CT SCANS

AND THEIR APPLICATION

Those Super Rays!

X-rays were discovered in 1895 by Wilhelm Conrad Roentgen (1845-1923) who was a Professor at Wuerzburg University in Germany. Working with a cathode-ray tube in his laboratory, Roentgen observed a fluorescent glow of crystals on a table near his tube. One of Roentgen's first experiments late in 1895 was a film of the hand of his wife, Bertha.

THAT HAND

Properties of X / Gamma Rays

They are not detected by human senses (cannot be seen, heard, felt, etc.). They travel in straight lines at the speed of light. Their paths cannot be changed by electrical or magnetic fields. They can be diffracted to a small degree at interfaces between two different materials. They pass through matter until they have a chance encounter with an atomic particle. Their degree of penetration depends on their energy and the matter they are traveling through. They have enough energy to ionize matter and can damage or destroy living cells.

INTERESTINGLY!
Development of CT is thought by some to be the Greatest Legacy of the BEATLES
Records sales allowed EMI to fund scientific research Path of flight 600 times over 100 years CT technology 1200 times over 25 years

Why CT?
3-D image as compared to Only 2-D image possible on X Ray Superimposed structures made out seperately

COMPUTED TOMOGRAPHY
Tomos is the Greek word for cut or section, and tomography is a technique for digitally cutting a specimen open using X-rays to reveal its interior details.
A CT image is typically called a slice, as it corresponds to a slice from a loaf of bread. -

DEVELOPMENT
Ist Commercial CT Godfrey Newbold Hounsfield Hayes, England Thorn EMI Research Laboratories Idea conceived in 197 Made public 1972 Received Nobel along with Allan McLeod Cormack in 1979

CT EQUIPMENT
X RAY TUBE DETECTORS

ARRANGED IN THE GANTRY

SOFTWARE HARDWARE COMPUTER WITH DISPLAY TERMINAL

CT THEN AND NOW A LONG WAY [7mins 300 ms]

EMI SCANNER In 1971 each slice took > 5 min. Computation time 7 mins / image Water-filled perspex tank with a pre-shaped rubber "head-cap" at the front, which enclosed the patient's head. The water-tank was used to reduce the dynamic range of the radiation reaching the detectors (between scanning outside the head compared with scanning through the bone of the skull).

AND TODAY

Whole body can be scanned in < 30 seconds

A bit of history
In the U.S., the first installation was at the Mayo Clinic
As a tribute to the impact of this system on medical imaging the Mayo Clinic has an EMI scanner on display in the Radiology Department.

The original scanner

And TODAYS CT SCANNER

Generation/configuration/detector s/beammin scan/ time

First : translate-rotate1~2pencil thin2.5 min Second : translate-rotate3~52narrow fan10 sec Third : Rotate-rotate256~1000wide fan0.5 sec Fourth : Rotate-fixed600~4800wide fan1 sec Fifth: electron beam1284 detectorswide fan electron beam33 ms Sixth : Spiral CT Seventh : Multi Row Detector CT

MAJOR JUMP SPIRAL CT

Helical / Spiral CT was introduced in the early 1990s, Development led by Willi Kalender and Kazuhiro Katada In older CT scanners, the X-ray source would move in a circular fashion to acquire a single 'slice', once the slice had been completed, the scanner table would move to position the patient for the next slice; meanwhile the X-ray source/detectors would reverse direction to avoid tangling their cables. Replaced by two technologies : Slip rings to transfer power and data on and off the rotating gantry, and the Switched Mode power supply - powerful enough to supply the Xray tube, but small enough to be installed on the gantry.

