CH 3+4+5+6+7 PDF

Chapter Three
7/11/2018 Dr. Jamal Al-Nabulsi MIS 1

Introduction
 Projection radiology, also called conventional
radiography, is the most commonly used method of
medical imaging utilizing x-rays. A conventional
radiograph represents a projection of the three-
dimensional volume of the body onto a two-
dimensional imaging surface. The projection
radiograph represents the transmission of the x-ray
beam through the patient, weighted by the integrated
loss of beam energy due to scattering and absorption
in the body. It is useful to think of a projection
radiograph as a shadow cast by a semitransparent body
illuminated by x-ray.

Introduction (cont.)
A general projection A fluoroscopy A mammography

radiography system system system

instrumentation
Radiographic System
The x-ray tube generates a
short pulse of x-rays as a
beam that travels through
the patient. X-ray photons
that are not absorbed within
the patient or scattered
outside the region of the
detector impinge upon the
large area detector,
ultimately creating an
image on a sheet of film (or
A conventional projection
alternatively within an radiographic system
electronic detector).

Instrumentation (cont.)
X-ray tube
X-rays are generated using x-
x-ray
tube as shown in the figure.
Glass housing; vacuum
The operation of an x-
x-ray tube is
shown schematically in this figure.
X-ray tube (cont.)
 A thin thoriated tungsten wire, called the filament, contained
within the cathode. A current 3-5 amperes is passed through the
filament.
 electrical resistance causes the filament to heat up and discharge
electrons through a process called thermionic emission. The
electrons now ready to be accelerated toward the anode when the
anode voltage is applied, producing the tube current (mA). The
filament current directly controls the tube current, which typically
ranges between 50 -1200 mA.
 Once the filament current is applied, the tube is ready to
produce x-rays by applying a high voltage (kVp) between the
anode and cathode for a short time.
 The tube voltage is typically generated by transforming the
AC line voltage to a higher voltage and then rectifying this
voltage. Typical values for the tube voltage 30-150 kVp .
X-ray tube (cont.)
 When the tube voltage applied, electrons are accelerated
toward the anode.
 The focusing cup containing the filament in the cathode, is
shaped to help focus the electron beam toward a particular
spot on the anode. This target on the anode disk is coated
with a rhenium-alloyed tungsten.
 The anode disk itself is made from molybdenum. These
energetic electrons bombard the target transferring energy
by both collisional and radiative transfer. This results in both
characteristic and bremsstrahlung x-rays. This is shown in
the figure in the next slide. The majority of the x-rays
produced by an x-ray tube are from bremsstrahlung.
X-ray tube (cont.)
Bremsstrahlung is 1%
Heat is 99%
As the filament current is
applied, the anode is set
into rotation.
Anode rotation is necessary
to avoid melting the anode
target area because of the
high-energy transfer from
the accelerated electrons to
the target.
The anode rotates at 3200-
3600 rpm
X-ray tube (cont.)
 kVp applied for short duration and controlled by:
 Fixed timer (silicon-controlled rectifier (SCR)), or
 Automatic exposure control (AEC), 5mm thick
ionization chamber triggers SCR
 Tube current mA controlled by filament current
 mA times exposure time yields mAs
mAs measures x-ray exposure

Sections of an X-
X-ray machine
Simplified block diagram

Sections of an X-
X-ray machine (cont.)
Detailed
circuit
Fixed X-
X-Ray Machine Portable X-
X-ray Machine

Filtration and Restriction
 The x-rays that are generated within the anode
don't all enter the patient, and not all that enter
the patient leave his body. So it is necessary to
modify the x-ray before entering the human body.
This can be accomplished by using filtration and
restriction.
 Filtration is the process of absorbing low-energy x-
ray photons before they enter the patient.
 Restriction is the process of absorbing the x-rays
outside a certain field of view.

filtration
 There are three important filtering processes in a
projection x-ray machine, which reduce the number of
low energy x-ray photons that enter the body:
1. The tungsten anode absorbs a large fraction of low-
energy x-ray photons before they leave the anode
2. The glass housing of the tube and the dielectric oil
that surrounds it filters out more low-energy photons
(these two processes are called inherent filtering)
3. Added filtering: it arises from metal placed in the x-ray
beam path outside the tube. Common materials to
filter x-ray are:
 Aluminum (1-2 mm thick)
 copper/Aluminum (Cu has 8keV characteristic x-ray, must
be followed by thin layer of Al, measured in mm Al/Eq).
Restriction
 Three basic kinds of beam restriction:
 Diaphragms are flat pieces of lead with holes cut into them
centered on the x-ray beam, and close to the tube window.
Effective in dedicated systems with one purpose such as chest
radiography.
 Cones and cylinders: fixed in their geometry and can have
good performance
 Collimators: expensive, but are so much more flexible and
better performing that they are used nearly all the time in
projection x-ray systems. They have variable diaphragms
comprised of movable pieces of lead. Most often, there are
two collimators, one near the tube and one further away from
the tube. Mirror also is placed between the two collimators to
shine the light through the second collimator
Restriction (cont.)

Compensation Filters and Contrast Agents
 Attenuation is the process in which x-rays are
absorbed or scattered by the body or other
objects in the field of view (FOV).
 Body tissues attenuate x-rays in different
amounts depending on their linear attenuation
coefficients and the x-ray energies.
 compensation filters and contrast media are
used to artificially change the natural
attenuation of the body prior to detecting the
x-rays.

Compensation Filters
 Different body parts attenuate or stop x-rays accordance to
there thickness; so thick or dense parts stop more x-rays
than thinner ones.
 Compensation filters are used to overcome the problem of
imaging body part with various thickness with the same
exposure (such as torso) because of the limitation in
dynamic range of x-ray detectors.
 Compensation filters are comprising a specially shaped
aluminum or leaded plastic object
 Compensation filters can be placed between the x-ray tube
and patient, or in some cases between the patient and
detector.
 compensation filters are thicker where the body part is
thinner and vice versa.
Compensation Filters (cont.)

