hello everybody and welcome to the CT

Physics course this is the first in a

series of videos that build on from one

another and the purpose of today's talk

is just to provide an introduction a

road map that you can use to plot your

journey through CT physics and we're

going to start at the very beginning by

defining what exactly CT is and looking

at the CT machine you can see the CT

machine here with the outer Gantry the

table which the patient lies on and

lasers to ensure that the patient's

lying directly in the middle of the CT

machine and you'll see why that becomes

important later on if I remove this

outer casing we can see the inner

workings of the CT machine an x-ray

Source the place where the patient is

going to lie and then detectors here now

at its very core CT or computer

tomography utilizes x-ray radiation to

generate attenuation data through a

single slice of a patient around

multiple different angles around that

patient the word tomography has its

origins in the Greek word Thomas meaning

section or slice we're taking a picture

of a section or slice of the patient now

this CT machine is going to need to

rotate around the patient and whilst

we're rotating the CT machine we're

Gathering attenuation data from all

different angles around that patient all

of that data is gathered by these

detector elements here and it's going to

be digitized and stored and later

processed into an image the process of

processing that data into an image is

complex it's computationally heavy and

it can only feasibly be done by

computers hence the term computed

tomography now we're going to look at

these processes in a bit more detail

here in future talks we're going to come

back to each one of these topics and

fill in all the finer details so we have

our CT machine here and it's rotating

rapidly around a patient like this all

the while Gathering data now let's look

at what happens in a single rotation of

this CT machine we're going to place a

fake patient in the middle here a very

simple patient the dark regions here are

not attenuating any x-rays these lighter

regions are attenuating X-rays to some

degree

what we can do is plot the degree of

attenuation on a graph you can see this

graph here the part where the X-ray is

traveling through the most attenuating

material is going to give us our highest

attenuation value as we head out to the

peripheries of these objects they get

thinner essentially there's less

distance for the x-rays to travel

through those objects and you can see

how attenuation tapers off here the

regions where there's no x-ray

attenuation we've got no attenuation

plotted on our graph now what we can do

is change the angle of the CT or the

incident x-rays as the CT machine

rotates and we can see how that data

changes when we change the angle here

there're going to be certain points

where x-rays are going to pass between

these two objects and create two

separate regions of attenuation on our

graph here this x axis on our graph

represents the detector here and we can

digitize these values here these analog

values here and plot them over time on

something that's known as a sinogram

which I'm going to show you how that's

generated here let's look at one

rotation of this CT machine here see how

the graph is changing and see how we're

generating that cogram now obviously

this is an extremely simple example the

human body has tissues with differing

attenuation and it's complex it's not

just two single objects within the human

body what we're going to do is generate

this data here the sinogram that we've

generated here shows us how the

attenuation within the tissues have

changed over time one and as time passes

we also changing the angle of incidence

towards the patient here we're rotating

the CT machine around here so this is

showing different angles the data at

different angles along the one single

rotation of the CT machine what we can

then do here is store that data but also

process that data and turning that data

into an image that we can use clinically

is what's known as image reconstruction

data processing and ultimately display

of an

image acquiring the image and storing

the image is a separate process we're

going to to label that data acquisition

and storage importantly data acquisition

the scanning parameters that we choose

initially here the tube Peak voltage the

filament current the region of anatomy

the coverage that we're going to cover

with a patient the pitch of our CT

machine the relationship between how

fast the patient is moving through the

CT scanner and how fast the CT scanner

is rotating or whether we're going to

use contrast all of these decisions that

we make at this data acquisition part of

our CT scan are decisions that are made

once once we've acquired that data we

can't then go and change the data that

we're recording here if we wanted a

different set of data we would have to

repeat that CT scan on the other end of

the spectrum we can create multiple

different types of images using

different algorithms depending on the

clinical question or the image that

we're trying to create here we're going

to cover all of these processes in later

talks we're going to look at back

projection we'll look at the convolution

kernels or algorithms of filtered back

