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Imaging Techniques in Radiology: CT

Wim Tukker systeemspecialist CT UMCG

End terms for Imaging Techniques in Radiology


Following the book The Essential Physics of Medical Imaging 2nd ed by Bushberg et al.
Know -> Understand -> Explain (Read), (optional)

Ch 13.

Computed Tomography 13.1 Explain basic principles 13.2 Explain geometry and historical development 13.3 Understand detectors and detector arrays 13.4 Explain slice thickness, pitch 13.5 Explain tomographic reconstruction process 13.6 Understand digital image display 13.9 Explain artifacts

What to expect?

Monday 26 march 2012 09.00 12.00 h

- CT Techniques - Clinical CT applications: head and neck - CT in Cardiology - Dual Energy CT - CT in Archeology

Thursday 29 march 2012 13.00 16.00 h

- CT Techniques - Clinical CT applications: chest and abdomen - Radiation dose - Cone Beam CT - CT in Forensics (CSI-Groningen)

What to expect?

Monday 26 march 2012 09.00 12.00 h

- CT Techniques - Clinical CT applications: head and neck - CT in Cardiology - Dual Energy CT - CT in Archeology

Thursday 29 march 2012 13.00 16.00 h

- CT Techniques - Clinical CT applications: chest and abdomen - Radiation dose - Cone Beam CT - CT in Forensics (CSI-Groningen)

CTs in UMCG: Radiology, Nucleair Medicine & Radiotherapie

Siemens Somatom Sensation-16

Siemens Somatom Sensation-64 (2x)

Siemens Somatom Definition (Dual Source)

Siemens Biograph 64 slice mCT (PET-CT)

Siemens Symbia 2 and 16 slice SPECT-CT

Siemens Sensation Open

Toshiba AquilionONE

Philips

Brilliance iCT

tion Source Defini Siemens Dual

G.E.

CT750 HD

Conventional tube diagram

Straton X-ray tube diagram (Sensation 64 and Definition) Cooling rate 5 MHU/min

Straton X-ray tube design

Double z-Sampling: two focus spots alternating 4.640 per second

Sensation 64, Definition

Double z-Sampling:

0.4 x 0.4 x 0.4 mm isotropic resolution

CT technique

Configuration detector system Sensation 64 and Definition (A-tube) Thin collimation plates Ceramic scintillationmaterial (solide state detector) Very short after glowing time (gadolinium oxi-sulfide) < 0,00043 sec! Photodiode-array

m 4 x 1.2 m > 1.2 24 x

m 4 x 1.2 m m x 0.6 m overage 32 Zc 28.8 mm

Adaptive Array Detectors Bushberg, page 339 - 342

CT technique

Configuration detector system Sensation 64 and Definition (A-tube)


Sensation 16 24 rows of detectors 16.128 elements 1.344 canals per slice Max. 2320 projections each 360 Sensation 64 and Dual Source 40 rows of detectors (DSCT 2x, A and B) 26.880 elements (DSCT system B 14.080) 21.504 canals per slice (DSCT system B 11.264) Max. 4608 projections (views) each 360

Bushberg, page 339 - 342

Collimation: principle

Sensation-16: 24 detectors on row!

eff. slice-thickness

8 x 2.7 mm + 16 x 1.35 mm: true detectorwidth!


Bushberg, page 339 - 342

Pitch en Table Feed Table feed: per rotation Pitch: table feed per rotation / total width of collimated beam E.g. table feed 12 mm, collimation 16 x 0.75 > beam pitch 1 E.g. table feed 9.6 mm/rotation, collimation 64 X 0.6 (32 x 0.6=19.2 mm) > pitch 0.5

Effective mAs mA.s produkt remains equal. E.g. Increasing pitch > shorter scantime > more mA. E.g. Decreasing rotationtime > longer total scantime > less mA.

Bushberg, page 345 - 346

Pitch

Is there influence of the pitch on the slice thickness?

