BMT 2012 Clinical CT Applications

Imaging Techniques in Radiology: CT
Wim Tukker systeemspecialist CT UMCG
End terms for Imaging Techniques in Radiology

Following the book The Essential Physics of Medical Imaging 2nd ed by Bushberg et al.
Know -> Understand -> Explain (Read), (optional)
Ch 13.
Computed Tomography 13.1 Explain basic principles 13.2 Explain geometry and historical development 13.3 Understand detectors and detector arrays 13.4 Explain slice thickness, pitch 13.5 Explain tomographic reconstruction process 13.6 Understand digital image display 13.9 Explain artifacts
What to expect?
Monday 26 march 2012 09.00 12.00 h
- CT Techniques - Clinical CT applications: head and neck - CT in Cardiology - Dual Energy CT - CT in Archeology
Thursday 29 march 2012 13.00 16.00 h
- CT Techniques - Clinical CT applications: chest and abdomen - Radiation dose - Cone Beam CT - CT in Forensics (CSI-Groningen)
What to expect?
Monday 26 march 2012 09.00 12.00 h
Thursday 29 march 2012 13.00 16.00 h
CTs in UMCG: Radiology, Nucleair Medicine & Radiotherapie
Siemens Somatom Sensation-16
Siemens Somatom Sensation-64 (2x)
Siemens Somatom Definition (Dual Source)
Siemens Biograph 64 slice mCT (PET-CT)
Siemens Symbia 2 and 16 slice SPECT-CT
Siemens Sensation Open
Toshiba AquilionONE
Philips
Brilliance iCT
tion Source Defini Siemens Dual
G.E.
CT750 HD
Conventional tube diagram
Straton X-ray tube diagram (Sensation 64 and Definition) Cooling rate 5 MHU/min
Straton X-ray tube design
Double z-Sampling: two focus spots alternating 4.640 per second
Sensation 64, Definition
Double z-Sampling:
0.4 x 0.4 x 0.4 mm isotropic resolution
CT technique
Configuration detector system Sensation 64 and Definition (A-tube) Thin collimation plates Ceramic scintillationmaterial (solide state detector) Very short after glowing time (gadolinium oxi-sulfide) < 0,00043 sec! Photodiode-array
m 4 x 1.2 m > 1.2 24 x
m 4 x 1.2 m m x 0.6 m overage 32 Zc 28.8 mm
Adaptive Array Detectors Bushberg, page 339 - 342
CT technique
Configuration detector system Sensation 64 and Definition (A-tube)

Sensation 16 24 rows of detectors 16.128 elements 1.344 canals per slice Max. 2320 projections each 360 Sensation 64 and Dual Source 40 rows of detectors (DSCT 2x, A and B) 26.880 elements (DSCT system B 14.080) 21.504 canals per slice (DSCT system B 11.264) Max. 4608 projections (views) each 360
Bushberg, page 339 - 342
Collimation: principle
Sensation-16: 24 detectors on row!
eff. slice-thickness
8 x 2.7 mm + 16 x 1.35 mm: true detectorwidth!

Pitch en Table Feed Table feed: per rotation Pitch: table feed per rotation / total width of collimated beam E.g. table feed 12 mm, collimation 16 x 0.75 > beam pitch 1 E.g. table feed 9.6 mm/rotation, collimation 64 X 0.6 (32 x 0.6=19.2 mm) > pitch 0.5
Effective mAs mA.s produkt remains equal. E.g. Increasing pitch > shorter scantime > more mA. E.g. Decreasing rotationtime > longer total scantime > less mA.
Pitch
Is there influence of the pitch on the slice thickness?
Is there any influence of the pitch on the spatial resolution? Effective mAs (radiationdose) stays equal. Bushberg, page 345 - 346
What to expect?
Monday 26 march 2012 09.00 12.00 h
Thursday 29 march 2012 13.00 16.00 h
CT-scan Brain
Protocol CT-scan Brain Indications Standard Trauma Tumor or abces (MRI preferred) Metastases (MRI preferred) Stereolithography Navigation (stereotaxie)
Radiation-dose 1.1 mSv
Guidelines for radiology report Increased brain pressure? Brain shifting? Bleeding? Differences in density? Abnormalities: localisation, size and number? Fractures? Bone destruction?
CT-scan Brain sequential or spiral?
MPR in OM-direction (Orbito-Meatal)
OM
Axial view in spiral CT (source images)
MPR; Multi Planar Reconstruction

