Biomedical Imaging Systems

Chapter three
Computed Tomography
 Introduction

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 History
(Early 1900’s) Alessandro Vallebona (Italy) had the idea of
taking slices of the body for imaging (Tomography)
(1971) First CT Scan performed
(1974) CT Scanners installed
The inventors of the CT scan are credited as Godfrey
Hounsfield (Britain) and Allan Comrack (South Africa).

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 State of the
Art
• Widely prevalent
• Over the past 20
years their use has
increased greatly
• 3D imaging, and
better clarity

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5
6
Computed Tomography
- Introduction
• Computed Tomography, CT for short (also referred to as CAT, for Computed Axial
Tomography), utilizes X-ray technology and sophisticated computers to
create images of cross-sectional “slices” through the body.

• CT exams and CAT scanning provide a quick overview of pathologies and enable
rapid analysis and treatment plans.

• Tomography is a term that refers to the ability to view an anatomic section or slice
through the body.

• Anatomic cross sections are most commonly refers to transverse axial tomography.

• The CT scanner was developed by Godfrey Hounsfield in the very late 1960s.

• This x-ray based system created projection information of x-ray beams passed
through the object from many points across the object and from many
angles (projections).

• CT produces cross-sectional images and also has the ability to differentiate tissue
densities, which creates an improvement in contrast resolution.
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Computed Tomography
- Introduction
• The x-ray tube in a CT scanner is designed to produce a fan shaped beam of x-rays
that is approximately as wide as your body.

• Tissue attenuation is measured over a large region from one position of the x-ray tube

• The x-ray tube on a CT scanner is more heavy duty than tubes used for standard film
imaging since the unit rotates.

• Opposite the patient is an array of detectors that measure the intensity of the x-
ray beam at points laterally across the patients body.

• Modern CT scanners use solid state detectors that have very high efficiency at the
low energy of x-rays produced by CT scanners.

• Solid state detectors are made of a variety of materials that create a

semiconductor
junction similar to a transistor.

• Ultrafast ceramic detectors use rare earth elements such as silicon, germanium,
cadmium, yttrium or gadolinium, which create a semiconducting p-n junction.

• f Ceramic
o r m an array of very small, efficiMfast,
eendci tacan
di eagtbee cextremely
t o r s that can cover
anda are
large
1- Ja n- 19 l m i ng m o da il esit 8
solid-detectors are very stable, produced
Computed Tomography
- The basics

• The x-rays are produced in a part of the ring and the ring is able to rotate around
the patient.

• The target ring contains an array of detectors and is internally cooled so the to
reduce electronic noise and to cool the anode.

• The patient is put into the system using a precise high speed couch.

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Introduction
• Posteroanterior and lateral
chest radiographs give 3D
information concerning the
location of an abnormality.
• In CT, the two views shown
here are extended to
almost 1,000 views, and
with
appropriate computer
processing true 3D
information concerning the
patient's anatomy can be
 Tomography
 Computed tomography (CT) is a medical imaging method
employing tomography.
 The word "tomography" is derived from the Greek τoµoς
(slice) and γραφιν (to write).
 A large series of 2D X-ray images (slices) of the inside of
an
object are taken around a single axis of rotation.
 Digital geometr y processing is used to generate 3D images of
the object from those slices.
 X-ray tube at x-ray lube
T2 ------
atT1 position
- .,.

From T1lo
T2

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Prllll
clple

of
Tomo
Tomography
 Tomographic images

• The tomographic image is a picture of a slab of the

patient’s
anatomy
• The 2D CT image corresponds to a 3D section of the
patient
• CT slice thickness is very thin (1 to 10 mm) and is
approximately uniform
• The 2D array of pixels in the CT image corresponds to
an equal
number of 3D voxels (volume elements) in the patient

• Each pixel on the CT image displays the average x-ray

attenuation
 Modern CT
1. gantry aperture scanner
(720mm diameter)
2. microphone
3. sagittal laser alignment
light
4. patient guide lights
5. x-ray exposure
indicator
light
6. emergency stop
buttons
7. gantry control panels
8. external laser
alignment lights
9. patient couch
10. ECG gating monitor
 CT Gantry –Internal
1.
structure
x-ray tube
2. filters, collimator, and
reference detector
3. internal projector
4. x-ray tube heat
exchanger (oil cooler)
5. high voltage generator
(0-75kV)
6. direct drive gantry
motor
7. rotation control unit
8. data acquisition system
(DAS)
9. detectors
10. slip rings
Generations of CT
1st generation: rotate/translate, pencil beam