Is there any influence of the pitch on the spatial resolution? Effective mAs (radiationdose) stays equal. Bushberg, page 345 - 346

What to expect?

Monday 26 march 2012 09.00 12.00 h

- CT Techniques - Clinical CT applications: head and neck - CT in Cardiology - Dual Energy CT - CT in Archeology

Thursday 29 march 2012 13.00 16.00 h

- CT Techniques - Clinical CT applications: chest and abdomen - Radiation dose - Cone Beam CT - CT in Forensics (CSI-Groningen)

CT-scan Brain

Protocol CT-scan Brain Indications Standard Trauma Tumor or abces (MRI preferred) Metastases (MRI preferred) Stereolithography Navigation (stereotaxie)

Radiation-dose 1.1 mSv

Guidelines for radiology report Increased brain pressure? Brain shifting? Bleeding? Differences in density? Abnormalities: localisation, size and number? Fractures? Bone destruction?

CT-scan Brain sequential or spiral?

MPR in OM-direction (Orbito-Meatal)

OM

Axial view in spiral CT (source images)

MPR; Multi Planar Reconstruction


Bushberg, page 359 - 360

CT-scan Brain sequential or spiral?

Z: 5 mm/index 5 mm

X-Y: 5 mm/index 5 mm (sequential)

Partial Volume Effect

Z: 3 mm/index 1.5 mm
Bushberg, page 371 - 372

CT-scan Brain, examples

Stroke! ICH Intra Cranial Hematoma

Most common question: Bleeding or no-bleeding? No-bleeding > start - Anti-thrombolytic drugs - Antiplatelet medicine like Aspirin 3D

CT-scan Brain, examples

CT with IV-contrast: 100 ml Visipaque 320

Abces

MRI-T1

MRI-FLAIR

MRI-T2

MRI-T1 + gado

CT-scan Brain, examples

white and grey matter oedema

Vasculitis (inflammation)? Same patient: possible cause of the abces?

Spiral CT of maxillary sinus (NBH)

MPR
Transversal Coronal

Radiation-dose 0.2 mSv

MPR Transversal

MPR Coronal
Bushberg, page 359 - 360

Spiral CT of maxillary sinus (NBH)

Thickening of mucus MPR

Bushberg, page 359 - 360

Spiral CT of maxillary sinus (NBH)

MPR

B-cell lymphoma

Advantage CT: superior bone/air visibility, why?


Bushberg, page 359 - 360

Spiral CT of maxillary sinus (NBH)

Same patient, MRI

Advantage MRI: superior soft tissue visibility

Spiral CT of petrosal bone (mastoid)

On a sagital image MPR // canalis facialis

MPR perpendicular to canalis facialis

Coronal
Radiation-dose 0.3 mSv

Axial

Coronal

Coronal

Coronal
Bushberg, page 359 - 360

Spiral CT of petrosal bone (mastoid)

Axial (transversal)

Anatomy

Bushberg, page 359 - 360

DSA versus CT (coronal MIP)

Golden standard

Spiral CT of brain arteries (CTA)

I.V. contrast: Visipaque 320; 80 ml with flow 4 ml/sec.

Radiation-dose 1.2 mSv


4 5 6

Start scan manually!

Spiral CT of brain arteries (CTA)

Scan in 10 15 sec.

Advantages CTA: Non-invasive, short scanning time with onlimited 3D processing.


Bushberg, page 361

Spiral CT of brain arteries (CTA)

Top of basilar arterie

Candidate for coiling procedure?


Bushberg, page 361

One-Stop Diagnose CVA

Unwell with left hemiparesis: infarction right hemisphere?

Entrance

One-Stop Diagnosis CVA

Unwell with left hemiparesis: infarction right hemisphere?

