CAMRT Review: CT Theory Flashcards
Limitations of 2D imaging?
- Superimposition of structures
- Difficult to distinguish slight density differences
- Difficult to identify precise location of abnormalities
What is a focal plane?
Tomography term
“Section thickness”
What is the fulcrum?
Imaginary pivot point about which the x-ray tube and the IR move
“Dead center”
Blur is increased as distance from the focal plane _________?
Increases
Increased tomographic angle = _______ section thickness
Decreased
Advantages of tomography over general radiography?
- Increased radiographic contrast
- Increased subject contrast
- Decreased superimposition
Disadvantages of tomography over general radiography?
-Increased patient dose
Basic principles of CT?: why do we use it over general radiography?
- minimize superimposition
- improve contrast
Primary disadvantages of CT?
- Increased radiation dose
- Artifacts
- Decreased spatial resolution
What is the scan point on the table?
-Can use to determine the location of a pathology
What is the scannable range of the table?
-How much area can be scanned without having to move the patient
What components are housed within the gantry?
- Tube
- Detector array
- Generator
- Filtration
- Collimators
- DAS
What is the aperture of the gantry? What is the isocenter?
The hole in the gantry that the patient moves through. The isocenter is the center of that hole
What is a CT x-ray tube designed for?
To dissipate heat
Is a glass or metal envelope better? Why?
Metal
- prevents arcing
- increases current
- increases heat dissipation
What is different about CT anodes? What are they made out of?
- Larger
- Thicker
- Smaller target angle
- High rotation speeds
- Rhenium, Tungsten, and Molybdenum
- Graphite base
Types of filtration?
- Added
- Inherent
What does filtration do?
- Hardens beam: removes longer wave-length x-rays
- Beam uniformity: more homogeneous
- Decreases patient dose
Types of collimation schemes?
- Source: before patient, dose profile
- Post-patient: keeps beam a slice not a fan
Hounsfield Units of water, air, bone, and metal?
Air: -1000
Water: 0
Bone: 1000
Metal: 2000
Why does CT use high kVps?
- Decrease attenuation on coefficient : more penetration
- Decrease contrast of bone to soft tissue: more scatter
- Increase radiation flux at detector : more radiation to detector
2 types of gantry geometries?
- Continuous: detectors and tube rotate
2. Stationary: detectors stationary, tube rotates
What are scout images used for?
- Planning the scan
- not considered data acquisition
2 methods of data acquisition?
- Axial
2. Helical
Another name for axial scans?
Conventional/serial
Advantages of axial scanning?
- Slices perpendicular to patient
- Acquisition can vary
- Highest image quality
3 ways data can be acquired during an axial scan?
- Contiguous
- Gapped
- Overlapped
Disadvantages of axial scans?
- Increased exam time
- Scan delay: not good for scanning contrast filled vessels
- Increased likelihood of motion artifacts
What enables helical scans?
Slip ring technology
Advantages of helical scanning?
- Decreased scan time
- Scans a volume of tissue
- Reduces misregistration
- More reformatting and reconstruction
- Less contrast required
What type of data does image reconstruction use?
Raw data
What type of data does image reformatting use?
Image data
Disadvantage of helical scanning?
-Image quality is compromised: missing info: interpolation
4 types of data?
- Scan data
- Raw data
- Filtered raw data
- Image data
What is scan data?
Data that arise from the detectors
- require preprocessing corrections before the image reconstruction phase can occur
- prevents poor image quality
What is raw data?
Preprocessed measurement (scan data) data -can be stored and retrieved as needed
When does raw data turn into image data?
When it is reconstructed using algorithms
Reconstruction algorithms? (4)
- Back projection: data gets smeared
- Filtered back projection: removes blurring from smearing “convolved data”
- Fourier transform: used to reconstruct MRI
- Iterative Reconstruction: think automatic rescaling “makes image look better electronically”
Image reconstruction algorithms? (Changes the way raw data is manipulated to create image data)
- Standard: balance noise and detail
- Smoothing: soft tissue visualization, but decreases spatial res.
- Edge Enhancement: improved detail, but decreases contrast resolution
How does a CT image appear on a computer? How does it go from raw data to be displayed?
-Analog data is first converted to digital to assign HU, then it is converted back so that we can see it as tissue not numbers
Reformatting improved with _______ (thinner/thicker) slices?
Thinner
When do stair step artifacts occur?
When thick slices are used for reformatting
How is slice thickness controlled in SDCT?