CT-scan Brain sequential or spiral?
Z: 5 mm/index 5 mm
X-Y: 5 mm/index 5 mm (sequential)
Partial Volume Effect
Z: 3 mm/index 1.5 mm
CT-scan Brain, examples
Stroke! ICH Intra Cranial Hematoma
Most common question: Bleeding or no-bleeding? No-bleeding > start - Anti-thrombolytic drugs - Antiplatelet medicine like Aspirin 3D
CT with IV-contrast: 100 ml Visipaque 320
Abces
MRI-T1
MRI-FLAIR
MRI-T2
MRI-T1 + gado
white and grey matter oedema
Vasculitis (inflammation)? Same patient: possible cause of the abces?
Spiral CT of maxillary sinus (NBH)
MPR
Transversal Coronal
MPR Transversal
MPR Coronal
Thickening of mucus MPR
MPR
B-cell lymphoma
Advantage CT: superior bone/air visibility, why?

Same patient, MRI
Advantage MRI: superior soft tissue visibility
Spiral CT of petrosal bone (mastoid)
On a sagital image MPR // canalis facialis
MPR perpendicular to canalis facialis
Coronal
Axial
Coronal
Coronal
Coronal
Spiral CT of petrosal bone (mastoid)
Axial (transversal)
Anatomy
DSA versus CT (coronal MIP)
Golden standard
Spiral CT of brain arteries (CTA)
I.V. contrast: Visipaque 320; 80 ml with flow 4 ml/sec.

4 5 6
Start scan manually!
Scan in 10 15 sec.
Advantages CTA: Non-invasive, short scanning time with onlimited 3D processing.

Bushberg, page 361
Top of basilar arterie
Candidate for coiling procedure?

Bushberg, page 361
One-Stop Diagnose CVA
Unwell with left hemiparesis: infarction right hemisphere?
Entrance
One-Stop Diagnosis CVA
Unwell with left hemiparesis: infarction right hemisphere?
Entrance
CTA VRT
CTA MIP
Day 3
Day 30
Perfusion-CT
Traumatology
Technique: VRT Hit by a baseball pole-axe

Bushberg, page 360-362
Traumatology
Trauma capitis
SSD
?
VRT
Traumatology
(same patient)
Take Home Message: always start with looking at source images (first reconstruction)
Traumatology
More metal artefacts
Traumatology
Future: further reduction of metal artefacts
By courtesy of Dr. J. Wildberger and Dr. A. Mahnken, University of Aachen
Traumatology
Movement artefacts
Traumatology
Gunshot
Protocol CT-scan Neck Indications Standard Oncology Trauma CTA (Hernia to MRI)
Guidelines for radiology report Soft tissue evaluation. Pathology? Nodules, glands? CTA: stenosis? CTA: aneurysm? Fractures? Bone destruction?
CT neck with contrast
Hindering metal artefacts
Maligne lymfoma with necrotic lymph gland. Future: Iterative reconstruction, less artefacts and lower dose!
Partial Volume effect
Enlarged thyroid: problems with swallow
MPR 1 mm
MPR 3 mm
MPR 5 mm
MPR coronal direction: 1, 3 - 5 mm slice thickness Partial Volume effect: sharp versus unsharp, noisy versus a better S/N ratio
Traumatology
Wear, (slijtage)
Traumatology
Fracture second Cervical Vertebra
Traumatology
Fracture 3th Lumbar Vertebra
Traumatology
Fracture 2th Lumbar Vertebra (near to transverse lesion)
Traumatology
Same patient
Report after 2 years: no complaints, no limitations
Break
What to expect?
Monday 26 march 2012 09.00 12.00 h
Thursday 29 march 2012 13.00 16.00 h
Cardiology
Fly Through (RCA)
2002 Sensation-16!
Cardiology
Cardiac Imaging = need for speed !
CTA: image quality is inversely proportional to the heartrate
Two possibilities: decrease scantime or the heart rate (> 70 bpm beta-blockers) Faster scanning = higher temporal (time) resolution - Rotationtime of 500, 420, 370 up to 270 ms (limitation by G-forces) - Half-scan reconstruction (180 degrees): 250, 210, 185 up to 135 ms
Cardiology
Aquisition methodes for CTA in SSCT or DSCT
1. Spiral (retrospective, with ECG-pulsing)

- Classic method for CTA (all vendors) Advantage: - Phase shifting possible (with wide pulsing) - More phases to use in Cardiac Function Disadvantage: - Radiation dose between 8-15 mSv (or even higher)
Applications: Coronary Arteries, Cardiac Function, Valves, Bypass
Cardiology
Multislice Spiral Single Source CT
Raw Data plus recorded ECG-signal (retrospective reconstruction).