SPIRAL CT
Speed - a large volume can be covered in 20-60 seconds the patient can hold their breath for the entire study, reducing motion artifacts Optimal use of intravenous contrast enhancement, The study is quicker than the equivalent conventional CT permitting the use of higher resolution acquisitions in the same study time Well-suited for 3D imaging

Multislice CT
Similar in concept to the helical or spiral CT - but more than one detector ring Initially 2 rings in mid nineties, with a 2 solid state ring model designed and built by Elscint (Haifa) called CT TWIN, with one second rotation (1993) Now 4, 8, 16, 32, 40 and 64 detector rings, with increasing rotation speeds. Current models (2007) have up to 3 rotations per second, and isotropic resolution of 0.35mm voxels with z-axis scan speed of up to 18 cm/s.

Major benefit - increased speed of volume coverage. This allows large volumes to be scanned at the optimal time following intravenous contrast administration; this has particularly benefitted CT angiography techniques - which rely heavily on precise timing to ensure good demonstration of arteries.

Dual Source CT
Siemens introduced a CT model with dual X-ray tube and dual array of 64 slice detectors, at the 2005 RSNA medical meeting. Only half the rotation needed for image as compared to other CT macines Dual sources increase the temporal resolution by reducing the rotation angle required to acquire a complete image, thus permitting cardiac studies without the use of heart rate lowering medication, as well as permitting imaging of the heart in systole.

Wait theres More!

256 Slice CT
First prototype unit made by Toshiba Medical Systems

Still in development phase

CT BRAIN

CT THORAX

CT ABDOMEN

CT ABD mid renal

Three dimensional (3D) Image Reconstruction

FROM THIS

BONE RECONSTRUCTION

CIRCLE OF WILLIS

BENEFITS
CT scanning is painless, noninvasive and accurate. Unlike conventional x-rays, CT scanning provides very detailed images of many types of tissue as well as the lungs, bones, and blood vessels. CT examinations are fast and simple; in emergency cases, they can reveal internal injuries and bleeding quickly enough to help save lives. CT has been shown to be a cost-effective imaging tool for a wide range of clinical problems. CT may be less expensive than MRI. In addition, it is less sensitive to patient movement. CT can be performed if you have an implanted medical device of any kind, unlike MRI. No radiation remains in a patient's body after a CT examination.

DRAWBACKS
Main - radiation. However, the benefit of an accurate diagnosis far outweighs the risk. The effective radiation dose from this procedure is about 10 mSv, which is about the same as the average person receives from background radiation in three years. Contra indicated if pregnant. CT scanning is, in general, not recommended for pregnant women because of potential risk to the baby. Nursing mothers should wait for 24 hours after contrast material injection before resuming breast-feeding. The risk of serious allergic reaction to contrast materials that contain iodine is rare, and radiology departments are well-equipped to deal with them.

LIMITATIONS
Very fine soft-tissue details in areas such as the knee or shoulder can be more readily and clearly seen with MRI
Very obese may not fit into the opening of a conventional CT unit.

Radiation exposure
Recent comprehensive survey in the UK - CT scans constituted 7% of all radiologic examinations Contributed 47% of the total collective dose from medical X-ray examinations in 2000/2001. Increased CT usage has led to an overall rise in the total amount of medical radiation used, despite reductions in other areas.

Typical scan doses

Examination / Effective dose in mSv / milli rem Chest X-ray 0.1 10 Head CT 1.5 150 Abdomen CT 5.3 530 Chest CT 5.8 580 Chest, Abdomen and Pelvis CT 9.9 990 Cardiac CT angiogram 6.7-13 670 1300 CT colonography (virtual colonoscopy) 3.6 - 8.8360 - 880

Adverse reactions to contrast agents

Renal damage
Mild reactions nausea, vomiting, itching Death

 CT colonoscopy / bronchoscopy

RECENT APPLICATIONS

Newer CT scan has the ability to both predict stone composition and delineate structural features necessary to predict stone fragility to lithotripter shock waves.

Cardiac CT
Reconstructing mummies!

SDH

EDH

PARENCHYMAL HEMORRHAGE

HEMORRHAGIC CONTUSION

TRAUMA - pneumocephalus

INFARCT

SMALL ARTERY INFARCTS

HOPE YOU LEARNT

SOMETHING TODAY!