Еlektrotehnički fakultet, Beograd, 2021.

Nuklearna medicinska tehnika

KOMPJUTERIZOVANA TOMOGRAFIJA X ZRACIMA

(CT SKENER)
KOMPJUTERIZOVANA TOMOGRAFIJA (eng. CT = computed tomography) koristi X zrake (tj. rendgensku
cev kao izvor) i spada u transmisione radiografske modalitete slikanja.

Tomografija je slikanje po slojevima iz više uglova. Ovo omogućava da se 2D slika sloja rekonstruiše
tako da nema preklapanja organa, što je osnovni nedostatak projekcionih modaliteta.
Tomografski princip slikanja sreće se kod raznih modaliteta: CT, SPECT, PET, MRI.
Kompjuterizovana tomografija nekad je nazivana i kompjuterizovana aksijalna tomografija (eng. CAT =
computed axial tomography), jer su se slike visokog kvaliteta dobijale samo u aksijalnim ravnima.
Savremeni CT uređaji imaju izotropnu prostornu rezoluciju u sve tri dimenzije, zahvaljujući čemu mogu
da se dobiju aksijalne, koronalne i sagitalne slike visokog kvaliteta.
Being a tomographic modality, CT yields images with much better soft tissue contrast than projection
radiographic techniques.

U projekcionoj radiografiji, bilo da se koristi film ili digitalna radiografska ploča, rezolucija kontrasta je
takva da se pouzdano mogu razlikovati samo četiri materijala: kost, mast, voda i vazduh. Kontrast CT
uređaja je bar 10 puta veći. To omogućava da se na slici sloja vidi, na primer, krvni ugrušak u mozgu ili
da se razlikuje siva od bele moždane mase.

CT ima nešto lošiju prostornu rezoluciju nego rendgenska slika, ali mnogo bolju rezoluciju kontrasta, a
time i veću mogućnost razlikovanja jedne od drugih vrsta tkiva. Visoka rezolucija kontrasta CT uređaja
omogućila je razvoj mnogih metoda ispitivanja. Sprovode se, na primer, CT angiografija, CT
kolonoskopija, slikanje toraksa (grudnog koša), jetre, urinarnog trakta, gastrointestinalnog trakta i
vaskularnog sistema.

Radi se i CT srca, iako je kod ove primene brzina formiranja slike kritičan faktor, zbog brzog pomeranja
srca.

Prostorna rezolucija CT uređaja je sa početnih 3−4 mm, u prvoj generaciji CT sistema, kod savremenih
uređaja poboljšana na ispod jednog milimetra.

Vreme slikanja je sa 2−3 min po sloju kod prvih uređaja skraćeno na par sekundi za više stotina slojeva
kod poslednjih generacija CT sistema (spiralnih i konusnih CT mašina).
There are several imaging methods competing with CT, the most important being magnetic resonance
imaging (MRI). High values of the attenuation coefficient μ are due to a high density or high atomic
number of the medium. Gray values in CT images are a direct physical representation of the material
properties. This is clearly an advantage in comparison to MRI, where the gray values can be tuned by
various parameters of complicated scanning protocols such that the direct relation to physical
properties is lost.

CT MR

CT scans are widely used in emergency rooms (na odeljenjima za hitne slučajeve), because the scan
takes fewer than 5 minutes. An MRI, on the other hand, traje između 15 i 90 minuta.
An MRI typically costs more than a CT scan. One advantage of an MRI is that it does not use ionizing
radiation, while CT does.
A major advantage of CT is that it is able to image bone, soft tissue and blood vessels all at the same
time. MRI, on the other hand, provides even more soft tissue detail than a CT scan.
Nazivi ravni kroz ljudsko telo: midsagitalna ili
medijalna ravan (crvena), parasagitalne ravni
(žute), koronalna ili frontalna ravan (plava) i
transverzalne ili aksijalne ravni (zelene).
Mogućnost naginjanja gentrija (eng. gantry tilt) kod većine današnjih CT uređaja dopušta slikanje i u
kosim ravnima.

S obzirom na specifičan položaj mozga u lobanji, u kranijalnoj tomografiji pogodnije su slike slojeva pod
izvesnim uglom u odnosu na transverzalnu ravan. Na ovaj način se takođe izbegava direktna izloženost
očiju snopu X zraka.
Generacije CT uređaja

Geometrija paralelnih tomografskih zraka

1. generacija 2. generacija
Geometrija lepezasto raspoređenih tomografskih zraka (lepezasta geometrija snopa)

Ugao lepeze je
tipično ≈ 60°

3. generacija 4. generacija

Geometrija paralelnih zraka
Kod današnjih CT uređaja, koji imaju geometriju 3. generacije,
Lepezasta geometrija snopa
rendgenska cev i redovi detektora su fiksirani za noseći okvir
(eng. gantry) koji rotira. Ovakva konstrukcija, kod koje izvor i
detektor zajedno rotiraju, na engleskom se zove "rotate-rotate"
geometry. Osa rotacije gentrija zove se izocentar.
Lučni detektor ima centar u žiži rendgenske cevi. Dok gentri
rotira, žiža ostaje u nepromenjenom položaju u odnosu na sve
deksele, zahvaljujući čemu je moguća primena rešetke za
smanjenje uticaja rasejavanja na detektoru (videti slajd 11).
Ovo nije slučaj u 4. generaciji uređaja, kod koje nepokretni
prstenasti (kružni) detektor ima centar u izocentru.

