Clinical Radiology (2001) 56: 302309

doi:10.1053/crad.2000.0651, available online at http://www.idealibrary.com on

Multi-slice Technology in Computed Tomography
PETER DAWSON, WILLIAM R. LEES
Department of Imaging, UCL Hospitals, London, U.K.
Received: 30 June 2000 Revised: 28 September 2000 Accepted: 28 September 2000
Multi-slice systems represent a considerable advance in CT and will assure the future of the technique for
many years to come. This article describes this new technology, indicating its provenance and its position
in the evolution of CT. While it does not seek to be a physics and engineering text, enough detail of these
are given to allowan informed discussion of the many advantages and a few potential problems associated
with the technology. A discussion of a number of applications and a brief consideration of contrast
enhancement regimens and the possible need for their modication are presented. Dawson, P. & Lees,
W. R. (2001). Clinical Radiology 56, 302309. # 2001 The Royal College of Radiologists
Key words: helical/spiral, computed tomography, multi-slice.
When rst introduced nearly 30 years ago [1], computed
tomography (CT) ushered in a new paradigm in X-ray
imaging and was a considerable inuence in the later
development of magnetic resonance imaging (MRI). MRI,
with its high contrast sensitivity and resolution and lack of
ionizing radiation, then looked set soon to supplant CT
almost completely, if not in quite the short time scale
envisaged by MRI's more enthusiastic proponents.
The advent of spiral/helical CT [2,3,4] changed this
outlook somewhat. There had been a logical developmental
progression from rst generation linear and rotary move-
ments pencil beam systems (Fig. 1a), to second generation
( fewer) linear and rotary movements fan beam systems
(Fig. 1b), to third generation wider angle fan beam systems
with no linear but, rather, continuous rotary movement of
tube and detector (Fig. 1c), to fourth generation complete
3608 detector ring and moving tube-only systems (Fig. 1d).
Now, in the spiral/helical systems, the table/patient
moved continuously (in the z-direction) during rotation of
the tube so that a whole volume, rather than serial discrete
slices, could be acquired in one complex movement (Fig. 2).
Single-slice acquisition times had decreased in the course of
this sequence of developments from5 min to less than 1 s.
Of course, demands on X-ray tubes, and on the
mathematician, increased at each step. While various
arguments were advanced to the eect that spiral technol-
ogy could be associated with a reduced radiation dose to
the patient, CT in both old and new forms still undoubtedly
represented a signicant radiation burden [5]. In fact, it
represented the largest contribution of all diagnostic
procedures and the greatest single contribution to the
non-natural total population burden and genetically
signicant dose. However, it now oered such power and
versatility by way of acquisition of large anatomical
volumes in a single breath-hold; examination of smaller
anatomical volumes at high spatial resolution, seamless
volume data sets, and the capacity to perform meaningful
`multi-phase' CT studies, that its future, compared to MRI
or any other technique, was assured.
What further progress could be made? Rotation times,
already under 1 s, could be reduced to perhaps 0.5 s but,
for mechanical and electronic reasons, probably to not
much less. The `centrifugal' force acting on the X-ray tube
during a 0.5 s rotation exceeds 10 g. Higher speeds would
require the development of a xed anode system, which is
impractical. The other obvious evolutionary change was to
increase the number of detectors by introducing a multiple
contiguous detector arc system and to utilize a beam which
is also `fanned' in the z-direction ( patient axis) to a degree
depending on how many detector arcs are used (Fig. 3). This
immediately demands another leap in the mathematical
demands of image reconstruction and introduces a number
of other diculties discussed below. The rst step in this
direction was taken by Elscint with its `Twin' machine in
1993 which had just two contiguous detector arcs. This
development led to a halving of any scan time, all other
things being equal, since it may be seen as either acquiring
two slices at a time or as covering twice the z-axis distance
per rotation.
