MEYNARD Y.

CASTRO, RRT
MAKATI MEDICAL CENTER, INC
CT-MRI TECHNOLOGIST
 MEYNARD Y. CASTRO, RRT
MAKATI MEDICAL CENTER, INC
CT-MRI TECHNOLOGIST
 Uses computer to
process information
collected from the
passage of x-ray beams
through an area of
anatomy
 CT Image: transaxial
 Old Name: Computed
Axial Tomography (CAT)
◦ Computed Axial
Tomography (CAT)
◦ Computed Transaxial
Tomography (CTAT)
◦ Computed
Reconstruction
Tomography (CRT)
◦ Digital Axial
Tomography (DAT)
◦ Body Section
Roentgenography
CT image is not based
on principles of direct
projection imaging
(e.g. conventional x-
ray)
1
• X-rays photons are created

2
• Directed through the patient

3
• Strike the detector

4
• DAS (converts sampled data to digital format “view”)

5
• Transmitted to the CPU (brain of CT)

6
• Images reconstruction

7
• Computer monitor displays the image
 CT PROCESS
Data Acquisition
1 X-ray tube
2 Patient
3 Detector array
4 Analog (electrical) signal
5 Analog-to-digital Converter (ADC)

6 Digital Data
Image Reconstruction
7 Computer
8 Digital-to-analog Converter (DAC)

9 Analog data
Image Display
10 Display Monitor
 GENERAL SEGMENTS PURPOSE
GET DATA
DATA ACQUISITION
To acquire the information
USE DATA
Use the information collected in
IMAGE RECONSTRUCTION
the previous segment & prepare it
for display
DISPLAY DATA
IMAGE DISPLAY The process data are converted
into shades of gray for viewing
 Patient’s Body:
◦ Loaf of bread
 Patient’s Skin:
◦ Crust of the bread
 Patient’s Internal
Organs:
◦ White portion of the
bread
ADVANTAGES
 Eliminate superimposition
 Low contrast resolution
 Superior quality image

DISADVANTAGES
 High patient dose
 Worse spatial resolution (1 lp/mm)
◦ Screen-film radiography= 7 lp/mm
◦ Digital radiography = 5 lp/mm
 X-ray X-ray

Patient Patient

Detector Film

Computer Darkroom

CT image Radiograph
CT CONVENTIONAL
 HISTORICAL DEVELOPMENT
Allesandro Vallebona proposed a
method to represent a single slice
1930’s
of the body on the radiographic
film (topography)
Godfrey Newboid Hounsfield first
1970
demonstrated the CT technique
First clinical CT scan in London
with prototype EMI head scanner
1971
(80 x 80 matrix; 5 minutes scan
time; 180 translation/1o rotation)
First clinical scan on USA whole
1973 body CT scanner designed (320 x
320 matrix)
First body CT scan of Hounsfield in
1974 a prototype of the EMI body
scanner
Prototype of the EMI CT1010 body
1975
scanner installed
 HISTORICAL DEVELOPMENT
17 companies offered 3rd
1976 generation CT scanners (5 seconds
scan time)
200 scanners installed in US (512 x
1978
512 matrix; ECG-triggered scan)
Hounsfield & Allan Mcleod
1979 Cormack shared the Nobel Prize in
Physics
Major development in CT scanners
1980 (1024 x 1024 matrix; 1-3 seconds
scan time)
1990 Helical CT is introduced (Toshiba)
Twin-slice CT is developed
1991
(Elscint)
Development of multi-slice
1992 scanners, with 4-slice scanners
(0.5 second scan time)
Multislice CT is introduced
1998
(General Electric)
 HISTORICAL DEVELOPMENT
Sixteen-slice helical CT is
2002
introduced
Sixty-four slice helical CT is
2004
introduced
Dual-source CT is announced
2005
(Siemens)
320-slice helical CT is introduced
2007
(Toshiba)
 MEYNARD Y. CASTRO, RRT
MAKATI MEDICAL CENTER, INC
CT-MRI TECHNOLOGIST
 X-axis: the width of
the slice
 Y-axis: the height of
the slice
 Z-axis: the thickness
of the plane
 The grid formed from
the rows and columns
of pixels
 Original EMI: 80x80
matrix
 Most Common: 512x512
matrix
 Large Matrix Size: better
spatial resolution
 Small Matrix Size: poor
spatial resolution
 A picture element
(2D)
 Each of cell
information
 Two dimensional
 Large Pixel Size: poor
spatial resolution
 Small Pixel Size:
better spatial
resolution
 Volume element (3D)
 Large Voxel Size:
poor spatial
resolution
 Small Voxel Size:
better spatial
resolution
 The diameter of image
reconstruction
 FOV increased, fixed
matrix size
◦ Result: increase/larger
pixel size
◦ Poor spatial resolution
 Fixed FOV, increase
matrix size
◦ Result: decrease/smaller
pixel size
◦ Better spatial resolution
 The degree to which an
x-ray beam is reduced
by an object
 Scattering and
absorption
 INTERMEDIATE
LOW ATTENUATION HIGH ATTENUATION
ATTENUATION

