Introduction
y Computed Tomography CT imaging is a method or
acquiring and reconstructing a cross sectional images of an object .
CT
Advantages Limitations Improved contrast resolution Less spatial resolution comparing with conventional x ray High dose for pt.
No superimposition of tissue
Less scattering
Artifacts
3D imaging and reconstruction in MDCT
Ct room
y Operating console (image control and viewing) y Computer (multiprocessor: allows the computer to
perform several functions at the same time) y Gantry: diameter: 70 cm tilting: -30 to +30
CT
CT
y CT Gantry :housing of
the main CT scanner components. 1- x-ray tube 2-Filter 3- Generator 4- DAS 5- collimators 6-detectors y Scan modes : 1- scan by scan 2-spiral
y X-ray tube: 120-140 Kvp y Filter: shape the x-ray beam by removing lower energy
photons. y Generator: - 3 phase -high frequency (small enough that they can be mounted on the gantry). y DAS (Data Acquisition System): is a device located between the detector array and the computer. its function: 1. amplifies the detector signal. 2. converts the analog signal to digital signal (ADC). 3. transmits the digital signal to the computer.
y Collimator:
1. Pre-patient collimator: controls: - patient dose - determines the dose profile. Note: as pre-patient collimator is narrowed increase patient dose profile becomes more rounded 2. Post-patient collimator: controls slice thickness. As slice thickness : partial volume effect spatial resolution patient dose because of: - increased overlap of slices - increased mAs
y Detector array:
tow tybes: 1. Gas-filled detector: high-pressure xenon gas. 2. Solid state detector: use a scintillator, cadimum tungstate (CdWo4) optically coupled to a photodiode.
Spiral CT
y continuous data
collection - i.e. volume data
y (Spiral CTs offer
both modes of acquisition.)
Pitch
y Pitch is dist. travelled by
table during 1 rotation / slice thickness y If the table speed 10mm/s
during 1 sec rotation , slice thickness 10 mm
what is the pitch value ??
Pitch
Pitch
Pitch
Which is higher dose ???
linear attenuation coefficient
y Each element of CT image (pixel) has a CT number ,
depending on linear attenuation coefficient which describes the change in intensity of x ray beam at some distance of material traveled.
CT number
y CT No.= ( -w/ w). K
y CT No. =Hounsfield unit (H) y Window level = CT No (density) y Window width =Contrast
CT Numbers or Hounsfield Units
CT window
Multislice CT
y multislice CTs allow
collection of more than one slice per scan. y Detector configuration of 4, 8, 16, 32, 64 (128, 256 in development).
Multislice CT
y Faster acquisition of same volume y thinner slices giving better axial resolution y scan larger volume.
y In MSCT : y Pitch is dist. travelled by table during 1 rotation /
beam width
MDCT
Basic protocol
Brain CT
y Indications : y Trauma y CVA y Hydrocephalus y Headache y Tumors and follow up
Brain CT
y Preparation : no special y 1- Explain the procedure to the patient and insure that the patient in
stable position to avoid movement during the procedure y 2- Move any radiopaque material in the area of examination
y Pt. position : supine , head first (head in head rest) , Hands on the y y y y y
patients side and extend the legs, OML parallel to gantry .?? Scout : lateral skull To determine the slice thickness, position and number on it and to control the position Divided into 2 group 1- posterior fossa 2- anterior fossa
Brain CT
Brain CT
Posterior fossa Start point End point Slice thickness Table increment Foramen magnum 3rd venticle 5 mm 5 mm Anterior fossa 3 rd venticle Vault of brain 10 mm 10 mm
y Gantry angulation: 12-
15 degree y Pitch: 1 y kV: 120 kv y mAs: 300 mAs per slice y Note:Thin slices used in posterior fossa because we have small structures and to reduce partial volume artefact.
Brain CT
Scanning parameters
y kVp 120 , mA 400 y Rotation time 0.75 sec. y Slice thickness 3 mm y Detector configuration 64*0.625 y Scan mode Helical y Pitch 0.876 (< 1) y Window soft tissue / bone y WL : 40/200 y WW 200/2000
Brain CT
y CM Usage: y Non-ionic CM 300 mg/iodine/ml y CM maybe used in follow up and metastasis cases y The dose when CM is used: y Adult : 50 ml y Children 1ml/kg up to 50 ml y CT angiogram 100 ml, delay 15 second
Hydrocephalus
Sinuses CT scan:
y The sensitivity of: y X-ray 25% y CT 95% y Disadvantages in sinuses x-ray: y X-ray needs two projections y Difficult in positioning y More time consuming
Sinuses CT
y Indication: y Sinusitis y Air fluid level y Headache y Mucosal thickening y Pt . Prepration : as brain protocol . y Sinuses scan can be done in two ways .
Sinuses CT
y 1st : y Patient position: y Patient in prone position y Head is extended and chine supported on the head
rest y Hands on the patients back and extend the legs y Scout: y Lateral view
Sinuses CT
y Start position: Anterior margin of frontal siniuses y End position: Posterior wall of sphenoid sinuses y Gantry angulation: Parallel to the posterior wall of maxillary sinuses and at y y y y y y y y y y
90 degree to hard palate. Slice thickness: 3-5 mm Table increment:3- 5 mm Pitch: 1 kV: 120 mAs: 100-150 per slice WW: 4000 WL: 700 Notes: In sinuses CT scan we decrease the mAs to reduce the artifact and to reduce the dose Small slice thickness used to see osteomeatal complex.
