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X ray CT MRI
History Conventional tomography vs Mechanism
CT
Energy - types -characters Spinning precession -
of EMW Mechanism alignment - NMV - Larmor
equation - MR active nuclei -
Photon - ray - beam - Disadvantages of x ray -
common atom and molecule
projections- EV indications of ct
- excitation - relaxation - flip
Definition - Mechanism - History angle - FID
characters
Components of scanner Components of MR scanner
Components of X ray tube
Scanner generations Spatial encoding
Focal spot - angular
DSCT K space
projections
Types of scanning Types of pulse
Filtration - grid device
Steps of image formation TR - TE - Pulse sequence
Limitation
CT number - window Factors of image quality
Types of interaction
Types of resolution Types of relaxation
Types of detectors
mechanisms - T2*
Factors of image quality -
X ray vs mammography
according to steps Factors of MR signal
Factors of exposure - of brightness
quality
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Physics of X ray

History of X ray:

German physicist "Wilhelm Konrad Rontgen" discovered X ray in 1896. X

ray were being utilized clinically in the bone fractures. He won Noble Prize
in 1901.

He called it X radiation to signify an unknown type of radiation

Energy:

 Definition: capacity to perform work

 Unit: joule
 Forms:
o kinetic energy: due to motion
o Potential energy: due to position
o Wave energy: oscillation travels through space or medium
 Types: (according to propagation)

1- Transverse wave: oscillations perpendicular to the direction of wave

transfer

2- Longitudinal wave: oscillations parallel to the direction of wave transfer

 Types: (according to nature)

Mechanical waves:
Oscillations, travels through a medium, in the same direction, for a long
time and distance

Electromagnetic waves:
Electric and magnetic components perpendicular to each other, travels
through space, and propagates, at the speed of light 3 X 108 m/s
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Characters of electromagnetic waves:

 Cycle: a complete vibration, starting from zero energy - maximum

amplitude - zero - maximum value on the opposite direction - zero
 Periodic time: time of one cycle
 Wave length: distance between two crests or two troughs
 Amplitude: the highest peak from rest
 Frequency: number of cycles per second (measured by Hz)
 Velocity: rate of propagation = frequency X wave length

Einstein wave energy equation E = hƲ = hc / λ

h= Plank constant, Ʋ= frequency, c= speed of light, λ= wave length

Electromagnetic spectrum:

Range of all frequencies of electromagnetic waves, extending from low

frequency (long wave length) to high frequency (short wave length)

Types of EMW:

1- Visible 2-Non-visible

1- Ionizing: enough energy to break chemical bonds between atoms 

formation of charged ions

2- Non-ionizing: not enough energy to break chemical bonds between

atoms  excitation, movement of one electron to a higher level 
formation of unstable atom
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 Photon: unit of electromagnetic waves

 Ray: imaginary line between tube and detector

 Beam: group of rays with different angles

 Beam geometry: parallel - fan - cone

 Projections (transmission): series of X ray beams passing through

patient at same orientation with different angles
= information derived from X ray photons when they scan an object from
different angles and directions

 Electron volt: Unit of energy in EMW, it equals the amount of

energy needed to move a single electron across an electric potential
difference of 1 volt
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Definition of X ray:

Transverse, non-visible, , ionizing EMW, with a high frequency (3 X 1016 -

3 X 1019 hz), short wave length (0.01 - 10 nanometer), and high energy
(100 eV to 100 keV) - soft and hard X ray.

Mechanism of X ray generation:

X rays are generated in an X ray tube, a vacuum tube that uses a high
voltage to accelerate electrons
When free electrons interacts with shell electrons or nucleus of atoms, the
energy given up in this interaction appears as EMW known as X ray

Steps:

1- Electron generation: by thermionic emission from a heated filament

(cathode)

2- Electron motion: accelerating voltage  displacing space charge

towards anode  electron movement with kinetic energy equivalent to
accelerating voltage

3- Electron interaction: fast moving electrons are suddenly stopped by

impact on target material (anode)

Methods of x ray generation:

1- Bremsstrauhlung - braking radiation: when free electrons are deflected

by the charge of the nucleus  decelerate  lose their energy as X ray
These X rays has a continuous spectrum

2- Fluorescence - K-shell - characteristic radiation: when free electrons hit

shell electrons  they knock electrons out of the inner electron shell 
electrons from higher energy levels fill up the vacancy  lose their energy
as X ray
These X rays have spectral lines, these lines depend on the target element
(characteristic).
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Components of X ray tube:

1. Vacuum tube:
 An evacuated tube, as any gas will scatter electrons  Decrease
efficiency of the tube
 Any Oxygen will make cathode ionized and broken
2. Cathode:
 Source of electrons
 Electrical heated tungsten filament
3. Focusing cup: to focus electrons from cathode to anode
4. Anode:
 High atomic number metal, usually tungsten
5. Copper anode block: to conduct heat away from Anode
6. Accelerating voltage: between cathode and anode
7. Current:
 Energy of electron = charge of electron X accelerating voltage
= 100 kV X 1.6 X 10-19 coulmbs = 1.6 X 10-14 joules
= 100 kV X 1 eV

Focal spot:

The source of X ray beam

 Sharp  better resolution

 Large  more heat tolerance

Angular distribution:

The direction in which photons travel away from the target.

