PRINCIPLES OF CT SCAN
ABDOMEN
GUIDE- PROF.DR P. K. PANDEY(M.S)
PROFESSOR,DEPT. OF SURGERY
PRESENTED BY-
PRAKASH CHINNANNAVAR
HISTORY OF CT SCAN
1917-J RADON,WORKING WITH
GRAVITATIONAL THEORY
1956-BRACEWELL WORKING IN
RADIOASTRONOMY
1961-OLDENDORF UNDERSTOOD
CONCEPT OF CT
1972-G.N.HOUNSFIELD PUT A CT
SYSTEM TOGETHER.
HISTORY OF CT SCAN
CT was originally proposed and used as an extension of
the basic X-ray: doctors wanted to see inside the head,
but standard X-ray techniques could not penetrate the
dense skull while distinguishing soft tissues
The first scanners could only do one slice at a time and
each slice took 4 minutes to complete
By 1976, whole body scanners were developed
Today’s machines can acquire a slice in less than half a
second (.1 second for the GE top-end multislice
LightSpeed Pro16 with Xtream)
Advancements still occurring through new technology
COMPUTED TOMOGRPHY
BASIC PRINCIPLE of CT is that the internal
structure of an object can be reconstructed from
multiple projections of that object.
The ray projections are formed by scanning a
thin cross section of the body with a narrow x-
ray beam and measuring the transmitted
radiation with a sensitive radiation detector.
The detector adds up the energy of all the
transmitted photon. The numerical data from
multiple ray sums are than computer processed
to reconstruct an image.
CT SCANNER
It is having 3 component–
1. X-ray tube
2. collimator
3. Detector –two types of
detectors used in CT
scanner-
Scintillation crystals
Xenon gas ionisation
chambers
• various designs of CT scanner-
1. First generation (translate –rotate ,one detector )
2. Second gen. (translate – rotate ,two detector)
Third gen. (rotate – rotate ) Fourth gen. (rotate –fixed)
IMAGE RECONSTRUCTION
- In CT cross section of body is divided into many tiny
blocks and each is assigned a number proportional
to the degree that the block attenuate the x-ray
beam.
- The linear attenuation coefficient (µ) is used to
quantitate attenuation and is determined by
composition and thickness of ‘voxel’ ,along with
quality of the beam .
- CT numbers are derived by comparing linear
attenuation coefficient of a pixel with that of water
and are described in HOUNSFIELD UNIT .
•
CT density scale :-
Water – ‘0’ HU
Air - ‘-1000’ HU
Calcification – ‘+1000’ HU
Fat - ‘-100’ HU
Hemorrhage – ’60-70’ HU
Bone appears white; gases and liquids are
black; tissues are gray
Improvements over X-Rays
Provides 3D images
and cross-sectional
views instead of basic
2D images
CT Scans can show
soft tissue as well as
bone, allowing
physicians to detect problems such as cancerous tumors
Extremely helpful in determining organ anatomy, especially following
trauma
Can determine tissue density difference of less than 1% while X-
rays can allow determine tissue density difference of 5%
A present-day
Circa 1975, in the
scan, showing a
early days of the CT
six-fold increase
scan.
in detail
History of CT Scan (continued)
Specifications First CT (circa Modern CT
1970) Scanner
(2001)
Time to acquire one 4-5 minutes 0.5 seconds
CT image
Pixel size 3 mm x 3 mm 0.5 mm x 0.5 mm
Number of pixels in an 64,000 256,000
image
Artifacts
Aliasing Artifact or Streaks
These appear as dark lines which radiate away
from sharp corners. It occurs because it is impossible for
the scanner to 'sample' or take enough projections of the
object, which is usually metallic. It can also occur when
an insufficient X-ray tube current is selected, and
insufficient penetration of the x-ray occurs. These
artifacts are also closely tied to motion during a scan. .
Ring Artifact
Probably the most common mechanical artifact, the
image of one or many 'rings' appears within an image. This
is usually due to a detector fault
Noise Artifact
This appears as graining on the image and is caused by
a low signal to noise ratio. This occurs more commonly
when a thin slice thickness is used. It can also occur
when the power supplied to the X-ray tube is insufficient
to penetrate the anatomy.
Motion Artifact
This is seen as blurring and/or streaking which is caused
by movement of the object being imaged.
Beam Hardening
This can give a 'cupped appearance'. It occurs when
there is more attenuation in the center of the object than
around the edge. This is easily corrected by filtration and
software.