Entrance

CTA VRT

CTA MIP

Day 3

Day 30

Perfusion-CT

Traumatology

Technique: VRT Hit by a baseball pole-axe


Bushberg, page 360-362

Traumatology

Trauma capitis

SSD

?
VRT
Bushberg, page 360-362

Traumatology

(same patient)

Take Home Message: always start with looking at source images (first reconstruction)
Bushberg, page 360-362

Traumatology

More metal artefacts

Traumatology

Future: further reduction of metal artefacts

By courtesy of Dr. J. Wildberger and Dr. A. Mahnken, University of Aachen

Traumatology

Movement artefacts

Traumatology

Gunshot

Protocol CT-scan Neck Indications Standard Oncology Trauma CTA (Hernia to MRI)
Radiation-dose 1.1 mSv

Guidelines for radiology report Soft tissue evaluation. Pathology? Nodules, glands? CTA: stenosis? CTA: aneurysm? Fractures? Bone destruction?

CT neck with contrast

Hindering metal artefacts

Maligne lymfoma with necrotic lymph gland. Future: Iterative reconstruction, less artefacts and lower dose!

Partial Volume effect

Enlarged thyroid: problems with swallow

MPR 1 mm

MPR 3 mm

MPR 5 mm

MPR coronal direction: 1, 3 - 5 mm slice thickness Partial Volume effect: sharp versus unsharp, noisy versus a better S/N ratio
Bushberg, page 371-372

Traumatology

Wear, (slijtage)

Traumatology

Fracture second Cervical Vertebra

Traumatology

Fracture 3th Lumbar Vertebra

Traumatology

Fracture 2th Lumbar Vertebra (near to transverse lesion)

Traumatology

Same patient

Report after 2 years: no complaints, no limitations

Break

What to expect?

Monday 26 march 2012 09.00 12.00 h

- CT Techniques - Clinical CT applications: head and neck - CT in Cardiology - Dual Energy CT - CT in Archeology

Thursday 29 march 2012 13.00 16.00 h

- CT Techniques - Clinical CT applications: chest and abdomen - Radiation dose - Cone Beam CT - CT in Forensics (CSI-Groningen)

Cardiology

Fly Through (RCA)

2002 Sensation-16!

Cardiology

Cardiac Imaging = need for speed !

CTA: image quality is inversely proportional to the heartrate

Two possibilities: decrease scantime or the heart rate (> 70 bpm beta-blockers) Faster scanning = higher temporal (time) resolution - Rotationtime of 500, 420, 370 up to 270 ms (limitation by G-forces) - Half-scan reconstruction (180 degrees): 250, 210, 185 up to 135 ms

Cardiology

Aquisition methodes for CTA in SSCT or DSCT

1. Spiral (retrospective, with ECG-pulsing)


- Classic method for CTA (all vendors) Advantage: - Phase shifting possible (with wide pulsing) - More phases to use in Cardiac Function Disadvantage: - Radiation dose between 8-15 mSv (or even higher)

Applications: Coronary Arteries, Cardiac Function, Valves, Bypass

Cardiology

Multislice Spiral Single Source CT

Raw Data plus recorded ECG-signal (retrospective reconstruction).


Siemens

z - Position

s uou feed in ont an & C c s iral sp

Image data

180 degrees reconstruction

Reco n

Reco n

Delay

Reco n

Reco n
Half scan segment

Time

Reconstruction: delay in percentage or time in msec (e.g. start at 75 %).

Cardiology

Multislice Spiral Single Source CT

Siemens

z - Position

Reco n

Dela y
Half scan segment

Reco n

Time
Very low heartrate or table feed (pitch) to high: gaps!

Reco n

us Volume Gaps o inu l t Con pira S n& a Sc ed Fe

180 degrees reconstruction

Reco n

Cardiology

Gaps in a 16-slice CT

Cardiology

Single Source CT Temporal resolution of maximum 165 ms

Temporal Resolution = Rotation Time = 165 ms 2

Cardiology

Single Source CT 180 degrees recon Technical challenge with high heart rates
60 bpm 100 bpm

Cardiology

Comparison between Single Source and Dual Source CT Cardio-imaging: high temporal- and spatial resolution

Siemens Somatom Sensation-64 Cardiac (Single Source)

Siemens Somatom Definition (Dual Source)

