Академический Документы
Профессиональный Документы
Культура Документы
Beijing, China
Imaging for Radiation Treatment Planning II: CT: Principles & applications. Howard Amols, Ph.D. Memorial Sloan Kettering Cancer Center New York, USA
1.0 hr
IA
EA
Acknowledgements
Many slides kindly provided by Dr. Lawrence N. Rothenberg, Member Emeritus, Memorial Sloan Kettering Cancer Center
IA
EA
Talk Outline 1.History and Properties of CT Scanning 2.Commissioning and Quality Assurance 3.Using CT for 3D treatment planning
IA
EA
IA EA
IA
EA
Radiography - Disadvantages
Two-dimensional image of three-dimensional object Poor low contrast performance However, Doses are low (entrance surface): PA Chest-0.1 mGy, Skull-2 mGy, Abdomen-4mGy, Hand-0.3 mGy CT doses are several cGy (10 mGy = 1cGy = 1 rad = 1000 mrad)
IA
EA
Two Images
Radiography Computed Tomography
IA
EA
What is CT?
X-ray CT is a cross-sectional imaging modality that derives a two dimensional distribution of x-ray attenuation from one dimensional projections In x-ray CT, the primary quantity is attenuation, derived from transmission measurements Using a stack of relatively thin slices, the three dimensional problem is reduced to a two dimensional one
IA
EA
Axial CT: Scanner rotates, then patient/couch translates to measure the next slice, rotate, translate, etc. Helical or spiral CT: continuous motion of couch and gantry rotation
IA
EA
Computed Tomography
Image shows gray levels for Hounsfield units associated with each of 5122 pixels Typical settings: 120 - 140 kV, 200 - 300 mA (Note: 80 or 100 kV being used to reduce dose and/or enhance iodine contrast, lower mA for screening or pediatric exams to reduce dose) Gantry rotation times: 0.33s to 2.0 s depends on CT scanner design and type of exam
IA
EA
IA
EA
History of CT
1895 Roentgen discovers X-rays 1917 Radon solves mathematical problem of determining a 2D distribution from its 1D projections (or line integrals) 1958 Soviet scientists develop plans for x-ray CT scanner. Work unknown outside of USSR until many years later 1960s Oldendorf, Cormack, and Kuhl independently investigated this concept in medical imaging 1967 Hounsefield initiates development of an x-ray brain CT scanner for clinical use at EMI Ltd. (some money came from the Beatles!) 1971 First CT scanner installed at Atkinson Morely Hospital, London 1972 First scanners installed in US 1975+ CT scanners first used for radiation therapy 3D treatment planning 1979 Hounsfield and Cormack share Nobel Prize for Medicine 1989 First Spiral CT scanners 1998 First Multi-slice CT scanners 2000 > 3000 clinical CT installations
IA
EA
Before CT:
IA
EA
Toshiba TAT
IA
EA
IA
EA
Early CT development
EMI Mk1 head only scanner, introduced 1971 1st generation, i.e. translate-rotate geometry, parallel rays, pencil beam, one NaI detector per slice 180 rotation, 5 mins per acquisition (2 slices), 5 mins per reconstruction Only 160 x 160 matrix Water bag/box
IA
EA
EA IA
Front View
Rear View
IA
EA
4 Generations of CT Scanners
First generation: pencil x-ray beam and a combination of translation and rotation
IA
Third generation: fan beam and a combined rotational motion of the x-ray source and ~ 500 to 900 detectors Fourth generation: rotational motion of the x-ray tube and a stationary array of ~ 1200 detectors
EA
Second generation: fan x-ray beam, multiple detectors and a combination of translation and rotation
Note: Tomotherapy is based on the concept of helical CT, except kV x-ray tube is replaced by 6MV Linac
IA
Patient couch continuously translates
EA
table movement (mm) per rotation Pitch collimator width (mm) at isocenter
Note: Pitch < 1.0 means slices overlap. Gives better image quality, but 21 higher patient dose and longer scan times. Required for respiratory gated scans.
IA
EA
IA
EA
IA EA
Key:
1. Tube, 2. Collimator, 3. Tube Controller, 4. HV Gen (-), 5. Detector, 6. DAS, 7. HV Gen (+), H. OB Comp., 9. Stat Comp.
IA
EA
X-ray tubes
IA
EA
IA EA
IA EA
Note: detector response time must be < 1ms: >1000 projection images acquired during <0.5 sec scan rotation.
IA
EA
IA
EA
IA
EA
Note: Massive amounts of imaging data acquired by a busy Department Terabytes/yr. >40% of all digital data in the entire world will soon be medical images! Need PACS.
IA
EA
IA
EA
Note: Results from fact that linear attenuation coefficient is proportional to electron density AND atomic number (Z3)
IA
EA
IA EA
CT reconstruction
1. Each slice in the patient consists of 512x512 pixels 2. We make thousands of individual attenuation measurements thru the slice from many directions 3. Essentually, `x unknowns (voxel attenuation values) and `x equations (attenuation measurements 4. Can in principle be solved as `x simultaneous equations
IA
EA
Rearranging with measurable or known quantities on the left, and the unknowns to be determined on the right -(1/x)ln(I/Io) = (1 + 2 + 3 + 4 + 5 ++ n)
IA
EA
CT reconstruction
Note: Although mathematically correct, solving thousands of simultaneous equations is not a practical way to calculate image reconstructions.
