CT Physics

Prepared by
HABIBA KHALID
MIT
Definition of CT
• A CT scan, or computed tomography scan, (formerly
known as a computed axial tomography or CAT scan) is
a medical imaging procedure that uses computer-
processed combinations of many X-ray measurements
taken from different angles to produce cross-sectional (
tomographic) images (virtual "slices") of specific areas of
a scanned object
Xray vs CT
Image integration
Generations
3 and 4 generation
rd th
Equipment of CT
Xray tube of CT
Filter
Placed between the x-ray source and the patient
(similar to that used in plain film radiography).
1. Removes low energy (soft) x-rays that do not
contribute to image formation but do increase patient
dose.
2. As the low energy x-rays are removed there is a
narrower spectrum of x-ray energies creating a more
"monochromatic" beam. Image reconstruction is
based upon the assumption of a single energy,
monochromatic beam.
3. In some scanners the filter is shaped to shape the
beam e.g. "bow-tie" filter. The lateral edges of a
body are thinner than the centre meaning the x-ray
beam is less attenuated. A shaped filter
compensates for this by attenuating the lateral
edges of the beam more than the centre. These
filters come in different shapes/sizes depending on
the body part imaged. In the diagram above, the
filter is designed for imaging the chest or abdomen.
If the head was being imaged then a smaller filter
would be used, to match the size of the head.
Collimator
The Collimator is
placed between
the filter and the
patient.
1. Lowers radiation
dose to patient
2. Restricts scatter
from outside of
desired slice
Detector Array
• The original single-slice scanners had one row of detectors.
Now all scanners are multi-slice and have 8-64 rows of
detectors. There are generally 1000-2000 detectors in each
row.
Important properties for detectors
• High detection efficiency for x-rays in CT energy range
• High dynamic range
• Narrow gaps between active elements (good geometrical
efficiency)
• Fast response
• Low cost
• Small physical size
Types of detectors
1. Solid state detector (SSD)
• There is a solid scintillator layer that
converts the x-rays into visible light
photons. The photodiode then
converts the photon input into an
electrical signal.
Properties:
• High detection efficiency (~90%)
• High geometrical efficiency (~80%)
• Small physical size of detector
elements
• Most commonly used detector.
2. Ionization chamber detector (no
longer used)
• The detector array is a single vessel
filled with gases of a high atomic
number (Krypton / Xenon) and
subdivided into separate detectors by
tungsten septae.
• The x-rays ionize the gas and produce
a signal at the collection electrodes.
Properties:
• Lower detection efficiency (~50%)
• High stability
• Consistent sensitivity between
detector elements
• Superseded by solid-state detectors
and no longer used. Unsuitable for
multi slice scanners.
Gantry
A slip-ring enables continuous rotation of the CT
scanner gantry. Brushes on the rotating gantry,
through contact z the stationary ring, allows
power to be supplied to the gantry and the signal
to be passed to the computer. Rotation times are
between 0.25 - 3 seconds.
Acquiring an image
Axial vs spiral scanning
"Step and shoot"
[Link] stops and rotates to acquire data from
single slice
2.X-rays switched off
[Link] moves to next slice
[Link] to acquire data from next slice
Spiral scanning
• Aka helical
• Gantry keeps rotating continuously
releasing x-ray beams.
• The couch simultaneously moves.
• This results in a continuous spiral scanning pattern.
Advantages:
• Avoids respiratory miss registration from different
breaths in as scan performed during one breath
• More effective use of contrast agent as faster
scanning enables scanning during multiple phases in
one contrast injection e.g. portal venous,
angiographic, delayed
• Overlapping slices allows better reconstruction and
helps in showing smaller lesions
• Pitch > 1 can be used to reduce scan time and / or
radiation dose and still cover the same volume
• All images are now acquired in this way.
Pitch
• The pitch is the measure of overlap during scanning.
Pitch = distance couch travels / width of slice

Pitch = 20/10 = 2

Pitch = 10/10 = 1
Pitch = 5/10 = 0.5
• A pitch number > 1 = couch travels more than the
width of the beam i.e. there are gaps
A pitch number < 1 = couch travels less than the
width of the beam i.e. there is overlap
• For higher pitch numbers
Advantages:
• Lower radiation dose
• Quicker scan
Disadvantages:
• More sparsely sampled
Multi slice scanning
• Rather than just have one row of
detectors, we now have multiple parallel
rows of detectors. Certain rows of
detectors can then be selected to change
the slice thickness along with the
collimator. 
Advantages:
• Faster scanning due to wider total active
detector width
• Better dynamic imaging due to faster
scanning times
• Thinner slices
• 3D imaging is enabled by thin slices
• Simultaneous acquisition of multiple
slices
Detector arrays
Types of Multislice Detector Types:
[Link]
[Link]
[Link] arrays
Linear array

