COMPUTED TOMOGRAPHY

 Creation of a cross-sectional tomographic section of the PRINCIPLES OF OPERATION

body with a rotating fan beam, a detector array and
computed reconstruction CONVENTIONAL OR AXIAL TOMOGRAPHY
Other Names:  Plane of the image is parallel to the long axis of the body
 Computed Axial Tomography (CAT)  Produces sagittal and coronal images
 Computed Transaxial Tomography (CTAT)
COMPUTED TOMOGRAPHY
 Computed Reconstruction Tomography (CRT)
 Plane of image is perpendicular to the long axis of the body
 Digital Axial Tomography (DAT)
 Produces a transverse image
 Body Section Roentgenography
 Greek Word: “Tomos” = slice/section; “Graphia” = CT IMAGE
describing  A transaxial/transverse image

CT SCANNER TRANSLATION/SWEEP
 Consists of an x-ray source emitting finely collimated x-ray  It refers to movement of source-detector assembly across
beam and a single detector both moving synchronously in a the patient
translate or rotate mode or a combination of both  Results in a projection
 Projection: represents the attenuation pattern of patient
COMPUTERS
profile
 Used Binary System
 Detector signal: has a dynamic range of 12 bits (4096 gray
BINARY DIGIT/BIT levels)
 Can code for 2 values or 2 shades of gray which correspond
PROJECTION
to white and black
 An intensity profile
 8 bits – 1 byte
 2 bytes – 1 word ALGORITHM
 16 bits – 1 word  Computer-adapted mathematical calculation applied to raw
date during image reconstruction
STORAGE REQUIREMNENT
 Kilobytes, megabytes, gigabyte or terabytes RECONSTRUCTION
 Creation of an image from date

RECONSTRUCTION TIME
BRIEF HISTORY  Time needed for the computer to present a digital image
after an examination has been computed
1930’S – ALLESANDRO VALLEBONA
 Time between the end of imaging and the appearance of an
 Proposed a method to represent a single slice of the body on
image
the radiographic film (Topography)

1970 – GODFREY NEWBOID HOUNSFIELD

 First demonstrated the CT technique GENERATIONS OF COMPUTED TOMOGRAPHY

1972-1974 1ST GENERATION

 First clinical CT scanners were installed  A demonstration project
 Characteristic: translate/rotate (Bushong) or
1979 rotate/translate (Reveldez)
 Hounsfield & Allan Mcleod Cormack shared the Nobel Prize  X-ray Beam Shape: pencil beam
in Physics  Detector: single detector
 Imaging Time: 5-minute imaging time
1980
 CT scan machine became widely available
2ND GENERATION
EMI SCANNER
 Characteristic: translate/rotate (Bushong) or
 1st CT scan machine
rotate/translate (Reveldez)
 180 translation/1o rotation
 X-ray Beam Shape: narrow fan beam
 Detector: multiple detector (5-30)
 Imaging Time: 30 seconds
ACTA  Advantage: speed
 1st CT system that could make images of any part of the  Rationale: consist of multiple detectors
body  Disadvantages:
 Did not require water tank o Increased scattered radiation
o Increased radiation intensity toward the edges of the
beam
▪ Compensation: used of bowtie filter
  Bow-tie Filter: equalize the radiation intensity that reaches 3. Computer
the detector array