Sinuses CT
y In MDCT .. y Slice thickness 2 mm y Pitch < 1 for high resolution
Sinuses CT
Sinuses CT
y 2nd : y Pt . Position : supine , head first y Scout : lateral skull y Start : aleveolar process of maxilla y End : upper limit of frontal sinus y Gantry tilt with OML y Axial images
Rec.
coronal images
Sinuses CT
Chest CT
y Types for scanning : y 1- Routine y 2- High resolution HR y 3- Pulmonary embolism PE
Routine chest CT
y Indications : y Tumors y Circulatory pathology y Inflammatory conditions y Trauma y Pericardial disease
Routine chest CT
y Pt. prepration : y 1- Explain the procedure to the patient and insure that
the patient in stable position to avoid movement during the procedure y 2- Move any radiopaque material in the area of examination y 3- breath must be held during the procedure y 4- KFT should be done before scanning
y CM Usage: (IV ) y Non-ionic CM 300 mg/iodine/ml y The dose when CM is used: y Adult : 100 ml y Rate 2.3 ml/sec y Delay time 20-25 sec ( aterial phase )
y Pt position : y Pt in supine position , head first , hands above the
head to reduce partial volume artifact. y Technique : y Scout view AP Chest
Single slice protocol
y Start position: above the sternal notch y End position: adrenal glands ?? y Gantry angulation: none y Slice thickness: 8-10 mm y Table increment:8-10 mm y Pitch: 1 y kV: 120 y mAs: y Window : soft tissue / lung / bone( not routine ) y WW: 350/1500/2500 y WL: 40/-550/250
1.5
High resolution CT
y Indications y To differentiate of pulmonary nodules and focal lung
disease y Diffuse lung disease : lung fibrosis , bronchiectasis ( widening of the bronchi or their branches )
y Start position: above the sternal notch y End position: below diaphragm y Gantry angulation: none y Slice thickness: 1-2 mm y Table increment:8- 10 mm y Pitch: none ( scan by scan) y kV: 120 y mAs:200 y Window : lung y WW:1500 y WL: -550 y Note : without IV contrast .
PE protocol
y Indications : y Vascular disease y Mediastenum disease y CM : y Non-ionic CM 300 mg/iodine/ml y The dose when CM is used: y Adult : 120-150 ml y Rate 2.8-3 ml/sec y Delay time 20-25 sec ( aterial phase )
y Start position: diaphragm y End position: sternal notch ?? y Gantry angulation: none y Slice thickness: 3 mm y Table increment: 3 mm y Pitch: 1 y kV: 120 y mAs:200 y Window : soft tissue y WW: 350 y WL: 40
Abd & pelvis CT
y Indications : y Tumors y Circulatory pathology y Inflammatory conditions y Trauma y Renal stones y Lymphadenopathy
Abd & pelvis CT
y Patient preparation: y Explain the procedure to the patient and insure that
the patient in stable position to avoid movement during the procedure. y Breath must be held during the procedure y remove any radiopaque material in the area of examination y KFT should be done before exam
CM Usage
y Oral CM : y 200 ml of Ba ( 20-25 ml of non ionic CM ) with 800 ml
water y 1-1.5 hr before the exam y Last cup on the table to fill the stomach y IV contrast : y Adult volume : 100 ml y Rate 2.3 ml/sec y Delay 60 sec ( portal venous phase )
Abd & pelvis CT
y Patient position: y Patient in supine position y Head in head rest y Hands on the patient head ( to reduce dose and
artifacts ) and extend the legs y Scout : y AP abdomen
scout
SSCT protocol
y Start position: Above the diaphragm y End position: Symphysis Pubis y Gantry angulation: No angulation y Slice thickness: 7-10 mm (3mm in MDCT) y Table increment: 7-10 mm y Pitch: 1 y kV: 120 y mAs: 300 y Window: Soft tissue
Abd & pelvis CT
Renal stone protocol
y CT is useful for both radiopaque and radiolucent stone y Start position: Above the diaphragm y End position: Symphysis Pubis y Gantry angulation: No angulation y Slice thickness: 3-5 mm (2 mm in MDCT ) y Table increment: 3-5 mm y Pitch: 1 y kV: 120 y mAs: 300 y Window: Soft tissue y Without IV and Oral CM
Renal stone
Special protocols (liver , adrenal , pancrease )
y It s called multiphase protocols y Steps : y 1- scout view ( AP Abdomen ) y 2- pre contrast phase y 3- arterial phase y 4- Portal venous phase
Multiphase
Pre contrast Arterial phase ( oral but not IV ) Scan field From diaphragm to SP From diaphragm to iliac crest ( on the organ ) 20 -25 sec Or by bolus tracer Portal venous phase From diaphragm to SP
Delay time
Without IV
60 sec
Slice thickness
5 mm
2-3 mm
5 mm
multiphase
lumbar Spine CT
y Benefits of CT scan over MRI in spinal Imaging: y MRI has a narrow tunnel y Some patient have irremovable metals in the spine
region y CT is good for fracture y Indication: y Lumber disc disease mainly in L4-L5, L5-S1 y Spinal stenosis y Surgery follow up (laminoctomy)
L spine CT
y Patient preparation: y Explain the procedure to the patient and insure that
the patient in stable position to avoid movement during the procedure. y Move any radiopaque material in the area of examination
L spine CT
y Patient position: y Patient is supine position knee is flexed for less y y y y
movement Arms should be lifted above the head and if the patient can t , keep them over the chest Scout : Lateral lumbar spine By lateral scout we plan the angle of the gantry( parallel to the disk space and cover all intervertebral foramen)
Scout
Parameters
y Start position: L3 y End position: S1 y Gantry angulation: Mainly it must be parallel to the disk space of vertebra ( 3 slices for each disk ) y Slice thickness: 3-5 mm y Table increment: 3-5 mm y Pitch: 1 y kV: 120 y mAs: 300 y Window: Soft tissue/ Bone window y WW: 500/ 1500 y WL: 60/250
L spine CT