All the rows of the detectors are the same width

2. Adaptive array
The elements within the central detector rows are the
thinnest and they get wider towards the outside.
Advantages:
• As few detector elements as possible activated to still give a
large range of detector slices
• Fewer detector rows activated means fewer septae dividing
up the rows. This improves the dose efficiency.
Disadvantage:
• Upgrading to more data channels requires an expensive
detector replacement.
3. Hybrid array
• Similar to linear arrays in that the elements within the
detector rows are the same width across. However,
the central group of detector rows are narrower than
the outer rows.
• These are the main detector arrays used for 16-slice
scanners and above.
Multi slice pitch
• There are two methods to calculate the pitch in a multi
slice scanner. The first (pitchd) is analogous to the
single slice pitch and only takes into account the width
of the x-ray beam.
Pitchd = couch travel per rotation / width of x-ray beam
• However, this does not fully represent the overlapping
of the x-ray beam and, instead, pitchx is now used.
Pitchx = couch travel per rotation / total width of
simultaneously acquired slices
• This is comparable to the definition of pitch for single
slice spiral scanning as the total collimated width is
analogous to the detector subgroup width in single
slice spiral scanning.
Physics
• A CT image is made up of pixels along a grey scale.
What determines the level of grey is the density of the
material or the linear attenuation coefficient and this
is represented numerically by the Hounsfield Units
(also called the CT number). The Hounsfield units are
set so that water measures 0 and everything else is
relative to this.
HU = 1000 x (μt - μw) / μw
• where:
μt = attenuation coefficient of tissue
μw = attenuation coefficient of water
• Each detector in the CT scanner samples a
line of the patient and the sum total of the
attenuation of the material passed
through along the beam path is calculated.
As the gantry rotates the detectors receive
beams at different angles so in the end we
have a series of values of summed linear
attenuation coefficients from different
angles. Now these need to be processed
to form an image.
Typical Hounsfield unit
values
Tissues HU
Bone +1000
Liver 40-60
White matter 20-30
Grey matter 37-45
Intravascular blood 30-45

Fresh clotted blood 70-80

Muscle 10-40
Kidney 30
CSF 15
Water 0
Fat -50 to -100
Air -1000
Post-Processing
Back projection
There are a few main issues with back projection:
• 1. Too few projections cause artefacts in the image as
there are too few directions of summed LACs to
accurately represent the image. Typically 2000
projections are used.
• 2. Even with a large number of projections the edges
of structures are not well delineated due to the
averaging out of values and there is blurring caused
by the back projection technique. This is corrected
with filtered back projection.
Iterative Reconstruction

This is generally a more time consuming method but is

proving useful for low dose CT studies.
It involves several steps:
[Link] back-projection is initially performed to assign a
number value to all pixels in the matrix.
[Link] computer then calculates what it expected the
detectors to have received based on the image
generated THEN works out the difference between the
actual detector measurements and the calculated
measurements, and uses this information to generate
an updated image.
[Link] continues through multiple iterations, each time
bringing the calculated values closer and closer to the
true values.
CT image quality
The image quality is mainly determined by 3 factors:
• Resolution
• Noise
• Contrast
Resolution
• Resolution is the measure of how far two objects must
be apart before they can be seen as separate details
in the image. For two objects to be seen as separate
the detectors must be able to identify a gap between
them.
• Resolution is measured in line pairs per centimeter
(lp/cm) i.e. the number of line pairs that can be
imaged as separate structures within one centimeter.
There are two types of
resolution in CT scanning:
• Trans-axial resolution (7
lp/cm)

• Axially across the patient

• Z-sensitivity (0.5 - 10 mm)

• Along the length of the

patient in the z-direction
Trans-axial resolution
• The minimum trans-axial resolution is determined by
the actual detector size, however it is often quoted as
the "effective detector width" at the iso-center of the
scanner (center of the bore of the scanner). The
"effective detector width" and the actual detector size
are slightly different due to the divergence of the
beam. The smaller the "effective detector width" the
higher the resolution.
• The trans-axial resolution is affected by scanner
(hardware) factors or scan and reconstruction
parameters.
Scanner factors
1. Focal spot
• Size