3RD GENERATION GANTRY

 Characteristic: rotate/rotate  Largest component
 X-ray Beam Shape: wide fan beam  Subsystems: x-ray tube, detector array, high voltage
 Detector: curvilinear detector array (30) generator, patient couch and mechanical support
 Imaging Time: <1 second
X-RAY TUBE
 Advantages:
 Power capacity: must be high
o Better x-ray beam collimation
o >120 kVp
o Decreased scattered radiation
o 400 mA
o Good image reconstruction
 High speed rotors: for heat dissipation
 Disadvantage: ring artifacts
 Anode heat capacity: 7 MHU (Spiral CT)
 Compensation: software connected image reconstruction
 Heat storage capacity: 8 MHU
algorithm
 Anode cooling rates: 1MHU/min
NOTE: Third generation designs have the advantage that thin tungsten
septa can be place between each detector in the array and focused on  Focal spot size: small
the x-ray source to reject scattered radiation. ▪ Take note: CT scanners designed for high spatial
resolution imaging not for direct projection
4TH GENERATION imaging
 Characteristic: rotate/stationary  Limiting characteristics:
 X-ray Beam Shape: wide fan beam o Focal spot design: must be robust or strong
 Detector: fixed circular detector array (4000) with detector o Heat dissipation
ring  X-ray tube life: approx. 5000 exposures (Conventional CT)
 Imaging Time: <1 second  Focal-Spot Cooling Algorithms:
 Advantage: no ring artifacts o Design to predict the focal spot thermal state
 Disadvantage: o To adjust the mA setting accordingly
o Increased patient dose
o high cost DETECTORY ARRAY
NOTE: The detectors are no longer coupled to the x-ray source and  The entire collection of detectors
hence cannot make used of focused septa to reject scattered  Group of detectors
radiation. However, detectors are calibrated twice during each  The image receptor in CT
rotation of the x-ray source, proving a self-calibrating system. Third  Detector: absorbs radiation and converts it to electrical
generation system are calibrated only once every few hours. signal
 Optimal Characteristics:
5TH GENERATION (early 1980s) o High detector efficiency – ability of the detector to
 Electron beam CT capture transmitted photons and change them to
 Ultrafast CT scanner electronic signals
 X-ray tube rotation is mechanical o Low or no after glow – brief, persistent flash of
 No moving parts scintillation that must be taken into account &
 Electron Gun: produces a focused electron beam that subtracted before image reconstruction
generates a rotating x-ray fan beam after being steered o High scatter suppression
along tungsten target rings o High stability – allows a system to be used without
6TH GENERATION (early 1990s) interruption of frequent calibration
 The helical (or spiral) CT scanner  Types:
 Volumetric scanners o Gas-filled detector – previously used
 Introduced by Will Kalender and Kazuhiro Katada o Scintillation & solid-state detectors – recently used
 Uses slip ring technology  Gas detector:
 Excels in 3D multiplanar reformation o Basis: ionization of gas
 Slip Ring: electromechanical device that conduct electricity o Three types:
and electric signals through rings and brushes across a 1. Ionization chamber
rotating surface onto a fixed surface 2. Proportional counter
3. Geiger-Muller counter
7TH GENERATION o Characteristics:
 The multi-detector row CT ▪ Excellent stability
 64-Slice CT ▪ Large dynamic range
▪ Low quantum efficiency
IMAGING SYSTEM DESIGN  Scintillation detector:
o Characteristic:
3 MAJOR COMPONENTS ▪ high x-ray detection efficiency (90%)
1. Gantry
2. Operating Console
▪ reduces patient dose
 ▪ allows faster imaging time DYNAMIC RANGE
▪ improves image quality  The ratio of the maximum signal measured to the minimum
signal the detectors can measure
o Crystals used: Sodium iodide
o Replaced by: DATA ACQUISITON SYSTEM (DAS)
▪ Bismuth germinate (BGO)  Computer-controlled electronic amplifier and switching
▪ Cesium iodide (CsI) device
o Current crystal of choice:  Where signal from each radiation detector is connected
 Consists of:
▪ Cadmium tungstate (CdWO4)
o Preamplifier
▪ Special ceramics
o Integrator
o Photodiode: converts light into electrical signal o Multiplexer
o Characteristics: o Logarithmic
▪ Small o Amplifier
▪ Cheap o Analog-to-digital converter
▪ Does not require power supply
HIGH VOLTAGE GENERATOR
 High frequency power
 High voltage step-up transformer
THREE IMPORTANT FACTORS CONTRIBUTING TO DETECTOR
 Power: 50 kW
EFFICIENCY
 Accommodates higher x-ray tube rotor speeds
1. GEOMETRIC EFFICIENCY  Accommodates instantaneous power surges characteristic of
 The area of the detectors sensitive to radiation as a fraction pulsed system
of the total exposed area
PATIENT COUCH
 The amount of space occupied by the detector collimator
plates relative to the surface area of the detector  Supports the patient comfortably
 Construction: low-Z material (carbon fiber)
2. QUANTUM EFFICIENCY
 The fraction of incident x-rays on the detector that are  Rationale: it does not interfere with x-ray beam transmission
absorbed and contribute to the measured signal & patient imaging
 Features: should be
3. CONVERSION EFFICIENCY
o Smoothly and accurately motor driven
 The ability to accurately convert absorbed xray signal to
electrical signal
▪ Rationale: precise positioning is possible
o Capable of automatic indexing
OVERALL/DOSE EFFICIENCY ▪ Rationale: operator does not have to enter the