Contrast Agents
 Contrast agents are chemical compounds
that are introduced into the body in order
to increase x-ray absorption within the
anatomical regions into which they are
introduced, thereby enhancing x-ray
contrast. So it becomes possible to
visualize the difference between
anatomical structures of the soft tissues
on an x-ray film
Contrast Agents (cont.)
Barium
When the energy of x-ray

Iodine
photons slightly exceeds
the K-shell binding energy
of a material, the probability
of photoelectric interaction
significantly rises.
K-edge absorption: the
effect produced by the
ejection of the electrons
from the K-shell (caused by
the photoelectric
interaction) and completely
absorption of x-ray photons.

Contrast Agents (cont.)
 The two common contrast agents used in x-ray diagnoses are:
 Iodine:
 Can be synthesized into soluble compounds that are safely
introduced through intravascular injection or ingestion
 Used for imaging of Blood vessels, heart chambers, tumors,
infections Kidneys, bladder
 Naturally exist in thyroid, and hence X-ray is very good for thyroid
imaging
 Barium
 Administered as a “chalky milkshake”
 Used in the gastrointestinal tract, Stomach, bowel
 Air
 Does not absorb x-ray
 “opposite” type of contrast
 By Inflating the lungs, air provides contrast for lung tissues

Scattering Control
 Scattering is a random phenomenon, this process
will cause a random (fog) throughout the image if
lift uncorrected, thereby reducing the contrast of
the direct image.
 There are three methods in conventional
radiography to reduce the effects of scatter:
1. Grids
2. Airgaps
3. Scanning slits.

Grids
 Scatter-reducing grids use thin strips of lead alternating with
highly transmissive interspace material, typically aluminum
and sometimes plastic. The figure in the next slide shows a
linear focused grid that has lead strips arranged in lines and
angled toward the x-ray tube. By careful placement of the grid,
photons that travel from the source to the detector pass
through the interspace material, and are not severely
attenuated by the grid. Photons that arise from Compton
scattering within the patient, however, travel off-axis, intercept
the lead strips, and are absorbed In the grid. Linear grids have
the advantage that the x-ray beam can be angulated along the
grid line direction, allowing adjustments of the viewing angle.
Furthermore focused grids have the advantage that very few x-
rays are blocked by the geometry of the grid.
Grids (cont.)
Effectiveness in
scatter reduction?
h- the height of the

lead strips
b- the spacing between
the lead strips

Grids (cont.)
 The problem with the grid using is that as the lead strips
become wider or packed more closely, they will stop some
photons in the primary beam. To improve the image more
amount of radiation must arrive to the grid, which
increases the radiation dose to the patient.
 The grid conversion factor (GCF) characterizes the amount
of additional exposure required for a particular grid.
Use grid when tube
voltage above 60 kVp
 Typical GCF values range from 3 to 8. Use grid when

imaging a body part
 Grid visible on x-ray film (lines) thicker than 10 cm.
 Move grid during exposure
 Linear or circular motion.
Airgaps
 Leaving an airgap between the patient and
the detector is an effective means of scatter
rejection. Because the scattered photons
diverge radially from their point of origin
inside the object, while the primary beam
photons diverge from the source, separating
the source and detector reduces the
percentage of scattered photons that reach
the plane of the detector.

Scanning Slits
 Scanning slits are mechanical lead slits that are
placed in front of and in back of the patient. These
slits are moved together during the x-ray exposure,
effectively providing a linear scan of the patient.
These systems can provide greater than 95%
scatter reduction. The disadvantages of using
scanning slits are:
 More complex system
 Costly system
 Longer exposure time.

Film--Screen Detectors
Film
 About 1 to 2 % of x-rays are stopped by the
film. To improve their efficiency, x-ray units
have intensifying screens on both sides of
the radiographic film.
 The intensifying screens stop most of the x-
rays and convert them to light, which then
exposes the film. This is a very efficient
process, and the screens cause only a small
amount of additional image blurring.

Intensifying Screens
 The phosphor is the active part of an intensifying screen
(figure below); its purpose is to transform x-ray photons into
light photons. The light photons then travel into the film,
causing it to be exposed and to form a latent image.
Magnesium oxide Polyester plastic
or titanium dioxide
25 μm thick
A plastic protective coating is applied to the film side of the screen to

protect it from repeated film loading and unloading.
Calcium tungstate (CaWO4) is an excellent fluorescent phosphor for
radiological applications.
Radiographic Cassette
.
Radiographic cassette is a holder for two intensifying screens

and the film sandwiched between. One side of the cassette is
radiolucent, while the other usually includes a sheet of lead
foil. So the cassette can be loaded only one way into the x-ray
machine.
X-Ray Image Intensifiers
 X-ray image intensifiers (XRII) are used in fluoroscopy, where
low-dose, real-time projection radiography is required.
0.5 mm aluminum sheet to
support input phosphor
Block diagram of an XRII

X-Ray Image Intensifiers (cont.)
 X-rays pass through an input window made of aluminum or
titanium.
 The x-rays then strike a 0.5 mm thick input phosphor
{Sodium activated Cesium Iodide [CsI(Na)]}.
 The x-ray photons that are absorbed in the input phosphor
generate flashes of light toward the photocathode.
 Photocathode generates free electrons within the vacuum
tube.
 The electrons are accelerated through a series of electrodes
(dynodes) toward the anode, which is kept at a voltage of 25-
35 kV.
 The electrons are then absorbed by either the anode or the
output phosphor screen.
X-Ray Image Intensifiers (cont.)
 The output phosphor is deposited on the output window
(15 mm piece of glass 25-35 mm in diameter). The anode is
a thin aluminum film placed on the inner side of the
phosphor to keep light from passing back into XRII. The
light passing through the output window typically
encounters a lens, which magnifies the image.
 The magnified light image leaving the XRII can be used in
three ways:
 A light sensor can be put to provide an automatic gain control to the
tube current, to provide constant image brightness.
 The light image is fed into a TV camera to provide a real-time
viewing capability by sending the camera’s signal into a TV monitor.
 The image is fed into a film camera, which can be capture selected
still images into film.