Only 2 x-ray detectors used (two different slices)

Parallel ray geometry
Translated linearly to acquire 160 rays across a 24 cm
FOV
Rotated slightly between translations to acquire 180
projections at 1-degree intervals
About 4.5 minutes/scan with 1.5 minutes to reconstruct
slice
 1st generation (cont.)
Large change in signal due to increased x-ray flux
outside of head
Solved by pressing patient’s head into a flexible
membrane
surrounded by a water bath
NaI detector signal decayed slowly, affecting
measurements made temporally too close together
Pencil beam geometry allowed very efficient scatter
reduction, best of all scanner generations
2nd generation: rotate/translate, narrow fan beam
Incorporated linear array of 30 detectors
More data acquired to improve image quality (600 rays x 540
views)
Shortest scan time was 18 seconds/slice
Narrow fan beam allows more scattered radiation to be detected
 3rd generation: rotate/rotate, wide fan beam
Number of detectors increased substantially (to more than
800 detectors)
Angle of fan beam increased to cover entire patient
Eliminated need for translational motion
Mechanically joined x-ray tube and detector array rotate
together
Newer systems have scan times of ½ second

Challenge: ring artifact

 Ring artifacts

• The rotate/rotate geometry of

3rd generation scanners leads to a
situation in which each detector
is responsible for the data
corresponding to a ring in the
image
• Drift in the signal levels of
the detectors over time affects
the t values that are
backprojected to produce the
CT image, causing ring
artifacts
Ring artifacts

• Ring artifacts
resulting from
defective detector
element in 3rd
generation single-
slice scanner.
 4th generation: rotate/stationary
Designed to overcome the problem of ring artifacts
Stationary ring of about 4,800 detectors
3rd vs. 4th generation
 5th generation: stationary/stationary

 Developed specifically for cardiac tomographic imaging

 No conventional x-ray tube; large arc of tungsten
encircles patient and lies directly opposite to the detector
ring.

 Electron beam steered around the patient to strike the

annular tungsten target.
 Capable of 50-msec scan times; can produce fast-frame-
rate
CT movies of the beating heart
5th generation: stationary/stationary
 6th generation: helical

• Helical CT scanners acquire data while the table is moving

• By avoiding the time required to translate the patient table,
the total scan time required to image the patient can be
much shorter.
• Allows the use of less contrast agent and increases
patient throughput
• In some instances the entire scan be done within a single
breath-hold of the patient
6th generation: helical
 7th generation: multiple detector array

• When using multiple detector arrays, the collimator spacing

is wider and more of the x-rays that are produced by the
tube are used in producing image data
– Opening up the collimator in a single array scanner increases the slice
thickness, reducing spatial resolution in the slice thickness dimension
– With multiple detector array scanners, slice thickness is
determined by detector size, not by the collimator
Slice thickness in multiple detector
arrays
Essential Parameters of CT (1972-
2005)
CT-
detectors
 CT - Detectors
Xenon detectors
Solid-state detectors
Multiple detector arrays
 Xenon detectors
Use high-pressure (about 25 atm) nonradioactive xenon gas, in
long thin cells between two metal plates
Very thick (e.g., 6 cm) to compensate in part for relatively low
density
Thin metal septa separating individual detectors improves
geometric
efficiency by reducing dead space between detectors
 Xenon detectors (cont.)
Long, thin plates are highly directional
Must be positioned in a fixed orientation with respect to the x-ray
source
Cannot be used for 4th generation scanners because those detectors
must record x-rays as the source moves over a wide angle
 Solid-state detectors
Composed of a scintillator coupled tightly to a photodetector
(typically a photodiode)
Scintillator emits visible light when an x-ray is absorbed,
similar to an x-ray intensifying screen
Photodetector converts light intensity into an electrical
signal
proportional to the light intensity
 Solid-state detectors (cont.)
• Detector size typically 1.0 x 15 mm (or 1.0 x 1.5 mm for multiple
detector arrays)
• Scintillators used include CdWO4 and yttrium and gadolinium
ceramics
• Better absorption efficiency than gas detectors because of higher
density and higher effective atomic number
 Solid-state detectors (cont.)
• To reduce crosstalk between adjacent detector
elements, a small gap between detector elements is
necessary, reducing geometric efficiency somewhat
• Top surface of detector is essentially flat and
therefore capable of x-ray detection over a wide
range of angles
• Required for 4th generation scanners and used in
most high-tier 3rd generation scanners as well
 Multiple detector arrays
• Set of several linear detector arrays, tightly abutted
• Use solid-state detector arrays
• Slice width is determined by the detectors, not by the collimator
(although collimator does limit the beam to the total slice thickness)
 Multiple detector arrays (cont.)
3rd generation multiple detector array with 16
detectors in the slice thickness dimension and 750
detectors along each array uses 12,000 individual
detector elements
4th generation scanner would require roughly 6
times as many detector elements; consequently
currently planned systems use 3rd generation
geometry
 Slice thickness:
single detector array scanners
Determined by the physical collimation of the
incident x-ray beam with two lead jaws
Width of the detectors places an upper limit on slice
thickness
For scans performed at the same kV and mAs, the
number of detected x-ray photons increases linearly
with slice thickness
Larger slice thicknesses yield better contrast
resolution (higher SNR), but the spatial resolution in
the slice thickness dimension is reduced
 Slice sensitivity profile
For single detector array scanners, the shape of the
slice sensitivity profile is a consequence of:
 Finite width of the x-ray focal spot
 The fact that the image is computed from a number of
projection angles encircling the patient
 Other minor factors
Helical scans have a slightly broader slice
sensitivity profile due to translation of the patient
during the scan
 Slice thickness:
multiple detector array scanners

