Medical Imaging Modalities

Computed Tomography (CT)

Gizeaddis L.
Jimma University
Jimma Institute of Technology
Biomedical Engineering Department
 Introduction
In conventional radiography:

Heart, lung & ribs are all superimposed on

the same film.

In medical tomography:

Slices capture each organ in its actual 3D

dimensional position.
 Introduction

With a conventional radiograph, information with respect to the

dimension parallel to the x-ray beam is lost.

Limitation can be overcome, to some degree, by acquiring two

images at an angle of 90 degrees to one another.

For objects that can be identified in both images, the two films
provide location information.

CT is the first imaging modality that made it possible to probe the

inner depths of the body, slice by slice.
Introduction
Posteroanterior and lateral chest
radiographs give 3D
information concerning the
location of an abnormality.
In CT, the two views shown
here are extended to almost
1,000 views, and with
appropriate computer
processing true 3D information
concerning the patient's
anatomy can be displayed.
 Tomography
Computed tomography (CT) is a medical imaging method
employing tomography.

The word "tomography" is derived from the Greek oo (slice)

and (to write).

A large series of 2D X-ray images (slices) of the inside of an

object are taken around a single axis of rotation.

Digital geometry processing is used to generate 3D images of the

object from those slices.
Tomography
 Tomographic images

The tomographic image is a picture of a slab of the patients

anatomy

The 2D CT image corresponds to a 3D section of the patient

CT slice thickness is very thin (1 to 10 mm) and is approximately

uniform

The 2D array of pixels in the CT image corresponds to an equal

number of 3D voxels (volume elements) in the patient

Each pixel on the CT image displays the average x-ray attenuation

properties of the tissue in the corrsponding voxel
 Computed Tomography

3D volume (Human body)

2D (parallel slices)

1D set of
projections
of that slice

Recombined by a particular mathematical

algorithm to reconstruct i an image of the 2D
slice: Fourier analysis , filtered back projection.
 Modern CT scanner
1. gantry aperture (720mm
diameter)
2. microphone
3. sagittal laser alignment
light
4. patient guide lights
5. x-ray exposure indicator
light
6. emergency stop buttons
7. gantry control panels
8. external laser alignment
lights
9. patient couch
10. ECG gating monitor
 CT Gantry Internal structure
1. x-ray tube
2. filters, collimator, and
reference detector
3. internal projector
4. x-ray tube heat
exchanger (oil cooler)
5. high voltage generator
(0-75kV)
6. direct drive gantry
motor
7. rotation control unit
8. data acquisition system
(DAS)
9. detectors
10. slip rings
 Instrumentation of CT

Computer system
Data acquisition unit

Electronics
of the
Computer
Detectors system
Operators
Image
workplace
evaluation
X-ray tube
Image
processor
generator
Moveable
patient bed
 CT- Scanner Generations

Pencil Beam: inefficient use of the x-ray source , excellent scatter rejection
Fan Beam: linear detectors, scattered radiation accounts around 5%
Open Beam: used in projection radiography, highest detection of scatter
CT- Scanner Generations

Pencil beam geometry allowed very efficient

scatter reduction, best of all scanner
generations

Incorporated linear array of 30

detectors
Shortest scan time was 18
seconds/slice
Narrow fan beam allows more
scattered radiation to be detected
Need for translational motion
CT- Scanner Generations
 Ring artifacts

The rotate/rotate geometry of

3rd generation scanners leads to a
situation in which each detector
is responsible for the data
corresponding to a ring in the
image
Drift in the signal levels of the
detectors over time affects the t
values that are backprojected to
produce the CT image, causing
ring artifacts
Ring artifacts

Ring artifacts
resulting from
defective detector
element in 3rd
generation single-
slice scanner.
CT- Scanner Generations

Designed to overcome the

problem of ring artifacts
Stationary ring of about 4,800
detectors
1000 projections/sec
 3rd vs. 4th generation
The detectors toward the center of the array make the
transmission measurement It, while the reference detector that
measures I0 is positioned near the edge of the detector array.
If g1 is the gain of the reference detector, and g2 is the gain of the other
detector
3rd gen : ln( g1I 0 / g 2 I t ) t
4 th gen : ln( gI 0 / gI t ) t

The equation is true only if the gain terms cancel each other out,
If there is electronic drift in one or both of the detectors, the gain
changes between detectors.
3rd vs. 4th generation
 5th generation: stationary/stationary

Developed specifically for cardiac tomographic imaging

No conventional x-ray tube; large arc of tungsten encircles

patient and lies directly opposite to the detector ring.

