COMPUTED TOMOGRAPHY

COURSE DESCRIPTION: Study of principles involved in diagnostic

imaging modalities that produce cross-sectional, transaxial,
coronal and sagittal images of the human body.

LEARNING OBJECTIVES/OUTCOMES: At the end of the course, student

will understand the principles and concept of Computed Tomography
as a diagnostic imaging modality.

Student will:

 Outline the development of the application of CT in medical

diagnostic imaging;

 Describe terms relevant to CT and its components data

acquisition process;

 Differentiate conventional radiography with CT; illustrate

scanning procedures and explain images acquisition in CT;

 Describe the components of the CT imaging system;

 Explain the functions of collimators in CT

 List the CT computer data processing steps;

 Define raw data and image data;

 Name the common controls found on CT operator consoles and

describe how and why each is used;

 Identify the types and appearance of artifacts most commonly

affecting CT images;

 Identify and apply appropriate contrast medium for a

particular CT procedures;

 Name the radiation protection devices that can be used to

reduce patient dose in CT and describe the correct
application of each;

 Discuss general radiation safety and protection practices

associated with examinations in CT; and

 Explain and demonstrate quality assurance and quality

control test in CT
MODULE 1 HISTORICAL DEVELOPMENT
Unit Learning Outcome: Outline the development of the application
of CT in medical diagnostic imaging.

COMPUTED TOMOGRAPHY (CT)

CT imaging (also called CAT scanning for computed Axial

Tomography) was invented in 1972 by Godfrey Hounsfield in

England. Hounsfield used gamma rays (and x-rays) and a detector

mounted on a special rotating frame together with digital

computer to create detailed cross sectional images of objects.

Hounsfield’s original CT scan took hours to acquire a single

slice of image data and more than 24 hours to reconstruct this

data into a single image. Today’s stat-of-the-art CT systems can

acquire a single image in less than a second and reconstruct the

image instantly.

The invention of CT was made possible by the digital computer.

The basic algorithms involved in CT image reconstructed are based

on theories proposed by the scientist Radon in the late 1700’s.

to honor his remarkable discovery, Hounsfield was awarded the

Nobel Prize and was granted Knighthood by the Royal Family of

England.

GODFREY NEWBOLD HOUNSFIELD

 Born: Aug 28, 1919

Birthplace: Newark, Nottinghamshire, England

Died: Aug 12, 2004

Sir Godfrey Hounsfield pioneered a great leap forward in medical

diagnosis: computerized axial tomography, popularly known as the

“CAT scan.” Ushering in a new and sometimes controversial era of

medical technology, Hounsfield’s device allowed a doctor to look

inside a patient’s body and examine a three-dimensional image far

more detailed than a conventional X-ray. The importance of this

advance was recognized in 1979, the year Hounsfield received the

Nobel Prize for physiology or medicine.

Godfrey Newbold Hounsfield was born August 28, 1919, in Newark,

England, the youngest of five children of a steel-industry

engineer turned farmer. Hounsfield’s technical interest began

when, to prevent boredom, he began to figuring out how the

machinery on his father’s farm worked. From there he move on to

exploring electronics, and by his teens was building his own

radio sets. He graduated from London’s City and Guilds College in

1938 after studying radio communication.

When Wold War II erupted, Hounsfield volunteered for Royal Air

Force, where he studied and later lectured on the new and vital

technology of radar at the RAF’s Cranwell Radar School. After the

war he resumed his education, and received a degree in electrical

and mechanical engineering from Faraday House Electrical

Engineering College in 1951. Upon graduation, Hounsfield joined

Thorn EMI (Electrical and Musical Industries) Ltd., an employer

he has remained with his entire professional life.

At Thorn EMI, Hounsfield worked on improving radar system and

then on computers. In 1959, a design team led by Hounsfield

finished production of Britain’s first large all-transistor

computer, the EMIDEC 1100. Hounsfield moved on to work on high-

capacity computer memory devices, and was granted a British

patent in 1967 titled “Magnetic Films for Information Storage.”

Hounsfield’s work in this period included the problem of enabling

computers to recognize patterns, thus allowing them to “read”

letters and numbers. In 1967, during a long walk through the

British countryside, Hounsfield’s knowledge of computers, pattern

recognition, and radar technology all came together in his mind.

