GROUP 3

TOPIC: IMAGE QUALITY AND QUALITY ASSURANCE

COURAGE MLAMBO
BLESSED CHARI
TINAISHE TIMIRE
Image quality

 refers to the clarity, sharpness, and level of detail present in the images produced
by the CT scanner.
 CT scans use X-ray technology and multiple cross-sectional image slices to create
detailed images of the body's internal structures.
 Many factors affect the quality of the image produced.
 Some of these variables can be regulated by the operator.
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Factors that the operator can control

 milliampere (mA) level

 scan time
 slice thickness
 field of view
 reconstruction algorithm
 kilovolt-peak (kVp)
Reconstruction algorithm

 Depending on the manufacturer, this feature may be called algorithm, convolution

filter, or simply filter.
 By choosing a specifi c algorithm, the operator selects how the data are fi ltered
in the reconstruction process.
 Changing the reconstruction algorithm will change the way the raw data are
manipulated to reconstruct the image.
slice thickness

 In general, thinner slices produce sharper images

 to create an image the system must flatten the scan thickness into two dimensions
 The thicker the slice, the more flattening is necessary.
Factors affecting image quality in ct

 Spatial resolution
 Contrast resolution
 Noise
 Artifacts
 Dose optimization
 Post-processing and visualization
Noise

 Noise in computed tomography is an unwanted change in pixel values in an

otherwise homogeneous image.
 Often noise is defined loosely as the grainy appearance on cross-sectional
imaging; more often than not, this is quantum mottle.
 Noise in CT is measured via the signal to noise ratio (SNR).comparing the level
of desired signal (photons) to the level of background noise (pixels deviating from
normal).
 The higher the ratio, the less noise is present in the image.
 Noise in a cross-sectional image will equal a decrease in the picture quality and
inadvertently will hinder the contrast resolution.
Factors affecting noise

 mAs
 Slice thickness
 Patient size
 Reconstruction algorithm
 Noise metrics
 Magnitude
 Texture
 Non-uniformity
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Spatial resolution

 refers to the ability of the CT scanner to differentiate small structures within an

image.
 Higher spatial resolution means better detail and sharpness in the image.
 It depends on factors like the size of the X-ray beam, the number of detectors, and
the pitch of the scanner
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Contrast resolution

 refers to the ability of the CT scanner to differentiate between tissues with similar
densities.
 It affects the ability to distinguish between different types of tissues, tumors, or
abnormalities.
 Better contrast resolution allows for more accurate diagnosis.
 It is influenced by factors like X-ray tube voltage, tube current, and image
reconstruction algorithms.
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Artifacts

 These are undesirable features in the CT image that do not represent the true
anatomy.
 They can occur due to various reasons like metal implants, patient motion, beam
hardening, or image reconstruction errors.
 Artifacts can degrade image quality and lead to misinterpretation.
 Techniques like metal artifact reduction algorithms and motion correction can
help minimize artifacts and improve image quality.
Dose optimization

 CT scans involve exposure to ionizing radiation.

 It is important to balance image quality with radiation dose to ensure patient
safety.
 Advancements in CT technology have led to dose reduction strategies like
automatic exposure control, iterative reconstruction algorithms, and low-dose
protocols.
 These techniques aim to maintain high image quality while minimizing radiation
exposure.
Post-processing and visualization

 A number of factors can degrade the post-processed images, reducing their

usefulness in diagnosis.

 Advanced post-processing techniques like multi-planar reconstruction, maximum

intensity projection, or volume rendering can enhance the visualization of specific
structures or abnormalities.
 In addition, the radiologist interpreting these images must understand the type of
images being viewed, and the various limitations and strengths of different
rendering and segmentation techniques.
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Quality Assurance (QA)
 optimization of image quality and dose to the patient
 plays a vital role in ensuring safe and effective examinations
 makes sure a CT system is producing the best possible image quality using the minimal radiation
dose to the patient
 provides methods for the systematic monitoring of the system’s performance so problems can be
identified and corrected
QA Program Concepts

 the tests that make up a program must be performed on a regular basis

 The results from all the tests must be recorded using a constant format
 documentation should state whether the tested parameter is within specified
guidelines
QA Phantoms

 Many aspects of image quality can be evaluated using phantoms

 Most phantoms are designed with many components so that a single phantom can
be used to examine a broad range of scanner parameters
CT Number Uniformity
 it relates to the fact that a CT number of each pixel in the image of an homogeneous object
should be the same over various regions
 the difference in the CT number between a peripheral and a central region of an homogeneous
test object should be < ± 4 HU
 CT number uniformity can be assessed at the same time as measuring noise, by placing four
additional ROI (N, E, S and W) at positions near the edge of the image of a uniform phantom
 Mean CT number is then noted for these four regions, as well as the central one
 The deviation from the central value should be calculated and the tolerance should be < ± 4 HU
 test is performed on a weekly basis
Axial image of an homogenous phantom
CT Number Linearity
 It concerns the linear relationship between the calculated CT number and the linear attenuation
coefficient of each element of the object
 Deviations from linearity should be < ± 4 HU
 CT number linearity is assessed using a phantom containing inserts of a number of different
materials (materials should cover a wide range of CT numbers)
 test is performed semi-annually
Noise
 noise is generally assessed using cylindrical phantoms, which are either filled with water or made
of a tissue equivalent material
 Noise = 1/√dose
 once an axial image of the phantom has been acquired, noise is obtained from the standard
deviation in CT number in a region of interest (ROI) placed centrally within the image
 noise figures given in manufacturers’ specifications are quoted for a specific phantom (e.g.
manufacturer’s QA phantom) and for specified scan parameters
 dose for axial scans can be measured by taping an ion chamber to the surface of the phantom
 the tolerance of the measured value from the specified value should be ± 15%
 test is done on a weekly basis
Spatial Resolution Test (High Contr)
 can be evaluated using a line pairs phantom which contains groups of lead strips having different
strip width and spacing
 the resolution is given as the number of visible line pairs (lead strip and space) per millimeter
 the spatial resolution measured should be equal to the manufacturer’s specifications for that
scanner at minimum ±0.5 lp/cm discrepancy
 measurement using line pairs is considered subjective
 test is performed monthly
Line pairs phantom
Contrast Resolution Test (Low Contr)

 to evaluate contrast resolution a phantom is used that contains objects of varying

sizes.
 these objects have only a small difference in density from their background.
 the phantoms are scanned at different mAs settings
 an observer is then required to detect objects as distinct
 test is performed on a monthly basis
Radiation Dose
 to monitor the amount of radiation to which patients are exposed
 measurements are made using standard head and body CT dose index (CTDI)
phantoms and a pencil ionization chamber.
 the CTDI is a measure of dose from a single rotation of the gantry
 measurements are made in the centre of the phantom and in several locations on
the periphery and averaged in order to derive a weighted value (CTDIw)
 the CTDI values produced are compared to reference dose values
 tolerance should be ± 20 % of the quoted value
Laser Light Accuracy Test

 test for laser lights located both inside and outside the gantry
 a specific phantom designed for the purpose and provided by the scanner
manufacturer is used
 The light field should coincide with the radiation field to within 2 mm.
 This test is usually performed semiannually.
Slice Thickness Accuracy
 measurements of selected slice thickness are determined using a phantom that
includes a ramp, spiral, or step-wedge
 the phantom contains objects with known measurements and provides a standard
to compare with the scanner
 for a slice thickness of 5 mm or greater, the slice thickness should not vary more
than ±1 mm from the intended slice
 for a slice thickness of less than 5 mm, the slice thickness should not vary more
than ±0.5 mm
 this test is usually performed semiannually
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