INTRODUCTION

DEFINITION / FACTS ABOUT CT

Computer tomography (CT), originally known as computed axial
tomography (CAT or CT scan) and body section rentenography as then it
was used only in axial plane. But now a days it is called as Computerized
Tomography because of its involvement in all the three planes (axial,
saggital, transverse)
it is a medical imaging method employing tomography where digital
geometry processing is used to generate a three-dimensional image of the
internals of an object from a large series of two-dimensional X-ray images
taken around a single axis of rotation.

The word "tomography" is derived from the Greek tomos (slice) and
graphein (to write). CT produces a volume of data which can be
manipulated, through a process known as windowing, in order to
demonstrate various structures based on their ability to block the X-ray
beam.

HISTORY

The first commercially viable CT scanner was invented by Godfrey

Newbold Hounsfield in Hayes, England at Thorn EMI Central Research
Laboratories using X-rays.

Hounsfield conceived his idea in 1967, and it was publicly announced in

1972.

It is claimed that the CT scanner was "the greatest legacy" of the Beatles; the
massive profits from their record sales enabled EMI to fund scientific
research.

Allan McLeod Cormack of Tufts University, Massachussetts, USA

independently invented a similar process and they shared a Nobel Prize in
medicine in 1979.

PIXEL AND VOXEL

The assimilated CT scan images consist of a 3D volume that consist of
volume elements( Voxel) and a smallest single component of the image on a
2D grid (Pixel).
Each Voxel is small in size (0.1-0.4mm for each face and hence the image
has a reasonably high resolution. Whereas the intensity,volume and value of
pixel can vary thus displaying multiple cominations of the data element.

SCOUT IMAGE IN Y AXIS-SAGGITAL VIEW

SCOUT IMAGE IN X AXIS - SAGGITAL VIEW

Indications of CT scan
CT scan images are used when patients are been fitted for implants. Surgeon
gets more information about anatomy of patients mouth before a dental
implant results in a better outcome.

 Width and density of jaw bone can be assist and exact placement of alveolar
nerve in order to prevent painful nerve damage.
It also helps to visualize never location prior to wisdom tooth extraction.

Prototype of CT scanner

The original 1971 prototype took 160 parallel readings through 180 angles,
each 1 apart, with each scan taking a little over five minutes. The images
from these scans took 2.5 hours to be processed by algebraic reconstruction
techniques on a large computer.
The first production X-ray CT machine (called the EMI-Scanner) was
limited to making tomographic sections of the brain, but acquired the image
data in about 4 minutes (scanning two adjacent slices) and the computation
time (using a Data General Nova minicomputer) was about 7 minutes per
picture.

 This scanner required the use of a water-filled Perspex tank with a preshaped rubber "head-cap" at the front, which enclosed the patient's head. The
water-tank was used to reduce the dynamic range of the radiation reaching
the detectors (between scanning outside the head compared with scanning
through the bone of the skull).

EMI SCANNER

Tomosynthesis
Simple motion of a tube and Detector was used before CT to create images
at a given depth.
All anatomy not at the target level was blurred. This gave a somewhat crude
image and was quickly replaced by CT.

With the advent of digital detectors and the ability to post process this
imaging method is making a comeback.

Generations
generation

configuration

first

detector

beam

Min scan time

Translate -rotate 1-2

Pencil thin

2.5min

second

Translate -rotate 3-52

Narrow fan

10sec

Third

Rotate- rotate

256-1000

Wide fan

0.5sec

fourth

Rotate- fixed

600-4800

Wide fan

1sec

fifth

Electron beam

1284

Wide fan electron 33ns

beam

1st & 2nd generation

In the first and second generation designs, the X-ray beam was not wide
enough to cover the entire width of the 'slice' of interest.
A mechanical arrangement was required to move the X-ray source and
detector horizontally across the field of view.
After a sweep, the source/detector assembly would be rotated a few degrees,
and another sweep performed.

 This process would be repeated until 360 degrees (or 180 degrees) had been
covered. The complex motion placed a limit on the minimum scan time at
approximately 20 seconds per image.
Third and fourth generation designs differ in the arrangement of the
detectors.
In 3rd generation, the detector array is as wide as the beam, and must
therefore rotate as the source rotates.
In 4th generation, an entire ring of stationary detectors are used.

Electron Beam CT
Electron beam tomography (EBCT) was introduced in the early 1980s, by
medical physicist Andrew Castagnini.

It is a method of improving the temporal resolution of CT scanners.

Because the X-ray source has to rotate by over 180 degrees in order to
capture an image the technique is inherently unable to capture dynamic
events or movements that are quicker than the rotation time.

