Spiral CT and its Quality Control Procedures

By
Ali Adeel (Medical Physics MP-01)

Report submitted to Dr. Tariq Majeed in partial fulfillment of
requirements for the course of Physics of Nuclear Medicine



Department of Physics and Applied Mathematics,
Pakistan Institute of Engineering & Applied Sciences,
Nilore, Islamabad, Pakistan
December, 2012
i
Dedication
This report is dedicated to my parents who taught me well
instead of having financial problems. It is also dedicated to my
teachers especially Mr. Muhammad Asif and Dr. Bilal Masood
for their guidance. It is also dedicated to my friends Muhammad
Umer Asif, Farhan Ijaz Ahmad, Muhammad Jamil, Khawar
Sultan and all those who collectively enabled me to gain the
status I have today.
ii
Acknowledgement
First of all thanks to ALLAH ALMIGHTY, WHO has blessed me with too many
abilities while I have not requested for any of these, so I am able to do this.
After that I acknowledge my Parents and all Teachers, who supported me both
morally and technically, especially supervisor Dr. Tariq Majeed, who helped me at
every step in this report.
I also acknowledge to Dr. Rehan Abdullah, he taught me about paragraph formatting.
I also acknowledge to www.shaunakelly.com from where I learned multi-level listing,
list numbering and modifying heading styles. I acknowledge to all authors, editors,
publishers etc. of reference material.


Ali Adeel
iii
Table of Contents

List of Figures ............................................................................................................... iv
List of Tables ................................................................................................................. v
Abstract / Executive Summary ..................................................................................... vi
1) Introduction ............................................................................................................ 1
1.1) From X-rays to CT .......................................................................................... 3
1.2) Basic Principles of CT..................................................................................... 3
1.3) Generations of CT ........................................................................................... 5
2) Material and Methods ............................................................................................ 7
2.1) Spiral or Helical CT Scanning ........................................................................ 7
2.2) Multislice Spiral CT ...................................................................................... 11
2.3) Dose Calculation in Spiral CT ...................................................................... 13
2.4) Quality Control Procedure in Spiral CT ........................................................ 14
2.4.1) CT Numbers or Hounsfield Units .......................................................... 15
2.4.2) Other Quality Control Checks ............................................................... 16
3) Result Discussion ................................................................................................. 17
3.1) Advantages of Spiral CT ............................................................................... 17
3.2) Disadvantages of Spiral CT........................................................................... 17
3.3) Importance of Spiral CT Quality Assurance ................................................. 17
4) Summary & Conclusion ....................................................................................... 19
References .................................................................................................................... 20
Vita ............................................................................................................................... 21


iv
List of Figures

Figure 1.1: Posteroanterior and lateral chest radiographs give three-dimensional
informationconcerning the location of an abnormality [2]. ........................................... 4
Figure 1.2: Scan motions in computed tomography [1]. ............................................... 6
Figure 2.1: Spiral CT scanning [1]. ............................................................................... 8
Figure 2.2: Working principle of slip rings. .................................................................. 8
Figure 2.3: Application of slip ring in spiral CT. .......................................................... 8
Figure 2.4: Variation in slice thickness with respect to pitch. ..................................... 10
Figure 2.5: A schematic of a fixed-array detector geometry for a multislice spiral
scanner (Left). Four configurations connecting the data acquisition channels to single
or multiple elements of the arrayed detectors produce four different slice thicknesses
(Right) [3]. ................................................................................................................... 12
Figure 2.6: CT image of a quality control phantom [1]. .............................................. 15

v
List of Tables
Table 1-1: Energy Sources and Tissue Properties Employed in Medical Imaging [1]. . 2
Table 2-1: Common Quality Control Measurements for Computed Tomography [1].
...................................................................................................................................... 15