Cardiology

Dual Source CT: principle Normaly only 1 tube (Source) is used for scanning (A-tube, Single Source)

Cardiology

Dual Source CT Heart rate independent temp. resolution of 83 ms

Temporal Resolution = Rotation Time 4 = 83 ms

Cardiology

Dual Source CT Reliable imaging of all heart rates


60 bpm 100 bpm

Cardiology

Aquisition methodes for CTA in SSCT or DSCT


move move move

2. Sequential (prospective, step and shoot) - Alternative method (reducing radiation)


Advantage: radiation dose between 2-4 mSv - Calcium Scoring between 0.8 and 1.5 mSv Disadvantage: no phase shifting possible, - only in future Cardiac Function possible - sometimes steps between slices

Applications: Non-Coronary (e.g. RF Ablatio), Calcium Scoring

Cardiology

Prospective Sequential (Step and Shoot)

- Sometimes steps between slices - Higher heartrate: bigger and more steps - Use betablockers to decrease heartrate and steps

Cardiology

Prospective Sequential (Step and Shoot)

- Sometimes steps between slices - Higher heartrate: bigger and more steps - Use betablockers to decrease heartrate and steps

Cardiology

Timing of contrast

Test bolus
Standardised automatic Bolus Tracking - place of ROI: Descending Aorta Threshold 100 HU Advantage: less movement, less artefacts compared to Ascending Aorta, operator independent manual

Bolus tracking manual


- place of ROI: outside the patient in air or fat
2 cm below the bifurcation of the trachea

Cardiology

Cardiac contrast protocols (UMCG)


Contrast: Iomeron 400 Injector: MedRad Stellant, Dual Source CT Contrast ml/sec Cardiac spiral and sequential Dual Flow Cardiac-bypass Extra series 3 5 4 3 5 Saline (NaCl) ml/sec ml

Contrast: Iomeron 400 Injector: MedRad Stellant, Sensation-16 and Sensation-64 Contrast ml/sec Cardiac spiral and sequential Biphasic Cardiac-bypass Extra series 3 5 4 3 5 Saline (NaCl) ml/sec ml

ml 3 80 20 3 60

ml 3 65 80(30-70%) 3 60

4 4

50 30

4 4

30 30

Cardiology

Timing of the reconstruction (spiral mode)

5% 10 % 15 % 20 % 25 % 30 % 35 % 40 % 45 % Start phase 50 % 55 % 60 % 65 % 70 % Manual or automatic (best phase) 75 % 80 % 85 bpm > 65-70% 85 % 90 % 85 bpm < 30-35% 95 % 100 %

65 %

70 %

75 %

80 %

Cardiology

Case
> 50% stenosis & complete occlusion RCA

Male, 57 y Chest-Pain on ER Dual Source CT > CAG > PTA Retrospective spiral CTA with ECG-Pulsing 30-80% full dose, rest 20% dose Start phase reconstruction 70%

RCA LCX LAD

No significant stenosis

Cardiology

Cardiac Function Evaluation

Systolic phase

Do not include the pappilary muscles! Diastolic phase epicardium

endocardium - Recommanded: 20 Phase reconstruction - 2 mm, index 2 mm (256 matrix if possible)

Cardiology

Case
Wall thickness ES Wall thickness ED

Siemens Circulation Evaluation Program

Wall thickening

Wall motion

Cardiology

Aorta Valves

Recommanded: - 20 Phase recon, 1 mm, index 1 mm (512 matrix) - Kernel medium/sharp - No ECG-pulsing (3-6 mSv)

What to expect?

Monday 26 march 2012 09.00 12.00 h

- CT Techniques - Clinical CT applications: head and neck - CT in Cardiology - Dual Energy CT - CT in Archeology

Thursday 29 march 2012 13.00 16.00 h

- CT Techniques - Clinical CT applications: chest and abdomen - Radiation dose - Cone Beam CT - CT in Forensics (CSI-Groningen)

Dual Energy

Dual Energy CT

Dual Energy is based on the unique energy dependant attenuation profiles of different sorts of tissue like fat, soft tissue, bone and contrast.

