BM4101 MEDICAL

IMAGING SYSTEM
UNIT III COMPUTED TOMOGRAPHY
Need for sectional images, Principles of sectional scanning, Methods of
Reconstruction-Iterative, Back projection, convolution and Back-Projection, multislice CT,
Artifacts.
Reference:
[Link] and [Link], Radio graphic imaging, CBS Publications, New Delhi, 1989
Donald [Link], Elizabeth [Link], Martin [Link] and Martin [Link], MRI from
picture to proton, 2nd Edition, Cambridge University press, New York 2007.
Need for sectional images
• Computed tomography (CT) is an imaging procedure that uses
special x-ray equipment to create detailed pictures, or scans, of areas inside the
body. It is sometimes called computerized tomography or computerized axial
tomography (CAT).
• Cross Sectional Imaging is a discipline of radiology that encompasses the use of a
number of advanced imaging techniques that feature in common the ability to
image the body in cross section. This discipline typically focuses on the diagnosis
and characterization of abnormalities of chest, abdomen, and pelvis.
• Cross-sectional imaging allows morphologic characterization of mediastinal
masses and the surrounding tissues. CT, 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 machine’s computer to
generate cross-sectional images—or “slices”—of the body.
• CT, 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 machine’s computer to generate cross-sectional images—or “slices”—of the body.
• These slices are called tomographic images and contain 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 image of the
patient that allows for easier identification and location of basic structures as well as possible
tumors or abnormalities. 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.
• Each time the x-ray source completes one full rotation, the CT computer uses sophisticated
mathematical techniques to construct a 2D 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.
Principles of sectional scanning
• The term computed tomography derives from computed (with computer), tomo (to
cut), and graph(y) (pictures). CT uses ionizing radiation, or x-rays, coupled with
an electronic detector array to record a pattern of densities and create an image of
a “slice” or “cut” of tissue. The x-ray beam rotates around the object within the
scanner such that multiple x-ray projections pass through the object .
• The CT x-ray tube (typically with energy levels between 20 and 150 keV), emits
N photons (monochromatic) per unit of time. The emitted x-rays form a beam
which passes through the layer of biological material of thickness Δx. A detector
placed at the exit of the sample, measures N + ΔN photons, ΔN smaller than 0.
Attenuation values of the x-ray beam are recorded and data used to build a 3D
representation of the scanned object/tissue.
• There are basically two processes of the absorption: the photoelectric effect and
the Compton effect.
• Unlike x-ray radiography, the detectors of the CT scanner do not produce an
image. They measure the transmission of a thin beam (1-10 mm) of x-rays through
a full scan of the body. The image of that section is taken from different angles,
and this allows to retrieve the information on the depth
• In order to obtain tomographic images of the patient from the data in "raw" scan,
the computer uses complex mathematical algorithms for image reconstruction.
• The image by the CT scanner is a digital image and consists of a square matrix of
elements (pixel), each of which represents a voxel (volume element) of the tissue of
the patient.
• In conclusion, a measurement made by a detector CT is proportional to the sum of
the attenuation coefficients.
• The typical CT image is composed of 512 rows, each of 512 pixels, i.e., a square
matrix of 512 x 512 = 262,144 pixels (one for each voxel). In the process of the
image, the value of the attenuated coefficient for each voxel corresponding to these
pixel needs to be calculated.
• Each image point is surrounded by a halo-shaped star that degrades the contrast and
blurs the boundary of the object. To avoid this, the method of filtered back
projection is used. The action of the filter function is such that the negative value
created is the filtered projection, when projected backwards, is removed, and an
image is produced, which is the accurate representation of the original object.
• Before the data are presented on the screen, the conventional rescaling was made
into CT numbers, expressed in Hounsfield Units (HU), as mentioned before.
Generation in CT
• CT scanners were first introduced in 1971 with a single detector for brain study
under the leadership of Sir Godfrey Hounsfield, an electrical engineer at EMI
(Electric and Musical Industries Ltd).
