COMPUTED TOMOGRAPHY SCAN

"The cornerstone of a radiologic

technologist's responsibility is to
produce consistently high- quality
examinations while ensuring the safety
and well- being of patients."

Conventional radiographs depict a

three-dimensional object as a
two-dimensional image.

3D - Objects/shapes that can be

measured in 3 directions (L*W*H)

2D - a flat plane figure or a shape

that has two dimensions length and
width

Conventional Radiography VS.

Computed Tomography

Computed tomography (CT)

overcomes the problem of
superimposition in structures by
scanning thin sections of the body with
a narrow x-ray beam that rotates
around the body, producing images of
each cross section.

Another limitation of the conventional

radiograph is its inability to distinguish
between two tissues with similar
densities. The unique physics of CT
allow for the differentiation between
tissues of similar densities
 Computed Tomography

- It uses a collimated x-ray beam that

is directed on and rotates around the
patient, and the attenuated
image-forming x-radiation is measured
by a digital detector whose response is
transmitted to a computer.
- After the signal from the detector is
analyzed, the computer reconstructs or
Computed Tomography
reformats the image and displays it on
●​ A sophisticated computerized
a monitor.
method that is used to obtain
data and transform them into
CROSS-SECTIONAL SLICES
"cuts," or cross-sectional slices
of the human body.

GREEK:
TOMOS - slice or section
GRAPHI A - describing

●​ A method of acquiring and

reconstructing images of a thin Cross Sectional Anatomy:
cross-section based on -​ Refers to the shape of the
measurements of attenuation anatomy that is seen/viewed on
—- HOUNSFIELD UNIT the monitor when cutting the
body with a plane

CROSS-SECTIONAL SLICES

●​ Often referred also as "Cuts" or

"Cross-Sectional Cut"
●​ A reformation function of CT to
generate images based on the
PRINCIPLES OF OPERATION:
body plane by which the data is
taken and analyzed.
- Uses a computer to process
information collected by an x-ray
1. Axial Cut/Slice - the image formed
detector from the passage of x-ray
when cutting the body into top and
beams through the area of anatomy
bottom sections.
resulting to creation of cross-sectional
●​ the image generated from
images.
cutting the body through the
horizontal plane or the x-axis of
the body.
 ●​ Rotation - movement of the
2. Coronal Cut/Slice - the image source-detector assembly
formed when cutting the body into before acquiring the next slice
anterior and posterior proportions.
●​ the image generated from ●​ Slice
cutting the body through the -​ the cross-section image formed
Coronal plane or the Y-axis of after acquisition (cut)(Axial
the body traversing either of the Cut/Slice, Coronal Cut/Slice,
lateral sides of the body. etc.);
-​ determined by the array of
3. Sagittal Cut/Slice - the image detectors (e.g., 16-Slice CT,
formed when cutting the body into right 32-Slice CT, 64-Slice CT, etc.)
and left portions. -​ The sum of the density of the
●​ the image generated from object - The "Intensity Profile" or
cutting the body through the "Projection"
Sagittal Plane or the Y-axis of
the body traversing the anterior ●​ Slice Thickness - Also called
and/or posterior portion of the the "Sensitivity Profile"
body. .
●​ Reconstruction - the
Computed Tomographic Slices manipulation to create pixels
●​ A cross-sectional view of the that are then used to create an
anatomy representing a specific image (e.g., MIP, MinIP)
plane in the patient's body
running across the different ●​ Reformation - used when image
axes to which the images are data are assembled to produce
reformatted. images in different planes. (e.g.,
Multiplanar Reconstruction, 3-D
Body Axes: Reconstruction)
●​ X-axis
●​ Y-axis 3-D REFORMATION
●​ Z-axis -​ A special software that allows
reformation of the entire scan
Body Planes: volume in only one image
●​ Coronal Plane
●​ Sagittal Plane WINDOWS
●​ Axial/Horizontal Plane -​ Gray-level mapping
-​ Allows alteration of the
Terminologies: displayed image contrast by
●​ Translation - the scanning adjusting the window width and
motion of the source and level
detector assembly across a
subject (a.k.a Sweep)
.
Bone Window ✓ Also referred to as
-​ Filter: UB/YB 1. Kernel,
-​ Window Center: 500 2. Algorithm, or,
-​ Window Width: 1600 3. Convolution Filter

Mediastinal Window TERMINOLOGIES:

-​ Filter: A
-​ Window Center: 40 ●​ Scan Modes
-​ Window Level: 400
1. Step-and-Shoot Scanning (1980s)
Lung Window
-​ Filter: YA i. The x-ray tube rotated 360 degrees
-​ Window Center: -600 around the patient to acquire data for a
-​ Window Width: 1600 single slice
ii. The motion of the x-ray tube was
halted while the patient was advanced
on the CT table to the location
appropriate to collect data for the next
slice

- Commonly referred as:

• Axial Scanning,
• Conventional Scanning; or
• Serial Scanning
FILTER
●​ Necessary because the rotation
Radiography: of the x-ray tube entwined the
-​ Used to reduce the amount of system cables, limiting the
low energy photons exiting the rotation to 360 degrees.
x-ray tube
2. Helical (Spiral) Scanning (1990s)
Computed Tomography
1. Helps to reduce the range of x-ray -​ Eliminated the cables and
energies that reach the patient by thereby enabled continuous
eliminating the photons with weaker rotation of the gantry
energies. -​ Allowed for uninterrupted data
acquisition that traces a helical
2. A mathematical function to an path around the patient
attenuation profile (aka. Convolution)
that reduces statistical noise and Dimensions to take note:
creates an image that is pleasing to
the eye. ●​ Length is the most elongated
dimension of an entity.
- the distance along the longest COMPUTER
dimension and the two ends of an -​ Serves as the link between RT
object/line. and CT Components

●​ Width is also known as the Functions:

breadth, is the interval from one 1. Data Acquisition
side to another which measures 2. Image Reconstruction
over a specific entity whose 3. Image Display
lengths form 90-degree angles. 4. Image Processing
5. Storage
●​ Height measures the vertical
distance of an object between ●​ At the heart of the computer
its top and base used in CT are the
MICROPROCESSOR and the
CC - Craniocaudal ​ ​ = Height PRIMARY MEMORY it
Trv - Transverse​ ​ = Length determines the time between
AP - Anteroposterior ​ = Width the end of imaging and the
appearance of an Image
(RECONSTRUCTION TIME)
CT IMAGING SYSTEM DESIGN ↓

3 Major Components REPLACED

↓
1.​ OPERATING CONSOLE ARRAY PROCESSOR
2.​ COMPUTER
3.​ GANTRY -​ does many calculations
simultaneously and hence is
significantly faster than the
CONTROL CONSOLE microprocessor

●​ contains meters and controls for

selection of proper imaging GANTRY
technique factors, for proper -​ Largest component of CT
mechanical movement of the installation.
gantry and the patient couch,
and for the use of computer Aperture - opening in the gantry
commands that allow image through which the patient passes and
reconstruction and transfer it is usually 28 inches in diameter

Man-machine interface
-​ It allows the operator to control
and monitor scan parameters.
Components: Detector Array - determines the
1. X-ray tube number of slices produced per gantry
2. Collimators rotation
3. X-ray Detectors -​ E.g., 16-, 32-, 64-, 128-Slice CT
4. Data Acquisition System Scanners
5. High Voltage Generator

X-RAY TUBE
-​ A device that generates the
x-ray beam.

