those in the heart.
▪ Oral contrast agents, such as barium-based compounds, are used for
imaging the digestive system, including the esophagus, stomach,
and gastrointestinal (GI) tract.
Cont.

▪ Contrast material might be given to you:

▪ By mouth. If your esophagus or stomach is being scanned, you may
need to swallow a liquid that contains contrast material. This drink may
taste unpleasant.
▪ By injection. Contrast agents can be injected through a vein in your
arm to help your gallbladder, urinary tract, liver or blood vessels stand
out on the images. You may experience a feeling of warmth during the
injection or a metallic taste in your mouth.
▪ By enema. A contrast material may be inserted in your rectum to help
visualize your intestines. This procedure can make you feel bloated and
uncomfortable
 Cont.

With contrast Without contrast

acute appendicitis acute stroke

staging cancer closed head injuries

diverticulitis lung disease

inflammatory bowel disease tissue swelling or injury in your arms or

legs
pancreatitis kidney stones

pulmonary embolism spinal trauma

Generations of CT

▪ First-Generation EMI CT scanner

▪ Second Generation of CT : Reducing scan time
▪ Third Generation of CT: Rotate/rotate, wide fan beam
▪ Fourth-Generation CT scanners
▪ Fifth Generation Electron-Beam CT (EBCT)
First-Generation Bench top

▪ This is the first time that CT was performed and is the basis for the Nobel
Prize in Medicine.
▪ The very first CT scans were performed on a first generation geometry on
a CT bench top. In the bench top systems patients were not imaged but
rather an object to be imaged is placed on a stage that can rotate (i.e.
like a slow and well calibrated record player).
▪ Then in order to image patients (rather than biological samples) a
rotating gantry is needed so that the patient can lie on an imaging table
and the x-ray source and detector will rotate around the patient.
▪ Both of the bench top and first generation rotating CT systems share a
common configuration that is referred to as a translate/rotate acquisition
First-Generation Rotating CT

▪ In first generation CT scanners, there was one X-ray source and one X-
ray detector. So, in order to acquire an axial image of the patient, one
ray would go through body of patient and be measured using a single
detector. The x-ray source and the detector moved together to collect
the data. In order to reconstruction one slice the x-ray source would
have to translate many times for each view. Then the source and tube
were rotated with respect to the patient (or another object being
imaged).
▪ This process was very time-consuming and scanners were slow. Such
scanners with only one source and one detector proved that there
was tremendous value in CT but they could be very slow taking ½ hr
for an average acquisition of several slices
Second Generation of CT : Reducing scan time

▪ Second generation CT was a refinement on first generation CT but still using

the same general concepts. The translate and rotate acquisition was still used
but while 1st generation CT had only one x-ray source and detector, in
2nd generation CT there was a small fan beam appeared that enabled more
coverage than just one detector (5-53 detectors at a time).
▪ Second generation CT was significantly faster taking an average exam from a
significant fraction of an hour to the order of minutes. An average scan during
on this system was ~1.5 minutes. Each slice went from taking 5 minutes on 1st
generation to as low as 20 seconds on 2nd generation.
▪ Second generation CT is still a translate rotate acquisition but was significantly
faster than 1st generation CT. Multiple versions of second generation CT were
built where more detectors used at once lead to more speedup
Third Generation of CT: Rotate/rotate, wide fan beam

▪ Then a significant improvement was again made going from 2 nd generation

CT to 3rd generation CT where the translation of source within each view was
eliminated by having a fan-beam shaped x-ray beam acquiring all the data
(for a slice) within each view.
▪ This acquisition mode can be termed rotate-rotate as both the x-ray source
and x-ray detector are rotating together. Using a rigid ring the x-ray tube
and detector can be mounted such that they rotate around the patient.
▪ In 3rd generation CT a scan takes a few seconds on average compared
2nd generation CT where it was on the order of minutes.
▪ 3rd generation CT survived as the base of modern CT for several reasons but
mainly the speed of acquisition and mechanical simplicity.
Cont.