vi
Abstract / Executive Summary
This report explores spiral CT and its quality control procedures. First of all question
of why we need medical imaging (as CT is one of these) is addressed and different
imaging modalities with their principle are described. After that principle of
conventional X-rays imaging are discussed to some extent, because CT evolved from
this modality.
Afterwards basic principles of conventional CT are elaborated; different generations
of CT are also briefly explained so that a sequence may be established between
different generations. Although there were technological developments from one
generation to other but spiral CT has to wait for slip ring technology.
Working principle of spiral or helical computed tomography is discussed in material
and method section. Although spiral CT is superior to conventional CT in many
aspects but there were difficulties to attain same image quality using spiral CT.
Related problems and corresponding solution are also summarized. Multislice with its
important parameters is also briefly touched.
Relation of dose with different parameters of spiral CT is established so that risk and
benefit analysis can be done. Parameters used for quality control procedures, allowed
values for these parameters and frequency for their testing is also described.
In the end advantages and disadvantages associated with spiral CT are briefly
summarized, no doubt spiral CT is superior in comparison with conventional CT in
many aspects and will replace it with time.

1
1) Introduction
Natural science is the search for truth about the natural world. In this denition,
truth is dened by principles and laws that have evolved from observations and
measurements about the natural world. The observations and measurements are
reproducible through procedures that follow universal rules of scientic
experimentation. They reveal properties of objects and processes in the natural world
that are assumed to exist independently of the measurement technique and of our
sensory perceptions of the natural world. The mission of science is to use observations
and measurements to characterize the static and dynamic properties of objects,
preferably in quantitative terms, and to integrate these properties into principles and,
ultimately, laws and theories that provide a logical framework for understanding the
world and our place in it [1].
As a part of natural science, human medicine is the quest for understanding one
particular object, the human body, and its structure and function under all conditions
of health, illness, and injury. This quest has yielded models of human health and
illness that are immensely useful in preventing disease and disability, detecting and
diagnosing illness and injury, and designing therapies to alleviate pain and suffering
and to restore the body to a state of wellness or, at least, structural and functional
capacity. The success of these efforts depends on (a) our depth of understanding of
the human body and (b) the delineation of ways to intervene successfully in the
progression of disease and the effects of injuries [1].
Progress toward these objectives has been so remarkable that the average life span of
humans in developed countries is almost twice its expected value a century ago.
Greater understanding has occurred at all levels, from the atomic through molecular,
cellular, and tissue to the whole body, and includes social and lifestyle inuences on
disease patterns. The human body is an incredibly complex system. Acquiring data
about its static and dynamic properties results in massive amounts of information.
One of the major challenges to researchers and clinicians is the question of how to
acquire, process, and display vast quantities of information about the body so that the
information can be assimilated, interpreted, and utilized to yield more useful
diagnostic methods and therapeutic procedures. In many cases, the presentation of
information as images is the most efcient approach to addressing this challenge. As
2
humans we understand this efciency; from our earliest years we rely more heavily on
sight than on any other perceptual skill in relating to the world around us. Physicians
increasingly rely as well on images to understand the human body and intervene in the
processes of human illness and injury. The use of images to manage and interpret
information about biological and medical processes is certain to continue its
expansion, not only in clinical medicine but also in the biomedical research enterprise
that supports it [1].
Images of a complex object such as the human body reveal characteristics of the
object such as its transmissivity, opacity, emissivity, reectivity, conductivity, and
magnetizability, and changes in these characteristics with time. Images that reveal one
or more of these characteristics can be analyzed to yield information about underlying
properties of the object, as depicted in Table 1-1. For example, images
(shadowgraphs) created by x rays transmitted through a region of the body reveal
intrinsic properties of the region such as effective atomic number Z, physical density
(grams/cm
3
), and electron density (electrons/cm
3
). Nuclear medicine images,
including emission computed tomography (ECT) with pharmaceuticals releasing
positrons [positron emission tomography (PET)] and single photons [single-photon
emission computed tomography (SPECT)], reveal the spatial and temporal
distribution of target-specic pharmaceuticals in the human body [1].
Table 1-1: Energy Sources and Tissue Properties Employed in Medical Imaging [1].