It is determined by pre-patient collimators, can only be as wide as the detector, but can be narrower
How is slice thickness determined for MDCT?
- pre patient collimator width
- detector configuration
What is volume averaging determined by?
Slice thickness
Thicker slice = more averaging
-increases likelihood that structured will be superimposed
What is retrospective slice incrementation? (Post-processing). Why is it useful?
Enables the operator to chance the slice center of an image
- no increase in patient dose
- can decrease partial volume effect
- cannot change slice thickness in SDCT
Retrospective slice incrementation: can you make the slice smaller than the acquisition slice? Why/why not?
No.
-noise
What is pitch?
Ratio of the table movement per 1 gantry rotation to the slice thickness
Does pitch change slice thickness?
No, it just changes how much anatomy is in 1 slice
Advantages of increased pitch? (Less than 1.5)
- decreased scan time: pt motion, holding breath
- improved imaging of contrast filled vessels
- decreased patient dose
- decreased heat load
- minimal loss of image sharpness
Pitch formula: SDCT
Pitch = table movement in 1 gantry rotation / slice thickness
Pitch formula: MDCT
Pitch = table movement per 1 gantry rotation / slice thickness x number of slices
Anatomy coverage formula: SCDT?
Pitch x total acquisition time x (1/rotation time) x slice thickness
Anatomy coverage formula: MDCT?
Pitch x total acquisition time x (1/rotation time) x slice thickness x number of slices
Increased matrix = _________ pixel size
Decreased pixel size
Decreased pixel size = __________ spatial resolution?
Increased
What is a voxel?
Volume of tissue
-isotropic = same dimensions all around, what we want
What is sampling when referring to pixels?
The pixel detects radiation throughout the entire scan and then averages it at the end to display a shade of grey
What is bit depth?
The amount of greys that a pixel can show
Where should the window level be set at for a scan?
Close to what the HU is of what you want to see
Increased WW = __________ contrast
Decreased, long scale contrast
When is long scale contrast good?
When there are many different densities to be seen
When is short scale contrast good?
When looking at similar densities
Decreased WL = __________ brightness
Increased brightness
What is the SFOV?
Scan field of view: determines the area within the gantry that the raw data will be acquired from
What is the DFOV?
Display field of view: determines how much of the acquired raw data will be used to create an image
Does DFOV change pixel size?
Yes
Decreased DFOV = _________ spatial resolution?
Increased
Is DFOV of magnifying better for spatial resolution?
Decreasing DFOV
What is the difference between analog and digital data?
Analog is continuous data
Digital is one value
Why is the table made out of carbon fibre?
- strength
- low absorption
- vibrational properties
Advantages of the power injector?
- volume, injection rate, and delay can be preprogrammed
- protocols can be user defined and stored for injection consistency
- injection pressure is monitored enabling administration precision
Limitations of the power injector?
- kinked tubing
- high viscosity
- incompatible equipment
Miscentering of 3-6cm can result in an increase in dose of _____%?
18-41%
Miscentering in elevation by 20-60mm can result in a dose of up to ____%
140%
Major function of the DAS?
Data acquisition system: measures the # of photons that strike the detector (measures the electric signal that comes from the detectors and coverts it to digital)
- ADC
- sends signal to computer for recording
Detectors operate more consistently with a _________ beam?
Homogenous
What do collimators do?
- decrease patient dose
- decrease scatter reaching IR
- controls slice thickness by shaping the x-ray beam
- controls voxel length
What do the detectors do?
Measure the x-ray photon energy and convert it into an electric signal
Is a long and skinny detector or a short and wide detector better? Why?
Long and skinny because wider ones pick up more scatter
Smaller detector = ________ spatial resolution?
Increased
Detector characteristics? (4)
- DQE
- Stability
- Fast response time
- Wide dynamic range
What is DQE?
Detective quantum efficiency: how well a detector can capture, absorb and convert x-rays
What increases DQE?
- Wider detector : increases surface area
- Decreased spacing
- Composition: high atomic #, high density, high thickness
What is detector stability?
How much can you take before you snap
-how much radiation can it take before it has to be recalculated
What is detector response time?
How quickly can a detector detect another photon?
-ready to detect another photon quickly after receiving one already
What is detector dynamic range?
- we want wide
- variety of signals able to be detected
- able to capture a wide range of photon energies and display them in a variety of electric signals
Types of detectors?
- Ionization chamber xenon gas
2. Solid-state scintillation
How does a xenon gas detector work?