Siemens
z - Position
s uou feed in ont an & C c s iral sp
Image data
180 degrees reconstruction
Reco n
Reco n
Delay
Reco n
Reco n
Half scan segment
Time
Reconstruction: delay in percentage or time in msec (e.g. start at 75 %).
Cardiology
Multislice Spiral Single Source CT
Siemens
z - Position
Reco n
Dela y
Half scan segment
Reco n
Time
Very low heartrate or table feed (pitch) to high: gaps!
Reco n
us Volume Gaps o inu l t Con pira S n& a Sc ed Fe
180 degrees reconstruction
Reco n
Cardiology
Gaps in a 16-slice CT
Cardiology
Single Source CT Temporal resolution of maximum 165 ms
Temporal Resolution = Rotation Time = 165 ms 2
Cardiology
Single Source CT 180 degrees recon Technical challenge with high heart rates
60 bpm 100 bpm
Cardiology
Comparison between Single Source and Dual Source CT Cardio-imaging: high temporal- and spatial resolution
Siemens Somatom Sensation-64 Cardiac (Single Source)
Siemens Somatom Definition (Dual Source)
Cardiology
Dual Source CT: principle Normaly only 1 tube (Source) is used for scanning (A-tube, Single Source)
Cardiology
Dual Source CT Heart rate independent temp. resolution of 83 ms
Temporal Resolution = Rotation Time 4 = 83 ms
Cardiology
Dual Source CT Reliable imaging of all heart rates

60 bpm 100 bpm
Cardiology
Aquisition methodes for CTA in SSCT or DSCT

move move move
2. Sequential (prospective, step and shoot) - Alternative method (reducing radiation)

Advantage: radiation dose between 2-4 mSv - Calcium Scoring between 0.8 and 1.5 mSv Disadvantage: no phase shifting possible, - only in future Cardiac Function possible - sometimes steps between slices
Applications: Non-Coronary (e.g. RF Ablatio), Calcium Scoring
Cardiology
Prospective Sequential (Step and Shoot)
- Sometimes steps between slices - Higher heartrate: bigger and more steps - Use betablockers to decrease heartrate and steps
Cardiology
Prospective Sequential (Step and Shoot)
- Sometimes steps between slices - Higher heartrate: bigger and more steps - Use betablockers to decrease heartrate and steps
Cardiology
Timing of contrast
Test bolus
Standardised automatic Bolus Tracking - place of ROI: Descending Aorta Threshold 100 HU Advantage: less movement, less artefacts compared to Ascending Aorta, operator independent manual
Bolus tracking manual

- place of ROI: outside the patient in air or fat
2 cm below the bifurcation of the trachea
Cardiology
Cardiac contrast protocols (UMCG)

Contrast: Iomeron 400 Injector: MedRad Stellant, Dual Source CT Contrast ml/sec Cardiac spiral and sequential Dual Flow Cardiac-bypass Extra series 3 5 4 3 5 Saline (NaCl) ml/sec ml
Contrast: Iomeron 400 Injector: MedRad Stellant, Sensation-16 and Sensation-64 Contrast ml/sec Cardiac spiral and sequential Biphasic Cardiac-bypass Extra series 3 5 4 3 5 Saline (NaCl) ml/sec ml
ml 3 80 20 3 60
ml 3 65 80(30-70%) 3 60
4 4
50 30
4 4
30 30
Cardiology
Timing of the reconstruction (spiral mode)
5% 10 % 15 % 20 % 25 % 30 % 35 % 40 % 45 % Start phase 50 % 55 % 60 % 65 % 70 % Manual or automatic (best phase) 75 % 80 % 85 bpm > 65-70% 85 % 90 % 85 bpm < 30-35% 95 % 100 %
65 %
70 %
75 %
80 %
Cardiology
Case
> 50% stenosis & complete occlusion RCA
Male, 57 y Chest-Pain on ER Dual Source CT > CAG > PTA Retrospective spiral CTA with ECG-Pulsing 30-80% full dose, rest 20% dose Start phase reconstruction 70%
RCA LCX LAD
No significant stenosis
Cardiology
Cardiac Function Evaluation
Systolic phase
Do not include the pappilary muscles! Diastolic phase epicardium
endocardium - Recommanded: 20 Phase reconstruction - 2 mm, index 2 mm (256 matrix if possible)
Cardiology
Case
Wall thickness ES Wall thickness ED
Siemens Circulation Evaluation Program
Wall thickening
Wall motion
Cardiology
Aorta Valves
Recommanded: - 20 Phase recon, 1 mm, index 1 mm (512 matrix) - Kernel medium/sharp - No ECG-pulsing (3-6 mSv)
What to expect?
Monday 26 march 2012 09.00 12.00 h
Thursday 29 march 2012 13.00 16.00 h
Dual Energy
Dual Energy CT
Dual Energy is based on the unique energy dependant attenuation profiles of different sorts of tissue like fat, soft tissue, bone and contrast.
Dual Energy
Dual Energy is based on the unique energy dependant attenuation profiles of different sorts of tissue like fat, soft tissue, bone and contrast.
Thomas Flohr, First performance evaluation of a DSCT; Eur Radiology (2006)
Dual Energy
Determination stones in kidney
Anno Graser MD et all (Mnich-Grosshadern)
Dual Energy
Determination stones in kidney
Uric acid-stones (9%)
Calcium oxalate-stones (80%)

