Body

Research title: Computerized Assisted Tomography (CAT/CT) Submitted to: Prof. Dr. Moshira M.
Abdul Latif By: Ahmed T. M. El-Shanawany ---------------
fac1. Introduction. Computed Tomography (CT) has been one of the major advancements in diagnostic radiology and oncology. Most modern hospitals have a CT scanner in their shock-trauma centers for immediate scans to explore for major internal injuries such as internal bleeding and aortic aneurysm. This research describes CT history, principles, clinical applications, advantages and limitations. 2. Definition. According to the Merriam Webster Dictionary, computerized tomography is defined as "radiography in which a three-dimensional image of a body structure is constructed by computer from a series of plane cross-sectional images made along an axis called also computed axial tomography, computerized axial tomography, computerized tomography". It is more simplified according to the Encyclopedia Britannica as it is defined as "a diagnostic imaging method using a low-dose beam of X-rays that crosses the body in a single plane at many different angles". 3. Associated Terms.
1.
Radigraphy. Radiography is the use of ionizing electromagnetic radiation such as Xrays to view objects.
2.
Medical Radiography. Medical Radiography is the use of ionizing electromagnetic radiation as a diagnostic aid in the identification of medical conditions.
3.
X-ray. According to the Encyclopedia Britannica X-ray is "an electromagnetic radiation of extremely short wavelength and high frequency, with wavelengths ranging from about 108 to 1012 meter and corresponding frequencies from about 1016 to 1020 hertz (Hz)".
4. Terminology. Computerized Assisted Tomography (CAT/CT) consists of two main words "computerized" and "tomography".
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Research title: Computerized Assisted Tomography (CAT/CT) Submitted to: Prof. Dr. Moshira M. Abdul Latif By: Ahmed T. M. El-Shanawany ---------------
Computerized or Computerized Assisted; means that the analysis and production of the image is based on a computerized program and the operator can not do it himself. Tomography; The word "tomography" is derived from the Greek tomos (slice) and graphein (to write). Computed tomography was originally known as the "EMI scan" as it was developed at a research branch of EMI, a company best known today for its music and recording business. It was later known as computed assisted tomography (CAT or CT scan) and body section rntgenography. According to Eric Whaites in his textbook 'Essentials of Dental Radiography and Radiology', "Tomography is a specialized technique for producing radiographs showing only a section or slice of a patient". Eric Whaites described the concept of tomography in a very simple way when he descried it as dividing up the patient like a loaf of sliced bread. The section is thus referred to as the focal plane or focal trough. Structures outside the section (i.e. the rest of the loaf) are blurred and out of focus. By taking multiple slices, three-dimensional information about the whole patient can be obtained. Types of tomography; the following Table lists the various types of tomography according to the source of data Source of data Atom probe Laser scanning confocal microscopy Cryo-electron microscopy Electrical capacitance Electrical resistivity Electrical impedance Magnetic resonance Magnetic induction Nuclear magnetic moment Neutron Sonar Interferometry Name Atom probe tomography Confocal microscopy (Laser scanning confocal microscopy) Cryo-electron tomography Electrical capacitance tomography Electrical resistivity tomography Electrical impedance tomography Functional magnetic resonance imaging Magnetic induction tomography Magnetic resonance imaging or nuclear magnetic resonance tomography Neutron tomography Ocean acoustic tomography Optical coherence tomography
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Abbreviation APT LSCM Cryo-ET ECT ERT EIT fMRI MIT MRI MRT
OCT
Optical microscope Photoacoustic spectroscopy Positron emission Positron emission & X-ray Quantum state Gamma ray Seismic waves Photoacoustic spectroscopy Ultrasound
Optical projection tomography Photoacoustic imaging in biomedicine Positron emission tomography Positron emission tomography Quantum tomography Single photon emission computed tomography Seismic tomography Thermoacoustic imaging Ultrasound-modulated optical tomography Ultrasound transmission tomography X-ray tomography Zeeman-Doppler imaging
OPT PAT PET PET-CT SPECT TAT UOT CT, CATScan
X-ray Zeeman effect
5. Historical Notes before CT. The invention of computed tomography is considered to be the greatest innovation in the field of radiology since the discovery of X-rays. This cross-sectional imaging technique provided diagnostic radiology with better insight into the pathogenesis of the body, thereby increasing the chances of recovery. In 1979, G.N. Hounsfield and A.M. Cormack were awarded the Nobel Prize in medicine for the invention of CT. Today, CT is one of the most important methods of radiological diagnosis. It delivers non-superimposed, cross-sectional images of the body, which can show smaller contrast differences than conventional X-ray images. This allows better visualization of specific differently structured soft-tissue regions, for example, which could otherwise not be visualized satisfactorily. Since the introduction of spiral CT in the nineties, computed tomography has seen a constant succession of innovations. And here you are a brief notes about the historic dates till the introduction on CT;
11/8/1895; Discovery of X-ray radiation.