It depends on photon energy

 High energy  directed forward

 Low energy  equal intensities in all directions
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Characters:

1- Non visible

2- travel in straight line and diverge from the origin

3- respond according to inverse square law

4- cause scatter radiation

5- photons have different energy

6- travel at speed of light

7- highly penetrating

8- cause biological damage

9- affect radiographic and photographic films

10- cause fluorescence of some materials

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Filtration:

Function: X ray photons are emitted from different energy levels (shells)
 they have varying energy  varying penetration energy (polychromatic
photons)
Filters prevent photons with low energy from passing  allow only
photons with high penetration  decrease dose of radiation - uniform of x
ray beam

Types:

1. Inherent: at widow of tube (housing - insulating oil - glass insert)

2. Added: interposed between X ray tube and patient (AL - Cu)
3. Compensating - wedge: Different degree of attenuation  makes
exposure across film uniform despite varying body part thickness
used in mammography - AP full spinal imaging - foot imaging
4. Composite: combination of 2 or more materials to increase efficiency

Grid device:

Definition: a series of thin lead strips and thick plastic strips (low density
material)

Function: Lead absorbs 90% of scattered rays and allows 70% of primary
beam to pass through gaps  improves the quality of image

Grid ratio (GR) = Height of strips / width of interspaces between strips

If increased  increase absorption of scatter rays  increase contrast but

increase patient dose (not used in small parts or in children)

Types:

1. Stationary:
a. Focused: Strips are parallel to the beam  decrease
beam cut off
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b. Parallel: Strips are parallel to one another  increase

beam cut off - decrease density towards film edge
used with small field or long distance
2. Moving: It moves during exposure, in a direction perpendicular
to grid strips  decrease the shadow of grid lines on image
3. Crossed: 2 grids are superimposed with their grid lines at right
angles  increase absorption of scatter rays  increase
contrast but increase patient dose

Limitation of X ray tube:

1. Heat:
 Causes milting and damage of tube, and terminates its life
 Affected by voltage: Increased  decrease heat - increase X ray
 Avoided by: rotating anode - copper anode - oil circulating
through anode
2. Patient dose:
 Scattered radiation obscures primary beam and decreases
contrast
 Affected by thickness of body part: increased  increase
scattering
 Scattered radiation is decreased by:
o Scattering produced by the patient:
1. Controlling field size: cones and diaphragm
2. Compression of the patient: moving the overlying
tissues laterally
3. Increased voltage: to increase primary beam
o Scattering produced after beam leave the patient:
1. Using grid device
2. Decrease air gap: by decreasing distance between
patient and film
3. Flat metal filter: placed on the cassette
 Patient dose is decreased by: �
1. Increase kV
2. Decrease mA
3. Increase X ray tube -object distance
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4. Decrease object film distance

5. Filtration
6. Compress the patient

Types of X ray - tissue interaction

1. Penetration (transmission): no interaction - no loss of energy - no

change in direction

1. Attenuation: interaction between X ray beam and tissues (attenuator)

 number of photons remaining in the beam is decreased.
Primary X ray beam: beam before interaction. Secondary X ray beam:
beam after interaction
Attenuation = absorption + scattering

Photoelectric Compton scattering Pair production

absorption

Photon interacts with a bound
electron
(Binding E > photon E) 
complete absorption  all
energy are transferred to the
electron, then transferred
from electron to the tissues
Dependent on atomic number
 good contrast in diagnostic
X ray image
Photon interacts with an
unbound electron
(Binding E < photon E) 
incomplete absorption  part
of energy is transferred to the
electron, and the rest scatters
in a different direction from
the original photon
Not dependent on atomic
number
Photon interacts with nucleus
(through its magnetic field)
 photon disappears and is
replaced by electron and
positron
When positron hits electron 
annihilation  emission of 2
photons  scatter
Dependent on atomic number
High Z  strong nuclear force

In low photon energy (100 In high photon energy (500 In high photon energy (> 1.02
keV) keV - 30 meV) meV)
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Types of image receptors in X ray imaging:

1. Film X ray imaging

2. Computed radiography X ray imaging (CR)
3. Direct digital radiography X ray imaging (DDR)
4. Fluoroscopy X ray imaging

1- Film X ray imaging

Mechanism:

X ray photons transmitted through the patient interact with silver bromide
particles  photochemical interaction  reduction of silver bromide into
silver  dark signal

Layers:

1. Polyester film base layer: for mechanical strength

2. Emulsion layer: consists of photosensitive material

Types: Silver halides crystal (bromide - chloride - iodide)

3. Adhesive layer: attach emulsion to base

4. Protection layer: prevents mechanical damage

2- Computed radiography X ray imaging (CR)

Mechanism:

A flat panel detector is replaced by imaging plate made of phosphor.