Electron beam steered around the patient to strike the

annular tungsten target.

Capable of 50-msec scan times; can produce fast-frame-rate

CT movies of the beating heart
5th generation: stationary/stationary
5th generation: stationary/stationary
 6th generation: helical

Helical CT scanners acquire data while the table is moving

By avoiding the time required to translate the patient table,

the total scan time required to image the patient can be much
shorter.

Allows the use of less contrast agent and increases patient

throughput

In some instances the entire scan be done within a single

breath-hold of the patient
6th generation: helical
 7th generation: multiple detector array

When using multiple detector arrays, the collimator spacing

is wider and more of the x-rays that are produced by the tube
are used in producing image data
Opening up the collimator in a single array scanner increases the slice
thickness, reducing spatial resolution in the slice thickness dimension

With multiple detector array scanners, slice thickness is determined

by detector size, not by the collimator
Slice thickness in multiple detector arrays
Essential Parameters of CT (1972-2005)
 What is measured?
Case 1: Homogeneous object, monochromatic radiation
 How do we measure an object?

In the simplest case the object is sampled linearly with a pencil

beam for different angles and the projection profile is determined.
 Tomographic reconstruction

Each ray acquired in CT is a transmission measurement through the

patient along a line

The unattenuated intensity of the x-ray beam is also measured

during the scan by a reference detector

I t I 0 e t
ln(I 0 / I t ) t
 Reconstruction Algorithms

There are numerous reconstruction algorithms:

Arithmetic (Algebraic) reconstruction (ART)

Simple backprojection

Filtered backprojection
Image Reconstruction: ART
Image Reconstruction: ART
 Image Reconstruction: Simple backprojection

Starts with an empty image matrix, and the value from each ray
in all views is added to each pixel in a line through the image
corresponding to the rays path

A characteristic blurring is a byproduct

A filtering step is therefore added to correct this blurring

 Simple backprojection

Projection Data curvilinear integral of absorption coefficient regarding Y

y y

object x x

X-ray
tube
Data Acquisition field Reconstruction field
Blur
Simple Backprojection
Backprojection: linear
Backprojection: two projections linear
Backprojection: multiple projections
 Filtered backprojection

The raw view data are mathematically filtered before being

backprojected onto the image matrix

Involves convolving the projection data with a convolution kernel

Different kernels are used for varying clinical applications such as

soft tissue imaging or bone imaging
 Filtered backprojection

Projection Data, P
x y

Filtered Projection data

Reconstruction Filter
x
x

or
Multidirectional
x Backprojection

Filtered Backprojection
Convolution kernel
Filter
Filtered Backprojection

Unfiltered Backprojection

Filtered Backprojection
 Projection and Radon transform

Consider the 2D parallel-beam geometry as in Figure (a) in which

(x,y) represents the distribution of the linear attenuation coefficient
in the xy-plane.
A new coordinate system (r,s) is
defined by rotating (x,y) over the
angle .
This gives the following
transformation formulas:
 Projection and Radon transform
For a fixed angle , the measured intensity profile as a function of r as shown in Figure
(b) is given by

Each intensity profile is transformed into

an attenuation profile

Where p(r) is the projection of the function (x,y) along the angle
 Projection and Radon transform

Stacking all these projections p(r) results in a 2D dataset p(r,) called a

sinogram.
In mathematics, the transformation of
any function f(x,y) or (x,y) into its
sinogram p(r,) is called the Radon
transform
 Backprojection and Inverse Radon transform

Given the sinogram p(r,), what is the original function f(x,y)

or (x,y)?

This procedure is called backprojection and is given by

It means also finding Inverse radon transform

 Backprojection and Inverse Radon transform

Projection in four direction, surface plot of single dot and sinogram

Backprojection surface plot and image of backprojection of entire

sinogram
 The central slice theorem

given the sinogram p(r,), what is the original function f(x,y)?

We need a mathematical expression for the inverse Radon

transform

The projection theorem, also called the central slice theorem,

gives an answer to this question.
 The central slice theorem
Let F(kx,ky) be the 2D FT of f(x,y)

Projection theorem states that The 1D FT with respect to variable r of

the Radon transform of a 2D function is
the 2D FT of that function.
Hence, it is possible to calculate f(x,y) for
each point(x,y) based on all its projections
p(r), varying between 0 and .
Flow of direct Fourier reconstruction.
Projection Slice Theorem
Projection Slice Theorem
Image Reconstruction
 CT Image representation- Hounsfield Units

a digital 8-bit, 8x8 images is shown as an array of numbers

on the left and brightness levels on the right.
 Hounsfield Units
In modern CT scanners, the images consist of 512512 pixels
representing the CT number, which is expressed in Hounsfield
units(HU)

CT values represent the linear attenuation coefficient of the tissue in

each volume element, relative to of the water.