Discoverer: The physicist and later Nobel Prize winner Wilhelm Conrad Roentgen (18451923), dean at the Julius Maximilian University of Wurzburg and holder of the chair of physics.
1896.
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F.H. Williams succeeds in taking the first chest X-ray in Boston, and Carl Schleussner develops the first silver bromide coated photographic X-ray plates in Frankfurt a. Main, Germany. Diagnostic results can now be archived; until then, fluorescent screens resulting in high radiation exposure had been used.
1903. E.A.O. Pasche builds a collimator for suppressing scattered radiation
Radiation protection for all parties involved for the first time; until then, both patients and physicians always had to face the "bare" X-ray tube. 6. History of CT. The reconstruction of images from projections was attempted as early as 1940 without the use of the modern computer technology. In 1940, Gabriel Frank was able to describe the basic idea of modern tomography including such concepts as Sinograms (i.e. representation of measurement data as linear samples versus view samples) and optical back projection. In 1956, Allan M. Cormack conducted experiments on reconstructive tomography in medical applications. He reconstructed attenuation coefficients of tissues to improve the accuracy of radiation treatment which lead to the development of a mathematical theory for image reconstruction. However, due to difficulty of calculations, his work was not recognized at the time. The first clinical CT scanner was developed in 1967 by Godfrey N. Hounsfield at the Central Research Laboratories of EMI, Ltd., in England. When he was investigating pattern recognition techniques, he concluded that X-ray measurements taken through a body from different directions would allow the reconstruction of its internal structure. Due to the low-intensity of the gamma source, it took 9 days to complete the data acquisition and construct the image including the computation of 28,000 simultaneous equations in 21 hours. After further refinement of the data acquisition, images were constructed in less than 5 minutes. This led to the installation of the first clinical CT device at AtkinsonMorley Hospital in September 1971. A month later, the first patient with a large cyst was scanned and the pathology was confirmed from the image. In 1979, Cormack and Hounsfield shared the Nobel Prize for their contributions in the development of computed tomography in the field of physiology and medicine. 7. Timeline.
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1917
Johann Radon demonstrated that the image of a 3-dimensional object can be recostructed from an infinite number of 2-dimsneisonal projections of the object
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1956 1958 1960 1963 1966 1967 1968 1971 1972 1973 1975 1979 1985 1989
Ronald Bracewell publishes paper mapping sunspots using a series of onedimensional images to reconstruct a two-dimensional image using Fourier transform William Oldendorf builds a model CT scanner without a computer Oldendorf applies for a patent for his model Alan Cormack publishes results from experimental scanner using a computer to reconstruct images from data David Kuhl publishes paper with the transmission images of a subject's thorax Bracewell reconstructs lunar images without using Fourier transforms EMI patents Godfrey Hounsfieild's method apparatus and the apparatus for scanning the body with X-rays The first CT scanner, limited to the head, demonstrated by EMI at Atkinson Morley's hospital in London The first CT scanner demonstrated in the United States Robert Ledley markets ACTA, a whole body CT scanner Second generation Delta CT scanners are marketed GEs third generation CT scanners are marketed Cormack and Hounsfield are awarded the Nobel Prize in Medicine for the invention of CT Superfast CT is developed by Douglas Boyd First spiral CT enters the market
8. CT Principles; (Conventional Radiography vs. Computerized Tomography). The principal of CT is the measuring of the spatial distribution of physical material to be examined from different directions and to compute superposition free images from this data. It is basically a technique of X-ray photography by which a single plane of a patient is scanned from various angles in order to provide a cross-sectional image of the internal structure of that plane. For conventional radiography, the relative distribution of X-ray intensities is what is being measured. The following Figure demonstrates how this is achieved.
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An X-ray source of intensity Io is used to send uniform intensity X-rays through a patient. The X-rays then exit the other side with an intensity of I(x,y) and interact with a radiography film sheet. The exiting X-rays are attenuated by the varying material densities that they pass through. The different paths through the material will attenuate the X-rays by varying amounts, based only on the mass attenuation coefficient (), since the distance (d) is the same on all point of the radiography film. It is this variance that is recorded by the two dimensional radiography film and is shown as lighter or darker contrasts. This process has some limitations. Specifically, the image captured is a two dimensional representation of three dimensional anatomy. As a result, structures are overlapping on the image and make positional details hard to see. Another limitation is that the mass attenuation coefficients for tissues do not vary greatly. Thus, it is difficult to resolve some internal structures. However, computed tomography (CT) provides solutions to these limitations. The principle of CT is to have many measurements of attenuation through the plane of a finite thickness cross section of the patient. The following Figure shows this concept.