Dual Energy

Dual Energy is based on the unique energy dependant attenuation profiles of different sorts of tissue like fat, soft tissue, bone and contrast.
Thomas Flohr, First performance evaluation of a DSCT; Eur Radiology (2006)

Dual Energy

Determination stones in kidney

Anno Graser MD et all (Mnich-Grosshadern)

Dual Energy

Determination stones in kidney

Uric acid-stones (9%)

Calcium oxalate-stones (80%)


Anno Graser MD et all (Mnich-Grosshadern)

Dual Energy

Bone Subtraction

Christoph Becker MD et all (Mnich-Grosshadern)

Dual Energy

Evaluation Myocard Perfusion with DE Perfusion CT

- Anatomy - Function - Perfusion

Ischemia

Dual Energy

Dual Energy:
Possible applications - differentiation in composite of kidneystones - simply removing of bony structures and calcification by way of subtraction - virtuel reconstruction of a native series - differentiation between benign and malign nodules, cysts and other abnormalities - differentiation between cartilage, tendons and ligaments (traumatology) - detection of inflammation, e.g. in softplaques

Developments in Dual Source CT

What to expect?

Monday 26 march 2012 09.00 12.00 h

- CT Techniques - Clinical CT applications: head and neck - CT in Cardiology - Dual Energy CT - CT in Archeology

Thursday 29 march 2012 13.00 16.00 h

- CT Techniques - Clinical CT applications: chest and abdomen - Radiation dose - Cone Beam CT - CT in Forensics (CSI-Groningen)

Archeology

Mummie Janus (RMO) Egyptologist Dr. H. te Velde Medical student T. Valke

AZG 1973

Archeology

1998 Mummie Janus

Archeology

1998 Mummie Janus

hart

Archeology

Unit of Art in Medicine, Manchester; Facial reconstruction made by Denise Smith and Caroline Wilkinson.

Archeology

Unit of Art in Medicine, Manchester; Facial reconstruction made by Denise Smith and Caroline Wilkinson.

Archeology

1 juni 1999 disclosure of the reconstructed head by the acting representative Egyptian ambassador, mr. Ashraf Elkholy.

Archeology

1 juni 1999 disclosure of the reconstructed head by the acting representative Egyptian ambassador, mr. Ashraf Elkholy.

Archeology

Corpse preserved in peat (veenlijk)

Meisje van Yde

Archeology

Museum-Assen Meisje van Yde

But is it reliable?

Tarbot

END

Imaging Techniques in Radiology: CT

Wim Tukker systeemspecialist CT UMCG

What to expect?

Monday 26 march 2012 09.00 12.00 h

- CT Techniques - Clinical CT applications: head and neck - CT in Cardiology - Dual Energy CT - CT in Archeology

Thursday 29 march 2012 13.00 16.00 h

- CT Techniques - Clinical CT applications: chest and abdomen - Radiation dose - Cone Beam CT - CT in Forensics (CSI-Groningen)

Image Reconstruction: Backprojection Each individual projection gives a contribution to the eventual picture advancement (beeldopbouw).

Voxels en pixels. In practise we look more to the pixels then to voxels. Realise that a pixel is always an addition of a volume. In an other way: a pixel is a 2-dimensional display of a 3-dimensionale measurement.