• Smaller focal spots give higher resolution, but the max mA is limited to
prevent damage to the anode.
• There are usually two available focal spot sizes on CT scanners, for example:

• Fine = 0.7 mm
• Broad = 1.2 mm
• Properties

• Flying focal spot: the position of the focal spot is rapidly altered in the
transaxial plane and/or the Z-axis. Each focal spot position increases the
number of projections sampled and improves spatial resolution. For
example, if the position of the focal spot moves in the X-Y plane, then the in-
plane resolution increases.
• Focus-detector distance (FDD)
• Focus-isocentre distance (FID)
2. Detector size
• Smaller detectors give higher resolution but more
detectors within an area also means more partitions
(dead space) and a reduced overall detection
efficiency.
3. Detector design properties
• Quarter ray detector offset: the centre of the detector
array is offset from the centre of rotation by one
quarter the width of an individual detector. As the
gantry rotates to 180° the centre of the detector array
is now offset by half the width of a detector giving an
interleaved sampling of the patient. 
Scan parameters
1. Number of projections
• Larger number of projections gives finer resolution
(up to a point).
2. Reconstruction filter
• Higher resolution or "sharp" kernels (e.g. bone
reconstruction) have better spatial resolution than
soft kernels (e.g. soft tissue reconstruction).
• However, higher resolution kernels do not average
high spatial frequency signals and therefore produce
more noise.
3. Pixel size
• The pixel size (d) in mm is give by the equation:
d = FOV/n
where:
FOV = field of view (mm)
n = image matrix size
• The highest spatial frequency that can be obtained
(fmax) is called the Nyquist limit and is given by:
fmax = 1/2d
• From this equation you can see that the higher the
pixel size, the lower the maximum spatial frequency.
• To improve spatial frequency we can:
• Reduce the field of view (smaller FOV = smaller pixel size
as seen in the first equation). We can do this
retrospectively by a targeted reconstruction of the
original data into a small field of view.
• Increase the matrix size (larger n = small pixel size as
seen in the first equation)
Z-sensitivity
• Z-sensitivity refers to the effective imaged slice width.
Factors affecting z-sensitivity
1. Detector slice thickness
• The wider (in the z-axis) the detector row, the lower
the resolution
2. Overlapping samples
• Acquiring the data using overlapping slices can
improve Z-sensitivity. This is achieved by using a low
spiral pitch e.g. pitch <1.
3. Focal spot
• A fine focal spot improves the z-sensitivity
Importance of slice
thickness
1. Noise
• The thinner the slice the better the resolution BUT the
worse the noise
2. Partial volume effect
• Thicker slices increase the partial volume effects
3. Isotropic scanning
• Thin slices allow isotropic scanning, i.e. the pixels in the
axial and the z-axis are the same size (cubes). The
advantages of this are:
• Reduced partial volume effect
• Better multi-planar reformatting
• Improved volume rendering e.g. displaying 3D
representations of the data (e.g. cardiac imaging, vascular
imaging, CT colonography etc)
Noise
• Even if we image a perfectly uniform object (e.g. a water
filled object) there is still a variation in the Hounsfield units
about a mean. This is due to noise. Noise degrades the
image by degrading low contrast resolution and introducing
uncertainty in the Hounsfield units of the images.
• We can measure noise in any uniform region of the image
e.g. with a water phantom. The standard deviation of the
CT number in a selected region-of-interest gives the mean
noise measurement.
• There are three sources of noise:
[Link] noise
[Link] noise
[Link] introduced by the reconstruction process e.g. back-
projection.
Stochastic noise
• This is the dominant source of noise in an image. Photon registration
by the detectors is a stochastic process. The number of photons
detected will vary randomly about a mean value and that variation is
the noise. The noise in the final image is given by:
Noise (standard deviation) ∝ 1/√(no. of photons)
• From this equation we can say that increasing the number of
photons reduces the amount of noise and, therefore, anything that
increases the number of photons (increases the photon flux) will
reduce the noise. If we double the number of photons we will reduce