An X-ray source is used to scan a patient along this plane, while a detector on the opposite side measures the attenuated X-rays along this plane and the computer records this capture. Once the patient has been scanned from one side of the plane to the other side, both X-ray source and detector rotate around the patient by a predetermined amount and the translational scan is repeated. The internal components of the patient are interpreted by the computer as a group of small volumes, each with their own average mass attenuation coefficient. These volumes are called voxels (like pixels on a TV screen). The smaller the voxel volume, the higher the resolution of the image. In order to generate an image of the cross section, the computer must attempt to calculate the average mass attenuation coefficients () of each of the voxel volumes. This could be determined algebraically with a very large number of simultaneous equations;
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however a simpler method called filtered back-projection was used in the early CT scanners and remains in use today. X-ray scans are collected in sets called projections, which are made across the patient in a particular direction in the section plane. To reconstruct the image from the X-ray measurements, each voxel must be viewed from multiple different directions. A complete data set requires many projections at rotational intervals of 1 or less around the cross section. Back-projection effectively reverses the attenuation process by adding the attenuation value of each X-ray in each projection back through the reconstruction image. This requires a significant computer power to quickly generate the patient image. Because this process initially generates a blurred image, the data from each projection are mathematically altered (filtered) prior to back-projection to eliminate the blurring. 9. CT Generations.
1.
First Generation: Parallel-Beam Geometry.
Parallel-beam geometry is the simplest technically and the easiest with which to understand the important CT principles. Multiple measurements of x-ray transmission are obtained using a single highly collimated x-ray pencil beam and detector. The beam is translated in a linear motion across the patient to obtain a projection profile. The source and detector are then rotated about the patient isocenter by approximately 1 degree, and another projection profile is obtained. This translaterotate scanning motion is repeated until the source and detector have been rotated by 180 degrees. The highly collimated beam provides excellent rejection of radiation scattered in the patient; however, the complex scanning motion results in long (approximately 5-minute) scan times. This geometry was used by Hounsfield in his original experiments [Hounsfield, 1980] but is not used in modern scanners.
2.
Second Generation: Fan Beam, Multiple Detectors.
Scan times were reduced to approximately 30 s with the use of a fan beam of x-rays and a linear detector array. A translate-rotate scanning motion was still employed; however, a larger rotate increment could be used, which resulted in shorter scan times. The reconstruction algorithms are slightly more complicated than those for first-generation algorithms because they must handle fan-beam projection data.
3.
Third Generation: Fan Beam, Rotating Detectors.
Third-generation scanners were introduced in 1976. A fan beam of x-rays is rotated 360 degrees around the isocenter. No translation motion is used; however, the fan beam must be wide enough to completely contain the patient. A curved detector array consisting of several hundred independent detectors is mechanically coupled to the x-ray source, and both rotate together. As a result, these rotate-only motions
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acquire projection data for a single image in as little as 1 s. Third-generation designs have the advantage that thin tungsten septa can be placed between each detector in the array and focused on the x-ray source to reject scattered radiation.
4.
Fourth Generation: Fan Beam, Fixed Detectors.
In a fourth-generation scanner, the x-ray source and fan beam rotate about the isocenter, while the detector array remains stationary. The detector array consists of 600 to 4800 (depending on the manufacturer) independent detectors in a circle that completely surrounds the patient. Scan times are similar to those of third-generation scanners. The detectors are no longer coupled to the x-ray source and hence cannot make use of focused septa to reject scattered radiation. However, detectors are calibrated twice during each rotation of the x-ray source, providing a self-calibrating system. Third-generation systems are calibrated only once every few hours. Two detector geometries are currently used for fourth-generation systems: (1) a rotating x-ray source inside a fixed detector array and (2) a rotating x-ray source outside a notating detector array. The following Figure shows the major components in the gantry of a typical fourth-generation system using a fixed-detector array.
Both third- and fourth-generation systems are commercially available, and both have been highly successful clinically. Neither can be considered an overall superior design.
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5.
Fifth Generation: Scanning Electron Beam.
Fifth-generation scanners are unique in that the x-ray source becomes an integral part of the system design. The detector array remains stationary, while a high-energy electron beams is electronically swept along a semicircular tungsten strip anode, as illustrated in the following Figure.