Slika nije precizna: lučni detektor

treba da ima centar u žiži cevi,
a ne u izocentru!

Jednu projekciju (eng. projection ili

view) čine podaci sa detektora dobijeni
slikanjem objekta pod jednim uglom.
U lepezastoj geometriji snopa treće generacije CT uređaja, dekseli su raspoređeni u detektorski red
oblika kružnog luka sa centrom u izvoru X zraka (tj. u žiži rendgenske cevi). Zahvaljujući ovakvom
rasporedu, nema razlike fluensa po dekselima zbog opadanja intenziteta polja fotona sa kvadratom
rastojanja od izotropnog tačkastog izvora.

detektorski modul

Kod CT skenera sa više detektorskih redova (MDCT), detektorski moduli ređaju se tako da u svakom
detektorskom redu obezbede lučni raspored deksela u odnosu na izvor. Svaki detektorski modul sadrži
veći broj deksela sa pridruženom elektronikom koja uključuje napajanje za pojačavače, pojačavačka kola
vezana za izlaze deksela i A/D konvertore.
CT skener sa više detektorskih redova (eng. MDCT = multi-detector row CT, još se naziva i multi-slice CT,
mada sloj nije obavezno isto što i red deksela - videti slajdove 20−22) je uređaj kod kog je više redova
detektora istovremeno pokriveno snopom X zraka.

Paul Suetens - Fundamentals Of Medical Imaging (2009)

Skener sa jednim MDCT skener sa
detektorskim detektorom sačinjenim
redom od više redova deksela

As MDCT scanners use more detector rows at once, their width in the z-axis dimension gives rise to cone
beam geometry (konusna geometrija snopa). Most conventional 64 to 128 detector array MDCT scanners
still make use of only slight cone angles, on the order of 2°−4°. Ovakvo uzak konusni snop dopušta da se
pri rekonstrukciji slike koristi aproksimacija paralelnih lepezastih snopova.
In cone beam CT scanners (tzv. CBCT, CT sa konusnim snopom) the cone angle approaches 20°, which
requires special cone beam reconstruction algorithms to be used. Cone beam acquisition is used for whole
organ imaging (slikanje celog organa, bez translacije kreveta).
Some cone beam systems (mostly dental, maxillofacial and breast CT systems) use flat panel detectors that
extend up to the standard 30×40 cm dimensions (tzv. volume CT).
 Increased gantry rotation speed,
combined with an increasing
number of detector rows on the CT
gantry, has led to the acquisition
times per CT image going from 135
seconds per image in 1972 to more
than 200 images (slices) per second
today.
CT gantry rotation speeds are
approaching 5 rotations per second
(0.2 s per rotation).
Tremendous centrifugal forces on
the order of 40 g act on the rotating
hardware, which weighs up to 1 ton
and more. This has a significant
impact on scanner design for
(fokusirana na žižnu tačku cevi)
mechanical reasons.

T.M. Buzug - Computed Tomography (From Photon Statistics To Modern Cone-Beam CT) (2008)

The trend with CT X-ray tubes is to use shorter exposure times with high power levels (100 kW or more).
Higher tube power does not mean higher patient's dose, but in contrast, it is potentially the basis of
measures that significantly reduce the patient's dose. More X-ray power allows using stronger filtration,
which removes undesired low-energy photons from the spectrum, photons that would otherwise mainly
contribute to the patient's dose but not to the CT image.
M.M. Lell et al. - Evolution in Computed Tomography, Investigative Radiology, Vol. 50, No. 9, 2015
A typical MDCT detector consists of 800 to 1000 detector elements in each row and of up to 320 detector
rows in the z-direction. Challenges associated with large detector panels are: increased scatter, heel effect
and cone beam artifacts. With the 320 detector row CT scanner, one single rotation allows for coverage of
160 mm, enough for covering organs such as the brain or the heart within one single rotation.

Nizovi detektora prikazani u bočnom preseku (duž z ose)

Dimenzije detektora CT skenera izražavaju se projektovane na izocentar.

If, for example, the source-to-isocenter distance is 50 cm and the source-to-detector distance is 95 cm,
and the (minimum) CT slice thickness is quoted on a scanner as 0.5 mm, the actual detector array width is
larger by the magnification factor 95/50, so the physical width of the detector arrays is 0.95 mm.
Almost all modern CT systems are equipped
with scintillator detectors. Such a detector
consists of two main components: a
scintillator and a photon detector (najčešće
fotodioda). In a first step, X-rays entering the
detector are converted into visible light
inside the scintillator.