3
1.1) From X-rays to CT
In conventional radiography, subtle differences of less than about 5 percent in subject
contrast (i.e., x-ray attenuation in the body) are not visible in the image. This
limitation exists for the following reasons [1]:
1. The projection of three-dimensional anatomic information onto a two-
dimensional image receptor obscures subtle differences in x-ray transmission
through structures aligned parallel to the x-ray beam. Although conventional
tomography resolves this problem to some degree, structures above and below
the tomographic section may remain visible as ghosts in the image if they
differ signicantly in their x-ray attenuating properties from structures in the
section.
2. Conventional image receptors (i.e., lm, intensifying and uoroscopic screens)
are not able to resolve small differences (e.g., 2%) in the intensity of incident
radiation.
3. Large-area x-ray beams used in conventional radiography produce
considerable scattered radiation that interferes with the display of subtle
differences in subject contrast.
To a signicant degree, each of these difculties is eliminated in computed
tomography (CT). Hence, differences of a few tenths of a percent in subject contrast
are revealed in the CT image. Although the spatial resolution of a millimeter or so
provided by CT is notably poorer than that provided by conventional radiography, the
superior visualization of subject contrast, together with the display of anatomy across
planes (e.g., cross-sectional) that are not accessible by conventional imaging
techniques, make CT exceptionally useful for visualizing anatomy in many regions of
the body [1].
1.2) Basic Principles of CT
The mathematical principles of CT were first developed by Radon in 1917. Radon's
treatise proved that an image of an unknown object could be produced if one had an
infinite number of projections through the object. Mathematical details are not
discussed in this report, we can understand the basic idea behind tomographic
imaging with an example taken from radiography [2].
4
With plain film imaging, the three-dimensional (3D) anatomy of the patient is reduced
to a two-dimensional (2D) projection image. The density at a given point on an image
represents the x-ray attenuation properties within the patient along a line between the
x-ray focal spot and the point on the detector corresponding to the point on the image.
Consequently, with a conventional radiograph of the patient's anatomy, information
with respect to the dimension parallel to the x-ray beam is lost. This limitation can be
overcome, at least for obvious structures, by acquiring both a posteroanterior (PA)
projection and a lateral projection of the patient as shown in Figure 1.1. For example
the PA chest image in Figure 1.1 yields information concerning height and width,
integrated along the depth of the patient, and the lateral projection provides
information about the height and depth of the patient, integrated over the width
dimension. Imagine that instead of just two projections, a series of 360 radiographs
were acquired at 1-degree angular intervals around the patient's thoracic cavity. Such
a set of images provides essentially the same data as a thoracic CT scan. However, the
360 radiographic images display the anatomic information in a way that would be
impossible for a human to visualize: cross-sectional images. If these 360 images were
stored into a computer, the computer could in principle reformat the data and generate
a complete thoracic CT examination [2].

The tomographic image is a picture of a slab of the patient's anatomy. The 2D CT
image corresponds to a 3D section of the patient, so that even with CT, three
Figure 1.1: Posteroanterior and lateral chest radiographs give three-
dimensional informationconcerning the location of an abnormality [2].
5
dimensions are compressed into two. However, unlike the case with plain film
imaging, the CT slice-thickness is very thin (l to 10 mm) and is approximately
uniform. The 2D array of pixels (short for picture elements) in the CT image
corresponds to an equal number of 3D voxels (volume elements) in the patient.
Voxels have the same in-plane dimensions as pixels, but they also include the slice
thickness dimension. Each pixel on the CT image displays the average x-ray
attenuation properties of the tissue in the corresponding voxel [2].
1.3) Generations of CT
Early (rst-generation) CT scanners used a pencil-like beam of x-rays and a
combination of translational and rotational motion to accumulate the many
transmission measurements required for image reconstruction (Figure 1.2-a).
Although this approach yields satisfactory images of stationary objects, considerable
time (4 to 5 minutes) is required for data accumulation, and the images are subject to
motion blurring. Soon after the introduction of pencil-like beam scanners, fan-shaped
x-ray beams were introduced so that multiple measures of x-ray transmission could be
made simultaneously (Figure 1.2-b). Fan beam geometries with increments of a few
degrees for the different angular orientations (e.g., a 30-degree fan beam and 10-
degree angular increments) reduced the scan time to 20 to 60 seconds. Fan beam
geometries also improved image quality by reducing the effects of motion. CT
scanners with x-ray fan beam geometries and multiple radiation detectors constitute
the second generation of CT scanners [1].
The third and fourth generations of CT scanners eliminate the translational motion of
previous scanners and rely exclusively upon rotational motion of the x-ray tube and
detector array (third generation Figure 1.2-c) or upon rotational motion of the x-ray
tube within a stationary circular array of 700 or more detectors (fourth-generation
scanner, Figure 1.2-d). With these scanners, data accumulation times as short as 1
second are achievable [1].
6