Anno Graser MD et all (Mnich-Grosshadern)
Dual Energy
Bone Subtraction
Christoph Becker MD et all (Mnich-Grosshadern)
Dual Energy
Evaluation Myocard Perfusion with DE Perfusion CT
- Anatomy - Function - Perfusion
Ischemia
Dual Energy
Dual Energy:
Possible applications - differentiation in composite of kidneystones - simply removing of bony structures and calcification by way of subtraction - virtuel reconstruction of a native series - differentiation between benign and malign nodules, cysts and other abnormalities - differentiation between cartilage, tendons and ligaments (traumatology) - detection of inflammation, e.g. in softplaques
Developments in Dual Source CT
What to expect?
Monday 26 march 2012 09.00 12.00 h
Thursday 29 march 2012 13.00 16.00 h
Archeology
Mummie Janus (RMO) Egyptologist Dr. H. te Velde Medical student T. Valke
AZG 1973
Archeology
1998 Mummie Janus
Archeology
1998 Mummie Janus
hart
Archeology
Unit of Art in Medicine, Manchester; Facial reconstruction made by Denise Smith and Caroline Wilkinson.
Archeology
Unit of Art in Medicine, Manchester; Facial reconstruction made by Denise Smith and Caroline Wilkinson.
Archeology
1 juni 1999 disclosure of the reconstructed head by the acting representative Egyptian ambassador, mr. Ashraf Elkholy.
Archeology
1 juni 1999 disclosure of the reconstructed head by the acting representative Egyptian ambassador, mr. Ashraf Elkholy.
Archeology
Corpse preserved in peat (veenlijk)
Meisje van Yde
Archeology
Museum-Assen Meisje van Yde
But is it reliable?
Tarbot
END
Imaging Techniques in Radiology: CT
Wim Tukker systeemspecialist CT UMCG
What to expect?
Monday 26 march 2012 09.00 12.00 h
Thursday 29 march 2012 13.00 16.00 h
Image Reconstruction: Backprojection Each individual projection gives a contribution to the eventual picture advancement (beeldopbouw).
Voxels en pixels. In practise we look more to the pixels then to voxels. Realise that a pixel is always an addition of a volume. In an other way: a pixel is a 2-dimensional display of a 3-dimensionale measurement.
CT Chest
level window
40 400
level window
40 400
HU: Hounsfieldschale level - window level - 650 window 1600

CT technique Daily calibration of the CT
level window
40 800
Bushberg, page 358
Matrix
CT technique Bushberg, page 356
CT technique
Bushberg, page 356
Backprojection: filtered (Kernel)
1 pixel (voxel) Matrix in CT: 512x512
CT technique
Page 352 - 355
Influence Kernel on Sharpness
Influence Kernel on Noise
Spatial resolution
10 mm low Kernel (filter)
5 mm low Kernel 2 mm with a spatial filter (1H)
CT technique
Effect of the kernel