projection we'll look at F

transformation and F based

reconstruction as well as iterative

reconstruction which is the most

commonly used in current CT systems now

I've said to you that the data that

we've Acquired and stored we can process

to create different types of images

depending on what we're looking for

clinically essentially what we've

created here is a matrix of attenuation

values at specific locations within an

array we're looking at a single slice of

a patient and each pixel within this

image correlates to a specific voxal

within the patient a small volume of

tissue at a specific location in that

patient now let's have a closer look at

what we can do with this Matrix or this

array of data to manipulate the images

that we're

creating I've said to you each point in

this image each pixel in this image has

an attenuation value now we use a value

known as a houndsfield unit a

houndsfield unit correlates to the

degree of attenuation at a specific

point or a specific pixel within an

image and that houndsfield unit has been

standardized relative to the attenuation

of water we say that water has an

attenuation value of zero houndsfield

units anything that attenuates x-rays

less than water is going to have

negative Hound field unit values

anything that's more dense or attenuates

x-rays more than water is going to have

positive houndsfield unit values now we

can't see numbers we can't look at a

table of numbers and say oh that's

definitely a brain what we need to do is

convert that into an image that we can

visually process and we do that by

applying the gray scale and matching

that to specific houndsfield

units now we can move that gray scale we

can spread out that gray scale and

correlate that grayscale to specific

houndsfield units which represent the

degree of attenuation you can see with

this current grayscale value we've got

bone being very bright and water being

almost black here now what we've done

essentially is we've created an array

we've created a table of numbers that

correlate to specific locations within

this image that array has numbers for it

houndsfield units representing

attenuation representing a single slice

within a patient now with CT scanning we

create multiple arrays that we can stack

on top of one another and because we can

stack the data on top of one another and

correlate those harfield units to

specific gray scale values what we can

create is a scrollable axial image here

we can scroll through the anatomy scroll

through that array of numbers now we've

also created a stack of arrays and

they're the same dimensions and they're

representing continuous regions of

anatomy within the

patient why can't we take that array and

cut it at a different angle and

represent the houndsfield units from

that angle that's exactly what we can do

in multipler reformatting we can take

our original data set and create coronal

images sagittal images from the same

data set these are representing the same

data that was acquired in that initial

image because it's from the same data

set we can cross-correlate accurately

between these images you can see these

faint green L here represent exactly

where our axial slice is located exactly

where our sagittal plane is and exactly

where our coronal plane is here I've

isolated the pineal gland which is

highly attenuating to x-rays it's been

calcified here and we can

cross-correlate in this multiplan AR

reformatting we don't have to take

different images in the coronal plane

and in the sagittal planee and somehow

stitch them
together now we've allocated a specific

grayscale value to specific houndsfield

units here what if we were interested in

say just the bones what we can do is

shift that grayscale across to the

houndsfield units that correlate mostly

to Bones anything outside of the regions

of that grayscale is either going to be

completely black or completely white

what we've done is shifted the grayscale

window this process is called windowing

we've created here a bone windowed CT

scan and this process of moving the

window changing the window level and

changing the window width is going to be

the subject of a complete talk where we

look at houndsfield units and window

essentially with this data set that

we've created there are hundreds of

different ways that we can manipulate

this data and display the data

differently depending on the clinical

question that we're answering we can

even figure out where the surfaces are

here and place an external an artificial

external light source and creates a 3D

image like this where it looks like a

light is shining on the surface of the

bones here we're getting Shadows formed

this is all computer algorithms from the

same initial data set the possibilities

here are endless but it relies on the

fact that we've taken the sufficient

data initially in that data acquisition

mode so we've looked now at data

acquisition and we've looked at image

processing those are two of the three

major facets in CT Imaging the third

facet is the patient is the CT scan

going to answer the clinical question

that we're after are there other

examinations or investigations that we

can do that will still provide us with

the same clinical answer without

exposing the patient to ionizing