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X-rays are produced at the point where the electron beam hits the anode, resulting in a source of x-rays that rotates about the patient with no moving parts [Boyd et al., 1979]. Projection data can be acquired in approximately 50 ms, which is fast enough to image the beating heart without significant motion artifacts [Boyd and Lipton, 1983]. An alternative fifth-generation design, called the dynamic spatial reconstructor (DSR) scanner, is in use at the Mayo Clinic [Ritman, 1980, 1990]. This machine is a research prototype and is not available commercially. It consists of 14 x-ray tubes, scintillation screens, and video cameras. Volume CT images can be produced in as little as 10 ms. 10. Process. X-ray slice data is generated using an X-ray source that rotates around the object; X-ray sensors are positioned on the opposite side of the circle from the X-ray source. The earliest sensors were scintillation detectors, with photomultiplier tubes excited by (typically) cesium iodide crystals. Cesium iodide was replaced during the 1980s by ion chambers containing high-pressure Xenon gas. These systems were in turn replaced by scintillation systems based on photodiodes instead of photomultipliers and modern scintillation materials with more desirable characteristics. Many data scans are progressively taken as the object is gradually passed through the gantry.
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Newer machines with faster computer systems and newer software strategies can process not only individual cross sections but continuously changing cross sections as the gantry, with the object to be imaged slowly and smoothly slid through the X-ray circle. These are called helical or spiral CT machines. Their computer systems integrate the data of the moving individual slices to generate three dimensional volumetric information (3DCT scan), in turn viewable from multiple different perspectives on attached CT workstation monitors. This type of data acquisition requires enormous processing power, as the data are arriving in a continuous stream and must be processed in real-time. In conventional CT machines, an X-ray tube and detector are physically rotated behind a circular shroud (see the image above right); in the electron beam tomography (EBT), the tube is far larger and higher power to support the high temporal resolution. The electron beam is deflected in a hollow funnel-shaped vacuum chamber. X-rays are generated when the beam hits the stationary target. The detector is also stationary. This arrangement can result in very fast scans, but is extremely expensive. CT is used in medicine as a diagnostic tool and as a guide for interventional procedures. Sometimes contrast materials such as intravenous iodinated contrast are used. 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. Once the scan data has been acquired, the data must be processed using a form of tomographic reconstruction, which produces a series of cross-sectional images. The most common technique in general use is filtered back projection, which is straight-forward to implement and can be computed rapidly. In terms of mathematics, this method is based on the Radon transform. However, this is not the only technique available: the original EMI scanner solved the tomographic reconstruction problem by linear algebra, but this approach was limited by its high computational complexity, especially given the computer technology available at the time. More recently, manufacturers have developed iterative physical model-based expectation-maximization techniques. These techniques are advantageous because they use an internal model of the scanner's physical properties and of the physical laws of X-ray interactions. By contrast, earlier methods have assumed a perfect scanner and highly simplified physics, which leads to a number of artifacts and reduced resolution - the result is images with improved resolution, reduced noise and fewer artifacts, as well as the ability to greatly reduce the radiation dose in certain circumstances. The disadvantage is a very high computational requirement, which is at the limits of practicality for current scan protocols. Pixels in an image obtained by CT scanning are displayed in terms of relative radiodensity. The pixel itself is displayed according to the mean attenuation of the tissue(s) that it corresponds to on a scale from +3071 (most attenuating) to -1024 (least attenuating) on the Hounsfield scale. Pixel is a two dimensional unit based on the matrix size and the field of view. When the CT slice thickness is also factored in, the unit is known as a Voxel, which is a three-dimensional unit. The phenomenon that one part of the detector cannot differentiate between different tissues is called the "Partial Volume Effect". That means that a big amount of cartilage and a thin layer of compact bone can cause the same attenuation in a voxel as hyperdense cartilage alone. Water has an attenuation of 0