He envisioned a medical diagnostic system in which an X-ray

machine would image thin “slices” through the patient’s body and

a computer would process the slice into accurate representation

which would display the tissues, organs, and other structures in

much greater detail than a single X-ray could produce. Computers

available in 1967 were not sophisticated enough to make such a

machine practical, but Hounsfield continued to refine his idea

and began working on a prototype scanner. He enlisted two

Radiologist, James Ambrose and Louis Kreel, who assisted him with

their practical knowledge of radiology and also provided tissue

samples and test animals for scans. The project attracted support

from the British Department of Health and Social Services, and in

1971 a test machine was installed at Atkinson Morely’s Hospital

in Wimbledon. It was highly successful, and the first production

model followed a year later. These original scanner were designed

for imaging the brain, and were hailed by neurosurgeons as a

great advance. Before the CAT scanner, doctors wanting a detailed

brain X-ray had to help their equipment see through the skull by

such dangerous technique as pumping chemicals or air into the

brain. As head of EMI’s Medical Systems section, Hounsfield

continued to improve the device, working to lower the radiation

exposure required, sharpen the images produced, and develop

larger models which could image any part of the body, not just

the head. This “whole body scanner” went on the market in 1975.

CAT scanner generated some resistance because of their expense:

even the earliest models cost over $300,000, and improved

versions several times as much. Despite this, the machines were

so useful they quickly became standard equipment at larger

hospitals around actually reduced medical costs by eliminating

exploratory surgery and other invasive diagnostic procedures. The

scanner won Hounsfield and his company more than thirty awards,

including the MacRobert Award, Britain’s highest honour for

engineering. In 1979, Hounsfield collection of scientific

tributes was topped off with the Nobel Prize. That year’s Nobel
was shared with Allan M. Cormark, an American Nuclear physicist

who had separately developed the equations involved in

reconstructing an image via computer. A surprising feature of the

selection was that neither man had a degree in medicine or

biology, or a doctorate in any field. Asked what he would do with

the large monetary award which came with the Nobel Selection,

Hounsfield replied he wanted to build a laboratory in his home.

In an interview with Robert Walgate of the British journal Nature

after the Nobel announcement, Hounsfield commented, “I’ve always

searched for original ideas; I am absolutely opposed to doing

something someone else has done.”

Hounsfield moved on to position as chief staff scientist and then

senior staff scientist for thorn EMI. He continued to improve the

CAT scanner, working to develop a version which could take an

accurate “snapshot” of the heart between beats. He has also

contributed to the next step in diagnostic technology, nuclear

magnetic resonance imaging. In 1986, he became a consultant to

Thorn EMI’s Central Research Laboratories in Middlesex, near

long-time home in Twickenham.

Hounsfield was awarded the 1979 Nobel Prize for medicine,

together with Souht-African-born physicist Allan Cormack, for his

pioneering work on the application of computer techniques to x-

ray examination of the human body. He was knighted in 1981.

Working at the Central Research Laboratories of EMI he developed

the first commercially successful machine to use computer-

assisted tomography, also known as computerized axial tomography

(CAT). In CAT, a high-resolution x-ray picture of an imaginary

slice through the body (or head) is built up from information

taken from detectors rotating around the patient. These

“scanners” allow delineation of very small changes in tissue

density. Introduced in 1973, early machines were used to overcome

obstacles in the diagnosis of diseases’ of the brain, but the

technique has now been extended to the whole body. Although

Cormack worked on essentially the same problems of CAT, the two

men did not collaborate, or even meet.

Terminology The

word “tomography” is derived from the Greek tomos (slice) and

graphein (to write). Computed tomography was originally known as

the “EMI scan” as it was developed at a research branch of EMI, a

company best known today for its music and recording business. It

was later known as computed axial tomography (CAT or CT scan) and

body section rontgenography.

Although the term “computed tomography” could be used to describe

positron emission tomography and single photon emission computed

tomography, in practice it usually refers to the computation of

tomography from x-ray images, especially in older medical

literature and smaller medical facilities.

Although the term “computed tomography” could be used to describe

positron emission tomography and single photon emission computed

tomography, in practice it usually refers to the computation of

tomography from X-ray images, especially in older medical

literature and smaller medical facilities.

In MeSH, “computed axial tomography” was used from 1977-79, but

the current indexing explicitly includes “X-ray” in the title.

Diagnostic Use

Since its introduction in the 1970s, CT has become an important

tool in medical imaging to supplement x-rays and medical

ultrasonography. It has more recently been used for preventive

medicine or screening for disease, for example CT colonography

for patients with high risk of colon cancer, or full-motion heart

scans for patients with high risk of heart disease. A number of

institutions offer full-body scans for the general population.