CT Chest

level window

40 400

level window

40 400

HU: Hounsfieldschale level - window level - 650 window 1600


CT technique Daily calibration of the CT

level window

40 800

Bushberg, page 358

Matrix
CT technique Bushberg, page 356

CT technique

Bushberg, page 356

Backprojection: filtered (Kernel)

1 pixel (voxel) Matrix in CT: 512x512

CT technique

Page 352 - 355

Influence Kernel on Sharpness

Bushberg, page 352-355

Influence Kernel on Noise

Bushberg, page 352-355

Spatial resolution

10 mm low Kernel (filter)

5 mm low Kernel 2 mm with a spatial filter (1H)

CT technique

Bushberg, page 352 - 355

Effect of the kernel


CT technique Bushberg, page 352 - 355

contrast resolution
(chicken)

(chop)

(steak) (stone) (wood) (bacon rag)

CT technique

Bushberg, page 352 - 355

spatial resolution

CT technique

Bushberg, page 352 - 355

Influence Slice Thickness on Spatial Resolution

Partial Volume Effect

CT technique

Spatial resolution smal details - interstitial lungtissue - Inner Ear structures - Temporal Mandibulair Joint

Contrast resolution contrast - braintissue - abdominal organs, liver - bloodvessels, lymphnodes

method thin slices higher kV lower radiationdose sharp kernel wide window

method - thicker slices - lower kV - relative higher dose (Alara) - soft kernel - small window

Bushberg, page 352-355

What to expect?

Monday 26 march 2012 09.00 12.00 h

- CT Techniques - Clinical CT applications: head and neck - CT in Cardiology - Dual Energy CT - CT in Archeology

Thursday 29 march 2012 13.00 16.00 h

- CT Techniques - Clinical CT applications: chest and abdomen - Radiation dose - Cone Beam CT - CT in Forensics (CSI-Groningen)

CT Chest

Difference between X-Ray and CT Scoutview?

Fan beam projection

Scoutview A.P.
Bushberg, page 330

CT Chest

Window level: mediastinum-setting

Ascending Aorta

Superior Vena Cava Pulmonary Artery

Descending Aorta

Pleural Effusion
Bushberg, page 358

CT Chest

Window-level: lung-setting

Bushberg, page 358

CT Chest

Lung Metastasis

CT Chest

HD Diaphragmatic Hernia Curved MPR


Bushberg, page 358-360

CT Chest

Carcinoma of the Oesophagus

Gastric tube Bushberg, page 358-360

CT Chest

Atherosclerosis

CT Chest

Heavy smoker, 67 y Coughing, blood

First visit jan 2005

Next visit sept 2008

CT Chest

Lung carcinoma with hilair adenopathy (lymphoma)

CT Chest

VRT (Volume Rendering Technique) usefull or not?

CT Chest

Virtual scopy: usefull or not?

Virtual Scopy

CT Chest

Future: evaluation long embolia with Dual Energy Perfusion CT

CT Chest

Stent control thoracic aneurysm

CT Abdomen

Stomach Pancreas

Gallstones

Superior Mesenteric Artery

Liver

Adrenal Spleen Diaphagm

Kidney

Abdominal anatomy

CT Abdomen

Determination of a heamangioma of the Liver

Four fasic Liver CT

CT Abdomen

Protocol living kidney donation

CT Abdomen

Evaluation The Urological System: Ureters; Urinary Bladder;

Intra-Uterine Device (IUD).

Protocol living kidney donation

CT Abdomen

Abnormality?

CT Abdomen

Abdominal Aortic Aneurysm

CT Trauma

Polytrauma

CT Trauma

ATLS trauma-scheme X-thorax (chest) X-cervical spine lateral X-pelvis

clavicula # ribfractures trace fluid right femur #

CT Trauma

Ultra-sound of the abdomen - fluid in the chest - fluid around spleen and liver CT or Operation Room? -> CT!

CT Trauma

- ventral pneumothorax *) - heamatothorax, right side - multiple ribfractures *)

*) Artificial respirating

CT Trauma

CT Abdomen (arterial phase) - Rupture of the spleen - Active arterial bleeding - Fluid round the organs Operation Room? No!

CT Trauma

Groin; liesstreek

DSA (Digital Subtraction Angiography) - Arterial extravasation followed by embolisation

CT trauma

First take away the life threatening situations!

DSA - Embolisation; glue procedure (artificial infarct)

CT Trauma

Collateral damage
- Clavicula #

MPR (Multi Planar Reconstruction)

MIP (Maximum Intensity Projection)

CT Trauma

# Cervical 2

Collateral damage

Break

What to expect?