In axial scanning (i.e., with no table movement)

where, for example, four detector arrays are used,
the width of the two center detector arrays
almost completely dictates the thickness of the
slices
For the two slices at the edges of the scan, the inner
side of the slice is determined by the edge of the
detector, but the outer edge is determined either by
the outer edge of the detector or by the collimator
penumbra, depending on collimator adjustment
 Slice thickness: MDA
(cont.)
In helical mode, each detector array contributes to
every reconstructed image
• Slice sensitivity profile for each detector array needs to be
similar to reduce artifacts
Typical to adjust the collimation so that the focal
spot – collimator blade penumbra falls outside the
edge detectors
 Causes radiation dose to be a bit higher (especially for
small slice widths)
 Reduces artifacts by equalizing the slice sensitivity
profiles between the detector arrays
Pitch
• Pitch is the patient couch movement per rotation divided
by
slice thickness

• Contiguous spiral
– Pitch = 1, that is 10mm/10mm

• Extended spiral
– Pitch = 2, that is 20mm/10mm

• Overlapping spiral
– ½, that is 5mm/10mm
Pitch

SMALL PITCH

LARGE PITCH
CT –image reconstruction
Simple Back projection Reconstruction
Simple Back projection Reconstruction
 Interpolation
CT reconstruction algorithms assume that the x-ray
source has negotiated a circular, not helical, path
around the patient
Before the actual CT reconstruction, the helical data
set is interpolated into a series of planar image sets
With helical scanning, CT images can be
reconstructed at any position along the length of the
scan
 Interpolation (cont.)
Interleaved reconstruction allows the placement of
additional images along the patient, so that the
clinical examination is almost uniformly sensitive to
subtle abnormalities
Adds no additional dose to the patient, but
additional time is required to reconstruct the images
Actual spatial resolution along the long axis of
the patient still dictated by slice thickness
 Filtered
backprojection
• The raw view data are mathematically filtered before being
backprojected onto the image matrix

• Involves convolving the projection data with a convolution

kernel
• Different kernels are used for varying clinical applications such as
soft tissue imaging or bone imaging
 I

simple backprojection filtered

backprojection

I -
 Filtered backprojection

Projection Data, P
x y

＊ Filtered Projection data

Reconstruction
Filter x
x
ω
or
Multidirectional
x Backprojection

Filtere d B a c k p
M edical imag ing mod alitie s 73
Convolution kernel

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Filter

75
Filtered Backprojection

Unfiltered
Backprojection

Filtered
Backprojection

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 Hounsfield Scale

• CT numbers are quantitative

• CT scanners measure bone density with good accuracy

– Can be used to assess fracture risk

• CT images typically possess 12 bits of gray scale, for a

total
of 4,096 shades of gray (CT numbers range from -1,000
to
+3,095).

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78
Hounsfield Scale

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 Windowing and Leveling

• For resolving relative differences in gray scale at fixed

pupil diameter, the human eye has limited ability (30 to 90
shades of gray), and 6 to 8 bits is considered sufficient for
image display.
• windowing and leveling the CT image is the way to perform
this post-processing task (which nondestructively adjusts the
image
– The contrast and (W)
window width brightness).
determines the contrast of the image, with
narrowerwindows resulting in greater contrast.