Phosphor is a substance which shows the phenomenon of luminescence

Luminescence: emission of light by a substance resulting from photon

reactions, not resulting from heat

Steps:

1. Exposure: X ray photons transmitted through the patient are stored

within phosphor plate, forming the latent image
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2. Scanning: Stimulation of phosphor plate using laser light  releasing

photons energy  producing a luminescent signal  converted into
electrical signal by photomultiplier tube
3. Monitoring: Electric signals are processed and converted into a digital
image by Analogue to digital conversion and monitored on the screen
4. Processing: Raw image is processed to increase image quality
5. Erasing: CR reader applies ultraviolet light to the phosphor plate to
erase latent image

Advantages:

a. Low radiation dose

b. High contrast
c. Rapid result
d. Always proper exposure (No need to repeat examination)
e. Ability to process images
f. Ability to display, store and archive images

3- Digital direct radiography (DDR):

Mechanism:

A flat panel detector is replaced by Digital image receptor made of a

scintillated material (amorphous silicon - cesium - selenium)

The panel directly converts the X ray beams into minute electrical signals,
which are converted into digital image and displayed on computer screen

4- Fluoroscopy X ray imaging

Fluoroscopy: Real time visualization of moving anatomic structures

Mechanism:

1. A continuous X ray beam passes through the patient and falls on a

fluorescing screen
2. Faint light is emitted and amplified by an image intensifier
3. The image is displayed on a TV monitor and recorded digitally as a
single or series of images for real time viewing (cine fluoroscopy)
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Difference between X ray and mammography

X ray mammography

Voltage High (80 - 140 kV) Low (25 - 35 kV)

Target Tungsten -Molybdenum (low energy for

small breast)
-Tungsten (high energy for
dense breast)

Mechanism Bremsstrahlung Characteristic

Focal spot Large: for more heat loading Small

Small: for better image

Window Enclosure glass Beryllium (not glass)

Grid Stationary - moving Moving

GR = 8:1 to 12:1 GR = 4:1 or 5:1

Screen Double screen - double Single screen - single

emulsion film emulsion film
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Factors of exposure:

1- Potential difference (by Voltage): (quality)

It affects energy of X ray photons

 low voltage  low dose energy  low penetration  more

attenuation  low density
 High voltage  high dose energy  high penetration  less
attenuation  high density

2- Current (by mA): (quantity)

It affects number of X ray photons

mA= current of electrons flow from cathode filament to anode

ranging from 0 - 400
Increase mA  increase electron flow  increase amount of X ray

3- Time of exposure (by mAs): (quantity)

mAs = current by mA X time by seconds

higher mA allow short scan time

4- Target material: (quantity)

High atomic number (Z)  more X ray production

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Factors of image quality:

Density - contrast - sharpness - noise - artifact - distortion

1- Density

Definition:

The degree of blackening on the film (the amount of metallic silver

deposited

Factors:

1. Exposure factors:
o Tube voltage: increased  increase speed of photons
o Tube current by mA: increased  increase number of photons
o Time of exposure: increased  increase number of photons
o Intensifying screen speed: increased  decrease time of
exposure
2. Distance  inverse square law
3. Amount of scatter: increased  increase kVp  increase penetrating
power of photons  increase density
4. Image receptors sensitivity: Increased  decrease mAs needed

2- Contrast

Definition:

The ability to distinguish between different densities in an image through

gray scale range
Contrast sensitivity determines the range of visibility with respect physical
contrast

High contrast sensitivity 

Tissues with high or low physical contrast well be seen

Low contrast sensitivity 

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Tissues with high physical contrast well be seen

Tissues with low physical contrast well not be seen

Factors:

1. Exposure factors:
 Potential difference: Decrease eV  increase contrast
 Tube current and time of exposure: Increased mAs  increase
contrast
2. System contrast factors:
 Scattering: Increased  decrease contrast
Limited by using proper filtration - collimation - grids
3. Subject factors:
Different body parts absorb X ray at different rates  different
contrasts (organ absorption coefficient)
Factors:
 Density of body parts: Increased  increase absorption of X
rays  appears light
Air - black / Fat - dark gray / water - light gray / bone - white
 Thickness of body parts: Increased  increase absorption of X
rays  appears lighter than thinner parts
4. Image receptors factors:
 Type and sensitivity of image receptors

3- Sharpness (blurring - Details)

Definition: ability to visualize small objects (details) in image

Factors:

1. Geometric factors:
a. Focal spot size: Decreased  better image details
b. Direction of X ray beam: Perpendicular  recording adjacent
structures according to their actual spatial relationships
c. Object film distance (OFD): Distance between patient and film
Decreased  less magnification and less distortion of image
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d. Focal object distance (FOD): Distance between X ray tube and

patient
Increased  improve definition - image size becomes more
nearly to object size
2. Absorption factors: Change in absorption near edge of round
structures
Decreased by choice of patient position
3. Movement factors: Movement of patient parallel to the film during
exposure
Decreased by immobilization
4. Screen factors: Increase thickness of screen

4- Noise

Definition: Background signal intensity higher than the scanned tissue

(scattering)

Blurring: Decrease visibility of small objects or details

Noise: Decrease visibility of small low-contrast objects

5- Artifact

Definition: signals appear in images which are not related to structure in

the body

Causes:

Metal - Motion - Beam hardening (As CT)

6- Distortion

Definition: Misrepresentation of organ size and shape

Causes:

1. Magnification: size and shape distortion

2. Divergence of X ray beam: it is because X rays originate from a
narrow source (X ray tube) and diverge to spread on image receptor
Limited by collimators
Central ray (CR) should strike the film at 90°
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Physics of CT

Conventional tomography:

 Using a moving X ray source and a moving film, to avoid

superimposition of tissues, and obtain a diagnostic image of a special
type of tissue

 Points above and below the focal plane don't project to the same film
position and appear blurred

 Useful in IV urography - osteomyelitis

Computed tomography:

 imaging modality based on X ray tissue interaction, to get multiple

cross-sections (axial or transverse) slices images, which are
reconstructed by a computer.