IA
EA
Backprojection
IA
EA
IA EA
Filtered Backprojection
IA
EA
IA EA
IA
EA
CT Numbers - HU
IA
EA
IA
EA
EA IA
IA
EA
33 cm
IA
EA
47
IA EA
48
IA
EA
Air Brass
Aluminium
Steel
IA
PMMA
EA
39760 (saturated?)
838.220.92%
50
Steel
IA
PMMA
EA
80000 (saturated?)
2012.667.75%
51
IA
EA
IA
EA
Operating parameters
X-ray Tube Voltage (kVp)
X-Ray Tube Current (mA) Scan Time (sec) Beam On - Start Angle Scanner Rotation Angle
Filtration
Patient Orientation
Source Collimation Slice Thickness
IA
EA
IA
EA
IA
EA
56
IA
EA
GE Medical Systems
IA
EA
Effective Dose, E
(Prev. Effective Dose Equivalent, HE)
Thorax: 11 - 15 mSv (Gelieijns) Abdomen: 15 - 20 mSv Head: 1 - 2 mSv Note: CTDIvol Higher for Head
IA
EA
Same Probability of Occurrence of Cancer and Genetic Effects as for Whole Body Uniform Dose
CT Simulation
CT simulator combines some of the functions of imaging for radiation therapy planning, the computerized treatment planning system, and the conventional simulator CT Simulator contains: CT Scanner Patient couch that simulates Linac treatment couch Laser localization System similar to Linac treatment room lasers Computer graphics workstation image manipulation, target volume and normal tissue delineation, beam geometry display Interface to treatment planning system: scanner can export images, contours, plus isocenter coordinates to treatment planning system via electronic network or via `sneaker net
IA
EA
Simulation Procedure
IA
Patient Positioning and immobilization Scouts for patient alignment CT Scan Isocenter definition Isocenter Marking using laser localization system Isocenter tattoos and bi-angulation or triangulation tatoos, cast lines
EA
IA EA
IA
EA
IA EA
IA
EA
IA EA
(Contouring)
IA
EA
IA EA
IA EA
IA EA
IA EA
IA EA
IA EA
IA EA
Third Generation
IA
EA
IA EA
IA EA
Helical Scanning
IA
EA
IA
EA
Rays
IA
EA
Views
IA
EA
Multi-slice CT pitch
Where
IA
EA
IA
EA
GE Lightspeed 16
IA
EA
Detector Pitch
Table movement (mm) per 360-degree rotation of gantry Detector width(mm) at isocenter
Collimator Pitch
Use collimator pitch for MDCT to be consistent with pitch for single slice
IA
For MDCT:
EA
Collimator Pitch
Table movement (mm) per 360-degree rotation of gantry Collimator width(mm) at isocenter
Detector Pitch N
85
CTDI Ideal = 1 T
D 1 (z) dz
-
CTDI Reg =
1 nT
-7 T
+50 mm
D (z) dz
CTDI 100 =
CTDIw =
1 nT
-50 mm
IA
EA
(New IEC CT Dose Quantity)
(New IEC CT Dose Quantity)
+7 T
Volume CTDI
Spiral: CTDIvol = CTDIw / Pitch or Axial: CTDIvol = CTDIw * NT/I
IA
EA
Operating parameters
Bolus
The Patient Size and Tissue Composition Anatomy Being Imaged Generally: Increased Dose Provides Better Low Contrast Performance
IA
EA
Repeat Scans
IA EA
IA EA
IA EA
IA EA
IA EA
IA EA
IA EA
Normal tissue damage vs. radiation dose for organs with large volume effect (e.g., liver, lung, kidney)
1.2
0.8
NTCP
2/3
EA
1/3
100 Dose (Gy) 150
1/6
0.4 0.2 0 0
IA
50 200
0.6
Normal tissue damage vs. radiation dose for organs with small volume effect (e.g., spinal cord, optic chiasm)
1.2
0.8
NTCP
0.4 0.2 0 0
IA
50 100 Dose (Gy) 150 200
0.6
EA
IA
EA
Conventional Radiography
IA
EA
Helical, or Spiral CT
The Patient couch advances at a constant speed through the gantry while the x-ray tube rotates continuously around the patient (slip ring technology) The acquired transmission data can be reconstructed to provide images at any point along the patients axis during scan and slices as thin as 1 mm can be obtained quickly Reduces conventional scan times of 20-30 min to 5-10 min Pitch distance, in mm, the couch moves during one revolution of the x-ray tube Pitch Factor pitch divided by the collimated slice thickness (range between 1 and 2)
IA
EA
IA
EA
Multi-row (slice) CT
IA
EA