the noise by √2 (i.e. increasing the number of photons by a factor of 4
will halve the noise).
• Doubling the number of photons can be achieved by:
• Doubling the tube current (mA)
• Doubling the rotation time (s)
• Doubling the slice thickness (mm)
• Increasing the tube kilovoltage (kV) also increases the photon flux but
it is not directly proportional (output is approximately ∝ kV2).
Contrast
Factors influencing contrast:
• Noise: a higher noise will obscure any contrast
between objects
• Tube current: a higher tube current reduces the
noise in the image
• Inherent tissue properties: the difference in the
linear attenuation coefficient of adjacent imaged
objects will determine the contrast between those
objects
• Beam kilovoltage: a higher beam energy will
generally reduce the contrast between objects
• Use of contrast media
CT artefacts
Causes of image artefacts can be grouped into a few
categories:
• Physics based
• Patient properties
• Scanner based
• Helical and multislice artefacts
Physics based
Beam hardening
• An x-ray beam has photons of different energies that
vary around a mean 'beam energy'. As the beam
passes through a dense area the lower energy
photons are more likely to be absorbed and the
higher energy photons are more likely to remain. This
results in a higher mean beam energy. This focally
increased mean beam energy is interpreted as being
due to it passing through a less attenuating material
relative to the surroundings and so a lower Hounsfield
unit is assigned and the image will be represented as
more black.
Conceptual representation
of beam hardening artefact
This is particularly common in the posterior fossa on a
CT head scan due to the dense petrous bones.
Cupping artefact
• This beam hardening artefact also produces another
type of artefact called the cupping artefact. The
centre of an object is usually the thickest and,
therefore, the beam will become harder in the centre
than at the periphery and is assigned lower
Hounsfield units.
• This can be corrected with a 'beam hardening
correction' algorithm.
Solutions to beam hardening
• Pre-patient filter: This absorbs the soft x-rays and
minimises the beam hardening artefact
• Bow-tie filter: Pre-harden the x-ray beam
Partial volume artefact
• If a dense object only partially protrudes into a
detector stream the attenuation is averaged with its
surroundings and it will be assigned a lower
Hounsfield unit. In the image above, the dense circle
lies on a less dense background. The object fills
detector stream 2 resulting in a very high attenuation
(white). In detector stream 3 none of the dense object
is imaged and so the attenuation is low (black). In
detector stream 1 the object is only partially imaged
and so the attenuation is an average between the
dense object and the less dense background.
• N.B. partial voluming will only ever reduce the
apparent attenuation of an object, it will
never increase the apparent attenuation.
Incomplete projection
• An object may protrude into the slice in one projection
but not in the opposing projection, especially at the
periphery of the image where the beam is more
divergent. If this happens a variant of partial voluming
artefact occurs in which the object appears streaked
due to the inconsistencies produced during imaging.
• These streak artefacts can be caused, for example,
when a patient's arms are by their side and are
imaged in some projections but not others.
Solution
• Smaller slice thickness
Photon starvation
• This is another cause of streak artefacts. In projections
that have to travel through more material, e.g. across
the shoulders, as the x-ray beam travels through more
x-ray photons are absorbed and removed from the
beam. This results in a smaller proportion of signal
reaching the detector and, therefore, a larger
proportion of noise. The streaks are due to the
increased noise which is why they occur in the direction
of the widest part of the object being scanned.
Solutions
Adaptive filtering: the regions in which the attenuation
exceeds a specified level are smoothed before
undergoing backprojection.
mA modulation
The tube current (mA) can be varied with the gantry
rotation. Higher mA's (greater signal) are used for the
more attenuating projections to reduce the effect of
photon starvation. The mA required can either be
calculated in advance from the scout view or during the
scan from the feedback system of the detector.
Patient properties-
Metallic artefacts