Tomography: tomo (cut - section - slice - layer)

Slice: Cross sectional part of the body scanned to produce CT image

It had 3 dimensions (volume= length, width, and depth)
Depth= slice thickness, determined by the width of the X ray beam.

Idea (principle) (how axial cuts available):

- X ray travels in straight lines  conventional tomography has low

contrast resolution and long time
- Solution: X ray tube rotate by 360 degree with patient motion
simultaneously to get axial cuts

- X ray beams pass through the body from different points and angles 
projection information  creation of CT cross sectional images
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Disadvantages of X ray:

1. Travels in straight lines

2. Depicts 2 dimensions (not 3 dimensions)  tissue overlying and

superimposition  blurring and decreased image quality

3. Depicts a specific part (not slices)

4. Can't differentiate between 2 tissues having the same density

5. Low accuracy in detection soft tissue lesions

Indications of CT: For detection of:

 Blood clots and infarction - Brain tumors - sinus infections

 Cardiac imaging - Bone fractures - Internal organ rupture

 Biopsy

 Radiation therapy planning - monitoring treatment

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Scientific efforts in CT:

Radon:

If we have an infinite number of projections through the body, from

different angles and directions, reconstructing cross sectional images is
available. So, If the human body is scanned, the internal structures can be
reconstructed from different projections

Cormack :

Mathematical equations for projections - measurements of photons

transmission - calculating the absorption coefficient for each organ

Absorption coefficient: amount of X ray photons absorbed or attenuated by

a specific organ or tissue

Hounsfield:

1969 Design the first prototype of CT scanner

1971 first CT head scanner
1973 clinically used
1975 whole body scanning
1979 Nobel Prize for Cormack and Hounsfield

Components of CT scanner:
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1. Power room: Processor - transformer - voltage systems

2. Scanner room: Table - gantry

3. Operator room: archiving and display image

Scanner room:

In which the patient is located and scanned

It consists of table and gantry

Isocenter point: the point at which the 3 axes (X, Y, Z) meet table with 2
motion directions (Y, Z)

Describe the gantry:

External view:

Ring shape with aperture 70 - 90 cm

X ray hole - internal microphone - control panel - patient in and out -

gantry tilting

Internal view (main parts of the gantry):

1. X ray tube:

 Metal target (high atomic target) e.g. Tungsten, cadmium, gold

 Electron beam interacts with the whole metal target

2. Generator:

 Peak power 60 - 100 kW

 Voltage 80 - 100 - 120 - 140 kV

3. Filters: As X ray

4. Collimator:
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Definition: A device used to narrow the ray beam, by making the

direction of rays more parallel

(2 collimators)

a. Pre-patient collimator (slice collimator):

Mounted to X ray tube
Function:

 Protects the patient by limiting radiation exposure

 Controls slice thickness by limiting beam width

b. Post patient collimator (detector collimator):

Mounted to detector
Function:

 Decreases scatter radiation and noise

5. Detector:

 Panel cassette with silver film

 Rotates simultaneously with X ray tube

 Converts penetrating photons into electrical charges, which are

converted into a digital image

 Has single elements (individual detector) or multiple elements

(array detector)

 Types: (according to function)

a. Xenon gas detector:

o Glass filled with Xenon gas

o Photons interacts with xenon gas producing ions 

accelerated to produce electric signals (raw data)

b. Solid crystal detector:

o Consists of crystals
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o Photons strike crystals  they lighten  photo-diode

transfers light into electric signals

 Types: (according to design)

a. Single detector (SDCT)

o Each gantry rotation produces data for a single slice

o Has one element or multiple elements arranged in

(linear, arc, ring)

b. Multidetector (MDCT)

o Each gantry rotation produces data for multiple slices

o Has multiple parallel rows or arrays (4 - 64 - 128)

6. Data acquisition system (DAS):

 Function: transfers electric signals into digital signals (analog to

digital conversion ADC)

7. Slip ring:

 Electro-mechanical device

 Function: provides continuous electric power and connection

with gantry cables to rotate continuously  avoid twisting of
gantry cables

Scanner generations:
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1st 2nd 3rd 4th 5th

X ray Single Single Single Single No conventional

X ray tube
source X ray tube X ray tube X ray tube X ray tube
Idea: Tungsten
arc lies opposite
to detector ring

collimator Pencil beam Narrow fan Wide fan Wide fan Wide fan

3° - 10° 50° - 55°

detector 1 element 30 element 400 elements 2000

elements
linear Arc ring
ring

S&D Translate and Translate and Translate and Rotating Stationary

rotate rotate rotate source - detectors
motion
simultaneously simultaneously simultaneously fixed
detector

Time 5 m / slice 20 s / slice 5 s / slice 2 s / slice

Low scatter faster faster faster Ultrafast for

cardiac imaging
Advantage

Disadvantage Slow time Higher cost Higher cost Higher cost High cost

Higher Higher Higher

scattering scattering scattering

Dual source CT DSCT

 X ray source: 2 sources

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 Collimator: wide fan beam

 Detector: 2 arc detectors

 S & D motion: Translate and rotate simultaneously

 Idea: 2 different x ray tubes with different kV (80 - 140) and 2

corresponding detectors  we can get information from different
tissues with different densities, or from static and dynamic tissues, in
a very short time

