Physical Principles for imaging By CT

Scan Technique

By

Dr.Nabaa Naji
Physiology Dept./ Medical Physics Unit
Mustansiriyah Medical College

1
Dr.Nabaa Naji/Mustansiriyah Medical College
A CT scan, or CAT (Computer Aided Tomography) scan was invented in 1960
by Sir Godfrey Hounsfield. It is one of the diagnostic tools and a medical imaging
procedure that uses a special kind of X-ray machine. Instead of sending out a single
X-ray through the body as with ordinary x-ray, several beams are sent at the same
time from different angles. This allows more detailed images from within the body to
be constructed, allowing the user to see inside the object without cutting and these
images are then interpreted by a doctor. Medical imaging is the most common
application of X-ray CT. Its cross-sectional images are used for diagnostic and
therapeutic purposes in various medical disciplines.

The structure of CT scan machine:

1. CT scan machine
2. Rotating X-ray source
3. Rotating X-ray detector
4. Motorized platform
5. Data acquisitions unit
6. Image reconstruction unit
7. CPU and memory
8. Monitor and printer

The CT scanner is typically a large,

box like machine with a hole, or short tunnel in the center. In the CT scanner there is
one X ray source but a large number of detectors. This machine is also provided with
a narrow examination table (motorized platform) that slides into and out of this
tunnel, the patients lies on it during the examination.

In CT scan the radiofrequency waves (called X-ray) are used within the following
frequency range:

Frequency Type range

Low frequency 125KHz – 1342KHz

High frequency 13.56MHz

Ultra-high frequency 960MHz

Super high frequency 2.45GHz

2
Dr.Nabaa Naji/Mustansiriyah Medical College
Working Principle of CT scan:

Preparation for CT exam:

a. Any metal objects should be removed from the
body before starting the scanning. Metal can
interfere with the CT scan results. These items
include jewelry, glasses, and dentures.

b. Before starting the exam, the technologist

begins by positioning patient on the CT
examination table, usually lying flat on back or
less commonly, on one side or on stomach.

c. Straps and pillows may be used to help maintain the correct position and to hold
still during the exam. Depending on the part of the body being scanned, patient may
be asked to keep hands over head. Movement can result in blurry pictures.

d. If contrast media is used, it will be swallowed, injected through an intravenous line

(IV) or administrated by enema, depending on the type of examination, a contrast
material helps internal structures show up more clearly on the X-ray images. The
contrast material blocks X-rays and appears white on the images, allowing it to
highlight the intestines, blood vessels, or other structures in the area being examined.

e. Next, the table will move quickly through the scanner to determine the correct
starting position for the scan.

f. Then, the table will move slowly through the machine as the actual CT scanning is
performed.

g. Depending on the type of CT scan, the machine may make several passes.

h. Patient may be asked to hold breath during the scanning.

After the completion of the previous steps of patient preparations for the CT
exam, then, the following procedure being done to get a diagnostic image for the
required tissue or organ:

1. With CT scanning, numerous X-ray beams and a set of electronic X-ray

detectors rotate around patient, measuring the amount of radiation being
absorbed through the body. The X-ray tube and detectors are located opposite
to each other in a ring called a gantry.

3
Dr.Nabaa Naji/Mustansiriyah Medical College
 2. At the same time, the examination table is moving through the scanner, so that
the X-ray beam follows a spiral path.

3. CT scan images or “slices” show the body in the same kind of a loaf of sliced
bread. Now think about what a slice of that bread would look like if you pulled
it out of the loaf. What you’d see is the entire surface of that slice – from the
outer edge of the crust to the center and across to the other outer crust edge.
Just like slices of bread, CT scan images or “slices” show the body in the same
way. Each “slice” shows an image from the outer skin to the center part of the
body. A CT scan exam produces multiple images or “slices” providing many
different views.

4. Digital geometry processing is used to further generate a three-

dimensional volume of the inside of the object from a small series of two-
dimensional radiographic images taken around a single axis of rotation.

5. The computer workstation that processes the imaging information is located in

a separate control room, where the technologist operates the scanner and
monitors the examination.

CT scan control
4
room
Dr.Nabaa Naji/Mustansiriyah Medical College
 6. When the examination is completed, the patient will be asked to wait until the
technologist verifies that the images are of high enough quality for accurate
interpretation.