Figure 1.2: Scan motions in computed tomography [1].
7
2) Material and Methods
Several approaches to even faster CT scans have been pursued. Until recently,
multiple scan sequences to produce contiguous image slices required that the x-ray
tube stop its rotation and reverse its direction because the maximum extension of the
high-voltage cables had been reached. Thus, a successive slice-by-slice accumulation
technique was used to produce multi-slice images. In this technique, the total image
acquisition time is signicantly longer than the beam-on time because the table
increments (moves) to the next slice location and the patient breathes between slices.
2.1) Spiral or Helical CT Scanning
In the conventional CT systems described above, only a single slice can be acquired at
one time. If multiple slices are required to cover a larger volume of the body, the
entire thorax, for example, then the patient table is moved in discrete steps through the
plane of the X-ray source and detector. A single slice is acquired at each discrete table
position, with an inevitable time delay between obtaining each image. This process is
both time-inefficient and can result in spatial misregistrations between slices if the
patient moves [3].
In the early 1990s, the design of third- and fourth-generation scanners evolved to
incorporate slip ring technology. A slip ring is a circular contact with sliding brushes
that allows the gantry to rotate continually, untethered by wires as shown in
Figure 2.1
1
. The use of slip-ring technology eliminated the inertial limitations at the
end of each slice acquisition, and the rotating gantry was free to rotate continuously
throughout the entire patient examination. This design made it possible to achieve
greater rotational velocities than with systems not using a slip ring, allowing shorter
scan times. A typical spiral CT scheme is shown in Figure 2.2
2
and Figure 2.3 [2].

1
From Fundamentals of Physics by Halliday, Resnick and Walker
2
http://www.mdtmag.com/articles/2007/09/compressing-storage-demands-ct-imaging
8



Figure 2.1: Working principle of slip rings.
Figure 2.2: Application of slip ring in spiral CT.
Figure 2.3: Spiral CT scanning [1].
9
The trajectory of the X-ray beam through the patient traces out a spiral, or helix:
hence the name. This technique represented a very significant advance in CT because
it allowed scan times for a complete chest and abdominal study to be reduced from
~10 min to ~1 min . In addition, a full three-dimensional vascular imaging dataset
could be acquired very shortly after injection of an iodinated contrast agent, resulting
in a significant increase in the SNR of the angiograms. Incorporation of this new
technology has resulted in three-dimensional CT angiography becoming the method
of choice for diagnosing disease in the renal and the pulmonary arteries as well as the
aorta [3].
The instrumentation for spiral CT is very similar to conventional third-generation CT
scanners (some companies employ a fourth-generation design). However, because
both the detectors and the X-ray source rotate continuously in spiral CT, it is not
possible to use fixed cables to connect either the power supply to the X-ray source or
the output of the photomultiplier tubes directly to the digitizer and computer. Instead,
multiple slip-rings are used for power and signal transmission. Typical spiral CT
scanners have dual-focal-spot X-ray tubes with three kVp settings possible [3].
The main instrumental challenge in spiral CT scanning is that the X-rays must be
produced continuously, without the cooling period that exists between acquisition of
successive slices in conventional CT. This requirement leads to very high
temperatures being formed at the focus of the electron beam at the surface of the
anode. Anode heating is particularly problematic in abdominal scanning, which
requires higher values of tube currents and exposures than for imaging other regions
of the body. Therefore, the X-ray source must be designed to have a high heat
capacity and very efficient cooling. If anode heating is too high, then the tube current
must be reduced, resulting in a lower number of X-rays and a degraded image SNR
[3].
X-ray detector design is also critical in spiral CT because highly efficient detectors
reduce the tube currents needed and help to alleviate issues of anode heating. The
detectors used in spiral CT are either solid-state, ceramic scintillation crystals or
pressurized xenon-filled ionization chambers. Scintillation crystals, usually made
from bismuth germanate (BGO), have a high efficiency (75-85%) in converting X-
rays to light and subsequently to electrical signals via coupled photomultiplier tubes.
10
Gas-filled ionization chambers have a lower efficiency (40-60%), but are much easier
and cheaper to construct. The total number of detectors is typically between 1000
(third-generation scanners) and 5000 (fourth-generation systems) [3].
A number of data acquisition parameters are under operator control, the most
important of which is the spiral pitch p. The spiral pitch is defined as the ratio of the
table feed d per rotation of the X-ray source to the collimated slice thickness S:

d
p
S
= (1)
The value of p lies between 0 and 2 for single-slice spiral CT systems. For p values
less than 1, the X-ray beams of adjacent spirals overlap, resulting in a high tissue
radiation dose. For p values greater than 2, gaps appear in the data sampled along the
long axis of the patient. For large values of p, image blurring due to the continuous
motion of the patient table during data acquisition is greater as shown in Figure 2.4
3
.
A large value of p also increases the effective slice thickness to a value above the
width of the collimated X-ray beam: for example, at a spiral pitch value of 2, the
increase is of the order of 25%. The value of p typically used in clinical scans lies
between 1 and 2, which results in a reduction in tissue radiation dose compared to a
single-slice scan by a factor equal to the value of p [3].

Due to the spiral trajectory of the X-rays through the patient, modification of the back
projection reconstruction algorithm is necessary in order to form images that

3
From lecture of Prof. Dr. Lothar Schad, Faculty of Medicine Mannheim, University of Heidelberg
12/9/2008
Figure 2.4: Variation in slice thickness with respect to pitch.
11
correspond to those acquired using a single-slice CT scanner. Reconstruction
algorithms use linear interpolation of data points 1800 apart on the spiral trajectory to
estimate the data that would have been obtained at a particular position of a stationary
patient table. Images with thicknesses greater than the collimation width can be
produced by adding together adjacent reconstructed slices. Images are usually
processed in a way which results in considerable overlap between adjacent slices.
This has been shown to increase the accuracy of lesion detection, for example,
because with overlapping slices there is less chance that a significant portion of the
lesion lies between slices [2].
2.2) Multislice Spiral CT
The efficiency of spiral CT can be increased further by incorporating an array of
detectors in the z direction, that is, the direction of table motion. Such an array is
shown in Figure 2.5. The increase in efficiency arises from the higher values of the
table feed per rotation that can be used. Multislice spiral CT can be used to image
larger volumes in a given time, or to image a given volume in a shorter scan time,
compared to single-slice spiral CT. The collimated X-ray beam can also be made
thinner, giving higher quality three-dimensional scans. The spiral pitch P
ms
for a
multislice CT is defined slightly differently from that for a single-slice CT system:

ms
single
d
P
S
= (2)
where S
single
is the single-slice collimated beam width. For a four-slice spiral CT
scanner, the upper limit of the effective spiral pitch is increased to a value of eight. In
multislice spiral CT scanning the effective slice thickness is dictated by the
dimensions of the individual detectors, rather than the collimated X-ray beam width
[3].
12

