BASIC PRINCIPLES
OF CT
BY: AQSA SIDDIQUE
LECTURER: RADIOLOGY
MCMT-BKMC
POLYCHROMATIC X-RAY BEAMS
All x-ray beam sources for CT and conventional radiography produce x-
ray energy that is polychromatic. That is, the x-ray beam comprises
photons with varying energies.
The spectrum ranges from x-ray photons that are weak to others that
are relatively strong.
It is important to understand how this basic property affects the image.
Low-energy x-ray photons are more readily attenuated by the patient.
The detectors cannot differentiate and adjust for differences in
attenuation that are caused by low-energy x-ray photons.
To the detectors, any x-ray photon that reaches the detector is treated
identically, whether it began with high or low energy.
This phenomenon can produce artifacts.
Beam-hardening Artifacts
Artifacts are objects seen on the image but not present in the
object scanned.
Artifacts always degrade the image quality.
Artifacts that result from preferential absorption of the low
energy photons, which leaves higher-intensity photons to strike
the detector array, are called beam-hardening artifacts.
This effect is most obvious when the x-ray beam must first
penetrate a dense structure, such as the base of the skull.
Beam-hardening artifacts appear as dark streaks or vague areas
of decreased density, sometimes called cupping artifacts.
How to overcome/avoid this
artifact?
Filtering the x-ray beam with a substance, such as Teflon or
aluminum, helps to reduce the range of x-ray energies that reach
the patient by eliminating the photons with weaker energies.
It makes the x-ray beam more homogeneous.
Creating a beam intensity that is more uniform improves the CT
image by reducing artifacts.
Additionally, filtering the soft (low-energy) photons reduces the
radiation dose to the patient.
VOLUME AVERAGING
The process in CT by which different tissue attenuation values
are averaged to produce one less accurate pixel reading is called
volume averaging.
All CT examinations are performed by obtaining data for a series
of slices through a designated area of interest.
The nature of the anatomy and the pathology suspected
determines how the examination is performed.
Scanners allow the technologist to select slice thickness, and
these scanners vary in the thickness choices available.
In general, the smaller the object being scanned, the thinner the
CT slice required.
Again, the loaf of bread analogy is helpful. This time, though, it is
raisin bread.
As the loaf is sliced and examined, some slices contain raisins
and others do not. If the slices are thick, it increases the
possibility that even though a given slice contains a raisin, it will
be obscured by the bread.
If the slices are thin, the likelihood of missing a raisin decreases,
but the total number of slices increases.
Continuing the analogy and switching to rye bread, in which
small caraway seeds are being sought, one can easily understand
how the slice thickness must be adjusted depending on the
object being examined
Thicker CT slices increase the likelihood of missing very small
objects.
For example, if 10-mm slices are created, and the area of
pathologic tissue measures just 2 mm, normal tissue represents 8
mm and is averaged in with the pathologic tissue, potentially
making the pathologic tissue less apparent on the image, in a
fashion similar to the raisins in the bread.
This process is referred to as volume averaging, or partial volume
effect.
Therefore, if an area scanned produces images that are
suspicious for a mass, but not definitive, creating thinner slices of
the same area may be useful.
??
Why do some scanning
protocols use thicker cuts?
RAW DATA VERSUS IMAGE DATA
All of the thousands of bits of data acquired by the system with
each scan are called raw data.
The terms scan data and raw data are used interchangeably to
refer to computer data waiting to be processed to create an
image.
Raw data have not yet been sectioned to create pixels; hence,
Hounsfield unit values have not yet been assigned.
The process of using the raw data to create an image is called
image reconstruction.
Once raw data have been processed so that each pixel is
assigned a Hounsfield unit value, an image can be created; the
data included in the image are now referred to as image data.
The reconstruction that is automatically produced during
scanning is often called prospective reconstruction.
The same raw data may be used later to generate new images.
This process is referred to as retrospective reconstruction.
SCAN MODES
Several different types of scan modes defined here; that are:
1. Step-and-Shoot Scanning
2. Helical (Spiral) Scanning
3. Multidetector Row CT Scanning
Step-and-Shoot Scanning
The scanning systems of the 1980s operated exclusively in a
“step-and-shoot” mode.
In this method
1) The x-ray tube rotated 360° around the patient to acquire data
for a single slice,
2) The motion of the x-ray tube was stopped while the patient
was advanced on the CT table to the location appropriate to
collect data for the next slice,
3) Steps one and two were repeated until the desired area was
covered.