 The product of geometric, quantum and conversion room between each scan
efficiency
 The product of the following factors COLLIMATION
o Stopping power of the detector material  Restricts the volume of tissue irradiated
o Scintillator efficiency (in solid-state types)  Purpose:
o Charge collection efficiency (in xenon types) o Reduces patient dose
o Geometric efficiency o Improved image contrast
o Scatter rejection  Types: post patient & pre-patient collimator
 Normal value: b/n 0.45-0.85  Pre-patient Collimator
 Value <1: non-ideal detector system o Limits the area of the patient that intercepts the useful
o Result: increased in patient dose to maintain image beam
quality o Mounted on the x-ray tube housing or adjacent to it
 Purpose: to decrease patient dose
CAPTURE EFFICIENCY  Determines:
 Refers to the ability with which the detector obtains photons o Dose profile
that have passed through the patient o Patient dose
ABSORPTION EFFICIENCY  Predetector/Post Patient Collimator
o Restricts the x-ray beam viewed by the detector array
 Refers to the number of photons absorbed by the detector
 Depends on: physical properties of the detector face  Purpose:
o Thickness o to decrease scattered radiation
o Material o to improved contrast
 Determines:
RESPONSE TIME o Slice thickness
 The time required for the signal from the detector to return o Sensitivity profile
to zero after stimulation of the detector by x-ray radiation so
that it is ready to detect another x-ray event OPERATING CONSOLE
 A function of the detector design  Contains meters and controls
o For selection of proper imaging technique factors
 o For proper mechanical movement of the gantry and SLIP-RING TECHNOLOGY
patient couch  Slip ring: electromechanical device that conducts electricity
o For the use of computer commands and electrical signals through rings and brushes
▪ Allow image reconstruction and transfer o Allows the gantry to rotate continuously
 2-3 operating consoles without interruption
o 2 for CT radiologic technologists o Made MSCT possible
▪ 1st: To operate imaging system  Brushes: transmit power to the gantry components
o Composition: silver graphite alloy
▪ 2nd: to post-process images for filming and filing
▪ Used as sliding contact
 1 for physician
o Replacement of brushes:
o To view the images
o To manipulate contrast, size & general visual ▪ Every year
appearance ▪ During preventive maintenance
o Accepts the reconstructed image from operator’s
console
o Displays reconstructed image for viewing and diagnosis IMAGE CHARACTERISTICS
 Two monitors:
IMAGING MATRIX
o 1st: provided for operator
 Layout of cells in rows and columns
▪ To annotate patient data on the image (e.g.  Original EMI: 80x80 matrix
hospital identification, name, patient number, age, o 6000 cells of information
gender)  Current system: 512x512 matrix
▪ To provide identification for each image (e.g. o 262,144 cells of information
number, technique, couch position)  Pixel: a picture element
o 2nd: allows the operator to view the resulting image o Each cell of information
before transferring it to hard copy or physician’s o Two-dimensional
viewing console  Pixel Size = FOV ÷ matrix size
 Technique factors:  Voxel: a volume element
o kVp: <120 o The tissue volume
o mA: 400 (maximum)  Voxel (mm3) = pixel size (mm2) x slice thickness (mm)
▪ varied according to  CT number/Hounsfield unit: the numeric information
▪ patient thickness to reduce patient dose contained in each pixel
o Slice thickness: 0.5-5 mm  Matrix: rows and columns of pixels displayed on a digital
 Physician’s work station: allows the physician image
o To call up any previous image  Field of view (FOV): the diameter of image reconstruction
o To manipulate image to optimize diagnostic information o FOV increased, fixed matrix size
 Scan time: length of time required per scan ▪ Result: increase/larger pixel size
o Fixed FOV, increase matrix size
COMPUTER
▪ Result: decrease/smaller pixel size
 Unique subsystem of the CT imaging system
 Microprocessor & primary memory: heart of the computer CT NUMBER/HOUNSFIELD UNIT (HU)
o Determine reconstruction time  Used to assess the nature of tissue
 Array processors:  HU: scale of CT number
o Mostly used in CT instead of microprocessors  Range: -1000 – +3000
o Rationale:  Formula: CT Number = k (µt-µw/ µw)
▪ Does many calculations o k: constant that determines the scale factor for the
▪ Faster than microprocessors (<1 sec reconstruction range of CT number
time) o µt: attenuation coefficient of the tissue in the pixel
 Computer memories: ROM & RAM under analysis
 Random access memory: temporary memory that stores o µw: x-ray attenuation coefficient of water
information while software is used
 Read only memory: for storage data only and cannot be CT NUMBER FOR VARIOUS TISSUES
overwritten TISSUES APPROXIMATE CT NUMBER
 Central Processing Unit (CPU): performs calculations and Dense bone 3000
logical operations under control of software instruction Bone 1000
o Heart of the computer Liver 40-60
 Special requirements: Muscle 50
o Controlled environment White matter 45
o Relative Humidity: <30% Gray matter 40
o Temperature: <20°C Kidney 30
o High humidity and temperature: contribute to Blood 20
CSF 15
computer failure
Water 0
 Fat -100 Small voxel size Better SR
Lungs -200 Large detector size Poor SR
Air -1000 Small detector size Better SR

