Computed Tomography

UNIVERSITY OF SOUTH AUSTRALIA
UniSA STEM – Applied Physics

PHYSICS FOR MEDICAL RADIATION 3
Tutorial 5
1. Briefly describe cone-beam CT

Cone-beam computed tomography is medical imaging technique that uses a cone-shaped beam of
x-rays and a flat panel detector to produce 3D images of the body. Unlike tradiation CT, which uses
a fan-shaped beam, cone-beam CT captures a large colume of data in a single rotation around the
patient. This allows for faster scanning times and more detailed images, particularly of complex
structures like the head and neck. Cone-beam CT is commonly used in dentistry, orthopedics and
radiation therapy planning
2. What are the advantages of CT angiography

1. Non-invasive - Unlike tradiational angiography, which requires insertion of a catherter into
the blood vessels, CTA is non-invasice and does not require and incisions or injections
2. Fast - A relatively quick procedure, taking only a few minutes to complete
3. High resolution widely available - CTA provides high-resolution images of blood vessels,
allowing for detection of even small leisions or abnormalities
4. Reduced risk – Compared to traditional angiography, CTA has lower risk of complications
such as bleeding or infection
5. Cost-effective – CTA is generally less expensive than tradiational angiography, making it
more accessible option for many patients
3. Describe (a) Filtered Back Projection reconstruction, (b) Iterative reconstruction

(a) Filtered back projection (FBP) is commonly used algorithm for reconstructing images from
CT scans. The FBP algorithm works by mathematically processing the raw data acquired
from the CT scanner to produce a reconstructed image of the patient’s body. The FBP
algorithm works in several steps. First, the raw data is collected by CT scanner as a series of
projections, which are then processed using a mathematical filter to remove noise and other
artifacts. Next, the filtered data is back-projected onto a 2D gird to produce a preliminary
image. Finally, the preliminary image is filtered again to remove any remaining artifacts,
resulting in a final reconstructed image. One advantage of FBP reconstruction is that it is
relatively fast and efficient, making it practical option for routine clinical use. However it has
some limitations including limited accuracy in cases where the patient’s anatomy is complex
or the data is noisy.
(b) Iterative reconsution is a CT image reconstruction technique that uses mathematical
algorithms to iteratively improve quality and accuracy of CT images. Unliked FBP algorithm,
which is a linear algorithm, iterative reconstruction is a non-linear and computationally
intensive method that can produce high-quality images even from noise or incomplete data.
The interative reconstruction process works by first creating an initial estimate of the image
from the raw CT data which is then used as a starting point for further refinement. The
algorithm then compares this initial estimate with the measured data, and interatively
modifies the estimate to improve its accuract. This process sis repeated many times until the
algorithm converges to a final image that best matches the measured data. Iterative
reconstruction has several advantages over FBP including the ability to handly more complex
data and to produce images with reduced noise and artifacts. It can also enable a lower
radiation dose to be used in CT imaging as it is able to produce high-quality images from a
lower amount of raw data. However, iterative reconstruction is more computationally
intensive than FBP which can increase processing time and cost. Additionally, because the
algorithm is iterative, it may require multipe iterations to achieve the desired image quality,
which can further increase processing time.
4. Write a short note on isotropic reconstruction.

Isotropic reconstruction is a methof of reconstructing three-dimensional images from CT scans, in
which the image resolution is equal in all three dimensions. This means that pixel size in the x, y,
and z dimensions are the same, resulting in a voxel that is a cube rather than a rectangular prism.
The isotropic reconstruction technique involves the use of interpolation algorithms to resample the
original image data in a way that ensures that the pixel size is uniform in all three dimensions. This
method allows for more accurate visualization of small structures and enables images to be viewed
from any angle ithout distortion or loss of detail. Isotropic reconstruction si particularly useful in
medical image, where It can help improve accuracy of diagnostic and surgical planning, especially
for small structures such as blood vessels, nerves, and organs. Isotropic images can also be used for
virtual endoscopy and other diagnostic and therapeutic applications.
5. Explain dose modulation (mA modulation) in CT

Dose modulation also known as mA modulation is a technique used in CT scanning to adjust the x-
ray tube current (mA) in real-time based on the thickness and composition of the tissue being
imaged. The goal of dose modulation is to achieve the desired image quality with the lowest
possible radiation dose to the patient. During a CT scan, the x-ray tube emits a continuous beam of
radiation as the scanner rotates around the patient. With dose modulation, the tube current is varied
in real-time to esure that the amount of radiation delivered to the patient is appropriate for the
specific anatomy being imaged. For example, in areas of the body with less dense tissue, such as
the lungs, the tube current can be reduced to minimize the dose, while in areas with more dense
tissue, such as bone, the tube current can be increased to ensure adequate image quality. Dose
modulation is typically accomplished through the use of automatic exposure control (AEC)
software, which continuously monitors x-ray transmission through the patient during and the scan
and adjusts the tube current accordingly. Some CT scanner salso have software that can account for
patient size and shape, further optimizing dose delivered to patient. Dose modulation is an effective
technique for reducing radiation exposure during CT scans, while maintaining image quality. By
adjusting tube current based on specific anatomy being imaged, dose modulation helps to ensure
that each patient receives a personalized and optimized radiation dose during their CT scan.
6. Write a short note on CTDIvol and DLP