In a multislice system the focal-spot-to-isocenter and the focal-spot-to-detector
distances are shortened compared to those in a single-slice scanner, and the number of
detectors in the longitudinal direction is increased from one long element to a number
of shorter elements. There are two basic types of detector arrangements, called fixed
and adaptive. The former consists of 16 elements, each of length 1.25 mm, giving a
total length of 2 cm. The signals from sets of four individual elements are typically
combined. With the setup shown in Figure 1.33, four slices can be acquired with
thicknesses of 1.25, 2.5, 3.75, or 5 mm. These types of systems are typically run in
either high-quality (HQ) mode with a spiral pitch of 3 or high-speed (HS) mode with
a spiral pitch of 6. The second type of detector system is the adaptive array, which
consists of eight detectors with lengths 5, 2.5, 1.5, 1, 1, 1.5, 2.5, and 5 mm, also
giving a total length of 2 cm. As for the fixed detector system, four slices are usually
acquired with 1, 2.5, or 5 mm thickness. Unlike the fixed detector system, in which
only specific pitch values are possible, the pitch value in an adaptive array can be
chosen to have any value between 1 and 8 [3].
Fan-beam reconstruction techniques, in combination with linear interpolation
methods, are used in multislice spiral CT. One important difference between single
slice and multislice spiral CT is that the slice thickness in multislice spiral CT can be
Figure 2.5: A schematic of a fixed-array detector geometry for a multislice spiral
scanner (Left). Four configurations connecting the data acquisition channels to single
or multiple elements of the arrayed detectors produce four different slice thicknesses
(Right) [3].
13
chosen retrospectively after data acquisition, using an adaptive axial algorithm. The
detector collimation is set to a value of 1, 2.5, or 5 mm before the scan is run. After
the data have been acquired, the slices can be reconstructed with a thickness between
1and 10 mm. Thin slices can be reconstructed to form a high-quality three-
dimensional image, but the same dataset can also be used to produce a set of 5-mm-
thick images with a high SNR [3].
2.3) Dose Calculation in Spiral CT
The radiation dose delivered during a CT scan is somewhat greater than that
administered for an equivalent radiographic image. A CT image of the head requires a
dose of about 1 to 2 rad, for example, whereas an abdominal CT image usually
requires a dose of 3 to 5 rad. These doses would have to be increased signicantly to
improve the contrast and spatial resolution of CT images. The relationship between
resolution and dose can be approximated as:

2
3
s
D a
e b
| |
=
|
\ .
(3)
where D is the patient dose, s is the signal/noise ratio, e is the spatial resolution, b is
the slice thickness, and a is a constant. From above equation the following are
apparent:
1. A twofold improvement in the signal-to-noise ratio (contrast resolution)
requires a fourfold increase in patient dose.
2. A twofold improvement in spatial resolution requires an eightfold increase in
patient dose.
3. A twofold reduction in slice thickness requires a twofold increase in patient
dose.
In multislice computed tomography, patient dose is described as the CT dose index
(CTDI). When the distance that the patient moves between slices (the couch
increment CI) equals the slice thickness ST, the CTDI equals the dose averaged over
all slices (multislice average dose MSAD). When the couch increment is less than the
slice thickness, the MSAD is the CTDI multiplied by the ratio of the slice thickness
(ST) to the couch increment (CI); that is,
14

ST
MSAD CTDI
CI
(
=
(

(4)
Patient dose decreases signicantly outside of the slice. A conservative rule of thumb
(i.e., an overestimate) is that the dose is 1% of the in-slice dose at an axial distance of
10 cm from the slice [1].
2.4) Quality Control Procedure in Spiral CT
Many electronic components and massive amounts of data processing are involved in
producing a CT image. A consequence of the separation between data acquisition and
image display is the difculty of observing and investigating imaging system
problems through observation of the image alone. In such a complex system, image
quality can be ensured only through prospective monitoring of system components
and tests of overall system performance with standard phantoms. These measurements
should be correlated with patient dose to ensure that the proper balance is maintained
among variables that affect contrast, spatial resolution, image noise, and patient
radiation dose [1].
Typical measurements of CT performance are given in Table 2-1, and examples are
shown in Figure 2.6. The fundamental system performance indicators are CT number,
resolution, noise, and patient dose. Figure 2.6 shows CT image of a quality control
phantom. Image quality is evaluated by analysis of regions of interest and by visual
inspection. The mean and standard deviation of pixel values in region 1 indicate CT
number calibration, while comparison of region 2 with region 1 yields contrast
information. The serrated patterns at 3 and 9 oclock on the image indicate slice
thickness and alignment. The rows of small dark circles (low CT number) at 1 oclock
is an indication of high contrast resolution [1].
15
Table 2-1: Common Quality Control Measurements for Computed Tomography [1].