- Tungsten plate in between the chambers attract ions
- The movement of the electrons causes an electric current proportional to the number of photons absorbed by the system
- *Photons come in and hit the xenon gas and lose an electron that is attracted to the negative plate and the now positive ion is attracted to the positive plate
Advantages and disadvantages of a xenon gas detector?
Advantages? -less expensive -highly stable -no afterglow Disadvantages? -needs to be under pressure -lots of space -loss of photons at aluminum casing (decreased DQE)
How does a solid state/scintillation detector work?
-converts x-rays to light to electrical
What do scintillation detectors require?
Amplifiers to beef up the signal to get it proportional to the x-ray energy
MDCT detector configurations?
- Matrix array: same size, isotropic
2. Adaptive array: anisotropic, different sizes, larger further from center
Do thin slices or thick slices take up more storage space?
Thin
CT generations?
1st Gen: narrow pencil beam, no detector array, translate-rotate 180 degrees
2nd Gen: narrow fan beam, linear detector array, translate-rotate 180 degrees
3rd Gen: wide fan beam, rotate-rotate 360 degrees, curved detector array
4th Gen: wide fan beam, rotate-fixed 360 degrees, circular single row detector array
5th Gen: fan beam, stationary-stationary, used for cardiac in 1980s, decreased spatial res
6th Gen: dual source, fan beam, rotate-rotate, improved spatial resolution, cardiac imaging
Which generation is most susceptible to scatter?
4th because of the circular detector array
Other technical applications of CT?
- Cardiac imaging
- CT fluoroscopy
- CT Angiography
- CT screening
- CT simulation
What is CT simulation?
- used to determine the exact size, location, and shape of a tumor for treatment
- patients skin marked for treatment
How do CT simulators differ from conventional CT scanners?
- larger gantry aperture
- flat table top
- software capable of creating a targeted treatment path
Can CT simulation machine do conventional CT? Can conventional CT scanners do CT simulation?
CT simulation can do conventional CT, but not the other way around
What are the 2 parts that make up radiopharmaceuticals?
- The drug portion: goes to the source
2. The radioactive isotope: so we can see it
What is the most common tracer used in nuclear medicine?
Technetium 99M
Contraindications for a nuclear medicine scan?
- no barium for 48hrs
- no previous NM tests within the last week
- appropriate prep: fasting, stop meds
- removed all attenuating artifacts (metal)
During a NM scan, gamma radiation is emitted from the _______ and captured by the detector?
Patient
During a skeletal NM scan, which parts of the body usually have increased uptake?
- bladder
- sternum
- SI joints
What is SPECT?
Single Proton Emission Computed Tomography
What is PET?
Positron Emission Tomography
Advantages of SPECT over PET?
- requires less space and consumables
- no cyclotron required
- operating costs
- no positron emission
What is spatial resolution? How is it measured?
The ability of a scanner to display 2 different objects immediately adjacent to one another without blurring them together
-lp/mm
Increased spatial frequency = ________ object size?
Decrease
Decreased spatial frequency = __________ object size?
Increased
What is the modulation transfer function?
The ratio between image accuracy in comparison to the actual object scanned
-scale of 0-1
Increased MTF = __________ object size
Increased
What is contrast resolution?
2 objects with very similar densities will look different rather than the same
Is the relationship of spatial frequency and image size linear?
No
What is the uncoupling effect?
Automatic rescaling: overexposures can still look great on digital
What is automatic tube current modulation?
-adjusts mAs as you scan the patient
Can automatic tube current fix quantum mottle?
No, it can only manipulate what its been given
Typical kVp for adults and children?
Adults: 120-140kVp
Children: 80kVp
Small filament = _________ penumbra = ______ detail
Small filament = decreased penumbra = increased detail
Focal spot size only affect ____________?
Spatial resolution
Quantum mottle = _________ contrast?
Decreased
Increased SNR = _________ contrast
Increased contrast
Increased slice thickness = ________ contrast
Decreased because of more averaging
Increased slice thickness = ___________ SNR
Increased because thicker slices have more photons in them
Decreased pixel size = ___________ contrast resolution
Decreased because it catches less photons
Pixel size formula?
Pixel size = DFOV/matrix size
The pixel should be ____ the size of the object being scanned?
1/2
3 general appearance of artifacts on CT image?
- Streaks
- Ring/band
- Shading
Types of artifacts?
- Beam hardening
- Partial Volume
- Motion
- Metallic
- Out-of-field
- Cone beam
- Rings and Bands
- Noise
Beam hardening artifact?
