Lecture No. 9 Basic Principles of CT Scan

Lecture notes
No. 9
Physical Principles(CT) (MDR 522)

ADVANCE PHYSICS
&INSTRUMENTATION Basic principles of CT Scan
OF CT SCAN
INTRODUCTION
 Clinical CT was introduced in 1971 - limited to axial imaging of the brain in

neuroradiology
 It developed into a versatile 3D whole body imaging modality for a wide range of
applications for example
• oncology, vascular radiology, cardiology, traumatology and interventional

radiology.
INTRODUCTION
 CT scan be used for
• diagnosis and follow-up studies of patients
• planning of radiotherapy treatment
• screening of healthy subpopulations with specific risk factors.

INTRODUCTION
 Nowadays dedicated CT scanners are available for special
clinical applications, such as
• For radiotherapy planning - these CT scanners offer an extra wide bore, allowing the CT
scans to be made with a large field of view.
• The integration of CT scanners in multi modality imaging applications, for
example by integration of a CT scanner with a PET scanner or a SPECT
scanner.
INTRODUCTION
 Other new achievements for dedicated diagnostic imaging new achievements

concerns for example the development of a dual source CT scanner (a CT scanner that
is equipped with two X-ray tubes), and a volumetric CT scanner (a 320 detector row
CT scanner that allows for
scanning entire organs within one rotation).

INTRODUCTION
 CT scanning is perfectly suited for 3D imaging and used

in, for example, brain, cardiac, musculoskeletal, and whole body
CT imaging
CT PRINCIPLES
 X-ray projection, attenuation and acquisition of transmission profiles
The purpose of a CT acquisition is to measure x-ray transmission through a patient

for a large number of views.
 Different views are achieved in CT primarily by using:
• detectors with hundreds of detector elements along the detector
arc (generally 800-900 detector elements)
• by rotation of the x ray tube around the patient, taking about 1000
angular measurements
• by tens or even hundreds of detector rows aligned next to each other
along the axis of rotation
CT PRINCIPLES
 The values that are assigned to the pixels in a CT image are associated with the
average linear attenuation coefficient μ (m-1) of the tissue represented within that
pixel.
 The linear attenuation coefficient (μ) depends on the composition of the

material, the density of the material, and the photon energy as seen in Beer’s law:
• I(x) is the intensity of the attenuated X ray beam

• I0 the un attenuated X ray beam
• x the thickness of the material.
 As an X ray beam is transmitted through the patient, different tissues are
encountered with different linear attenuation coefficients.
 The intensity of the attenuated X ray beam, transmitted a distance d, can be

expressed as:
 A CT image is composed of a matrix of pixels representing the average
linear attenuation co-efficient in the associated volume elements (voxels).
 Illustration: a simplified 4 x 4 matrix representing the
measurement of transmission along one line.
 Each element in the matrix can in principle have a different
value of the associated linear attenuation coefficient.
 The equation for the attenuation can be expressed as:
 From the above it can be seen that the basic data needed
for CT is the intensity of the attenuated and un attenuated
X ray beam, respectively I(d) and I0, and that this can be
measured.
 Image reconstruction techniques can then be applied to
derive the matrix of linear attenuation coefficients, which is
the basis of the CT image.

Hounsfield Units
 In CT the matrix of reconstructed linear attenuation
coefficients (μ material) is transformed into a corresponding
matrix of Hounsfield units (HU material), where the HU scale
is expressed relative to the linear attenuation coefficient of
water at room temperature (μwater):
• HU water = 0 as (μ material = μ water)

• HUair = -1000 as (μmaterial = 0)
• HU=1 is associated with 0.1% of the linear attenuation coefficient of water.
HOUNSFIELD UNITS
 Typical values for body tissues.
• The actual value of the HU depends on:
 Composition of the tissue or material
 Tube voltage
 Temperature
CT NUMBER WINDOW
 Hounsfield units are usually visualized in an eight bit grey scale offering
only 128 grey values.
 The display is defined using
• Window level (WL) as CT number
of mid-grey
• Window width (WW) as the number
of HU from black -> white

HOUNSFIELD UNITS
 The choice of WW and WL is dictated by clinical need
 Optimal visualization of the tissues of interest in the CT image can only be

achieved by selecting the most appropriate window width and window level.
 Different settings of the WW and WL are used to visualize
for example soft tissue, lung tissue or bone.