radiation what region of anatomy do we

need to cover do we need to give

contrast these are all decisions that we

need to make with regards to the patient

themselves it's these three facets that

we need to think about when acquiring a

CT scan because they all relate to the

two major outcomes of CT scanning the

first is image quality is this CT scan

going to be of sufficient quality that

allows us to make a diagnosis or allows

us to rule out a

diagnosis that comes at the tradeoff of

radiation dose we're always trying to

minimize radiation dose we're exposing

the patient to x-rays to ionizing

radiation often over large regions of

anatomy now these two qualities these

two outcomes are often opposing when we

try and increase image quality we often

have to do that by increasing radiation

dose the same goes with trying to reduce

radiation dose we're often reducing

image quality and I would encourage you

throughout this course to keep these two

outcomes at the Forefront of your mind

they're incredibly important you'll see

that these type of questions come up

over and over again in exams and rightly

so because they're so important if any

of you have done any of my previous

physics past paper question banks that

I'll link below in the description

you'll know that I take questions from

past papers and rank them in order of

frequency I try and bring up the most

common questions that come up in exams

having looked at CT questions related to

image quality and radiation dose come up

over 40% of the time these are

incredibly important things that we need

to keep at the Forefront of our mind so

we've now looked at the three major

facets and we've looked at image quality

and radiation dose we're going to go

into each one of these in later talks

and I want to shift gears a little bit

and look at something that I feel is

foundational to CT before we go into the

specific lectures

whenever you're learning a new subject

there's often a topic that you need to

know in order to understand that subject

if you were trying to learn a new

language that utilized a different

alphabet system to the one that you're

used to there's no ways that you'll be

able to learn that language to read that

language to write in that language to

understand that language without knowing

the alphabet of that language for me

this is the alphabet of CT you may have

thought to yourself can't I take a

frontal radio graph and a lateral radio

graph put them at right angles to one

another and cross-correlate the

attenuation data and create a CT after

all we've exposed the region of anatomy

that we're interested in at two separate

angles surely we can see from the front

see from the side and see where that

attenuation is going to be and

ultimately plot a CT scan can't we put

them at right angles take the specific

slice that we're interested in look at

the attenuation values on that specific

slice and then project those attenuation

values across the slice from the frontal

side and from the lateral side and then

somehow mathematically calculate where

these attenuation values cross and

figure out what the attenuation value is

at these crosshairs at these regions

here if you blow your eyes at this you

can see where the vertebrae are and

where the heart is you can see where the

lungs are less attenuating lungs and you

can see where x-rays aren't passing

through any patient at all they're

unattenuated they're transmitted all the

way through to our detector is there not

some way that we can create a CT scan

from this well I want to show you why

that's impossible why we need multiple

views and why CT is so data in intensive

by creating all of this data at

different angles let's take a simple

Matrix that's 2x two we've got four

variables here we're trying to figure

out the attenuation of these four

variables WX Y and Zed if we were to

take a frontal radiograph of these four

variables we place detectors on the one

side of the patient and we pass x-rays

through that patient we can get

attenuation calculations here how much

those x-rates have been attenuated we

can can do the same from

90° effectively taking a lateral radio

graph of this 4x4 Matrix we've now

created attenuation values for the rows

and the columns in this Matrix we can

then go about working out how these

atation values have come about we can

add these two variables do the same here

and do the same from our different view

we've essentially created four separate

equations that will help us to calculate

what these variables are got four

variables and four equations and if you

know anything about simultaneous

equations this will be enough to go and

calculate the values of these variables

you see this adds up to 7 13 5 and 15 we

can confidently say that these are the

attenuation values in each one of these

pixels within the Matrix and we can

apply a gray scale to those if we want

to create an image so we've created a

very basic image here in our image we've

got 512 by 512 pixels can this be

extrapolated out further when we

increase the number of pixels we've now

increased The Matrix size to 3 three

we've got nine variables here again we

can take a frontal and a lateral and

create different equations here now

we've created six separate equations