- Caused by natural filtration of the x-ray beam by the object
- Shading/streaks/
- select appropriate SFOV or use beam hardening reducing software to avoid
Partial volume artifact?
- Caused by more than 1 type of tissue contained in a pixel
- Shading
- Use smaller pixels and thinner slices to avoid
Motion artifacts?
- Caused by: voluntary or involuntary motion
- Shading, streaking, or blurring
- Short scan times, sedation, immobilization, communication, software correction and cardiac gating to avoid
Metallic artifacts?
- Caused by the density of the metal
- streaks
- Improved HU range, proper changing instructions, high kVp, thinner slices
Out of field artifacts?
- Caused by: anatomy that extends out of the SFOV
- streaks/shading
- move arms out of way, increased size of SFOV to avoid
Cone beam artifacts?
- Cause by interpolation of data
- streaks/shading near areas with large density differences
- ONLY IN MDCT*
- use lower pitch, cone beam reconstruction algorithms
Ring and Band artifacts?
- appear from malfunctioning or miscalibrated detector elements
- rings/bands
- unique to 3rd gen CT
- recalibrate scanner, call service engineer
3 types of noise artifacts?
- Quantum noise: scanner efficiency, patient size
- Inherent Physical Limitations: electronic noise in the DAS
- Reconstruction Parameters: high res reconstruction algorithms increase noise
How to reduce noise artifacts?
- increased mAs
- low noise DAS
- smoothing algorithms
3 main categories of post-processing for CT?
- Basic functions
- Retrospective reconstruction
- Reformatting
Type of 2D reformatting?
-MPR: formatting the image data into different planes that the one it was taken in
Types of 3D reformats?
- MIP :max intensity projection
- MinIP: minimum intensity
- SR: surface rendering
- VR: volume rendering
What is MIP?
Maximum Intensity Projection
- pixels show the highest value detected and eliminate other values
- high attenuation structures visualized
What is MinIP?
Minimum Intensity Projection
- pixels show the minimum values detected and eliminate other values
- low attenuating structures
What is SR? How does it work?
- predetermined threshold
- if the CT number is within the threshold, it is shown, if not, it is eliminated
- we see the shell of an object
- if threshold is too low: structures can be excluded
- if threshold is too high (large): other materials that we don’t want to see might be included
- only 10% of voxels contribute to image
What is VR? How does it work?
- all voxels contribute to image
- 3D semi-transparent representation of an object
What is segmentation?
- ROI editing
- removed or isolates structures on an image for better demonstration of an area of interest
- automatic or manual
Forms of contrast media?
- Liquid
- Powder/paste
- Gas
Types of contrast we use?
- Air
- C02
- Water
- Barium sulfate
- Iodinated water soluble
Purpose of air and gas?
- distention
- increase contrast
Is spastic colon more likely to happen with air or C02?
Air
How can air/gas be administered?
- Injection
- Orally
- Rectally
Cons of using water as a contrast media?
- fast transit time/absorption
- poor bowel distention
How can water be administered?
-orally
Barium sulfate concentration for CT?
1-3%
2 forms of barium sulfate?
Liquid: low concentration and viscosity
Paste: high concentration and viscosity
Routes of administration of barium sulfate?
- orally
- rectally
What is VoLumen? Why is it used?
- 0.1% barium sulfate solution
- HU: 15-30 (less than mucosal lining)
- resembles water on image, but increases bowel distention, transit time, and visualization of mucosa and bowel wall
Iodinated water soluble contrast media routes of administration?
- orally
- rectally
- injection: IV
What can we inject intrathecally?
- air
- gas
- iodinated water soluble
3 methods of IV administration from least used to most commonly used in CT?
- Drip infusion
- Hand bolus
- Mechanical Injection
What vein is preferred when establishing a line in the CT department?
AC vein
What is the minimum amount of saline flushed to verify the patency of the line?
10ml
Mechanical injector components?
- Warming Device
- Syringes
- Pressure mechanism
- Control panel
3 phases in order from first to enhance to last to enhance?
- Arterial (bolus)
- Non-equilibrium (venous)
- Equilibrium (delayed)
Peak enhancement of arterial organs occurs ______seconds after the injection?
15-45
Which organ requires a scan delay of 4 mins or longer. Why?
The brain because of the blood brain barrier
When does each phase occur?
