TUGAS ILMU BEDAH SARAF

HOUNSFIELD UNIT

Disusun Oleh: Christina Agustin

NIM: 11.2014.137

Pembimbing :
dr. Fadhil, Sp.BS

KEPANITERAAN KLINIK ILMU BEDAH STASE BEDAH UROLOGI

RUMAH SAKIT UMUM DAERAH TARAKAN
PERIODE 27 JULI 2015 3 OKTOBER 2015
FAKULTAS KEDOKTERAN
UNIVERSITAS KRISTEN KRIDA WACANA
JAKARTA
2015

Computed tomography
Dr Henry Knipe and Ass. Pr. Mirjan M. Nadrljanski et al.
Computed tomography (CT) scanning, also known as computerized axial
tomography (CAT) scanning, is a diagnostic imaging procedure that uses X-rays in order to
present cross-sectional images ("slices") of the body. Cross sections are reconstructed from
the measurements of attenuation coefficients of X-ray beams in the volume of the object
studied.
CT is based on the fundamental principle that the density of the tissue passed by the X-ray
beam can be measured from the calculation of the attenuation coefficient.
So, CT allows the reconstruction of the density of the body, by two dimensional section
perpendicular to the axis of the acquisition system.
The emitter of X-rays (typically with energy levels between 20 and 150 keV), emits N
photons (monochromatic) per unit of time. The beam passes through the layer of biological
material of thickness delta x. A detector placed at the exit of the sample, measures N + deltaN
photons, delta N smaller than 0. So, the X-rays interacted with the object and the beam have
been attenuated.
There are basically two processes of the absorption: the photoelectric effect and theCompton
effect. This phenomenon is represented by a single coefficient mju.
In the specific case of the CT, the emitter of X-rays rotates around the patient and the
detector, placed in diametrically opposite side, picks up the image of a body section (beam
and detector move in synchrony).
Unlike X-ray radiography, the detectors of the CT scanner does not produce an image. They
measure the transmission of a thin beam (1-10mm) of X-rays through a full scan of the body.
The image of that section is taken from different angles and this allows to retrieve the
information on the depth (in the third dimension).
In order to obtain tomographic images of the patient from the data in "raw" scan, the
computer uses complex mathematical algorithms for image reconstruction.
If the X-ray at the exit of the tube is made monochromatic or quasi-monochromatic with the
proper filter, one can calculate the attenuation coefficient corresponding to the volume of
irradiated tissue by the application of the general formula of absorption of the X-rays in the
field (see Figure 1).

The outgoing intensity I(x) of the beam of photons measured will depend on the location. In
fact, I(x) is smaller where the body is more radioopaque.
Hounsfield chose a scale that affects the four basic densities, with the following values:

Air = - 1000

Fat = -60 to -120

Water = 0

Compact bone = +1000

The image of the section of the object irradiated by the X-ray, is reconstructed from a large
number of measurements of attenuation coefficient. It gathers together all the data coming
from the elementary volumes of material through the detectors. Using the computer, it
presents the elementary surfaces of the reconstructed image from projection of the data
matrix recconstruction, the tone depending on the attenuation coefficients.
The image by the CT scanner is a digital image and consists of square matrix of elements
(pixel), each of which represents a voxel (volume element) of the tissue of the patient.
In conclusion, a measurement made by a detector CT is proportional to the sum of the
attenuation coefficients.
The typical CT image is composed of 512 rows, each of 512 pixels, i.e., a square matric of
512 x 512 = 262144 pixels (one for each voxel). In the process of image, the value of
attenuated coefficient for each voxel corresponding to these pixel needs to be calculated.
Each image point is surrounded by a halo-shaped star that degrades the contrast and blurs the
boundary of the object. To avoid this, the method of filtered back projection is used. The
action of the filter function is such that the negative value created is the filtered projection,
when projected backwards, is removed and an image is produced, which is the accurate
representation of the original object.
The CT scan deals with the attenuation of the X-rays during the passage through the body
segment. However, several features distinguish it from conventional radiology: the image is
reconstructed from a large number of measurements of attenuation coefficient.
Before the data are presented on the screen, the conventional rescaling was made into CT
numbers, expressed in Hounsfield Units (HU), as mentioned before. CT numbers based on
measurements with the EMI scanner invented by Sir Godfrey Hounsfield 6, a Nobel prize
winner for his work in 1979, related the linear attenuation coefficient of a localized region

