RXD32602

Physics, Instrumentation and Technique of Computed Tomography

Topic 1: Physics and Instrumentation of Computed Tomography (CT)

Prepared by:
NORLIYANA BINTI ANUAR

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 TOPIC LEARNING OUTCOMES

At the end of this topic, students should be able to:

i. Explain the basic physics of computed tomography.

ii. Explain the basic instrumentations of computed tomography.
iii. Explain data retrieving and image reconstruction.
iv. Differentiate the types of CT dose.
v. Describe the radiation protection concept applied in CT.

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 INTRODUCTION

• CT technique was first demonstrated

by Godfrey Hounsfield in 1970.
• The mathematics used to construct CT
images was developed by Alan
Cormack.

https://www.history.com/news/experts-stunned-by-ct-scan-of-
tiny-mummy
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Limitation of film-based radiography
1. Superimposition of all structures on the
film. Therefore, difficult or impossible
to distinguish a particular details.

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2. Difficult to distinguish
between a homogenous
object of non-uniform
thickness and heterogenous
object.

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THE GOAL OF CT THE METHODOLOGICAL APPROACH

• X-ray beam is transmitted through a specific cross section of

1. To minimize the patient.
superimposition • Hence, no superimposition of structures above and below the
specific cross section or slice of tissue.

• X-ray beam is collimated into a thin beam that only passes

2. To improve through the cross section of tissue to be imaged.
image contrast • Hence, minimize scatter production and improve the contrast
of the image.

• Special electronic detectors are positioned opposite of the x-

ray tube.
3. To record very • The detectors are quantitative and can measure very small
small differences differences in tissue contrast.
in tissue contrast • Hence, able to produce digital data and subsequently
processed by a digital computer that uses special algorithm
to reconstruct the cross section images. 9
BASIC INSTRUMENTATION

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 Major Components

1. X-ray tube
2. Gantry
• Tube / detectors
• Control button
3. Generator
4. Couch / table
5. Control panel and navigator
6. Pressure injector

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https://oncologymedicalphysics.com
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 Component: Gantry
• The gantry includes:
i. X-ray tube
ii. Detector array
iii. High voltage generator
iv. Patient support couch / table
v. Mechanical support for each component.
• It can be angulated up to 30o depending on the system.
• Gantry aperture allow the technologist to approach the
patient from front and back of gantry.
• Most scanner has 70 cm (700 mm) aperture size.
• Other components equipped:
i. Control button for table movement and
emergency switch.
ii. Laser for centering. 13
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http://www.wikiradiography.net
 Component: X-Ray Tube
• Rotating anode tube operates from 150mA –
400mA.
• Latest generation used fan beam that is
projected from slit collimation.
• MSCT can be energized up to 60s continuously.
• Therefore, it places considerable thermal
demand on x-ray tube.
• MSCT also has very large x-ray tube.
• The anode heating capacity can be of 8 million
HU (MHU) or more.
• The focal spot size is small for better spatial
resolution.

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https://www.siemens-healthineers.com/computed-tomography/single-source-ct/
somatom-go-all/technical-specifications 16
 Component: Detectors
• MSCT have multiple detectors in a detector array that numbers up to tens of thousands.
• Type of detectors used previously is gas-filled detectors (sodium iodide, (NaI).
• Now, all are scintillation, which is solid state detectors.
• Sodium iodide (NaI) was then replaced by bismuth germinate (Bi4Ge3O12) and cesium
iodide (CsI).
• Cadmium tungstate (CdWO4) and special ceremics are the current materials of choice.
• Scintillation detectors have high x-ray detection efficiency, which is 90% of the x-rays
incident on the detectors are absorbed.
• This will also reduce patient radiation doses, allow faster imaging time, improves
image quality by increasing the signal-to-noise ratio.

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 Component: Collimation (Collimator)
• Collimation is required to reduce patient
radiation dose by restricting the volume
of tissue irradiated.
• It also improves image contrast by
limiting scatter radiation.
• However, in MSCT, two collimators are
used:
i. Pre-patient collimator
ii. Pre-detector collimator.

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• Pre-patient collimator:
– Mounted on the x-ray tube housing or
adjacent to it.
– It limits the area of the patient that
intercepts the useful beam.
– Hence, reduce the patient radiation dose.