CT technique Bushberg, page 352 - 355
contrast resolution
(chicken)
(chop)
(steak) (stone) (wood) (bacon rag)
CT technique
spatial resolution
CT technique
Influence Slice Thickness on Spatial Resolution
Partial Volume Effect
CT technique
Spatial resolution smal details - interstitial lungtissue - Inner Ear structures - Temporal Mandibulair Joint
Contrast resolution contrast - braintissue - abdominal organs, liver - bloodvessels, lymphnodes
method thin slices higher kV lower radiationdose sharp kernel wide window
method - thicker slices - lower kV - relative higher dose (Alara) - soft kernel - small window
What to expect?
Monday 26 march 2012 09.00 12.00 h
Thursday 29 march 2012 13.00 16.00 h
CT Chest
Difference between X-Ray and CT Scoutview?
Fan beam projection
Scoutview A.P.
Bushberg, page 330
CT Chest
Window level: mediastinum-setting
Ascending Aorta
Superior Vena Cava Pulmonary Artery
Descending Aorta
Pleural Effusion
Bushberg, page 358
CT Chest
Window-level: lung-setting
Bushberg, page 358
CT Chest
Lung Metastasis
CT Chest
HD Diaphragmatic Hernia Curved MPR

CT Chest
Carcinoma of the Oesophagus
Gastric tube Bushberg, page 358-360
CT Chest
Atherosclerosis
CT Chest
Heavy smoker, 67 y Coughing, blood
First visit jan 2005
Next visit sept 2008
CT Chest
Lung carcinoma with hilair adenopathy (lymphoma)
CT Chest
VRT (Volume Rendering Technique) usefull or not?
CT Chest
Virtual scopy: usefull or not?
Virtual Scopy
CT Chest
Future: evaluation long embolia with Dual Energy Perfusion CT
CT Chest
Stent control thoracic aneurysm
CT Abdomen
Stomach Pancreas
Gallstones
Superior Mesenteric Artery
Liver
Adrenal Spleen Diaphagm
Kidney
Abdominal anatomy
CT Abdomen
Determination of a heamangioma of the Liver
Four fasic Liver CT
CT Abdomen
Protocol living kidney donation
CT Abdomen
Evaluation The Urological System: Ureters; Urinary Bladder;
Intra-Uterine Device (IUD).
Protocol living kidney donation
CT Abdomen
Abnormality?
CT Abdomen
Abdominal Aortic Aneurysm
CT Trauma
Polytrauma
CT Trauma
ATLS trauma-scheme X-thorax (chest) X-cervical spine lateral X-pelvis
clavicula # ribfractures trace fluid right femur #
CT Trauma
Ultra-sound of the abdomen - fluid in the chest - fluid around spleen and liver CT or Operation Room? -> CT!
CT Trauma
- ventral pneumothorax *) - heamatothorax, right side - multiple ribfractures *)
*) Artificial respirating
CT Trauma
CT Abdomen (arterial phase) - Rupture of the spleen - Active arterial bleeding - Fluid round the organs Operation Room? No!
CT Trauma
Groin; liesstreek
DSA (Digital Subtraction Angiography) - Arterial extravasation followed by embolisation
CT trauma
First take away the life threatening situations!
DSA - Embolisation; glue procedure (artificial infarct)
CT Trauma
Collateral damage
- Clavicula #
MPR (Multi Planar Reconstruction)
MIP (Maximum Intensity Projection)
CT Trauma
# Cervical 2
Collateral damage
Break
What to expect?
Monday 26 march 2012 09.00 12.00 h
Thursday 29 march 2012 13.00 16.00 h
S/N
165 mAs
165 mAs
20 mAs
20 mAs Optical Magnification
CT fysics
Effect mAs on image quality
20 mAs
110 mAs
CT fysics
Radiation-protection in CT: AEC (Automatic Exposure Control)