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Hounsfield units (HU), while air is -1000 HU, cancellous bone is typically +400 HU, cranial bone can reach 2000 HU or more (os temporale) and can cause artifacts. The attenuation of metallic implants depends on atomic number of the element used: Titanium usually has an amount of +1000 HU, iron steel can completely extinguish the X-ray and is, therefore, responsible for well-known line-artifacts in computed tomograms. Artifacts are caused by abrupt transitions between low- and high-density materials, which results in data values that exceed the dynamic range of the processing electronics. Contrast mediums 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. Often, images are taken both with and without radiocontrast. CT images are called precontrast or nativephase images before any radiocontrast has been administrated and postcontrast after radiocontrast administration. 11. Radiation Dose. CT scanning is a relatively high dose procedure that is becoming much more common worldwide. The Helical and Multislice CT scanners typically have larger doses than the conventional CT scans, due to the continuous nature of the scan. The electron beam CT scanner will deliver approximately 20% less radiation than a patient would receive from a conventional CT scan. The primary explanation for this is that the Electron Beam CT scanner is essentially a fast shuttered camera only turning on for brief periods of 50 to 100 msec as needed to acquire the images. The following Table shows the various doses from CT scans, along with some other activities. Estimates of radiation exposure are given in rem (radiation equivalent man) which is based on the total amount of X-ray expected to be absorbed by the patient (100 millirem = 1 milliSievert). Source of Radiation Natural Background (Annual) Average Dose to Nuclear Energy Worker Chest X-ray Conventional CT Chest Conventional CT Abdomen Helical CT Chest Helical CT Body Scan Electron Beam CT Body Scan Dose (mrem) 350 170 10 800 1000 700 1800 320
It can be seen that the doses for CT scans are higher than those for normal X-ray radiography, or those typically received by a Nuclear Energy Worker. Because CT procedures involve far higher radiation exposures than those received in conventional Xray exams, there is a growing concern that such exposure could contribute to the development of a radiation-induced cancer later in life. This concern is currently being investigated by the U.S. Food and Drug Administration. Due to the high radiation dose that a patient could receive from a CT scan, screening without symptoms is usually not justified. As for utilizing the CT scans for certain diagnostic purposes, the radiation does is
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minimal in comparison to the benefits achieved. Technological advancement in detector sensitivity would allow a decrease in patient dose, while not compromising image quality. 12. Artifacts. Although CT is a relatively accurate test, it is liable to produce artifacts, such as the following:
1.
Streak artifact.
Streaks are often seen around materials that block most X-rays, such as metal or bone. These streaks can be caused by undersampling, photon starvation, motion, beam hardening, or scatter. This type of artifact commonly occurs in the posterior fossa of the brain, or if there are metal implants. The streaks can be reduced using newer reconstruction techniques.
2.
Partial volume effect
This appears as "blurring" over sharp edges. It is due to the scanner being unable to differentiate between a small amount of high-density material (e.g., bone) and a larger amount of lower density (e.g., cartilage). The processor tries to average out the two densities or structures, and information is lost. This can be partially overcome by scanning using thinner slices.
3.
Ring artifact.
Probably the most common mechanical artifact, the image of one or many "rings" appears within an image. This is usually due to a detector fault.
4.
Noise artifact.
This appears as graining on the image and is caused by a low signal to noise ratio. This occurs more commonly when a thin slice thickness is used. It can also occur when the power supplied to the X-ray tube is insufficient to penetrate the anatomy.
5.
Motion artifact.
This is seen as blurring and/or streaking, which is caused by movement of the object being imaged. Motion blurring might be reduced using a new technique called IFT (incompressible flow tomography).
6.
Windmill.
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Streaking appearances can occur when the detectors intersect the reconstruction plane. This can be reduced with filters or a reduction in pitch.
7.
Beam hardening.
This can give a "cupped appearance". It occurs when there is more attenuation in the center of the object than around the edge. This is easily corrected by filtration and software. 13. Clinical Applications. CT scan has many diagnostic clinical applications. It improves the diagnosis accuracy by delineating details of the organs including soft tissues and bones. CT scan can provide information about the spread of an infection or tumors to different body parts and can assist surgical interventions, biopsies, and radiotherapies. Some of the clinical applications of a CT scan are further described in the following subsections. 13.1 Contrast Agents and Drugs. In a CT scan, the use of different non-radioactive contrast agents is often required to enhance the visibility of blood vessels, soft tissues, and certain organs. Contrast agents can be administered through various methods. Agents containing iodine are injected into the vein to enhance the imaging of blood vessels and organs such as kidneys. It also accentuates the appearance between normal and abnormal tissue in organs like liver and spleen. Barium sulfate and gastrografin can be orally consumed to enhance CT images of the abdomen and pelvis. Barium sulfate can also be administered by enema for imaging the colon. For very special cases of lungand brain imaging, a xenon contrast agent can be inhaled by the patient. In addition to the contrast agents, for imaging of certain organs such as colon, a drug may also be injected to slow down the normal movement of the bowel. As this movement could distort the scan and make it more difficult to interpret the image. 13.2 Body Imaging and Diagnosis. CT scan is used as a diagnostic tool for cancer, trauma, musculoskeletal disorders, infections and cardiovascular diseases. Not only CT scan can detect and confirm the presence of cancers, but can also reveal the size, location, and extent of a tumor. Usually in a CT scan, benign tumors such as neurofibromas and lipomas can be differentiated from malignant tumors based on their density. In addition, a CT scan can help distinguish between tumor and abscess since the later appears as a soft tissue mass with more lucent center. A CT scan can also
