Announcement

Computed Tomography: Principle and Applications

Mid-term exam : 9 March 2015

Prof. Defeng Wang
Department of Imaging and Interventional Radiology,
The Chinese University of Hong Kong
Email: dfwang@cuhk.edu.hk

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CT image principle

Overview

CT image principle

CT data acquisition

100 years ago, a German scientist Roentgen discovered X-ray, which

Helical CT

enables people to

Multi-slice CT

Image formation

view the anatomic structure of human body without operation

Image quality

Image reconstruction and visualization

Surface rendering

Disadvantages:

MIP, MinIP and Volume rendering

Superimposed image

Virtual endoscopy

Clinical applications

Couldnt view soft tissues generally

Conventional CT

CT Perfusion

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CTA
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History of CT scanner

Cont.
The helical and multi-slice CT scanners were introduced in

In 1972, Godfrey N. Hounsfield developed the first clinically

1989 and 1998 respectively, so that CT has opened the way

useful CT scanner

to 3D images of the heart and dynamic (4D) studies.

Based on the mathematical and experimental methods developed

by A. M. Cormack;
With CT scanner, we could view

Both shared the Nobel Prize in physiology or medicine in 1979.

On the day he won the Nobel prize in 1979, Hounsfield had some home-spun words of advice for all would-be Nobel

1. Tomographic or slice anatomy

prizewinners: "Don't worry too much if you don't pass exams, so long as you feel you have understood the subject. It's
amazing what you can get by the ability to reason things out by conventional methods, getting down to the basics of what

2. Density difference

is happening."

In 1974, Robert S. Ledley developed the first whole-body CT

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scanner.

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Characters

Notion of CT:

Computed tomography (CT):

Computed tomography (or computerized axial

tomography) is an examination that uses X-ray and
computer to obtain a cross-sectional image of the human

an image modality that produces cross-sectional image

representing the X-ray attenuation properties of the body.

Cross-sectional image formation is based on the following
procedure:

body.

I. X-ray tube produces x-rays

II. X-rays are attenuated when going through the body
III.X-rays are measured by an X-ray detector
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CT device:

CT contrast
 For clear visualization of vessels or lymphatic system, general CT
scanning may produce misdiagnosis.
 Sometimes CT contrast is essential before CT scanning.
 Urografin
 Omnipaque (iodine compound)
 However, contrast injection may cause side-effect:

(a) Schematic representation

(b) CT scanner

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1.

Emesis

2.

Palpitation

3.

Urticaria

4.

Edema

5.

Spasm

6.

Shock

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X-ray

X-ray beams

X-ray beams, a set of lines, which covers the entire field of

view (FOV);
Repeat scanning for a large number of angles and generate line
attenuation measurements for all possible angels and distances
from the center;
The actual attenuation at each point of the scanned slices can be
reconstructed from all the previous measurements.
(a)Parallel x-ray beams;(b) fanned x-ray beams;(c)repeated process of (a) with
rotation;(d)repeated process of (b) with rotation.
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X-ray Attenuation

Cont.

When X-ray passes through objects, it will be attenuated (energy reduction)

The X-ray absorption is proportional to the density of object.

by two ways:
 Absorption
 Scattering (not considered in CT)
More attenuation

Less attenuation

Lambert-Beer Law:

where I is the transmitted X-ray energy after absorption, Io is the incident Xray,

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is absorption coefficient,

is the object thickness.

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Risks of CT

Cont.

Iodine is the usual contrast dye. Some patients are allergic to

iodine and may experience a reaction that may include nausea,
breathing difficulty, or other symptoms.

For an object with n voxels, there is

Radiation exposure during pregnancy may lead to birth defects.

With scanning times of n or more than n,

The amount of radiation during a CT procedure should be

reduced to produce the least harm to people; CT scan should be
carried out when it is really necessary.

could be computed and the CT values could be obtained.