This `multi-slice' technique [610] has been extended by
several commercial companies (Table 1) to four simul-
taneous slices. Actually, all the commercial systems employ
many more than four contiguous detector arcs in their
systems, ranging from eight to 34, but, for reasons discussed
below, only a maximum of four contiguous slices can be
selected for acquisition in practice. These systems will be
0009-9260/01/040302+08 $35.00/0 # 2001 The Royal College of Radiologists
Author for correspondence and guarantor of study: Prof. Peter
Dawson, Department of Imaging, The Middlesex Hospital, Mortimer
Street, London W1N 8AA, U.K. Fax: 01494 728222; E-mail:
phd728222@aol.com
MULTI-SLICE TECHNOLOGY IN COMPUTED TOMOGRAPHY 303
discussed in a little more detail below but just one example
of what is achievable is described here. In such a `multi-
slice' system with four slice acquisitions and with a 0.5-s
rotation, the scanning speed will be eight times that of a
current state-of-the-art 1-s rotation single detector ring
spiral/helical system. The liver, for example, could be
examined with, say, 5-mm collimation (z-axis resolution) in
less than 6 s.
In fact, for a variety of reasons which will be touched on
below, not quite this advance in speed should usually be
Fig. 1 Four generations of incremental CT machines. (a) First generation linear and rotating pencil beam system; (b) linear and rotating fan beam
system; (c) rotation only (tube and detectors) wide angle fan beam system; (d) fourth generation 3608 detector ring-rotating tube system.
Table 1 Manufacturers of current multi-slice CT systems
Manufacturer System name Detector array
General Electric Lightspeed Matrix array (20 mm)
Siemens Somatom Plus 4
Volume Zoom
Adaptive array (20 mm)
Marconi MX 8000 Adaptive array (20 mm)
Toshiba Aquilion Matrix/Adaptive array
(32 mm)
304 CLINICAL RADIOLOGY
sought in practice but the potential is, nevertheless,
remarkable.
DETECTOR GEOMETRY
Three dierent detector array geometries are used by
dierent manufacturers (Fig. 4). Those used by Marconi
and Siemens are identical, the former having acquired
Elscint technology by take-over and the latter via a research
collaboration. The dierent designs have an eect on the
minimum slice thickness available and the number of slices
available at this minimum width, the range of choice of slice
thickness and the maximum volume/z-axis distance which
may be scanned in any one system rotation. The slice
thickness and number of contiguous slices (up to four) are
chosen by beam collimation and by electronic selection
and/or summation of detector signals.
As an example, consider the conguration in Fig. 4a.
Each detector ring is 1.25 mm wide in the z-direction. The
four central rings may be selected to give a 4 1.25 mm
simultaneous slice acquisition, or signals from pairs of
contiguous rings can be summed to allow 4 2.5 mm
simultaneous slice acquisitions; summing the signals of
three and four detector rings yields 4 3.75 and 4 5 mm
simultaneous slice acquisitions, respectively.
By taking the signals of eight together
(8 1.25 mm 10 mm), on either side of the mid-line,
2 10 mm simultaneous slices may be obtained.
Beam collimation allows the selection of half of each
detector yielding a 2 0.625 mm slice acquisition.
Geometrical considerations dictate that there is a
diculty with detector array designs such as this. Figure 5
may be taken to be the 16 1.25 mm system conguration.
This shows that only for the innermost detector arcs are the
X-rays close to perpendicular to the z-axis. For the outer
detector arcs the rays fall more obliquely and, during
rotation are `smeared' within the patient in a double cone.
The so-called cone angle, y, in Fig. 5 is in fact about 1
degree and so is greatly exaggerated in this drawing to
emphasis the point. As shown in the right half of Fig. 5, if
the outer detector (here 1.25 mm) bands are selected, the
broadening during rotation results in an eective slice
thickness of some 3 mm. This may be shown by simple
geometrical considerations and calculations based on
Fig. 5. This is unfortunate since it means we cannot in
practice perform, say, 16 1.25 mm simultaneous slices
using system 4 (Fig. 4a). However, combining the signals of
groups of four (4 5 mm) results in much reduced
distortion of the selected nominal 5-mm slice thickness as
also shown in the left half of Fig. 5.
These geometrical considerations clearly indicate the
considerable, though not necessarily insurmountable,
diculties involved in building systems with more detector
arcs covering a greater z-axis distance because of the
distorting eects of increasing the cone angle, y, and it is
clear why there are limitations on the choice and/or number
of simultaneous contiguous slices which may be selected for
simultaneous acquisition.