 Advantages:

o Double speed scanning compared to SSCT

o Half dose of radiation

o Helpful in high advanced techniques (cardiac - lung and brain

infarction - 3D volume rendering - surface shaded display -
angiography)

o In cardiac scanning: avoid β blockers

Types of scanning mode:

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Single data acquisition Volume data acquisition

SDA VDA
Scan and scan Spiral

Slice by slice Helical CT

Applied in 1st and 2nd generations 3rd and 4th generations

Idea - X ray tube rotates by 360° for - X ray tubes rotates by 360°
a single slice, then data is continuously, with moving the
collected, and table move to the table at a continuous constant
next slice speed, Data is collected in volume

- Slices are parallel to each other - Slices are not parallel to each
i.e. the start and end point are other i.e. the start and end point
the same are not the same

Characteristics 1- contiguous slices  no 1- continuous X ray output - tube

skipped areas rotation - table movement 
continuous data acquired

Non-contiguous slices  skipped -No mis-registration

areas  mis-registration

2- serial, sequence scanning 2- Data in volume 3D (block data)

3- High resolution 3- reformatting images

4- Follow the contrast media

(angiography)

4- Long time scanning due to 5- Short time scanning (chest

interscan delay scanning with breath hold)

6- Maximal table speed 10 mm/s

CT image formation:

3 steps: data acquisition - reconstruction - display

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1- Data acquisition step

 Definition:

o The process in which the patient is probed with X ray beam

from different directions during 360° - The data is acquired
when X rays pass through the patient to strike detector and
converted by DAS into digital values

I = I0e-µx
I: intensity of X ray beam after it left the patient
I0: intensity of initial X ray beam
e: constant
µ: linear attenuation coefficient
x: absorber thickness

 Stages:

o X ray emission

o X ray tissue scanning (by scan and scan or helical)

o X ray tissue interaction

o X ray photons transmission by detectors

 Major components used for this step:

o Generator - X ray tube - collimator - detectors - DAS

Beam attenuation µ:

Definition: The ratio of beam intensity at the exit point (I1) to the entering
point (I0)

Linear attenuation coefficient µ cm-1:

Definition: A quantitative measurement indicates the amount of photons

attenuated by the tissue, measures by cm-1, so called linear
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Factors:

1. Photon energy

2. Attenuator properties (atomic number - thickness - density)

Attenuation degree is reflected on image as a degree of blackening (gray

scale)

 High attenuation  Bright signal (hyper)

 Mild attenuation  Gray signal (iso)

 Low attenuation Dark signal (hypo)

Definition of view:

- The X ray tube rotates around the patient by 360°  X ray photons are
transmitted from different angles and directions  producing views

- One complete scan around the body produces several hundred views 
data is reconstructed to produce image for each slice

2- Data reconstruction step

Definition:

The process in which raw data is reconstructed in the matrix by computer

system to create CT image

 In conventional X ray: X ray photons transmitted are exposed to a

photographic film covered by silver  silver deposition reflects
blackening

 In CT: Digital data is recorded and reconstructed by computer system

Raw data:

Raw = scan = computer = digital data = numerical values (computer

language 01011)
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The data formed in DAS and stored in computer to reconstruct CT image

This data includes the following:

1. Measurements of the transmitted photons which strike the detector

2. Measurements of all projections from all directions

3. Measurements of linear attenuation coefficients which reflect

absorption coefficients in scanned tissues

Matrix:

 is a 2 dimensional array of numbers arranged in rows and columns

 Matrix size = number of rows X number of columns

 Rows and columns consists of small squares in 2 dimensions called

pixels (picture element) and small cubes in 3 dimensions called voxels
(volume elements)

 Each pixel has numerical values called linear X ray attenuation

coefficients of tissue scanned. The average of these values represents
CT number of the tissue in CT image.

CT number:

 The average of all calculated linear X ray attenuation coefficients of

all pixels in tissue scanned
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 It is expressed in Hounsfield units

Hounsfield scale: Bone 1000 / water 0 / air -1000

 It is related to linear X ray attenuation coefficient, and affected by its

factors
High µ  white, low µ  black

Window:

 A selected range of CT number values to display on image

 Window width: determines the range of CT numbers that fall within

selected range
Controls contrast

o Wide window  more densities seen - less contrast

o Narrow window  less densities seen - more contrast

 Window level: determines the center CT number value of the width

Controls brightness

o High level  more dense tissues

o Low level  less dense tissues

 Windowing: manipulation of window width and window level by

software to provide optimum differentiation between tissues  improve
contrast

3- Data display step

Definition:

The process in which digital data (created from reconstruction step) is

converted into electrical signals by digital to analogue converters

Factors of CT image quality

Contrast - Sharpness - noise - artifacts (As X ray)

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To optimize CT image quality  you should produce balance among

contrast - detail noise - dose to the patient

Types of CT artifacts

1. Metal: metal is highly reflector to X ray beam  interacts with beam

 detector can't detect beam
 Improved by: removing metals

2. Motion (ghost image): patient movement during exposure

 Improved by: Immobilization - Sedation

3. Beam hardening: X ray energy is decreased as it passes through

material short ray paths (central) become less attenuating than long ray
paths (peripheral)  central darkness
 Improved by: Filtration

4. Partial volume effect: when the voxel contains different substances 

the resulting CT number will be average of their values
 Improved by: Decrease slice thickness