▪ So, the modern CT is typically an X-ray source and X-ray detectors mounted in
an arc facing the source. In the sections below we will describe the standard
data acquisition methods on these systems.
▪ The modern CT systems may even include new configurations such as 2 tubes
and 2 detectors mounted on the same gantry.
▪ Other state-of-the-art systems now include x-ray detectors large enough to
cover an entire organ (e.g. the brain or the heart) in a single rotation of the
system.
▪ While some have made different classification systems, we believe that all these
systems are based on 3rd generation CT where the x-ray source and detector are
rigidly mounted on the gantry across from one another. We don’t introduce new
generation terminology for 2T2D systems or whole organ coverage systems
Fourth-Generation CT scanners

▪ The 4th generation CT geometry is considerably different from

3rd generation geometry in that the x-ray detectors surround the
entire circle (much like a P.E.T. detector).
▪ The x-ray source rotates in 4th generation CT and the detector is
stationary, so this generation we term rotate-stationary.
▪ The scans times were similar on 3rd generation CT and 4th generation
CT and 3rd generation CT required many more detector elements (~
three times as many) to cover the full ring around the patient.
Fifth Generation Electron-Beam CT (EBCT)

▪ The final generation of CT which is truly a different acquisition

method is that of 5th generation CT. In all of the other methods above
there is significant mechanical motion of the parts on the gantry.
▪ In 5th generation CT both the x-ray source material and the detector
are stationary. In this sense this is a stationary-stationary design.
▪ The x-tube in this design is a scanning x-ray tube, where the electrons
are steered magnetically (like in old TVs) rather than physically
moving the x-ray tube. This method allows for very fast acquisitions
and is ideal for cardiac scanning (with a temporal resolution of a
given slice as low as 17ms)
Cont.

▪ The niche of 5th generation CT was dedicated cardiac scanning. However,

these scanners did not have full volumetric coverage and the flux that could
be delivered was more limited.
▪ In the end, the third generation CT ended up winning out compared with the
relatively niche design of 5th generation CT.
▪ Especially when we went wider coverages because you can get higher power
on the third generation CT and the gantry rotation time just keeps getting
faster and faster.
▪ With the difference in temporal resolution shrinking between what the
electron beam CT could provide and what a good third generation CT could
provide the 3rd generation geometries have become the heart of modern CT
scanners
Parallel Beam CT
Cont.

▪ After all of that in parallel beam CT we still have acquired only one
slice of the patient. This then needs to be repeated for each slice after
translating the table. That is why parallel beam CT was replaced with
fan-beam CT
Fan Beam CT
Cont.

▪ Fan-Beam CT was introduced in 3rd generation CT. The reason it is

called Fan-Beam, is because the beam coming out of the x-ray tube
makes the shape of a fan.
▪ Instead of translating you just turn on the x-rays and then the whole
slice in this direction and here is covered in x-rays so we can get one
rotation relatively quickly and don’t have to wait for those
translations anymore.
▪ Each rotation in fan-beam CT provides just one slice. Therefore,
many rotations are needed to cover the full anatomy. This is where
cone-beam CT comes in for even more acceleration in the speed of
acquisition
Cone Beam CT
Cont.

▪ Then what came after fan-beam CT is called Cone-Beam CT and the

geometry is the same as the third generation CT (i.e. an x-ray source and
x-ray detector mounted straight across one another). However, in this
case the detector has many more rows so the shape of the x-ray beam
coming out looks more like a cone than a fan.
▪ Each rotation is still fast (just like in fan-beam CT) but fewer rotations are
needed in order to scan the entire anatomy of interest. As you can see in
the figure more of the volume is covered at one time and thus we are
need fewer rotations in cone-beam CT.
▪ On a modern (state-of-the-art) CT scanner one can scan the whole heart
or the whole head in just one single rotation (more discussion on this
below).
Cont.