Fluoroscopic Machine
Fluoroscopic machines
are X-ray machines that
generate soft X-rays to
produce dynamic
visualizations on a
fluoroscope. Internal
body organs are viewed
through the use of a
contrast medium that
is opaque to X-rays.

Fluoroscopic Machine (cont.)
Portable
fixed

Medical Applications
 Orthopedic
 Chest
 Abdomen
 Mammography
 Angiography

Mammography
 Detection and diagnosis (symptomatic and screening) of breast cancer
 Pre-surgical localization of suspicious areas
 Guidance of needle biopsies.
Breast cancer is detected on the
basis of four types of signs on the
mammogram:
– Characteristic morphology of a
tumor mass
– Presentation of mineral deposits
called microcalcifications
– Architectural distortions of
normal tissue patterns
– Asymmetry between
corresponding regions of
images on the left and right breast
Mammography (cont.)
 Image contrast is due
to varying linear
attenuation
coefficient of different
types of tissue in the
breast (adipose tissue
(fat), fibroglandular,
tumor).
 Ideal energy
distribution of X-ray
should be below
20keV for average size
breast, slightly higher
for denser breast
X-Ray Projection Angiography
 Imaging the circulatory system. Contrast agent: Iodine (Z=53)
compound; maximum iodine concentration ~ 350 mg/cm3
 Monitoring of therapeutic manipulations (angioplasty,
atherectomy,
intraluminal stents,
catheter placement).
Short intense x-ray
pulses to produce
clear images of
moving vessels.
Pulse duration: 5-10
ms for cardiac
studies …100-200 ms
for cerebral studies

Catheterization Laboratory

Catheterization Laboratory (cont.)

Summary
 Projection radiography system consists of an x-ray tube, devices for
beam filtration and restriction, compensation filters, grids, and a
film screen detector (or digital detector)
 The detector reading (or image gray level) is proportional to the
number of unabsorbed x-ray photons arriving at the detector, which
depends on the overall attenuation in the path from the source to
the detector.
 Long wavelength X-rays have low energy; short wavelength photons
have high energy;
 X-rays are formed by slowing down of electrons; or by quantum
jumps in energy from electron shells in heavy atoms.
 X-rays are produced using a rotating anode tube;
 X-rays are used to produce shadow pictures.
 X rays are attenuated exponentially in materials
 There are many ways in which X rays are used as a diagnostic tool.

Chapter Four

Introduction
 Computed tomography (CT) is a radiographic
inspection method that uses a computer to reconstruct
an image of a cross sectional plane of an object. In
conventional radiography, information on the slice
plane projects into a single line; whereas in the
associated CT image, the full spatial information is
preserved
 CT has become an indispensable tool for visualizing
anatomic structures in the human body. CT generates
three-dimensional images of internal organs in
seconds, giving physicians precise information
regarding disease conditions.

Conventional X-Ray Tomogram
A tomogram is an image of plane or slice within the body.
Conventional x ray tomogram is generated using motion
tomography, a procedure in which the x-ray source and detector
are moved in opposite directions in order to keep one plane in
focus.

 The transformation that takes 1-D projections of a 2-D
object over many angles is called the 2-D Randon
transform, and it has an inverse.
 A wide variety of medical conditions is visible in CT
images that are not visible in conventional radiographs.
 CT scanners measure so-called CT numbers in
Hounsfield units, which are constant from scan to scan.
 Manufacturers put considerable effort toward lowering
both the scanning and image reconstruction times.
 A very important area of current research and
development involves the display and analysis of 3-D CT
data set.

CT Scanner Block Diagram

Operation of CT Scanner
 High voltage supply drives the x-ray tube that can be mechanically
rotated along the circumference of a gantry.
 Patient is lying in a tube in the center of gantry.
 The X-rays passes through the patient and produces an image on
detectors, which are fixed in a place around the circumference of the
gantry in a large quantity.
 Microcomputer senses the position of tube in the gantry and samples
the output of the detector scanner which is opposite to the x-ray tube.
 A calculation based on the data of a computer scan of the tube is
made by the computer.
 The O/P unit then produces a visual image of a transverse plane cross
the section of patient.
 The output may be displayed on the cathode ray tube or
photographed with a camera to produce a hard copy record.

CT Scanner

CT Scanner (cont.)

CT Scanner (cont.)

CT Scanner (cont.) High speed
processor system
System
transformer
Integrated
console
Image archiving
X-ray high voltage
(optical disc)
system
CT Instrumentation
 The fundamental measurement required by a CT
scanner is the measurement of x-ray attenuation along
a line between an x-ray source and an x-ray detector. In
order to reconstruct an image of a 2-D cross-section, a
collection of such measurements are required along all
lines within the cross-section.
 Seven generations of basic CT designs have been
developed to obtain these fundamental data. Roughly
speaking, the seven generations were developed in
sequence to improve overall performance, mostly
toward faster acquisition of both cross-sectional and
volumetric data.

First Generation
 First generation (1G) scanners are no longer manufactured
for medical imaging, but their geometry is still used to
explain the theoretical ideas underlying image
reconstruction. The geometry of 1G scanner consists of a
single source, collimated (meaning that its beam is
restricted) to a thin line, and a single detector that moves
in unison along a linear path tangent to a circle that
contains a patient.
1G advantages
 In 1G paths between source and detector can be measured
within a given projection, also angular projections may be
measured. Scattered radiation goes mostly undetected in
1G scanners, therefore the measured attenuation of the
beam is almost certainly due to tissues along the ray.
First Generation (cont.)