5. Ring: defective detector element  one or more rings centered at the

center of rotation
 Improved by: Calibration of the detectors
 32

Types of resolution:

1. Contrast resolution (CR): the ability of the imaging system to

distinguish differences in image density
Improved by:
(Factors of contrast)

2. Spatial resolution: the ability of the imaging system to differentiate

between very small objects that are very close together
Improved by:
(Factors of sharpness) +

 Low pitch

 Reconstruction

Good SR and CR can't be achieved together without giving high radiation

dost to the patient

3. Temporal resolution (TR): the period for acquisition of a single frame

of a dynamic process (ex. Cine imaging)

Phases of CT image formation and their related factors

1- Data acquisition step factors

(X ray beam exposure factors - radiation dose factors)
 33

a. Potential difference (Kilovolt peak kVp): As X Ray

b. Current (by mA): As X Ray

c. Time of exposure:
Time of exposure to X ray beam to collect data for slices = time taken
for gantry to make 360 rotation degree

 mAs = current by mA X time by seconds

 higher mA allow short scan time

 Factors affecting mAs choosing:

1. Region of interest (abdomen - heart - vessels - brain)

2. Anatomic part density

3. Patient size

4. Type of scanning: helical  tube heating

5. Type of scanner

mA is more common in practice than kVp, due to:

 Choosing of mA is more flexible (20-800), kVp is limited

 mA has more straight forward effect on image quality

d. Pitch

Pitch = table displacement per one rotation / beam width

choice of pitch affects image quality and patient dose

 pitch = 1: beams are contiguous for adjacent rotations

 34

 pitch > 1: beams are not contiguous for adjacent rotations, there
are gaps in between beams in which tissue is not irradiated
 less image quality - less radiation dose

 pitch < 1: beams overlap, a volume of tissue is irradiated more

than once per scan
 more image quality - more radiation dose

2- Data reconstruction step factors

a. Field of view (FOV)

Definition: Diameter of the examined area
Types:

 Scan field of view (SFOV):

o The actual area of interest scanned by CT scan

o determines area within gantry in which raw data is

acquired

 Display field of view (DFOV):

o The section of data selected to display on the monitor

o Can be equal to or less than SFOV

Decreased FOV  increase details - increase noise

b. Matrix:

Matrix size = number of columns X number of rows

pixel size = DFOV / matrix size

Increase matrix = decrease pixel / voxel size  high details -

high resolution - high noise

c. Slice thickness = beam width = pre patient collimator width:

 35

 Increase slice thickness  low details - low resolution

 Decrease slice thickness  high details - high resolution -

high noise

d. Increments:

 Distance between reconstructed images

 Increase distance  loss of data

3- Data display step factors

a. Window width
b. Window level
 36

Physics of MRI

Nuclear magnetic resonance:

 Developed by Isaac Rabi

 When nuclei of hydrogen atoms are placed in a magnetic field, they
will align with main direction of this field
 When these nuclei are subjected to energy of radiofrequency (RF),
the nuclei will absorb this energy
 When RF is stopped, the nuclei return to their original positions, and
re-emit this energy in the form of signal

Spinning: Precession

(Rotation around axis) (Rotation around magnetic field

axis)

Positively charged protons spin on Axis of movement of spinning

their own axis  production of protons rotates around another
magnetic field axis
Rate of precession = number of
revolution / s

Alignment:

Definition: When nuclei are placed in an external magnetic field, their

magnetic moments line up with external magnetic field line

Types:

Parallel alignment Anti-parallel alignment

The alignment of magnetic The alignment of magnetic

moments in the same direction of moments in the opposite direction
the main field of the main field
 37

Net magnetic vector (NMV):

 It has 2 components (transverse and longitudinal)

 Transverse components cancel one another
 Net magnetic vector reflects the balance between parallel and anti-
parallel magnetic moments
 Increases field strength  increase number of protons aligned parallel
to the main field  increase image quality

Larmor equation:

Calculation of the rate of precession of protons in an external magnetic

field

ω0 = B 0 X ɣ
ω: rate of precession of protons, B: strength of the external magnetic field,
ɣ: gyromagnetic ratio

Gyromagnetic ratio:

The rate of precession of a specific nucleus at a magnetic field strength of

1 T, measured by mHz / T, it is constant for each nucleus

MR active nuclei:

 When a nucleus has an even proton number  the spins cancel each
other  no net magnetic field
 When a nucleus has an odd proton number  the spins don't cancel
each other  net magnetic field (MR active)
Ex. H1 - C13 - N15 - O17 - P31 - Na23
 38

Common atom in MRI: Hydrogen

Causes:

1. Most common in human body

2. Contains a single proton  highly active in MR

Common molecule in MRI: water

Causes:

1. Most common in human body

Excitation Relaxation

Transfer from longitudinal to Transfer from transverse to

transverse magnetization longitudinal magnetization

Transfer from ground state to Transfer from excited state to

excited state ground state

Flip angle:

The angle of rotation of net magnetization vector by a radiofrequency

pulse relative to the main magnetic field

Free induction decay (FID):

The observable NMR signal generated when NMV returns from transverse
magnetization to longitudinal magnetization and loses its energy.
 39

MR scanner (hard ware)

Components:

2. The magnet
3. Gradient system
4. Radiofrequency system

1- The magnet

Function:

It generates the main static magnetic field by moving electric current. The
direction of magnetic field can be clockwise or counter-clockwise