- Arterial (bolus): immediately after injection, 15-22secs
- Non-Equilibrium (venous): 1 min after bolus phase
- Equilibrium (delayed): 2 mins after bolus phase
What do we see during the delayed phase?
Organ parenchyma
What is the worst phase for liver scans?
Delayed
Portal venous scans of the liver should occur ____ seconds after the bolus injection to include the arterial and venous enhancement?
60 seconds
Peak enhancement for the kidneys is ______ seconds after the bolus injection because they also excrete contrast?
80-120 seconds
The timing of the 3 phases is controlled by what 3 things?
- Pharmacokinetics
- Patient factors
- Equipment
Increased volume = ________ magnitude of peak enhancement?
Increased
Increased volume = _______ time to peak?
Increased
Increased volume = ________ time a given level of enhancement is maintained?
Increased
Total volume of contrast formula?
V- (ml/sec)(sec)
Optimal imaging occurs at ____HU?
200
Increased flow rate = ________ magnitude of peak enhancement?
Increased
Increased flow rate = _______ time to peak enhancement?
Decreased
Increased flow rate = _________ duration of contrast injection?
Decreased
Increased weight = _________ magnitude of peak enhancement?
Decreased
Increased weight = __________ time to peak
No effect
Increased heart rate = __________ magnitude of peak?
No effect
2 automated triggering methods?
- Test bolus: 10-15 images taken at same anatomic location, gives you the time at which you should start the real scan
- Bolus triggering: when HU threshold is reached, injection starts
The level of risk associated with a CT exam is considered acceptable if?
- the patient is aware of the risk
- the patient receives some type of benefit
- ALARA is maintained to reduce risk
What is absorbed dose? What is it measured in?
The amount of energy absorbed per unit mass of material
-grays (Gy)
What is effective dose?
Attempts to account for the effects specific to the patient’s tissue that absorbed the radiation dose
2 main classifications of radiation effects?
- Stochastic: no threshold, late effects, cancer, hereditary effects
- Deterministic: threshold, early effects
Max dose limit for canadian radiation workers?
20mSv whole body
Early- non-stochastic effects? (3)
- skin erythema
- epilation
- pericarditis
In CT, which dose is greater: the entrance skin dose, or dose at the center of the patient?
Entrance dose
What is the partial shielding effect?
The dose at the periphery of the patient is higher than that of the middle of the patient (organs absorb/block) the radiation as it goes through the patient
Are organ doses higher for thinner or thicker patients?
Thinner, because less partial shielding
What is over-ranging?
Exposed scan length is greater than planned scan length
-occurs in helical scans
Decreased SFOV = ____________dose?
Increased because smaller patients have a more uniform dose distribution which means a higher total dose (entrance + exit radiation)
Decreased slice thickness = _________ patient dose?
Increased because you must increase technique or else there is too much noise
3 cardinal rules of radiation protection?
- Time
- Distance
- Shielding
CT shielding?
- In-plane (bismuth): don’t use during scout, in the image
- Out of plane (lead): must be wrapped 360 deg around patient, reduces scatter
- Secondary: room walls due to scatter
A 1yr old is _____ times more likely than a 50yr old to get cancer when the same dose is used?
6 times
What is a DRL? What is their purpose?
Diagnostic Reference Level
- promote better control of patient exposures to x-rays
- identifies acceptable limits for an exam
What does dosimetry allow?
-techs to compare their doses with a national average
What dosimeter is the easiest method for recording exposure in CT?
Ionization chamber
What do dosimetry phantoms measure?
CTDI (computed tomography dose index)
3 CT dose measurements that we should be aware of and their units of measurement
- CTDI: grays (Gy): dose of 1 slice
- DLP: dose length product: mGy/cm: dose of entire scan
- ED: effective dose: sieverts (Sv)
What dose measurement allows dose to be compared between scanners?
CTDI
Does CTDI work for helical scans?
No, we must estimate for helical scans as this only works with contiguous slices
Does CTDI include scatter in dose?
Yes
Types of CTDI measurements? (4)
- CTDI(fda): index that relates to # of slices and slice width used
- CTDI(100): modification to accommodate smaller slice widths
- CTDI(w): dose in the x-y axis to accommodate dose uniformity
- CTDI(volume): dose in the z-axis (slice thickness)
CTDI volume formula?
CTDI(volume) = CTDI(w)/pitch
DLP formula?
DLP = CTDI(volume) x scan length
______ (dose measurement) is directly proportional to scan length?
DLP
ED formula?
ED = DLP x K (factor always given)