Second Generation
 A second generation (2G) scanner has additional
detectors, forming a detector array, arranged along a
line or a circle. The source and detector array move
linearly in unison, to cover the field of view (FOV).
 The source is collimated as a fan beam, so that energy
is kept within the slice but spread over the detector
array.
 Using 2G scanner geometry its possible to make a
larger rotation after each linear scan and thereby
complete a full scan in a less time.
 Scattering effect must be taken in consideration in 2G
scanner. So detectors in these scanners are collimated
to receive radiation only from the correct direction.
Second Generation (cont.)

Second Generation (cont.)
 Example 6.1: consider a 1G or 2G scanner whose source-
detector apparatus can move linearly at a speed of 1.0 m/sec
and that the field of view has a diameter of 0.5 m. suppose
further that 360 projections over 180o are required and that it
takes 0.5 sec for the source-detector apparatus to rotate one
angular increment, regardless of the angle. What is the scan
time for a 1G scanner? What is the scan time for a 2G scanner
having 9 detectors spaced 0.5o apart?

Third Generation
 The third generation (3G) geometry has a fan-beam that
covers the image region with the source held in a single
position.
 The source and detector array don’t need to perform a linear
scan; instead they simply rotate in synchrony.
 To obtain a sufficient number of samples per (fan-beam)
projection, a large number of detectors is needed, and this
makes 3G system more expensive than 2G system.
 The simple rotational motion and highly parallel detection
capability allows for significant decrease in scan time.
 Detectors are collimated as in 2G. They are small in size, so
they cannot be as efficient as those in 1G and 2G systems.
 To obtain same image quality as in 1G and 2G systems, the
dose must be slightly higher.
Third Generation (cont.)

Fourth Generation
 The fourth-generation (4G) scanner has a single rotating
source with a larger ring of stationary detectors.
 The detectors are not collimated. They can be large in size
since they lie on a large ring. So the detection efficiency of a
4G scanner is higher than that of a 3G scanner.
 A 4G has the source outside the detectors with slight gaps
between the detectors through which the x-rays can be fired.
 The scattering is a major problem with 4G system; because
the detectors cannot be collimated. They can also receive
scattered radiation.
 These two factors compromise the performance, so that
image quality in 4G systems is comparable to that of 3G
systems.
Fourth Generation (cont.)

Fifth Generation
 Fifth generation (5G) scanners are known as electron beam
computed tomography (EBCT).
 These scanners are designed to solve a problem of limitation in
speed of the scanning; because the source and detectors need to
rotate in the first four generations.
 EBCT uses a flying electron beam, steered electromagnetically, to hit
one of four tungsten anode strips that encircle the patient.
 X-rays are generated when the electron beam strike the tungsten
anode; the resultant radiation is collimated into a fan-beam, which
passes through the patient and is detected on the other side by a
stationary ring of detectors.
 No moving parts are required in the 5G systems
 EBCT is an expensive design, but with extremely small scan-time.
 The only CT method that can capture stop-action images of a
beating heart without ECG.
Fifth Generation
(cont.)

Sixth Generation
 The sixth generation (6G) scanner is also called a
helical CT. It consists of a conventional arrangement of
the x-ray source and detectors (as in 3G and 4G
systems) which can continuously rotate. While the
tube is rotating and acquiring projection data, the
patient table is set into motion, sliding the patient
through the source detector plane. With this
movement, the position of the source carves out a
helix with respect to the patient.
 Continuous rotation of the large mass comprising the
x-ray source and detectors requires what is called slip
ring technology in order to communicate with the
controlling stationary hardware.
Sixth Generation (cont.)

Seventh Generation
 A seventh generation (7G) scanner is emerging with advent and growth
of multislice CT scanners.
 In these scanners a “thick” fan beam (cone beam) is used, and multiple
(axial) parallel rows of detectors are used to collect the x-rays within
this thick fan.
 When a multiple detector array is combined with a helical scanner, the
pitch of the helix can be larger, and full 3-D scans can be even faster.

Seventh Generation (cont.)

Comparison of CT Generations
Generation Source Source Detector Detector Source- Advantages Disadvanta
Collimation collimation Detector ges
movement
1G Single x- Pencil Single None Move linearly Scattered Slow

ray tube and rotate in energy is
beam unison undetected
Single x- Fan beam, not Collimated Move linearly Faster than Lower efficiency
2G enough to
Multiple to source and rotate in and larger noise
ray tube 1G because of the
cover FOV direction unison
collimation in
detectors
3G Single x- Fan beam, Many Collimated Rotate in Faster 2G, More

ray tube enough to to source synchrony continuous expensive than
cover FOV direction rotation using 2G, low
a slip ring efficiency
Single x- Fan beam Stationary Cannot Detectors are Higher High scattering
4G covers FOV ring of collimate fixed, source efficiency since detectors
ray tube are not
detectors detectors rotates than 3G
collimated
Many tungsten Fan beam Stationary Cannot No moving Extremely fast, High cost,
5G anodes in single ring of collimate parts capable of stop- difficult to
(EBCT) large tube
detectors detectors
action imaging
of beating heart
calibrate
6G 3 G/4G 3G/4G 3G/4G 3G/4G 3G/4G plus Fast 3D A bit more

linear patient images expensive
(Spiral) table motion
7G Single x- Cone Multiple Collimated 3G/4G/6G Fast 3D Expensive

ray tube arrays of to source motion images
Multislice
7/14/2018 beam detectors
Dr. Jamal Al-Nabulsi direction MIS 27
X-Ray Source and Collimation
 Nearly all CT scanners use one x-ray source
 All use rotating anode design and are oil-cooled.
 Some scanners use pulse mode (dual energy studies), but
most continuously excite the x-ray tube during data
acquisition.