This is however a controversial practice, given its cost,

significant radiation exposure, lack of proven benefit, and the

risk of finding incidental abnormalities that may trigger

additional investigations.

 CT or CAT scans are special x-ray tests that produces

cross-sectional images of the body using x-rays and a

computer. These images allow the radiologist, medical

doctor who specializes in image of the body, to look at the

 inside of the body just as you would look at the insider of

a loaf bread by slicing it. This type of special x-ray, in

a sense, takes “pictures” of slices of the body so doctors

can look right at the area of interest. CT scans are

frequently used to evaluate the brain, neck, spine, chest,

abdomen, pelvis, and sinuses.

 CT has become a commonly performed procedure. Scanners are

found not only in hospital x-ray department, but also in

out-patient offices.

 CT has revolutionized medicine because it allows doctors to

see diseases that, in the past, could often only be found

at surgery or at autopsy. CT in non-invasive, safe, and

well-tolerated. It provides a highly detailed look at many

different parts of the body.

 If you are looking at a standard x-ray image or radiograph

(such as a chest x-ray), it appears as if you are looking

through the body. CT and MRI are similar to each other, but

provide a different view of the body than an x-ray does. CT

and MRI produce cross-sectional images that appear to open

the body up, allowing the doctor to look at it from the

inside. MRI uses a magnetic field and radio waves to

produces images, while CT uses x-rays to produce images.

Plain x-rays are an inexpensive, quick exam and are

accurate at diagnosing things such as pneumonia, arthritis,

 and fractures. CT and MRI better evaluate soft tissue such

as the brain, liver, and abdominal organs, as well as look

for subtle abnormalities that may not be apparent on

regular x-rays.

SUMMARY:

 Godfrey Hounsfield invented CT, engineer from EMI Ltd.,

London

 Developed the first clinical useful CT in 1971

 Hounsfield and Cormack shared the 1979 Nobel Prize in

Medicine

 Allan McLeod Cormack-South African-born of Tufts University

in Massachusetts independently invented a similar process.

 The first EMI-scanner was installed in Atkinsons Morely

Hospital in Wimbledon, England, and the first brain-scan

was done on 1 October 1971.

The Computed tomography imaging system is revolutionary. No

ordinary image receptor, such as screen film or an image

intensifier tube, is involved. A collimated x-ray beam is

directed on the patient, and the attenuated image-forming x-

radiation is measured by a detector whose response is transmitted

to a computer.
 After the signal from the detector is analyzed, the computer

reconstructs the image and displays the image on a monitor.

Computer reconstruction of the cross-sectional anatomy is

accomplished with mathematical equations (algorithms) adapted for

computer processing.

Helical CT, which has emerged as a new and improved

diagnostic tool, provides improved imaging of anatomy comprised

by respiratory motion. Helical CT is particularly good for the

chest, abdomen, and pelvis, and it has the capability to perform

conventional transverse imaging for regions of the body where

motion is not a problem, such as the head, spine, and

extremities.

The latest advance in digital radiography is digital

radiographic tomosynthesis. This imaging technique uses an area

x-ray beam to produce multiple digital images. The images form a

three-dimensional data set from which any anatomical plane can be

reconstructed. The result is even better image contrast.

Conventional tomography is called axial tomography because

the plane of the image is parallel to the long axis of the body;

this result in sagittal and coronal images. A CT image is a

transaxial or transverse image that is perpendicular to the long

axis of the body. Coronal and sagittal images can be

reconstructed from the transverse image set.

 The intensity of radiation detected varies according to this

attenuation pattern and forms an intensity profile of projection.

SUMMARY

Since its introduction by Godfrey Hounsfield and Allan Cormack,

CT has continued to evolve. New techniques cover a wide variety

of applications. However, with such technologic innovations

comes complexity. To develop and practice the most safe and

effective scanning methods, radiologic technologists must first

understand the physical principles that make up the foundation of

CT.

MODULE 2 RELEVANT NOMENCLATURE

Unit Learning Outcome: Contrast the generations of CT scan

machine

Topics:

 First generation CT scan

 Second Generation CT scan

 Third Generation CT scan

  Fourth Generation CT Scan

 Fifth Generation CT scan

GENERATIONS OF CT SCAN

1. FIRST GENERATION

The previous description of a finely collimated x-ray beam,

single detector assembly translating across the patient and

rotating between successive translations. The original EMI

scanner required 180 translations, each separated by a 1-degree

rotation. It incorporated two detectors and split the finely

collimated x-ray beam so that two contiguous slices could be

imaged during each scan. The principal drawback to these units

was that merely 5 minutes was required to complete one scan.