With this immutable geometrical framework in mind,
two manufacturers, Siemens and Marconi have developed
an `adaptive' array detector (AAD; Fig. 4b). Here the
Fig. 2 The spiral/helical CT principle. The patient moves continu-
ously in the axial (z) direction during rotation of the gantry. A single
detector arc is used and if there is no table movement a single CT slice
is obtained during a gantry rotation of thickness determined by the
collimation used.
Fig. 3 The detector geometry of a multi-slice spiral/helical CT
system. Sixteen detector rings are illustrated. The size of the `cone
angle', y, is exaggerated.
Fig. 4 Prole of the various detector ring geometries used in the
commercial systems. (a) Consists of 16 identical detector rings (matrix
array); (b) and (c) exploit ring detector widths of variable size
[`adaptive' (b) and `matrix/adaptive' (c) arrays] see discussion.
MULTI-SLICE TECHNOLOGY IN COMPUTED TOMOGRAPHY 305
detectors are of increasing z-axis width the further they lie
from the centre (y 0) of the array. Another manufacturer,
Toshiba, has made a less dramatic step in this direction with
its array (Matrix/Adaptive) (Fig. 4c) which is also larger,
32 mm as opposed to 20 mm for the other manufacturers.
Table 2 shows simultaneous slice thickness acquisitions
possible with the various systems. The 2 0.5 mm and
4 1 mm selections are obtained using collimation allow-
ing radiation to fall on half of each central detection array
and on the medial two-thirds of the 1.5 mm detector arc.
Four 2.5 mm selections are made by collimation, allowing
radiation to fall on the two 2.5 mm rings and on the two 1
and 1.5 mm rings; the signals from the latter being
combined electronically.
Quite how tolerable the distortions introduced by the
greater cone angle of this system will be with some slice
selections remains to be seen. This is a highly technical area
but some generalization may be made. The adaptive arrays
do not represent a complete response to the slice width
distortion problem and, indeed, if detector arrays covering
greater z-axis distances are yet to be developed, the matrix
rather than the adaptive arrays will be the basis.
The whole matter of detector array eciency of these
various systems remains to be determined, especially as, in
addition to the detector material and its properties, it is
clearly dependent on such novel factors as the size of
insulator gaps between detector arcs (an eective `dead
space') as well as on the total number of detectors.
PITCH
The concept of pitch in spiral systems has come to be well
understood. With single-slice systems it is dened as:
Pitch
Table movement per rotation
Collimation (slice thickness)
An alternative denition, adopted for multi-slice systems by
Siemens, GE and Toshiba, but not Marconi, is:
Pitch
0

Table movement per rotation
Detector z collimation
The existence of two denitions holds the potential for
confusion. Some examples may help:
(1) If 4 5 mm ( 20 mm) slices are obtained with a table
speed of 20 mm per rotation, then, on the rst
denition the pitch is 20/20 1.
On the second denition, it is 20/5 4.
(2) If 2 10 mm ( 20 mm) slices are obtained with a
table speed of 20 mm per rotation, then, on the rst
denition the pitch is 20/20 1.
On the second denition, it is 20/10 2.
It is the rst denition which must be used as an indicator
of dose, as will be discussed later.
As with single slice spiral, the image quality declines as
pitch (however dened) increases, though in a non-linear
manner. This is a factor which sets a practical limit to some
of the exaggerated theoretical claims being made for the
speeds of these systems, as will be discussed further. The
pitch also inuences slice prole [11,12]. An illustration of
some dierent pitches in a four-multi-slice system is shown
in Fig. 6.
EXAMINATION SPEEDS
We have seen that for four-slice mode the data
acquisition time may be simply one-quarter times that of
a single-slice spiral CT system set at the same slice
Table 2 Slice width combinations possible with the various systems
General Electric Siemens/Marconi Toshiba
2 0.625
4 1.25 4 0.5
4 2.5 4 1 4 1
4 3.75 4 2.5 4 2
4 5 4 5 4 3
2 10 2 8 4 8
2 10
Fig. 5 If too many simultaneous slices are selected, the outer ones
will be considerably distorted with loss of eective spatial (z-axis)
resolution, as shown in the right half. Where thicker slices are selected
the distortion is minimized, as shown in the left half.