X-Ray Source and Collimation (cont.)
 X-rays generated by CT tube need collimation and filtration.
 Collimation into a fan, typically between 30 and 60 degrees in
fan angle, is accomplished using two pieces of lead that form a
slit between them. A motor controls how wide the slit is, to
control the fan thickness.
Generally, copper
followed by aluminum
is used to narrow the
energy spectrum
(harden the beam) of
the x-ray entering the
patient.

CT Detectors
 Most modern scanners use solid-state detectors. These
detectors contain a scintillation crystal in the first stage,
typically a cadmium tungstate, sodium iodide, bismuth
germanate, yttrium-based, or cesium iodide crystal.
 X-rays interact with the crystal mainly by photoelectric effect,
producing photoelectrons. These electrons are excited and
emit visible light when they de-excite. This scintillation
process results in a burst of light.
 The light is then converted to electric current using a solid-
state photodiode attached tightly to the scintillator.
 Some 4G and 5G scanners use photomultiplier tubes to
convert light to electricity.
 In the 3G scanners, very small and highly directional detectors
are required. So xenon gas detectors may be used.
CT Detectors (cont.)
 Xenon gas detectors use compressed xenon gas in long, thin
tubes, which when ionized generate a current between an anode
and cathode. These detectors are less efficient than solid-state
detectors, but they are highly directional.
 In single-slice scanner each crystal would typically be 1.0 mm ×
15 mm in size.
 Slice thickness is an important concept in detector dimensions.
Slice thickness is equal to detector height (15 mm)
 In multiple detector array the individual solid-state detectors 1.0
mm x 1.25 mm in size. In these systems, slice thickness is
controlled by the detector height. For example, if there are 16
rows of detectors, each 1.25 mm in height, its possible to acquire
16 simultaneous projections, each 1.25 mm thick, or 8
simultaneous projections, each 2.5 mm thick.
CT Detectors (cont.)

Gantry and Slip Ring
 The gantry of a CT system holds the x-ray tube and detectors
so that they can be rotated around the patient rapidly and
repeatable.
 The fan angle, size of the detector array, and separation
between the x-ray tube and detector array must be capable of
imaging a 50 cm field of view.
 A slip ring comprises a large cylinder with grooves on the
outside so that brushes can make continuous electrical
contact with the rotating cylinder.
 X-ray tube and detectors are mounted inside the cylinder
and are in continuous electrical contact with the (stationary)
controlling and data processing electronic hardware.

Gantry

Slip Ring

Patient Table
 The patient table is more than just a place to put the patient.
In helical scanners, it is an integral part of the data acquisition
hardware, since it must be moved smoothly and precisely in
synchrony with source and detector rotation.

CT Images

Image Formation
 In CT system, the x-rays propagate through a cross-section
of the patient and then the detectors detect the exit beam
intensity integrated along a line between the x-ray source
and each detector. The integrated x-ray intensity at any
given detector is given by:
X-ray spectrum Linear attenuation coefficient
 For monoenergetic model Ē is effective energy.

Ē is that energy which in a
given material will produce
the same measured intensity
from a monoenergetic source
as from the actual
polyenergetic source.
CT Number
 To compare data from different scanners with different x-
ray sources and hence different effective energies, CT
numbers are computed from the measured linear
attenuation coefficients at each pixel. The CT number is
defined as:
 h has Hounsfield units (HU).

 h=0 HU for water;
 h=-1000 HU for air;
 h=1000 HU for bone;
 Range from -1000 to 3000
 CT numbers are rounded to the nearest integer.
Summary

Chapter Five
7/17/2018 Dr. Jamal Al-Nabulsi 1

What is Nuclear Medicine
 Also known as nuclide imaging
 Introduce radioactive
substance into body
 Allow for distribution and
uptake/ metabolism of
compound ⇒ Functional
Imaging!
 Detect regional variations of
radioactivity as indication of
presence or absence of specific
physiologic function
 Detection by “gamma camera”
or detector array
 (Image reconstruction)
Atomic Structure
 An atom={a nucleus, electrons}
 nucleons = {protons; neutrons}
 Nuclide: unique combination of protons and neutrons in a
nucleus
 mass number A = # nucleons
 atomic number Z = # protons = # electrons
 An element is denoted by it’s A and Z
 Example:

Atomic Structure (cont.)
 Isotopes: atoms with the same Z but different A
– E.g. C-12 and C-11
– Chemically identical
 Isobars: atoms with the same A but different Z
– Different elements
– E.g. Carbon-11 and boron-11
 Isotones: atoms with the same number of neutrons but
different A
 Isomers: atoms with the same Z and A but with different
energy levels (produced after gamma decay)
 Stable nuclides:
– # neutrons ~= # protons (A ~= 2Z) when Z is small
– # neutrons > # protons when Z is large
 Unstable nuclides (radionuclides, radioactive atoms)
– Likely to undergo radioactive

Radioactive Decay
Mass Defect the difference between the sum of the
masses of the atom’s constituents and the actual mass.
 Mass and energy are related by Einstein’s equation.
There is an amount of energy “missing” from the atom
(equivalent to the mass defect). This missing energy is
termed the binding energy and can be computed from
E = Δmc2
 The energy required to remove an electron completely
from an atom is the electron binding energy
 The energy required to separate the constituent
protons and neutrons in a nucleus is the nuclear
binding energy.

Radioactive Decay (cont.)
 Radioactive decay: rearrangement of nuclei to
lower energy states = greater mass defect
 Parent atom decays to daughter atom
 Daughter has higher binding energy / nucleon
than parent
 A radioatom is said to decay when its nucleus is
rearranged
 A disintegration is a radioatom undergoing
radioactive decay
 Energy is released with disintegration.