* translate-rotate

* pencil beam

* single detector

* 1 degree rotation

* water-filled bag-perspex tank with a pre-shaped rubber

“head-cap” at the front, which enclosed the patient’s head.

* the water-tank was used to reduce the dynamic range of

the radiation reaching the detectors (between scanning outside

the head compared with scanning through the bone of the skull)

* 180 degree rotation/projection approximately 5 minutes

to generate a single image.

 2. SECOND GENERATION

These units incorporated the natural extension of the single

detector to a multiple detector assembly intercepting a fan-

shaped rather than a pencil-sized x-ray beam.

The principal advantage of the second generation CT scanner was

speed. These scanners had 5 to 30 detectors in the detector

assembly, and therefore shorter scan times were possible.

Each translation was separated by rotation increments of 5

degrees or more. With a 10-degree rotation increment, only 180

translations would be required for a 180-degree scan.

* Translate-rotate

* multiple detectors

* partial fan beam

* 5-10 degrees of rotation

3. THIRD GENERATION

The curvilinear detector array results in a constant source-to-

detector path length, which is an advantage for good image

reconstruction. This feature of the third generation detector

assembly also allows for better x-ray collimation to reduce the

effect of scatter radiation. This type of collimation is called

predictor or post-patient collimation, and it functions much as a

radiographic grid does in conventional radiographic examination.

 There is also pre-patient collimation to restrict patient

dose. Pre-patient collimation also determines the thickness of

the tissue that is imaged.

Slice thickness is also called sensitivity profile.

* rotate-rotate

* multiple culvilinear detectors

* fan shaped x-ray beam

* pre-patient and post patient collimations

* scanning takes a long time because of each rotation

back rotation

* breath holding rotation by rotation

FOURTH GENERATION

 Rotate only

 Beam hardening artifacts are most marked at high contrast

interface such as between dense bone of the brain streaks

(lower HU) occurs

 This can give a “cupped appearance”. It occurs when there

is more attenuation in the center of the object than around

the edge. This is easily corrected by filtration and

software.

 Ring artefact may arise in fourth generation systems if a

single detector is faulty or miscalibrated.

  Probably the most common mechanical artefact, the image of

one or many “rings” appears within an image. This is

usually due to a detector fault.

Noise artefact-this appear as graining on the image and is

caused by a low signal to noise ratio. This occurs more

commonly when a thin slice thickness is used. It can also

occur when the power supplied to the x-ray tube is

insufficient to penetrate the anatomy.

 Windmill- streaking appearances can occur when the

detectors intersects the reconstruction plane. This can be

reduced with filters or a reduction in pitch.

 Multiplanar Reconstruction (MPR)

 Although diagnosis is usually made from axial images alone,

MPR or reformatting program adds new dimension to CT

imaging.

 It gives different perspective of anatomy (from axial to

sagittal, coronal and even oblique

 It is done without additional doses of radiation

 Increased comfort to patient who cannot assumed desired

positioning.

 Circular detector array (180)

 Only the source rotate

FIFTH GENERATION
 Use an electron gun that reflects and focuses a fast-moving

electron beam along a 210 degree arc of a large diameter

tungsten target ring in the gantry

 The x-ray beam produced is collimated to transverse and

strike the detector ring.

 Multiple detector ring permits the simultaneous acquisition

of multiple image sections.

 There are no moving parts, which allows images to be

obtained in as little as to 50 to 100 ms thereby decreasing

motion artifacts.

 It is very useful in cardiac imaging and in patients unable

to cooperate for routine studies require breath holding

 Helical scanners

 Development of slip ring

 Continuous rotation of the tube and detector

 Shorten the examination time drastically since back

rotation is not required.

 In helical CT, the x-ray tube (and detector array) rotates

continuously about the patient collecting view data, and

the patient is moved at a constant speed. The x-ray tube

focal spot focus defines a spiral or helix.