HELICAL/SPIRAL SCANNING
CONTRAST MATERIAL
1. Ionic monomeric contrast media (high-osmolar contrast
media, HOCM), e.g. amidotrizoate, iothalamate,
ioxithalamate
2. Ionic dimeric contrast media (low-osmolar contrast
media, LOCM), e.g. ioxaglate
3. Nonionic monomeric contrast media (low-osmolar
contrast media, LOCM), e.g. iohexol, iopentol, ioxitol,
iomeprol, ioversol, iopromide, iobitridol,
iopamidol
4. Nonionic dimeric contrast media (iso-osmolar contrast
media, IOCM), e.g. iotrolan, iodixanol
Risks of CT Scan
Low-risk procedure
Main risk is allergic reaction to contrast
dye, often mild and resulting in itching,
hives, or a rash
More radiation than modern standard X-
Ray, but still minimal amount
Only radiation risk significant only for
pregnant women
Which CT Scanner is best?
Axial v. Helical scanners
Axial scanners
Longer time to scan
Danger in misregistration of scanner
Helical scanners
Quicker scan time
Images for overlapping slices can be generated
More complicated image reconstruction
Single-slice vs. Multi-slice detectors
Single-slice detectors
Slow exam times
Multi-slice detectors
Much quicker exam times
Up to 4 slices in 0.5 seconds
What typically gets scanned
brain and spinal abnormalities
brain tumors and strokes
sinusitis
aortic aneurysms and other blood vessels
hemorrhage
chest infections
diseases of organs such as the liver,
kidneys, and lymph nodes in the
abdomen.
CONTRAINDICATIONS
FOR CT SCAN
-CONTRAST ALLERGY
-CLAUSTROPHOBIA
-PREGNANCY
CT APPLICATIONS
LIVER
LIVER
HEPATIC PARENCHYMA
ATTENUATION VALUE AROUND 45-65
HEPATICSPLENIC ATTENUATION DIFFERENCE
AFTER IV CONTRAST ADMINISTRATION THIS ATTENUATION DIFFERENCE
REVERSES
PRINCIPLES OF HEPATIC
CONTRAST ENHANCEMENT
TO INCREASE ATTENUATION VALUE DIFFERENCE BETWEEN
LIVER LESIONS AND NORMAL HEPATIC PARENCHYMA
ATTENUATION VALUE DEPENDS ON
HISTOLOGY,VASCULARITY,NECROSIS,CALCIFICATION,HEMO
RRAGE.
USUALLY HEPATIC NEOPLASMS HAVE LOWER ATTENUATION
VALUE THAN NORMAL LIVER EXCEPT IN DIFFUSE FATTY
LIVER WHERE THEY ARE HYERATTENUATING
HEPATIC CONTRAST
ENHANCEMENT
VASCULAR
REDISTRIBUTION
EQUILIBRIUM
HEPATIC CYST
BILIARY HAMARTOMAS
LIVER HEMANGIOMAS
FOCAL NODULAR HYPERPLASIA
HEPATOCELLULAR ADENOMA
HEPATOCELLULAR CARCINOMA
FIBROLEMELLAR
HEPATOCELLULAR CARCINOMA
METASTASIS TO LIVER
PYOGENIC LIVER ABSCESS
HYDATID CYST OF LIVER
BILARY SYSTEM
PRINCIPLES OF BILIARY TRACT
IMAGING
USG IS INITIAL IMAGING STUDY
CT DETECTS BILIARY
DILATATION,BILIARY WALL
THICKENING,DUCTAL
STONES,PANCREATIC MASS,
ADENOPATHY
PORCELAIN GALL BLADDER
GALL BLADDER CARCINOMA
CAROLI’S DISEASE
CHOLEDOCOLITHIASIS
MIRIZZI SYNDROME
INTAHEPATIC
CHOLANGIOCARCINOMA
SPLEEN
SPLENIC CYSTS
NON HODGKIN’S LYMPHOMA
HODGKIN’S LYMPHOMA
PANCREAS
PANCREATIC CARCINOMA
CHRONIC PANCREATITIS
MUCINOUS CYSTIC NEOPLASM
GASTRINOMA
ACUTE PANCREATITIS
CHRONIC PANCREATITIS
PSEUDOPANCREATIC CYST
INFECTED PANCREATIC
NECROSIS
RETROPERITONEUM
RETROPERITONEAL
HEMATOMA
IDEOPATHIC
RETROPERITONEAL FIBROSIS
RETROPERITONEAL SARCOMA
PSOAS ABSCESS FROM
INFECTED URINOMA
HORSESHOE KIDNEY
POLYCYSTIC KIDNEY DISEASE
RENAL CELL CARCINOMA
RENAL TUBERCULOSIS
NORMAL ADRENAL GLAND
ADRENAL ADENOMA
ADRENAL CARCINOMA
PHEOCHROMOCYTOMA
GASTROINTESTINAL TRACT
NORMAL ESOPHAGUS
ESOPHAGEAL
ADENOCARCINOMA
ESOPHAGEAL PERFORATION
GASTRIC WALL
GIST
GASTRIC
ADENOCARCINOMA
GASTRIC LYMPHOMA
SMALL BOWEL LYMPHOMA
COLON CARCINOMA
MULTISEGMENTAL CROHN
COLITIS
ULCERATIVE COLITIS
CT COLONOGRAPHY
CT IN BLUNT TRAUMA
ABDOMEN
METHOD OF CHOICE INITIAL
EVALUATION IN HEMODYNAMICALLY
STABLE AND UNSTABLE TRAUMA
ACCURACY IN DIAGNOSIS IS 97%
ALSO EVALUATE EXTRA-ABDOMINAL
INJURIES
ROLE OF MDCT.