Features:
1. Anode Material: Tungsten,
Rhenium, & Molybdenum
2. Anode Angle: 12 degrees
3. Anode Type: Rotating anode
bremsstrahlung (3600 - 10,000 rpm)
4. Anode Heating Capacity: 6 MHU
5. Focal Spot Size: Small
6. Straton x-ray tube
7. Current: 200-800 mA; Voltage:
120-140 kVp
X-RAY DETECTOR
●​ CT x-ray tubes are expected to -​ Absorbs radiation and converts
last for at least 50,000 absorbed energy into a small
exposures. electrical signal proportional to
the radiation intensity

X-RAY DETECTOR Types:

●​ Can be mounted either in a 1. Scintillation Detectors - Solid state
stationary ring around the detectors
gantry or on a support frame ●​ High quantum & conversion
called an array that rotates in a efficiency
circle around the patient ●​ Photoreactive crystals:
opposite the x-ray tube -​ Bismuth Germanate
Oxide
●​ Absorbs radiation and converts -​ Cadmium Tungstate
absorbed energy into a small -​ Ceslum lodide
electrical signal proportional to -​ Sodium lodide - 1st
the radiation intensity Crystal
 2. RESPONSE TIME - speed with
which the detector can detect and
x-ray event and recover to detect
another event.

3. DYNAMIC RANGE - ratio of the

largest signal to be measured to the
precision of the smallest signal to be
discriminated.

2. Gas Detectors - Xenon gas • 4. NO AFTERGLOW - persistence of

Excellent stability and large dynamic the image even after the radiation has
range but lower quantum efficiency. been turned off.

5. STABILITY - steadiness of detector

response

COLLIMATOR ASSEMBLY
-​ Restricts the useful x-ray beam.

Functions:
1. Reduces patient dose
2. Improves image contrast
3. Controls slice thickness

CRITERIA FOR SELECTING X-RAY

Types:
DETECTORS:
1. Pre-patient Collimator
2. Post-patient or Pre- detector
1. EFFICIENCY - ability to capture,
Collimator
absorb, and convert x-ray photons to
electric signals.

a) Geometric - area of the detector

sensitive to radiation as a fraction of
total exposed area.
b) Quantum - fraction of the incident x-
ray that are absorbed and contributed
to the measured signal.
c) Conversion - ability to accurately
convert absorbed x-ray signal into an
electrical signal.
d) Over-all - product of GE, QE and
CE (0.45-0.85)
Pre-patient Collimator
-​ Controls patient radiation ●​ Composed of wood and carbon
exposure fiber
-​ Low “Z”
-​ Won’t interfere with x-ray
beam transmission and
patient imaging

INDEXING - movement of the patient

couch.

LASER SYSTEM
-​ Used as guide for alignment or
centering of the patient within
the scanner
Post-patient or Pre- detector
Collimator
3 Types:
-​ Adjust image slice thickness
●​ Internal Laser Light (Axial)
●​ Wall-Mounted Lasers (Coronal
and Axial)
●​ Overhead Sagittal Laser

HISTORY:

The first scanners were limited in the

ways in which these cuts could be
performed. All early scanners
produced axial cuts; that is, slices
looked like the rings of a tree
HIGH VOLTAGE GENERATOR
visualized in the cut edge of a log
●​ Three-phase power for the
efficient production of x-rays.
- Hence, acquiring its Acronym "CAT
●​ High frequency generators for
Scan" (COMPUTERIZED AXIAL
small, compact, and added
TOMOGRAPHY SCAN"
efficiency
PRINCIPLES OF OPERATION:
.
PATIENT COUCH
●​ Analogy: Loaf of a bread
●​ Designed to move in
-​ Each CT slice correlates to a
Increments according to scan
slice of the bread
program. Located at the rear of
-​ The Crust is to the skin of the
the CT gantry
patient's body
-​ The white portion is to the
internal organs
 ●​ X-ray beam is represented by Reduction of the slice thickness can:
the Knife
1. Limits the x-ray beam that passes
through the body; thereby reducing the
amount of scatter radiation.

2. Diminished superimposition of
structures.

FIGURE 1-1 The thickness of the

Computed Tomographic Slices : cross-sectional slice is referred to as
Analogy its Z-axis

●​ Thickness of the slices are

determined by the diameter of HISTORY
the Chainsaw/Hack Saw Teeth
With newer models, scanners that
- Determined by the size of the offer options in more than just the
collimators and detector element. (CT transverse plane, the word "Axial" has
Machines) been dropped from the name. But, if
the old Acronym "CAT" were to be
The first scanners were limited in the used, it now represents the phrase
ways in which these cuts could be "COMPUTER- ASSISTED
performed. All early scanners TOMOGRAPHY"
produced axial cuts.
Other terms used for denoting CT
Thickness of the slices are determined Scanning:
by the diameter of the collimators. ●​ Computerized Trans-axial
Tomography
-​ Also referred to as the "Z-axis". ●​ Computerized Reconstruction
-​ can be selected by the operator Tomography
depending on the choices ●​ Digital Axial Tomography
available on the specific
scanner.
EMI MARK 1 - first CT Machine what is known as
​ ↓
EMI Group Limited (originally an "TOMOGRAPHY"
initialism for Electric and Musical
Industries, also referred to as EMI ●​ Disadvantage: Ineffective when
Records Ltd. or simply EMI) it came to soft tissue imaging.