Line of Stability

Radioactivity
 Radioactivity describes how many radioactive atoms
are undergoing radioactive decay every second. It
doesn't reflect the type of radiation or the energy of
that radiation. The common unit of radioactivity is the
Curie (Ci), where 1 Ci = 3.7  1010 disintegrations per
second (dps). A disintegration is an atom undergoing
radioactive decay.
 The SI unit for radioactivity is the Becquerel (Bq),
where 1 Bq = 1dps. Clearly:
1 Ci = 3.7  1010 Bq
 Radioactivity in the range of mCi or MBq, is common
in nuclear medicine procedures.
Modes of Decay
 There are four main modes of radioactive decay:
1. Alpha decay ( alpha particles are 2 protons & 2 neutrons)
2. Beta decay (beta particles are like electrons)
3. Positron decay (positrons are antimatter electrons)
4. Isomeric transition (gamma rays produced)
 Ionizing radiations fall into two classes:
1) Particulate radiation
2) Electromagnetic radiation
 Medical imaging is concerned with:
 Positrons (positron emission tomography [PET])
 Gamma rays (planar scintigraphy, single photon emission
computed tomography [SPECT] )
Alpha Decay
 Alpha decay: the nucleus emits a Helium-4 particle
(alpha particle)
– Alpha decay occurs most often in massive nuclei that have too
large a proton to neutron ratio. Alpha radiation reduces the
ratio of protons to neutrons in the parent nucleus, bringing it
to a more stable configuration.
– mostly occurring for parent with Z > 82

Beta Decay
 Beta decay occurs when, in a nucleus with too many protons or
too many neutrons, one of the protons or neutrons is
transformed into the other.
 Mass number A does not change after decay, proton number Z
increases or decreases.
 Beta minus decay (or simply Beta decay): A neutron changes
into a proton, an electron (beta particle) and a antineutrino

Positron Decay
 Also known as Beta Plus decay
– A proton changes to a neutron, a positron (positive electron), and
a neutrino
– Mass number A does not change, proton number Z reduces

Mutual Annihilation after Positron Decay
 The positron later annihilate a free electron, generate two
gamma photons in opposite directions
– The two photons each have energy 511 KeV, which is the energy
equivalent to the rest mass of an electron or positron
– These gamma rays are used
for medical imaging
(Positron Emission
Tomography), detected
using a coincidence
detection circuit.

Gamma Decay
 A nucleus (which is unstable) changes from a higher
energy state to a lower energy state through the emission of
electromagnetic radiation (photons) (called gamma rays).
The daughter and parent atoms are isomers.
– The gamma photon is used in Single photon emission
computed tomography (SPECT)
 Gamma rays have the same property as X-rays, but are
generated different:
– X-ray through energetic electron interactions
– Gamma-ray through isometric transition in nucleus
m-metastable

radiotracers
 Decay mode:
– Clean gamma decay: do not emit alpha or beta particles
– Positron decay: positron will annihilate with electrons to produce
gamma rays
 Energy of photon:
– Should be high so that photons can leave the body with little attenuation
– Hard to detect if the energy is too high
– Desired energy range: 70-511 KeV
 Half-life
– Should not be too short (before detector can capture) or too long (longer
patient scan time)
– Minutes to hours desired
 Half-value-layer (HVL)
– Thickness of tissue that absorbs half of the radioactivity produced
– Should be around the dimension of the organ to be imaged
 Monoenergetic
– Energy sensitive detectors can discriminate the primary photons from
scattered ones.
Common Radionuclides in Nuclear Medicine

The Technetium Generator
Molybdenum
 Can be produced from an on-site generator

– 99Mo 99mTc 99Tc, Half-value layer
 Decay characteristics of 99mTc:
– half life = 6.02h, E = 140 KeV, HVL = 4.6 cm
 Used in more than 90% of nuclear imaging

Common Radiotracers

Chapter Six

Overview of Imaging Modalities
 Planar Scintigraphy
– Use radiotracers that generate gamma ray decay, which
generates one photon in random direction at a time
– Capture photons in one direction only, similar to X-ray,
but uses emitted gamma rays from patient
– Use an Anger scintillation camera
 SPECT (single photon emission computed tomography)
– Use radiotracers that generate gamma ray decay
– Capture photons in multiple directions, similar to X-ray
– Uses a rotating Anger camera to obtain projection data
from multiple angles

Overview of Imaging Modalities (cont.)
 PET (Positron emission tomography)
– Uses radiotracers that generate positron decay
– Positron decay produces two photons in two
opposite directions at a time
– Use special coincidence detection circuitry to
detect two photons in opposite directions
simultaneously
– Capture projections on multiple directions

Planner Scintigraphy
 Capture the emitted gamma
photons (one at a time) in a
single direction.
 Imaging principle:
– By capturing the emitted
gamma photons in one
particular direction,
determine the radioactivity
distribution within the body.
 On the other hand, X-ray
imaging tries to determine
the attenuation coefficient to
the x-ray.
Anger Scintillation Camera
 Multihole lead collimator.
 ~25-60 cm circular or rectangular
sodium iodide 𝑁𝑎𝐼 scintillation crystal.
Compare the detected signal to a threshold
Compute the location with highest activity
Convert light to electrical currents

Convert detected photons to lights
Absorb scattered photons

Collimators
 The collimator is a 1 to 2-inch thick slab of lead the same
dimensions as the scintillation crystal, with a geometric
array of holes in it. The lead that separates each hole is called
a septum. The collimator provides an interface between the
patient and the scintillation crystal.
 There are four types of collimators:
a) Parallel hole (most common)
b) Converging hole (magnifies)
c) Diverging hole (minifies)
d) Pin-hole (2 – 5 mm).
When a converging or diverging

collimator is used, the image is
not the same size as the object.
As the source object is moved away from
7/17/2018 Dr. Jamal Al-Nabulsi
the pinhole, its image gets smaller. 25
Scintillation Crystal
 Scintillation crystal:
 Emit light photons after deposition of energy in the
crystal by ionizing radiation.
 Most commonly used: sodium iodide with thallium
doping : 𝑁𝑎𝐼[𝑇𝑙] detection of X-rays & gamma rays
 Detectors used for planar scintigraphy:
 Single large-area 𝑁𝑎𝐼[𝑇𝑙] crystal.
 Diameters: ~25-60 cm.
 Thickness: ~0.6-2.5 cm (low-energy). The thicker
crystals are used for high-energy gamma rays, while the
thinner crystals are used for low-energy gamma rays.