IMAGE RECONSTRUCTION LINE PAIR

 One bar and its interspace of equal width
FILTER BACK PROJECTION
 Process by which an image is acquired during CT and stored SPATIAL FREQUENCY
in computer memory is reconstructed  Used to describe CT spatial resolution
 Filter: refers to mathematical function  Low SF: represents large objects
 High SF: represents small objects
MULTIPLANAR REFORMATION (MPR)
 A method for generating coronal, sagittal, or oblique images EDGE RESPONSE FUNCTION (ERF)
from the original axial image data  Mathematical expression of the ability of the CT scanner to
 MSCT: excels in 3D MPR reproduced a high-contrast edge with accuracy
 3D MPR Algorithm: most frequently used MODULATION TRANSFER FUNCTION (MTF)
 Mathematical expression for measuring resolution
 The ratio of the image to the object as a function of spatial
THREE 3D MPR ALGORITHMS
frequency
1. MAXIMUM INTENSITY PROJECTION (MIP)  Used to describe CT spatial resolution
 Reconstruct an image by selecting the highest value pixels  MTF = 1: faithfully represents the object
along the arbitrary line  MTF = 0: image is blank and contain no information
 Widely used in CT Angiography  MTF = intermediate values: intermediate levels of fidelity

2. SHADED SURFACE DISPLAY (SSD) CHARACTERISTICS OF CT IMAGING SYSTEM CONTRIBUTING TO

 Computer-aided technique that identifies narrow range of IMAGE DEGRADATION
values as belonging to the object to be imaged 1. Collimation
3. SHADED VOLUME DISPLAY (SVD) 2. Detector size and concentration
 Very sensitive to the operator-selected pixel range 3. Mechanical/electrical gantry control
 Previously: applied to bone imaging 4. Reconstruction algorithm
 Recently: applied to virtual colonoscopy
IMAGE FIDELITY

 Measured by determining the optical density along the axis

IMAGE QUALITY of the image
FIVE PRINCIPAL CHARACTERISTICS OF CT IMAGE LIMITING RESOLUTION
1. Spatial resolution
2. Contrast resolution  Spatial frequency at MTF equal to 0.1
3. Noise
IMPORTANT MEASURES OF IMAGING SYSTEM PERFORMANCE
4. Linearity
1. Artifacts generation
5. Uniformity
2. Contrast resolution
SPATIAL RESOLUTION 3. Spatial resolution
 Ability to image small object that have high subject contrast
CONTRAST RESOLUTION
 Expressed in: line pairs/millimeter (lp/mm)
 The ability to distinguish one soft tissue from another
 A function of pixel size
without regard for size or shape
 Take note: SR for a CT image is limited to the size of the pixel
 Take note: CR is superior to CT
 Image reconstruction and post processing tasks: powerful
o Rationale: better x-ray beam collimation
way to affect SR
 Ability to image low-contrast objects:
 Formula: SR (cm) = ½ {1/SF (lp/cm)}
o Limited by:
FACTORS AFFECTING/INFLUENCING SPATIAL RESOLUTION ▪ Size and uniformity of the object
1. Pixel size ▪ Noise of the system
2. Slice thickness
3. Voxel size X-RAY ABSORPTION IN TISSUE
4. Design of pre-patient and pre-detector collimators ▪ Determined by the mass density of the body part
5. Detector size
▪ Characterized by x-ray linear attenuation coefficient
FACTORS EFFECT IN SPATIAL RESOLUTION
X-RAY LINEAR ATTENUATION COEFFICIENT
Thick slice thickness Poor SR
Thin slice thickness Better SR ▪ A function of x-ray energy and atomic number of the tissue
Large pixel size Poor SR
NOISE
Small pixel size Better SR
 The percentage standard deviation of a large number of
Large voxel size Poor SR
pixels obtained from a water bath image
  The variation in CT number above or below the average  Extrapolation: estimation of value beyond the range of
values known values
 Appears as graininess  Data interpolation: performed by interpolation algorithm
 Take note: the resolution of low-contrast objects is limited
by the noise of the CT imaging system PITCH/SPIRAL PITCH
o Evaluation test: 20cm water bath  The relationship between patient couch movement and x-
o Frequency: daily ray beam width
 Spiral Pitch Ratio:
PIXEL VALUE NOISE o PITCH = Couch movement each 360° ÷ Beam width
Equal 0  MSCT Pitch: 1
Large variation High o Rationale:
Small Variation Low ▪ Multiple slices are obtained