HOUNSFIELD UNITS
 Same image data at different WL and WW
WL -593, WW 529 WL -12, WW 400

HOUNSFIELD UNITS
 The minimum bit depth that should be assigned to the Hounsfield unit is 12,
this enables creating a Hounsfield scale that runs from –1024 HU to +3071
HU, thus covering most clinically relevant tissues.
 A wider Hounsfield scale with a bit depth of 14 is useful for extending the
Hounsfield unit scale upwards to +15359 HU thus making it compatible with
materials that have a high density and high linear attenuation coefficient.
 An extended Hounsfield scale allows for better visualization of body parts

with implanted metal objects such as stents, orthopedic prosthesis’s, dental- or
cochlear implants.
HOUNSFIELD UNITS
 From the definition of the Hounsfield unit
• for substances and tissues, except for water and air, variations of the Hounsfield
units occur when they are derived at different tube voltages.
 The reason is that as a function of photon energy different substances and tissues
exhibit a non linear relationship of their linear attenuation coefficient relative to
water.
 This effect is most notable for substances and tissues that have a relatively high
(effective) atom number such as contrast enhanced blood (iodine) and bone
(calcium).
HOUNSFIELD UNITS
 In clinical practice, considerable deviations between the expected and the

actually observed HU may occur.
 Causes for such inaccuracies may be the dependence of the HU for example on
the:
 Reconstruction filter
Size of the scanned field of view
 Position within the scanned field of view.
 Image artefacts.
HOUNSFIELD UNITS
 When performing clinical studies over time, one should take into account
that even on the same scanner, with time, a certain drift of the HU may occur.
 In multicenter studies that involve different CT scanners, significant

variations in the observed HU may also occur between centers.
 Therefore, quantitative imaging in CT requires special attention and often

additional calibrations of the CT scanners are needed.
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Lecture notes

Physical Principles(CT) (MDR 522)

 Clinical CT was introduced in 1971 - limited to axial imaging of the brain in

• oncology, vascular radiology, cardiology, traumatology and interventional

 CT scan be used for

• diagnosis and follow-up studies of patients

• planning of radiotherapy treatment

• screening of healthy subpopulations with specific risk factors.

 Nowadays dedicated CT scanners are available for special

clinical applications, such as

• The integration of CT scanners in multi modality imaging applications, for

example by integration of a CT scanner with a PET scanner or a SPECT

 Other new achievements for dedicated diagnostic imaging new achievements

scanning entire organs within one rotation).

 CT scanning is perfectly suited for 3D imaging and used

 X-ray projection, attenuation and acquisition of transmission profiles

The purpose of a CT acquisition is to measure x-ray transmission through a patient

 The linear attenuation coefficient (μ) depends on the composition of the

• I(x) is the intensity of the attenuated X ray beam

 The intensity of the attenuated X ray beam, transmitted a distance d, can be

for CT is the intensity of the attenuated and un attenuated

 Image reconstruction techniques can then be applied to

derive the matrix of linear attenuation coefficients, which is

the basis of the CT image.

• HU water = 0 as (μ material = μ water)

 Typical values for body tissues.

• The actual value of the HU depends on:

 Composition of the tissue or material

 The display is defined using

• Window level (WL) as CT number

• Window width (WW) as the number

of HU from black -> white

 The choice of WW and WL is dictated by clinical need

 Optimal visualization of the tissues of interest in the CT image can only be

 Different settings of the WW and WL are used to visualize

for example soft tissue, lung tissue or bone.

WL -593, WW 529 WL -12, WW 400

 An extended Hounsfield scale allows for better visualization of body parts

 From the definition of the Hounsfield unit

 In clinical practice, considerable deviations between the expected and the

Size of the scanned field of view

 Position within the scanned field of view.

 In multicenter studies that involve different CT scanners, significant

 Therefore, quantitative imaging in CT requires special attention and often

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