Instead of rotating a conventional X-ray tube around the patient, the EBCT
machine houses a huge vacuum tube in which an electron beam is electromagnetically steered towards an array of tungsten X-ray anodes arranged
circularly around the patient.
Each anode is hit in turn by the electron beam and emits X-rays that are
collimated and detected as in conventional CT.

The lack of moving parts allows very quick scanning, with single slice
making the technique ideal for capturing images of the heart.

EBCT has found particular use for assessment of coronary artery calcium, a
means of predicting risk of coronary artery disease.

Helical or Spiral CT
Helical, also called spiral, CT was introduced in the early 1990s, with much
of the development led by Willi Kalender and Kazuhiro Katada.

In older CT scanners, the X-ray source would move in a circular fashion to

acquire a single 'slice', once the slice had been completed, the scanner table
would move to position the patient for the next slice; meanwhile the X-ray
source/detectors would reverse direction to avoid tangling their cables.

In helical CT the X-ray source are attached to a freely rotating gantry.

During a scan, the table moves the patient smoothly through the scanner;
the name derives from the helical path traced out by the X-ray beam.

It was the development of two technologies that made helical CT practical:

slip rings to transfer power and data on and off the rotating gantry, and the
switched mode power supply powerful enough to supply the X-ray tube, but
small enough to be installed on the gantry.

Multislice CT
Multislice CT scanners are similar in concept to the helical or spiral CT but
there are more than one detector ring.

It began with two rings in mid nineties, with a 2 solid state ring model
designed and built by Elscint (Haifa) called CT TWIN, with one second
rotation.

Later, it was presented 4, 8, 16, 32, 40 and 64 detector rings, with increasing
rotation speeds. Current models (2007) have up to 3 rotations per second,
and isotropic resolution of 0.35mm voxels with z-axis scan speed of up to 18
cm/s.

This resolution exceeds that of High Resolution CT techniques with singleslice scanners, yet it is practical to scan adjacent, or overlapping, slices however, image noise and radiation exposure significantly limit the use of
such resolutions.

The major benefit of multi-slice CT is the increased speed of volume

coverage. This allows large volumes to be scanned at the optimal time .
The ability of multi-slice scanners to achieve isotropic resolution even on
routine studies means that maximum image quality is not restricted to
images in the axial plane - and studies can be freely viewed in any desired
plane.

Dual Source CT
Siemens introduced a CT model with dual X-ray tube and dual array of 64
slice detectors, at the 2005 Radiological Society of North America (RSNA)
medical meeting.

Dual sources increase the temporal resolution by reducing the rotation angle
required to acquire a complete image, thus permitting cardiac studies
without the use of heart rate lowering medication, as well as permitting
imaging of the heart in systole.

The use of two x-ray units makes possible the use of dual energy imaging.

Diagnostic use
Since its introduction in the 1970s, CT has become an important tool in
medical imaging to supplement X-rays and medical ultrasonography.
Although it is still quite expensive, it is the gold standard in the diagnosis of
a large number of different disease entities.
It has more recently used for preventive medicine or screening for disease,
for example CT colonography for patients with a high risk of colon cancer.

Although a number of institutions offer full-body scans for the general

population, this practice remains controversial due to its lack of proven
benefit, cost, radiation exposure.

Advantages
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.
Third, 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.

Hazards : Adverse reactions to contrast agents

Because CT scans rely on intravenously administered contrast agents in
order to provide superior image quality, there is a low but non-negligible
level of risk associated with the contrast agents themselves.
Certain patients may experience severe and potentially life-threatening
allergic reactions to the contrast dye.
The contrast agent may also induce kidney damage. The risk of this is
increased with patients who have preexisting renal insufficiency, preexisting
diabetes, or reduced intravascular volume.

 In general, if a patient has normal kidney function, then the risks of contrast
nephropathy are negligible.
Patients with mild kidney impairment are usually advised to ensure full
hydration for several hours before and after the injection.
For moderate kidney failure, the use of iodinated contrast should be avoided;
this may mean using an alternative technique instead of CT e.g. MRI.

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.

Many data scans are progressively taken as the object is gradually passed
through the gantry.

 They are combined together by the mathematical procedure known as

tomographic reconstruction.
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.

