Medical Equipment II

(BIS 543)

X-Ray Computed Tomography (CT)

Dr. Ayman Eldeib

Spring 2012
Medical Equipment II CT

BIS 543

Modern Medical Imaging Techniques

X-Ray Computed Tomography (CT)

CT-principle: reconstruction of crosssections from projections

Spring 2012

Medical Equipment II CT

BIS 543

CT: History
CT founded in 1970 by Sir Godfrey Hounsfield
Engineer with EMI, LTD. First applications were in neuroradiology

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Medical Equipment II CT

BIS 543

Tomography
Tomography is imaging by sections or sectioning, through the use of any kind of penetrating wave.

Basic principle of tomography: superposition free tomographic cross sections S1 and S2 compared The image is perpendicular to the long axis with the projected image P. of the body
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Medical Equipment II CT

BIS 543

X-Ray Computed Tomography (CT)

X-ray Computed Tomography (CT) is a medical imaging method employing tomography created by computer processing. Computerized Axial Tomography (CAT) scan produces a volume of data which can be manipulated in order to demonstrate various bodily structures based on their ability to block the X-ray beam.

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Medical Equipment II CT

BIS 543

CT: Image Quality

Spatial resolution Ability to resolve small objects in an image Measured in lp/cm Contrast resolution Ability to differentiate small density differences in an image

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Medical Equipment II CT

BIS 543

CT: Attenuation Information

X-ray beam passes through patient Each structure attenuates X-ray

beam differently
According to individual densities Radiation received by detector

varies according to these densities

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Medical Equipment II CT

BIS 543

CT: Density Information

Transferred from detector to CT computer (A to D converter) Reconstructed by computer into a cross-sectional image Displayed on screen Each pixel displayed on monitor has varying brightness o The greater the attenuation, the brighter the pixel o The less attenuation, the darker the pixel Density values correspond to a range of numbers: Hounsfield scale
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Medical Equipment II CT

BIS 543

 A CT scan image consists of many cells, each assigned a number and displayed as a brightness level on the monitor. Each cell is called a pixel. The pixel is a 2-dimensional representation of a corresponding tissue volume. The tissue volume is called a voxel and is determined by the pixel size X the slice thickness (1-10mm).
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CT: Numbers

Medical Equipment II CT

BIS 543

CT: Numbers
The numerical information stored in each pixel is a CT number or Hounsfield Unit (HU). CT numbers range from -1000 to +1000 for each pixel: Water is defined as 0. -1000 corresponds to air while +1000 corresponds to dense bone. Soft tissues range from 0-100. Fat is -100.
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Medical Equipment II CT

Cont.

BIS 543

CT: Numbers
Enormous waste of information: Actual range of image is 2000 HU's or shades of gray. A video screen can only display 256 shades of gray. Therefore, windowing is needed.

Cont.

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Medical Equipment II CT

BIS 543

CT: Window Settings

The technologist or radiologist selects a CT number that is about the average CT number of the body tissue being examined. The computer is then instructed to assign one shade of gray to each of the 128 CT numbers below and each of the 128 CT numbers above. The center CT number is called the window level. The range of CT numbers above and below the window level is called the window width.

Spring 2012

Medical Equipment II CT

BIS 543

CT: Window Settings

Cont.

Window width Determines range of CT numbers displayed on an image o Values above this range = white o Values below this range = black Window level Sets the center CT number displayed on the monitor Determines the location on the Hounsfield scale about which the window width will be centered
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Medical Equipment II CT

BIS 543

CT: Basic Components

Gantry X-Ray Tube Detector Control Console

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Medical Equipment II CT

BIS 543

CT: Gantry
Houses the following: CT X-ray tube High voltage generator Detector array Data acquisition system Slip ring Can be angled from 15o-30o -this is useful in imaging the skull Table automatically positions the patient in exact increments.
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BIS 543

CT: The X-Ray Tube

Anode heat capacity
3.5 MHU up to 6.5 MHU
o Determines maximum mAs o Determines volume length o Dictates generator size

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Medical Equipment II CT

BIS 543

CT: Detector Elements

Capture energy that has not been attenuated by the patient. There are three main types:

Xenon detectors Solid-state detectors Multiple detector arrays

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Medical Equipment II CT

BIS 543

CT: Detector Elements

Xenon Detectors
Using high-pressure (about 25 arm) nonradioactive xenon gas, in long thin cells between two metal plates The sepra that separate the individual xenon detectors can also be made quite thin, and this improves the geometric efficiency by reducing dead space between detectors. The long, thin ionization plates of a xenon detector are highly directional For this reason, xenon detectors must be positioned in a fixed orientation with respect to the x-ray source. Therefore, xenon detectors cannot be used for fourth-generation scanners, because those detectors have to record x-rays as the source moves over a very wide angle Xenon detectors can be used only for third-generation systems
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Medical Equipment II CT

Cont.