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CT number

CT number of different organs and tissues

In reconstructed CT images, the value of each pixel (intensity

value) represents the CT number which is defined as following

: the linear attenuation coefficient

: Hounsfield unit (HU)
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CT data acquisition design

Window and Level

Helical CT

Window size: the width of the displayed gray level interval

Window level: the center of the displayed gray level interval

For soft tissues

For lungs

(a)

 Widely used nowadays

 Table translates and the x-ray tube rotates continuously
around the patient
table feed (TF)
TF=axial translation per tube rotation
z=slice thickness
pitch:
pitch = TF/z
Typical pitch ratio: 0.5, 1.0, 1.375, 1.5, 2.0

(b)

CT image of chest:(a) Window size=1600,level=-600;(b) window size=400,level=40

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Larger pitch?

Faster scanning, worse quality

Smaller pitch?

Better quality, slower scanning

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Cont.

The 4C of Helical CT

 Continuous source rotation with the patient translation

 Continuously rotating tube/detector system

through X-ray beam

 Patient couch moves as X-ray tube rotates

 Continuously generating X-ray

 Continuously table feed
 Continuously data acquisition

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Scanning mode

Cont.

Image reconstruction continuously

Overlapping image reconstruction

SliceThickness

Slice Thickness

}}

Overlap

TF=thickness

TF<thickness

1. No overlap

1. Overlap of slices

2. No gap

2. More images created

{
Increment
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{
Increment
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Advantages and limitations of helical CT:

Cont.
Image reconstruction with gaps

Advantages:

Slice Thickness

A. Examination time is greatly reduced and patient comfort is much

improved.
B. Image noise is usually less with helical CT.
C. Helical CT has no inter-scan delay.

TF>thickness
1. Gaps between slices

D. Helical CT misses no anatomy in the scanned volume for no-gaps

scanning.

2. Less images created

Limitations:
As more data is acquire in helical CT, image reconstruction takes more time
(interpolation needs more time than conventional CT).

{
Increment

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Cont.

Multi-slice CT

More than one detector,

while traditional only have
one

Advantages:
 Same acquisition in short time

Multi-slice CT is a development of conventional helical CT, with multiple

detectors on the opposite side of X-ray beams, which enables multiple images
acquisitions.
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 Thin slices give better z-axis resolution

 Scan larger volumes in the same time
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Detectors

Cont.

A CT slice of the chest showing the lungs using single-slice and multislice CT scanners. The image acquired from multi-slice CT gives better
quality.

Fixed detector length: flexible combination, convenient thickness change

Variable detector length: less detectors number, less X-ray absorption
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Different X-ray detectors

Cont.

Scintillation crystal with photomultiplier tube (PMT)(

)
(scintillator: material that converts ionizing radiation into
pulses of light)
high absorption efficiency
low packing density
PMT used only in the early CT scanners

Gas ionization chambers()

replace PMT
X-rays cause ionization of gas molecules in chamber
ionization results in free electrons/ions
these drift to anode/cathode and yield a measurable electric
signal
lower absorption efficiency than PMT systems, but higher
packing density

Resolution can be improved

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Cont.

Cont.

Scintillation crystals with photodiode ()

current technology
Scintillator material converts X-rays into visible light, which
hits the photodiode, causing it to produce measureable electric
current
high absorption efficiency
very fast response time

Photon counting detectors()

recent detector
Can reduce the dosage
based on direct conversion
Direct conversion material (cadmium telluride or cadmiumzinc-telluride) converts x-ray photons into electronic charges
proportional to photon energy
Produced charge is 10 times larger than that produced by the
scintillator/ photodiode combination
Electronic noise no longer dominates the signal

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Image formation

Cont.
Know the meaning and 90 degree
projection

The Fourier-slice theorem

where F(u,v) is the Fourier transform of f(x,y),

is the Fourier

transform of one CT projection whose direction is /2+ relative to x-axis.

The formula states that the FT of a projection is a slice (orthogonal to the projection
direction) from the 2-D FT of the original image.
Illustration of the Fourier-slice theorem.

After break, talk a little before T1

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CT image reconstruction

Cont.