●​ Referred to as a "BRAIN ACTA Scanner (1974)

TISSUE SCANNER"
-​ designed to only take ●​ (Automated Computerized
pictures of the brain Transverse Axial Scanner)
.
●​ Revealed a brain tumor in a ●​ World's 1st Whole-bodyScanner
41-year-old female patient. developed by Dr. ROBERT S.
. LEDLEY
Attributed to "Dr. Godfrey Newbold
Hounsfield and Allan Mcleod Cormack"
Although all CT manufacturers began
-​ Recipient of Nobel Prize in with the same basic [ form, each
Medicine in 1979 attempted to set their scanners apart
in the marketplace by adding features
Dr. ALLAN MCLEOD CORMACK and functionality to the existing
developed the mathematics employed technology.
for the reconstruction of images
acquired with the equipment of Dr. For example:
Godfrey Newbold Hounsfield.
The Preliminary Image Each
Dr. GODFREY NEWBOLD Scanner Produces
HOUNSFIELD (1970) invented the first
CT scanner. Topogram​ - "Siemens"
Scout ​​ - "GE Healthcare"
✓ Extended the capability of a Scanogram ​ - "Toshiba"
computer so that it could interpret Surview ​ - "Philips"
X-ray signals so as to form a
2-Dimensional image of a complex The Method of Scanning
objects.
Continuous Acquisition Scanning
-​ Spiral (SIEMENS)
Dr. ALESSANDRO VALLEBONA -​ Helical (GE HEALTHCARE
. AND PHILIPS)
●​ Proposed a method to -​ Isotropic (TOSHIBA)
represent a single slice of the
body on a radiographic film.
"Once one understands what each ●​ Axial Tomography
operation accomplishes, switching ●​ Results in Coronal and Sagittal
terms to accommodate scanners is Images
simple." ●​ Images the anatomy that lies on
PIVOT point
Main advantages of Computed ↓
Tomography over Conventional FULCRUM
Radiography ​ ↓
Point where no movement occurs in
1.​ Elimination of superimposed either direction
structures
Images at this level are stationary,
2.​ The ability to differentiate small thereby appearing less blurred but
differences in density of with high contrast
anatomic structures and
abnormalities; and

3.​ The superior quality of the

images

CONVENTIONAL TOMOGRAPHY

- is called axial tomography because

the plane of the image is parallel to the
long axis of the body; this results in
either sagittal and coronal images

- could eliminate superimpositions and

more clearly define small intra- lesions
of the in-focus structures yet images
remain dull and blurred.
— MIDTERM — "Back Projection"
CONVENTIONAL TOMOGRAPHY -​ compiles the information from
all of the attenuation profiles to
IMAGE create an image
●​ Those that lie outside the
fulcrum will be blurred. "IMAGE RECONSTRUCTION"
-​ designation of Hounsfield Units
●​ Thickness of tissue that will be on every pixel that makes up
imaged is called Tomographic the matrix of every
Section structure/slice
↓
Controlled by: -​ Conversion of the
Tomographic Angle data/information from the
↓​ attenuated profile to a matrix.
- The degree of tube travel
​ ​ ​ ↓ Disadvantage:
Small Tomographic Angle: -​ it produces a streak artifact in a
-​ Section thickness is entire star pattern of the image
anatomy, resulting to a
conventional radiograph Solution:
Larger Tomographic Angle: - application of a "FILTER"
-​ Blurs out objects that lie
approximately 3mm from the
object plane CT UNITS/HOUNSFIELD UNITS

●​ Term applied to each numerical

information contained in each
PIXEL
●​ Passage of photons through a
structure or by redirection
(Scattering)

HYPERDENSE - area with highest

density
ISODENCE - between hyperdense &
hypodense
HYPODENSE - area with least density
 TISSUE TYPE CT NUMBER

BONE 1000

MUSCLE 50

WHITE MATTER 45

GRAY MATTER 40

BLOOD 20

CSF 15

WATER 0

FAT -100
CONVENTIONAL TOMOGRAPHY
LUNGS -200

AIR -1000 If the thickness angle is less than 10

degrees, the section thickness will be
ATTENUATION quite large.
-​ This technique is called
-​ Degree to which the beam is Zonography
reduced ​ ↓
A relatively large zone of tissue
is imaged.
"Filtered Back Projection"
Used when subject contrast is low.
- uses a Fourier Theory to reduce
statistical noise and create an image Best applied in chest and renal
that is pleasing to the eye. examinations (typically requiring 5-10
degrees).
a+b=0
c+d=1
a+c=1
b+d=0

- mathematical logarithmic functions in

which the data from the projections
acquired by each detector that were
stored in the Computer Memory are
reconstructed with the use of a
Filter/Kernel.
DIGITAL RADIOGRAPHIC
TOMOSYNTHESIS

Is a method for performing

high-resolution limited- angle
tomography at radiation dose levels
comparable with projectional
radiograph

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 compared to a
conventional tomogram.
CONVENTIONAL TOMOGRAPHY
PANORAMIC TOMOGRAPHY AND DIGITAL RADIOGRAPHIC
TOMOSYNTHESIS VS. COMPUTED
Developed for fast dental survey and TOMOGRAPHY SCANNING
other diagnostic examination for
curved bony structures of the head,
such as the mandible.

1. X-ray tube and the image receptor

move around the head

2. X-ray tube beam is collimated to a

slit, then the image receptor translates
behind the collimator, so it is exposed
several seconds along its length.
COMPUTED TOMOGRAPHY STEPS IN CT IMAGE PRODUCTION:
SCANNING
1. "DATA ACQUISITION SYSTEM"
- Electronics that performs systematic
A CT image is a trans-axial or collection of x-ray transmission or
transverse image that is attenuation measurements from the
perpendicular to the long axis of the patient.
body (as seen in the figure on the left)
When the source-detector assembly
The precise method by which a CT makes one sweep, or translation,
imaging system produces a transverse across the patient, the internal
image is extremely complicated, and structures of the body attenuate the
understanding it requires strong x-ray beam according to their mass
knowledge of physics, engineering, density and effective atomic
and computer science. The basic number.
principles, however, can be observed if
one considers the simplest of CT The intensity of radiation detected
imaging systems, which consists of a varies according to this attenuation
finely collimated x-ray beam and a pattern, and an intensity profile, or
single detector. The x-ray source and projection, is formed as shown in
the detector move synchronously. Figure 28-3.

STEPS IN CT IMAGE PRODUCTION

●​ Data Acquisition

- Systematic collection of x-ray

transmission or attenuation
measurements from the patient.

●​ Image Reconstruction

- Process of producing an image of a

2D distribution from estimates of its
line integrals along a finite number of
lines of known locations

●​ Image Display, Manipulation,

Storage, & Communication

- Digital image processing such as

reformation and gray-scale
manipulation
2. "IMAGE RECONSTRUCTION" "CONVOLUTION"
- the process of applying a filter
- Process of producing an Image of a function to an attenuation profile
2D distribution from estimates of its
line integrals along a finite number of Also referred to as:
lines of known locations 1. Algorithm
2. Convolution Filter
Computer processing of these 3. Kernel
projections involves effective
superimposition of each projection to Effect:
reconstruct an image of the - it can enhance or suppress data of a
anatomical structures within that slice. body part depending on the types of
algorithm that is used
Performed by mathematical or - can affect the spatial resolution or the
logarithmic functions in which the data low contrast resolution
from the projections acquired by each
detector that were stored in the ●​ Filter functions can only be
Computer Memory are reconstructed. applied to raw data (not image
data)