Typical scintillator materials used are

cezijum jodid (CsI), bismut germanat
(Bi4Ge3O12, skraćeno BGO) ili kadmijum
volframat (CdWO4). (fokusirana na žižnu tačku cevi)
Nejednaka širina detektorskih redova
(detector rows of unequal width along
the z axis, tzv. adaptive array detectors)
povazana je sa konačnim brojem
pristupnih elektronskih kanala za
akviziciju podataka, ako je broj ovih
kanala manji od broja redova, što je
slučaj kod starijih skenera. Da bi se
koristili svi redovi detektora, neophodno
je binovati ih tako da ukupan broj binova
bude jednak broju pristupnih kanala.
Pogodno je da se binuju samo unutrašnji
redovi, dok se spoljašnji redovi izrađuju
širim, tako da jedan kanal odgovara
jednom binu. Problem sa binovanjem
užih kanala je što fizički razdvojeni
dekseli unutar jednog bina smanjuju
efikasnost detekcije, zbog sastava
između njih na kojim se gubi deo
dospelih fotona.
U slučaju detektora sa slike 2.29.d),
pristupnih kanala ima ili 40 (bočni redovi
se ne koriste) ili samo 32 (40:2 + 6 + 6).
Kod novijih skenera, kanala za podatke
ima dovoljno za konfiguraciju jedan red
→ jedan kanal.
 X-cev

Četkice

Izvor visokog
napona

Klizni
prstenovi

16 cm
Četkice
Detektor

Osnovni delovi u unutrašnjosti MDCT uređaja firme Klizni

General Electric: rendgenska cev, izvor visokog napona, prstenovi
lučni redovi detektora (ukupne širine 16 cm duž z ose),
klizni prstenovi i četkice (za kontakte sa prstenovima).
 1. Gantry aperture (otvor gentrija, prečnika 70 cm)
2. Microphone
3. Sagittal laser alignment light
4. Patient guide lights
5. X-ray exposure indicator light
6. Emergency stop button (taster za hitno zaustavljanje)
7. Gantry control panel (+ na donjoj slici)
8. External laser alignment lights
9. Patient couch (krevet za pacijenta)

1. Gantry tilt (+/-30 degrees)

2. Laser alignment lights on/off
3. Couch in/out
4. Free (manual) couch movement
5. Zero couch position
6. Couch up/down
7. Home button (couch out & down)
 1. X-ray tube
2. Filters, collimator
3. ?
4. X-ray tube heat exchanger (oil cooler)
5. High voltage generator (0-75 kV)
6. Direct drive gantry motor
7. Rotation control unit
8. Data acquisition system (DAS)
9. Detectors
10. Slip rings (+ na donjoj slici)
11. Detector temperature controller
12. High voltage generator (75-150 kV)
13. Inverter (ispravljač) (AC to DC)
14. ?

Slip rings and brushes (klizni prstenovi i četkice) electrically

connect the components on the rotating gantry with the rest of the
system.
Korišćenjem kliznih prstenova omogućena je kontinualna rotacija
gentrija: nisu više neophodni kablovi za povezivanje delova sistema
koji rotira sa drugim delovima uređaja, pa nema potrebe za
vraćanjem pokretnih delova unazad da se odmotaju kablovi. Tanki
provodni klizni prstenovi, po kojim klize četkice, omogućavaju
napajanje generatora visokog napona mrežnim naponom i prenos
podataka sa detektora ka kompjuteru, kao i prenos upravljačkih
signala od kompjutera do komponenti u gentriju.
Today, most CTs are helical, multi-detector-row, third generation (rotate-rotate) systems.

Kod helikoidalnog (spiralnog) CT-a, gentri kontinualno rotira tokom slikanja, rengenska cev neprekidno
emituje X zrake, sto sa pacijentom kontinualno translira kroz gentri, dok se akvizicija projekcija sa
detektora vrši u diskretnim vremenskim trenucima.

Žižna tačka rendgenske cevi opisuje helikoidu u odnosu na pacijenta.

Pitch je korak helikoide (tj. pomeraj kreveta tokom jedne rotacije gentrija) izražen širinom snopa na
izocentru (tj. na osi rotacije).

Pitch settings near 1.5 allow for faster scanning and are used za slikanja toraksa i za pedijatrijska
slikanja, where speed is important usled moguće pojave zamućenja zbog pokreta.

Increasing pitch to above 1 increases the volume of tissue that can be imaged at a given time. This is a
major advantage of multislice helical CT: the ability to image a larger volume of tissue in a single
breath-hold. It is particularly helpful in CT angiography, radiation therapy treatment planning, and
imaging of uncooperative patients.

Low pitch values are used when a very large patient is to be scanned and the other technique factors
(kV and mAs) are already maximized.
 In a single detector array scanner, the detector row was
13 to 16 mm wide, and the X-ray beam collimation was
used to determine the slice thickness (debljinu sloja).