For a image f(x,y), it can be expressed as

By letting

With the theory of integral calculus, the final result is as

Inside is 1D, outside is 2D
following:
and

The inner expression is in the form of an inverse 1-D FT, with the
added term .
From Fourier-slice theorem,

Usually a window is applied to the ramp filter

the hamming function is used.

. Practically,

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Cont.

Cont.
CT reconstruction procedure:
1. Compute the 1-D FT of each projection.
2. Multiply each FT by the filter function

which has been

multiplied by a suitable (e.g., Hamming) window.

3. Obtain the inverse 1-D FT of each resulting filtered
transform.
4. Integrate (sum) all the 1-D inverse transforms from step 3.
(a) Frequency domain plot of filter |w| after band limit with a box filter.(b)
Spatial domain representation.(c) Hamming windowing function.(d) Windowed
ramp filter, formed as the product of (a) and (c).(e) Spatial representation of the
product (note the decrease in ringing).
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Image quality

Cont.
Number of projections

The spatial resolution of a CT image depends on the

If there are more projections, more data are available for

following factors:

image reconstruction and improvement on spatial resolution

size of focal spot

If the focal spot size increases, more geometric unsharpness
introduced, thus decreasing spatial resolution.
detector width
Higher spatial resolution is able to be obtained for smaller
detector element sizes.
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Cont.

Cont.

Slice thickness
Smaller slice thickness improves spatial resolution, since
partial volume effect is less.

Pixel matrix
The number of pixels used to reconstruct the CT image has
a direct influence on spatial resolution under a fixed FOV.
Increasing matrix size for fixed FOV can improve spatial
resolution (e.g. 512*512->1024*1024)

CT images of lungs with different slice thickness

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Cont.

Cont.

Noise
quantum noise or statistical noise, electronic noise
quantum noise is dominant
Number of noise rely on:
the total exposure
increasing power reduces noise but increases patient dose
the reconstruction algorithm
Both the applied filters and the interpolation methods influence
the image noise
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Cont.

Cont.
Contrast between an object and its background depends
primarily on:
1. their attenuation properties
2. a variety of physical factors
the spectrum of the X-ray tube
the amount of beam hardening

Artifact-free reconstruction of a
simulated water bowl with iron
rod.

Same slice reconstructed after

noise was added.

a number of low energies x-rays are absorbed

scatter
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Cont.

Cont.

Artifacts
Normal phantom (simulated plexiglas
plate with three amalgam fillings)
Normal phantom (simulated water
with iron rod)

Beam hardening artifacts

Aliasing artifacts when the number
of detector samples is too small
(ringing at sharp edges)
Scatter
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Cont.

Cont.
Stairstep artifacts

Motion artifacts
movement of an object

Normal phantom (simulated plexiglas

plate with three amalgam fillings)

happen when the helical pitch is too large.

Motion artifacts caused by a short

movement of the iron rod
The stairstep artifact is visible in 3D images as a helical winding along inclined surfaces.

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Image reconstruction & visualization

Cont.
Other artifacts:
Metal artifacts are due to a combination of beam hardening,
scatter, nonlinear partial volume effect, and noise

Image reconstruction and visualization are important:

The development of CT technique makes it urgent and
essential to visualize 3-D organs and tissues.

3-D reconstruction enables better data visualization and

CT image of a slice through the

prosthesis showing steak artifacts
due to the metallic implant.

diagnosis.

3-D visualization avoids doctor from 2-D data sea,
which may cause misdiagnosis due to mass 2-D images.

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Marching cubes algorithm

Surface rendering-Surface shaded display (SSD)

SSD recognizes tissue by its intensity and shows the surface of the organs
as an opaque object.

For surface rendering,

The 8 voxels from neighboring slices are used to form a

 Predefined thresholding value is necessary in SSD.

cubic.

 Using shading technique for visualization.

Voxels with intensity values larger than the preset

thresholding value are assigned as inner(outer) voxels;
otherwise, they are outer(inner) voxels.

The iso-surface can be constructed with triangulations
according to the distribution in the former step.
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Cont.

Cont.

A 2-D example. Each point of the grid has a weigh

(intensity) and the thresholding value is 5 here.
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Cont.