"Attenuation Profile"
3. IMAGE DISPLAY, MANIPULATION,
●​ the correlation of the ray STORAGE, AND COMMUNICATION
position to the sum of the
attenuation properties of each - Digital image processing such as
ray. reformation and gray-scale
●​ created for each view of the manipulation
scan
​ ​ ↓ STEPS IN CT IMAGE PRODUCTION:
"Back Projection"
1.​ Get data
-​ compiles the information from 2.​ Use data
all of the attenuation profiles to 3.​ Display data
create an image

Conversion of the data/information ITERATIVE RECONSTRUCTION

from the attenuated profile to matrix
- a more robust reconstruction
"FILTERING" algorithm BUT requires more computer
capacity but can result in improved
- a mathematical function for the contrast resolution at lower patient
reconstruction of images tat is applied radiation dose.
to reduce/minimize "STREAK
ARTIFACT"
- starts with an assumed image, 3. Output
computes projections from the -​ The final back projection image
image, compares it with the original that is produced.
projection data, and updates the image
on the basis of the difference between RAW DATA VS. IMAGE DATA
the calculated and the actual
projections Raw Data - refers to the thousands of
bits of data acquired by the system
Advantage: -​ Have not yet been sanctioned
-​ Noise suppression, thereby to create pixels; hence,
improving low contrast Hounsfield Unit values have not
detectability. been assigned
-​ In comparison with filtered back
projection, radiation dose Image Reconstruction - the process
patients are reduced by as in which the raw data is created into an
much as 50% image

STAGES OF ITERATIVE Image Data - processed raw data;

RECONSTRUCTION each pixel are assigned a Hounsfield
Unit value resulting to creation of an
1. Input image
-​ Using the raw data produced by
the computed tomographic Prospective Reconstruction - the
scanner a standard filtered back process in which the reconstruction is
projection algorithm is utilized to automatically produced during
create a primary image. scanning

2. Image reconstruction loop Retrospective Reconstruction - the

a) A sequence is then performed process in which the raw data is later
where a forward projection to the used for generating new images
primary image creates artificial raw
data,
b) simulated data is then correlated to
the measured raw data where an
updated image is generated, and then
c) a filtered back projection is used to
back-project the updated image onto
the new updated image; this is
repeated until the differences in the
images reach a preset value.
SEVEN GENERATIONS OF THE CT SECOND GENERATION
MACHINE ●​ TRANSLATE-ROTATE
GEOMETRY
FIRST GENERATION
●​ PARALLEL BEAM GEOMETRY Features:
& TRANSLATE-ROTATE 1. Narrow Fan Beam
GEOMETRY 2. 5-30 detectors (linear array)
3. 10 degree rotation/translation
Features: 4. 20 sec to 3.5 min imaging time
1. Pencil Beam 5. Head and body scanner
2. 1-3 detectors (linear array)
3. 1 degree rotation/translation Disadvantage: Increased scatter
4. For head scan only radiation
●​ Bow tie filter
Disadvantage: 3-5 minutes imaging
time

FIRST GENERATION CT Scanners

The very first CT scans were

performed on a first- generation
geometry on a CT benchtop. In the
benchtop systems patients were not
imaged but rather an object to be
imaged is placed on a stage that can
rotate (l.e., like a slow and well
calibrated record player).

Then in order to image patients (rather

than biological samples) a rotating
gantry is needed so that the patient
can lie on an imaging table and the
x-ray source and detector will rotate
around the patient.
THIRD GENERATION FOURTH GENERATION
●​ ROTATE-ROTATE GEOMETRY ●​ ROTATE-STATIONARY
GEOMETRY
Features:
1. Wide Fan Beam Features:
2.750-1000 detectors (curvilinear 1. Wide Fan Beam
array) 2. Detector ring
3. Thin tungsten septa to reject scatter 3. Thin tungsten septa to reject
radiation scatter radiation
4. Continuous rotation
5. 0.35 - 10 seconds per slice Disadvantage: Increased Px dose
.
Disadvantage:
1. Ring artifact

If any single detector or bank of

detectors malfunctions, the acquired
signal or lack thereof results in a ring
on the reconstructed Image. These
ring artifacts were troublesome with
early third generation CT imaging
systems.
Radiation detection is accomplished
Software-corrected Image through a fixed circular array of
reconstruction algorithms now detectors which contains as many as
remove such artifacts x-ray source 4000 individual elements
 SLIP RING - electromechanical
devices consisting of circular electrical
FIFTH GENERATION conductive rings and brushes that
●​ STATIONARY-STATIONARY transmit electrical energy across a
GEOMETRY ELECTRON rotating surface. - Allows continuous
BEAM COMPUTED gantry rotation.
TOMOGRAPHY

Features:
1. Electron gun (130 kV)
2. Detector ring (±216° arc)
3. 4 Tungsten target rings (+210° arc)
4. For cardiac imaging: Heart scanner
5. 50 ms per scan

Developed by ANDREW
CASTAGNINI

SPIRAL (HELICAL) CT SCANNER

SIXTH GENERATION
●​ SPIRAL or HELICAL Also referred to as Volume CT
GEOMETRY Scanners

Features: A technique that is made to increase

1. Dual Source CT scanner scanning of larger volume in less
2. Dual set of detectors amount of time by which the patient
3. Slip-ring technology moved continuously through the gantry
4. Excels in 3D MPR while the x-ray tube and detector
rotates continuously for several
Developed by: rotations
WILLI KALENDER & KAZUHIRO
KATADA The beam traces a spiral path
around the patient
Dr. Willi Kalender has made significant In the helical CT scanner, the main
contributions to the introduction and purpose of the slip ring is that:
development of volume spiral CT -​ Slip ring is used to transmit the
scanning. (Courtesy Willi Kalender, electricity and electrical signal
Nürnberg, Germany.) across the moving interface of
the gantry of the helical CT
scanner.
SPIRAL (HELICAL) CT SCANNER -​ It improves better rotational
A technique that is made to increase (360° degree) capability for
scanning of larger volume in less diagnostic and affordability for
amount of time by which the patient three- dimensional (3D) image
moved continuously through the gantry scanning techniques.
while the x-ray tube and detector -​ It also allows faster scan times
rotates continuously for several and minimal infers and delays.
rotations -​ Slip ring produces multiple
slices along with the helical (or
With volume CT scanners, the x-ray spiral) track in a very short
tubo and detectors rotate continuously duration (within few minutes).
as the patient moves continuously
through the gantry. As a result, the
x-ray beam traces a path (beam SEVENTH GENERATION
geometry) around the patient. This ●​ TURBO CHARGED SPIRAL
method of scanning the patient is GEOMETRY MULTI-SLICE CT
referred to as helical or spiral CT. SCANNER FLAT PANEL CT
(Courtesy Toshiba America Medical
Systems, Tustin, Calif.) Features:
1. Cone beam
2. Multiple detector array
3. Slip-ring technology
4. Reduced motion artifacts
5. Improved image quality
MUTLI-SLICE HELICAL COMPUTED
TOMOGRAPHY

