Basics of Computed Tomography (CT)
By: Dr./ Nesreen Mohey
Lecture 3
Intended Learning Outcomes
By the end of this session, you should be able to:
- Enumerate the medical uses of computed
tomography.
- Differentiate between axial and helical CT.
- Differentiate between matrix, pixel &voxel.
- Identify the different reconstruction techniques.
- Identify the different CT artifacts.
How does a CT scan work?
Computed Tomography (CT)
- Computed Tomography is an imaging modality
that uses X-rays to produce cross sectional images
called “slices” of the body.
- These slices can be “stacked” together to form a
3D image for easier identification of structures.
- Unlike conventional X-ray (which uses a fixed X-
ray tube) - CT scanner uses a motorized X-ray
source that rotates around the body in a circular
opening called “gantry”.
Medical Uses of Computed Tomography
For example, imaging of:
1- Brain: e.g to detect infarction, hemorrhage, tumors.
2- Neck: Contrast CT is the study of choice for neck masses.
3- Lungs: e.g HRCT (High resolution CT) for lung parenchyma,
routine contrast CT, CT bronchoscopy.
4- CT Angiography: type of contrast CT used to visualize the arteries
and veins throughout the body.
5- Cardiac CT: for coronary artery diseases.
6- Abdomen and pelvis: either non enhanced (e.g for renal stones),
enhanced CT or CT colonography.
7- Bones: mainly for fractures, dislocation of joints.
8 -Guide procedures: such as biopsy, surgery and radiation therapy.
Note: CT scan uses higher levels of ionizing radiation than
radiographs does.
Conventional (Axial) VS Helical (spiral) CT
Conventional (Axial) CT
• “Step and shoot”
1. Gantry stops and rotates to acquire data from single
slice.
2. X-rays switched off
3. Patient moves to next slice
4. Rotates to acquire data from next slice
Limitations;
1. Longer scan time.
2.Slice misregestration e.g ; patient breathing.
3. Inaccurate generation of MPR & 3D images.
Helical (spiral) CT
- Gantry keeps rotating continuously releasing X-ray beams.
- The couch simultaneously moves.
- This results in a continuous spiral scanning pattern.
Advantages:
1.Faster scan times.
2.Less motion artifact.
3.Effective use of contrast agent.
4.Better image reconstruction and helps in showing smaller lesions.
All images are now acquired in this way.
Cone Beam CT
- Cone shaped X-ray beam.
- Mainly used for dental imaging.
- The size of CT machine is smaller.
- Less dose of radiation than general radiology.
Hardware of CT machine
X-ray tube:
As the patient enters the scanner, the X- ray source
rotates continuously emitting X-rays that penetrate a
given part of the body, the tissues of body attenuate
X-rays to different degrees, the rays that pass
through the body hits detectors.
Detectors: Converts the X-rays into electronic
signals, these signals allow the computer to
calculate an image.
Filter:
To reduce patient dose of radiation and
improve image quality.
Collimator:
Used to reduce scatter radiation reaching the
detectors.
Digital Image (Matrix, Pixel & Voxel )
* Image Matrix:
The image matrix is composed of columns and rows that define
the pixels within an image.
- Matrix : is an array of numbers arranged in rows and columns, each
number represents the value of the image at that location.
So, a CT image= Matrix with thousands of pixels.
* PIXEL
The pixel is the 2D element that makes up the image
matrix, each pixel is a respective value that will
represent a brightness level.
* VOXEL
VOXEL= 3D PIXEL
The CT number
• Each pixel stores a value known as the CT number.
• The CT number is also known as the Hounsfield unit (HU).
The Hounsfield scale of CT numbers
This scale is running from -1000 HU for air,
between -50 to -100 HU for fat, 0 HU for
water, +40 to+80 HU for soft tissues,
around +1000 HU for bone and over 3000
HU for metals.
- These values are determined by the
application of specific window values.
CT Windowing
-Windowing, (also known as grey-level mapping) is the process in which the CT
image greyscale component of an image is manipulated via the CT numbers
(Hounsfield Units), doing this with change the appearance of the picture to
highlight particular structures. The brightness of the image is adjusted via the
window level (WL). The contrast is adjusted via the window width (WW).
Window Width and Window Level
The window Width (WW)
• It is the measure of the range of CT numbers
(HU units ) that a CT image contains and
represented by different shades of gray.
• Any HU value that falls below the lower value
of the window width will show up as black on the Lung Window Mediastinal Window
scan while any HU value that is above the upper
value of the window width will be white.
The Window Level (WL)
Is the window center or midpoint of HU.
Bone Window
Reconstruction techniques
Multiplanar reformation (MPR)
MPR involves the process of converting
data from axial plane into another plane
such as coronal, sagittal or oblique
planes.
Curved planar reformation (CPR)
It enables tracing a curved structure, such as a blood vessel or ureter.
This is very useful in CT/MR angiography (CTA).
Maximum Intensity Projection (MIP)
- Only the pixel with the highest Hounsfield number
is represented.
- It tends to display bone and contrast material-filled
structures while other lower-attenuation structures
are not well visualized.
Minimum intensity projection (MinIP)
Only the low-density structures with the lowest Hounsfield
value is represented, so, only the most hypodense structures
are represented.
An optimal tool for assessment of lung & tracheobronchial tree.
3D Reconstruction
It recognizes tissues by its density to create a 3D
image.
Volume Rendering (VR): 3D representation of data,
done for better visualization of human anatomy,
surgical treatment planning and in medical
teaching.
CT Endoscopy: Internal organs are seen as if a
virtual endoscope is penetrating the body.
CT Artifacts
Motion Artifact
A patient-based artifact that occurs either with:
-Voluntary
- or involuntary patient movement during image
acquisition. (e.g Breathing, pulsation of heart and
vessels)
Metallic Artifact
- Caused by high attenuation objects such as
metal implants and artificial hips.
- Appear as dark and light lines emerging from
the object.
Truncation artifact
- Curvilinear bands along the edge of the
image.
- Occurs when parts of the imaged body part
remain outside the field of view e.g . Morbid
obesity
Beam hardening
- From a very dense target (e.g bone or iodinated
contrast).
- Appears as multiple dark bands between two
dense objects, for example, at the posterior fossa.
Ring Artifact
- Caused by miscalibration or failure of
one or more detector elements in a CT
scanner.
- They occur close to the isocenter of
the scan and are usually visible on
multiple slices at the same location.
Reformation Artifacts
Stair step artifacts
- Appear around the edges of structures in multiplanar
and 3D reformatted images.
- They are less severe with helical scanning.
THANK YOU
27
Dr. Nesreen Mohey
[email protected]
www.gu.edu.eg
