Computed Tomography (CT) Scan
What is a computed tomography (CT) scan?
It refers to a computerized x-ray imaging
procedure in which a narrow beam of x-rays
is aimed at a patient and quickly rotated
around the body, producing signals that are
processed by the computer to generate
cross-sectional images, or “slices.”
These slices are called tomographic images
and can give a clinician more detailed
information than conventional x-rays.
Once a number of successive slices are
collected by the machine’s computer,
they can be digitally “stacked” together
to form a three-dimensional (3D) image
of the patient that allows for easier
identification of basic structures as well
as possible tumors or abnormalities.
How does CT work?
• Unlike a conventional x-ray—which uses a fixed x-ray tube—a CT scanner uses a
motorized x-ray source that rotates around the circular opening of a donut-shaped
structure called a gantry.
• During a CT scan, the patient lies on a bed that slowly moves through the gantry while
the x-ray tube rotates around the patient, shooting narrow beams of x-
rays through the body.
• Instead of film, CT scanners use special digital x-ray detectors, which are located
directly opposite the x-ray source.
• As the x-rays leave the patient, they are picked up by the detectors and transmitted
to a computer.
How does CT work?
• Each time the x-ray source completes one full rotation, the CT computer uses
sophisticated mathematical techniques to construct a two-dimensional image slice of
the patient.
• The thickness of the tissue represented in each image slice can vary depending on the
CT machine used, but usually ranges from 1-10 millimeters.
• When a full slice is completed, the image is stored and the motorized bed is moved
forward incrementally into the gantry.
• The x-ray scanning process is then repeated to produce another image slice.
• This process continues until the desired number of slices is collected.
How does CT work?
• Image slices can either be displayed individually or stacked together by the computer to
generate a 3D image of the patient that shows the skeleton, organs, and tissues as well
as any abnormalities the physician is trying to identify.
• This method has many advantages including the ability to rotate the 3D image in space
or to view slices in succession, making it easier to find the exact place where a problem
may be located.
How does CT work?
• Image slices can either be displayed individually or stacked together by the computer to
generate a 3D image of the patient that shows the skeleton, organs, and tissues as well
as any abnormalities the physician is trying to identify.
• This method has many advantages including the ability to rotate the 3D image in space
or to view slices in succession, making it easier to find the exact place where a problem
may be located.
Basic principle of CT
Simple back projection smears each view along the path it was
acquired to form an image, resulting in a blurred version of the
correct image. In simple terms, back projection is a process that
"smears" or distributes data from a set of projections (like X-
rays) back into an image, helping to reconstruct a 2D or 3D
representation of an object.
By setting all the pixel values along a ray to the same value and
summing the back projected views the final image is obtained.
To correct for the blurring effect of simple back projection,
filtered back projection is used.
Each view is filtered before back projection by convolution with
a filter kernel to create a set of filtered views.
By back projecting the filtered views the resultant image is a
better representation of the correct image.
Using an infinite number of views will improve the image quality
of the resultant image, making it more like the correct one.
Basic principle of CT
A spiral CT scan, also known as a helical CT scan, is a type of CT scan where the patient
moves continuously through the scanner while the X-ray tube rotates, creating a
continuous, spiral-shaped data set for image reconstruction.
Working:
Unlike traditional CT scans that acquire images slice by slice, spiral CT scans obtain a
continuous volume of data as the patient moves through the scanner.
Advantages:
•Faster scanning: Spiral CT allows for faster acquisition of images, enabling quicker
examinations.
•Improved visualization: It provides better visualization of blood vessels and other
structures, particularly useful for diagnosing conditions like pulmonary embolism.
•3D imaging: The continuous data set allows for the creation of 3D images, providing a more
comprehensive view of the scanned area.
•Reduced radiation exposure: The continuous scanning process can potentially reduce the
need for multiple scans, leading to lower radiation exposure.
Block diagram of CT scan
CT Imaging block and Image generation process
Here's an overview of the process of CT image generation:
1. X-ray Source and Detector: The CT machine consists of an X-ray
source and a detector. The X-ray source emits a controlled amount of
X-ray radiation, which passes through the body.
2. Rotating Scan: The patient lies on a table that moves into a circular
or donut-shaped opening in the CT scanner. The X-ray source and
detector are mounted on a rotating gantry that surrounds the patient.
As the gantry rotates, it emits X-ray beams from various angles.