FACTORS AFFECTING NOISE ▪ Z-axis location and reconstruction width can be

1. kVp and filtration selected after imaging
2. Pixel size  CTA Pitch: <1:1
3. Slice thickness  Pitch >1:1:
4. Detector efficiency o Decreases Z-axis resolution
5. Patient dose – primary control of noise o Rationale: a wide section sensitivity profile

LINEARITY VOLUME IMAGING

 Describes the amount to which the CT number of a material
is exactly proportional to the density of this material (in
Hounsfield units)
 Evaluation test: five-pin performance test object
 Frequency: daily
UNIFORMITY
 The consistency of the CT numbers of an image of a
SENSITIVITY PROFILE
homogeneous material across the scan field
SPATIAL UNIFORMITY
 Constancy of pixel values in all region of the reconstructed
image
 Evaluation test: plotting the CT number in histogram/line
graph
 Acceptable value: +/- 2 mean value (Standard Deviation)
 Formula:
o TISSUE IMAGED = Beam width x Pitch x Imaging time
▪ For 360° gantry rotation/sec
o TISSUE IMAGED = (Beam width x Pitch x Imaging time)
÷ gantry rotation
▪ If gantry rotation is not 360°/sec
 Full Width at Half Maximum (FWHM):
o The width of sensitivity profile at one half of its
maximum value
 If MSCT pitch = 1:1:
o Sensitivity profile: 10% wider than conventional CT
 If MSCT pitch = 2:1:
o Sensitivity profile: 40% wider than conventional CT