BIS 543

CT: Detector Elements

Xenon Detectors
Xenon detectors for CT are ionization detectorsa gaseous volume is surrounded by two metal electrodes, with a voltage applied across the two electrodes As x-rays interact with the xenon atoms and cause ionization (positive atoms and negative electrons), the electric field (volts per centimeter) between the plates causes the ions to move to the electrodes, where the electronic charge is collected The electronic signal is amplified and then digitized, and its numerical value is directly proportional to the x-ray intensity striking the detector Xenon detector technology has been surpassed by solid-state detectors, and its use is now relegated to inexpensive CT scanners
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Medical Equipment II CT

Cont.

BIS 543

CT: Detector Elements

Solid-state Detectors

Cont.

A solid-state CT detector is composed of a scintillator coupled tightly to a photodetector. The scintillator emits visible light when it is struck by x-rays, just as in an x-ray intensifying screen The light emitted by the scintillator reaches the photodetector, typically a photodiode, which is an electronic device that converts light intensity into an electrical signal proportional to the light intensity. solid-state detectors typically have better x-ray absorption efficiency
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Medical Equipment II CT

BIS 543

CT: Detector Elements

Multiple Detectors Arrays

Cont.

Multiple detector arrays are a set of several linear detector arrays, tightly abutted. The multiple detector array is an assembly of multiple solid-state detector array modules. With multiple detector arrays, slice width is determined by the detectors, not by the collimator (although a collimator does limit the beam to the total slice thickness). To allow the slice width to be adjustable, the detector width must be adjustable. It is not feasible, Therefore, with multislice systems, the slice width is determined by grouping one or more detector units together. To combine the signal from several detectors, the detectors are essentially wired together using computer-controlled switches.
Spring 2012
Medical Equipment II CT

BIS 543

CT: Slice Thickness

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Medical Equipment II CT

BIS 543

CT: Multislice Fundamentals

Everything is better (R)esolution Z-axis, spatial, low contrast (S)peed (V)olume Thin slice - organ-specific coverage (P)ower Enough photons uncompromising image quality

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Medical Equipment II CT

BIS 543

CT: Control Console

Set scan parameters kVp, mA, scan time, reconstruction filter, etc. Set scan mode Digital radiograph, axial or volume Control the contrast to an optimum level by changing the brightness on the screen. Review and archive images Post-processing
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Medical Equipment II CT

BIS 543

CT: Image Reconstruction

e.g. Simple Backprojection Method

Assume that a very simple 2 x 2 image is known only by the projection values Using algebra (N equations in M unknowns), one can solve for the image values in the simple case of a 4-pixel image Simple backprojection starts with an empty image matrix (an image with all pixels set to zero), and the m value from each ray in all views is smeared or backprojected onto the image matrix.
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Medical Equipment II CT

BIS 543

CT: Scanning Methods

Digital projection
AP (anteroposterior projection, i.e. frontal), PA, Lat or Oblique projection Surview, Scanogram

Conventional CT
Axial
o Start/stop

Volumetric CT
Helical or spiral CT
o Continuous acquisition

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BIS 543

CT: Scanning Methods

Digital Projection
X-ray tube and detector remain stationary Patient table moves continuously With X-rays on Produces an image covering a range of anatomy Similar to a conventional X-ray image, e.g. flat plate of the abdomen Image used to determine scan location

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Medical Equipment II CT

BIS 543

CT: Scanning Methods

Conventional (Axial) CT
X-ray tube and detector rotate 360 Patient table is stationary
With X-rays on

Produces one crosssectional image Once this is complete patient is moved to next position
Process starts again at the beginning
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Medical Equipment II CT

BIS 543

CT: Scanning Methods

Volumetric CT

X-ray tube and detector rotate 360 Patient table moves continuously
With X-rays on

Produces a helix of image information

This is reconstructed into 30 to 1000 images
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Medical Equipment II CT

BIS 543

CT: Scanning Methods

Advantages of Volumetric CT

More coverage in a breath-hold

Chest, Vascular studies, trauma

Reduced misregistration of slices

Improved Multi-planar reformatting (MPR), 3D and Maximum intensity projection (MIP) images

Potentially less IV contrast required Gapless coverage Arbitrary slice positioning

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Medical Equipment II CT

BIS 543

CT: Generations
First Generation (Original EMI Scanner)

Translate-rotate mechanism Linear translation through the patient called a scan. Each scan is followed by a 1O rotation before beginning another scan. This continued until the tube had moved a total of 180O Pencil-thin X-Ray beam. A single paired detector. Scan time is up to 5 minutes per slice [Primary disadvantage of lst generation scanners].
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Medical Equipment II CT