Thus, CT values are relatively stable for a single organs and are to a
large extent independent of the X-ray tube spectrum.
Hounsfield Scale
 Hounsfield Scale

CT numbers are quantitative

CT scanners measure bone density with good accuracy

Can be used to assess fracture risk

CT images typically possess 12 bits of gray scale, for a total

of 4,096 shades of gray (CT numbers range from -1,000 to
+3,095).
 Windowing and Leveling

For resolving relative differences in gray scale at fixed pupil

diameter, the human eye has limited ability (30 to 90 shades of
gray), and 6 to 8 bits is considered sufficient for image display.

windowing and leveling the CT image is the way to perform this

post-processing task (which nondestructively adjusts the image
contrast and brightness).
The window width (W) determines the contrast of the image, with narrower
windows resulting in greater contrast.

The level (L) is the CT number at the center of the window.

 Windowing and Leveling

A narrow window
produces a very
high contrast
image,

The thoracic images (top) illustrate the dramatic effect of

changing the window and level settings.
 Spiral CT
Continuous source
rotation with the
patient translation
through x-ray beam
Patient couch moves
as x-ray tube rotates
spiral pattern results
No inter-scan delay
(unlike Conventional
CT)
 Four Step Process of Conventional CT
START 1 2
Tube And Detectors Are X-ray tube Energized
Accelerated To Const. Speed Data Collected
For 360 Deg.

4 3
STOP
Table & Patient
Indexed To The
Next Scanning Position Tube & Detectors
Slow Down & Stop
 Section thickness Vs index

INDEX SCAN INDEX SCAN

 Spiral CT
No inter-scan delay
Inter-scan delay is a small delay between slices or volumes
that is needed during standard axial scanning for the x-ray
tube to stop and reverse direction.
Inter-scan delay can also be used to allow extra time
during a scan for tube cooling

Volumetric imaging within one breath-hold, at least

25s
Pitch
Pitch is the patient couch movement per rotation divided by
slice thickness

Contiguous spiral
Pitch = 1, that is 10mm/10mm

Extended spiral
Pitch = 2, that is 20mm/10mm

Overlapping spiral
, that is 5mm/10mm
Pitch

SMALL PITCH

LARGE PITCH
 Pitch

As spiral CT pitch increases, patient dose is reduced

Pitch in excess of 2 is not recommended for any clinical

examination

Too much anatomy would be skipped

Patient dose is approximately proportional to 1/pitch

Interpolation
Reconstruction of spiral CT images is the same as that for
conventional CT except for interpolation

The transverse image is reconstructed from spiral data

first by interpolation,

then by filtered back projection

Interpolation is the computation of an unknown value

using known values on either side
 Interpolation
Volume averaging increases
with increasing pitch

By increasing the pitch the

helix becomes more spread
out and small structures can
be missed

This is similar to stretching

a slinky toy
 X-Ray Tube

For very long scan times, mA must be reduced so

that x-ray tube loading will not be exceeded

High anode heat capacity and rapid cooling are

required

In spite of the high heat load, tube life is comparable

to conventional CT at about 50,000 exposures
 Spiral CT technique selections

Spiral CT operation requires the following

unique technique selections
Scan time

Beam collimation

Couch feed velocity

Z-axis spacing for image reconstruction

CT Artifacts
CT Artifacts
 Partial Volume Artifacts

The CT number in each pixel is proportional

to the average in the corresponding voxel.
For voxels containing all one tissue type, is
representative of that tissue.
Some voxels in the image, however, contain a
mixture of different tissue types.
when this occurs, for example with bone and
soft tissue, the is not representative of
either tissue but instead is a weighted
average of the two different values.
Partial Volume Artifacts
Partial Volume Effects
 Beam Hardening

As a spectrum of x-rays
passes layers of tissue, the
lower-energy photons in the
x-ray spectrum are
attenuated to a greater
degree than the higher-
energy components of the
spectrum.

Therefore, spectrum becomes progressively skewed toward the higher-

energy x-rays in that spectrum.
 Beam Hardening

a higher-energy spectrum is called a "harder" spectrum;

hence the term beam hardening.
Metallic Implants