AIR/GAS SOFT TISSUE BONE

Low density Intermediate density High density

Low Z Intermediate Z High Z

Small structure - Large structure

BLACK GRAY WHITE

 The amount of x-ray
beam that is scattered
or absorbed per unit
mass
 Example: water
◦ 0.18 cm-1 at 125-kVp
◦ 18% absorbed or scattered
per centimeter
 Inversely related to the
photon energy
 Directly related to the
atomic number and
mass density of an
object
 CT numbers or density
values
 The numeric
information contained
in each pixel
 Quantify the degree that
a structure attenuates
an x-ray beam
 Negative: beam
attenuation < water
 Positive: beam
attenuation > water
 Photons with varying
energy
 Low energy: more
readily attenuated
 High energy: able to
penetrate the object
 Causes artifact (e.g.
Beam hardening)
 Cupping artifact
 Results from preferential
absorption of the low
energy photons
 Leaves higher intensity
photons to strike the
detector array
 Higher energy photons
are attenuated less by
the tissue
 Most common: skull base
 Radiographic
Appearance: dark streaks
or vague areas of
decrease density
 Prevention: use Teflon or
aluminum filter
◦ More homogenous beam
◦ Reduces artifact & patient
dose
◦ Improves image quality
 Partial volume effect
 The process in CT by
which different tissue
attenuation values are
averaged to produce one
less accurate pixel
reading
 Influencing Factors:
◦ Slice thickness (z-axis)
◦ Pixel size (x- & y-axis)
 Thick Slice:
◦ Increases partial volume
effect
◦ Increases likelihood of
missing very small objects
 Example: 10 mm slice
◦ 8 mm: normal tissue
◦ 2 mm: pathologic tissue
◦ Average: 5 mm
 Prevention: use thin slice
 Large Pixel Size (large x
& y dimension):
◦ Increases chance that a
pixel will contain tissues of
different densities
 Example: a pixel with
◦ Calcium: 600 HU
◦ Lung tissue: -600 HU
◦ Average: 0
 Lead to: inaccuracy in
the image
 Prevention: use small
pixel size
 STEP-AND-SHOOT SCANNING
 HELICAL/SPIRAL SCANNING
 MULTIDETECTOR ROW SCANNING
 1980s scanning systems
 Axial, conventional or serial scanning
 Methods:
◦ X-ray tube rotated 360o
◦ Motion of the tube was halted (while the table is
advanced to appropriate location)
◦ Repeat the process until the desired area was
covered
 1990s
 Enable continuous
rotation of the
gantry
 Uninterrupted data
acquisition
 Allows data for many
slices to be acquired
with each gantry
rotation
 Single Row: one
slice/rotation
 Two Rows: two
slices/rotation
 Multiple Rows: multiple
slices/rotation
 Most scans: axial  Effect: poor quality
images
plane
 Many head
protocols: coronal
plane
 Adjusted by:
◦ Positioning the patient
◦ Positioning the gantry
◦ Reformatting the
image data
 Changing imaging
plane:
◦ Provides additional
information
 Primary Reason: When
the anatomy lies vertical
than horizontal (e.g.
ethmoid sinus)
 Second Reason: to
reduce artifacts created
by surrounding
structures
◦ Coronal plane reduces the
number of streak artifacts
& partial volume effect
 MEYNARD Y. CASTRO, RRT
MAKATI MEDICAL CENTER, INC
CT-MRI TECHNOLOGIST
 GANTRY
 PATIENT COUCH
 X-RAY GENERATOR
 COMPUTER SYSTEM
 OPERATOR’S CONSOLE
 PHYSICIAN’S VIEWING CONSOLE
 (1)
 Data are acquired GANTRY
when x-rays pass
through a patient to
strike a detector and Patient
are recorded
 The first step in
creating CT image
(2)
PATIENT COUCH
 Ring-shaped part of
the CT scanner
 Largest component
 Houses many
components
necessary to produce
& detect x-rays:
◦ HV generator
◦ X-ray tube
◦ Collimators
◦ Detector array
◦ Patient support couch
◦ Cooling system
 Aperture:
◦ The diameter of the
opening (70-90 cm)
◦ The central opening in
the gantry
 Tilt: ±15 to ±30
 Laser light: used to
position the patient
within the scanner
 Control Panels:
◦ Located on the side of
the gantry
◦ Allow the RT to control
 Light
 Gantry tilt
 Table movement
 Microphone: allows
communication
between the RT &
patient
 The major components that are involved in
data acquisition are the gantry and the
patient table
 These subsystems receive electronic
commands from the operating console and
transmit data to the computer
◦ Rationale: for image production and
postprocessing tasks
 The gantry houses many of the components
necessary to produce and detect x-rays
 An electromechanical
device
 Purpose:
◦ Conducts electricity and
electrical signals through
rings and brushes
◦ Permits the gantry frame to
rotate continuously
 Advantage: eliminates
the need to straighten
twisted system cables
 Make MSCT possible
 Brushes: transmit  During preventive
power to the gantry maintenance
components
◦ Composition: silver
graphite alloy
 Used as sliding
contact
◦ Replacement of
brushes:
 Every year
 High frequency
generators
 Purpose:
◦ Produces high voltage
(120-140) transmits it to
the x-ray tube
 High kVp:
◦ Increase beam intensity
◦ Increase beam penetration
◦ Reduce patient dose
◦ Reduce heat load
 Included in the gantry
 Devices that perform
oil-to-air heat exchange
 Example: blower
 Produce the x-ray
photons that create the
CT image
 Focal Spot: 0.5 mm &
0.1 mm
 Anode Heat Capacity:
measured in MHU
 Heat Dissipation Rate:
measured in MHU
7 MHU
15-cm-diameter disc
5 cm thick
 Removes long-
wavelength (soft) x-
rays
 Advantages:
◦ Reduces patient dose
◦ Minimize artifacts
◦ Improves image
quality
 Used to shape the x-ray
beam
 Body Scanning Filters:
◦ Used to reduced the beam
intensity at the periphery
of the beam
 Examples:
◦ Wedge filter
◦ Bowtie filter
◦ Trough filter
 Restricts the x-ray
beam
 Controls the slice
thickness
 Advantages:
◦ Reduces scatter radiation
◦ Improves contrast
resolution
◦ Decreases patient dose
 Prepatient Collimator
 The source collimator
 Located between the x-ray
tube & the patient
 Purpose:
◦ To limit the area of the patient
that intercepts the useful beam
◦ To decrease patient dose
 Determines:
◦ Patient dose
◦ Dose profile
 Predetector/Postpatient
Collimator
 Located below the patient &
above the detector array
 Purpose:
◦ To restrict the x-ray beam viewed
by the detector array
◦ To decrease scatter radiation
◦ To improve contrast
 Determines:
◦ Slice thickness
◦ Sensitivity profile
 Convert x-rays into electrical
signal
 The IR in CT imaging system
 Purpose:
◦ Collects attenuation
information
◦ Measures the intensity of
the transmitted x-ray
radiation
 Types:
◦ Xenon Gas
◦ Solid-State
 High detector
efficiency
 Low or no
afterglow
 High scatter
suppression
 High stability
 Consists of 3
tungsten plates
 Pressurized xenon
gas fills the
chambers
 Absorption
Coefficient: 60-87%
 Characteristics:
 Stable under pressure
 Less expensive
 Easier to calibrate
 Highly stable
 No afterglow
 Disadvantage:
 Loss of x-ray
photons in the
casing window
 PROCESS