Photomultiplier Tubes
 The photomultiplier tube is a
vacuum tube with two important
components: a sensitive
photocathode, and a series of
electrodes, called dynodes.
 The photomultiplier tube serves
two important functions: it
converts light into an electrical
signal, and it amplifies this
signal.
Original Anger camera had seven
photomultiplier tubes, but modern gamma Arrangement of 61
photomultiplier tubes on
cameras have 3, 61, 75, or 91 tubes. More the face of an Anger camera
tubes means better spatial resolution and
image uniformity, but higher cost.
Photomultiplier Tubes (cont.)
 For every 7-10 photons incident
upon the photocathode, an
electron is released.
 Dynode: positively charged for
each electron reaching a dynode,
3-4 electrons are released.
 106-108 electrons reach anode for
each electron liberated from the
cathode.
 Outputs a current pulse each time
a gamma photon hits the crystal.
This current pulse is then
converted to a voltage pulse
through a preamplifier circuit.
Positioning Logic
 When a gamma photon interacts with the crystal,
thousands of scintillation photons are produced,
and every photomultiplier tube produces an
output pulse.
 The goal of the Anger camera's positioning logic
circuitry is to determine both where the event
occurred on the face of the crystal and the
combined output of all the tubes, which
represents the light output of the crystal (which
in turn represents the energy deposited by the
gamma photon).

Pulse Height Analyzer
 Pulse height analysis is the use of a scintillation counting
system to obtain an energy spectrum from a radioactive source.
This energy spectrum is a plot of the number of pulses with a
given pulse height as a function of the pulse height as shown in
the figure below. The measured spectrum is a function of the
energies of gamma rays emitted by the source, and the
interactions of these photons in both the body and the crystal.
Arbitrary Unit
Pulse Height Analyzer (cont.)
 Non-Compton events have higher energy  photopeak of
the pulse height spectrum (Z-pulse).
 AU = arbitrary unit, can be energy units.
 Advantages: reducing Compton photons, reducing multiple
hits.
 The window’s lower threshold is set to discriminate against
Compton events, which have lower energy than a non-
Compton event.
 The window’s upper threshold is set to discriminate against
multiple (simultaneous, summed ) events, which have more
energy than a single event (and for which "position" is a
meaningless concept).

Gating circuit
 In practice, proper window setting is vital, as a window
that is not centered around the photopeak (an offset
window ) can degrade field uniformity of response for
many cameras.
 Gating circuitry (microprocessor-based correction
circuitry) can maintain good uniformity even with offset
pulse height windows.
 In such cameras the scattered can be reduced by
eliminating any Compton scattered photons that show
up in lower half of the photopeak.
 Some cameras have 2 or 3 separate pulse height windows
to simultaneously image the multiple emissions of some
radionuclides.
Image Formation
 The primary mechanism for creating
images in planar scintigraphy is to
detect and estimate the position of
individual scintillation events on the
face of an Anger camera.
Event Position Estimation
(self reading from the text
book p-p
p 261-263)

Acquisition Modes
 For each photopeak, an Anger camera can provide
the estimated (x, y) position, z-pulse value, and
time of the corresponding scintillation event.
 Several methods (modes) are used to create
images:
 List mode.
 Static frame mode.
 Dynamic frame mode.
 Multiple-gated acquisition.
 Whole body mode.

List Mode
 Complete information: (X, Y)
position, Z-pulse value, and
time markers.
 Disadvantage: huge storage space.

Single Frame Mode
 The value in each
pixel indicates
the number of
events happened
in that location
over the entire
scan time = total
count of photons.

Dynamic Frame Mode
 A temporal succession of
frame mode images.
 After the first image is
created and stored, its
buffer (matrix) is zeroed
and another image is
accumulated.
 Useful for imaging
transient physiological
processes.

Multiple Gated Acquisition
 Similar to frame mode.
 Instead of fixed Δt, a
trigger signal (e.g.
ECG) is used to “zero”
the matrix and restart
accumulation.

Whole Body
 In this mode the body is divided into a matrix of
pixels, and series of static frames are acquired to cover
the body, in a step and shoot sequence.
 The camera or bed continuously move to acquire slices
(frames) of the whole body.
 The most common (2-D) matrix sizes used in nuclear
medicine are 64x64, 128x128 and 256x256, although
matrices up to 1024x1024 are available.

