Computed Tomography Computed Tomography (CT):

Physics and Technology

JH JH Siewerdsen Siewerdsen PhD PhD
Dept. Dept. of of Medical Medical Biophysics, Biophysics, University University of of Toronto Toronto Ontario Ontario Cancer Cancer Institute, Institute, Princess Princess Margaret Margaret Hospital Hospital

Hounsfields CT Scanner Projection radiography Detector I0 source

jeff.siewerdsen@uhn.on.ca

Clinical Applications
M M OMalley OMalley MD MD
Dept. Dept. of of Medical Medical Imaging, Imaging, University University of of Toronto Toronto Dept. Dept. of of Medical Medical Imaging, Imaging, University University Health Health Network Network / / Mt. Mt. Sinai Sinai Hospital Hospital

martin.omalley@uhn.on.ca
Medical Biophysics Medical Imaging IBBME Ontario Cancer Institute Princess Margaret Hospital University Health Network

Circa 1895 Sir Godfrey Hounsfield Nobel Prize, 1979

Turntable I d and linear track I = Io e-0(x,y)dy 9-day acquisition 2.5-hr recon

P = ln(Io/I) = (x,y)dy

Overview
Computed Tomography (CT)
- Basic principles of CT
Natural history of scanner technologies (generations)

First Generation CT
Scan and Rotate: Linear scan of source and detector Line integral measured at each position: P(x) Rotate source-detector Repeat linear scan Projection data: P(x;) P(x)

- CT reconstruction
Fourier slice theorem Filtered backprojection Other techniques

x xx xxx x x

- Image quality / artifacts

Physical factors Performance metrics

- Radiation dose
Magnitude and risk (in context)

- Applications
Diagnostic imaging IG interventions Radiation therapy

CT Generations
1st Generation (1970) 2nd Generation (1972)

Fourier Slice Theorem

The Fourier Transform of a projection of an object at a given angle yields a slice of the Fourier Transform of the object at the corresponding angle in the Fourier domain.

y
FT

v x u F(u,v)

Pencil Beam Translation / Rotation

WA Kalender, Computed Tomography, 2nd Edition (2005)

Fan Beam Translation / Rotation

f(x,y)

CT Generations
3rd Generation (1976) 4th Generation (1978)

CT Image Reconstruction
Fourier Slice Theorem

p(,)

F [p(,)]
v x F(u,v) X-rays u

Fan Beam Continuous Rotation

Fan Beam Continuous Tube Rotation Stationary Detector

f(x,y)

CT Image Reconstruction
y

Sinogram p(x,)
Sinogram Sinogram: Line integral projection: p(x) p(x;)

F -1[F(u,v)]
x

v u

p(x) = ln(Io/I) = (x,y)dy

measured at each angle () Projection data (sinogram): p(x;)

f(x,y)

p(,)

F(u,v)

Backprojection
Simple Backprojection: Trace projection data P(x;) through the reconstruction matrix from the detector (x) to the source Simple backprojection yields radial density (1/r) Therefore, a point-object is reconstructed as (1/r) Solution: Filter the projection data by a ramp filter |r|

P(x;)

CT Image Reconstruction
Filtered Back-Projection
Projection p(,)

X-ray source

Object

Sinogram Filtered Sinogram

CT Image Reconstruction
Filtered Back-Projection
t kPr oj ec

Filtered Backprojection: Implementation

Loop over all views (all ) Projection at angle p(,)

Filtered Projection g(,)

Ba c

Backproject g(, ). Add to image (x,y)

Object Space

Filtered Sinogram

(x,y)

CT Image Reconstruction
Filtered Back-Projection

Helical CT
Slip ring gantry Continuous gantry rotation Continuous couch translation

k-P Bac

ct roje

Reconstructed Image
Table increment / rotation (mm) Beam collimation width (mm)

Pitch <1 : Overlap Higher z-resolution Higher patient dose Pitch = Pitch >1: Non-overlap Lower z-resolution Lower patient dose

Object Space

Filtered Sinogram
WA Kalender, Computed Tomography, 2nd Edition (2005)

Recent Advances: Dual-Source CT

From Fan to Cone

Two complete x-ray and data acquisition systems on one gantry. 330 ms rotation time (effective 83 ms scan time)
Siemens Medical Solutions Somatom Definition

Recent Advances: Multi-Detector CT

Multiple slices acquired in each revolution Higher speed Reduced slice thickness (Improved axial resolution)
4x 1.25 mm 4x 4x 2.5 mm 3.75 mm 4x 5.0 mm

Recent Advances: Multi-Detector CT

GE Light Speed multi-row CT detector

Fast (whole-body) scans at high resolution (thin slices)

Dynamic (4D) imaging

Recent Advances: Cone-Beam CT

Fully 3-D Volumetric CT

CT Detectors
Gas (Xenon) Scintillator / Semiconductor

Conventional CT: Fan-Beam 1-D Detector Rows Slice Reconstruction Multiple Rotations

Cone-Beam CT: Cone-Beam Collimation Large-Area Detector 3-D Volume Images Single Rotation

Conventional (old) Single-slice CT only

State of the art Well-suited to MDCT

K. Kanal, University of Wisconsin

Cone-Beam CT

Single-Slice CT vs Multi-Detector CT

Projection data (2D) 200 2000 projections over 180o 360o

Volume reconstruction ~1 mm spatial resolution + soft tissue visibility

K. Kanal, University of Wisconsin

Cone-Beam Filtered Backprojection

Weight Filter 2D Interpolation
CT

Contrast
Why CCT >> Crad? Radiograph

Geometry Reconstruction Volume

19 22 40 17 30 21 25 63 25 20

282

Contrast =

I1 I2 (I1 + I2)/2

20 19 25 19 22 18 24 25 25 40

237

CCT =

6325 =86% (63+25)/2 282237 =17% (282+237)/2

Repeat

# of voxels # of projections

Crad =

CT Image Reconstructions

CT Number (Pixel Value)