306 CLINICAL RADIOLOGY
collimation and with the same rotation speed. If the multi-
slice CT system has a 0.5-s rotation speed, but the single
slice CT machine had a rotation speed of 1 s then a
theoretical increase of speed of eight times is available.
However, as we have also seen, it may be best in the
interests of image quality optimization to use a pitch of,
say, three rather than four and this will yield a six times
increase in speed. Hu et al. [12] have shown in studies on
one commercial system that a two to three times increase in
volume acquisition rate as compared with a single-slice
system is fully compatible with comparable image quality.
Thereafter some loss is entailed in increasing acquisition
speed.
The top speeds available should only be used in specialist
applications (see below). The real `speed' advantage of these
systems lies in their ability to obtain more modest volume
studies at high resolution during, where appropriate, a
single breath-hold.
Reconstruction times range from 0.5 to 2 s per image for
axial slice reconstructions. Such rapid reconstructions are
vital given the huge amount of data and number of images
which may be generated. For example, suppose a multi-slice
scanner has a rotation time of 0.5 s and a reconstruction
time per image of 0.5 s and is used to perform a
4 2.5 mm scan of a 40 cm z-axis body length. If axial
slices are reconstructed at 0.5 mm, then we can say:
Image acquisition time is (400/4 2.5) 0.5 20 s
Number of images is 400/(2.5) 160
Reconstruction time is 160 0.5 80 s.
When higher z-axis resolution scans are performed these
numbers go up but it is clear that the scanning and
reconstruction times (leaving aside any o-line sophisti-
cated work) are short. Within well-funded and well-staed
CT units in some countries patient throughput may be
signicantly increased. In the NHS this advantage will
probably not be exploited since most time is spent getting
the patients to the CT unit and preparing them.
CLINICAL APPLICATIONS
Headline top speeds of multi-slice instruments are
impressive and there are some applications where it is
useful to run them at their limits. However, in general it is
more sensible to view them as oering an unprecedented
trade-o between ultra-high speed CT (with some sacrice
of image quality), intermediately high-speed CT covering
moderately large volumes in short periods (while maintain-
ing image quality) and high z-axis resolution CT (isotropic
voxels) of more modest volumes in short times. An outline
of some applications under these headings is given below.
Ultra High-speed CT
Though it involves some loss of image quality, this may
be useful in such circumstances as multiple trauma cases
and unco-operative patients.
For example, using 4 5 mm slice selection and a pitch
( prime) of 6 (entailing some image quality loss), and with a
0.5-s rotation time, a 1200-mm long (z-axis) body segment
can be scanned in only 20 s.
Or, to take another example, the lungs (300 mm) may
be scanned at 4 5 mm slice selection with the same pitch
of 6 and 0.5 s rotation time can be scanned in only 5 s,
obviously in a single breath-hold.
Intermediately High-speed CT
Here image quality is not sacriced by use of a pitch
0
of,
say, 3. With 4 5 mm slice selection and 0.5-s rotation
time, pelvis, abdomen and chest (say 700 mm) may be
covered in only [700/(4 5)] 0.5 4/3 23 s.
Such a protocol would provide a remarkably good
whole-body survey examination on a single breath-hold. It
could, of course, be timed with respect to the infusion of
contrast medium so as to cover the liver during the portal
venous enhancement phase.
High Z-axis Resolution CT (Isotropic)
Any number of examples might be given but consider: A
high resolution (isotropic) CT examination of the thorax
with 4 1 mm slice selection at 0.5-s rotation time and
pitch ( prime) 6 would allow coverage of moderate z-axis
distance of 300 mm in 25 s.
For the mediastinum, 5-mm slice reconstructions can be
made and if high resolution examination of the lungs is
required, 1.52 mm slice reconstructions could be made by
slice summation/averaging. The original isotropic data set
can be used for three-dimensional reconstructions including
virtual bronchoscopy and endoscopy, or for HRCT of the
lungs in any plane if desired.