The photon enters the

1
channel

2 Xenon gas is ionized

Ions are accelerated &

3
amplified

Electric current is produced

4
(raw data)
 Scintillation
detectors
 Use a crystal that
fluoresces
 High Z & density
 Chief Advantage:
increased absorption
efficiency
 Composition:
 Cadmium tungstate
 Bismuth germinate
 Cesium iodide
 Ceramic rare earth
compounds (Gd or Y)
 Photodiode: converts
light into electrical
signal (analog)
 Characteristics:
 High absorption
coefficients (nearly
100%)
 No loss in front
window
 Produce afterglow
 More sensitive to
temp. fluctuation &
moisture
 FACTORS THAT AFFECT THE AMOUNT OF
SCATTER RADIATION THAT REACHES THE IMAGE
Placement of detectors
Shape & size of detectors
Detector spacing
Detector aperture (width)
 Detector Placement
 As close together as
possible
 So all x-rays are
converted to data
 Deep, narrow
detector
 Accept less scatter
 Desirable
 Short, wide detector:
 Accept more scatter
 Undesirable
 Spacing Bars:
 Separates the
detector
 Allows the detector
to be placed in arc or
circle
 Detector Spacing:
 Measured from the
middle of one
detector to the
another neighboring
detector
 Detector Aperture:
 The size of the
detector opening
 Small Detector:
 Good spatial
resolution
 Good scatter
rejection
 SOLID-STATE CRYSTAL PRESSURIZED XENON GAS
Moderate photon
High photon absorption
absorption
Sensitive to temperature &
Highly stable
moisture
Low-density material
Solid material
(gas)
Can exhibit afterglow No afterglow
Losses attributable to
No front window loss front window and spaces
taken up the plates
 The configuration of
the x-ray tube to the
detectors
 1st-7th Generations
 Original EMI:
◦ 180 translations
◦ 1o rotation
 A demonstration
project
 EMI medical division
 Very long scan times
 No longer in use
 Characteristics:
◦ Translate-rotate
◦ Pencil beam
◦ Single detector
◦ 5 minutes
 Characteristics:
◦ Translate-rotate
◦ Narrow fan beam
◦ Multiple detector (5-
30)
◦ 30 seconds
 Principal Limitation:
◦ Examination time (20
secs or longer)
 Advantage: speed
 Disadvantage:
◦ Increased scatter
◦ Increased intensity
toward the edges of the
beam
 Bow tie filter
 Bow Tie Filter:
◦ Equalize the radiation
intensity that reaches
the detector
 Rotate only system
 De facto baseline
model
 Most widely used
 Today: helical,
multislice 3rd
Generator
 Contains reference
detector
◦ Measures unattenuated
x-ray beam
 Characteristics:
◦ Rotate-rotate
◦ Wide fan beam
◦ Curvilinear detector
array (30)
 30-60o
◦ Subsecond
 Advantage:
◦ Tube directly focused
on the detector array
◦ Better collimation
◦ Decrease scatter
◦ Improve image quality
◦ Good image
reconstruction
◦ Reduce scan time
◦ Prevents motion
artifacts
 Disadvantage:
◦ Ring artifacts
 Annulus (ring) of
anatomy
 Compensation:
◦ Software connected
image reconstruction
algorithm
 Rotate-only systems
 Characteristics:
◦ Rotate-stationary
◦ Wide fan beam
◦ Fixed detector array
(4800) with detector
ring
◦ Subsecond
 Advantage:
◦ Free of ring artifacts
 Disadvantage:
◦ Motion artifact
◦ Increased patient dose
 Overscan
 Closer SID
◦ High cost
 Overscan: a tube arc
greater than 360o
 Electron beam CT
Ultrafast CT scanner
 Produced by Imatron
(1980)
 X-ray Source: large
electron gun
 No moving parts
◦ X-ray tube & detector
 Advantage: speed
 Disadvantage:
◦ Poor spatial resolution
◦ High cost
◦ Difficulties obtaining
insurance
reimbursement
 Application: cardiac
imaging
 Produces a focused electron beam that
generates a rotating x-ray fan beam after
being steered along tungsten target rings
 Helical/Spiral CT
 Continuous
acquisition scanning
 Late 1980s (1990)

 Introduced by Will
Kalender and Kazuhiro