Fleming's right hand rule determines the magnitude and direction of the
magnetic field due to current

Types:

1- Non electro magnet (permanent magnet):

- It consists of ferromagnetic substance which creates a magnetic field

without electric current, and maintains it without an external power supply

- Disadvantages:

1. Very heavy
2. Low magnetic field strength (Max = 0.5 T)
3. Low safety (the field cannot be turned off in an emergency)
4. Rely on a constant external temperature
 41

2- Electro magnet (using electric current):

a. Resistive magnet:

 Mechanism: using high and constant power supply to create a

magnetic field.
 Advantage: more safety (the field can be turned off in an emergency)
 Disadvantages:
o High cost (requires a large amount of power)
o Low magnetic field strength (Max = 0.3 T)
o Poor field homogeneity

b. Superconducting magnet:

 Mechanism: It consists of a coil made of niobium-titanium (Nb-Ti)

alloy, whose resistance is eliminated in low temperature  The coil is
cooled to near absolute zero ( 4° Kelvin / -269° C) by liquid helium 
a superconducting state  electric current flows forever

 Advantages:
o Maintained without additional power supply
o High magnetic field strength (Max = 18 T)
o High field homogeneity
 41

Quenching:
A sudden loss in superconductivity of the magnet  breakdown of
magnetic field strength

Homogeneity:
Having a uniform (homogeneous) strength throughout magnetic field. It is
adjusted by shimming

Shimming:
Process of adjustment of homogeneity

Shielding:
Process of controlling the external interference to the magnet

Isocenter point:
The geometric center point of the main magnetic field, where the
magnetic field strength is not affected by any of the 3 gradient fields
= Point in the magnetic bore where all 3 gradient axes coincide at 0/0/0
point, it divides each axis into a positive half and a negative half

Cartesian coordinate system:

Every point in magnet is determined by X, Y and Z values.
X: width of the bore (left/right)
Y: Height (up/down)
Z: Length (parallel to the bore - direction of the main magnetic field B0)
 42

2- The radiofrequency system

Components:

1- RF generator (sensitizer):
Function: It sends RF pulses

RF pulses: (EMW energy transmitted at the resonant frequency of

hydrogen according to Larmor equation)

2- RF coils:
Function: They produce a magnetic field when a current is passed through
them
Types:
1. Transmitter RF coil:
used in excitation of the spins
2. Receiver RF coil (antenna):
used in receiving MR signal from the patient
3. Transceiver RF coil (T/R):
used in excitation of the spins and receiving MR signal from the
patient

3- The gradient system

3 separate gradient coils

Function:
They alter the magnetic field strength along X / Y / Z axes
They are applied for slice selection and spatial encoding
They are switched on separately or in combination
The changing magnetic fields generated when the gradients are switched
on and off lead to noise during MR scan
 43

Spatial encoding (positional information):

Definition:

Localization of MR signals in their correct positions.

Mechanism:

Applying a MF superimposed on main MF  predictable variation in MF

along predetermined axis  MF becomes highest at one end and lowest at
the other end  protons at one end spin faster and at the other end spin
slowly

Factors:

Slice - frequency - phase - amplitude

Slice selection Frequency encoding Phase encoding

gradient gradient gradient

Function selecting a slice identifying a signal from identifying a signal

a column of pixels within from an individual
the selecting slice voxel

Mechanism A gradient MF is A gradient MF is applied A gradient MF is

applied on Z axis  on x axis  protons applied on y axis
protons precess with precess with different
different frequencies frequencies
 RF is applied with
specific frequency 
only protons in a
certain slice which
have same
precessional
frequency are excited

Time sequence: Gz  Gy  Gx
At the end: a mixture of signals with different frequencies or phases are
received according to their locations, and collected in K space
 44

K space:

 An area where collected data from signals are stored according to

frequency / phase / amplitude, to allow data reconstruction for image
formation
 It is composed of perpendicular lines (vertical frequency - horizontal
phase). It's divided into 2 halves (positive - negative)
 It's filled by localization of each signal in each pixel, according to its
frequency (column), phase position (row), amplitude (bright - dart -
iso)
 It's managed by gradient coils
 45

Types of pulses:

Spin echo Gradient echo Inversion recovery

sequence GE
SE

Parameter TR- TE Flip angle TI

mechanism RF in 90°  RF in RF in 90  -ve - Inverting pulse in 180° to

180° gradient to invert NMV in -180°  RF in
dephase the spins 90°
and +ve gradient - When the pulse is removed
to rephase them  NMV begins to relax back
to B0  inverted B0 begins to
Image More: Less shorten and return to its
 Maximal signal original position
quality
 Minimal - When RF is applied in null
artifacts point of tissue (a point in
 Minimal which there is no B0)  no
variations due transverse magnetization 
to field no signal for that tissue
inhomogeneity

Time Long: 2 RF  SAR Short Inversion recovery time of a

certain tissue (TI):
Time in which the tissue
returns to its original B0,
between inverted 180° pulse
and passing through the null
point

Use Not commonly used Overcame SE -STIR (short time inversion

problems recovery)
- FLAIR (fluid attenuation
inversion recovery)
 46

Repetition time (TR):

Time between one RF excitation and the next

Echo time (TE):

Time between RF excitation pulse, and collection of data

Pulse sequence:

Series of RF pulses, gradients application, ADC, intervening time periods to

get signals

* Spin echo pulse sequence:

90° excitation pulse  180° rephasing pulse  TE

* Multi spin echo pulse sequence:

90° excitation pulse  multiple 180° pulses  multiple TE

Result: multiple images with different contrasts in time of one image.