Collimator settings ranged from 1 mm (thin slice) to 10

mm (thick slice) or larger. The single detector array
system integrated the X-ray signal over the entire width
of each dexel, and so changing slice thickness was solely
a function of the collimation.

Pomeraj kreveta je isti u

sva tri slučaja (8 mm za
jednu rotaciju gentrija),
ali se širina snopa
smanjuje i zato pitch raste.
Kod MDCT-a debljina sloja i širina snopa X zraka
su odvojene. The slice thickness is determined
by the detector configuration (tj. širinom
detektorskog reda i eventualnim binovanjem
redova pri akviziciji ili binovanjem podataka sa
detektorskih redova pri rekonstrukciji sloja),
and the X-ray beam width is determined by the
collimator (što određuje ukupan broj redova n
pokrivenih snopom).
The width of a single detector array measured
at isocenter (tipično T = 0.5−0.625 mm kod
novih skenera) determines the minimum slice
thickness, while the overall X-ray beam
thickness (nT) is determined by the collimator.
Take an example where a 64-slice MDCT with 0.625 mm detector array width scans 200 mm of anatomy
at pitch = 1 (n = 64, T = 0.625 mm, nT = 40 mm).
Five gantry rotations are required, and with a 0.5 s rotation time, this takes 2.5 s.
A total of 320 very thin CT scans can be reconstructed (svaki debljine 0.625 mm), delivering excellent
spatial resolution along the z-axis of the patient.

Compare this to combining the acquired projection data from 8 contiguous detectors (združivanje, tj.
"binovanje" projekcija sa 8 uzastopnih detektorskih redova) and reconstructing 5 mm thick CT images
(8 × 0.625 mm = 5 mm) , which would lead to 40 images covering the same 200 mm section of anatomy.
For a fixed technique (e.g. 120 kV, 300 mA and pitch =1 for a helical scan), the radiation dose to the
patient will be the same. Indeed, the two described image data sets were reconstructed from the same
physical CT acquisition, so of course the dose was the same.
However, the 0.625 mm images are eight times thinner than the 5 mm images, and consequently each
thin CT image makes use of eight times fewer detected X-ray photons. The 0.625 mm images provide
more spatial resolution in the z-axis. However, the use of an eightfold reduction in photons means that
they are a factor of √8 = 2.8 times noisier. One can acquire thin 0.625 mm images with the same low-
noise levels as the 5 mm images, by increasing the dose by a factor of 8. For example, at 120 kV as
before, increase the mA to 600 (2×), increase the rotation time from 0.5 to 1 s (2×), and go to a pitch of
0.5 (2×). However, given heightened concerns about the radiation dose levels in CT, using thicker CT
slices for interpretation is a good way to reduce noise while keeping dose levels low.

The message is this: even though MDCT scanners allow a vast number of thin images to be
reconstructed, there is a trade-off in terms of image noise, patient dose, and z-axis resolution, and that
trade-off needs to balance patient dose with image quality.

In another example of a 64-slice scanner (preciznije: skener sa 64 detektorska reda) with 0.5 mm wide
detector arrays, the reconstructed stack of images can be 64 × 0.5 mm slices, or 32 × 1 mm, 16 × 2 mm,
8 × 4 mm, 4 × 8 mm, etc. Ovaj postupak bi se mogao nazvati softversko binovanje.

In the image reconstruction phase, after the scan, any combination of signals from adjacent detector
arrays is still possible, and that's what determines the reconstructed slice thickness!

It is typical to reconstruct 5 mm axial slices for radiologist interpretation, and 0.5 to 0.625 mm axial
slices to be used for reformatting to coronal or sagittal data sets.
In older MDCT scanners with 4 to 32 detector arrays, the number of data acquisition channels in many
cases was less than the number of detector arrays. For example, one vendor's 16-detector scanner had
only 4 data channels. In this setting, the desired slice thickness had to be selected prior to the CT scan.
For the 1.25-mm detector row width, the user could acquire 4 × 1.25 mm for a total collimated beam
width of 5.0 mm. If a wider beam is to be used, the signals from adjacent detector arrays are combined
(i.e. acquired jointly through a single data acquisition channel). Hardverskim binovanjem signala from
two adjacent detector arrays, for example, the scanner could acquire 4 × 2.5 mm data, corresponding
to 10 mm beam collimation. By binning 3 and 4 adjacent detector signals, 4 × 3.75 (15 mm beam
collimation) or 4 × 5.0 mm (20-mm collimation) could also be acquired, respectively.

Kod rânih MDCT-a, iako je broj detektorskih redova npr. 16, postojala su samo 4 kanala elektronike, pa
se pre skniranja vrši izbor: 1 red → 1 kanal (dakle akvizicija 4 tanka sloja, svaki širine jednog
detektorskog reda) ili binovanje po 2, 3 ili 4 susedna reda u po 1 kanal (dakle i dalje 4 sloja, ali deblja,
širine 2, 3 ili 4 detektorska reda).
 Smer translacije
kreveta

Kod MDCT-a, projekcije iz kojih se

rekonstruiše slika sloja potiču sa
raznih detektorskih redova.