Katada
 Volumetric scanners
 Uses slip ring
technology
◦ Eliminated the interscan
delay
 Helical Scan process
◦ Continually rotating x-
ray tube
◦ Constant x-ray output
◦ Uninterrupted table
movement
 Advantage:
◦ Speed
◦ Improved image
resolution
 Images with improved
iodinated concentration
◦ Decreased motion
artifact
 Respiratory & cardiac
 Advantage: ◦ Beneficial to department
◦ Improved diagnostic productivity
accuracy ◦ Superior MPR & 3D
◦ Beneficial to patient reformation
comfort
◦ Beneficial to department
productivity
◦ Superior MPR & 3D
reformation
 Applications:
◦ CTA
◦ Virtual bronchoscopy
 Multidetector row CT
(MDCT)
 Produces multiple
slices in a single
rotation
 Advantage:
◦ Provides longer & faster
z axis coverage/gantry
rotation
◦ Increased volume
coverage/unit time
 Types:
◦ Uniform array detector
◦ Variable array detector
(adaptive, nonuniform,
hybrid)
 Application:
◦ Axial data acquisition
 Used when speed is not a
major concern
 Used when optimal
resolution is required
e.g. IAC
◦ Helical data acquisition
 Purpose:
◦ Measure x-ray
photons (sampling)
◦ Converts the
information to a
digital signal (ADC)
◦ Sends the signal to
the computer
 Analog (Electric):
signals emitted
from the detector
 Computers:
◦ Require digital
signals
 Sampling Rate:
◦ Sample
rate/frequency
◦ The number of
samples taken per
second from the
continuous
◦ 1000/second
 Supports the patient
comfortably
 Construction: low-Z
material (Carbon
fiber)
◦ Rationale: it does not
interfere with x-ray
beam transmission &
patient imaging
 Features: should be
◦ Smoothly and
accurately motor driven
 Rationale: precise
positioning is possible
◦ Capable of automatic
indexing
 Rationale: operator
does not have to enter
the room between each
scan
 Incrementation:
◦ Index, feed or step
◦ The process of moving
the table by a specified
measure
◦ Unit: millimeter (mm)
 Scannable Range:
◦ The degree to which a
table can move
horizontally
◦ Determine the extent a
patient can be scanned
without positioning
 Weight Restriction:
◦ Limit: 220 kg (Siemens)
◦ >220 kg
 Table increment
inaccuracy
 Patient Positioning:
◦ Head first
◦ Feet first
◦ Supine
◦ Prone
 MEYNARD Y. CASTRO, RRT
MAKATI MEDICAL CENTER, INC
CT-MRI TECHNOLOGIST
 The process of using raw data to create an
image
 Prospective Reconstruction:
◦ The reconstruction that is automatically produced
during scanning
 Retrospective Reconstruction:
◦ The process of using the same raw data to later
generate new image
 MAXIMUM INTENSITY PROJECTION (MIP)
 SHADED SURFACE DISPLAY (SSD)
 SHADED VOLUME DISPLAY (SVD)
 Simplest form of 3D
imaging
 Reconstruct an image
by selecting the
highest value pixels
along the arbitrary
line
 Widely used in CT
Angiography
 A computer-aided
technique
 Identifies narrow
range of values as
belonging to the
object to be imaged
 Application:
◦ Bone imaging
◦ Virtual colonoscopy
 Very sensitive to the
operator-selected
pixel range
 Provides an image
that appears very 3D
(volume rendered)
 The path of the x-ray
beam takes from the
tube to the detector
 Ray Sum:
measurement of how
much the beam is
attenuated
 A complete set of ray
sums
 Attenuation Profile:
created for each view
 Used by the computer to solve many
mathematical equation
 Necessary for information from the detector
array to be converted to information for
image display
 Baron Jean-Baptiste-Joseph Fourier
 Separates a function into its frequency
components
 A mathematical method of creating missing
data
 Estimating value of an unknown function
using the known value
 Linear Interpolation: assumes that an
unknown point falls along a straight line
between two known points