 MODULE 3. CT Scan Machine

Parts of CT Scan Machine

 CT components

 CT21 tube

 Gantry

 Detection

 Collimator

 Rotate/Translate

 Computers

SYSTEM COMPONENTS

It was convenient to classify the components of conventional x-

ray imaging system into three major subsystems: The x-ray tube,

the generator, and the operating console. It also convenient to

identify the three major components of a CT imaging system: the

gantry, the computer, and the operating console. Each of these

major components has several subsystems.

GANTRY

The gantry includes the x-ray tube, the detector array, the

high-voltage, the patient support couch, and the mechanical

support for each.

Gantry is a framework of the steel bar rose on side support

the bridge over and rotates around the patient from cross

sectional views.
 These subsystems receive electronic commands from the

operating console and transmit data to the computer for image

production and post processing.

X-ray tube

-Used in CT imaging have special requirements. Some operate

at relatively low tube current, for many, the instantaneous power

capacity must be high.

The anode heating capacity must be at least several million

heat units (MHU), and some tube designed specially for CT with 8

MHU capacity.

High speed rotors are used in most for the best heat

dissipation. Experience has shown that x-ray tube failure is a

principal cause of CT imaging system malfunction and the

principal limitation on sequential imaging frequency.

FocaL spot size is also important in most designs, even

though the CT image is not based on principles of direct

projection imaging. CT Imaging systems designed for high spatial

resolution imaging incorporate x-ray tubes with a small focal.

Spatial resolution is a measure of the accuracy or detail of

a graphic display, expressed as data per inch, lines per mm.

Contrast resolution referred to as the ability of an image

modality to distinguish various contrasts of an acquired image.

x-Ray tubes are energized differently, depending on the CT

imaging system design. Third generation CT imaging system

operate with either a continuous or a pulsed x-ray beam.

Continuous x-ray beams at tube current upto 400 MA are produced

during the entire rotation,

Pulsed x-ray beams at tube currents approximately 1000 Ma

are produced with widths from 1 to 5 ms at pulse repetition rates

of 60 Hz.

Detector array

Early CT imaging systems had one detector. Modern CT

imaging systems have multiple detectors in an array numbering up

to tens of thousands in two general classifications:

scintillation detectors and gas detector.

Scintillation detectors

Early scintillation detector arrays contained scintillation

crystal photomultiplier tube assemblies. These detectors could

not be packed very tightly together and they required a power

supply for each photomultiplier tube. Consequently, they have

been replaced with scintillation crystal-photodiode assemblies.

Photodiodes convert light into electrical signal. They are

smaller and cheaper, do not require a power supply, and are as

efficient as other CT radiation detectors.

Sodium Iodide (NaI) was the crystal used in the earliest imaging

system. This was quickly replaced by Bismuth Germinate and Cesium

Iodide (cSI). Cadmium tungstate (CDWO) and special ceramics are

the current crystals of choice. The concentration of

scintillation detectors is an important characteristic of a CT

imaging system that affects the spatial resolution of the system.

Scintillation detectors have high x-ray detection efficiency.

Approximately 90% of the x-rays incident on the detector are

absorbed and contribute to the output signal. It is now possible

to pack the detectors so that the space between them is nil.

Consequently, the overall detection efficiency approaches 90%.

Gas detectors

Gas filled detectors are also used in CT imaging

systems. They are constructed of a large metallic chamber with

baffles are like grid strips and divide the large chamber into

many small chambers.

Collimation

-is required during CT imaging for precisely the same

reasons as in conventional radiography. Proper collimation

reduces patient dose by restricting the volume of tissue

irradiated. More important, it enhancement image contrast by

limiting scatter radiation.

In conventional radiography, there is only one collimator,

which is mounted on the x-ray tube housing. In CT imaging, there

are usually two collimation. One collimation is mounted on the x-

ray tube housing or adjacent to it. This collimation limits the

area of the patient that intercepts the useful beam, and thereby

determines patient dose. This pre-patient collimator usually

consists of several sections so that a nearly parallel x-ray beam

results.

The pre-detector collimator restricts the x-ray beam viewed

by the detector array. This collimator reduces the scatter

incident on the detector array and, when properly coupled with

pre-patient collimator, defines the slice thickness, also called

sensitivity profile. The pre-detector collimator reduces scatter

radiation reaching the detector array and therefore improves

image contrast.

HOW A CT SCAN SYSTEM MOVES

1. A motorized table moves the patient through a circular opening

in the CT imaging system.

2. While the patient is inside the opening of the CT imaging

system, an x-ray source and detector within the housing rotate

around the patient. A single rotation takes about 1 second. The

x-ray source produces a narrow, fan-shaped beam of x-rays that

passes through a section of the patient’s body.