CTDIvol (Computed Tomography Dose Index Volume) and DLP (Dose Length Product) are two
common measures used to estimate the radiation dose delivered to a patient during a CT scan.
CTDIvol is a measure of radiation dose delivered to a single slice of the patient during the CT scan.
It is calculated based on tube current, scan time, and slice thickness of a CT scan. CTDI vol is
reported in unity of mGy and is used to estimate the radiation dose to a single slice of tissue.
DLP, on the other hand, is a measure of the radiation dose delivered to the entire length of the
scanned volue. It is calculated by multiplying CTDI vol by the length of the scanned volume. DLP is
reported in units of mGy-cm and is used to estimate the total radiation dose to the patient during the
entire CT scan
It is important to note that while CTDIvol and DLP are useful measures, they do not take into accunt
individual patient factors such as size, age and underlying medical conditions that can affect
radiation dose.
7. Write a short note on (a) DRL, (b) MIP
(a) DRL stands for Dose Reference Level and is a term to refer to a standardized radiation dose
used for a particular imaging procedure. The DRL is an established radiation dose that is
considered appropriate for a specific imaging procedure, taking into account the diagnostic
information required and the radiation risk for the patient. The urpose of establishing DRLs is
to ensure that the radiation dose delivered to patients uding imaging procedures is appropriate
and optimized. By using, standardized radiation doses, healthcare providers can compare
radiation dose used in their facility to other facilities and make necessary adjustments to
ensure that patients are receiving the appropriate level of radiation during their imaging
procedures.
(b) MIP stands for Maximum Intensity Projection, which is a visulaisation technique to display
the maximum intensity of a certain feature within a 3D image data set. MIP is commonly
used in CT and MRI to display blood vessels, airways and other tubular structures. MIP
works by selecting the brightest pixels along a given line of sight through the 3D image data
set and displaying only those pixels. The result is an image that highlights the maximum
intensity of a particular feature within the image data set, while suppressing the other areas of
the image. MIP is particularly useful for visualizing blood vessels and other tubular structures
as it enhances the contrast between the vessel wall and the surrounding tissues. By displaying
only the brightest pixels, MIP can create a 3D image that shows the entire length and course
of a blood vessel, making it easier for clinicans to identify areas of narrowing blockages or
other abnormalities. While MIP is a valuable visualization technique, it does have some
limitated. Because MIP only displays the brightest pixels, it can sometimes result in loss of
information in areas where the intensity is not as high. Additinaly, MUP does not provide
information about the thickness or structure of the vessel wall which can be important for
diagnosing certain conditions
8. Describe any two CT artifacts

CT artifacts are discrepancies or distortions in the CT images that do not correspond to true
anatomy or pathology of the patient. They can arise from variety of sources including harfwarte and
software erros, patient motion and patient characteristics.
Beam hardening artifact: this artifact occurs due to the differential attenuation fo x-rays as they pass
through different materials. X-rays passing through denser tissues such as bone are more likely to
be absorbed, leadking to a reducting in intensity of the x-ray beam. This results in an artifact in the
image that appears as streaks or shading around the denser tissue. This artifact is commonly seen in
images of the head or the sinuses due to the presence of bone
Motion artifact: motion artifact occurs when patient moves during the CT scan resulting in bluring
or streaking of the image. Patient motion can result from a variety of factos such as breathing,
swallowing, or involuntary movements. Motion artifact can be minimized by instructing patient to
hold their breath during the scan or by using motion correction techniques. However, in some cases,
motion artifact cannot be eliminated entirely and may require repeat scans to obtain a diagnostic
image.
9. What are the main differences between CT in diagnostic and Radiotherapy departments?
1. Purpose: the primary purpose of CT in diagnostic departments is to obtain high-quality
images of the patients anatomy to assist in diagnosis and treatment planning. In radiotherapy
departments, CT is primarily used for treatment planning and to verigy the position of the
patient before treatment.
2. Imaging parameters: the imaging parameters used for CT in diagnostic and radiotherapy
departments can be different. In diagnostic CT, a range of imaging parameters such as slice
thickness, radiation dose and contrast administration may be adjusted to optimize image
quality for diagnosis. In contrast, CT in radiotherapy departments typically ses a single
imaging protocol to provide accurate information about the position of the patient and the
tumour.
3. Positioning: in diagnostic CT, the patient is positioned to optimize image quality and may be
asked to hold their breath or remain still during the scan. In radiotherapy departments, the
patient is positioned to ensure that the tumour is in the correct location for treatment. This
may involve the use of immobilisaiton devices and the use of a flat couch rather than a curved
couch typically used in diagnostic CT.
4. Radiation dose: the radiation dose used in diagnostic CT is typically higher than that used in
radiotherapy CT. In diagnostic CT, the goal is to obtain high-quality images which often
requires a higher radiation dose. In contrast, radiotherapy CT aims to minimize the radiation
to the patient while still providing accurate treatment planning information.

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UNIVERSITY OF SOUTH AUSTRALIA

UniSA STEM – Applied Physics

1. Briefly describe cone-beam CT

2. What are the advantages of CT angiography

3. Describe (a) Filtered Back Projection reconstruction, (b) Iterative reconstruction

4. Write a short note on isotropic reconstruction.

5. Explain dose modulation (mA modulation) in CT

6. Write a short note on CTDIvol and DLP

8. Describe any two CT artifacts

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