BIS 543

Second Generation

CT: Generations

Major objective was to increase speed. Multiple detectors Incorporated the natural extension of the single detector to multiple detectors. 5-30 detectors now used Fan-shaped beam to be used ,with the multiple detectors. Also a translate-rotate mechanism, but Fewer linear scans are required because 30 detectors gather more data per scan. This allows greater rotary steps. Up to 30o rotation between scans instead of 1o Fewer linear scans result in faster scan times. [Scan times down to 20 seconds].
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Medical Equipment II CT

BIS 543

CT: Generations
Third Generation

Rotate-rotate mechanism. X-Ray tube and detector are rotated concentrically about the patient.

No linear translations
Larger fan-shaped X-Ray beam, 30o-60o. Larger number of detectors used to read the larger fan-shaped beam

[between 288-700 detectors].

Decreases scan time to as low as 1 second.
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Medical Equipment II CT

BIS 543

Fourth Generation

CT: Generations

Rotate-fixed mechanism.
Only the tube rotates. The detectors are fixed. Beam is fan-shaped as the 3rd generation.. Radiation detection is through a fixed circular array of detectors
[Up to 2400 elements in the detector array].

Capable of 1 second scan times.

No clear advantage between 3rd and 4th generation scanners.
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Medical Equipment II CT

BIS 543

CT: Generations

Spring 2012

Medical Equipment II CT

BIS 543

Helical Scanners

CT: Generations

Newest CT technology, available since 1990. Slip-ring technology allows continuous rotation of the tube Allows simultaneous translation and data acquisition. Continuous data acquisition can be achieved in a single breath hold. (360o rotation in 1 second or 1 rev/sec) Results in a dramatic increase in speed and consequently throughput. (20-40 seconds for HCT scan vs. 4-6 minutes with conventional CT) Increased 3D longitudinal resolution, optimizing image quality. Position and spacing of axial slices can be chosen after data acquisition. Radiation dose decreased slightly because of decreased repeats due to motion artifacts Image reconstruction takes time and can't be viewed immediately. (Patient can be removed after collection of the raw data)
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Medical Equipment II CT

BIS 543

Helical Scanners

CT: Generations

Cont.

During helical acquisition, the data are acquired in a helical path around the patient Before reconstruction, the helical data are interpolated to the reconstruction plane of interest. Interpolation is essentially a weighted average of the data from either side of the reconstruction plane, with slightly different weighting factors used for each projection angle. Helical scanning allows the production of additional overlapping images with no additional dose to the patient.
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Medical Equipment II CT

BIS 543

CT: Quality Assurance (Calibration)

CT scanners are subject to all the misalignment, miscalibration, and malfunctioning difficulties of a conventional x-ray unit. They have the additional complexities of the multimotional gantry, the interactive console, and the associated computer. Each of these subsystems allows more possibilities for drift and instability, resulting in degradation of image quality. Therefore, a dedicated quality assurance program is essential for each CT scanner. Such a program includes daily, weekly, monthly, and annual measurements and observations in addition to the ongoing preventive maintenance program.
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Medical Equipment II CT

BIS 543

CT: Quality Assurance (Calibration)

Device Water bath five-pin performance phantom Measurements Noise, spatial uniformity Linearity Interval Daily daily

Cont.

Edge, wire, or hole array Ramp Dosimeter Miscellaneous

Spatial resolution Slice thickness Dose Table incrementing light localizer, collimator
Medical Equipment II CT

Monthly Monthly Monthly Monthly

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BIS 543

CT: Quality Assurance (Calibration)

Five-pin test phantom

Cont.

The five-pins are each made of a different material with known physical and X-ray absorption properties, as shown in the following table :
Material Polyethylene Polystyrene Nylon Plexiglas Water
Spring 2012

Density (g/cm3) 0.94 1.05 1.15 1.19 1.00

Linear Attenuation Coefficient at 60keV 0.185 0.196 0.222 0.229 0.206

Medical Equipment II CT

Approximate CT number -85 -10 100 115 0

BIS 543

CT: Post Processing Options

Visualization of vasculature in relation to pathology
Show course of vessels Show stent placement Define vascular stricture

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BIS 543

CT: Post Processing Options

Cont.

Neuro-Angiography
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Medical Equipment II CT

Thin-Slice Spiral Neck

BIS 543

CT: Post Processing Options

Cont.

MasterCut
Panoramic View

MIP 4D-Angio

Renal Arteries
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Medical Equipment II CT

Thin-Slice Spiral Lungs

BIS 543

Questions ?

Spring 2012

Medical Equipment II CT

BIS 543