The step-and-shoot method was necessary because the rotation
of the x-ray tube entwined the system cables, limiting rotation to
360°.
Consequently, gantry motion had to be stopped before the next
slice could be taken, this time with the x-ray tube moving in the
opposite direction so that the cables would unwind.
Although the terms are imprecise, this method is commonly
referred to as axial scanning, conventional scanning, or serial
scanning.
Helical (Spiral) Scanning
Many technical developments of the 1990s allowed for the
development of a continuous acquisition scanning mode most
often called spiral or helical scanning.
Key among the advances was the development of a system that
eliminated the cables and thereby enabled continuous rotation of
the gantry.
This, in combination with other improvements, allowed for
uninterrupted data acquistion that traces a helical path around
the patient.
Multidetector Row CT Scanning
The first helical scanners emitted x-rays that were detected by a
single row of detectors, yielding one slice per gantry rotation.
This technology was expanded on in 1992 when scanners were
introduced that contained two rows of detectors, capturing data
for two slices per gantry rotation.
Further improvements equipped scanners with multiple rows of
detectors, allowing data for many slices to be acquired with each
gantry rotation
IMAGING PLANES
Understanding the workings of CT scanning requires familiarity
with imaging planes.
The bread slicing analogy presented earlier helps explain body
planes.
A brief review of the directional terms used in medicine may also
make a discussion of body planes easier to understand.
All directional terms are based on the body being viewed in the
anatomic position.
This position is characterized by an individual standing erect, with
the palms of the hands facing forward.
This position is used internationally and guarantees uniformity in
descriptions of direction
The terms anterior and ventral refer to movement forward
(toward the face).
Posterior and dorsal are equivalent terms used to describe
movement toward the back surface of the body.
Inferior refers to movement toward the feet (down) and is
synonymous with caudal (toward the tail or, in humans, the feet).
Superior defines movement toward the head (up) and is used
interchangeably with the term cranial or cephalic.
Lateral refers to movement toward the sides of the body.
Inversely, medial refers to movement toward the midline of the
body.
The terms distal and proximal are most often used in referring to
extremities (limbs).
Distal (away from) refers to movement toward the ends.
The distal end of the forearm is the end to which the hand is
attached.
Proximal (close to), which is the opposite of distal, may be
defined as situated near the point of attachment.
For example, the proximal end of the arm is the end at which it
attaches to the shoulder
To help visualize the imaginary body planes, it is helpful to think
of large sheets of glass cutting through the body in various ways.
All sheets of glass that are parallel to the floor are called
horizontal, or transverse, planes.
Those that stand perpendicular to the floor are called vertical, or
longitudinal, planes
A sheet of glass that divides the body into anterior and posterior
sections is the coronal plane.
The sagittal plane divides the body into right and left sections.
The sagittal plane that is located directly in the center, making
left and right sections of equal size, is appropriately referred to as
the median, or midsagittal, plane.
A parasagittal plane is located to either the left or the right of the
midline.
Axial planes are cross-sectional planes that divide the body into
upper and lower sections.
Oblique planes are sheets of glass that are slanted and lie at an
angle to one of the three standard plane
Changing the image plane shows the same structures in a new
perspective.
The loaf of bread analogy can help to explain this change.
For example, if a coin is baked within the bread and lies standing
on edge in the loaf, a sharp knife cutting through the bread
lengthwise will show the coin as a flat, rectangular density.
However, if the bread is restacked and cut in an axial plan, the
coin appears circular
The image plan can be adjusted by positioning the patient,
gantry, or both to permit scanning in the desired plane or by
reformatting the image data.
Scanning in the desired planes produces better images than
reformatting existing data, although advances in CT technology
have reduced the quality difference.
Changing the image plane in CT provides additional information
in a fashion similar to the coin within the bread.
Changing the image plane from axial to coronal is indicated for
two distinct reasons.
The primary reason is when the anatomy of interest lies vertically
rather than horizontally.
The ethmoid sinuses are an example of this principle.
Because the ethmoid turbinates lie predominately in the vertical
plane, images taken in an axial plane show only sections of the
anatomy, with no view of the entire ethmoid complex.
In the images are taken in the coronal plane, which is more
suitable for displaying the ethmoid sinus structures and more
readily shows an obstruction.