3. A detector opposite from the x-ray source records the x-rays

passing through the patient’s body as a “snapshot” image, Many

different “snapshots” (at many angles through the patient) are

collected during one complete rotation.

4. For each rotation of the x-ray source and detector, the image

data are sent to a computer to reconstruct all of the individual

“snapshots” into one or multiple cross-sectional image (slices)

of the internal organs and tissues.

MODULE 4
OVERVIEW OF THE LIMITATIONS OF CLASSIC RADIOGRAPHY

(CONVENTIONAL X-RAY)

1. Superimposition of the three dimensional information onto

two dimension causes the loss of low-tissue contrast

anatomic structures.

2. Presence of scatter obscures low-tissue contrast anatomic

structures

3. superimposition of the three dimensional information onto

two dimensional causes the loss of low-tissue contrast

anatomic structures.

4. Ordinarily plain c-ray films are superimposition

shadowgrams: the images of all superimposed structures

appear on the film

ADVANTAGES OF CT OVER CLASSIC RADIOGRAPHY

1. Three dimensional information in the form of series of

thin slices of the internal structures of the part in

question.

2. The system is much more sensitive compared to

conventional radiography so that differences in tissue can

be clearly delineated (.5%-1%)

3. Ct measures x-ray attenuation of individual tissue

accurately, allowing the basic nature of tissue to be

studied.
4. Is a tomographic imaging technique that generates cross-

sectional images in the axial plane.

5. The word tomography is derived from the Greek “tomos”

(volume) and “graphein” (to write)

6. Allessandro Vallebona –Italian Radiologist proposed a

method to represent a single slice of the body on the

radiographic film. This method was known as Tomography.

The idea is based on simple principles of projective

geometry.

7. CT images are maps of the relative linear attenuation

values of tissues.

8. CT x-ray technique use a high kVp (120-140) with heavy

filtration.

9. Fan beam is passed through the patient, and measurements

of transmitted x-ray beam intensities are made by an array

of detectors.

10. Measured x-ray transmission values called projections.

11. CT images are derived by mathematical analysis of

multiple projections (180)

12. Data collection-projections are acquired from multiple

points around the patient.

13. Gives a whole new way of looking at the body because it

provides the equivalent of cross-sectional slice radiographs

of the whole body.

 FOUR Characteristics of spiral ct (Helical)

 Continuously rotating tube/detector system

 Continuous radiation

 Continuous data acquisition

 Continuous table feed

This means that each acquisition provides a complete

volumetric data set.

Interpolation algorithm computer program (360 degrees)

MODULE 5: THE SCANNER

1. Types of Scanner
 2. Scan control

3. Image quality

4. Preparation of patient, table, gantry, controls and

display

5. System control

6. Function keys

7. System performance

8. Image review

TYPES OF CT SCANNER

1. CT scan abdomen

2. CT scan arthrography

3. CT scan bones

4. CT scan Brain/CT scan head

5. CT scan chest (CT scan lung)

6. CT scan neck

7. CT scan pelvis

There are several different types of CT machines depending

on the amount of slices. Multi-slice scanners come in 4, 6,

8, 16,32, 40 and 64 slice configurations… 64-slice CT

machines is said to have significantly improved CT

angiography )CTA), and is particularly recommended for

cardiac studies.

CT scan s based on the fundamental principle that the

density of the tissue passed by the x-ray beam can be

 measures from the calculation of attenuation coefficient.

Attenuation values of the x-ray beam are recorded and data

used to build a 3D representation of the scanned

object/tissue.

Scanning has three types

 Port scanning- used to list open ports and services

 Network scanning-use to list IP addresses

 Vulnerability scanning- used to discover the presence of

known vulnerabilities

SCANNING

- Look at all parts of (something) carefully in order to

detect some feature.

- Cause (a surface, object, or part of the body) to be

traversed by a detector or an electromagnetic beam.

 People often have CT-scans to further look at abnormality

seen on another test such as an x-ray or an ultrasound.

They may also have a CT to check for specific symptoms such

as pain or dizziness. People with cancer may have a CT to

look for the spread of disease.

 A head or brain CT examines the various structures of the

brain to look for mass, stroke, area of bleeding, or blood

vessel abnormality, it is also sometimes used to look at

the skull.
 A neck CT checks the soft tissue of the neck and in

frequently used to study a lump or mass in the neck or to

look for enlarged lymph node or glands.