A simplified illustration of a MDCT operating in spiral (helical) mode shows how the slices (1, 2, 3 & 4)
are reconstructed with information from different detector rows (A, B, C & D). For spiral scanning on a
MDCT system, a given slice in the patient is reconstructed from the data acquired by most or all of the
detector arrays as the patient's body translates through the gantry, što zahteva posebne algoritme
rekonstrukcije slike sloja.
Once the patient is on the table and the table is moved into the gantry bore, the technologist performs
a preliminary scan called the CT radiograph. This overview image (pregledna slika) is also called the
scout view, topogram, scanogram or localizer.
The CT radiograph is acquired with the CT X-ray tube and detector arrays stopped at a desired angle, the
patient is translated through the gantry, and a digital radiographic image is generated from this data.
CT systems can scan anterior-posterior (AP), posterior-anterior (PA), or lateral. It is routine to use one CT
radiograph for patient alignment. However, some institutions use the lateral localizer as well to assure
patient centering.
Using the scout scan, the CT technologist uses the software on the CT console to set up the CT scan
geometry. The process for doing this is specific to each vendor's CT scanner. However, a common theme
is to place guidelines to define each end of the CT scan. It is at this point in the scanning procedure that
all the CT scan parameters are set, usually using preset protocols. For a basic CT scan, these parameters
include kV, mA, gantry rotation time, type of scan (helical or axial), direction of scan (i.e. gantry tilt), pitch,
detector configuration (ako se primenjuje hardversko binovanje), reconstruction algorithm, mA
modulation parameters, and so on.

Figure a) shows the AP topogram of a thorax (antero-posteriorni = prednje-zadnji, tj. gledano spreda).
Here, axial slices with a thickness and distance of 8 mm up to 10 mm are typically scanned.
Using a topogram, it is possible to adapt the slice orientation to the anatomical situation by programming
the corresponding gantry tilts. If, for example, the lumbar vertebrae (lumbalni pršljenovi) are to be
examined, the gantry must be tilted such that it is adapted to the orientation of the individual vertebral
bodies, as shown in the lateral topogram of figure b) (lateralni = bočni).
Tri moguće akvizicione šeme na današnjim CT skenerima
CT acquisition is either axial (sequential or one single wide cone beam rotation) or helical. Sequential
acquisition (also called step and shoot) uses couch translation between successive axial acquisitions to
achieve sufficient coverage. Wide cone beam acquisition allows coverage of entire organs (heart or brain)
within one single rotation. Helical acquisition occurs simultaneously with couch translation and may allow
whole body coverage within a breath hold.
(IAEA - Status of Computed Tomography Dosimetry for Wide Cone Beam Scanners, 2011)
With the introduction of MDCT an increased contribution to patient dose has been seen because of:
• reduced geometric efficiency (over-beaming: penumbra of the collimator, due to finite size of focal
spot → less significant as beam width increases)
• additional tube rotations necessary before and after data acquisition over the planned scan range
(over-ranging: to image the entire volume, data is needed at both ends of scan → significant addition
to dose for large cone angles of the beam and for short scan ranges)
The X-ray beam has relatively constant intensity throughout its center, but the consequences of the finite
focal spot and the highly magnified collimator give rise to a penumbra at the edges of the beam. Because
the beam shape is so different in the penumbra region compared to the center of the beam, oblast
polusenke je neophodno izbeći i ona se pozicionira izvan aktivnih redova detektora - those X-rays go
through the patient but then strike either the lead shielding on the sides of the detector assembly or
inactive detector rows. This is called over-beaming. Kod novijih MDCT skenera, as more detector arrays
were used and as the beam width in the z-dimension consequently increased, the penumbra region of
the beam became a smaller fraction of the overall X-ray beam flux, and the geometrical efficiency
increased as a result.