Similarly, an upper abdominal CT examination (150 mm
length) could be carried out to include, say, pancreas and
kidneys using similar parameter choices in less than 15 s.
The isotropic data could be used to generate high-quality
CTA, including renal arteriography, if acquired at a suitable
time with respect to the administration of contrast medium.
The liver alone could be examined at 4 5 mm in less than
5 s and at 4 2.5 mm in less than 10 s. Consequently, a
hepatic arterial phase CT study can be achieved which is
truly likely to be completed in this phase throughout and
this can be followed after a suitable delay by portal venous
phase imaging.
Fig. 6 An illustration of some dierent pitches. At higher pitch,
overlap is eliminated. At lower pitch it is an important factor see
discussion.
MULTI-SLICE TECHNOLOGY IN COMPUTED TOMOGRAPHY 307
Of course, all this can only be achieved if the timing of
data acquisition with respect to the administration of
contrast is accurate and in this regard bolus timing software
will be invaluable.
RECONSTRUCTIONS
These systems are very demanding as regards the
requirements on image reconstruction algorithms. The
conventional 1808 and 3608 interpolation approaches used
in single-slice CT will simply not do when applied to multi-
slice data sets. Many artefacts of interpolation are
introduced and the variation in z-axis sensitivity for
dierent slices inevitably associated with the nite cone
angle is problematic.
New interpolation algorithms have been developed by
the manufacturers. These tend to work best when applied to
data obtained using certain pitch selections. Consequently,
manufacturers' advice on pitch and algorithm combi-
nations should be taken at least until experience is gained.
A steep learning curve in optimization of the use of these
CT systems seems in prospect.
The speed of implementation of the reconstruction
algorithms is of the order of 0.52 s per slice.
IMAGE QUALITY
Broadly speaking, the image quality of a reconstructed
axial slice should be much the same whether from a single-
or multiple-slice instrument but some caveats must be
entered. The variable z-axis sensitivity for dierent slices
and the need, ideally, to match choice of pitch to
reconstruction algorithm have been alluded to. The
manufacturers of the GE system, for example, oer a
choice between two pitch/algorithm combinations: a pitch
0
( pitch 0.75) of 3 for optimum image quality (HQ mode)
and a pitch
0
( pitch 1.5) of 6 for speed (HS mode).
Generally speaking, a pitch less than 4 ( pitch
0
less than 1) is
required to obtain single slice spiral image quality
equivalence.
While multi-slice spiral interpolation artefacts are an
important issue, especially in tissues with rapid z-axis
direction change and in patient or organ movement, the
increased system speed tends to mitigate these eects.
One point of considerable importance is that with the
higher z-axis spatial resolution acquisitions now possible,
e.g. 4 0.5 mm, the z-axis spatial resolution is the
equivalent of that in the axial plane; and, since the
acquisition is of a volume rather than of separate slices,
we have `isotropic' image data sets ideal for three-
dimensional reconstructions of various kinds and for
virtual endoscopy and bronchoscopy.
Regarding the more conventional axial slice reconstruc-
tions, these can be made at lesser resolution than that set by
the original slice thickness choice. Thus, an acquisition
could be made using 4 1 mm slice selection and the
complete data set used for three-dimensional reconstruc-
tions, but axial slices could be reconstructed for display and
general diagnostic purposes at, say, 5 or 10 mm by
combining/averaging contiguous slices. This not only
introduces some useful signal averaging with signal-to-
noise improvement but also tends to minimize the partial
volume eects often seen in thicker slices. It also oers the
not unimportant advantage of reducing the number of
images for review in hard copy format.
It should be noted that the reverse is also true in some
cases. For example, with the GE instrument it is possible to
perform the examination at 5-mm slice thickness but to
reconstruct at 1.25 mm.
DOSIMETRY
Given the prevailing anxieties about the contribution of
CT to the radiation burden of the population, this is an
important issue [5]. Basically, the considerations are the
same for a multi-slice as for a single-slice scanner but with a
handful of complications.
