PRINCIPLES OF

COMPUTED TOMOGRAPHY
Mohd Hafizi Mahmud
Centre for Medical Imaging Studies
Faculty of Health Sciences
Universiti Teknologi MARA Puncak Alam Campus
Conventional imaging vs CT imaging
 Limitations of radiography

 Superimposition of all structures on the film, which makes it

difficult and sometimes impossible to distinguish a particular detail
 Qualitative rather than quantitative process
Limitations of conventional tomography
 The problem of superimposition in radiography can
overcome by conventional tomography (geometric
tomography)
 Persistent image blurring that cannot be completely
removed, degradation of image contrast because of the
presence of scattered radiation created by the open
geometry of the x-ray beam, and other problems resulting
from film-screen combinations.
 Fail to adequately demonstrate slight differences in
subject contrast, which are characteristic of soft tissue.
Role of CT to overcome the limitations
 Minimal superimposition
 Improved image contrast
 The recording off very small differences in tissue contrast
 Data Acquisition
 Systematic collection of information from the patient to produce the CT
image.

Slice-by slice data acquisition

 Data are collected through different beam geometries to scan the patient.
 The x-ray tube rotates around the patient and collects data from the first slice.
The tube stops, and the patient moves into position to scan the next slice.
 This process continues until all slices have been individually scanned.
Volume data acquisition

 Spiral or helical geometry is used to scan a volume of tissue rather than one slice
at a time
 X-ray tube rotates around the patient and traces a spiral/helical path to scan an
entire volume of tissue while the patient holds a single breath.
 Generates a single slice per one revolution of the x-ray tube and is often referred to
as a single-slice spiral/helical CT (SSCT).
 Multislice spiral/helical CT (MSCT) is used to improve the volume coverage speed
performance of SSCT.
 MSCT scanners generate multiple slices per one revolution of the x-ray tube.
Eg, 4, 8, 16, 32, 40, or 64 slices per revolution of the x-ray tube.
 Scanning
 The x-ray tube and detectors rotate around the patient to
collect views (intensity readings).
 The detectors measure the radiation transmitted through
the patient from various locations.
 Relative transmission values or attenuation measurements
are calculated.
 The relative transmission values are sent to the computer
and stored as raw data
 Radiation Attenuation
 Reduction of the intensity of a beam of radiation as it passes
through an object.
 Attenuation in CT depends on the effective atomic density
(atoms/volume), the atomic number (Z) of the absorber, and the
photon energy.
 Considering homogenous beam and heterogenous beam.
Data Acquisition Geometries
 Data Processing