Example
 The multiple-gated acquisition mode can be used to study
beating hearts. In this mode, each cycle of the acquisition
is triggered by the R wave of the ECG, as shown below.
Suppose the HR is 50 bpm. We want each frame to last for
75 ms. What is the total number of frames?
Answer
 The HR is 50 bpm, so each heartbeat lasts 60/50 = 1.2 sec.
Each frame lasts 75 ms. Therefore, a heartbeat is divided
into:

Chapter Seven

SPECT & PET
 SPECT (single photon emission computed tomography)
 Use radiotracers that generate gamma ray decay
 Capture photons in multiple directions, similar to X-ray CT
 Uses a rotating Anger camera to obtain projection data from
multiple angles
 PET (Positron emission tomography)
 Uses radiotracers that generate positron decay
 Positron decay produces two photons in two opposite
directions at a time
 Use special coincidence detection circuitry to detect two
photons in opposite directions simultaneously
 Capture projections on multiple directions

Single Photon Emission Computed
Tomography (SPECT)
Dual head SPECT system

Single Photon Emission Computed
Tomography (SPECT)

SPECT Instrumentation
 Similar to CT, uses a rotating Anger camera to detect
photons traversing paths with different directions.
 Recent advances uses multiple Anger cameras
(multiple heads), reducing scanning time (below 30
minutes).
 Anger cameras in SPECT must have significantly better
performances than for planar scintigraphy to avoid
reconstruction artifacts.
 Collimators types used in SPECT
 Parallel-hole
 Fan-beam
 modern SPECT systems use multiple Anger camera
detectors (heads).
SPECT Instrumentation (cont.)
 The increased sensitivity provided by multihead systems can be

used in three ways:
1. Decrease noise while using the same acquisition time as with a
single-head system
2. Decrease acquisition time to get the same counts as a single-head
system
3. It may be traded for higher resolution through the use of higher
resolution/lower sensitivity collimators
Imaging Equation

Imaging Equation (cont.)

SPECT Applications
 Brain:
 Perfusion (stroke, epilepsy,
schizophrenia, dementia
[Alzheimer]).
 Tumors.
 Heart:
 Coronary artery disease.
 Myocardial infarcts:
 Respiratory
 Liver
 Kidney

Positron emission tomography (PET)

PET Principle
 Positron emission.
 Positron annihilation:
 Short distance from emission.
 Produces two 511 keV gamma rays.
 Gamma rays 180 deg opposite directions.
 Principle: detect coincident gamma rays.

Annihilation Coincidence Detection (ACD)
 Detect two events in opposite directions occurring
“simultaneously”
 Time window is 2-20 ns, typically 12 ns
 No detector collimation is required
 Higher sensitivity
Coincidence detection due to

positron decay and annihilation
PET Concept

limitations
 ACD has to detect true
coincidence events and reject
scattered or random
coincidence ones.
 511 keV photons requires thicker
scintillation crystal  lower
resolution for lower energy
events.
 Because of inefficient angular
acquisition, dual head SPECT
scanners are not ideal  use Sensitivity in PET:
- Measures capability of system to
ring detector PET systems. detect “trues” and reject “randoms”

Detector Block
•Detector blocks based
on the Anger camera
principle.
• Crystal (8x8 cuts) + 4
photomultiplier tubes
(PMTs).
• Cuts isolate light from
different scintillation
events. Bismuth Germanate (BGO)
BGO is used instead of NaI(TI) as the scintillation crystal. The linear

attenuation coefficient of BGO at 511 keV is 0.964 cm-1, where it is 0.343 cm-1 for
NaI(TI). So BGO detectors can be 1/3 the thickness of what would be NaI(TI).
Ring Detector
PET scans often have
lead or tungsten speta
between the detector
rings.
The purpose of the
speta is to collimate
the photons into a set
of 2-D slices.
Modern PET scanner has 3 rings of detectors with 48

detector blocks in each ring.
Each detector block has 64 subcrystals backed by 4 PMTs.
PET Evolution
Lutetium
oxyorthosilicate
LSO and gadolinium oxyorthosilicate (GSO) are new detector materials. The decay time
for them is on the order of 50 ns, a very significant improvement over NaI(TI) and BGO.
LSO & BGO have comparable attenuation coefficient, can be made small for good
spatial resolution, and still retain good stopping power.
Combined PET/CT Systems
 CT: provides high resolution anatomical information.
 PET: Low resolution functional imaging.
 Traditional approach:
 Obtain CT and PET images separately.
 “Mental” image-fusion (registration) of images is done
by the physician.
 Combined PET/CT: Acquiring PET and CT images
within the same system without moving the patient
relative to the table  more accurate registration.
 However, artifacts and registration errors due to
breathing and body motion cannot be avoided.

Combined PET/CT Systems (cont.)
 CT exam can be done during a breath hold unlike PET
exam which requires breathing.
 Advantages of combined PET/CT:
 Improved positional accuracy.
 Easier availability of PET and CT.
 Attenuation correction of PET images  better registration.

PET/CT Images

PET Applications
 Brain:
 Tumor detection
 Neurological function
(pathologic, neuroscience app.)
 Perfusion
 Cardiac
 Blood flow
 Metabolism
 Tumor detection (metastatic cancer)

Summary
 Three major imaging modalities:
 Planar scintigraphy
 SPECT
 PET
 Principle of Anger camera: collimator, scintillation
crystal, photomultiplier.
 Imaging principles of planar scintigraphy and SPECT:
 Both based on gamma decay.
 Very similar to X-ray projection and CT, except for the
attenuation factor.
 Practical systems mostly ignore the attenuation factor.

Summary (cont.)
 Imaging principle of PET:
 Coincidence detection: detect two photons reaching two
opposite detectors simultaneously (within a short time
window).
 Detected signal is the product of two terms, depending
on the radioactivity A and attenuation μ separately.
 Can reconstruct radioactivity more accurately if μ can be
measured simultaneously with PET/CT.
New Modality PET/MRI

Home work

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Chapter Three

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A general projection A fluoroscopy A mammography

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Glass housing; vacuum

mAs measures x-ray exposure

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Simplified block diagram

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When the energy of x-ray

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h- the height of the

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 Typical GCF values range from 3 to 8. Use grid when

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A plastic protective coating is applied to the film side of the screen to

Radiographic cassette is a holder for two intensifying screens

Block diagram of an XRII

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1G Single x- Pencil Single None Move linearly Scattered Slow

3G Single x- Fan beam, Many Collimated Rotate in Faster 2G, More

6G 3 G/4G 3G/4G 3G/4G 3G/4G 3G/4G plus Fast 3D A bit more