 CT of the chest is frequently use to further study an

abnormality on a plain chest x-ray. It also often used to

look for enlarged lymph nodes.

 Abdominal and pelvis CT look at the abdominal and pelvic

organs (such as the liver, spleen, kidneys pancreas, and

adrenal glands) and the gastro intestinal tract. These

studies are often ordered to check for a cause of pain and

sometimes to follow up on an abnormality seen on another

test such as an ultrasound.

 A sinus CT exam is used to both diagnose sinus disease and

to look for a narrowing or obstruction in the sinus

drainage pathway.

 A spine CT test is most commonly used to look for a

herniated disc or narrowing of the spinal canal (spinal

stenosis) in people with neck, arm, back, and/or leg pain.

It is also used to look for a fracture or break in the

spine.

IMAGES

 Field of View (FOV) is the diameter of the area being

imaged (e.g. 25 cm for a head scan)

 Ct pixel size is determined by dividing the FOV by the

matrix

 Pixel size = FOV

____________

Matrix size

25/512= 0.5 mm

35/512= 0.7 mm

 Voxel is a volume of element in the patient, it is the

product of pixel and slice thickness.

 Voxel= Pixel x slice thickness

 Pixels

Picture element

2-dimensional depiction (X,Y)

Each pixel represents the attenuation of x-rays as different

shades of gray

X direction is 512 lines

Y direction is 512 lines

512x512

Forms a grid boxes

Each box represents a pixel with a varying shade of gray

Includes pixel and Z-axis thickness of slice

Voxels with the same x,y and z dimensions are known as

“isotroptic voxels.

Provides equal spatial resolution in all plane

 Calibrated field of view (C-FOV)

C-FOV is also known as the scan “FOV” (raw data)

C-FOV is determined by the collimation used to shape the

beam.

Only objects that reside within the C-FOV are imaged.

Display field of view (D-FOV)

D-FOV is also known as the “reconstruction FOV” (image data)

D-FOV can be set to reconstruct anywhere and any size within

the C-FOV

Since no data exists outside of the C-FOV, no image can be

reconstructed there

The D-FOV is used to focus in on the area of interest.

 The Hu value of water is 0, the HU value of dense bone is

+1,000, and the HU value of air is -1,000.

CT scans are performed to analyze the internal structures

of various parts of the body. This includes the head,

where traumatic injuries, (such as blood clots or skull

fractures), tumors, and infections can be identified. In

the spine, the bony structure of the vertebrae can be

accurately defined, as can the anatomy of the

intervertebral discs and spinal cord. CT scan methods can

be used to accurately measure the density of bone in

evaluating osteoporosis.
 Occassionally, contrast material (an x-ray dye) is

placed into the spinal fluid to further enhance the scan

and the various structural relationships of the spine, the

spinal cord, and its nerves. Contrast material is also

often administered intravenously or through other routes

prior to obtaining a CT scan. CT scans are also used in

the chest to identify tumors, cysts, or infections that may

be suspected on a chest x-ray. CT scans of the abdomen are

extremely helpful in defining body organ anatomy, including

visualizing the liver, gall bladder, pancreas, spleen,

aorta, kidneys, uterus, and ovaries. CT scan in these

areas are used to verify the presence or absence of tumors,

infection, abnormal anatomy, or changes of the body from

trauma.

The technique is painless and can provide extremely

accurate images of body structures in addition to guiding

the radiologic technologists and radiologist in performing

certain procedures, such as biopsies, of suspected cancers,

removal of internal body fluids for various tests, and the

draining of abscesses which are deep in the body. Many of

these procedures are minimally invasive and have markedly

decreased the need to perform surgery to accomplish the

same goal.
Module 6

ARE THERE RISKS IN OBTAINING A CT SCAN

A CT scan is a very low-risk procedure. The most

common problem is an adverse reaction to intravenous

contrast material. Intravenous contrast is usually an

iodine-based liquid given in the vein, which makes many

organs and structures, such as the kidneys and blood

vessels much more visible on the CT scan. There may be

resulting itching, a rash, hives, or a feeling of warmth

throughout the body. These are usually self-limiting

reactions that go away rather quickly. It needed,

antihistamines can be given to help relieve the symptoms.

A more serious allergic reactions to intravenous contrast

is called an ANAPHYLACTIC REACTION. When this occurs, the

patient may experience severe hives and/or extreme

difficulty in breathing. This reaction is quite rare, but

is potentially life-threatening if not treated.