▪ Now Cone-Beam CT is the basis of modern CT scanners and it is, also

called multi-detector CT (MDCT), as there was a gradual progression
of rows of CT detectors on systems from 1,2,4,16, 64, until today
where state-of-the art systems can have 256 or more rows of CT
detectors. That is a huge leap in coverage from the early days of
3rd generation CT
 X-Ray Tube / X-Ray Tube and Detector from X-Ray Tube and Detector Number of detector rows
Detector within each View view to view from view to view

Parallel-Beam Translate Rotate 1 slice

Fan Beam —- Rotate 1-16 detector rows

Cone Beam —- Rotate More than 16 detector rows

What happens during the test?

▪ During the test, the patient will lie on his back on a table (like a bed). If your
test requires it, a healthcare provider may inject the contrast dye
intravenously (into your vein). This dye can make you feel flushed or have a
metallic taste in your mouth.
▪ When the scan begins:
▪ The bed slowly moves into the doughnut-shaped scanner. At this point, you
will need to stay as still as possible because movement can create blurry
images.
▪ The scanner takes pictures of the area the healthcare provider needs to see.
Unlike an MRI scan, a CT scan is silent.
▪ When the exam is over, the table moves back out of the scanner
Benefits

▪ CT scanning is painless, noninvasive, and accurate.

▪ A major advantage of CT is its ability to image bone, soft tissue, and blood
vessels all at the same time.
▪ Unlike conventional x-rays, CT scanning provides very detailed images of
many types of tissue as well as the lungs, bones, and blood vessels.
▪ CT exams are fast and simple. In emergency cases, they can reveal internal
injuries and bleeding quickly enough to help save lives.
▪ CT has been shown to be a cost-effective imaging tool for a wide range of
clinical problems.
▪ CT is less sensitive to patient movement than MRI.
Cont.

▪ Unlike MRI, an implanted medical device of any kind will not prevent
you from having a CT scan.
▪ CT imaging provides real-time imaging, making it a good tool for
guiding needle biopsies and needle aspirations. This is particularly
true of procedures involving the lungs, abdomen, pelvis, and bones.
▪ A diagnosis via CT scan may eliminate the need for exploratory
surgery and surgical biopsy.
▪ No radiation remains in a patient's body after a CT exam.
▪ The x-rays used for CT scanning should have no immediate side
effects
Risks

▪ The radiation dose for this procedure varies. See the 

Radiation Dose in X-Ray and CT Exams page for more information
about radiation dose.
▪ Women should always tell their doctor and x-ray or CT technologist if
there is any chance they are pregnant. See the 
Safety in X-ray, Interventional Radiology and Nuclear Medicine Pro
cedures
 page for more information about pregnancy and x-rays.
▪ Doctors do not generally recommend CT scanning for pregnant
women unless medically necessary because of potential risk to the
unborn baby.
Cont.

▪ IV contrast manufacturers indicate mothers should not breastfeed

their babies for 24-48 hours after contrast material is given. However,
the most recent American College of Radiology (ACR) Manual on
Contrast Media reports that studies show the amount of contrast
absorbed by the infant during breastfeeding is extremely low. For
further information please consult the ACR Manual on Contrast Media
 and its references.
▪ The risk of serious allergic reaction to contrast materials that
contain iodine is extremely rare, and radiology departments are well-
equipped to deal with them
 CT versus MRI

▪ The main differences between CT and MRI are:

▪ A CT scan uses X-rays, but an MRI uses magnets and radio waves.
▪ Unlike an MRI, a CT scan does not show tendons and ligaments.
▪ MRI is better for examining the spinal cord.
▪ A CT scan is better suited to cancer, pneumonia, abnormal chest x-rays, bleeding in the
brain, especially after an injury.
▪ A brain tumor is more clearly visible on MRI.
▪ A CT scan shows organ tear and organ injury more quickly, so it may be more suitable for
trauma cases.
▪ Broken bones and vertebrae are more clearly visible on a CT scan.
▪ CT scans provide a better image of the lungs and organs in the chest cavity between the
lungs.