(Early: T2 - Late: PD)

* Fast spin echo pulse sequence:

90° excitation pulse  multiple 180° pulses + multiple application of phase

encoding gradient  multiple TE

Result: One image in time less than time of one image.

 47

Factors of MR image quality:

To optimize MR image quality  you should produce balance among

contrast - size of volume studied - time

Factors affecting image quality:

Contrast - spatial resolution - SNR - artifact - time

1- Contrast

Definition: Different signal intensity (hyper - hypo - iso)

Factors:

 Extrinsic:
1. MF strength
2. MF homogeneity
3. Types of pulses
4. Hardware and software parameters
 Intrinsic:
1. Tissue magnetic susceptibility
a. temperature
b. viscosity
c. Composition (e.g. Age)
d. Dynamic / static
e. Behavior (e.g. Heart)
2. Tissue relaxation time: Increased  excited protons
release absorbed energy
3. Type of imaging:
a. Diffusion
b. Perfusion
c. Spectroscopy
d. Bold
 48

2- Spatial resolution

Definition: The minimal distance between 2 points that appear separate

Factors:

1. Slice thickness: ‫عكسي‬

2. FOV: ‫عكسي‬
3. Voxel size: ‫عكسي‬

3- Signal to noise ratio (SNR)

Definition: Relative contribution to detect signals from true signals and

random superimposed background signals (noise)

Signals: come from intentionally excited protons

Noise: come from all spins in the coil sensitive volume

Increase number of protons that contribute to signal strength in the image

 increase SNR

Factors:

1. Slice thickness: ‫طردي‬

2. FOV: ‫طردي‬
3. Voxel size: ‫طردي‬
4. TR: ‫طردي‬
5. TE: ‫عكسي‬
 49

4- Artifacts

1- Chemical shift artifact: the most noticeable

 Protons in fat and water have different resonant frequencies  signal

arising from protons in fat will be interpreted as arriving from a different
point along the frequency encoded axis relative to signal from water
 This difference depends on the strength of B0
 It is most noticeable around the bladder, kidneys and vertebral
endplates (regions with fat/water interfaces).

2- Aliasing artifact:

If the field of view is smaller than the area of tissue excites, structures that
are peripheral to the field of view will wrap around the image and be seen
on the opposite edge.

3- Radiofrequency artifact: RF noise degrades MR images.

Patient generated noise can occur due to eddy currents from thermal
movement of ions.
System-generated noise from coils or amplifiers may produce specific
patterns such as herring artifact.
Extrinsic RF may produce linear streaking and can arise from any
malfunctioning electrical device, e.g. light bulb or leaking RF door seals.

4- Ferromagnetic artifact:

Ferromagnetic objects alter the T1 and T2 decay characteristics of the

local magnetic environment  a signal void around the object.

5- Motion artifact (ghosting):

Caused by patient or biological motions e.g. cardiac, CSF pulsation, GIT,

Respiratory and arterial pulsations increased noise, edge blurring and
streaking.

Blood flow produces signal loss as protons in arterial or venous blood

moving and phase mismatches occur.

6. Partial volume averaging: as CT

 51

5- Acquisition time

Definition: The time required to collect data from one set of image

Factors: Time = TR x Number of excitations x Matrix size

Resolution SNR Time

TR
+ +
TE
-
NEX
+ +
Slice thickness
- +
Matrix size
+ - +
FOV
- +
Bandwidth
-
MF strength
+
 51

Types of relaxation mechanisms:

T1WI T2WI PDWI

Spin-Lattice Spin-Spin
relaxation relaxation

Mechanism T1 relaxation time of T1 relaxation time of PD: number of

a certain tissue: a certain tissue: protons in a voxel
The time required for The time required for
recovering of 63 % of losing of 63 % of More protons
longitudinal transverse (mobile)  more
magnetization from magnetization from signal  bright
its original value its original value, due
to dephasing

Signal intensity is Signal intensity is

measured relative to measured relative to
longitudinal transverse
magnetization value magnetization value
High  bright High  bright
Low  dark Low  dark

Display Based on T1 Based on T2

difference between difference between
tissues tissues

Fat: Fat: dark Fat:

Water: dark Water: Water:

White matter > gray Gray matter > White Gray matter > White
matter matter matter
(short T1) (High PD- Long T1) (High PD)
Main factor TR TE

Maximal Short TR Long TR Long TR

Short TE Long TE Short TE
contrast
To reduce T2 effect To reduce T1 effect To reduce T1 and T2
effects
 52

T2* relaxation time:

It appears after termination of the induction pulse, due to:

a. B0 inhomogeneity: due to applying gradient MF - defect in the

magnet
b. Spin-spin interaction

MR signals (brightness) depends on:

 Machine settings:

Fixed: B0
Changed: TR - TE - flip angle

 Tissue characteristics:

Fixed: Gyromagnetic ratio of the nucleus

Changed: T1 - T2 - PD - Arterial flow - Contrast agent

Bright pixels: Short T1 - Long T2 - High PD - High B0

Dark pixels: Long T1 - Short T2 - Arterial flow