When pitch is less than 1 ( pitch
0
5 4) there is overlap of
slice irradiation during rotation to some extent. This will
tend to increase dose but, since all information is used in
image reconstruction, an image with equal signal to noise
characteristics can be obtained in these circumstances by
reducing mAs per rotation. As pitch increases, overlap is
eliminated (Fig. 6).
Comparisons of dosimetry from dierent manufacturers'
machines should only be made on the basis of equivalent
denitions of pitch as well as equivalence of other imaging
parameters. Broadly speaking, the dosimetry of single- and
multi-slice machines in studying the same body volume with
identical collimation is the same.
However, one can easily see how the speed of these
machines, even when sensibly limited in practice in the
interests of image quality optimization, may lead to the
performance of multiple acquisitions in dierent phases
which could not have been contemplated before. While
some of this might be justiable in clinical management
terms, much may not and the associated increased radiation
burden must be borne in mind.
These systems oer such speed of image acquisition that
close to real-time CT uoroscopy in anatomical slabs up to
20 mm thick can be achieved, though there are questions
about the usefulness of this particular technique and about
the high radiation burden associated with it [13].
DEMANDS ON X-RAY TUBES
Single-slice spiral CT systems made greater demands on
X-ray tubes than earlier incremental machines. The
radiologist might sensibly fear that these `powerful' multi-
slice CT systems will make correspondingly powerful
demands on tubes. The issues are complex and the demands
on the tube are a function of several parameter choices for
the CT examination. However, simply speaking, the tube
total output required for a given body volume acquisition is
the same whether it is acquired more slowly (single-slice
spiral) or more quickly (multi-slice spiral). With a choice of
308 CLINICAL RADIOLOGY
pitch less than 1 to optimize image quality, there is, as
indicated earlier, overlap of data with consequent repeat
exposures. This means that mAs per rotation may be
reduced without loss of image quality but with reduced tube
demand and, as discussed, radiation dose.
However, yet again, the temptation to do more and to
perform multiple examinations of the same block of tissue
in dierent phases of contrast enhancement, rather than a
single coverage will have its own eects on tube lifetime per
case as it will have on dose per examination.
IMAGE STORAGE AND REVIEW
One issue generated by this new technology is that of the
storage of the huge numbers of images which it can
generate. To take just one example, consider the thorax
study discussed above: 4 1 mm at pitch 6 and 0.5-s
rotation time with a scan length of 300 mm. This will
generate 300 images. In multiphase abdominalpelvic scans
the number can easily be 500. Whether storage is on disc, in
hard copy form or by transfer to a PACS system, there are
clearly storage-space and storage-cost implications on a
greater scale than so far encountered with CT.
This raises a number of issues. How much data should be
downloaded to hardcopy, how much reporting should be
`soft-copy' and how much data should be digitally stored
long-term, in whatever form? Each department will have to
make its own decisions but in doing so must take account of
some basis facts. The cost of laser copier lm is 3 per
sheet. For our hypothetical example above of 300 images,
and assuming 20 images per sheet, the cost would be (300/
20) 3 45 the cost of hard-copying any manipu-
lated images (e.g. three-dimensional reconstructions). If,
say, 3-mm axial slice reconstructions were made, and if only
these were hard-copied, the cost would be reduced to 15.
The cost of digital storage can be estimated as follows.
One optical disk will store 5000 images and costs 17.
Such a disk will store some 17 or so of the 300-image
studies cited above. Our own experience is that many or
most studies generate more than 300 images so it is clear
that most units will use at least one disk per working day.
This is a modest cost but does not represent the whole story
as far as costs are concerned. Disks must be stored and data
archiving and retrieval demands signicant operator input
and disrupts work ow. Comparison with old archived data
is extremely time-consuming. Of course, if the original data
is all stored long-term and hard copy is also made the costs
are additive.
Our own approach is to perform both higher and lower
resolution axial slice reconstructions from the primary data
set, to carry out `soft-copy' reporting using the larger
number of the former and to generate hard copy of the
smaller number of the latter. Every CT Unit will evolve its
own policies which will be adapted with experience. It
should be noted that multiple workstations will be needed,
at not inconsiderable cost, to allow soft-copy reporting and
clinico-radiological conferencing.