Automatic adaption mA (tube current) to the shape (reference detectors) of a patient in the XY-axis (up to Sensation-16).
Object attenuation
lateral High attenuation 1.0 a.p.
Modulated tube current
0.75 LOW attenuation 0.50
Round objects, no reduction! Thick patients, children
0.25 0 0 500 1000 1500 2000 Scantime in ms 2500
Bushberg, page 366
CT fysics
Radiation-protection in CT: AEC (Automatic Exposure Control)
standard scan
with AEC
199mAs, noise = 12.9HU
189mAs, noise = 9.4HU
Bushberg, page 366
CT fysics
Care Dose 4D
Sensation 64, Dual Source Real-time tube current adaption: up to 66 % dose reduction compared to fixed mA!
Bushberg, page 366
CT fysics
CareDose 4D Optimal image quality, dose adapted to anatomy
140mAs 55mAs
110mAs
130mAs Bushberg, page 366
CT fysics
Absorbed dose: deposited energy in tissue (mGray)
Equivalent dose: biological effects in relation to the sort of ionising radiation (mSv) X-rays = factor 1 (protons = 5, neutrons = 5-20, = 20)
Effects: stochastic > no borderline, proportional to dose > tumorinduction and genetic damage
Effects: deterministic > borderline > cataract, infertility, skin damages
Effective dose: cumulative weighted organdose (mSv) > cancer risk.
CT fysics
Step one: calculating absorbed dose in mGray CTDI = Computer Tomography Dose Index
CT fysics
A measurement for radiation absorption is CTDIw (mGray). CTDIweighted = 1/3 x CTDIcenter + 2/3 CTDIskin.
D.L.P.
The Dose Length Product says more about the total amount of absorbed dose. DLP = CTDIw x st x n (multiply) st = slicethickness, beamwidth in Z-axis n = number of adjusted slices or rotations
CT fysics
CT fysics
Effective dose (E) in mSv: radiation risc for the patient
Definition organdose: average absorbed energy per organ (mGray). E = total organdose (mSievert)
E = WT x HT
WT = Organ weighted factor (ICRP 60*) HT = Absorbed organdose x quality factor (1)
* International Commission of Radiological Protection

CT fysics
Nucleair attack on Hiroshima 6 aug 1945 and Nagasaki 9 aug 1945
Japan: Hiroshima
Total number of Deaths Immediately: 78.000 End 1945: 140.000 2004: 237.062
CT fysics
Organ sensitivity after the A-bom radiation, Hiroshima (RERF, Radiation Effects Research Foundation)
Table. Numbers of cancer deaths by cancer type and strength of evidence for a radiation effect.
____________________________________________________________________ Total Estimated Evidence for Site Total Estimated Evidence for Deaths Excess Effect Deaths Excess Effect ____________________________________________________________________ Stomach Lung Liver Uterus Colon Rectum Pancreas Esophagus 2529 939 753 476 347 298 297 234 65 67 30 9 23 7 3 14 12 strong strong strong moderate strong weak weak strong moderate F. Breast Ovary Bladder Prostate Bone 211 120 118 80 32 37 10 10 2 3 47 1 6 strong strong strong weak moderate strong weak strong Site
Other solid 948 Lymphoma Myeloma 162 51
Gallbladder 228
CT fysics
Absorbed dose (mGy) > organdose (mSv) Weight factors: ICRP-norm Weightfactors for calculation of the effective (organ) dose.
(ICRP #26, 1977) (ICRP #60, 1990) Gonads Bone Marrow Colon Lung Stomach Bladder Breast Liver Oesophagus Thyroid Skin Skeleton Remainder Sum 0,25 0,12 0,12 0,15 0,03 0,03 0,30 1,00 0,20 0,12 0,12 0,12 0,12 0,05 0,05 0,05 0,05 0,05 0,01 0,01 0,05 1,00
What to expect?
Monday 26 march 2012 09.00 12.00 h
Thursday 29 march 2012 13.00 16.00 h
Cone Beam CT
Disadvantages 3D to 2D
NEVER BELIEVE AN X-RAY
2006
NewTom 3G DVT
i-CAT Cone Beam 3-D Imaging System
Cone Beam CT
A Clear Difference that You Can See!
Conventional Panoramic (OPG) Imposition of Tissue Projection Distortion Magnification Error
NewTom Panoramic Cone Beam CT No Distortion 1:1 Scale Exact Measurements
Cone Beam CT
Working of a Cone Beam CT