HELICAL COMPUTED
TOMOGRAPHY IMAGING
PRINCIPLES
- also referred to as "VOLUMETRIC
SCANNING" * FIGURE 5-6 Slice misregistration
- which refers to the fact that the end caused by patient breathing. These
result of such a scanning method is a two slices are taken at contiguous
block of data, not separate slices. table positions; slice (A) Is the last
slice in the first group of axial slices.
3 Basic Ingredients that define a The patient was allowed to breathe
Helical Scan Process: and then once again asked to hold his
1.​ Continually rotating x-ray tube breath. Slice (B) was the first slice in
2.​ Constant X-ray output the second group of scans. Slice (8) Is
3.​ Uninterrupted Table Mouvement Just 5 mm more Inferior, yet it appears
dramatically more Inferior. It is possible
Advantages: to miss lesions as large as 1 cm as a
1.​ Optimization of iodinated result of slice misregistration.
contrast medium administration.
2.​ Reduction of respiratory
misregistration MULTISLICE HELICAL COMPUTED
3.​ Reduction of motion artifacts TOMOGRAPHY IMAGING
from organs (e.g., Heart)​ PRINCIPLES

When the examination begins, the

x-ray tube rotates continuously.
While the x-ray tube is rotating, the
couch moves the patient through the
plane of the rotating x-ray beam. The
x-ray tube is energized continuously,
data are collected continuously, and an
image then can be reconstructed at
any desired z-axis position along the
patient.
 - If one wishes to estimate a value
between known values, that is
INTERPOLATION: If one wishes to
estimate a value beyond the range of
known values, that is
EXTRAPOLATION.

A.​ Single-Slice Helical Computed

Tomography
B.​ Multi-Slice Helical Computed
Tomography

MDCT designs continue to evolve.

Different manufacturers took slightly
different approaches to detector
configuration

INTERPOLATION ALGORITHM
-​ a mathematical method of
creating a missing data.

INTERPOLATION ALGORITHM
- a special computer program that
performs "DATA INTERPOLATION"

- a mathematical process of estimating

the value of unknown function using
the known value on either side of the
function.

- the reconstruction of an image at any

z-axis position
PITCH Pitch of 1: when the table movement
- also referred to as the "HELICAL is equal to the slice thickness during
PITCH RATIO" each gantry rotation.
- has two terminologies depending on
whether single or multislice CT 2. PITCH
scanners are used.
- is the relationship between patient What if the gantry rotation time is not
couch movement and x-ray beam 360 degrees in 1 s? In such a
width. (SDCT) situation, the volume of tissue imaged
becomes as follows:
●​ Single-Slice/Detector Helical
Computed Tomography

- It is termed as the "DETECTOR

PITCH" which is defined as table
distance traveled in one 360- degree
rotation divided by beam collimation.

●​ Multi-Slice/Detector Helical
Computed Tomography

- It is termed as the "BEAM PITCH"

which is defined as table distance
traveled in one 360-degree gantry
rotation divided by the total thickness
of all simultaneously acquired slices.

3. SENSITIVITY PROFILE
-​ Refers to a graph of detector
Increasing pitch to above 1:1 response across a slice
increases the volume of tissue that can
be imaged at a given time.

-The relationship between the

volume of tissue imaged and pitch is
given as follows:
IMAGE CHARACTERISTICS

IMAGE MATRIX
-​ An array of numbers in rows
and columns

PIXEL (Picture Element)

-​ Two-dimensional representation
of a corresponding tissue
-​ Cell of information (contains
numerical Information
represented as a:

1. CT number
2. Density Value The original EMI format consisted of
3. Pixel Intensity an 80 × 80 matrices for a total of 6400
4. Hounsfield Unit (HU)) individual cells of information.

Current imaging systems provide

matrices of 512 × 512 matrices,
resulting in 262,144 cells of
information.
FIELD OF VIEW
-​ the diameter of the area being
image

VOXEL (Volume Element)

-​ Tissue volume
An increased number of pixels in the
-​ The information contained in a
image matrix improves the picture
volume of tissue in the patient
quality and enhances the perception of
that is represented by the
details in the image.
PIXEL
Large Pixel Size
-​ Low detail

Increase number of Pixel

-​ Great detail

FIELD OF VIEW
-​ diameter of image
reconstruction

“Preliminary Image”
1. Scan Field of View (SFOV) Window Width
-​ Range of CT numbers used to
- Also called "Calibration field of map signals into shades of gray
View” ●​ Number of gray levels to be
- Determines the Area, within the displayed
gantry, from which the raw data are
acquired. WW: narrow:
- Scan data are always acquired ●​ few grays: high contrast wide:
around the "ISOCENTER" ●​ more grays: low contrast

Parts of the patient located outside the Image ReconstructionIn

SFOV may cause inaccuracies in the
image, called "OUT-OF- FIELD In CT is a mathematical process that
ARTIFACTS" generates tomographic images from
-​ Manifests on the image as X-ray projection data acquired at many
streaking, shading. and different angles around the patient.
incorrect Hounsfield
NumbersGantryRing outside Common Algorithms for Image
scan field where no data are Reconstruction:
being acquiredScan field of
viewIsocenter 1. BACK PROJECTION
2. FILTERED BACK PROJECTION
2. Display Field of View (DFOV) 3. ITERATIVE RECONSTRUCTION

- Also called "Zoom or Target" BIT DEPTH

- Determines how much of the -​ Refers to the number of bits
collected raw data is used to create an per pixel
image.
-​ Represents the Gray Levels of
●​ Affects the image quality by each pixel in a digital image
changing the pixel size matrix

- works in a manner similar to the -​ Also known as Gray Level -

zoom on a camera. represents the number of bits
per pixel which defines its
shade in the image.
WINDOWING kbits = 2k
-​ Gray-level mapping ●​ Each Pixel = 2k gray level
-​ Allows alteration of the
displayed image contrast by Pixel = 22 gray levels = 4 densities
adjusting the window width and Pixel = 22 gray levels = 256 densities
level or shades of gray
 - widely used in Computed
Tomography Angiography (CTA)

- simplest form of three-dimensional

imaging

- provides excellent differentiation of

the vasculature from surrounding
- Bit depth has an effect on the number tissue but lacks vessel depth because
of shades of gray, hence contrast superimposed vessels are not
resolution of the image. displayed

MULTIPLANAR REFORMATION THREE-DIMENSIONAL IMAGE OF

(MPR) CONTRAST-FILLED VESSELS
-​ Stacking of transverse
images to form a
three-dimensional data set

●​ MAXIMUM INTENSITY
PROJECTION (MIP)
●​ SHADED SURFACE DISPLAY
(SSD)
●​ SHADED VOLUME DISPLAY
(SVD)