A C
0 (5) 10
 1st interpolation algorithm: used 360o linear
interpolation
◦ Disadvantage: caused prominent blurring of the
reconstructed image
 Solution for blurring: 180o linear
interpolation
◦ Results:
 Improved Z-axis resolution
 Improved sagittal and coronal reformatted
views
 Scan data
 Computer data waiting to
be processed to create an
image
 Contains all measurement
obtained from detector
array
 HU value have not yet been
assigned
 Collected within the SFOV
 Requires more storage

RAW DATA
 Once the raw data have
been processed
 HU value have been
assigned
 Confined to those
displayed on the
monitor
 Data manipulation is
limited
 Requires 1/5 space
needed for raw data

IMAGE DATA
 Kernel or algorithm
 Purpose: used to
minimize streak
artifacts
 Convolution: the
process of applying a
filter to an
attenuation profile
 Applied only to raw
data (not image data)
 Reduces the
difference between
adjacent pixels
◦ Purpose: to produce
low contrast resolution
◦ Reduces spatial
resolution
◦ Smooth data more
heavily
 Accentuate the difference
between neighboring
pixels
◦ Purpose: to optimize
spatial resolution
◦ Produces high contrast
resolution
 Process by which an
image is acquired
during CT and stored
in computer memory
is reconstructed
 Filter: refers to
mathematical
function
 Calibration field of view
 Determines the area within
the gantry from which the
raw data are acquired
 Examples:
◦ Small - 25 cm (head)
◦ Medium – 35 cm (chest)
◦ Large – 42-50 cm (abdomen)

Scan Field of View

 Selection determines the
number of detector cells
collecting data
 Anything outside the SFOV
is not image
◦ Causes out-of-field artifacts
◦ Streaking, shading or incorrect
HU numbers

Scan Field of View

 Zoom or target
 Determines how much of the
collected data is used to create
an image
 The section of data selected
for display on the image
 Used to show the entire area
 Used to display a specific
region of interest in greater
detail
 Cannot be larger than the
SFOV