Over-beaming Profile of the X-ray beam at the detector along z axis

Over-ranging je neophodan da bi svaku tačku
(ili sloj) u pacijentu "video" svaki detektorski
red, tj. da bi svaki sloj bio rekonstruisan iz
podjednakog broja projkecija.
Over-ranging in a helical scan depends on beam width and pitch.
Uvodi se adaptivna dinamička kolimacija snopa pokretnim kolimatorima, kako bi
se eliminisalo nepotrebno izlaganje pacijenta izvan granica slikane regije.
Spiral image reconstruction requires data from
above and below each image position;
therefore, at least one additional half-rotation
(180° in parallel ray geometry) is necessary at
both ends of the spiral scan. As a result,
additional tissue is exposed to radiation outside
the imaged volume. For single-detector row
scanners, z-overscanning may be considered
irrelevant. However, the effect increases with
the number of detector rows and becomes
significant with large area detectors and cone-
beam geometry. To minimize the z-overscanning
effect, special dynamic collimators have been
introduced that asymmetrically open and close
at the edges of the scan range.
Rendgenska cev se u gentri montira tako da je ravan anodnog diska paralelna sa ravni rotacije
gentrija, pri čemu su ose rotacije anode i gentrija paralelne.
High angular velocities of the gantry create enormous centrifugal forces on the components that
rotate. The parallel mounting of the tube is necessary to reduce gyroscopic effects that would add
significant torque to the rotating anode if mounted otherwise (zbog vektorskog sabiranja
momenata impulsa rotirajuće anode i gentrija).
Furthermore, this configuration means that the anode-cathode axis, and thus the heel effect, run
parallel to the z-axis of the scanner. This eliminates heel-effect-induced beem intensity changes
along the fan angle (efekat potpetice je duž z ose, a ne u sloju!).
The angular beam output from a CT X-ray tube is wider in the dimension parallel to the anode disk
than in the anode-cathode dimension, and so this X-ray tube orientation is necessary, given the
approximately 60° fan beam angle of current scanners, compared to the max. 20° cone angle.
Most modern CT scanners use a continuous output X-ray source (neprekidni snop X zraka).
The X-ray beam is not pulsed during the scan. The detector array sampling time in effect becomes the
acquisition interval for each CT projection that is acquired! S obzirom da rendgenska cev daje neprekidni
snop (a ne impulsni) i da gentri rotira kontinualno (a ne koračno), interval tokom kog se beleži svaka
pojedinačna projekcija određen je vremenom potrebnim detektoru da projekciju registruje.

Sampling dwell times (vremenski interval tokom kog se beleži projekcija) typically run between
0.2 and 0.5 ms. This means that for a 0.5 s gantry rotation period between 1000 and 2500 projections
(views) can be acquired per 360°.

For a typical CT system with about a 50 cm source-to-isocenter distance, the circle that defines the
X-ray tube trajectory is about 3140 mm in circumference. Therefore, using a 4 kHz detector sampling rate
(i.e. 2000 projections during one gantry rotation period of 0.5 s), for example, the X-ray focal spot moves
about 3140 mm / 2000 ≈ 1.5 mm along the circumference of the circle per sample. Pomeranje žižne tačke
X cevi za 1,5 mm duž kružne putanje za vreme trajanja akvizicije jedne projekcije stvara zamućenje zbog
pokretanja (motion blurring).

To compensate for this, some scanners use a magnetic steering system for the electrons (magnetno
navođenje elektrona) as they leave the cathode and strike the anode.

With clockwise rotation of the X-ray tube in the gantry, the electron beam striking the anode is steered
counterclockwise in synchrony with the detector acquisition interval. Dok traje beleženje projekcije na
detektoru, magnetno polje šeta elektronski snop po žižnoj traci anode u smeru surotnom od rotacije
gentrija. Ovim se efektivno zaustavlja kretanje izvora u odnosu na pacijenta i sprečava pojava zamućenja.
Given the 1−2 mm overall dimensions of an X-ray focal spot, steering the spot a distance of approximately
1.5 mm is realistic in consideration of the physical dimensions of the anode and cathode structures.
 Focal spot steering can also be used to provide
oversampling in the z-direction of the scan
(naduzorkovanje u z pravcu). The electron beam is
steered using magnetic fields provided by deflection
coils (skretni kalemovi), and due to the anode angle,
modulating the electron beam landing location on the
focal track causes an apparent shift in the source
position along the z-axis of the scanner (dvostruko
uzorkovanje u z pravcu, eng. double z-sampling).
Navođenjem elektronskog snopa menja se položaj
žižne tačke u radijalnom pravcu diska anode, tako da
se projekcije beleže za dva različita položaja žižne tačke
na kosom delu anode. Premeštanjem žiže na strmom
delu anode, snop X zraka se pomera duž z pravca za
polovinu širine detektorskog reda (videti uvećan deo
na ilustraciji), čime se u aksijalnom pravcu projekcije
beleže dvostruko gušće od širine jednog detektorskog
reda. Prilikom rekontrukcije je potom moguće dobiti
slike slojeva sa dvostruko boljom aksijalnom
rezolucijom, tj. sa debljinom dvostruko manjom od
širine jednog detektorskog reda.

In another electron beam steering approach, electrostatic

collimators at the cathode (elektrostatički kolimatori pri katodi)
are used to steer the electron beam to alter its trajectory from
cathode to anode (elektrostatičko navođenje snopa elektrona).
 Siemens-ova Straton cev je novije generacije i
osim što sadrži skretne kalemove (eng. deflection
coils) za magnetno navođenje snopa (tzv. princip
leteće žižne tačke, eng. flying focal spot), ima i
rotirajući metalni zid za koji je anoda fiksirana
(eng. rotating envelope tube).
Kod ovakve konstrukcije, ležišta motora su izvan
cevi, čime su zaštićena od pregevanja, koje često
dovodi do njihovog kvara u standardnim cevima
sa rotirajućom anodom.
Rotirajuća cev spolja je obložena rashladnim
uljem koje cirkuliše kroz kućište (eng. tube
housing) i koje hladi i ležišta motora.