MAXIMUM INTENSITY PROJECTION

(MIP)
- reconstructs an image by selecting
the highest value pixels along any
arbitrary line through the data set and SHADED SURFACE DISPLAY (SSD)
exhibiting only those pixels
- sometimes called feature-extraction
or iso-surfacing

- initially applied to bone imaging and

now is used regularly for virtual
colonoscopy

- is a surface-rendered image that

provides a realistically looking
three-dimensional view of the surface
of a structure of interest within the
acquired volume set.
 Minimum intensity projection
(MinIP)

- is a data visualization method that

enables detection of low-density
structures in a given volume

- it consists of projecting the voxel

with the lowest attenuation value on
every view throughout the volume onto
a 2D image

- it is the optimal tool for the detection,

SHADED VOLUME DISPLAY (SVD) localization, and quantification of
ground-glass opacity, mosaic
- Otherwise known as attenuation, traction bronchiectasis,
Volume-rendering (VR) is a 3D cystic lung disease and linear
semitransparent representation of the attenuation patterns on chest CT
imaged structure.
- particularly useful for analyzing the
- Provides a very distinctive bile tree and pancreatic duct, which
boundaries of multiple tissues. are hypodense compared to
surrounding tissue, especially in the
- Display of the heart obtained during pancreatic and portal phase of contrast
cardiac computed tomography agent administration
angiography (CCTA). This image can
be rotated for three-dimensional
visualization. IMAGE QUALITY

●​ Spatial Resolution
●​ Contrast Resolution
●​ System Noise
●​ Density
●​ Uniformity
SPATIAL RESOLUTION SPATIAL FREQUENCY for CT
imaging systems is expressed often as
-​ Another term for “Detail line pairs per centimeter (lp/cm)
Resolution”
-​ Is the system’s ability to
resolve, as separate forms,
small objects that are very close
together

A function of pixel size: (The smaller

the pixel size, the better the spatial
resolution.)

Thinner slices, better resolution

EDGE RESPONSE FUNCTION (ERF)

- is a mathematical expression that

refers to the ability of the CT imaging
system to reproduce with accuracy a
high-contrast edge

MODULATION TRANSFER
FUNCTION (MTF)

- Is a term borrowed from radio

electronics that has been applied to
the description of the ability of an
imaging system to render objects of
different sizes onto an image.

A simplified illustration of spatial

frequency. A. If objects are large, not
many will fit in a given length and they
are said to have low spatial frequency.
B. If the objects are smaller, many
more will fit into the same length.
These are said to have high spatial
frequency.
FACTORS AFFECTING CONTRAST LOW SUBJECT CONTRAST
RESOLUTION -​ Structures that has almost the
same appearance (e.g.,
1. PIXEL SIZE Liver-Spleen)
- Smaller pixel size results in an
improved spatial resolution LOW CONTRAST DETECTABILITY
-​ Refers to the ability to
2. SLICE THICKNESS distinguish an object that is
- The thinner the slice, the sharper the nearly the same density as its
image background.

3. RECONSTRUCTION ALGORITHM LINEAR ATTENUATION

- depends on which parts of the data COEFFICIENT
should be enhanced or suppressed to - Characterizes the absorption of
optimize the image for diagnosis x-rays in tissue
- e.g., bone or detail filters - for high ●​ X-RAY: is a function of x-ray
contrast reconstruction algorithm energy and the atomic number
reduces visibility of the soft tissue of the tissue
structures ●​ For CT: absorption of x-rays by
the patient is determined also
4. FOCAL SPOT-SIZE by the mass density of the body
- Large focal spots reduces spatial part
resolution
The ability to image low-contrast
5. PITCH objects with CT is limited by the:
- Increasing pitch reduces spatial ●​ Size of the object
resolution ●​ Uniformity of the object
●​ Noise of the system
6. PATIENT MOTION
- Creates blurring thereby degrading
spatial resolution

CONTRAST RESOLUTION
- The ability to differentiate a structure
that varies only slightly in density from
its surroundings.
- Also referred to as the sensitivity of
the system

HIGH SUBJECT CONTRAST

-​ Structures that are easy to
distinguish (e.g., Bone-Soft
Tissue Interface) FAT-MUSCLE-BONE STRUCTURE
SYSTEM NOISE Noise measurements should include
- Percentage standard deviation of a five determinations: – four on the
large number of pixels obtained from a periphery and one in the center
water bath image
- Random variation in photon detection Noise measurement should not
- Appears on the image as graininess exceed 10

Noise depends on many factors:

●​ X-ray Flux photons number of
detected

1. Scanning Techniques LINEARITY

a.​ X-ray Tube Voltage -​ refers to the relationship
b.​ Tube Current between CT numbers and the
c.​ Slice Thickness linear attenuation values
d.​ Scan speed
e.​ Helical Pitch Ratio In relation to CT Number water = 0, it
refers to CT numbers uniformity
2. Detector Efficiency
3. Patient Pertains to machine calibration
a.​ Size
b.​ Amount of Bones and Softtissue - Made daily uses the FIVE-PIN
in the scanning plane PERFORMANCE TEST OBJECT

4. Inherent Physical Limitation of the

System
a.​ DAS (Data Acquisition System)
b.​ Scatter Radiation

5. Reconstruction Parameters
a.​ Filters/Kernels

6. Pixel Size, DFOV, Image Matrix Size

Low noise images appear very smooth

to the eye, and high-dose images
appear spotty or blotchy
Each of the five pins is made of a different
Noise should be evaluated daily plastic material that has known physical
through imaging of a 20-cm diameter and x-ray attenuation properties and is
positioned in a water bath
water bath
The plot of CT number versus linear UNIFORMITY
attenuation coefficient should be a -​ refers to the ability of the
straight line that passes through CT scanner to yield the same CT
number 0 for water number regardless of the
location of an ROI within a
Daily calibrations help to avoid homogeneous object.
fluctuations in linearity by
compensating for the tiny changes. - Any time that a water bath is imaged,
the pixel values should be constant in
CT Linearity is measured all regions of the reconstructed image
“Semiannually” (SPATIAL UNIFORMITY)

- Spatial uniformity can be tested

easily with an internal software
package that allows the plotting of CT
numbers along any axis of the image
as a histogram or as a line graph.

- Acceptable Spatial Uniformity (± 2δ)

Measured using a Water Phantom

done on a Weekly Basis
CT ARTIFACTS

- Any discrepancy between the CT

numbers represented in the image and
the expected CT number based on the
linear attenuation coefficient

- are objects seen on the image but

not present in the object scanned FIGURE 7-6 Partial volume artifacts
can occur when dense objects lie to
2 Categories: the edge of the SFOV and are only
present in some of the views used to
1. Physics Based Artifact - scanner create the image.
imperfection/problem

2. Patient Based Artifact - by patient

or metallic materials

PHYSICS-BASED ARTIFACTS

PARTIAL VOLUME ARTIFACT PARTIAL VOLUME ARTIFACT

- Occurs when dense objects lie to the
edge of the SFOV and are only SOLUTION
present in some of the views used to
create the image. 1. Use Thinner Slices (Best Method)
2. Changing the Slice Center
- can also occur if there is more than 3. Changing Slice Incrementation
one type of tissue contained within a (Overlapping Slices)
voxel.