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define tumor borders, cartilage invasion, and the anatomy of the surrounding tissues. Due to the high spatial contrast resolution of CT scans, most body parts and tissues can be accurately investigated. Imaging of head or brain by CT enables detection of blood clots, enlarged ventricles, internal bleeding, skull fracture, and obstruction in the drainage pathway of the sinus. CT exam of abdomen can reveal abnormalities in kidneys (e.g., kidney stones), liver, adrenal glands, pancreas, and appendicitis. It can also identify lump, enlarged lymph nodes or glands and occult fractures in the neck area. Herniated disc, spinal stenosis and fractures in the spine can also be detected via CT scans. A quantitative measurement of bone mineral content for the detection of osteoporosis can be obtained using a specific CT technology known as Quantitative CT (QCT). An advantage of QCT is that it can measure bone in three-dimensional sections and separate between cortical and trabecular bone with great anatomic detail. This information is useful for detection of fracture and determination of bone mineral content. Another application of CT technology known as CT angiography, utilizes contrasting agents to accentuate the blood vessels in different organs. This allows for the detection of vascular disorders and diseases which could lead to kidney failure, stroke or gangrene. 13.3 Surgical Intervention. Another application of CT where continuous images can be acquired is known as fluoroscopic CT (FCT). This technique allows for continuous monitoring of the surgical instrument, its path, and the targeted body part. This will eliminate the need for many exploratory surgical procedures such as thoracotomy and laparotomy. FCT is used in surgical interventions such as guided diagnostic biopsies to remove a sample tissue for pathologic testing. FCT can also be used for drainage of fluids from cyst, abscess, lymphoceles, or hematomas. In addition, FCT is effective in pain therapy treatments such as in spinal disk space therapeutic injections, and in minimally invasive operations like cyst removal and ablation of tumors.
13.4 Surgical and Radiotherapy Planning. The extent and location of the tumor are essential in the surgical and radiotherapy planning. CT imaging offers a detailed depiction of the tumor and adjacent tissues as well as staging of the tumor. The CT scan is more beneficial for small tumors which require higher precision during radiotherapy or surgical
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planning as compared to large tumors. 3D images constructed from CT scans are helpful when planning radiotherapy treatments. These images enable optimization of dose and radiation beams to destroy the cancerous cells while avoiding or minimizing dose to the major surrounding organs. 13.5 Surgical and Therapeutical Success Determination. CT scan plays an important role in determining the success of surgical and therapeutical procedures. In cancer treatments, several CT scans may be needed at different stages to confirm the degree of success in therapeutic treatment. For example, after tumor treatments, the extent of tumor removal could be determined using a follow-up CT scan. In the case of chemotherapy treatment of metastases, CT scan may not be as efficient in the success determination due to its small size and large spread in the body. 13.6 Virtual Endoscopy. Conventional endoscopy involves the use of instruments to visualize and explore the internal organs of the body. Due to the invasive nature of the endoscopic procedure, serious side effects such as perforation, infection and hemorrhage can be encountered. Conventional CT scans produce cross section of the body which needs to be viewed sequentially to extrapolate and construct the actual 3 dimensional anatomy. With the advent of spiral CT and Multislice CT along with the advancement of computing technology, direct 3D imaging of human anatomy is now available and is known as virtual endoscopy. This is a non-invasive diagnostic tool which provides simulated 3D visualizations of organs similar to those produced by conventional endoscopic procedures. Virtual endoscopy not only avoids the risks associated with conventional endoscopy, but also can visualize body parts which are not accessible or compatible with conventional endoscopy. Examples of virtual endoscopy include virtual colonoscopy and bronchoscopy. 13.7 Screening. Medical screening tests are usually beneficial since they can detect diseases in an earlier stage while they can be treated. Although screening with CT could identify certain diseases, it may not always be accurate. Thus, confirmatory tests and aggressive treatments such as chemotherapy or surgery may be required, which could lead to serious side effects. As a result, screening by CT is not currently recommended for people who do not present with symptoms. 14. Advantages.