with the attenuation coefficient of water, the multiplication factor of 1000 is used for CT
number integers.
So, the signal transmitted by the detector is processed by the PC in the form of the digital
information, the CT image reconstruction.
Prinsip CT-Scan:
Sinar X adalah pancaran gelombang elektromagnetik yang sejenis dengan gelombang radio,
panas, cahaya, dan sinar ultraviolet, tetapi dengan panjang gelombang yang sangat pendek.
Karena panjang gelombang yang sangat pendek itu, maka sinar X dapat menembus bendabenda. Pada CT, komputer dikerahkan untuk menggantikan peranan film-kaset dan peranan
kamar gelap dengan cairan-cairan developer serta fiksirnya seperti pada foto sinar X biasa.
Tabung Rntgen dan kumpulan detektor berada dalam suatu wadah yang disebut gantry. Di
tengah-tengah gantry tersedia lubang, yang berfungsi untuk dapat memasukkan atau
menggeser meja beserta pasien dengan motor.
Mulai pesawat CT generasi ketiga, gantry dapat dimiringkan ke belakang atau ke depan,
masing-masing maksimal sampai 200, sehingga tidak hanya penampang tegak saja yang dapat
dibuat, melainkan juga scan miring dengan sudut yang dikehendaki. Baik tabung Rntgen
maupun detektor-detektor bergerak memutari pasien sebagai obyek yang ditempatkan
diantaranya, 3600. Selama bergerak memutar itu, tabung menyinari pasien dan masingmasing detektor menangkap sisa-sisa sinar X yang telah menembus pasien, sebagaimana
tugas film biasa. Semua data secepat kilat dikirim ke komputer yang mengolahnya
(mengerjakan kalkulasi) secepat kilat pula. Hasil pengolahan muncul dalam layer TV yang
bekerja sebagai monitor. Hasilnya merupakan penampang bagian tubuh yang diputari itu dan
disebut scan.
Prinsip kerja CT-Scan hanya dapat men-scanning tubuh dengan irisan melintang (potongan
axial). Namun dengan memanfaatkan teknologi komputer maka gambaran axial yang telah
didapatkan dapat diformat kembali sehingga didapatkan gambaran coronal, sagital, oblique,
diagonal bahkan bentuk tiga dimensi dari objek tersebut. Suatu skala untuk mengukur
koefisien atenuasi jaringan pada CT disebut Hounsfield Unit (HU). Hounsfield Unit juga
sering disebut sebagai CT numbers.

Tabel 1. Contoh CT numbers dari Berbagai Jaringan

Jaringan

CT Numbers (HU)

Tulang

1000

Hepar

40-60

White Matter

20-30

Grey Matter

37-45

Darah

40

Otot

10-40

Ginjal

30

Cairan Serebrospinal

15

Air

Lemak

-50-(-100)

Udara

-1000

References :

1. Goldman LW. Principles of CT: Multislice CT. Journal of Nuclear Medicine

Technology. Vol. 36, No.2, 2008

2. Lazic J, Sobic V, Cikaric S. et al.Radiologija (Radiology Unviersity Manual),

Medicinska Knjiga, Belgrade 1997

3. Sprawls P. The Physical Principles of Medical Imaging, 2nd Ed. 1995, Medical
Physics Pub. (Madison, Wis)

4. Semnic R. CT Toraksa i Abdomena, Institut za Onkologiju Vojvodine, Sremska

Kamenica, Grpah Style, Novi Sad 2005

5. Stankovic JB, Milosevic NT. Osnovi radioloske fizike (Basic Principles of

Radiological Physics), PTT, Belgrade, 2007.

Hounsfield unit
Dr Yuranga Weerakkody and Kyle Greenway et al.

The Hounsfield unit (HU) is a quantity commonly used in computed tomography

(CT) scanning to express CT numbers in a standardised and convenient form. Hounsfield
units, created by and named after Sir Godfrey Hounsfield, are obtained from a linear
transformation of the measured attenuation coefficients 1. This transformation (figure 1) is
based on the arbitrary definitions of air and water:

radiodensity of distilled water at standard temperature and pressure (STP) = 0 HU

radiodensity of air at STP = -1000 HU

Hounsfield units are measured and reported in a variety of clinical applications. One well
known use is the evaluation of the fat content of the liver, with fatty liver diagnosed by the
presence of a liver-to-spleen ratio less than 1.0 or 0.8 2. Other less common uses include
assessing bone mineral density (BMD) 3, predicting the presence of anemia 4, and guiding the
management of kidney stones 5.

References :

1.Hounsfield GN. Computed medical imaging. Nobel lecture, December 8, 1979. J

Comput Assist Tomogr. 1980;4 (5): 665-74. Pubmed citation

2. Zeb I, Li D, Nasir K et-al. Computed tomography scans in the evaluation of fatty

liver disease in a population based study: the multi-ethnic study of atherosclerosis. Acad
Radiol.

2012;19

(7):

811-8. doi:10.1016/j.acra.2012.02.022 -Free

text

at

pubmed - Pubmed citation

3. Pickhardt PJ, Pooler BD, Lauder T et-al. Opportunistic screening for

osteoporosis using abdominal computed tomography scans obtained for other
indications. Ann. Intern. Med. 2013;158 (8): 588-95. doi:10.7326/0003-4819-158-8201304160-00003 - Free text at pubmed - Pubmed citation

4.Bruni SG, Patafio FM, Dufton JA et-al. The assessment of anemia from
attenuation values of cranial venous drainage on unenhanced computed tomography of

the

head.

Can

Assoc

Radiol

J.

2013;64

(1):

46-

50.doi:10.1016/j.carj.2011.08.005 - Pubmed citation

5.Ouzaid I, Al-qahtani S, Dominique S et-al. A 970 Hounsfield units (HU)

threshold of kidney stone density on non-contrast computed tomography (NCCT)
improves patients' selection for extracorporeal shockwave lithotripsy (ESWL): evidence
from a prospective study. BJU Int. 2012;110 (11b): E438-42.doi:10.1111/j.1464410X.2012.10964.x - Pubmed citation