✓PARTIAL VOLUME EFFECT

-​ A.k.a “Volume Averaging"
-​ The process wherein a
normal-sized tissue is averaged
to become less apparent in the
Image.

✓ Object won't appear on all views

FIGURE 5-16 A. Volume averaging
can occur when objects straddle
slices. B. By changing the slice center,
the partial volume effect is reduced.
BEAM HARDENING: PHOTON STARVATION
- The potential source of this serious
-​ caused by the polychromatic streaking artifacts are the highly
nature of the x-ray beam attenuating areas resulting to
insufficient photons reaching the
-​ increase in mean energy of the detectors
beam when It passes through
object

-​ Usually seen in petrous

pyramids, upper chest and
shoulders, hips
Two Classifications:

a) STREAKING ARTIFACT
SOLUTION:
-​ Appears as dark bands or
●​ Increase mA
streaks between dense objects
●​ Increase kV
on the image
●​ Increase slice thickness
b) CUPPING ARTIFACT
RING ARTIFACT
-​ Causes the periphery of the
- the result of miscalibrated or busted
Image to become lighter
detectors eventually shown as a
circular artifact.

SOLUTION:
1. Filtration (E.g., Aluminum, Bow-Tie
Filter)
2. Calibration Correction
3. Beam Hardening Correction
Software
4. Raising The kVp
5. Selection of appropriate SFOV (Best SOLUTION:
strategy available to the operator) ●​ Software correction
●​ Replacement of busted detector
banks
TUBE ARCING
- tungsten vapor in anode and cathode
Intercepts projectile electrons to the
target

-​ Electrical:

SOLUTION:
●​ Removal of Metallic Artifacts
from the body if possible
●​ Application of a Correction
Software (e.g.. O-MAR Function
SOLUTION: (Orthopedic Metal Artifact
●​ TUBE REPLACEMENT Reduction)
—
PATIENT-BASED ARTIFACTS
APPLICATIONS??
MOTION ARTIFACTS
-​ caused by voluntary or When do we use Computed
Involuntary motion Tomography Scanning?
-​ ghosting
What parts of the body will we be able
to image using this type of modality?

What should be observed when having

a CT scan examination? As a patient
or as a Radiographer?

CRANIAL

Diagnosis of CVA and intracranial

hemorrhage
SOLUTION:
●​ Reduction of scan time
Evaluating facial and skull fractures
●​ Good patient communication
●​ Immobilization
Detection of tumors.
METAL ARTIFACTS
-​ presence of metals in the scan
field
-​ Star streaking or starburst
manifestation
CHEST, CARDIAC AND ABDOMEN PATIENT CARE
●​ Patient Communication
●​ Patient Preparation
●​ Contrast Agent
●​ Injection Technique

PATIENT COMMUNICATION

What needs to be adapted by the CT

Technologist/Radiographer:
●​ Attentive
●​ Personal and Interactive Style
●​ Obtaining accurate medical
LOWER EXTREMITIES AND BLOOD history
VESSELS ●​ Ensuring the patient what can
happen during the examination

Only through effective

communication can this vital
information be gathered and imparted

DO COMMUNICATION SKILLS
REALLY MATTER?
DYNAMIC SCANNING
- Different structures enhances at ●​ Effective communication leads
different rates after contrast media to less time spent talking per
administration patient.

Studies have shown that the Total

examination time is decreased
when communication is increased.

DO COMMUNICATION SKILLS
REALLY MATTER?

Expectation of a patient of how a

quality service should be given
throughout the entire healthcare
setting:

1. How healthcare workers

communicate with patients, from the
registration desk to the billing COMMUNICATION BARRIERS:
department. 1. Language
2. How they and their families are 2. Power struggles
treated by the staff. 3. Misreading of body language, tone,
3. The type of Information they are and other non-verbal forms of
given. communication
4. Fuzzy Transmission
5. Receiver Distortion
DO COMMUNICATION SKILLS 6. Assumptions
REALLY MATTER? 7. Preconception
8. Past Experiences
Patients express the desire to have 9. Cultural Differences
interaction when:
Constitutes about 90% of
1. Personal communication
2. Caring ⬆
3. Respectful CATEGORIES OF NON-VERBAL
COMMUNICATION:
Commonly reported by dissatisfied a. Visual Communication
patients: b. Tactile
c. Vocal
1. A feeling that the provider focuses d. Time, Space, and Images
on them only as a disease process or e. Objects
as an organ to be examined.
Spaces as defined by North
Patients don't care how much you Americans:
know until they know how much you
care. i. Intimate Distance - 18 inches or
-​ Sir William Osler less; used to discuss confidential
matters
Patient Communication
●​ The process of creating ii. Personal distance - 1.5 to 4 feet;
meaning. which is analogous to a small
protective sphere or bubble that a
It does not consist of the transmission person maintains between themselves
of meaning. and others
-​ generated from within and are
not entirely contained in the iii. Social distance - 4 to 12 feet;
message described as a psychological distance,
-​ Not entirely transmittable or people begin to feel anxious when
transferrable. these boundaries are not maintained