7. The CT examination is usually completed within 30 minutes. The portion

requiring intravenous contrast injection usually lasts only 10 to 30 seconds.

Physical Principle of CT scanning:

The X-ray flows from the rotating X-ray beams, then they pass through the body they
detected on rotating X-ray detector. When X-ray passes through the body, the
intensity of the X-ray changed according to the nature of the body.

The image construction in CT scan follows on the law of radiation attenuation, as the
X-ray photons pass through a medium (Tissue), it will be absorbed and attenuated
(energy lost), the intensity of the incident X-ray photons reduces with increasing the
distance that the photon traverse (tissue thickness). The relationship between the
photon's intensity and thickness is described by the following equation and figure:

Where:

I :is the intensity after radiation absorption

I0 : is the original intensity of the incident radiation

µ: is the attenuation coefficient (cm-1)

X: is the thickness
Hounsfield envisioned dividing a slice into a matrix of 3-dimensional rectangular
boxes (voxels) of material (tissue). Conventionally, the X and Y directions are within
the plane of the slice, whereas the Z direction is along the axis of the subject (slice
thickness direction). The Z dimension of the voxels corresponds to the slice thickness.
The X and Y voxel dimension depend on the size of the area over which the x-ray
measurements are obtained (the scan circle) as well as on the size of the matrix (the
number of rows and columns) into which the slice is imagined to be divided. For
example, suppose that each translation covers 250 mm. After collection of all of the
views, the measurements cover a scan circle with a diameter of 250 mm. If this scan
circle is divided into a matrix of 250 rows × 250 columns, each voxel is 1 × 1 mm. If
a 512 × 512 matrix is used (as is common today), each voxel is approximately 0.5 ×
0.5 mm. This matrix is referred to as the reconstruction matrix.

5
Dr.Nabaa Naji/Mustansiriyah Medical College
 Reconstruction matrix. Hounsfield envisioned scanned slice as being
composed of matrix of small boxes of tissue called voxels, each with
attenuation coefficient μ. x-Ray transmission measurements (Ni) can be
expressed as sum of attenuation values occurring in voxels along path of ray
for Ni.

To carry out reconstruction, consider the row of voxels through which a particular ray
passes during data collection. Ni is the transmitted x-ray intensity for this ray
measured by the detector. No is the x-ray intensity entering the subject (patient) for
this ray. It can be shown that a derived measurement Xi can be related to a simple sum
of the attenuation values in the voxels along the path of the ray; for the row of voxels
in the following figure:

6
Dr.Nabaa Naji/Mustansiriyah Medical College
CT number: The CT numbers are calculated from the linear attenuation coefficient
values for each tissue individual voxel. It is the attenuation coefficient that is first
calculated by the reconstruction process and then used to calculate the CT number
values. Note that water is the reference material for CT numbers and has an assigned
value of zero. Tissues or materials with attenuation (density) greater than water will
have positive CT numbers. Those that are less dense will have negative CT numbers.
X-ray attenuation depends on both the density and atomic number (Z) of materials
and the energy of the x-ray photons. For CT imaging a high KV (like 120-140) and
heavy beam filtration is used. This minimizes the photoelectric interactions that are
influenced by the Z of a material. Therefore, CT numbers are determined by
the density of the tissues or materials. CT numbers are in Hounsfield Units. The CT
image is, for all practical purposes, an image of the densities of the tissue.

7
Dr.Nabaa Naji/Mustansiriyah Medical College
CT image process:

The scan phase of CT scan produces a data set, but not an image. The image
reconstruction phase produces a digital image from the scan data set by the process
of filtered back projection.

The final phase in which the digital image is converted into a visible analog image. In
this phase the digital image, consisting of a matrix of pixels with each pixel having a
CT number, is converted into a visible image represented by different shades of gray
or brightness levels.

Scan dose

CT dose is the amount of radiation needed to create CT image. There are many factors
that can affect CT dose and image quality. CT image quality is critical for making the
right diagnosis. The radiation dose reported in the gray or mGy unit is proportional to
the amount of energy that the irradiated body part is expected to absorb. A specific
measure, termed the computed tomography dose index (CTDI), is commonly used as
an estimate of the radiation absorbed dose for tissue within the scan region, and is
automatically computed by medical CT scanners.