– The level (L) is the CT number at the center of the window.

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 Windowing and Leveling

• A narrow
window
produces a very
high contrast
image,

The thoracic images (top) illustrate the dramatic

effect of
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changing the window and level settings.
 CT # vs BRIGHTNESS
LEVEL

+ 1000

-1000
CT #

1000
CT #

- 500
W 120
L 40
W 80
L 40
 v,1,u1ow
Pitc Width

h
B e a m Wid. Window
Level

Tim
Zoom
e
r
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 Spiral CT
• Continuous source
rotation with the
patient translation
through x-ray
beam
• Patient couch
moves
as x-ray tube
rotates
• spiral pattern results
• No inter-scan delay
90

(unlike Conventional
 Four Step Process of Conventional CT
STAR 1 2
T
Tube And Detectors Are X-ray tube Energized
Accelerated To Const. Data Collected
Speed For 360 Deg.

4 3
ST O
Table & Patient P
Indexed To The
Next Scanning Tube & Detectors
Position Slow Down &
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Stop
 Section thickness Vs index

INDEX SCAN INDEX SCAN

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 Spiral CT
• No inter-scan delay
– Inter-scan delay is a small delay between slices or volumes
that is needed during standard axial scanning for the x-ray
tube to stop and reverse direction.
– Inter-scan delay can also be used to allow extra time
during a scan for tube cooling

• Volumetric imaging within one breath-hold, at least

25s

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CT Artifacts

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CT
Artifacts

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 Partial Volume Artifacts

• The CT number in each pixel is proportional

to the average μ in the corresponding voxel.
• For voxels containing all one tissue type, μ
is representative of that tissue.
• Some voxels in the image, however, contain a
mixture of different tissue types.
• when this occurs, for example with bone
and soft tissue, the μ is not representative of
either tissue but instead is a weighted
average of the two different μ values.
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Partial Volume Artifacts

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Partial Volume Effects

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 Beam Hardening

• As a spectrum of x-rays passes

layers of tissue, the
lower-energy photons in the x-
ray spectrum are attenuated to a
greater degree than the higher-
energy components of the
spectrum.

• Therefore, spectrum becomes progressively skewed toward the higher-

energy x-rays in that spectrum.

99
 Beam Hardening

• a higher-energy spectrum is called a "harder" spectrum;

hence the term beam hardening.

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Metallic Implants

101
Computed Tomography
- Advantages & Disadvantages

Advantages:
 Desired image detail is obtained
 Fast image rendering
 Filters may sharpen or smooth reconstructed images
 Raw data may be reconstructed post-acquisition with a
variety of filters

Disadvantages
Multiple reconstructions may be required if significant
detail is required from areas of the study that
contain bone and soft tissue
 Need for quality detectors and computer software
 X-ray exposure
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 CT Slice

64+ Slice CT
•Faster scan times
•Reduced patient motion
•Increased resolution 0.35mm isotropic resolution
•3-D reconstructions
•Improved diagnostic accuracy
 Advantage of CT

Three-dimensional image free of superimposition

More sensitive to differences in tissue type (1% compared
with 10%)
Ability to manipulate and adjust image after scanning
(digital technology)
 CT Image Characteristics

High Resolution
Good contrast ratio
Slice View
Low blur
Possible Artifacts
Distortion
 A CT scan is recommended to help:

Evaluate acute cranial-facial trauma

determine acute stroke
Evaluate suspected subarachnoid or
intracranial hemorrhage
Evaluate headache
Determine if there abnormal development of the head and
neck
 (CT): Clinical Aspects

Commonest use – investigation of diseases pertaining to

visceral organs – Chest (lungs), Abdominal (Stomach,
Intestines, Liver, Pancreas), Brain.

Specialized uses – Cardiac CT, CT Angiography

 CT Clinical Applications

Brain
Thorax
Cardiac
Abdomen
Spine
Lung
Tumours
 Computed tomography

Positioning
Supine
Arms along the sides of
the body
Head immobilized in the
head holder
 LIMITATIONS OF CT

Unable to differentiate between tissues with slight contrast

differences < 1%.
CT ROOM LAYOUT
 Reading assignment
 maintenance of CT
 Radon transform
in ct image
reconstruction
 CT angiography
 power supply of CT

The end …..

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