Transmittable
●​ Message
iv. Public distance - 12 feet or more; Communication habits to Adopt:
requires a more formal style of ●​ Be a good listener.
language and a louder voice ●​ Use focused questions.
●​ Use the patient's name.
v. Ethnic, Age, and Sex Differences ●​ Use touch to comfort and be
aware of nonverbal messages.
PRACTICAL ADVICE: ●​ Develop a rapport with the
- Recognize that each of us has patient.
responsibilities both as a speaker and ●​ Explain before acting.
a listener. ●​ Glue the patient an opportunity
to ask questions.
Speaker's Responsibilities: ●​ Use reflective speech.
●​ Be audible. ●​ Give consistent messages.
●​ Be aware that your listener may
not have understood you. 1. Examination Initiation: Initiated by
●​ Be willing to ask questions of clinicians with appropriate credentials.
your listener to see whether he
or she understands you. 2. Screen Patient
- Verify examination by asking for the
Listener's Responsibilities: original requisition written by the
●​ Let the speaker know whether clinician.
he or she is inaudible.
●​ Let the speaker know that you Obtain Medical History:
are attentive. ●​ Can help ensure patient safety,
●​ If the speaker's message is guide the selection of
unclear, let him or her know that examination protocol, and offer
you need a point clarified. radiologists diagnostic
information.
Communication habits to avoid:
●​ Don't use false reassurance. CT Technologists responsibility to
●​ Don't ignore a patient's wishes. patients who will be undergoing an
●​ Don't speak like you are talking examination:
to a child.
●​ Don't assume that a 1. Provide patient education
nonresponsive patient can't 2. Secure an informed Consent
hear.
●​ Don't carry on a separate
conversation with a coworker
while a patient is present.
●​ Don't think being professional
means being cold.
●​ Don't blame the patient.
●​ Don't use abbreviations or
medical lingo.
1. Provide patient education Signed/Written Consent:
●​ At a minimum, the technologist ●​ a written agreement between
should describe: the patient and the medical
practitioner
1. How the procedure will be carried ●​ It contains:
out.
2. The approximate length of the 1. Statement or declaration confirming
procedure. that the patient is fully aware of any
3. Whether contrast agents will be side effects and risks Involved and
administered: agrees to participate in the treatment
4. If they are planned, then an plan.
explanation of how they will be
administered (e.g., oral, IV) and any
potential side effects is required. Laboratory Values:
5. What is expected of the patient. ●​ Blood Urea Nitrogen (BUN):
6. Any follow-up necessary after the -​ 7 to 25 mg/dL
examination has been completed.
●​ Serum Creatinine:
-​ 0.6 to 1.7 mg/dL
2. Secure an informed Consent
●​ Provide the patient an ●​ Glomerular Filtration Rate
opportunity to be an informed (GFR):
participant in his healthcare -​ 120 mL/min
decisions
●​ Effective Renal Plasma Flow
Elements of an Informed Consent: (ERPF):
1. Nature of procedure. -​ 500 mL/min
2. Reasonable alternatives to the
proposed Intervention. For assessment of RENAL
3. The relevant risks, benefits, and FUNCTION
uncertainties related to each
alternative. Factors affecting Serum Creatinine
4. Assessment of the patient's Value:
understanding. * Secretion of the proximal tubule
5. The acceptance of the Intervention -​ (resulting to overestimation of
by the patient. the GFR [10%-40% in healthy
persons, but is greater and less
predictable in patients with
INVASIVE CT EXAMINATIONS chronic kidney failure])
(e.g., Biopsies, administration of
contrast material) *(Sex) Higher in Men (0.7-1.3mg/dL
or 61.9 - 114.9 umol/L) compared to
Women (0.6-1.1mg/dL or
53-97.2umol/L)
 -​ from the fact that creatinine is —
mainly derived from the CONTRAST AGENT
metabolism of creatine in
muscle; consequently, its CONTRAST MEDIUM
generation is proportional to the - is a diagnostic agent used to
total muscle mass enhance subject contrast of organs
or structures (e.g., pathologies)
*Age, Race, Muscle Wasting, Diet
- changes the absorption
characteristics of the anatomic area
Laboratory Values Needed for Biopsy and alters subject contrast and
Procedures: radiographic density differences.
●​ Prothrombin Time (PT)
-​ 11 - 14 seconds - generally classified as NEGATIVE or
●​ Partial Thromboplastin Time POSITIVE.
(PTT):
-​ 25 - 35 seconds NEGATIVE:
●​ Platelet Count: Decrease attenuation of the x-ray
-​ 150,000 - 400,000 mm3 beam and produce areas of increased
density on the radiograph.
For assessment of BLOOD
COAGULATION POSITIVE:
Increase the attenuation of the x-ray
beam and produce areas of decreased
ABDOMINAL CT WITH CONTRAST density on the radiograph
●​ Light Evening Meal night before
the examination
●​ Laxative 9pm (Dulcolax Tablets, ●​ (2) two tissues must differ by at
Duphalac or Lactulose) least 10HU to be visible
●​ NPO at 12MN different on a CT scan
●​ No breakfast on the day of
examination FACTORS IN SELECTING
●​ Have the patient report to the CONTRAST MEDIA:
department at least 15 minutes
prior to the procedure "VOMPIIT"

PLAIN CT STUDIES: 1. Viscosity - resistance of fluid to flow

●​ No necessary preparations 2. Osmolality - a measure of the total
number of particles in a solution/kg of
BRAIN AND CHEST CT WITH water
CONTRAST ●​ It is the structural property of a
●​ Fasting for at least 4hours prior liquid regarding the number of
to the scheduled time of particles in solution
examination
 ●​ Measured in mOsm/kg FACTORS IN SELECTING
(milliosmoles per kilogram) of CONTRAST MEDIA:
water
●​ Osmolality of Blood Plasma is "VOMPIIT"
approximately 290 mOsm/kg
water 1. Viscosity - resistance of fluid to
●​ Contrast agents may have up to flow
7 times the number of particles 2. Osmolality - a measure of the total
in solution per unit of liquid as number of particles in a solution/kg of
blood. water
3. Miscibility- the ability of a medium
FACTORS IN SELECTING to mix with other fluids
CONTRAST MEDIA: 4. Persistence - the amount of time
●​ HOCM (High-Osmolality the contrast stays in the body
Contrast Media) 5. lonicity - classified as to whether
the molecules they contain will
- 1300-2140 mOsm/kg (4-7 times that separate into charged-particles when
of human blood) Older iodinated dissolved in an aqueous solution
contrast agents which presents greater 6. Iodine Content - volume
risk for an adverse reaction. distribution of iodine in the contrast
agent
●​ LOCM (Low-Osmolality 7. Toxicity
Contrast Media) (1980s)
Contrast Agent: Key Concepts
- 600-850 mOsm/kg (2-3 times that of
human blood) The most common formula for
calculating the dose of intravascular
- expensive, which is often preserved contrast for pediatric CT studies is 2
for patients that presents a hogh risk of mL/kg.
adverse reaction.
There is no proof that contrast
●​ LOCM (Low-Osmolality agents present a risk to the fetus.
Contrast Media) (1996) However, there is not enough evidence
to be certain they pose no risk.
- has osmolality equal to that of blood.
- e.g., Visipaque A very small percentage of the
- Suggested for patients who are at iodinated contrast medium given to a
risk of renal complications mother will be excreted into breast milk
and absorbed by the infant. Therefore,
it is believed to be safe for the
mother and infant to continue
breast-feeding after receiving a
contrast agent.
Administration of Contrast Media to
Pregnant or Potentially Pregnant
Patients

A. The radiologist should confer with

the referring physician and document
in the radiology report or the patient's
medical record the following:

I. That the information requested and

the necessity for contrast material
administration cannot be acquired via
other means (e.g., ultrasonography).

II. That the information needed affects

the care of the patient and fetus during
the pregnancy.

III. That the referring physician is of the

opinion that it is not prudent to wait to
obtain this information until after the
patient is no longer pregnant.

B. It is recommended that pregnant

patients undergoing a diagnostic
imaging examination with ionizing
radiation and iodinated contrast
material provide informed consent to
document that they understand the
risk-benefits of the procedure to be
performed and the alternative
diagnostic options available to them (if
any), and that they wish to proceedThe

(American College of Radiology.

Manual on Contrast Media, version 6,
2008:61-3)