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Computed tomography
Yesenia Soto and Ass. Pr. Mirjan M. Nadrljanski et al.

Computed tomography (CT) scanning, also known as, especially in the older

literature and textbooks, computerized axial tomography (CAT) scanning, is a
diagnostic imaging procedure that uses x-rays to build cross-sectional
images ("slices") of the body. Cross-sections are reconstructed from
measurements of attenuation coefficients of x-ray beams in the volume of the
object studied.

CT is based on the fundamental principle that the density of the tissue passed by
the x-ray beam can be measured from the calculation of the attenuation
coefficient. Using this principle, CT allows the reconstruction of the density of the
body, by two-dimensional section perpendicular to the axis of the acquisition
system.

The CT x-ray tube (typically with energy levels between 20 and 150 keV), emits
N photons (monochromatic) per unit of time. The emitted x-rays form a beam
which passes through the layer of biological material of thickness delta x. A
detector placed at the exit of the sample, measures N + deltaN photons, delta N
smaller than 0. Attenuation values of the x-ray beam are recorded and data used
to build a 3D representation of the scanned object/tissue.

There are basically two processes of the absorption: the photoelectric effect and

the Compton effect. This phenomenon is represented by a single coefficient, mju.

In the particular case of the CT, the emitter of x-rays rotates around the patient
and the detector, placed in diametrically opposite side, picks up the image of a
body section (beam and detector move in synchrony).

Unlike x-ray radiography, the detectors of the CT scanner do not produce an

image. They measure the transmission of a thin beam (1-10 mm) of x-rays
through a full scan of the body. The image of that section is taken from different
angles, and this allows to retrieve the information on the depth (in the third
dimension).

In order to obtain tomographic images of the patient from the data in "raw" scan,

the computer uses complex mathematical algorithms for image reconstruction.

If the x-ray at the exit of the tube is made monochromatic or quasi-

monochromatic with the proper filter, one can calculate the attenuation
coefficient corresponding to the volume of irradiated tissue by the application of
the general formula of absorption of the x-rays in the field (see Figure 1).

The outgoing intensity I(x) of the beam of photons measured will depend on the
location. In fact, I(x) is smaller where the body is more radio-opaque.

Hounsfield chose a scale that affects the four basic densities, with the following
values:

● air = -1000
● fat = -60 to -120
● water = 0
● compact bone = +1000
The image of the section of the object irradiated by the x-ray, is reconstructed
from a large number of measurements of attenuation coefficient. It gathers
together all the data coming from the elementary volumes of material through the
detectors. Using the computer, it presents the elementary surfaces of the
reconstructed image from a projection of the data matrix reconstruction, the tone
depending on the attenuation coefficients.

The image by the CT scanner is a digital image and consists of a square matrix

of elements (pixel), each of which represents a voxel (volume element) of the
tissue of the patient.

In conclusion, a measurement made by a detector CT is proportional to the sum

of the attenuation coefficients.

The typical CT image is composed of 512 rows, each of 512 pixels, i.e., a square
matrix of 512 x 512 = 262144 pixels (one for each voxel). In the process of the
image, the value of the attenuated coefficient for each voxel corresponding to
these pixel needs to be calculated.

Each image point is surrounded by a halo-shaped star that degrades the contrast
and blurs the boundary of the object. To avoid this, the method of filtered back
projection is used. The action of the filter function is such that the negative value
created is the filtered projection, when projected backwards, is removed, and an
image is produced, which is the accurate representation of the original object.

The CT scan deals with the attenuation of the x-rays during the passage through
the body segment. However, several features distinguish it from conventional
radiology: the image is reconstructed from a large number of measurements of
attenuation coefficient.

Before the data are presented on the screen, the conventional rescaling was
made into CT numbers, expressed in Hounsfield Units (HU), as mentioned
before. CT numbers based on measurements with the EMI scanner invented by
Sir Godfrey Hounsfield  , a Nobel prize winner for his work in 1979, related the
6

linear attenuation coefficient of a localized region with the attenuation coefficient

of water, the multiplication factor of 1000 is used for CT number integers. 

So, the signal transmitted by the detector is processed by the PC in the form of
the digital information, the CT image reconstruction.

Cases and figures


Figure 1


Image 1: CT scanner

Image 2: CT scanner internals

CT scanner (evolution)
Dr Daniel J Bell◉ and Dr Aditya Shetty◉ et al.

CT scanners were first introduced in 1971 with a single detector for brain study under the leadership of Sir
Godfrey Hounsfield, an electrical engineer at EMI (Electric and Musical Industries Ltd). Thereafter, it has
undergone multiple improvements with an increase in the number of detectors and decrease in the scan time.

First generation 
● detectors: one
● type of beam: pencil-like X-ray beam
● tube-detector movements: translate-rotate
● duration of scan (average): 25-30 mins

Second generation 
● detectors: multiple (up to 30)
● type of beam: fan-shaped x-ray beam
● tube-detector movements: translate-rotate
● duration of scan (average): less than 90 sec

Third generation 
● detectors: multiple, originally 288; newer ones use over 700 arranged in an arc
● type of beam: fan-shaped x-ray beam
● tube-detector movements: rotate-rotate
● duration of scan (average): approximately 5 sec
Fourth generation
● detectors: multiple (more than 2000) arranged in an outer ring which is fixed
● type of beam: fan-shaped x-ray beam
● tube-detector movements: rotate-fixed 
● duration of scan (average): few seconds

Other technologies
Other CT technologies have been adapted to third and fourth generation scanners, including:

● helical ("spiral") image acquisition

o used in all modern CT machines
o slip-ring technology made helical acquisition possible
● dual energy CT scanning

Practical points
● third and fourth generation scanner technologies are both used in many health care settings
o the fourth generation is a fundamentally different acquisition method, but the resulting image quality is
similar to the third generation for most applications

Helical CT image acquisition

Dr Daniel J Bell◉ and Dr Matt A. Morgan◉ et al.

Helical ("spiral") CT image acquisition was a major advance on the

earlier stepwise ("stop and shoot") method.

With helical CT, the patient is moved through a rotating x-ray beam and detector
set. From the perspective of the patient, the x-ray beam from the CT traces a
helical path. The helical path results in a three-dimensional data set, which can
then be reconstructed into sequential images for a stack. 

Helical CT allows a scan to be performed in a single breath-hold.

Most modern CT protocols use helical acquisition due to its speed and because it
reduces misregistration from patient movement or breathing. Sequential
scanning (step-and-shoot) acquisition is still used in some situations (e.g. helical
acquisition can lead to artifacts on head CT).
The radiation dose administered during helical acquisition depends on the speed
of the patient through the scanner, also known as the pitch.