• First generation
• detectors: one
• type of beam: pencil-like x-ray beam
• tube-detector movements: translate-rotate
• duration of scan (average): 25-30 mins
• Second generation
• detectors: multiple (up to 30)
• type of beam: fan-shaped x-ray beam
• tube-detector movements: translate-rotate
• duration of scan (average): less than 90 sec
• Third generation
• detectors: multiple, originally 288; newer ones use over 700 arranged in an arc
• type of beam: fan-shaped x-ray beam
• tube-detector movements: rotate-rotate
• duration of scan (average): approximately 5 sec
• Fourth generation
• detectors: multiple (more than 2000) arranged in an outer ring which is fixed
• type of beam: fan-shaped x-ray beam
• tube-detector movements: rotate-fixed
• duration of scan (average): few seconds
• Fifth generation
• detectors: stationary ring of detectors which is fixed
• type of beam: Fan electron beam is scanned over a wide target to cover half scan
• tube-detector movements: stationary-stationary
• duration of scan (average): few seconds
• Sixth generation
• Uses slip ring technology
• Allow gantry to rotate continuously without wires
• It acquires data while table is moving
• Seventh generation
• Uses multiple detector array
CT Detectors

• Detectors collect information regarding the degree to which each

anatomic structure attenuated the beam during a CT Scan Machine.
Instead of film to record the attenuated beam digital x-ray detectors
collect the information in CT Scans.
• Entire collection of detectors that are situated in an arc or a ring in a
system.
• Each measures the intensity of transmitted x-ray radiation along a
beam that’s projected from the x-ray source to a particular detector
element. There are also reference detectors within the array that help
calibrate data and reduce artifacts.
• Two Types of Detectors: Xenon Gas and Solid State Crystal
• Xenon Gas Detectors use pressurized xenon gas to fill the hollow chamber to produce
detectors that absorb 60-87% of the photons that reach them. Xenon gas is used because
it can remain stable under pressure and is significantly less expensive when compared to
the solid-state variety. It’s also easier to calibrate and is highly stable.
• A Xenon Detector Channel consists of three tungsten plates. The xenon gas is ionized
when a photon enters the channel. These ions are accelerated and amplified by the
electric field between the three plates. This collection charge produces an electric current,
which is then processed as raw data. The downside of xenon gas is that it must be kept
under pressure. The major factors hampering detector efficiency are the loss of x-ray
photons in the casing window and the space taken up by the plates.
• Solid State Crystal Detectors are also called scintillation detectors because they use a
crystal that fluoresces when struck by an x-ray photon. The photodiode is attached to the
crystal and transforms the light energy into electrical (analog) energy. Individual detector
elements are affixed to a circuit board.
• Solid state crystal detectors are made from a variety of materials, like cadmium tungstate,
cesium iodide, bismuth germinate and ceramic rare earth compounds like gadolinium of
yttrium. Solid state detectors have higher absorption coefficients because these solids
have high atomic numbers and high density in comparison to gases. They absorb close to
100% of all photons that reach them.
• There are several terms that describe elements of detector efficiency:
• Capture efficiency refers to the ability with which the detector obtains photons that pass
through the patient
• Absorption efficiency refers to the number of photons absorbed by the detector and are
dependent on the physical properties of the detector face, including thickness and
material.
• Response time refers to the time required for the detector signal to return to zero after
the detector is stimulated by x-ray radiation and is able to detect another x-ray event.
• Dynamic range is the ratio of the maximum detector signal measured to the minimum
signal they can measure.
• The efficiency of a CT Scan system detector depends on:
• The stopping power of the detector material
• The scintillator efficiency (in solid state types of detectors)
• The change collection efficiency (in Xenon types of detectors)
• The geometric efficiency, which is the amount of space occupied by the detector
collimator plated relative to the detector’s surface area
• The scatter rejection
Image reconstruction
• Image reconstruction in CT is a mathematical process that generates
tomographic images from X-ray projection data acquired at many
different angles around the patient. Image reconstruction has
fundamental impacts on image quality and therefore on radiation
dose. For a given radiation dose it is desirable to reconstruct images
with the lowest possible noise without sacrificing image accuracy and
spatial resolution. Reconstructions that improve image quality can be
translated into a reduction of radiation dose because images of the
same quality can be reconstructed at lower dose.
• Two major categories of reconstruction methods exist, analytical
reconstruction and iterative reconstruction (IR).
Backprojection
• Backprojection. The standard method of reconstructing CT slices is
backprojection. This involves "smearing back" the projection across the image at
the angle it was acquired. By smearing back all of the projections, you reconstruct
an image. This image looks similar to the real picture but is blurry - we smeared
bright pixels across the entire image instead of putting them exactly where they
belonged. You can see this effect in the simulator on the right-most panel.
