Image Quality

Chapter 6

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Scan Parameters
• Many factors affect the quality of the image produced. Those
that can be controlled by the operator are:
– Milliampere level (mA)
– Scan time
– Field of view
– Reconstruction algorithm
– Kilovolt-peak (kVp)
– Pitch (when helical mode is used)

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Milliamperes and Scan Time

• Referred to as mAs
• The total x-ray beam exposure
• Together they define the quantity of the x-ray energy
• Higher mA settings allow shorter scan times to be used
– A short scan time is critical in avoiding image
degradation as a result of patient motion

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Tube Voltage or Kilovolt Peak

• Commonly referred to as kVp

• Defines the quality (average energy) of the x-ray beam
• In CT, kVp does not change contrast as directly as it does
in film-screen radiography
• Compared with mA selection, choices of kVp are more
limited

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Impact of mAs and kVp on Radiation Dose

• The appropriate selection of mAs and kVp is critical to

optimize radiation dose and image quality
• It is more common to manipulate the mAs, rather than
the kVp, when modifying the radiation dose, because
– The choice of mA is more flexible (with available
settings typically ranging from 20 to 800 mA.)
– The effect of mA on image quality is more straight-
forward and predictable

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

The Uncoupling Effect

• Using digital technology, the image quality is not directly

linked to the dose, so even when an mA or kVp setting
that is too high is used, a good image results
• Makes CT physics somewhat different from that of film-
screen radiography

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Automatic Tube Current Modulation

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Slice Thickness and Field of View

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Reconstruction Algorithm and Pitch

• By choosing a specific algorithm, the operator selects

how the data are filtered in the reconstruction process
– Can only be applied to raw data
• Pitch
– The relationship between slice thickness and table
travel per rotation during a helical scan acquisition

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Scan Geometry
• Tube arc during the acquisition for each slice
– Full scan (360°) is most common
– Partial scan (180° + degree of arc of the fan angle)
• Also referred to as half-scans
– Overscans (400°) [360° (full scan) + 40 (typical field
of view) = 400° scan].
• Used mainly in fourth-generation scanners to
reduce motion artifact

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Image Quality Defined
• Applies to all types of images
• The comparison of the image to the actual object
• In many regards “quality” is a subjective notion and is
dependent on the purpose for which the image was acquired
• In CT, the image quality is directly related to its usefulness in
providing an accurate diagnosis
• This section deals primarily with the more objective measures
of image quality

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Image Quality

• Two main features are used to measure image quality

– Spatial resolution: the ability to resolve (as separate
objects) small, high-contrast objects
– Contrast resolution: the ability to differentiate
between objects with very similar densities as their
background

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Spatial Resolution

• Also called detail resolution

• Measured using two methods
– Directly, using a line pairs phantom
– Or by data analysis known as the modulation transfer
function (MTF)
• MTF is often used to graphically represent a
system’s performance

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Spatial Resolution (cont’d)

• Can be described in two dimensions

– In-plane resolution: resolution in the x,y direction
– Longitudinal resolution: resolution in the z direction

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Factors Affecting Spatial Resolution
• Matrix size
• Display field of view
• Pixel size
• Slice thickness
• Reconstruction algorithm
• Focal spot size larger focal spots cause more geometric
unsharpness in the image and reduce spatial resolution.
• Pitch In general, increasing the pitch reduces resolution.
• Patient motion

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• An isotropic voxel is a cube, measuring the same in the
x, y, and z directions. When the imaging voxel is equal in
size in all dimensions there is no loss of information when
data are reformatted in a different plane. This is
particularly important for imaging small vascular
structures. For example, the coronary, peripheral, and
carotid arteries frequently follow a twisting path and
often run perpendicular to the image plane.

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Contrast Resolution

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Contrast Resolution (cont’d)

• Measured using phantoms that contain objects of

varying sizes and with a small difference in density
(typically from 4 to 10 HU) from the background
• Noise plays an important role in low-contrast resolution
– Noise is the undesirable fluctuation of pixel values in
an image of homogeneous material
• “salt-and-pepper” look
– The presence of noise on an image degrades its
quality

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Factors Affecting Contrast Resolution
• mAs/dose increasing this will increase snr and hence
improve contrast resolution.
• Pixel size
• Slice thickness = Because thicker slices allow more
photons to reach the detectors they have a better SNR
and appear less noisy. However, this improvement comes
at the cost of spatial resolution in the z axis.
• Reconstruction algorithm = bone algorithms produce
lower contrast resolution (but better spatial resolution),
whereas soft tissue algorithms improve contrast
resolution at the expense of spatial resolution.
• Patient size = For the same x-ray technique, larger
patients attenuate more x-rays photons, leaving fewer to
reach the detectors. This reduces SNR, increases noise,
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 Other Contrast Resolution Considerations
• Subject contrast relates to the inherent properties of the
object scanned.
– Size of the object
• Inherent contrast
– Physical properties of the object and its background
– For example, the lung is said to possess high
inherent contrast because it is primarily air-fi lled.
The lowattenuation lungs provide a background that
makes nearly any other object discernible because of
its dramatic difference in density.
• Displayed contrast
– Window settings used to display the image
– For low-contrast objects to be visible, the
window level
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Kluwer set near
Health | Lippincott the
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Temporal Resolution
• How rapidly data are acquired
• Controlled by
– Gantry rotation speed
– Number of detector channels in the system
– Speed with which the system can record changing signals
• Reported in milliseconds
– 1,000 milliseconds = 1 second

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Review
The appropriate technique for a given patient
examination is 200 mAs. The technologist mistakenly
uses 100 mAs. Which aspect of image quality will be
most affected?
a. Spatial resolution
b. Contrast resolution
c. Temporal resolution

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
c. Contrast resolution

Insufficient mAs will result in increased noise, which

primarily affects contrast resolution.

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