Fan-beam of X-ray in CT Cone-beam of X-ray
Cone Beam CT
Working of a Cone Beam CT
LA Feldkamp, LC Davis, JW Kress: Practical cone-beam algorithm J. Opt. Soc. Am. (1984), 612-619
Cone Beam CT
Clinical applications Dental implantations
Oral and Maxillofacial Surgeons Orthodontists
Digital OPG - Curved MPR
MPR (Multi Planar Reformatting)
VRT (3D) (Volume Render Technique)
Cone Beam CT
Ray Sum Images
Panoramic Images
MIP (Maximum Intensity Projection)
Unlimited post processing in variable slice thickness
Cone Beam CT
Made by a Cone-Beam CT
Cone Beam CT
Effective dose
Illuma 137 S
NewTomVG 75 S
Ewoo 70 S
Kavo/Icat 68 S
NewTom 36 S
Galileos 29 S
Cone Beam CT
Sirona GALILEOS NewTom 3G NewTom VG
Planmeca ProMax 3D
2010
What to expect?
Monday 26 march 2012 09.00 12.00 h
Thursday 29 march 2012 13.00 16.00 h
Forensic Radiology
Forensic Radiology
Bicycle versus car; on purpose?
Forensic Radiology
Shooting - How many bullets? - Ballistic trajectory? - Cause of death?
Forensic Radiology
Dental identification
Exploded Bone Marrow
UMCG
Forensic Radiology
Dental identification
We had a match!
UMCG
Mummie Janus (RMO)
Meisje van Yde (Drents Museum)
Forensic Radiology
http://www.fbi.gov
Forensic Radiology
www.fbi.gov
www.marylandmissing.com
www.missingpersons.org
Forensic Radiology
Meisje van Nulde
Forensic Radiology
Meisje van Nulde
Forensic Radiology
Meisje van Nulde
Forensic Radiology
Meisje van Nulde
Rochelle
Rowena
Forensic Radiology
Thanks to ultra sound specialist: Jan Visscher
Forensic Radiology
Mouse !!!
Last Dinner ???

BMT 2012 Clinical CT Applications

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Imaging Techniques in Radiology: CT

Wim Tukker systeemspecialist CT UMCG

End terms for Imaging Techniques in Radiology

Monday 26 march 2012 09.00 12.00 h

Thursday 29 march 2012 13.00 16.00 h

Monday 26 march 2012 09.00 12.00 h

Thursday 29 march 2012 13.00 16.00 h

CTs in UMCG: Radiology, Nucleair Medicine & Radiotherapie

Siemens Somatom Sensation-16

Siemens Somatom Sensation-64 (2x)

Siemens Somatom Definition (Dual Source)

Siemens Biograph 64 slice mCT (PET-CT)

Siemens Symbia 2 and 16 slice SPECT-CT

Siemens Sensation Open

tion Source Defini Siemens Dual

Conventional tube diagram

Straton X-ray tube design

Double z-Sampling: two focus spots alternating 4.640 per second

Sensation 64, Definition

0.4 x 0.4 x 0.4 mm isotropic resolution

m 4 x 1.2 m > 1.2 24 x

m 4 x 1.2 m m x 0.6 m overage 32 Zc 28.8 mm

Adaptive Array Detectors Bushberg, page 339 - 342

Configuration detector system Sensation 64 and Definition (A-tube)

Bushberg, page 339 - 342

Sensation-16: 24 detectors on row!

8 x 2.7 mm + 16 x 1.35 mm: true detectorwidth!

Bushberg, page 345 - 346

Is there influence of the pitch on the slice thickness?

Monday 26 march 2012 09.00 12.00 h

Thursday 29 march 2012 13.00 16.00 h

Radiation-dose 1.1 mSv

CT-scan Brain sequential or spiral?

MPR in OM-direction (Orbito-Meatal)

Axial view in spiral CT (source images)

MPR; Multi Planar Reconstruction

CT-scan Brain sequential or spiral?

X-Y: 5 mm/index 5 mm (sequential)

Partial Volume Effect

CT-scan Brain, examples

Stroke! ICH Intra Cranial Hematoma

CT-scan Brain, examples

CT with IV-contrast: 100 ml Visipaque 320

CT-scan Brain, examples

white and grey matter oedema

Vasculitis (inflammation)? Same patient: possible cause of the abces?

Spiral CT of maxillary sinus (NBH)

Radiation-dose 0.2 mSv

Spiral CT of maxillary sinus (NBH)

Thickening of mucus MPR

Bushberg, page 359 - 360

Spiral CT of maxillary sinus (NBH)

Advantage CT: superior bone/air visibility, why?

Spiral CT of maxillary sinus (NBH)

Same patient, MRI

Advantage MRI: superior soft tissue visibility

Spiral CT of petrosal bone (mastoid)

On a sagital image MPR // canalis facialis

MPR perpendicular to canalis facialis

Spiral CT of petrosal bone (mastoid)

Bushberg, page 359 - 360

DSA versus CT (coronal MIP)

Spiral CT of brain arteries (CTA)

I.V. contrast: Visipaque 320; 80 ml with flow 4 ml/sec.