CH S NO:

KTHUT,GII PHU,
CH NH
BS NGUYN QUANG TRNG
BS H TH THANH TUYN
BS NGUYN QU KHONG

DN BI

I CNG

NGUYN L V K THUT CHP CT

GiI PHU HNH NH

U V NHC iM CA CT CNG CC
CH NH

I CNG

X QUANG

Vertebral Artery

Basilar Artery

middle cerebral

anterior cerebral

right internal carotid artery.

CT

MRI

VI DNG LCH S

1895: Roentgen khm ph ra tia X.

1972: Hounsfield pht minh ra my CT scanner.
1979: Hounsfield v Cormack nhn gii Nobel Y hc.
1980: Lauterbur v Damadian ch ra my MRI.
1988: Ra i th h CT xon c.
1992: Ra i th h CT a lt ct (MSCT) cn gi l
CT a dy detectors (MDCT).

01/11/2014

HOUNSFIELD

ROENTGEN

01/11/2014

LAUTERBUR

CT= COMPUTED TOMOGRAPHY

( TOMOS= SECTION= CT LP)

NGUYN L
MY CT C IN - CONVENTIONAL CT

My gm mt u pht
tia X v b phn cm
nhn (detector).
Thc hin cc lt ct
ging nh hnh nh ta
ct lt mt bnh m gi.

01/11/2014

12

CC THNH PHN CA
MT MY CT
GANTRY

COMPUTER

TABLE/COUCH
CONSOLE

HE THONG MAY CT
-He thong o: ging (ban) + khung may (gantry /
statif = au en + detectors)
- au en nghieng theo c quan can khao sat
- Chieu day lat cat 1 - 5 - 10mm

-He thong x ly d lieu: may vi tnh + phan mem

-He thong hien th hnh anh (console): man hnh,
ban phm : cho thay hnh anh nhng am o
khac nhau, kch thc khac nhau.
- Phng tien ghi d lieu: film, bang t, a t,CD.

MY CT SCANNER

GANTRY

TABLE/COUCH

NGUYN L CA CT

Jonas Rydberg, MD et al. Multisection CT: Scanning Techniques and Clinical Applications.
01/11/2014
16
Radiographics. 2000;20:1787-1806

NGUYN L
MY CT C IN - CONVENTIONAL CT

u pht tia X v b phn cm nhn (detector) quay

trn mt mt phng c nh, sau bnh nhn di
chuyn khi my khng pht tia.

01/11/2014

17

Cach tai tao hnh anh

au en phat tia va bo phan cm nhn (detectors)

gan ket vi nhau va se di chuyen theo qui nh
Detectors tiep nhan mot loat cac o ac s giam
cng o chum tia X (h s hp thu)sau khi tia X
qut qua mot lat cat c the (theo nhieu hng khac
nhau cua cung 1 lat cat)
May vi tnh chuyen cac he so hap thu mot lat cat
sang hnh anh cua lat cat o
Nguyen tac cua s tai tao hnh anh ky thuat so
tng t nh cach tnh cac con so cha trong mot
ma tran

CCH THU THP D LIU

S phoi hp
gia phan giai
trong khong gian
va phan giai he
so hap thu e
tao ra hnh anh

Xac nh he so hap thu tuyen tnh

Nguyen ly tnh toan theo ma tran

Cach tai tao hnh anh

Tuy theo cac con so ngoai vi cua s hap thu tia
ma bo phan tiep nhan o c, may tnh se tnh
s khac biet ve am o cua tng n v the tch
(voxel) ma tia X xuyen qua.
Voxel: n v the tch
Cac may hien nay co 256 x 256 = 65 536, 512 x
512 = 262 144, 1024 x 1024 voxel
Pixel: dien tch can ban cua voxel < 1mm2
May 512 x 512: pixel khoang 0,2 x 0,2mm
o day lat cat: 1 10mm tuy may, vung khao sat

NGUYN L
MY CT C IN - CONVENTIONAL CT

Joseph K.T.Lee. Lee computed body tomography with MRI correlation. 1998
01/11/2014

24

MA TRN (MATRIX) nh hng

NT CA HNH CT

80 X 80

PIXELS

6400

512 X
512
X 512
512

PIXELS
PIXELS
262144
262144

SO SNH HNH VI
MA TRN KHC NHAU
80 x 80

512 x 512

TI TO HNH 3D

CONVENTIONAL AND SPIRAL / HELICAL CT

u pht tia X v b phn cm nhn quay trn mt

mt phng c nh, bnh nhn di chuyn trong khi
my ang pht tia, rt ngn thi gian kho st.

01/11/2014

29

NGUYN L
MY CT A LT CT - MULTISLICE CT

Multislice CT = Multidetector CT.

Da trn nguyn l ca CT xon c, nhng thay v
1 dy detectors (b phn cm nhn), ngi ta thay
bng nhiu dy detectors.

01/11/2014

01/11/2014

31

My MSCT 4 gim thi gian kho st xung 8 ln so

vi my Spiral CT.