Medications which may include corticosteroids,

antihistamines, and epinephrine can reverse this adverse

reaction.

Toxicity to the kidneys which can result in kidney failure

is an extremely rare complication of the intravenous

contrast material used in CT scans. People with diabetes,

dehydrated individuals, or patients who already impaired

kidney function are most prone to this reaction. Newer

intravenous contrast agents have been developed which have

nearly eliminated this complication.

 The amount of radiation a person receives during a CT

scan is minimal. In men and non-pregnant women, it has not

been shown to produce any adverse effects. If a woman is

pregnant, there may be a potential risk to the fetus,

especially in the first trimester of the pregnancy. If a

woman is pregnant, she should inform her doctor of her

condition and discuss other potential methods of imaging,

such as an ultrasound which are not harmful to the fetus.

HOW DOES A PATIENT PREPARE FOR CT SCANNING, AND HOW IS IT

PERFORMED?

In preparation for a CT scan, patients are often asked

to avoid foods, especially when contrast material is to be

used. Contrast material may be injected intravenously, or

administered by mouth or by an enema in order to increase

the distinction between various organs or areas of the body.

Therefore, fluids and food may be restricted for several

hours prior to the examination. If the patient has a

history of allergy to contrast material (such as iodine),

the requesting physician and radiology staff should be

notified. All metallic materials and certain clothing

around the body are removed because they can interfere with

the clarity of the images.

Patient are placed on a movable table, and the table is

slipped into the center of a large donut-shaped machine

which takes the x-ray images around the body. The actual

procedure can take from a half an hour to an hour and half.

Of specific tests, biopsies, or interventional are performed

by the radiologist during CT scanning, additional time and

monitoring may be required. It is important during the CT

scan procedure that the patient minimize any body movement

by remaining as still and quiet as is possible. The

significantly increases the clarity of the x-ray images. The

CT scan technologist tells the patient when to breath or

hold his/her breath during scans of the chest and abdomen.

If any problems are experienced during the CT scan, the

technologist should be informed immediately. The

technologist directly watches the patient through an

observation window during the procedure, and there is an

intercom system in the room for added patient safety.

CT scans have vastly improved the ability of doctors to

diagnose many diseases earlier in their course and with much

less risk than previous methods. Further refinements in CT

scan technology continue to evolve which promise even better

picture quality and patient safety. Newer CT scans called

“spiral” or “helical” CT scans can provide more rapid and

accurate visualization of internal organs. For example, many

trauma centers are using these scans to more rapidly

diagnose internal injuries after serious body trauma. High

 resolution CT scans (HRCT) are used to accurately assess the

lungs for inflammation and scarring.

CT Scan AT A Glance

 CT scanning adds x-ray images with the aid of a computer to

generate cross-sectional views of anatomy.

 CT scanning can identify normal and abnormal structures and

be used to guide procedure.

 CT scanning is painless.

 Iodine-containing contrast material is sometimes used in CT

scanning. Patients with a history of allergy to iodine or

contrast materials should notify their physicians and

radiology staff.

Terminology The

word “tomography” is derived from the Greek tomos (slice) and

graphein (to write). Computed tomography was originally known as

the “EMI scan” as it was developed at a research branch of EMI, a

company best known today for its music and recording business. It

was later known as computed axial tomography (CAT or CT scan) and

body section rontgenography.

Although the term “computed tomography” could be used to describe

positron emission tomography and single photon emission computed

tomography, in practice in practice it usually refers to the

computation of tomography from x-ray images, especially in older

medical literature and smaller medical facilities.

Although the term “computed tomography” could be used to describe

positron emission tomography and single photon emission computed

tomography, in practice it usually refers to the computation of

tomography from X-ray images, especially in older medical

literature and smaller medical facilities.

In MeSH, “computed axial tomography” was used from 1977-79, but

the current indexing explicitly includes “X-ray” in the title.

Diagnostic Use

Since its introduction in the 1970s, CT has become an important

tool in medical imaging to supplement x-rays and medical

ultrasonography. It has more recently been used for preventive

medicine or screening for disease, for example CT colonography

for patients with high risk of colon cancer, or full-motion heart

scans for patients with high risk of heart disease. A number of

institutions offer full-body scans for the general population.

This is however a controversial practice, given its cost,

significant radiation exposure, lack of proven benefit, and the

risk of finding incidental abnormalities that may trigger

additional investigations.