Figure 2.6: CT image of a quality control phantom [1].
2.4.1) CT Numbers or Hounsfield Units
Mter CT reconstruction, each pixel in the image is represented by a high-precision
floating point number that is useful for computation but less useful for display. Most
computer display hardware makes use of integer images. Consequently, after CT
reconstruction, but before storing and displaying, CT images are normalized and
truncated to integer values. The number CT(x,y) in each pixel, (x,y), of the image is
converted using the following expression:

( , )
( , ) 1000
water
water
x y
CT x y

= (5)
Where ( , ) x y is the floating point number of the (x,y) pixel before conversion,
water

is the attenuation coefficient of water, and CT(x,y) is the CT number (or Hounsfield
16
unit) that ends up in the final clinical CT image. The value of
water
is about 0.195 for
the x-ray beam energies typically used in CT scanning. This normalization results in
CT numbers ranging from about -1000 to +3000, where -1000 corresponds to air, soft
tissues range from -300 to -100, water is 0, and dense bone and areas filled with
contrast agent range up to +3000 [1].
The accuracy of CT numbers is measured by scanning a water-lled phantom at least
monthly. The CT number for water should be zero over a 20-cm-diameter phantom,
with a variation of less than 1 CT number. Deviation from the expected CT number of
0 for water at any energy is adjusted by applying a correction factor for the pixel
value. Constancy of the value should be monitored with a daily scan [1].
2.4.2) Other Quality Control Checks
An overall check of system performance is obtained from semiannual measurements
of CT image noise, dened as the standard deviation of CT numbers in a region of
interest. Constancy of performance is checked by evaluation of the standard deviation
in the daily water scan mentioned previously. Resolution is measured by scanning
phantoms on a monthly basis. Of particular importance is low contrast resolution,
which is a sensitive indicator of changes in component performance as they affect
noise. Patient dose is evaluated semiannually. Specially designed ionization chambers
provide measurements from which the dose may be calculated for the exposure
conditions (narrow beam, variable slice thickness) used in CT. The values should
agree with manufacturers specications to within 20% [1].
A variety of physical and mechanical factors such as patient couch positioning and
indexing should be measured as part of a comprehensive quality control program. The
performance of the hard-copy device and system monitors should be checked for
distortion, brightness, contrast adjustment, and so on. The accuracy of image analysis
features such as distance measurements and measurements of bone density should
also be independently evaluated. Additional information on quality control in CT is
available in the publications of a number of advisory groups and individuals [1].