Monday 26 march 2012 09.00 12.00 h

- CT Techniques - Clinical CT applications: head and neck - CT in Cardiology - Dual Energy CT - CT in Archeology

Thursday 29 march 2012 13.00 16.00 h

- CT Techniques - Clinical CT applications: chest and abdomen - Radiation dose - Cone Beam CT - CT in Forensics (CSI-Groningen)

S/N

165 mAs

165 mAs

20 mAs

20 mAs Optical Magnification

CT fysics

Effect mAs on image quality

20 mAs

110 mAs

CT fysics

Radiation-protection in CT: AEC (Automatic Exposure Control)


Automatic adaption mA (tube current) to the shape (reference detectors) of a patient in the XY-axis (up to Sensation-16).

Object attenuation

lateral High attenuation 1.0 a.p.

Modulated tube current

0.75 LOW attenuation 0.50

Round objects, no reduction! Thick patients, children

0.25 0 0 500 1000 1500 2000 Scantime in ms 2500

Bushberg, page 366

CT fysics

Radiation-protection in CT: AEC (Automatic Exposure Control)

standard scan

with AEC

199mAs, noise = 12.9HU

189mAs, noise = 9.4HU

Bushberg, page 366

CT fysics

Care Dose 4D

Sensation 64, Dual Source Real-time tube current adaption: up to 66 % dose reduction compared to fixed mA!

Bushberg, page 366

CT fysics

CareDose 4D Optimal image quality, dose adapted to anatomy

140mAs 55mAs

110mAs

130mAs Bushberg, page 366

CT fysics

Absorbed dose: deposited energy in tissue (mGray)

Equivalent dose: biological effects in relation to the sort of ionising radiation (mSv) X-rays = factor 1 (protons = 5, neutrons = 5-20, = 20)

Effects: stochastic > no borderline, proportional to dose > tumorinduction and genetic damage

Effects: deterministic > borderline > cataract, infertility, skin damages

Effective dose: cumulative weighted organdose (mSv) > cancer risk.

Bushberg, page 362 - 366

CT fysics

Step one: calculating absorbed dose in mGray CTDI = Computer Tomography Dose Index

Bushberg, page 362 - 366

CT fysics

A measurement for radiation absorption is CTDIw (mGray). CTDIweighted = 1/3 x CTDIcenter + 2/3 CTDIskin.

D.L.P.
The Dose Length Product says more about the total amount of absorbed dose. DLP = CTDIw x st x n (multiply) st = slicethickness, beamwidth in Z-axis n = number of adjusted slices or rotations

Bushberg, page 362 - 366

CT fysics

Bushberg, page 362 - 366

CT fysics

Effective dose (E) in mSv: radiation risc for the patient

Definition organdose: average absorbed energy per organ (mGray). E = total organdose (mSievert)

E = WT x HT
WT = Organ weighted factor (ICRP 60*) HT = Absorbed organdose x quality factor (1)

* International Commission of Radiological Protection


Bushberg, page 362 - 366

CT fysics

Nucleair attack on Hiroshima 6 aug 1945 and Nagasaki 9 aug 1945

Japan: Hiroshima

Total number of Deaths Immediately: 78.000 End 1945: 140.000 2004: 237.062

CT fysics

Organ sensitivity after the A-bom radiation, Hiroshima (RERF, Radiation Effects Research Foundation)
Table. Numbers of cancer deaths by cancer type and strength of evidence for a radiation effect.
____________________________________________________________________ Total Estimated Evidence for Site Total Estimated Evidence for Deaths Excess Effect Deaths Excess Effect ____________________________________________________________________ Stomach Lung Liver Uterus Colon Rectum Pancreas Esophagus 2529 939 753 476 347 298 297 234 65 67 30 9 23 7 3 14 12 strong strong strong moderate strong weak weak strong moderate F. Breast Ovary Bladder Prostate Bone 211 120 118 80 32 37 10 10 2 3 47 1 6 strong strong strong weak moderate strong weak strong Site