Windowing
Windowing is the process of using the calculated Hounsfield units to make
an image.
The various radiodensity amplitudes are mapped to 256 shades of gray.
These shades of gray can be distributed over a wide range of HU values to
get an overview of structures.
Alternatively, these shades of gray can be distributed over a narrow range of
HU values (called a "narrow window") centered over the average HU value
of a particular structure to be evaluated. In this way, variations in the internal
makeup of the structure can be discerned. This is a commonly used image
processing technique known as contrast compression.
This scale of relative densities is based on air (-1000) ,
Water (0),dense bone(+1000)

 For example, to evaluate the abdomen in order to find Smalll masses in the
liver, one might use liver windows . Choosing 70 HU as an average HU
value for liver, the shades of gray can be distributed over a narrow window
or range. One could use 170 HU as the narrow window, with 85 HU above
and 85 HU below it, with 70 HU average value; Therefore the liver window
would extend from -15 HU to +155 HU.
All the shades of gray for the image would be distributed in this range of
Hounsfield values.
Any HU value below -15 would be pure black, and any HU value above 155
HU would be pure white in this example.
Using this same logic, bone windows would use a "wide window" (to
evaluate everything from fat-containing medullary bone that contains the
marrow, to the dense cortical bone) .

Artifacts
Although CT is a relatively accurate test, it is liable to produce artifacts,
such as the following:
Aliasing Artifact or Streaks
These appear as dark lines which radiate away from sharp corners.

It occurs because it is impossible for the scanner to 'sample' or take enough

projections of the object, which is usually metallic. It can also occur when
aninsufficient penetration of the x-ray occurs.

 Ring Artifact
Probably the most common mechanical artifact, the image of one or many
'rings' appears within an image. This is due to a detector fault.
Noise Artifact
This appears as gaining 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 kV or mA is too low.
Motion Artifact
This is seen as blurring which is caused by patient movement. This is not so
much a problem these days with faster scanning times in the use of MDCT.
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 .
Three dimensional (3D) Image Reconstruction
The principle
Because contemporary CT scanners offer isotropic, or near isotropic
resolution, display of images does not need to be restricted to the
conventional axial images.
Instead, it is possible for a software program to build a volume by 'stacking'
the individual slices one on top of the other. The program may then display
the volume in an alternative manner.

Multiplanar reconstruction
Multiplanar reconstruction (MPR) is the simplest method of reconstruction.

A volume is built by stacking the axial slices. The software then cuts slices
through the volume in a different plane (usually orthogonal).

Optionally, a special projection method, such as maximum-intensity

projection (MIP) or minimum-intensity projection (mIP), can be used to
build the reconstructed slices.
Fig.showing 1 3D and 3 MPR views

 MPR is frequently used for examining the spine. Axial images through the
spine will only show one vertebral body at a time and cannot reliably show
the intervertebral discs. By reformatting the volume, it becomes much easier
to visualise the position of one vertebral body in relation to the others.
MIP reconstructions enhance areas of high radiodensity, and so are useful for
angiographic studies.

mIP reconstructions tend to enhance air spaces so are useful for assessing
lung structure.

3D rendering techniques
Surface rendering
A threshold value of radiodensity is chosen by the operator (e.g. a level that
corresponds to bone). A threshold level is set, using edge detection image
processing algorithms.
From this, a 3-dimensional model can be constructed and displayed on
screen.
Multiple models can be constructed from various different thresholds,
allowing different colors to represent each anatomical component such as
bone, muscle, and cartilage.
However, the interior structure of each element is not visible in this
mode of operation

 Volume rendering
Surface rendering is limited in that it will only display surfaces which meet a
threshold density, and will only display the surface that is closest to the
imaginary viewer.

In volume rendering, transparency and colors are used to allow a better

representation of the volume to be shown in a single image - e.g. the bones
of the pelvis could be displayed as semi-transparent, so that even at an
oblique angle, one part of the image does not conceal another.

3D rendering software
Some examples of CT 3D surface rendering software include
Mimics, 3D doctor, Amira....etc
Some examples of CT 3D volume rendering software include 3D doctor,
ScanDoc-3D....etc

Image segmentation
Segmentation (image processing)
Where different structures have similar radiodensity, it can become impossible to
separate them simply by adjusting volume rendering parameters. The solution is
called segmentation, a manual or automatic procedure that can remove the
unwanted structures from the image
A volume rendering of this volume clearly shows the high density bones
Bone reconstructed in 3D

Using

segmentation tool
to remove the bone
to

show

vessels
Brain
vessels

reconstructed in 3D after bone has been removed by segmentation

brain

CONCLUSIONS
This paper discusses the possibilities of computer tomography in human
body/materials research. In this large interdisciplinary field not only high
quality 2D and 3D images of the internal structure of the body/material can
be obtained but with intelligent processing of the data even quantitative
information.

BIBLIOGRAPHY
Essentials of oral and maxillofacial radiology Freny R Karjodkar (2 nd
edition )
Oral radiology White and Pharoah
(5th and 6th edition)