A typical plain film X-ray involves radiation dose of 0.01 to 0.15 mGy, while a
typical CT can involve 10–20 mGy for specific organs, and can go up to 80 mGy for
certain specialized CT scans.

Types of CT machines:
A. Spiral CT

Spinning tube, commonly called spiral CT, or helical CT is an imaging technique in

which an entire X-ray tube is spun around the central axis of the area being scanned.
These are the dominant type of scanners on the market because they have been
manufactured longer and offer a lower cost of production and purchase.

8
Dr.Nabaa Naji/Mustansiriyah Medical College
In conventional CT technique, first a slice is made of the desired area, after which the
table moves up a little. In this way the patient is imaged slice by slice (step-by-step).
Around 1990, the ‘slip ring’ technique was developed where the x-ray tube and
detector ring rotate and continue scanning without interruption. This led to the so-
called spiral CT where the scanner table moves with constant speed through the ring
with the rotating x-ray tube and detectors. This generates a helix/spiral-shaped
pattern.

Spiral CT
B. Multi slice CT:
In multislice computed tomography (MSCT) or multidetector computed
tomography (MDCT), a higher number of tomographic slices allow for higher-
resolution imaging. Modern CT machines typically generate 64-640 slices per scan.

The development of the multislice CT scanner (also known as multidetector CT or

volume CT) significantly reduced scan time. As opposed to standard systems,
multislice CT uses multiple detector rows. In this setting, not just one slice is scanned
per rotation, but multiple slices simultaneously.

9
Dr.Nabaa Naji/Mustansiriyah Medical College
The Contrast Material (Dye):
Contrast media used for X-ray CT, as well as for plain film X-ray, are
called radiocontrasts. Radiocontrasts for X-ray CT are, in general, iodine-
based. Iodine has a high atomic number (53), and interactivity with the X-ray. It is the
excellent element for being able to differentiate between different tissues of the body
and how blood is transmitted through those tissues. This is useful to highlight
structures such as blood vessels that otherwise would be difficult to delineate from
their surroundings. Using contrast material can also help to obtain functional
information about tissues. A small catheter may be used so that the contrast material
(dye) can be given to the person during the exam, while oral contrast makes it easier
to see the bowel loops. Often, images are taken both with and without radiocontrast.

What Is CT- Scan Used For?

Doctors order CT scans for a long list of reasons:

 CT scans can detect bone and joint problems, like complex bone fractures and
tumors.
 If you have a condition like cancer, heart disease, emphysema, or liver masses,
CT scans can spot it or help doctors see any changes.
 They show internal injuries and bleeding, such as those caused by a car
accident.
 They can help locate a tumor, blood clot, excess fluid, or infection.
 Doctors use them to guide treatment plans and procedures, such as biopsies,
surgeries, and radiation therapy.
 Doctors can compare CT scans to find out if certain treatments are working.
For example, scans of a tumor over time can show whether it’s responding
to chemotherapy or radiation.

What are the side effects of CT scan?

 The contrast dye used in the test can make your kidneys worse, especially if
you have kidney disease and it could result in temporary kidney failure.
 If you are allergic to the contrast and did not take your allergy medication
before the test, you may get a rash or you may experience a low blood
pressure which will make you feel dizzy until you are treat.
 The contrast gets wash out from the body through passing urine so it is
advisable to drink lot of water after the scan.
 The x-ray radiation dosage used for CT is a bit higher than regular x-rays but
it is still too low to cause any harm to adults.

10
Dr.Nabaa Naji/Mustansiriyah Medical College
Examples of CT scan images:

A B

Image 1: A CT scan of a section of the brain. It is showing the difference

between normal or healthy individual (A)., and an image obtained when he
had suffered a stroke (right, red circle) due to brain arterial blood vessel
blockage (B).

Image 2: A contrast CT scan of brain cancer (red circle). The

contrast made the tumor clear and more visible.

11
Dr.Nabaa Naji/Mustansiriyah Medical College
 Image 3: CT Scan of Lower Arm With Contrast

12
Dr.Nabaa Naji/Mustansiriyah Medical College