Jonas Rydberg, MD et al. Multisection CT: Scanning Techniques and Clinical Applications.
01/11/2014
32
Radiographics. 2000;20:1787-1806

LAY MOC CHO CAC LAT CAT

- Scanogram hay scout-view hay mode radio : hnh
thang (face)hay hnh nghing
- nh ranh gii vung khao sat (tuy benh ly can tm)
- nh o day lat cat (tuy kch thc cua cau truc
giai phau muon khao sat)
- nh khoang cach gia cac lat cat
- nh o nghieng cua he thong au en
-Co the tai tao hnh 2D (coronal / sagittal) hay 3D
t hnh axial ban au

K THUT CHP CT LP iN TON

HNH CC LT CT DN NG (SCOUT VIEW)

ACA
ACM

ACP

BC THANG XM
(GRAY SCALE)

+ 1000

-1000

Thang xam HOUNSFIELD

+1000 xng ac

+200
O nc
- 200

+200 voi hoa nhe

tuyen tung, am roi
mau tu cu
+70 +50 : mau mi
+50 +35: chat xam
+35 +25: chat trang
+ 25 +10: phu, hoai t
+10 0 : dch nao tuy
-10
cac cau truc m

- 1000 khong kh

-200

CT HOUNSFIELD UNIT
XNG
1000

NC

CT HOUNSFIELD UNIT
M

KH (HI)

-100

- 500

THANG XAM HOUNSFIELD CA SO

-n v Hounsfield (HU) : o am o cac cau truc
-May co the ghi nhan c
- 1000 HU (kh) en + 1000 HU (xng ac)
0 la am o cua nuc
-Bnh thng mat ngi ch phan biet c khoang
20 mc o xam khac nhau
-Khai niem ca so (window)
. trung tam ca so (level - WL): am o trung bnh
cua cau truc can khao sat
. o rong ca so (width WW): khoang thay ro

am o bnh thng cua mot so mo

- Vo xng
+ 300 en
- Tuy xng
+ 180
- Mach mau co can quang
+ 80
- Mach mau khong can quang + 35
- Chat trang nao
+ 30
- Chat xam nao
+ 45
- Mau ti, cuc mau ong
+ 50
- Dch cua nang n thuan
+5
- Dch nao - tuy
0
- Nc (qui c)
0
- M
- 20
- Kh
- Voi hoa
+ 80

+ 1000 HU
+ 250
+ 120
+ 40
+ 35
+ 50
+ 90
+ 25
+8
- 100
- 1000
+ 200

Ca so : vung quan tam

Level : cau truc ma ta quan tam

Window : o rong cua ca so
Ca so xng: 300 / 1200
Ca so ho sau: 40 / 200
Ca so tren leu: 40 / 100
Ca so so mat: 50 / 200
Ca so hoc mat: -10 - +10 / 200 - 250

CA S M MM
W=80, L=35

CA S XNG
W=1200,L=300

GiI PHU S NO SO SNH VI

HNH NH CT V MRI

U V NHC iM CA CT
U iM
- nhanh
- co san nhieu ni
- gia ca chap nhan c
- phat hien c nhieu benh ly
CT c coi la xet nghiem e xoay x
(examen de debrouillage)
- t chong ch nh
- anh gia xng, voi hoa rat tot

CHONG CH NH TNG OI

- can tiem thuoc tng phan (contrast)

ngi co tien can d ng vi iod, suy
than.

CAC KHO KHAN

- neu c, tranh 3 thang au cua thai

ky
- benh nhan can nam yen (tre con,
benh nhan vat va can phai cho thuoc
an than hay thuoc ngu)

HAN CHE

- Benh ly ho sau: nhieu trng hp kho phan

nh chnh xac cac cau truc giai phau
- Mot so benh ly nao co the khong phat hien
c: nhoi mau nao sm, u mach dang hang
(cavernous angioma), x cng nhieu ni
(multiple sclerosis), sang thng nho, mot so
sang thng nhiem trung
- Khong anh gia c thng ton tuy trc
tiep (can myeloCT hay can quang tnh mach
- Khong the thc hien lat cat sagittal trc tiep
c nhng lt ct coronal th c, c bit i
vi cc xoang mt.

CC CH NH CA CT
(TRONG BENH LY SO NAO)

.
.
.
.
.

Chan thng so nao

Tai bien mach mau nao
U nao
Nhiem trung than kinh
D dang nao bam sinh

Chan thng so nao

1- Phat hien thng ton ho sau
2- Phat hien thng ton moi v tr
trong so, thng ton nhieu ni, ca hai
ban cau
3- Phat hien nhieu loai thng ton
phoi hp (giup co hng x tr thch
hp)
4- Phat hien c cac thng ton nho
khong gay hieu ng choan cho
5- Theo doi dien tien, ket qua ieu tr

Tai bien mach mau nao

1- xac nh co TBMMN, loai TBMMN (xuat
huyet hoc nhoi mau nao)
2- v tr, mc o lan rong cua thng ton t o
anh gia o nang cua thng ton
3- nguyen nhan cua TBMMN (do benh ong
mach , d dang mach mau , benh huyet hoc) giup
hng dan phng phap ieu tr.
4-theo doi dien tien benh
U nao
1- xac nh co khoi choan cho
2- xac nh v tr, kch thc, o lan rong,
ban chat cua u, anh hng cac cau truc
lan can. T o quyet nh mo hay khong
mo, phng phap mo, nguy c khi mo.

Nhiem trung than kinh

- ap xe nao, tu mu di mang cng
- viem mang nao, lao mang nao nao
- nhiem ky sinh trung
- nhiem virut
- bien chng cua nhiem trung than kinh:
tran dch nao that, viem nao that
D dang nao bam sinh
- tran dch nao that
- cac bat thng ve hnh thai, cau truc
nao trong qua trnh phat trien bao thai

XIN CM N QU ANH CH THEO DI

18/05/2013

39