Display Field of View

 MEYNARD Y. CASTRO, RRT
MAKATI MEDICAL CENTER, INC
CT-MRI TECHNOLOGIST
 The last phase in the creation of the CT
image
 Includes all of the system components
necessary to convert digital data created from
the reconstruction process to electrical
signals needed by the CT display monitor
(DAC)
 Used to display CT images
 >2000 different HU values
 High HU: assigns lighter shades of gray
 Lower HU: assigns darker shades of gray
 Monitor: displays only 256 shades of gray
 Human Eye:
◦ Limited to <40 shades of gray
◦ Cannot appreciate contrast differences <10%
 CT: Can differentiate contrast <1%
 Window Width:
◦ Mechanism that determines the quantity of HU
represented as shades of gray on a specific image
 Wide WW:
◦ 500-2000 HU
◦ Decrease image contrast
◦ Best for imaging tissues (CT numbers vary greatly)
◦ e.g. Lung imaging
 Narrow WW:
◦ 50-500 HU
◦ Increase image contrast
◦ Best in imaging the brain (CT numbers not vary
greatly)
 Window Center/Level:
◦ Mechanism that selects the center CT value of the
window width
 Increase WL: makes the image darker
 Decrease WL: makes the image brighter
LUNG WINDOW MEDIASTINAL WINDOW
WW = 1500 WW = 350
WL = -600 WL = 50
 REGION OF INTEREST
 HOUNDSFIELD MEASUREMENTS
 STANDARD DEVIATION
 DISTANCE MEASUREMENTS
 IMAGE ANNOTATION
 REFERENCE IMAGE
 IMAGE MAGNIFICATION
 MULTIPLE IMAGE DISPLAY
 An area on the image defined by
the operator
 Most often circular (may be
elliptic, square or rectangular)
 Valuabletools that aid in
image interpretation
 Indicatesthe amount of CT
number variance within the
region of interest
 Helpful in reporting the size
of the abnormality
 Essential for the placement
of a biopsy needle or
drainage apparatus
 Used to display optional
information
 Allows operator to
annotate images with
◦ Words
◦ Phrases
◦ Arrows
◦ Markers
 Examples:
◦ 15 mins delayed images
 Displays the slice lines
in corresponding
location on the scout
image
 Aids in localizing
slices according to
anatomic landmarks
 Uses only image data
 Does not improved resolution
 Makes image larger
 Increases the size of
the displayed images
 Uses the raw data to
reconstruct the
images
 Improves image
resolution
 Allows more than one image to be
displayed in a single frame
 Examples:
◦ 4 images per frame
◦ 6 images per frame
 MEYNARD Y. CASTRO, RRT
MAKATI MEDICAL CENTER, INC
CT-MRI TECHNOLOGIST
 Anything appearing
on the image that is
not present in the
object scanned
 Classification:
◦ Physics-based artifacts
◦ Patient-based artifacts
◦ Equipment-induced
artifacts
 BEAM-HARDENING
 PARTIAL VOLUME
 ALIASING
 EDGE GRADIENT
 Artifact that results
from lower-energy
photons being
preferentially
absorbed, leaving
higher intensity
photons to strike the
detector array
 Cause: polychromatic
nature of x-ray
 Appearance:
◦ Broad streaks
◦ Cupping
◦ Vague areas of high
density
◦ Dark bands or streaks
between dense objects
in the image
 Common site:
◦ Skull base
◦ b/n petrous bones of
the head
◦ Posterior fossa
 Correction:
◦ Use appropriate
filtration
◦ Calibration correction
◦ Beam hardening
correction software
◦ Increased kVp setting
◦ To select appropriate
SFOV
 Artifact that results
from beam hardening
 Appearance:
◦ A vague area of
increased density in a
somewhat concentric
shape around the
periphery of an image,
similar to the shape of
a cup
◦ The periphery of the
image is lighter
 Artifact that occurs
when more than one
type of tissue is
contained within a
voxel
 Artifact occurs when
a dense object lies to
the edge of the FOV
 Cause: thicker slice
 Appearance: shading
artifacts to appear in
the image
 Correction: use
thinner slices
 Wrap around artifacts
 Artifact that results
from insufficient
projection data
 Cause:
◦ High pitch
◦ Too few samples
(undersampling)
◦ Small FOV
 Appearance: fine
stripes appear to be
radiating from a
dense structure
 Correction:
◦ Slowing gantry rotation
speed
◦ Increasing scan time
◦ Reducing helical pitch
◦ Increase FOV
 Artifact arising from
irregularly shaped
objects that have a
pronounced difference in
density from surrounding
structures
 Artifacts that results
when barium and air lie
adjacent to each other in
the stomach
 Largely unavoidable
 Cause: angle of x-
ray beam varies
between two similar
views
 Appearance: streak
artifact or shading
(both light and dark)
 Correction:
◦ Thinner slices
◦ Use a low HU-value
oral contrast (water)
 MOTION
 METAL
 OUT-OF-FIELD
 Artifacts caused by
patient motion
 Cause: voluntary and
involuntary patient
motion
 Appearance:
 Shading
 Ghosting
 Streaking
 Blurring
 Correction:
◦ Explain the procedure
◦ Give clear breathing
instructions
◦ Immobilization devices
◦ Sedation
◦ Shorter scan time
◦ Manufacturer:
 Overscan modes
 Partial scan modes
 Software correction
 Cardiac gating
 B-blockers
 Artifacts caused by the
presence of metallic
objects in the SFOV
 Cause: objects present
that are beyond the
dynamic range of the
scanner
 Appearance: streaks
 Correction:
 Remove metallic objects
from SFOV
 Angle gantry
 Increase technique
 Thin slices
 Artifacts caused by
anatomy that extends
outside of the selected
SFOV
 Cause: patient’s arms
down by their side when
imaging the body
 Appearance: streaks &
shading on the image
 Correction:
 Raise the patient’s arms
 Use largest SFOV
 RING
 TUBE ARCING
 SPIRAL INTERPOLATION (HELICAL EFFECT)
 CONE BEAM EFFECT
 Artifacts caused by
imperfect detector
elements (faulty or out of
calibration)
 Occurs with 3rd
generation scanners
 Cause: detector problem
 Appearance: ring or
concentric rings centered
on the rotational axis
 Correction:
 Recalibrate
 Call service engineer
 High voltage arcing
 Artifact caused by
undesired surge of
electrical current (short
circuit)
 Cause: electrical surge
within the x-ray tube
 Presence of residual gas
molecules
 Appearance:
 No specific pattern
 Single slight streak to
multiple streak and
severe mottling
 Correction:
 Call service engineer
 Artifact that can occur
in helical scanning
attributable to the
helical interpolation and
reconstruction process
 Cause:
 Images are created
from views that are
not all in the same
plane
 Higher pitch
 Appearance: subtle
inaccuracies in CT
number
 Correction:
 Lower pitch
 Windmill artifact
 Appear only on MDCT
helical systems
 Cause:
 From the cone-shaped
x-ray beam
 Appearance: lines
appear in a windmill
formation
 Correction:
 Use pitch selection
recommended by
manufacturer
 Cone beam
reconstruction algorithm
 MEYNARD Y. CASTRO, RRT
MAKATI MEDICAL CENTER, INC
CT-MRI TECHNOLOGIST
 Refers to how well the image represents the
object scanned
 Directly related to its usefulness in providing
accurate diagnosis
 Assessment:
◦ Spatial (detail) resolution
◦ Low contrast (detectability) resolution
 SPATIAL RESOLUTION
 LOW-CONTRAST RESOLUTION
 TEMPORAL RESOLUTION
 Detail resolution
 The ability of a
system to define
small objects
distinctly
 Evaluation:
◦ A line pairs phantom
◦ MTF: the ratio of
accuracy of the image
compared with the
actual object scanned
(value = b/n 0-1)
 Mathematical expression for measuring
resolution
 The ratio of the image to the object as a
function of spatial frequency
 Used to describe CT spatial resolution
 MTF = 1: faithfully represents the object
 MTF = 0: image is blank and contain no
information
 MTF = intermediate values: intermediate
levels of fidelity
 Thin slice thickness
Small pixel size
Small detector aperture
Small voxel size
Large matrix size
Small DFOV
Better Spatial Resolution
(fixed matrix size)
Bone tissue filters
(reconstruction kernel)
Less pitch
Short scan time
Short focal spot size
 Low contrast sensitivity or sensitivity of the
system
 The ability of a system to differentiate a
structure that varies only slightly in density
from its surrounding tissue
◦ CT: can differentiate 0.5% contrast variation
◦ Screen-film: can differentiate 5% contrast variation
 Evaluation:
◦ Phantom
◦ Objects with varying sizes & with small differences
in density (4-10 HU) from the background
 The more objects
visible, the better the
system‘s low contrast
resolution capability
 Image Noise:
degrades the contrast
resolution
 Quantum mottle or
noise
 The undesirable
fluctuation of pixel
values in an image
 Appearance:
◦ Grainy
◦ Salt and pepper look
 Depends on:
◦ kVp and filtration
◦ Pixel size
◦ Slice thickness
◦ Detector efficiency
◦ Patient dose
 Inversely related to the
number of photons
used to form the image
 SNR: the number of x-
ray photons detected
per pixel
 High SNR: low image
noise, better contrast
resolution
 Increase mAs/Dose
Increase SNR
Large pixel size
Thick slice thickness
Better Contrast Resolution Soft tissue filters
(reconstruction kernel)
Small patient size
Wide window width
(Long scale of contrast)
 The speed that the data can be acquired
 Controlled by:
◦ Gantry rotation speed
◦ Number of detectors channels
 Unit: milliseconds
 High Temporal Resolution:
◦ Important when imaging moving structures
◦ Applications:
 Heart studies
 CT angiography
 Perfusion studies
 mA
 Scan time
 Slice thickness
 Field of view
 Reconstruction algorithm
 kVp
 Pitch (for helical scan)
 Note: total x-ray beam exposure is
dependent on mA, scan time & kVp
 Defines the quantity of the x-ray beam
 Product of mA setting & scan time
 mA: the electrons that flow from filament to
the anode (x-ray tube current)
 More flexible setting than kVp (20-800 mA)
 Higher mA:
◦ Allows shorter scan times