Some will argue that PACS where available will provide
the answer but such a claim may be simplistic. PACS
provides better work ow management with pre-fetching
and automated retrieval but currently has diculty
handling large data sets. The entry costs of even limited
PACS systems are very high.
CONTRAST AGENT ENHANCEMENT REGIMENS
There is no doubt that the advent of faster third and
fourth generation CT systems have made it necessary to
examine contrast enhancement regimes and to consider how
to tailor them to optimize enhancement of the examination.
The subsequent introduction on a wide scale of (single-
slice) spiral systems caused yet more confusion. It seems
sensible to ask at this early stage, before these multi-slice
systems are in widespread use, whether there is a need for
the further modication of enhancement regimens.
It is important to realize immediately that some things
are immutable, such as the fact that the cortical nephro-
gram will appear early and that the portal venous phase will
be delayed some 5060 s after the start of any contrast
medium infusion. Such considerations answer the questions
about timing but leave unresolved the issues of injection
volumes and concentrations (total dose) and injection rate.
Some simple immediate thoughts are possible. We already
know that slower infusion rates than those commonly used,
e.g. 3, 4 or 5 ml/s, are inadequate. Could faster injections
of, say, higher concentrations of agent with earlier CT data
acquisition be appropriate in some cases? Could smaller
total volumes of contrast agent delivered faster with earlier
data acquisition be an option in some applications of these
new faster systems?
Some careful thought and considerable experience will be
needed before these issues can be resolved.
CLINICAL EFFECTIVENESS
No studies of outcomes or of clinical eectiveness have
yet been performed. What can already be said is that the
apparent advantages of multi-slice technology of greater
speed, versatility and isotropic spatial resolution oer
considerable appeal to radiologists and clinicians and
would appear to broaden the repertoire of CT. The
seemingly inexorable onward march of MRI will not be
halted but CT may have been given a new lease of life.
REFERENCES
1 Hounseld GN. Computerised transverse axial scanning
(tomography). I Description of system. Brit J Radiology 1973;
46:10161022.
2 Kalender WA, Seissler W, Klotz E, Vock P. Spiral volumetric CT
with single breath-hold technique, continuous transport and
continuous scanner rotation. Radiology 1990; 176:181183.
3 Kalender WA, Polacin A. Physical performance characteristics of
spiral CT scanning. Med Phys 1991; 18:910915.
4 Brink JA. Technical aspects of helical (spiral) CT. Radiol Clin
North Am 1995; 33:825841.
5 Jessen K, Shrimpton PC, Geleijus J. Dosimetry for optimisation of
patient protection in computed tomography. Appl Rad Isotopes
1999; 50:165172.
MULTI-SLICE TECHNOLOGY IN COMPUTED TOMOGRAPHY 309
6 Fuchs T, Krause JU, Wolf H, Kalender WA. Experimental
evaluation of image quality of four-slice spiral CT. Radiology
1999; 213(P): 317.
7 Flohr T, Schaller S, Ohnesorg BM, Klingenbeck-Regn K, Kopp AF.
AF. Evaluation of image artifacts in multi-slice CT. Radiology
1999; 213(P): 317.
8 Hu H. Multi-slice helical CT: scan and reconstruction. Med Phys
1999; 26:518.
9 McCullough CH, Zink FE. Performance evaluation of a multi-slice
CT system. Med Phys 1999; 26:22232230.
10 Kachelrie M, Kalender WA. Dose reduction by generalized
3D adaptive ltering for conventional and spiral single-, multi-
row and cone-beam CT: theoretical considerations, simulations,
phantom measurements and patient studies. Radiology 1999;
213:283289.
11 Hu H, Fox SH. The eect of helical pitch and beam collimation on
the lesion contrast and slice prole in helical CT imaging. Med Phys
1996; 23:19431954.
12 Hu H, He HD, Foley WD, Fox SH. Four multi-detector-row
helical CT: image quality and volume coverage speed. Radiology
2000; 215:5562.
13 Silverman SG, Tuncali K, Adams DF et al. CT uoroscopy-guided
abdominal interventions: techniques, results and radiation
exposure. Radiology 1999; 212:673681.