Other solid 948 Lymphoma Myeloma 162 51

Gallbladder 228

CT fysics

Absorbed dose (mGy) > organdose (mSv) Weight factors: ICRP-norm Weightfactors for calculation of the effective (organ) dose.
(ICRP #26, 1977) (ICRP #60, 1990) Gonads Bone Marrow Colon Lung Stomach Bladder Breast Liver Oesophagus Thyroid Skin Skeleton Remainder Sum 0,25 0,12 0,12 0,15 0,03 0,03 0,30 1,00 0,20 0,12 0,12 0,12 0,12 0,05 0,05 0,05 0,05 0,05 0,01 0,01 0,05 1,00

What to expect?

Monday 26 march 2012 09.00 12.00 h

- CT Techniques - Clinical CT applications: head and neck - CT in Cardiology - Dual Energy CT - CT in Archeology

Thursday 29 march 2012 13.00 16.00 h

- CT Techniques - Clinical CT applications: chest and abdomen - Radiation dose - Cone Beam CT - CT in Forensics (CSI-Groningen)

Cone Beam CT

Disadvantages 3D to 2D

NEVER BELIEVE AN X-RAY

2006

NewTom 3G DVT

i-CAT Cone Beam 3-D Imaging System

Cone Beam CT

A Clear Difference that You Can See!

Conventional Panoramic (OPG) Imposition of Tissue Projection Distortion Magnification Error

NewTom Panoramic Cone Beam CT No Distortion 1:1 Scale Exact Measurements

Cone Beam CT

Working of a Cone Beam CT


Fan-beam of X-ray in CT Cone-beam of X-ray

Cone Beam CT

Working of a Cone Beam CT

LA Feldkamp, LC Davis, JW Kress: Practical cone-beam algorithm J. Opt. Soc. Am. (1984), 612-619

Cone Beam CT

Clinical applications Dental implantations

Oral and Maxillofacial Surgeons Orthodontists

Digital OPG - Curved MPR

MPR (Multi Planar Reformatting)

VRT (3D) (Volume Render Technique)

Cone Beam CT

Ray Sum Images

Panoramic Images

MIP (Maximum Intensity Projection)

Unlimited post processing in variable slice thickness

Cone Beam CT

Made by a Cone-Beam CT

Cone Beam CT

Effective dose

Illuma 137 S

NewTomVG 75 S

Ewoo 70 S

Kavo/Icat 68 S

NewTom 36 S

Galileos 29 S

Cone Beam CT

Sirona GALILEOS NewTom 3G NewTom VG

Planmeca ProMax 3D

2010

What to expect?

Monday 26 march 2012 09.00 12.00 h

- CT Techniques - Clinical CT applications: head and neck - CT in Cardiology - Dual Energy CT - CT in Archeology

Thursday 29 march 2012 13.00 16.00 h

- CT Techniques - Clinical CT applications: chest and abdomen - Radiation dose - Cone Beam CT - CT in Forensics (CSI-Groningen)

Forensic Radiology

Forensic Radiology

Bicycle versus car; on purpose?

Forensic Radiology

Shooting - How many bullets? - Ballistic trajectory? - Cause of death?

Forensic Radiology

Dental identification

Exploded Bone Marrow

UMCG

Forensic Radiology

Dental identification

We had a match!

UMCG

Mummie Janus (RMO)

Meisje van Yde (Drents Museum)

Forensic Radiology

http://www.fbi.gov

Forensic Radiology

www.fbi.gov

www.marylandmissing.com

www.missingpersons.org

Forensic Radiology

Meisje van Nulde

Forensic Radiology

Meisje van Nulde

Forensic Radiology

Meisje van Nulde

Forensic Radiology

Meisje van Nulde

Rochelle

Rowena

Forensic Radiology

Thanks to ultra sound specialist: Jan Visscher

Forensic Radiology

Mouse !!!

Last Dinner ???