• In order to reconstruct an image, you need 180 degrees of data (* actually 180 +
fan beam angle). Why? The remaining 180 degrees are simply a mirror image of
the first (because it does not matter which way a photon travels through tissue, it
will be attenuated the same amount). (Because of the fan beam geometry, you
need to measure an extra amount - equal to the fan angle - to actually get all of
the data you need, but the concept is the same.)
• In a fan-beam geometry, the angle of the fan determines how much of the object
is included in the reconstructible field of view. A point must be included in all 180
degrees of projections in order to be reconstructed correctly.
• There are many types of analytical reconstruction methods. The most
commonly used analytical reconstruction methods on commercial CT
scanners are all in the form of filtered backprojection (FBP), which uses a
1D filter on the projection data before backprojecting (2D or 3D) the data
onto the image space.
• Users of clinical CT scanners usually have very limited control over the inner
workings of the reconstruction method and are confined principally to
adjusting various parameters that potentially affect image quality. The
reconstruction kernel, also referred to as “filter” or “algorithm” by some CT
vendors, is one of the most important parameters that affect the image
quality. A smoother kernel generates images with lower noise but with
reduced spatial resolution. A sharper kernel generates images with higher
spatial resolution, but increases the image noise.
• The selection of reconstruction kernel should be based on specific clinical
applications. For example, smooth kernels are usually used in brain exams
or liver tumor assessment to reduce image noise and enhance low contrast
detectability, whereas sharper kernels are usually used in exams to assess
bony structures due to the clinical requirement of better spatial resolution.
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Iterative reconstruction
• Iterative reconstruction refers to an image reconstruction algorithm
used in CT that begins with an image assumption, and compares it to
real time measured values while making constant adjustments until
the two are in agreement.
• Computer technology limited early scanners in their ability to perform
the iterative reconstruction. Its ability to overcome noise associated
with filtered back projection without increasing radiation dose has
had a significant impact on the computed tomography image
reconstruction industry
Stages of iterative reconstruction

• Iterative reconstruction has three distinct stages.

• Input
• Using the raw data produced by the computed tomographic scanner a standard filtered
back projection algorithm is utilized to create a primary image.
• Image reconstruction loop
• A sequence is then performed where
• a forward projection to the primary image creates artificial raw data,
• simulated data is then correlated to the measured raw data where an updated image is
generated, and then
• 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.
• Output
• The final back projection image that is produced.
• Iterative reconstruction refers to iterative algorithms used to reconstruct 2D and 3D
images in certain imaging techniques. For example, in computed tomography an image
must be reconstructed from projections of an object. Here, iterative reconstruction
techniques are usually a better, but computationally more expensive alternative to the
common filtered back projection (FBP) method, which directly calculates the image in a
single reconstruction step.
• The reconstruction of an image from the acquired data is an inverse problem. Often, it is
not possible to exactly solve the inverse problem directly. In this case, a direct algorithm
has to approximate the solution, which might cause visible reconstruction artifacts in the
image. Iterative algorithms approach the correct solution using multiple iteration steps,
which allows to obtain a better reconstruction at the cost of a higher computation time.
• There are a large variety of algorithms, but each starts with an assumed image, computes
projections from the image, compares the original projection data and updates the image
based upon the difference between the calculated and the actual projections.
• The Algebraic Reconstruction Technique (ART) was the first iterative reconstruction
technique used for computed tomography by Hounsfield.
• The iterative Sparse Asymptotic Minimum Variance algorithm is an iterative,
parameter-free superresolution tomographic reconstruction method inspired
by compressed sensing, with applications in synthetic-aperture radar, computed
tomography scan, and magnetic resonance imaging (MRI).
 Iterative reconstruction

First image estimate is generated. An x-ray beam is simulated via forward projection to obtain
simulated projection data, which are then compared with the measured projection data. In
case of discrepancy, the first image estimate is updated based on the characteristics of the
underlying algorithm. This correction of image and projection data is repeated until a condition
predefined by the algorithm is satisfied and the final image is generated
Four different attenuation coefficients, in a 2 × 2 pixel matrix, are represented by five projections (p) at
three different angles (two acquired in horizontal, two in vertical, and one in oblique directions). The
matrix is successively updated by stepwise back projection. The corrected attenuation coefficients can be
used to generate synthesized projection data (P’) via forward projection. A subsequent cycle can be initiated until
a stop criterion is satisfied.