MULTISLICE SPIRAL CT IMAGING PRINCIPLES IMAGING TECHNIQUES

ADVANTAGE OF MSCT TWO PRINCIPAL DISTINGUISHING FEATURES OF MSCT

 Increases the volume of tissue that can be imaged at a given
time
o Rationale: it has the ability to image a larger volume of
tissue in a single breath-hold
 Helpful in:
o CT Angiography o Radiation therapy treatment
o Imaging uncooperative patients
INTERPOLATION ALGORITHMS
 A special computer program
 1st interpolation algorithm: used 360o linear interpolation
o Disadvantage: caused prominent blurring of the
reconstructed image
 Solution for blurring: 180° linear interpolation
o Results:
▪ Improved Z-axis resolution
▪ Improved sagittal and coronal reformatted views
o It allows imaging at a pitch <1
 Interpolation:
o Estimation of value between two known values
o A mathematical method of creating missing data
1. Several parallel detector arrays
2. Quickly energizing
MULTISLICE DETECTOR ARRAY
 Early 1990’s: initial demonstration of dual slice imaging
 Recently: 320 slice imaging
 Wider slice imaging:
o Better contrast resolution (at same mA setting)
 Rationale: detected signal is larger
o Slight decrease in spatial resolution
 Rationale: increased voxel size
 Smaller detector size: better spatial resolution
DUAL SOURCE MSCT
 Has two x-ray tubes & two detector arrays
 Principal advantage: speed
 Imaging time: 80 ms
DATA ACQUISITION RATE
 Slice Acquisition Rate (SAR): one measure of the efficiency
of the MSCT imaging system
 Formula:
o SAR = Slice acquired/360° ÷ Rotation time
Z-AXIS COVERAGE (Z)  Frequency: semi-annually
 Formulas:  Acceptable tolerance: within manufacture’s specifications
o Z = (N/R) x W x T x B
o Z = SAR x W x T x B CONTRAST RESOLUTION
 Assessment test: low-contrast test objects with built-in
 N: number of slice acquired
analytic schemes
 R: rotation time
 Frequency: semi-annually
 W: slice width
 Acceptable tolerance:
 T: time
o CT resolving power: should be 5 mm objects at 0.5%
 B: pitch
contrast
FEATURES OF MSCT
SLICE THICKNESS/SENSITIVITY PROFILE
ADVANTAGES RATIONALE
No motion artifacts Removes respiratory misregistration  Assessment test: ramp, a spiral or a step wedged (specially
Improved lesion detection Reconstructs at arbitrary z-axis intervals designed test objects)
Reconstructs at overlapping z-axis  Frequency: semi-annually
Reduced partial volume interval  Acceptable tolerance: w/in 1 mm of the intended slice
Reconstructs small than image interval thickness
Date obtained during peak of  Intended slice thickness of <5 mm: 0.5 mm acceptable
Optimized IV contrast enhancement tolerance
Reduces volume of contrast agent
Multiplanar images
Higher quality reconstruction COUCH INCREMENTATION
improved
 Assessment test: noting the position of the couch with tape
FEATURES OF MSCT measure & straightedge on the couch rails
LIMITATIONS RATIONALE  Frequency: monthly
Increased image noise Bigger x-ray tubes needed  Acceptable tolerance: within +/- 2 mm
Reduced z-axis resolution Increased with pitch
Increased processing time More data, more images needed LASER LOCALIZER
 For patient positioning
COMPUTED TOMOGRAPHY QUALITY CONTROL  Assessment test: specially designed test objects
 Frequency: semi-annually
NOISE AND UNIFORMITY
 Assessment test: 20-cm water bath PATIENT DOSE
 Frequency: weekly  Specified as CT dose index (CTDI)
 Acceptable tolerance:  High resolution: high patient dose
o Water: within +/- HU of 0  Monitored by: specially designed pencil ionization
o Uniformity: not > +/- 10 HU from center of periphery chamber/TLD
 Assessment in quantitative CT: the following should be  Frequency: semiannually
changed  Acceptable tolerance:
o CT scan parameters o Fixed technique: patient dose not vary from > +/- 10%
o Slice thickness  Should follow replacement of the tube
o Reconstruction diameter
o Reconstruction algorithm
CT SCAN ARTIFACTS
LINEARITY
ARTIFACTS
 Assessment test: five-pin insert performance
 Systematic discrepancy in CT numbers/HU
 Frequency: semi-annually
 Unintended optical density on a radiograph
 Analysis: should show relationship b/n the HU and electron
 More common in CT than in conventional radiographs
density
 Types:
 Acceptable tolerance:
o Streaking – due to an inconsistency in a single
o Correlation coefficient: at least 0.96% or 2 standard
measurement
deviation
o Shading – due to a group of channels or views deviating
 Assessment in quantitative CT: requires precise
gradually from the true measurement
determination of the value of tissue in HU
o Rings – due to errors in an individual detector
GAMMEX 464 calibration
 T test object o Distortion – due to helical reconstruction
 Used to evaluate noise, spatial and contrast resolution,  Four categories:
linearity and uniformity o Physics–based artifacts – caused by: physical processes
involved in the acquisition of CT data
SPATIAL RESOLUTION o Patient–based artifacts – caused by: patient movement