17
3) Result Discussion
3.1) Advantages of Spiral CT
- Improved lesion detection due to elimination of respiratory misregistration.
- Reduced amount of contrast. It is because of short time required for acquiring
the data set. This has obvious benefits related both to cost as well as the
incidence of adverse reactions. Reduction in amount of contrast required is up
to half the volume used in conventional CT.
- Ability to scan a particular phase of contrast delivery.
- Reduced patient time.
- Higher quality of multi-planar and three dimensional reformations. It is
possible due to reduction of motion artifacts [4].
3.2) Disadvantages of Spiral CT
- Increased image noise. This is related to both the interpolation technique and
the decreased power of the X-ray tube, necessitated by continuous scanning.
- Volume-averaging artifacts. As the pitch increases, partial volume averaging
increases.
- Additional processing time. The large amount of raw data leads to an increase
in the processing time, which can also temporarily interrupt patient scanning
[4].
3.3) Importance of Spiral CT Quality Assurance
A Quality Assurance (QA) program, which includes quality control tests, helps to
ensure that high quality diagnostic images are consistently produced while
minimizing radiation exposure. The QA program covers the entire x-ray system from
machine, to processor, to view box. Quality assurance enables the facility to recognize
when parameters are out of limits, which will result in poor quality images and can
increase the radiation exposure to patients. Simply performing the quality control tests
is not sufficient. When quality control test results exceed established operating
parameters, appropriate corrective action must be taken immediately and documented
[5].
18
Product manufacturers, vendors, and service companies all have information available
in the form of leaflets, videos and hands-on help. If the facility finds that they need
more instruction than there are guides which provide required one, please use these
companies and the medical physicist as resources [5].
The responsibility for the quality control tests should be assigned to a QA program
coordinator to ensure consistency in test methodology and interpretation of the data.
More than one person may perform the tests but one person should assume overall
responsibility for the day to day operation of the program. This leads to better
understanding of when to repeat tests, call for service, or consult with the practitioner
or medical physicist. The physician, medical physicist, and QC personnel, working
together as a team, are the key to providing optimum quality radiographic images [5].
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4) Summary & Conclusion
Because of the technical advantages of Spiral CT, clear indication for using it in the
study of those areas in which breath-hold speed of acquisition and the need or
opportunity to perform volumetric renderings are prominent. Specifically in
examination of chest and abdomen, it leads to high quality, more meticulous
examination with helical CT than with conventional CT. It is well suited for detection
and evaluation of small lesions e.g. pulmonary or renal mass as small as 5 mm in size
can be detected.
It also helps to perform needle localization phase of CT guided interventional
procedures more rapidly. It is also superior in CT angiography to produce
extraordinary images of the abdominal vasculature and organs as well as noninvasive
evaluation of the carotid arteries and intracranial vasculature. 'Virtual endoscopy' is
another most exciting prospect for spiral CT where 3D spiral CT data sets of a hollow
viscous (e.g. colon or tracheobronchial tree) are obtained. 'Endoscopic' images of the
viscous are then generated by a computer. One can visualize the smaller parts of
tracheobronchial tree with 'virtual bronchoscopy' where the fibro-optic bronchoscope
cannot reach because of smaller size of airway or pathological stenosis. Spiral CT is
inferior to conventional CT in imaging of motionless structures like brain and
musculoskeletal structures.
Scanning in spiral mode can be considered a mature technology. Further
improvements in the technical scanning parameters, increase in X-ray power and
refinements in data processing algorithms aimed at higher Z-axis resolution will lead
to better Images.

20
References
[1] E. Russell Ritenour William R. Hendee, Medical Imaging Physics, 4th ed. New
York, USA: Wiley-Liss, 2002.
[2] Jerrold T. Bushberg, The Essential Physics of Medical Imaging, 2nd ed. USA:
Lippincott Williams & Wilkins, 2002.
[3] Andrew Webb, Introduction to Biomedical Imaging, Metin Akay, Ed. New Jersey,
United States of America: John Wiley & Sons, 2003.
[4] Mandeep Singh Sudan, "Spiral Computed Tomography," JK Science (New
Horizons), vol. 1, pp. 138-139, January 1999.
[5] New Jersey Department of Environmental Protection Bureau of Radiological
Health. (2011, January) Compliance Guidance for Computed Tomography Quality
Control. Document.
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Vita
Author of this report was born in Lahore (Punjab). He did his matriculation from
Punjab School System and intermediate from Shalimar College Lahore, with 1
st

division. He completed his B.Sc [honors] in Computational Physics from Centre for
High Energy Physics, University of the Punjab, Lahore and got merit scholarship
regularly for 4 years. In November, 2011, he was selected for PAEC fellowship and
now doing MS in Medical Physics from PIEAS, Islamabad.

Ali Adeel
C-113 PIEAS Hostels,
Nilore, Islamabad