• Pre-detector collimator:
– Restrict the x-ray beam viewed by the
detector array.
– It reduces the scatter radiation incident
on the detector array, hence, improves
image contrast.

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 Component: Generator
• The generator is usually a small, solid-state high-frequency generator mounted on the
rotating scan frames.
• The high-tension cable is short because it is located close to the x-ray tube.
• Range of generators power rating: typically 30 kW – 60 kW (depending on scanner).
• These rating enable a large selection of exposure technique, such as:
a. 80 kV, 100 kV, 120 kV, 130 kV, and 140 kV.
b. 20 mA – 50 mA, in 1mA increments.

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 Component: Patient Support Couch / Table

• The patient couch provides platform on which patient lies during the examination.
• The couch should be strong and rigid, and able to provide safety and comfort for the
patient during the examination.
• The couch must be constructed of low-Z material (such as carbon fiber composites)
because of:
a. Low absorption
b. Provide excellent vibration-damping features
• It should be smoothly and motor driven to allow precise patient positioning that is
unaffected by patient’s weight.
• It is indexed automatically, so the operator does not have to enter the examination
room between imaging sequences.

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 Component: Control Panel

• The control panel/console allow:

i. Full control of physical system (e.g gantry control)
ii. For real-time processing such as multiplanar reformatting, 3D
manipulation, zoom, and pan.
• It also called integrated console, and consists of:
i. Floating keyboard – alphaneumerical keys, special function keys,
trackball or mouse, and window controls.
ii. Touch panel – scan setup and control parameters (without types
keyboard commands).
iii. Window controls – WW and WL controls.
iv. Image display / Monitor – display CT images for viewing and
manipulation.
v. High-capacity optical disk drive and CD writer
vi. Control functions – autoarchive, autowindow, and autovoice. 22
Component: Pressure Injector

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 Slip Ring Technology (navigator)
• It is electromechanical devices that conduct electricity
and electrical signal through rings and brushes from a
rotating surface onto a fixed surface.
• It allows continuous gantry rotation without
interruption as there is no need of cable. Therefore,
the gantry does not need to be rewound to a starting
position.
• Helical CT is made possible with slip ring technology.
• Important facts:
i. Slip ring provide electrical power to operate the
x-ray tube
ii. Slip ring also transfer the signals from the
detectors for input into image reconstruction
computer.
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 BASIC PHYSICS OF
COMPUTED TOMOGRAPHY

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 Data Acquisition
• Data acquisition refers to the systematic collection of information from patient to
produce the CT image.
• Two methods of data acquisition:
1. Slice-by-slice data acquisition:
• X-ray tube rotates around patient  data
acquisition  tube stop  table/patient
move to scan next slice  repeat until
complete.
2. Volume data acquisition:
• Use special beam geometry
(helical/spiral geometry)
• X-ray tube rotates around patient
helically  data acquisition. Notes:
• MSCT improved SSCT. SSCT – Single slice computed tomography
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MSCT – Multislice computed tomography
• MSCT generates multiple slices per revolution, while SSCT only
generates single slice per revolution.
• MSCT is now able to generate 4, 8, 16, 32, 64, 128, 256, or 320 slices
per revolution of the x-ray tube.
• Dual Source (two x-ray tubes) CT scanner are now available in clinical
CT practice.

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 Data Acquisition Geometries
• It is the way how the x-ray tube and detectors are arranged to collect transmission
measurements.
• 2 types:
i. Continuous rotation.
• X-ray tubes and detectors coupled and rotated 360o around the patient to collect
transmission measurements.
• Radiation beam used: fan

ii. Stationary detectors.

• X-ray tubes rotates 360o around the patient.
• It is positioned inside a stationary ring of detectors.
• Radiation beam used: fan

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 Two data acquisition geometries.
A: Continuous rotation. B. Stationary detectors.
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 Radiation Attenuation

• Attenuation is the reduction of the beam intensity as it passes

through an object.
• This involved the process of absorption and scattering of the photons.
• The degree of attenuation created the structures in CT images which
are represented by varying shades of gray.
• The lesser of attenuation, results in darker shades of grey and vice
versa.