Siemens Straton rotating tube

S obzirom da je anoda vezana za zid cevi, u direktnom je kontaktu sa okolnim rashladnim uljem, zahvaljujuću čemu
se hladi 10 puta efikasnije nego u klasičnoj konstrukciji cevi. S obzirom na efikasnije odvođenje toplote s nje, anoda
može da se napravi manjom, zbog čega je rotacija anode i zida cevi mehanički stabilnija, pa je moguće postići veće
brzine rotacije i time dodatno smanjiti zagrevanje žižne trake.
LIMAX tube design abandons the solid-state principle of the anode. In these tubes a liquid metal jet is subjected
to fast electrons. Liquid metal (eutectics of SnPb, GaInSn or PbBiInSn) streaming through a tube close to the
cathode is heated by the electron beam at the focal spot. While the heated material is transported through the
tubing, cold metal enters the focal spot area. The liquid metal is cooled by circulation through a heat exchanger.

LIMAX tube (Liquid Metal Anode X-ray)

The liquid metal is separated from the vacuum by a diamond, tungsten or molybdenum window of several
microns in thickness. In comparison to stationary anode X-ray tubes, this design has shown a significant
improvement in its ability to be continuously operated. However, in the current state of development, its peak
power does not reach the power values required for the latest CT generation (on the order of 150 kVA).
Vast majority of CT scans are either of the head or of the torso, and the torso is typically broken up
into the chest, abdomen, and pelvis (grudni koš, stomak i karlicu). These exams represent over 75% of
all CT procedures. All of these body parts are either round or approximately round (mnogi preseci
ljudskog tela su obli).

higher detector higher detector

exposure exposure

Filter treba da bude izabran tako da pravci X zraka koji imaju kraće odsečke
unutar tela pacijenta imaju duže odsečke unutar filtera.

The bow tie beam shaping filter (filter oblika leptir mašne za profilisanje intenziteta snopa) reduces
the intensity of the incident X-ray beam in the periphery of the X-ray field where the attenuation path
through the patient is generally thinner. This tends to equalize or flatten the X-ray fluence (i.e.
exposure) that reaches the detector array.
An ideal bow tie filter equalizes exposure of the image receptor accross the whole image of a round
object slice, što je homogen cilindrični fantom u aksijalnom preseku sa gornje slike.
All commercial CT scanners make use of a minimum of two bow tie filters - a head and a body bow tie.
The head bow tie filter is also used in pediatric body imaging on most scanners.
The most effective means to reduce radiation exposure is an adaptation of the dose to the patient's
body size and shape. This can be achieved by an adaptation of the X-ray tube current to the patient's
anatomy, either manually by selecting patient-individual mAs-settings or automatically with the use of
automatic anatomical tube current modulation (modulacija struje cevi). The role of mA modulation in CT
is analogous to that of automatic exposure control (AEC) in radiography and automatic brightness
control (ABC) in fluoroscopy. This technique modifies the tube output to maintain adequate dose when
scanning body regions with different attenuation, for instance thorax, abdomen and pelvis (grudni koš,
stomak i karlicu). The variation of the tube output is either predefined by an analysis of the localizer
radiograph (topogram, scout scan) or determined in real time by evaluating the signal of a detector row.

In some approaches, the attenuation of a standard-sized patient is stored in the control computer for
each body region. The user selects a reference mAs-setting in the standard scan protocol that will be
applied if the patient's attenuation matches the stored standard attenuation. If the patient's attenuation
deviates, the tube output will be adapted accordingly.
In addition, angular tube current modulation (ugaono zavisna modulacija struje cevi) is performed
during each rotation of the gantry to compensate for strongly varying X-ray attenuations in
asymmetrical body regions such as the shoulders and pelvis.

With use of anatomical dose modulation approaches, radiation exposure can be significantly reduced.
Several authors demonstrated radiation dose reduction by 20–68% (smanjenje pacijentne doze)
depending on the body region, without degrading image quality.
AEC reaches its limits with larger detector z axis coverage (i.e. larger beam cone angles) because the
beam then covers different anatomical regions at the same time which would require different
mA-settings, such as the transition from liver to lung or from shoulder to neck.
ECG-controlled tube current modulation (modulacija struje cevi kontrolisana EKG-om kod CT-a srca),
also known as ECG guided step-and-shoot technique or ECG gating ("gejtovanje" EKG signalom), is
based on the finding that the least amount of motion artifacts were found in CT coronal images
reconstructed from data in the ventricular diastolic phase (u fazi dijastole komora). The AEC raises the
X-ray intensity to a high level during mid-diastole to acquire the image data, and reduces to a low level
during the other phases of the cardiac cycle.
With older scanners, cardiac CT angiography
was frequently performed using
retrospective ECG gating combined with a
very low pitch (0.14–0.4), which resulted in
high radiation exposures exceeding 30 mSv.