Possible iso-surfaces in 3-D reconstruction.

Advantages and disadvantages of surface rendering

A 3-D surface rendering example:

Advantages:

 Produces binary images, which is convenient for interaction.

 Strong sense of reality.
 Completely provide 3D anatomic morphometry.
Disadvantages:

 SSD doesnt provide any densitometric information.

 The rendering result is sensitive to the thresholding value.
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MIP, MinIP and volume rendering

Cont.

Maximum intensity projection (MIP)

If the pixel value of the projected image is equal to the voxel that has the
highest value along the way, the result is MIP image.
The contrast of MIP is high
and it is widely used in
structures and tissues with
high density, like vessel,
bone, lung tumor
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Cont.

MinIP

A disadvantage of MIP is that the voxels whose value is not the highest along
Minimum intensity projection (MinIP)

the way are not represented.

Hypo-intense structures within hyper-intense structures can be masked because

If the pixel value of the projected image is equal to the voxel that has the lowest

only the material with the highest intensity along the projected ray is

value along the way, the result is MinIP image.

represented.

(a) show clearly the dissected flap. Performing MIP with increasing thickness,the
dissected flap disappears (b-c).
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Volume rendering (VR)

Cont.
MinIP is mainly used in the visualization of airway, and sometimes for that
of bile duct in liver.

Volume rendering utilizes the entire volume data (for MIP or MinIP, only 10%
are used), calculates the contributions of each voxel along a line from the
viewers eye through the data set, and displays the resulting composition for
each pixel of the display.

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Cont.

Cont.

VR involves 3 principle parts:

1.

The forming of an RGBA volume from the data

2.

Reconstruction of a continuous function from this discrete data set.

3.

Projecting the result onto the 2-D viewing plane from the desired point of
view.

The opacity contribution may range from 100% to 0%, which has an
First row: VR result

significant impact to the result.

Second row: opacity function

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VR advantages and disadvantages

Virtual endoscopy
Endoscopy is a way to see inside the body to screen and cure.

Advantages:
Thresholding value is not necessary in VR and all the voxels are used.
Voxels classification can be fuzzy (i.e., gradual changed opacity function).
VR can be used on data with unapparent boundary.

Disadvantages:
As the semitransparent projection with overlapping, VR is awkward to determine

Conventional endoscopy

spatial relationship.

Advantages:

The reconstruction is slow as the entire data is used.

Minimal invasive
High resolution

Painful and uncomfortable

Limited exploration

interactivity

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Disadvantages:

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Cont.

Cont.
Virtual endoscopy combines strengths of previous alternatives on

Virtual endoscopy is the navigation of a virtual camera through

patient-specific dataset:

the 3D reconstruction of a patients anatomy .

-spatial exploration
-cross-correlation with original volume

Adjusting the parameters

It is compact and intuitive to explore huge

based on the volume

amount of information.

rendering result:

Clinical studies:

Thresholding value

 Planning and post-operation: generates views

that are not observable in actual endoscopic

Opacity

examinations

Lighting

Perspective direction
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 color coding algorithms give supplemental

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Clinical Applications
Conventional CT

Cont.
thorax

head and neck

Subsequent CT slices through the brain show a subdural hemorrhage as a

hyperdense region along the inner skull wall (short arrows). This blood collection
causes an increased pressure on the brain structures with an important displacement
of the midsagittal line (long arrows)
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CT of the chest. (a) Mediastinal and (b) lung window/level settings, and (c) coronal
resliced image. The images show a congenital malformation of the lung located in
the left lower lobe. Notice the two components of the lesion: a dense multilobular
opacity (arrow) surrounded by an area of decreased lung attenuation (arrow heads)
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Cont.
urogenital tract

Cont.
abdomen

(a) Axial CT slice through the kidney showing a perirenal liposarcoma in

the nephrographic phase after intravenous injection of contrast medium.
(b) Reformatted coronal CT slice at the level of the aorta of the same
patient
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(a) A CT slice through the colon shows a polyp (arrow).