 Most important component of QC program and presence of metallic materials
 Assessment test: imaging a wire/edge/hole array/bar o Scanner–based artifacts – caused by: imperfections in
pattern scanner function
 o Helical and multi-section artifacts – caused by: image detector
reconstruction process. Very noise projections
Increase tube current
PHYSICS–BASED ARTIFACTS AVOIDANCE Use of adaptive filtration
 Beam hardening artifact Automatic tube current modulation
o Cupping artifact
o Streak artifact UNDERSAMPLING ARTIFACT
 Partial volume DESCRIPTION Two large an interval between projections
 Photon starvation Misregistration by the computer of
CAUSED information relating to sharp edges and
 Undersampling
small objects
BEAM HARDENING ARTIFACT View aliasing (fine stripes appearance)
EFFECT
Increased mean energy of the x-ray beam Ray aliasing (stripes appearance)
DESCRIPTION For view aliasing: Slower rotation speed
when it passes through object
CAUSED Polychromatic nature of the x-ray beam AVOIDANCE For ray aliasing: Quarter-detector shift
Cupping artifact Flying focal spot
Appearance of dark bands or streak
EFFECT PATIENT–BASED ARTIFACTS
(b/n metal or bone)
Pseeudoenhancement of renal cysts  Metallic materials
Built-in features: Filtration  Patient motion
Calibration correction  Incomplete projection
Beam hardening correction software
AVOIDANCE By operator: Patient positioning
Gantry tilting
Appropriate FOV selection METAL ARTIFACT
Appropriate bowtie filter CAUSED Presence of metal object in the scan field
MOST COMMONLY Incomplete attenuation profile
Bone and metal implants EFFECT
OCCUR Severe streaking artifacts
Asked patient to remove metallic objects
CUPPING ARTIFACT Use gantry angulation (for non-removable
Beam is hardened more in the middle AVOIDANCE items)
DESCRIPTION Increased kVp
portion of an object than those in the edges
CAUSED Beam hardening Thin slice thickness
The middle of the image appear darker than
EFFECT MOTION ARTIFACT
the periphery
AVOIDANCE Beam hardening correction CAUSED Patient motion (voluntary & involuntary)
EFFECT Misregistration artifacts
STREAK AND DARK BANDS ARTIFACTS By the operator: Use of positioning aids
DESCRIPTION Appear between two dense objects Immobilization
Metals (bullets, pacemaker, dental fillings) Sedation (infant)
Beam hardening Short scan time
CAUSED Poisson noise AVOIDANCE Instruct patient to hold breath
Patient motion By built-in features: Overscan & underscan
Edge effects modes
EFFECT High CT numbers on the image Software correction
AVOIDANCE Beam hardening correction Cardiac gating
MOST COMMONLY Bony regions of the body
OCCUR Used of contrast media INCOMPLETE PROJECTION ARTIFACT
Presence of anatomy lying outside the scan
DESCRIPTION
PARTIAL VOLUME ARTIFACT field produces severe artifacts
Distortion of signal intensity from an Portion of anatomy lies outside the field of
DESCRIPTION CAUSED
anatomy view
Anatomy that doesn’t lie totally within the Incomplete information of the anatomy by
CAUSED the computer
slice thickness EFFECT
Averaging the linear attenuation coefficient Generation of streaking and shading
EFFECT in a voxel that is heterogeneous in artifacts
composition Position patient so that no parts lying
AVOIDANCE
Thin slice selection outside the scan field
AVOIDANCE
Thin slice incrementation
SCANNER–BASED ARTIFACTS
MOST COMMONLY
Posterior cranial fossa  Ring artifacts
OCCUR
RING ARTIFACT
PHOTON STARVATION ARTIFACT
DESCRIPTION Artifacts seen in third generation CT scanner
DESCRIPTION Potential source of streaking artifacts
Faulty detector
High x-ray attenuation CAUSED
CAUSED Detector out of calibration
Highly attenuating structures
EFFECT Consistently erroneous reading at each
EFFECT Insufficient x-ray photons reaching the
 angular position
Circular artifact
Detector calibration
AVOIDANCE Selecting correct scan FOV (by using
calibration date)

HELICAL AND MULTISECTION CT ARTIFACTS

 Cone beam effect (helical)
 Stair–step artifacts (MSCT)
 Zebra or windmill artifacts (MSCT)

CONE BEAM EFFECT ARTIFACT

The x-ray beam becomes cone-shaped
DESCRIPTION
rather than fan-shaped
Increased number of section acquired per
rotation
CAUSED
Wider collimation Increase number of
detector rows
EFFECT Fundamental deficit in the acquired data
To acquire a more complete data set
AVOIDANCE
Employing cone beam reconstruction

STAIR STEP ARTIFACT

Serrations on coronal or sagittal reformats
DESCRIPTION
seen with helical and multidetector row CT
Increased number of section acquired per
rotation
CAUSED
Wider collimation Increase number of
detector rows
Artifacts similar to those caused by partial
EFFECT
volume
AVOIDANCE Employing cone beam reconstruction

ZEBRA ARTIFACT
Periodic stripes of more or less noise at the
DESCRIPTION image periphery seen on coronal or sagittal
reformats
CAUSED Helical interpolation
EFFECT Alternating high and low noise on image
AVOIDANCE Employing cone beam reconstruction