Latest generation of DSCT (dual source CT)

scanners has introduced a new scan mode, a
prospectively ECG-triggered helical data
acquisition with very high pitch values of
more than 3.0. This technique enables
acquisition of the entire volumetric data set
of the heart within a fraction of a single
cardiac cycle. The high pitch allows
acquisition with very low radiation exposure
(< 1 mSv).
Dual-energy CT (dvoenergetski CT) can be performed by simultaneously applying two X-ray tubes at
different kV and mA settings with dual-source CT or with single-source CT using fast kV switching.

With a dual-source system (DSCT), dual-energy scanning is reported to be dose-equivalent to

conventional single energy scanning, because the tube current in each X-ray tube can be adjusted
independently to optimize image quality and minimize dose.

Attenuation ceofficient for barium [cm−1]

X-ray photon energy

The two energies most frequently used with current systems are 80 and 140 kVp. Because the
K edges of two X-ray contrast media, iodine (33.2 keV) and barium (37.4 keV), are closer to the mean
energy of the 80 kVp beam than to the mean energy of the 140 kVp beam, the attenuation of contrast-
enhanced structures such as organs and blood vessels is significantly higher at 80 kVp.
With postprocessing techniques, sličnim onim kod dvoenergetske radiografije, the iodine content can
be identified and subtracted from a dual-source contrast-enhanced acquisition to yield virtual
unenhanced images. This capability can obviate an unenhanced CT scan in a multiphasic CT protocol
resulting in a reduction of total radiation dose.
 Dual-energy CT (DECT) performs a scan using two different X-ray spectra. Achieving optimal separation
between the low- and the high-energy spectra is important in DECT because the quality of material
decomposition depends on how different the two spectra are: the larger the difference between the
two spectra, the smaller the noise level. (Videti odeljak o dvoenergetskog radiografiji iz prezentacije
"03 - Projekciona radiografija II.pdf".)

There are several implementations of DECT in routine clinical use.

M.M. Lell et al. - Evolution in Computed Tomography, Investigative Radiology, Vol. 50, No. 9, 2015

Dual-source CT (DSCT) uses two tubes, operating at different potentials. Each tube's X-rays can be
selectively prefiltered to minimize patient's dose and to improve spectral separation. The additional
prefilter on the high-energy X-ray source removes the undesired low-energy photons before they
reach the patient. Another advantage of DSCT is that both tubes can be operated separately with
individual tube currents and with individual tube current modulation curves (the low-energy thread
requires larger angular modulation amplitudes than the high-energy thread).
For DSCT, there is a special high-pitch mode, which is a very fast spiral scan mode that uses pitch
values > 1. The data gaps occurring with single-source CT systems at pitch values greater than 1.5 are
closed by the data from the second source in DSCT systems. Since the cone angle of each of the two
beams in a DSCT scanner is only half as large as the cone angle of single-source systems of twice the
detector width, the same scan speed can be achieved with less cone beam artifacts (with the
remaining cone beam artifacts being corrected by the iterative image reconstruction).

Another DECT implementation is based on fast tube voltage switching such that every other projection
is performed at either the low- or the high-kilovolt value. This requires a dedicated X-ray tube and
X-ray power generator, but selective prefiltering of the high-kilovolt X-rays is impossible. Owing to the
finite rise and fall times of the tube voltage, the spectral separation is limited. In addition, the tube
current cannot be switched owing to the temporal inertia of the filament and the required differences
in mAs for the low- and the high-kilovolt raw data can only partially be realized by setting the dwell
times accordingly. An advantage of the kilovolt switching technology is that DECT can be provided in
the full 50 cm field of measurement; and therefore, patient positioning is not as critical as with smaller
field of measurements (26–35 cm), as it is the case with DSCT owing to space limitations in the gantry.

Dual-layer, or sandwich, detectors are another alternative to realize full-field DECT. The first detector
layer prefilters the X-rays; and thereby, the second layer sees the prefiltered X-rays that passed the
first layer. Thus, the second layer measures the high-energy spectrum, whereas the first layer mainly
captures low-energy photons. The spectral separation cannot be adjusted with such systems, and
separation will be limited, resulting in more noise. Sandwich detector DECT information provides
geometrically fully consistent low- and high-energy data, which is not the case with the other
implementations.
 Split-filter technique was introduced in single-source CT, using a prefilter that is split along the
z-direction such that (in the case of a 64-detector row system) the first 32 detector rows are prefiltered
differently than the last 32 detector rows. A spiral pitch value below 0.5 needs to be chosen to ensure
that each voxel is scanned with each of the two different spectra. The spectral separation achievable
with such an approach is comparable to the sandwich detector and the tube voltage switching
concepts.

Photon counting detectors are a highly promising technique for future diagnostic CT systems. Since
these detectors can discriminate many energy windows, they are intrinsically suited for multi-energy CT
applications.

M.M. Lell et al. - Evolution in Computed Tomography, Investigative Radiology, Vol. 50, No. 9, 2015