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There are several advantages that CT has over traditional 2D medical radiography. First, CT completely eliminates the superimposition of images of structures outside the area of interest. Second, because of the inherent high-contrast resolution of CT, differences between tissues that differ in physical density by less than 1% can be distinguished. Finally, data from a single CT imaging procedure consisting of either multiple contiguous or one helical scan can be viewed as images in the axial, coronal, or sagittal planes, depending on the diagnostic task. This is referred to as multiplanar reformatted imaging. CT is regarded as a moderate- to high-radiation diagnostic technique. The improved resolution of CT has permitted the development of new investigations, which may have advantages; compared to conventional radiography, for example, CT angiography avoids the invasive insertion of a catheter. CT Colonography (also known as Virtual Colonoscopy or VC for short) may be as useful as a barium enema for detection of tumors, but may use a lower radiation dose. CT VC is increasingly being used in the UK as a diagnostic test for bowel cancer and can negate the need for a colonoscopy. The radiation dose for a particular study depends on multiple factors: volume scanned, patient build, number and type of scan sequences, and desired resolution and image quality. In addition, two helical CT scanning parameters that can be adjusted easily and that have a profound effect on radiation dose are tube current and pitch. Computed tomography (CT) scan has been shown to be more accurate than radiographs in evaluating anterior inter-body fusion but may still over-read the extent of fusion. 15. Hazards and Disadvantages. Despite the many benefits mentioned, several hazards and disadvantages are present with CT imaging. One of the main hazards of CT imaging is the risk of allergic reaction (nephrotoxicity) to the contrast agent which may cause itching, hives or swelling of body parts. CT imaging involves exposure to small amount of ionized radiation which is considered a hazard for pregnant women and children. CT scanning may also involve uncomfortable body posture in order to obtain imaging of the desired body part. In addition, due to the physical shape of the CT equipment, claustrophobic patients may experience anxiety. Furthermore, early detection of diseases with CT scan may lead to more aggressive treatments such as chemotherapy or radiotherapy which may cause more serious side effects than if diseases were diagnosed based on symptoms. Early detection of diseases is also not 100% accurate. Hence, it may lead to confirmatory procedures, such as invasive biopsies, that in fact may not be necessary. 16. Recent Trends. 16.1 Perfusion CT. Any new CT scanner with a proper setup and advanced software can be used for Perfusion CT scanning. Perfusion CT is performed by periodic scanning of the patient prior to, during and subsequent to the injection of contrast agent
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containing iodine. It relies upon the extraction of functional information rather than anatomical data from the CT scan. Perfusion CT is a relatively new technique which is currently well established for brain imaging. It shows the volume and flow rate of blood present in the brain in addition to revealing the structure of brain tissue. Perfusion CT is useful for noninvasive diagnosis of cerebral ischemia (stroke), infarction, and assessment of cerebrovascular reserve for vascular stenoses. For instance, in case of an ischaemic stroke, perfusion CT can indicate whether brain tissues have died due to lack of blood, or whether some could be revived if corrective therapeutic treatments are provided. Perfusion CT can also be used to map tumors and assess their growth rate and stage. Although Perfusion CT scanning of other body organs such as liver or kidneys is currently feasible, it still requires further research to validate its use in some conditions. 16.2 PET/CT. The PET/CT scanner stands for positron emission tomography combined with computed tomography scanner. PET provides information regarding growth of tissues within the body by monitoring glucose metabolism whereas CT provides detailed information about the location, size, and shape of various body parts and lesions. The PET and CT technologies are integrated in the PET/CT scanner to provide both metabolic and anatomical information simultaneously. Metabolic activities of organs appear as colored images in PET/CT scan due to the chemical changes in tissues. For example, cancerous tumors are more active than normal tissues and hence appear in different colors. This combined information allows for higher accuracy in detecting tumors and locating different cancers such as breast, esophageal, cervical, melanoma, lymphoma, colorectal, and ovarian cancer. PET/CT also reduces errors in biopsy sampling, improves radiotherapy planning, and enhances the assessment of response to treatments such as chemotherapy.
17. References.
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Boas, F. Edward. "Evaluation of Two Iterative Techniques for Reducing Metal Artifacts in Computed Tomography." Radiology. 25 Feb. 2011. Web. 22 Oct. 2011. <http://radiology.rsna.org/content/early/2011/02/25/radiol.11101782.abstract>. "Computerized Tomography (CT)." Online Encyclopedia Britannica. Encyclopedia Britannica. Web. 22 Oct. 2011. <http://www.britannica.com/EBchecked/topic/130695/computed-tomography-CT>. "Computerized Tomography." Merriam Webster. Merriam Webster. Web. 22 Oct. 2011. <http://www.merriam-webster.com/dictionary/computed+tomography>. Cunningham, Ian A., and Philip F. Judy. The Biomedical Engineering Handbook: Second Edition. Ed. Joseph D. Bronzino. Sm-7. CRC Press LLC, 2000. Web. 22 Oct. 2011. <sm-7.net/upload/Detali mashin/bmt/The Biomedical Engineering Handbook - 2Ed - Bronzino/ch062.pdf>. Eliseleblanc. "CT: History and Development." WikiRadiography. 20 June 2009. Web. 22 Oct. 2011. <http://www.wikiradiography.com/page/CT+History+ %26+Development>. Gedgaudas-McClees, R. K, and W. E. Torres. Essentials of Body Computed Tomography. Ed. M. Greenberg. Saunders (W.B.) Co, 1990. Print. Gerhardt, P., and Gerhard Van Kaick. Total Body Computerized Tomography: International Symposium. Heidelberg, 1977. Print. Hendee, W. R. Cross Sectional Medical Imaging: A History. 1155-180. Print. Herman, Gabor T. Fundamentals of Computerized Tomography: Image Reconstruction from Projections (Advances in Computer Vision and Pattern Recognition). 2nd ed. Springer, 2009. Print.