In the case of the sinuses, it is relatively easy to change the
patient’s position so that images can be acquired coronally.
Obviously, this practice is not possible with all areas of the anatomy
that may benefit from coronal imaging, for example, the pelvis.
Because fat planes in the pelvis often run obliquely or parallel to the
transverse plane, in some cases, images obtained in the coronal
plane may be superior to those obtained in the axial plane.
However, scanning in the coronal plane is not common because of
the difficulty of positioning the pelvis.
In this case, reformatting image data from an axial into a coronal
plane may prove useful.
The second indication for scanning in a different plane is to
reduce artifacts created by surrounding structures.
For this reason, the coronal plane is preferred for scanning the
pituitary gland.
In the axial plane, the number of streak artifacts and the partial
volume effect are greater than in the coronal plane.
Most scans are performed in the axial plane, but many head
protocols require coronal scans.
OVERVIEW OF CT SYSTEM
OPERATION
This section provides a basic understanding of how a CT image is
created.
The CT process can be broken down into three main segments:
Data Acquisition → Get Data
Image Reconstruction → Use Data
Image Display → Display Data
X-ray photons are created when fast-moving electrons slam into
a metal target.
The kinetic energy (the energy of motion) of the electrons is
transformed into electromagnetic energy.
X-rays are produced when a substance is bombarded by fast-
moving electrons
In a CT system, the components that produce x-ray beams (X-RAY
TUBE) are housed in the gantry.
The x-ray tube contains filaments that provide the electrons that create
x-ray photons.
This is accomplished by heating the filament until electrons start to boil
off, hovering around the filament in what is known as a space cloud.
The generator produces high voltage (or kV) and transmits it to the x-
ray tube.
This high voltage propels the electrons from the x-ray tube filament to
the anode.
The area of the anode where the electrons strike and the x-ray beam is
produced is the focal spot.
The quantity of electrons propelled is controlled by the tube current
and is measured in thousandths of an ampere, milliamperes (mA).
The electrons then strike the rotating anode target and disarrange
the electrons in the target material.
The result is the production of heat and x-ray photons.
The vast majority (generally more than 99%) of the kinetic energy
of the projectile electrons is converted to thermal energy.
To spread the heat over a larger area, the target rotates.
Increasing the voltage increases the energy with which the
electrons strike the target and, hence, increases the intensity of the
x-ray beam.
The intensity of the x-ray beam is controlled by the kVp setting
The ability of the tube to withstand the resultant heat is called its
heat capacity, whereas its ability to rid itself of the heat is its
heat dissipation.
The length and frequency of scans are determined in part by the
tube’s heat capacity and dissipation rate
The x-ray photons that pass through the patient strike the
detector.
If the detector is made from a solid-state scintillator material, the
energy of the x-ray photons detected is converted to light.
Other elements in the detector, usually a photodiode, convert the
light levels into an electric current.
On older CT systems, detectors are sometimes of the xenon gas
variety. In this case, the striking photon ionizes the xenon gas.
These ions are accelerated by the high voltage on the detector
plates.
Regardless of the detector material, each detector cell is sampled
and converted to a digital format by the data acquisition system
(DAS).
Each complete sample is called a view.
The digital data from the DAS are then transmitted to the central
processing unit (CPU).
The CPU is often referred to as the brain of the CT scanner.
The reconstruction processor takes the individual views and
reconstructs the densities within the slice.
To create an image, information from the DAS must be translated
into a matrix.
To do so, the system assigns each pixel in the matrix one value,
or density number.
This density number, in Hounsfield units, is the average of all
attenuation measurements for that pixel.
These digitized data are then sent to a display processor that
converts them into shades that can be displayed on a computer
monitor.
Although there is wide variation in the design of scanners, they
share some characteristics.
The CT process can be broken down into three general segments:
data acquisition, image reconstruction, and image display.
In the first segment, the x-ray photons are created and directed
through the patient, where either they are absorbed or they
penetrate the patient to strike the CT system’s detectors. The
goal of this phase is to acquire the information.
In the second segment, the data are sorted so that each pixel has
one associated Hounsfield value. The goal of this phase is to use
the information collected in the previous segment and prepare it
for display.
In the final phase of creating the CT image, the processed data
are converted into shades of gray for viewing.
Therefore, one can generalize the phases involved in creating a
CT image as
1) obtaining data
2) using data
3) displaying data