3. Data Acquisition: The X-ray beams pass through the body and are
detected by the detectors on the opposite side of the gantry. The
detectors record the amount of X-ray radiation that reaches them. The
data obtained from these measurements is transmitted to a computer.
4. Reconstruction: The computer processes the data collected from
multiple X-ray projections and uses mathematical algorithms to
reconstruct cross-sectional images, or slices, of the body. These slices
are typically very thin (1-10 millimeters) and show detailed information
about the internal structures.
CT Imaging block and Image generation process
5. Image Display: The reconstructed CT images are
displayed on a computer monitor. Radiologists or other
medical professionals interpret these images to diagnose and
assess medical conditions.
6. Contrast Enhancement: In some cases, a contrast agent
may be administered to the patient, typically through an
intravenous (IV) injection. This contrast material helps
enhance the visibility of certain structures or abnormalities
in the CT images.
7. Three-Dimensional Reconstruction: In addition to 2D
slices, the CT data can be used to create 3D reconstructions
of the scanned area, providing a more comprehensive view
of the anatomy and pathology.
When would I get a CT scan?
CT scans can be used to identify disease or injury within various regions of the
body.
For example: Detecting possible tumors or lesions within the abdomen.
A CT scan of the heart may be ordered when various types of heart disease are
apprehended
A CT can also be used to image the head in order to locate injuries, tumors,
clots leading to stroke, hemorrhage, and other conditions.
It can image the lungs in order to reveal the presence of tumors, pulmonary
embolisms (blood clots), excess fluid, and pneumonia.
A CT scan is particularly useful when imaging complex bone fractures, severely
eroded joints, or bone tumors since it usually produces more detail than would
be possible with a conventional x-ray.
In CT scans, the CT number scale, also known as the Hounsfield scale, expresses various tissue and material densities as
Hounsfield Units (HU), with air at -1000 HU, water at 0 HU, and bone at +1000 HU.
•Hounsfield Units (HU):
These are the standardized units used to represent the CT number, which is a measure of the X-ray beam attenuation in a
tissue.
•CT Number Definition:
The CT number is calculated using the following formula: CT Number = (μmaterial - μwater) / μwater * 1000, where μ
represents the attenuation coefficient for the X-ray beam.
•Calibration Points:
Air is assigned a value of -1000 HU and water a value of 0 HU, serving as energy-independent calibration points.
•Radiodensity:
The Hounsfield scale allows for a quantitative description of radiodensity, which is the ability of a tissue to absorb X-rays.
Air: -1000 HU
Water: 0 HU
Bone: +1000 HU
Metal: Values can range from 2000 to 3000 HU
•Gray Scale Mapping:
CT numbers are mapped onto a gray scale for image display, and the display window
(window level and width) allows for adjusting the range of CT numbers displayed.
•Importance:
The Hounsfield scale is crucial for radiologists and other medical professionals to accurately
interpret CT scans and identify abnormalities.
What is a CT contrast agent?
As with all x-rays, dense structures within the body—such as bone—
are easily imaged, whereas soft tissues vary in their ability to stop x-
rays and therefore may be faint or difficult to see.
For this reason, contrast agents have been developed that are highly
visible in an x-ray or CT scan and are safe to use in patients.
Radiocontrast agents are typically iodine, barium-sulphate or
gadolinium based compounds.
Used to highlight the structure like blood vessels.
It can also help to obtain functional information about tissues.
What is a CT contrast agent?
Example: Examination of the circulatory system, an intravenous (IV) contrast agent
based on iodine is injected into the bloodstream to help illuminate blood vessels.
This test is used to look for possible obstructions in blood vessels, including those
in the heart.
Oral contrast agents, such as barium-based compounds, are used for imaging the
digestive system, including the esophagus, stomach, and gastrointestinal (GI) tract.
Are there risks?
CT scans can diagnose possibly life-threatening conditions such as
hemorrhage, blood clots, or cancer.
An early diagnosis of these conditions could potentially be lifesaving.
However, CT scans use x-rays, and all x-rays produce ionizing
radiation, it potential to cause biological effects in living tissue.
This is a risk that increases with the number of exposures added up
over the life of an individual.
In general, if imaging of the abdomen and pelvis is needed, doctors
prefer to use exams that do not use radiation, such as magnetic
resonance imaging (MRI) or ultrasound.