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• Factors that affect the attenuation are:
i. Tissue thickness
ii. Tissue density OBJECT
iii. Tissue atomic number (PATIENT)

iv. Energy of the x-ray beam X-RAY

BEAM

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 Data Processing

**Data processing essentially constitutes the mathematical principles involved in CT.

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1. Step 1: RAW DATA PREPROCESSING.
• The data is received from the detectors.
• The data will undergo preprocessing stage where corrections are
made, and some reformatting of the data occurred.
• This is important to facilitate image reconstruction.

2. Step 2: IMAGE RECONSTRUCTION.

• The scan data are converted into a digital image characterized by CT
numbers.

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 Hounsfield Unit
• It quantify the degree of beam attenuation.
• It is referred to as CT numbers or density values.

• Water  always 0
• Bone (higher attenuation)  +1000
• Air (lesser attenuation)  -1000
• It is referred to as CT numbers or
density values.

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HOUNSFIELD UNIT (at 125 kVp)

Tissue HU Linear attenuation coefficient

Dense bone 1000 0.460
Muscle 50 0.231
White matter 45 0.187
Gray matter 40 0.184
Blood 20 0.182
CSF 15 0.181
Water 0 0.180
Fat - 100 0.162
Lungs - 200 0.094
Air - 1000 0.0003
 CT Numbers
• Each pixel in reconstructed image is assigned as CT number.
• CT numbers are related to linear attenuation coefficients (µ) of the tissues that comprise
the slice and can be calculated as follows:

• Where, = linear attenuation coefficient of measured tissue

= linear attenuation coefficient of water
= constant or contrast factor

• The computer then will convert the numerical image into grayscale image, because it is
more useful to the radiologist.

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 Image Display, Storage, and Communication

DISPLAY DEVICE

• The grayscale image is displayed on a television monitor (CRT/LCD).

• The display image is influenced by physical characteristics, which are:

i. Luminance
ii. Resolution
iii. Noise
iv. Dynamic range

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WINDOWING
• CT image is composed of a
range of CT numbers.
• 2 Types of windowing:
- window width (WW)
- window level (WL)

• Types of window settings:

- bone window
- mediastinal (soft tissue)
window.
- Lung window.

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• The range of numbers  window width (WW)
• The center of the range  window level (WL) or window center (C).
• WW and WL are located on the control console.
• WW  controls the image contrast.
• WL  controls the image brightness (white to dark).
• Image contrast is optimized for the anatomy under study.
• Therefore, specified value of WW and WL must be used during the initial
scanning of the patient.

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PITCH
• Pitch is the ratio of the patient table increment to the total nominal beam width.
• In spiral CT, dose is always inversely proportional to pitch.
• A pitch number > 1 = couch travels more than the width of the beam i.e. there are gaps
• A pitch number < 1 = couch travels less than the width of the beam i.e. there is overlap
• For higher pitch numbers:
a) Advantages:
• Lower radiation dose
• Quicker scan
b) Disadvantages:
• More sparsely sampled
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Gap Overlap

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Types of Scanning Mode

1)Serial or axial scanning

2)Spiral or helical
scanning
• Axial scanning vs helical scanning

Axial scanning Helical scanning

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Scan and Step (AXIAL) Scanning

• It is one mode of scanning - first scanning mode developed and is still used
today for some procedures.

• It works like this, one complete scan around the body is made while the
body is not moving. Then the body is moved to the next slice position.
Spiral/Helical Scanning

• Spiral or helical scanning is a more recently developed mode and is used for many
procedures.
• The patient's body is moved continuously as the x-ray beam is scanned around the
body.
• This motion is controlled by the operator selected value of the pitch factor.
• As illustrated, the pitch value is the distance the body is moved during one beam
rotation, expressed as multiples of the x-ray beam width or thickness.
 Multislice Helical Computed Tomography

• When examination begins, the

x-ray tubes rotates continuously.
• While the x-ray tube is rotating,
the couch moves the patient
through the plane of the
rotating x-ray beam.
• This movement will appear like
helical movement.

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• The x-ray tube is energized
continuously, data are collected
continuously, and then an image
that can be reconstructed at any
desired z-axis position along the
patient.