The CT image pixel values have units of the attenuation coefficient, (cm-1 or mm-1)

GB

Commonly converted to a convenient scale: Hounsfield Units (HU) Pancreas AO HU = 1000

- water water

(sometimes)

(+1000)

Fat (-100) Polyeth (-60)

Liver Spleen Spine 1975 2000 Hounsfield Units (HU)

Liver (+85)

Water (0)

Brain (8) Breast (-50)

Noise
Noise: Standard deviation in voxel values in an otherwise uniform region of interest
2 vox =
(5.6 2.4) (-1.3 6.2) (4.4 4.2) (4.6 3.2)

Reconstruction Filter
Smooth Sharp

(3.8 4.2)

k E K xy Do a 3 xy a z
fc 0
Reduced Spatial Resolution Lower Noise Improved SNR Improved Soft-Tissue Visibility
www.impactscan.org

Bandwidth Integral
2 2 K xy df Twin Tinterp
Improved Spatial Resolution Higher Noise Reduced SNR Reduced Soft-Tissue Visibility

(Fourier domain integral over the low-pass smoothing filters)

Spatial Resolution
Factors affecting spatial resolution: Focal spot size Detector pixel size Slice thickness Pitch Number of projections Reconstruction filter (kernel) Field of view Patient motion

Artifacts

Rings

Shading

Streaks

Motion

Metrics of spatial resolution: Minimum resolvable line-pair Minimum resolvable Point-spread function (psf) line-pair group Modulation transfer function (MTF)

Metal

Lag

Truncation

Cone-Beam

Dosimetrics
Measure
Activity Exposure Absorbed Dose Effective Dose

Radiation Dose
(disintegrations / sec) (ionization in air) (1 Gy = 1 J/kg = 1 Rad) (1 Sv = 100 rem)

Common Units
Ci R rad rem

SI Units
Bq C/kg Gy Sv

Surface dose > Central dose Head: (Dsurf / Dcenter ) ~1 Body: (Dsurf / Dcenter) ~2 CTDIw combines: Peripheral dose: CTDIperiph Central dose: CTDIcenter

Electrometer (mGy / C)

Ion Chamber

Some forms of radiation more efficient than others at transferring energy to the cell. To level the playing field, multiply dose (Gy) by a quality factor (Q). Q compares biological damage to that associated with the same dose of X rays (photons). The resulting unit is the Sv (seivert). Thus, Sv = Gy x Q. 1 Sv is the amount of (any type of) radiation which would cause the same amount of biological damage as would result from 1 Gy of X rays.

CTDIw = (2/3 CTDIperiph + +1/3 CTDIcenter)

center

periphery

16 or 32 cm Diameter Acrylic Cylinder

Bushberg, The Essential Physics of Medical Imaging, 2nd Ed.

CT Dose Measurement (CTDI)

Dose estimate from a single scan: CT Dose Index (CTDI)

Factors Affecting Radiation Dose

kVp
Dose ~(kVp)2

CTDI =

fX L T

f = exposure-to-dose factor (mGy/R) X = exposure (R) L = length of ion chamber (100 mm) T = slice thickness (mm) Standard (Cylindrical) Phantoms: Head (16 cm diameter acrylic) Body (32 cm diameter acrylic)

mAs

Dose mAs

Kanal, University of Wisconsin

Kanal, University of Wisconsin

Typical Skin Dose: Head ~ 20 mGy Body ~ 40 mGy (induction of erythema: ~2 Gy)

Effective Dose
Effective Dose (mSv)
2 8 10-20 10-20

Computed Tomography
Key to numerous areas of medical imaging
- Screening - Diagnosis
E.g., low-dose CT screening of early-stage lung cancer E.g., almost everything E.g., PET-CT

Region
Head Neck Chest Abdomen Pelvis

Factor
0.0023 0.0054 0.017 0.015 0.019
(mSv/mGy.cm)

30 mGy x 30 cm = 900 mGy.cm

- Staging and prognosis - Treatment planning - Image guidance

E.g., Dose calculation in radiation therapy E.g., CT-guided biopsy, interventions, surgery, and RT E.g., Tumor regression; perfusion changes E.g., Micro-CT of mice (drug development, etc.)

20 mGy x 50 cm = 1000 mGy.cm

- Response assessment - Pre-clinical imaging

Effective Dose
Exam
Radiography

Computed Tomography
Approx. Period Backround Radiation
3 days 6 months 4 months 3.6 yrs 4.5 yrs 4.5 yrs
(typical background = 3 mSv / yr)

Remaining Challenges
- Reduced imaging dose - Imaging speed - Image quality
E.g., pediatrics mA modulation Low-dose protocols Cardiac imaging 4D CT-fluoroscopy E.g., Improved SNR Artifact management

Skull Chest (PA) Abdomen Pelvis Ba swallow Ba enema Head Chest Abdomen Pelvis

Effective Equivalent Dose (mSv) # CXR

0.07 0.02 1.0 0.7 1.5 7 3.5 1 50 35 75 350 100 400 500 500

2 8 10-20 10-20

Ongoing Developments
- Multi-detector CT (The Slice Wars)
Single-slice 8 16 64 256 slice Volume CT Dual-source Multiple-source No moving parts

CT

- Alternative source configurations (The Source Wars) - CT imaging functionality and applications