(b) A virtual colonoscopy program creates a depth view of the colon with
polyp (arrow) and allows the clinician to navigate automatically along the
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Cont.

Cont.
musculoskeleton

Liver
Dual phase liver exam

(a) On a sagittal reformatted CT image, an anterior-posterior course of an

acetabular fracture is visible.
(b) A 3D view on the acetabular surface more clearly localizes the course of the
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Venous phase
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CT perfusion

Post-processing
3D segmentation

Arterial phase

3D bronchoscopy

Perfusion is the passage of fluid through the lymphatic system or blood

vessels to an organ or a tissue. The practice of CT perfusion is the process
by which this perfusion can be observed , recorded and quantified.

No contrast enhancement is seen within the first 9 s. At 18 s early contrast is seen

within a CT Spot Sign, peaking at 36 s. Dissipation of contrast material is seen on
delayed image at 36 s .
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Cont.

Cont.
Images to the left show a brain scan where the arrows point to a dark area.
Image to the right is the same as on the left, but it has been converted to a color
map.
The red area indicates low perfusion in this part of the brain.

Why CT perfusion is needed?

 Brain infarction/thrombosis diagnosis.

When should CT perfusion be performed?

 After standard brain scan and no bleeding
is perceived.
 Suggested by neurologist and radiologist.

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Cont.

CT angiography

Upper picture to the left shows a normal CT image using perfusion protocol.
The other images show different parameters. E.g., BF (blood flow),
BV(blood volume),MTT(mean transit time)...

CTA uses a CT scanner to produce detailed images of both blood vessels

and tissues in various parts of the body.
 An iodine-rich contrast material (dye) is usually injected through a small
catheter placed in a vein of the arm.
 A CT scan is then performed while the contrast flows through the blood
vessels to the various organs of the body.
 After scanning, the raw data will be processed using computer and
reviewed in different planes and projections.

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Cont.

Cont.
Head CTA

CT angiography of the head in sagittal view.

Vascular Malformations
Circle of Willis

Aneurysms

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Cont.

Cont.(CTA)

Neck CTA

Benefits
examine blood vessels in many key areas of the body, including the brain,

Carotid

kidneys, pelvis, and the lungs.

bifurcations

displays the blood vessels more precisely than MRI or ultrasound.

a useful way of screening for arterial disease
Vertebral
arteries

safer and much less time-consuming

Risks

Aortic arch

may cause allergic reaction

should be avoided in patients with kidney disease or severe diabetes
significant dose of ionizing radiation with repeated examinations
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CT development tendency

Cont.

Fast scanning with thin slice

Low dose

The development of CT scanner enables thin slice scanning.

-multi-slice CT

In the past, CT development focused on acquiring better quality

image with lower noise.

For the same scanning target:

CT scanner
4-detector CT
16-detector CT
64-detector CT
640-slice CT

-resulted in high dose

Recently, lower dose CT scanning becomes a hot point.

Time
15s
<3s
<1s
The whole heart in
one scan

e.g. 64-detector CT scanner of Toshiba halved the dose without

influence image quality using advanced reconstruction algorithm.

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Cont.

Pre-operation planning

3D visualization

Femoral prosthesis implantation

As the CT slice become thinner, radiologists have to view a large

number of CT images.
-several hundreds or even more than 1,000

An effective way to solve this problem is to convert these 2D
images to 3D space.
3D visualization :
1. Image-guided biopsy / intervention
2. Pre-operation planning
3. Surgical operation navigation
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References

Operation navigation
Surgery Navigation for Hearing Aid Implant

[1]http://ebooks.cambridge.org/ebook.jsf?bid=CBO9780511596803
[2]Suetens P. Fundamentals of medical imaging[M]. Cambridge University Press, 2009.
[3]Gonzalez R C, Woods R E. Digital image processing[J]. 2002.
[4]http://users.polytech.unice.fr/~lingrand/MarchingCubes/applet.html
[5]http://www.clg.niigata-u.ac.jp/~tsai/home-page/lecture/3D_reconstruction.htm
[6]http://www.radiologyinfo.org/en/info.cfm?pg=angioct

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Thank you!

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