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• Advantages:
• Faster scanning due to wider total active detector width
• Better dynamic imaging due to faster scanning times
• Thinner slices
• 3D imaging which is enabled by thin slices
• Simultaneous acquisition of multiple slices

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IMAGE CHARACTERISTICS

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 IMAGE CHARACTERISTICS

• The image obtained in CT is different from that obtained in

conventional radiography.
• It is created from data received and is not a projected image.
• The x-rays form a stored electronic image that is displayed as a
matrix of intensities.

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 IMAGE MATRIX

• Matrix known as CT image format consists of many cells.

• Each cell is assigned with number and on the digital display.
• Each cell is combination of pixel and voxel.
• A pixel known as picture element (image surface), and the numerical
information contained in each pixel is a CT number or Hounsfield unit
(HU).
• The tissue volume is known as voxel (volume element) and it is
determined by multiplying the pixel size by the thickness of the CT
image slice.

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IMAGE RECONSTRUCTION

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 Multiplanar Reformation (MPR)

• Involves the process of converting data acquired in axial (transverse), into

another plane.

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Three Dimensional Reconstruction (3D)

Involves the process of

manipulating data from
axial image into three
dimensional image
which is the image can
be view in various
angle.

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 Shaded Surface Display (SSD)

• In SSD, the apparent surfaces are

determined within the volume of
data and the resulting surface is
displayed.
• It was initially applied in bone
imaging and now is used regularly
for virtual colonoscopy.

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 Maximum Intensity Projection (MIP)

• Simplest form of three-dimensional imaging.

• Provide excellent differentiation of the
vasculature from surrounding tissue but lacks
vessel depth because superimposed vessels
are not displayed.

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 Volume Rendering (VR)

• It is more sophisticated technique and produces 3D

images that have a better image quality.
• It provides more information compared with SSD.
• VR offers of seeing through surfaces, allowing
viewer to examine both external and internal
structures.

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CT RADIATION DOSE

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 CT Dose Descriptors

• Is a measuring radiation dose method in CT.

• There are 4 common CT dose descriptors:
(a) CTDIw – Weighted Computed Tomography Dose Index
(b) CTDIvol – Volume Computed Tomography Dose Index
(c) DLP – Dose-Length Product
(e) E – Effective dose

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CT DOSE DESCRIPTORS:
CTDI w
• The dose is not equal across scan plane, it is higher in periphery than
the centre.
• Therefore, CTDIw - Estimate of the average dose over a single slice.
• Unit: mGy

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CT DOSE DESCRIPTORS:
CTDI vol
• The concentration of the dose along a patient is determined by pitch.
• The higher the pitch, the larger the gaps between slices and the
lower the dose.
• Taking into account the pitch gives us the volume CTDI.
• CTDIvol = CTDIw / pitch
• Unit: mGy

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CT DOSE DESCRIPTORS:
DLP
• DLP is the total dose along the distance scanned.
• DLP = CTDIvol x distance scanned
• Unit = mGy.cm

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CT DOSE DESCRIPTORS:
EFFECTIVE DOSE
• Physical effect of total dose on patient
determined by the susceptibility of imaged Body region Tissue weighting
factor, k
area to radiation. (mSv mGy-1 cm-1)
• Radiation does not affect all organs equally, Head/neck 0.0031
each organ has a susceptibility to radiation that Head 0.0021
needs to be taken into account. Neck 0.0059
• Therefore, effective dose plays the role. Chest 0.014
• E = DLP x k where, k is the tissue Abdomen 0.015
weighting Trunk 0.015
factor based on region body
scan.
• Unit: mSv

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CT SCANNING
PARAMETERS
INTRODUCTION
• Scanning parameters is very important, because to produce good computed
tomography image.
• In order to achieve this, there must be careful selection of technical parameters that
control exposure of the patient and the display of the images .

Slice
Thickness

Spatial
Resolution FOV

SCANNING CT
PARAMETERS

Volume
Gantry Tilt investigation
/ scan range

Exposure
factors
Slice Thickness

• Maximum thickness is dependent on the size of the detectors and is usually

about 10 mm.

• Thin slices are: 1 – 2 mm. mainly used for CT angiography, base of skull and
extremity ( usually are suitable for 3D reconstruction).

• Thick slices are: 5 – 10 mm. mainly used for abdomen, pelvis and thorax.

• CONCLUSION:
- Thicker the slice thickness produce image of low contrast BUT, higher the
partial volume artifact, so that poor image definition produced.
Volume of investigation/Scan area/ scanning
range
• Volume of investigation = imaging volume = whole volume of
the region under examination (scan range).