we've got six equations and nine

variables to calculate whenever you have

more variables than you have equations

like we have here you cannot confidently

calculate each of these variables in

fact we've got an infinite number of

solutions to this specific set of

variables now it doesn't mean mean that

we don't have Solutions I've said we've

got an infinite number of solutions we

could in fact allocate numbers here

attenuation values that make these

equations true this adds up to 16 10 10

7 16 and 13 so it's not saying that

there isn't an answer to this we've got

a patient that has specific attenuation

values there is an answer we can't

calculate with the data from those two

views with the data that we've got from

our detected we can't accurately

calculate these values here watch how

these numbers change here

but they still remain true for the

equations that we created these still

add up to 16 10 10 7 16 and 13 if we

were to apply a grayscale value say to

these this would be the image that we

generate that would still comply with

the equations that we've generated but

this image that we looked at previously

also answers the variables in these

equations that we've made we've created

two completely different images from the

two views that we've looked at so

hopefully that convinces you that we

can't just take a frontal or a lateral

radio graph now how many angles would we

need how many equations would we need to

say create this image here which has got

512 by 512 pixels well we would need to

generate more than a quarter million

equations to solve for this image here

you can see why it's called computed

tomography no human is feasibly going to

solve

262,000 different simultaneous

equations we're going to need at least

512 different views if we've got 512

detectors that will give us a number of

equations here now when I was looking at

this for the first time I kept coming

back to the fact that can't isn't there

another way to try and calculate these

without having to get all of those

simultaneous equations and what really

convinced me that there isn't another

way is by looking at a Sudoku and

hopefully this will make the penny drop

there are more possible sodoku than

there are stars in the sky there are so

many ways that you can make a sodoku

here yet we know that the rules of a

soku means that in each row and in each

column there needs to be the numbers 1

to n

that means that if we were to look at

these numbers in here as attenuation

values and then measure the degree of

attenuation as we went through the rows

and as we went through the columns all

of them would add up to 45 45 arbitary

units now later on we're going to look

at attenuation passing through a patient

it's not a linear process and we're

going to account for that later but

let's stick to the basics here this

Sudoku if we had two detectors would

detect 45 in each row in each column we

can now change that Sudoku we've still

got 1 to n in each column again those

detectors are not going to measure any

difference no matter what Sudoku we use

the detectors can't detect that change

they need multiple different angles they

need at least nine different angles here

if we were to have nine detectors to

create those 81 different simultaneous

equations and solve for these 81

variables now that's actually quite

powerful we've got more Sudoku than

there are stars in the sky yet we only

need with a nine detector CT scan we

only need nine different angles Les to

figure out where these variables are

placed you can see how powerful it is we

can get very accurate images and that's

a benefit of CT we get very good spatial

resolution and once we've acquired that

data and stored that data we can do so

much we can manipulate that data and

create multiple different images so

that's what I want to cover today the

three major facets of CT the patient

data acquisition and storage and image

processing a display and how they relate

to image quality and radiation dose and

then looking at why we need multiple

angles within a CT machine and hopefully

I've given you a feeling as to how we're

going to process that data and

ultimately create our image in our next

talk we're going to look at the inner

workings of a CT machine we're going to

go through each one of these components

and we're going to look at how a CT

machine is able to rotate like this

while simultaneously acquiring the data

now to do that we are going to actually

virtually build our own CT machine

together I'm going to take you through

each one of these steps and Des describe

the various components that we're adding

to create our CT machine we'll also look

at the generations of CT machines and

how we can change our scanning

parameters depending on the data that

we're trying to acquire again as a

reminder in the first line of the

description I've linked a question Bank

to date we've helped over 4,500 students

not only pass but excel in their

Radiology Physics Exam so if you're

studying for a physics exam it's a

really high yield resource to figure out

what you know what you don't know where

you need to work on more and where you

don't now I'll see you all in in the

next video where we're going to dive

into the CT machine the hardware itself

until then goodbye everybody