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Hsieh, Jiang. Computed Tomography: Principles, Design, Artifacts, and Recent Advances. SPIE Publications, 2003. Print. Kim, K. W., B. I. Choi, and J. K. Han. "Postoperative Anatomic and Pathologic Findings at CT Following Gastrectomy." Radiographics 22 (2002): 323-36. Print. Klingebiel, R., M. Busch, G. Bohner, C. Zimmer, O. Hoffmann, and F. Masuhr. "Multislice CT Angiography in the Evaluation of Patients with Acute Cerebrobascular DiseaseA Promising New Diagnostic Tool." Journal of Neurology 249 (2002): 43-49. Print. Kopp, A. F., K. Klingenbeck-Regn, M. Heuschmid, A. Kttner, B. Ohnesorge, and T. Flohr. "Schaller S. and Claussen, C. D., Multislice Computed Tomography: Basic Principles and Clinical Applications." Electromedia 68 2 (2000): 94-105. Print. Mahesh, Mahadevappa. "Search for Isotropic Resolution in CT from Conventional through Multiple-Row Detector." Radiological Society of North America. RadioGraphics, July-Aug. 2002. Web. 22 Oct. 2011. <http://radiographics.rsna.org/content/22/4/949.full>. Modic, M. Multislice CT. Ed. M. F. Reiser, M. Takahashi, and C.R. Becker. 2nd ed. Berlin: Springer-Verlag, 2004. Print. Nemirovsky, Jonathan, Asaf Lifshitz, and Ilan Be'ery. "Tomographic Reconstruction of Incompressible Flow." AIP. 25 May 2011. Web. 22 Oct. 2011. <http://rsi.aip.org/resource/1/rsinak/v82/i5/p055115_s1?isAuthorized=no>. Pasler, Friedrich. Radiology (Color Atlas of Dental Medicine). Thieme, 1993. Print.
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Prokop, Mathias, Michael Galanski, Aart J. Van Der Molen, and Cornelia SchaeferProkop. Multislice Computed Tomography of the Body. 2nd ed. Thieme, 2003. Print. "Radiography." Wikipedia: the Online Encyclopedia. 17 Sept. 2011. Web. 22 Oct. 2011. <http://en.wikipedia.org/wiki/Radiography>. Seeram, Euclid. Computed Tomography: Physical Principles, Clinical Applications, and Quality Control. Vol. 1. Saunders, 1994. Print. SIEMENS Medical. Computerized Tomography: Its History and Technology. SIEMENS Medical. Siemens Medical. Siemens. Web. 22 Oct. 2011. <http://www.medical.siemens.com/siemens/en_US/gg_ct_FBAs/files/brochures/CT _History_and_Technology.pdf>. Whaites, Eric. Essentials of Dental Radiography and Radiology. 3rd ed. Churchill Livingstone, 2002. Amazon. ELSEVIER Science. Web. 22 Oct. 2011. <http://www.amazon.co.uk/Essentials-Dental-Radiography-RadiologyWhaites/dp/044310168X>. "X-ray Computerized Tomography." Wikipedia: the Online Encyclopedia. 19 Oct. 2011. Web. 22 Oct. 2011. <http://en.wikipedia.org/wiki/X-ray_computed_tomography>. "X-ray." Online Encyclopedia Britannica. Encyclopedia Britannica. Web. 22 Oct. 2011. <http://www.britannica.com/EBchecked/topic/650351/X-ray>.
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Research title: Computerized Assisted Tomography (CAT/CT) Submitted to: Prof. Dr. Moshira M.

Abdul Latif By: Ahmed T. M. El-Shanawany ---------------

OPT PAT PET PET-CT SPECT TAT UOT CT, CATScan

X-ray Zeeman effect

11/8/1895; Discovery of X-ray radiation.

1903. E.A.O. Pasche builds a collimator for suppressing scattered radiation

First Generation: Parallel-Beam Geometry.

Second Generation: Fan Beam, Multiple Detectors.

Third Generation: Fan Beam, Rotating Detectors.

Fourth Generation: Fan Beam, Fixed Detectors.

Fifth Generation: Scanning Electron Beam.

Partial volume effect

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