• The extent of the volume of investigation depends on the

clinical needs; in general the greater its value the higher the
integral dose to the patient, unless an increased inter-slice
distance or pitch factor is used.

• Conclusion:
- bigger the volume of investigation ( scan range ), higher the
possibility of motion artifact, so that poor image definition
produced.
Exposure factors
• Exposure factors = the settings of x-ray tube voltage (kV), tube
current (mA) and exposure time (s).

• In general, one to three values of tube voltage (in the range

between 80 and 140 kV) can be selected.

• With higher kVp (beam hardening), more quanta pass

through the region, thereby reducing noise. So that, good
image definition produced.
Gantry tilt

• Gantry tilt = the angle between the vertical plane and the
plane containing the x-ray tube, the x-ray beam and the
detector array.

• Its value normally lies in the range between -25° and +25°. The
degree of gantry tilt is chosen in each case according to the
clinical objective.

• It may also be used to reduce the radiation dose to sensitive

organs or tissues and to reduce or eliminate artifacts. So that,
when the artifact reduce, the good image definition will
produced.
Field of view (FOV)
• Field of view (FOV) = maximum diameter of the reconstructed image.

• Two types of FOV: scan FOV (SFOV) and display FOV (DFOV).

• Its value can be selected by the operator and generally lies in the range
between 12 and 50 cm.

• The choice of a small FOV allows increased spatial resolution in the image,
because the whole reconstruction matrix is used for a smaller region than is
the case with a larger FOV; this results in reduction of the pixel size. So
that, good image definition will produced.

• If the FOV is too small, relevant areas may be excluded from the visible
image. If raw data are available the FOV can be changed by post-
processing.
 Spatial resolution
• Described by the degree of blurring in an image.

• That depend on the subject (structure/organ) contrast.

• Low subject contrast : e.g: liver – spleen interface.

• High subject contrast : e.g: A sharp bone-soft tissue interface.

• Higher spatial resolution, good image definition will produced.

Spatial Resolution can be better when:

• Improves with thinner slice thickness
• Improves with edge enhancement reconstruction algorithm
• Improves when smaller FOV or larger matrix size is employed.
Edge Enhancement Reconstruction Algorithm

1. FILTERED BACKPROJECTION
• The backprojection smears or blurs the final image.
• In order to fix the blurring problem created by standard backprojection, filtered
backprojection is used.
• The term filter refers to mathematical function.
• Back projection has two distinctive limitations:
i. noise
ii. streak artefacts
• As the computer technology is advanced, the iterative algorithms are slowly replacing
this method of image reconstruction.

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2. ITERATIVE RECONSTRUCTION
• It refers to an image reconstruction algorithm used in CT that begins with an
image assumption, and compares it to real time measured values while
making constant adjustments until the two are in agreement.
• Computer technology limited early scanners in their ability to perform the
iterative reconstruction.
• However, this image reconstruction algorithm is now widely used due to the
improvement of computer technology over the past decade.
• Its ability to overcome noise associated with filtered back projection without
increasing radiation dose has had a significant impact on the computed
tomography image reconstruction industry.

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 RADIATION PROTECTION

JUSTIFICATION • There must be benefit associated with every exposure.

• Must ensure that doses delivered to patients are kept

ALARA.
OPTIMIZATION • Must apply all relevant radiation protection practices to
ensure dose is optimized and image quality is not
compromised.

• Doses should be within the limits established by

international and national organization.
LIMITATION • Intended to reduce stochastic effects and to prevent
detrimental deterministic effects.
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 REFERENCES

1. Seeram, E. (2016). Computed Tomography Physical Principles,

Clinical Applications, and Quality Control. Missouri: Elsevier.
2. Sherer, M. A. S, Visconti, P. J., Ritenour, E. R. & Haynes, K. W. (2014).
Radiation Protection in Medical Radiography. Maryland Height:
Elsevier Mosby.
3. Siegal, M. J. CT Dose Measures.
https://www.scbtmr.org/Portals/9/Meetings/2012/Symposium/CT%
20Dose%20Measures%20-%20Siegel.pdf

4. https://sites.google.com/site/frcrphysicsnotes/ct-dose

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