Iterative reconstruction
Multislice scanner
• The primary difference between single-slice CT (SSCT) and MSCT
hardware is in the design of the detector arrays.
• SSCT detector arrays are one dimensional that is, they consist of a
large number (typically 750 or more) of detector elements in a single
row across the irradiated slice to intercept the x-ray fan beam.
• In MSCT, each of the individual, monolithic SSCT detector elements in
the z-direction is divided into several smaller detector elements,
forming a 2-dimensional array . Rather than a single row of detectors
encompassing the fan beam, there are now multiple, parallel rows of
detectors.
• A detector design used in one of the first modern MSCT scanners
consisted of 16 rows of detector elements, each 1.25 mm long in the
z-direction, for a total z-axis length of 20 mm.
• Each of the 16 detector rows could, in principle, simultaneously
collect data for 16 slices, each 1.25 mm thick; however, this approach
would require handling an enormous amount of data very quickly,
because a typical scanner may acquire 1,000 views per rotation.
• If there are 800 detectors per row and 16 rows, then almost 13
million measurements must be made during a single rotation with a
duration of as short as 0.5 s.
Advantages of multi-slice CT scan
• The image quality is way much better than its traditional counterpart.
• Better image quality results in the early and precise diagnosis of diseases, which eventually means saving a lot
of suffering and money.
• The scanners used work at very high speed. Where it takes around 10 minutes on a conventional single-slice CT
to do a scan, the multi scanner can do the job within a few seconds and even more efficiently.
• Due to the less time taken, the multi-slice CT scan can be done on people in restless stage or those who are
unconscious. This is also helpful with children as it is difficult to get them to lie in one position for a long time.
• The emission of radiation is very low. A single slice scanner emits more harmful rays as compared to the
multi-slice scanner. For this reason, a multi-slice scan is favoured for children.
• In some cases of a single slice, the disease remains undiagnosed in its early stages due to low image quality.
Later on, when the difficulties are aggravated, the patient is referred for high-quality scans and sometimes so
much time is lost that the diseases go untreatable.
• Non-invasive Angiography can only be done on an MSCT. In angiography, multi-slice CT helps in creating a 3D
image with precise visualization of arteries & veins.
• 3D images of the bones, rib cage, spine etc can be obtained in multislice CT scan which results in better
assessment of the fractures and gives better images for the surgeon to operate upon the patient.
• It has been found in multiple studies that multislice CT leads to less repeatability as the images are good to
diagnose in only one scan. This avoids unnecessary cost and radiation to the patient.
Artifacts
• Artifacts are commonly encountered in clinical computed tomography (CT), and may obscure or simulate pathology. There
are many different types of CT artifacts, including noise, beam hardening, scatter, pseudoenhancement, motion, cone beam,
helical, ring, and metal artifacts.
• Motion artifact is a patient-based artifact that occurs with voluntary or involuntary patient movement during image
acquisition.
• Ring artifact is caused by a miscalibrated or defective detector element, which results in rings centered on the center of
rotation. This can often be fixed by recalibrating the detector.
• Beam Hardening
• An x-ray beam is composed of individual photons with a range of energies. As the beam passes through an object, it
becomes “harder,” that is to say its mean energy increases, because the lower-energy photons are absorbed more rapidly
than the higher-energy [Link] types of artifact can result from this effect: so-called cupping artifacts and the
appearance of dark bands or streaks between dense objects in the image.
• Cupping Artifacts.—
• X rays passing through the middle portion of a uniform cylindrical phantom are hardened more than those passing though
the edges because they are passing though more material. As the beam becomes harder, the rate at which it is attenuated
decreases, so the beam is more intense when it reaches the detectors than would be expected if it had not been hardened.
Therefore, the resultant attenuation profile differs from the ideal profile that would be obtained without beam hardening. A
profile of the CT numbers across the phantom displays a characteristic cupped shape
• Out of field “artifacts” are due to a suboptimal reconstruction algorithm, and can be fixed using a better algorithm. Images
can then be acquired using a field of view that is much smaller than the object being scanned, thus reducing the radiation
dose. • Higher resolution scanners will likely require iterative reconstruction or limited field of view scans to reduce the
radiation dose required to achieve an acceptable level of noise.