The metal produces a beam-hardening and photon

starvation artefact. This can also happen with other high
attenuation materials such as IV contrast.
Patient motion
Motion artefact can be caused by:
• Patient swallowing
• Breathing
• Pulsatility of heart and vessels
• Patient moving
If a patient or structure moves as the gantry rotates the object will be detected
as being in several positions and represented in the image as such.
Solutions
• Scan parameters
• Shorten scan time
• Spiral scanning
• ECG gating: this can be used prospectively to trigger image acquisition during a
specific point on the ECG when heart motion is lowest, or retrospectively by
reconstructing acquired data from specific ECG phases
• Patient parameters
• Breath hold
• Ensure comfortable patient position
• Tell patient to stay still and give clear instructions
Incomplete projections
• If there are objects lying outside the field of view,
especially high attenuation objects such as the arms,
this will create streak artefacts within the imaged area
as the arms will be detected in some projections and
not others leading to inconsistencies in the data.
Scanner based- Ring
artefact
• If there is a faulty detector
and the detectors do not
have the same gain relative
to each other (they are
operating at different
baselines) then as the
gantry rotates around the
patient this detector will
outline a circle. On back-
projection this will cause
a ring artefact.
Spiral and multislice
scanning artefacts
Helical artefacts
• In spiral scanning, as the gantry rotates it is also moving
in the z-axis. This means that a row of detectors is
moving in a spiral path. This can cause artefactual
representation of structures that are changing in shape
or position in the z-axis as they will be in different
positions for different projections used in the
reconstruction of the image. Nowadays this artefact is
rare as scanners have a large number of detectors and
pitch <1.
Worsened by:
• Increasing pitch
• Increased contrast between object and surrounding
structures
Cone beam artefact
• This is a particular artefact caused by multislice
scanners. As the section scanned increases per
rotation, a wider collimation is used. Because of this the
x-ray beam becomes cone-shaped instead of fan-
shaped and the area imaged by each detector as it
rotates around the patient is a volume instead of a flat
plane. The resulting artefact is similar to the partial
volume artefact for off-center objects. This is
particularly pronounced at the edges of the image. With
modern scanners cone beam reconstruction algorithms
correct this artefact.
Solution
• Reconstruction algorithm minimizes cone beam
artefacts
CT dose
Units of dose
• We can think of the different dose measurements as a
stepwise progression, each time adding an additional
variable into the equation.
1. CT Dose Index (CTDI)
• First, we measure the dose to the detectors from a single
gantry rotation to give us the CTDI.
CT dose index

Definition Dose to the phantom from

single gantry rotation
Units mGy
Affected by Collimator
Focus-isocentre distance
2. Weighted CTDI (CTDIw)
• The dose is not equal across the scan plane. It is higher in
the periphery than in the centre. We need to adjust for this
by making the average periphery dose make up 2/3 of the
dose to give us the weighted CTDI.
• There are separate calculations for imaging the head, body
and paediatric patients. In adults we use a head phantom
(16 cm) and a body phantom (32 cm) with dosimeters
placed at the periphery and centre in order to calculate the
weighted average of doses.
Weighted CTDI

Definition Adjusted for spatial variation of dose

Equation CTDIw = 1/3 CTDIcentre + 2/3 CTDIperiphery

Units mGy
3. Volume CTDI (CTDIvol)
• We don't scan single slices. The concentration of the
dose along a patient is determined by the pitch. The
higher the pitch, the larger the gaps between slices
and the lower the dose. Taking into account the pitch
gives us the volume CTDI.

Definition Accounts for effect of pitch. Higher pitch =

lower dose as less overlapping
However, many manufacturers autocompensate for
changes in pitch by adjusting mA to keep the noise and
dose constant.
Equation CTDIvol = CTDIw / pitch
Units mGy
4. Dose length product (DLP)
• Now we know the CDTIvol, we multiply this by the
distance along the patient we have scanned to give us
the dose length product. It is proportional to the
radiation risk to the patient
Definition: Total dose to phantom / patient along the distance
scanned
Equation DLP = CTDIvol x distance scanned
Units mGy*cmnt.
5. Effective dose (E)
• We now have the total dose along the patient. But radiation
does not affect all organs equally. Each organ has
a sensitivity to radiation that needs to be taken into
account. We display this as the effective dose.
Definition: Physical effect of total dose on patient determined by the
sensitivity of imaged area to radiation
Equation: In the latest ICRP103 guideline the equation used to calculate
effective dose is:
E = ΣT (WT) x ΣR (WRDT,R) or
E = Σ WTHT
Key: HT or WTDT,R is the equivalent dose in a tissue or organ (T)
WT is the tissue weighting factor
Units: Millisieverts (mSv) or [Link]-1 - note that the units have changed as
this is the effective dose to patients.
Factors affecting dose
Tube current
• Doubling mA = doubling of CTDI, DLP and E
Rotation time
• Doubling rotation time = doubling of CTDI, DLP and E
Pitch
• Doubling pitch = halving of CTDI, DLP and E
kVp
• Dose is approximately ∝ kVp2 i.e. doubling the kVp will
increase the dose by a factor of 4 (approximately).
The End