 Raw data (data received from the detectors) undergo some form of
preprocessing, in which corrections are made and some
reformatting of the data occurs.
 Image reconstruction : Scan data, which represent attenuation
readings are converted into a digital image characterized by CT
numbers.
 Conversion of the attenuation readings into a CT image is
accomplished by mathematical procedures referred to as
reconstruction algorithms eg. back-projection, iterative methods,
and analytic methods.
 CT Numbers
 Each pixel in the reconstructed image is assigned a CT number.
 CT numbers are related to the linear attenuation coefficients of the
tissues that comprise the slice
 t is the attenuation coefficient of the measured tissue, w is the
attenuation coefficient of water, and K is a constant or contrast factor
 CT and Energy Dependence
 The linear attenuation coefficient is affected by several factors,
including the energy of the radiation.
Why high kV technique is commonly used
in CT ?
 In CT, a high-kilovolt technique (about 120 kV) is generally
used for the following reasons:
▪ To reduce the dependence of attenuation coefficients on
photon energy
▪ To reduce the contrast of bone relative to soft tissues
▪ To produce a high radiation flux at the detector
Image Display, Storage & Communication
 After the CT image has been reconstructed, it exits the computer in
digital form.
 The gray-scale image is displayed on a television monitor (Cathode ray
tube [CRT]) or liquid crystal display.
 Display matrix can range from 64 64 to 1024 1024, but high-
performance monitors can display an image with a 2048 2048 matrix
 Windowing
 The CT image is composed of a range of CT numbers (e.g., +1000 to
1000, for a total of 2000 numbers) that represent varying shades of
gray.
 The process of changing the CT image gray scale
 The range of numbers – window width (WW), controls the image
contrast
 The center of the range- window level (WL), controls the image
brightness
 Format of CT Image
 The original clinical CT images were composed of an 80 80 matrix for a total of
6400 pixels.
 The size of the matrix is chosen by the technologist before the CT examination
and depends on the anatomy under study.
 The technologist must select the field of view (FOV) or reconstruction circle,
which is a circular region from which the transmission measurements are
recorded during scanning, known as scan FOV.
 The pixel is transformed into a voxel, volume element. The radiation beam passes
through each voxel and a CT number is then generated for each pixel in the
displayed image.
 The display FOV can be equal to or less than the scan FOV.
 The pixel size can be computed from the FOV and the matrix size through the
following relationship:
Pixel size = field of view/matrix size
 Each pixel in the CT image can have a range of gray shades e.g. 256, 512, 1024,
2048
 Data Flow in a CT Scanner
 The x-ray tube (and detectors) rotate around the patient, who is positioned
in the gantry aperture for the CT examination. This step is characterized by
the beam geometry and method of scanning and involves the passage of x-
rays through the patient. The x-ray beam is highly collimated by pre-patient
collimators.
 The radiation is attenuated as it passes through the patient. The transmitted
photons are measured by two sets of detectors, a reference detector, which
measures the intensity of radiation from the x-ray tube, and another set that
records x-ray transmission through the patient.
 The transmitted beam and reference beam are both converted into electrical
current signals that are amplified by special circuits. This is followed by
logarithmic amplification, in which the relative transmission readings (I0/I)
are changed into attenuation and thickness (x) data.
 Before the data are sent to the computer, they must be converted into digital
form. This is done by the analog-to-digital converters, or digitizers.
 Data processing begins. The digital data undergo some form of
preprocessing, which includes corrections and reformatting. The data
referred to as reformatted raw data. Additional data corrections are
performed on the data by using computer software.
 Convolution is performed on the data by the array processors.
 Specific reconstruction algorithm then reconstructs an image of the
internal anatomic structures under examination
 The reconstructed image can then be displayed or stored on magnetic or
optical tape or disks.
 The image processor shown allows the performance of various digital
image post-processing operations on the displayed image
 The control terminal is usually an operator’s control console, which
completely controls the CT system.
 Advantages of CT
 Excellent low-contrast resolution.
 By changing the WW and WL settings in image windowing, the contrast
scale of the image can be varied to suit the needs of the observer.
 3. With spiral/helical volume data acquisition, it provides volume data
acquisition in a single breath rather than slice-by-slice acquisition,
improvements in 3D imaging, multiplanar image reformatting, and other
applications, such as continuous imaging, CT angiography, and virtual
reality imaging, or CT endoscopy.
 CT has made available a variety of techniques intended to facilitate the
diagnostic process eg. quantitative CT, dynamic CT, perfusion CT, and
high spatial resolution CT, integrated SPECT/CT and PET/CT.
 The image can be modified to enhance its information content or analyzed
to obtain information about the shape and texture of lesions using image
processing algorithm.
 Provide 3D imaging.
 Limitations of CT
 The spatial resolution (line pairs per millimeter) of CT is notably
poorer compared with radiography.
 The dose in CT is generally higher for similar anatomical regions.
 It is difficult to image anatomic regions in which soft tissues are
surrounded by large amounts of bone, such as the posterior fossa,
spinal cord, pituitary, and the interpetrous space . The imaging
process may create artifacts that may obscure diagnosis.
 The presence of metallic objects on the patient produces streak
artifacts on CT images. CT also creates other artifacts not common
to radiography.
 Reference

 Seeram, E (2009). Computed Tomography: Physical principles, clinical

applications and quality control, 3rd ed., Saunders Elsevier, USA