◦ Reduces patient motion
◦ Avoids image degradation
 Small filament:
◦ Cannot tolerate high mA
◦ Provided for lower mA settings (<350 mA)
 Large filament:
◦ Can tolerate high mA
◦ Provided for higher mA settings (>350 mA)
 Scan time: the time the x-ray beam is on for
the collection of data for each slice (360o x-
ray tube rotation)
 Defines the quality (average energy) of the x-
ray beam
 Higher kVp:
◦ Increases the intensity of the x-ray beam
◦ Increases penetrability
 Usually fixed (80, 120 or 140 kVp)
 Does not change contrast directly
 Constant kVp, Reduce mAs
◦ Reduces patient dose
 Constant mAs, Reduce kVp
◦ Also reduces patient dose
◦ Increases beam attenuation
 Reduce mAs, Reduce kVp
◦ Inadequate exposure setting
◦ Increases quantum noise
 Uncoupling Effect: the image is not as directly
linked to the dose (digital technology)
 Note: manipulate mAs rather than kVp when
modifying the radiation dose
◦ Rationale:
 mAs is more flexible
 Directly affects image quality
 It has a significant impact on image quality
 Small slice thickness:
◦ Increases scan time
◦ Increases patient dose
◦ Better spatial resolution
 Large slice thickness:
◦ Decreases scan time
◦ Decreases patient dose
◦ Poor spatial resolution
 SFOV: determines the area within the gantry
for which raw data are acquired
 Scan Data: always acquired around the
gantry‘s isocenter
 DFOV: determines how much and what
section of collected raw data are used to
create an image
 Filter, algorithm, convolution filter, FC filter
 Purpose: designed to reconstruct optimal
images depending on tissue type
 Applied only to raw data
 Raw data must be available
 Soft tissue filter:
◦ Low spatial resolution
◦ Better contrast resolution
 Bone tissue filter:
◦ Better spatial resolution
◦ Low contrast resolution
 The relationship between slice thickness and
table travel per rotation
 Larger pitch: reduces spatial resolution
 Smaller pitch: increases spatial resolution
 MEYNARD Y. CASTRO, RRT
MAKATI MEDICAL CENTER, INC
CT-MRI TECHNOLOGIST
 Ensures that the CT system is producing the
best possible image quality using minimal
radiation dose to the patient
 CT tech & Medical Physicist:
◦ Responsible for performing and documentation
◦ Semiannual or annual
 Phantom:
◦ Used for CT quality control purposes (e.g. spatial &
contrast resolution)
◦ Water equivalent material
 Positioning and Alignment
Low contrast resolution
CT number uniformity & accuracy
Spatial Resolution
(from left to right)
 Spatial resolution (High contrast resolution)
 Contrast resolution (Low contrast resolution)
 Slice thickness accuracy
 Laser light accuracy
 Noise and uniformity
 Linearity
 Radiation dose
 Evaluation:
◦ MTF
◦ Line pairs phantom
 Simpler method
 Contains groups of lead
strips having different
strip width and spacing
 Frequency: monthly
 Current scanner: 10-
20 lp/mm
 Evaluation:
◦ Phantom
 Contains objects of
varying sizes (small
difference in density
from the background)
 Frequency: monthly
 Displayed 0.5%
density difference (5-
mm object)
 Evaluation:
◦ Phantom
 Contrast objects with
known measurement
 Frequency:
semiannualy
 Tolerance:
◦ ≥5 mm = not vary
more than ±1.0 mm
◦ <5 mm = not vary
more than ±0.5 mm
 Used for positioning
and alignment
 Evaluation:
◦ Phantom provided by
the scanner
manufacturer
 Frequency:
semiannualy
 Tolerance: coincide
with the radn field
within 2 mm
 Noise: the variation
of CT numbers
 Uniformity: ability of
the CT scanner to
yield the same CT
number
 Evaluation:
◦ Water phantom
 Frequency: weekly
 Tolerance:
◦ Noise = not exceed 10
◦ Uniformity = no more
than ±2 HU variation
 The relationship of
CT numbers & the
linear attenuation
coefficient of the
scanned object at a
designated kVp
 Evaluation:
◦ Phantom (five-pin test
object)
◦ Contains variety of
objects with known
densities
 Frequency:
semiannualy
 Any deviation from
the straight line
◦ Indicates scanner
malfunction
 Evaluation:
◦ CTDI phantoms
 Used to measure the
radiation dose delivered
for various CT
examinations
 Head & body CTDI
phantoms
◦ Pencil ionization
chamber
 Performed by medical
physicist
 CTDIvol:
◦ A measure of exposure
per slice
◦ The preferred
expression of radiation
dose in CT dosimetry
 Pencil Ionization
Chamber
◦ 100-mm-longt thin
cylindrical device
◦ Used in conjunction
with a CTDI phantom
 Calculate the dose
◦ Adult head examination
◦ Pediatric abdomen
examination
◦ Adult abdomen
examination
 ACR Reference
CTDIvol
◦ Adult head = 75 mGy
◦ Pediatric abdomen =
20 mGy (5 yrs old)
◦ Adult abdomen = 25
mGy
 Evaluation:
◦ CTDI phantoms
 Used to measure the
radiation dose delivered
for various CT
examinations
 Head & body CTDI
phantoms
 Pencil ionization
chamber
 Performed by medical
physicist