INDICATIONS
IN THE PAST-INDICATED FOR ONLY
HEMODYNAMICALLY STABLE PATIENTS
AND ASSOCIATED INJURIES
RECENTLY INCREASINGLY USED IN
UNSTABLE PATIENTS
ADVANTAGE OF CT OVER DPL
ADVANTAGE OF CT OVER FAST.
CT LARGELY REPLACED
RADIONUCLEOTIDE
SCINTIGRAPHY,ANGIOGRAPHY AND USG.
HEMOPERITONEUM
SPLENIC LACERATION
LIVER LACERATION AND
HEMATOMA
PANCREATIC LACERATION
RENAL LACERATION
INTERVENTIONAL CT
Therapeutic and diagnostic
Image guided procedures can also be
done under fluoroscopic, ulrasonographic
and MRI guided
CT provides precise, three dimensional
localisation
Can used in presence of open
wounds,dressings,ostomies etc
DIAGNOSTIC INTERVENTIONAL
CT
PERCUTANEOUS BIOPSY OF LIVER,
PANCREAS, ADRENAL
GLAND,RETROPERITONEUM,PARATHY
ROID
COMPLICATIONS ARE INFREQUENT
AND GENERALLY MINOR.
THERAPEUTIC
INTERVENTIONAL CT
DRAINAGE PROCEDURES
PERCUTANEOUS NEPHROSTOMY
CECOSTOMY
NEUROLYSIS
TUMOR ABLATION-CHEMICAL
-THERMAL
NEUROLYSIS
WHAT’S NEW IN CT?
VIRTUAL ENDOSCOPY
-IMAGING PERFORMED VIA CT TO PRODUCE
THREE DIMENSIONAL IMAGES
-USED TO DIAGNOSE
DIVERTICULOSIS,POLYPS AND
MALIGNANCY
-PROCEDURE
-OPTICAL COLONOSCOPY HAS BECOME
GOLD STANDARD IN SCREENING OF
COLORECTAL CANCERS.
ADVANTAGES-
-MORE COMFORTABLE
-NO SEDATION
-MORE DETAILED
EVALUATION
-TAKES LESSER TIME
DISADVANTAGES-
-EXPOSURE TO RADIATION
-SMALLER LESIONS NOT PICKED UP
-BIOPSY CAN’T BE TAKEN
COMPOSITE CT-PET SCAN
PROVIDES BOTH FUNCTIONAL AND
ANATOMIC IN SINGLE IMAGING
STUDY.
In the Future
Still a larger role for ct over next decade
MRI provided further stimulus
Multislice CT imagers take center stage
Image manipulation will become easier
Computer assisted diagnosis will become more
common
Still be need for understanding of principles of
CT
Conclusions
CT is not very exciting from a physics point of
view (… didn’t you think the Saha chapter on CT
was facinating?)
However, it is the most popular “modern”
imaging technique: available at over 30,000
world locations, including over 6,000 health care
centers in the US (many with multiple CT
machines)
New uses of CT are constantly being developed.
Recently, smaller CT setups are being used in
the OR to evaluate surgeries as they progress.
Better computer techniques will also enhance
the value of CT studies.
Thanks
