Computed tomography

Computed tomography (CT) is a medical imaging method employing tomography. Digital geometry processing is used to generate a three-dimensional image of the inside of an object from a large series of two-dimensional X-ray images taken around a single axis of rotation. The word "tomography" is derived from the Greek tomos (slice) and graphein (to write).

Computed tomography was originally known as the "EMI scan" as it was developed at a research branch of EMI, a company best known today for its music and recording business. It was later known as computed axial tomography (CAT or CT scan) and body section roentgenography.
CT produces a volume of data which can be manipulated, through a process known as windowing, in order to demonstrate various structures based on their ability to block the X-ray beam. Although historically the images generated were in the axial or transverse plane (orthogonal to the long axis of the body), modern scanners allow this volume of data to be reformatted in various planes or even as volumetric (3D) representations of structures.

Electroencephalography

Electroencephalography (EEG) is the measurement of electrical activity produced by the brain as recorded from electrodes placed on the scalp.
Just as the activity in a computer can be perceived on multiple different levels, from the activity of individual transistors to the function of applications, so can the electrical activity of the brain be described on relatively small to relatively large scales. At one end are action potentials in a single axon or currents within a single dendrite, and at the other end is the activity measured by the scalp EEG.
The data measured by the scalp EEG are used for clinical and research purposes. A technique similar to the EEG is intracranial EEG (icEEG), also referred to as subdural EEG (sdEEG) and electrocorticography (ECoG). These terms refer to the recording of activity from the surface of the brain (rather than the scalp). Because of the filtering characteristics of the skull and scalp, icEEG activity has a much higher spatial resolution than surface EEG.

Medical Imaging

Medical imaging refers to the techniques and processes used to create images of the human body for clinical purposes (medical procedures seeking to reveal, diagnose or examine disease) or medical science (including the study of normal anatomy and function). As a discipline and in its widest sense, it is part of biological imaging and incorporates radiology, radiological sciences, endoscopy, (medical) thermography, medical photography and microscopy . Measurement and recording techniques which are not primarily designed to produce images, such as electroencephalography (EEG) and magnetoencephalography (MEG) and others, but which produce data susceptible to be represented as maps ,can be seen as forms of medical imaging.

In the clinical context, medical imaging is generally equated to radiology or "clinical imaging" and the medical practitioner responsible for interpreting (and sometimes acquiring) the images is a radiologist. Diagnostic radiography designates the technical aspects of medical imaging and in particular the acquisition of medical images. The radiographer or radiologic technologist is usually responsible for acquiring medical images of diagnostic quality, although some radiological interventions are performed by radiologists.

Geometry processing

Geometry processing is a fast-growing area of research that uses concepts from applied mathematics, computer science and engineering to design efficient algorithms for the acquisition, reconstruction, analysis, manipulation, simulation and transmission of complex 3D models. Applications of geometry processing algorithms already cover a wide range of areas from multimedia, entertainment and classical computer-aided design, to biomedical computing, reverse engineering and scientific computing.

Tomography

CT's primary benefit is the ability to view the brain and or head only. A form of tomography can be performed by moving the X-ray source and detector during an exposure. Anatomy at the target level remains sharp, while structures at different levels are blurred. By varying the extent and path of motion, a variety of effects can be obtained, with variable depth of field and different degrees of blurring of 'out of plane' structures.
Although largely obsolete, conventional tomography is still used in specific situations such as dental imaging (orthopantomography) or in intravenous urography.

Tomosynthesis

Digital tomosynthesis combines digital image capture and processing with simple tube/detector motion as used in conventional radiographic tomography - although there are some similarities to CT, it is a separate technique. In CT, the source/detector makes a complete 360 degree rotation about the subject obtaining a complete set of data from which images may be reconstructed. In digital tomosynthesis, only a small rotation angle with a small number of discrete exposures are used. This incomplete set of data can be digitally processed to yield images similar to conventional tomography with a limited depth of field. However, because the image processing is digital, a series of slices at different depths and with different thicknesses can be reconstructed from the same acquisition, saving both time and radiation exposure.
Because the data acquired is incomplete, tomosynthesis is unable to offer the extremely narrow slice widths that CT offers. However, higher resolution detectors can be used, allowing very-high in-plane resolution, even if the Z-axis resolution is poor. The primary interest in tomosynthesis is in breast imaging, as an extension to mammography, where it may offer better detection rates, with little extra increase in radiation exposure.
Reconstruction algorithms for tomosynthesis are significantly different from conventional CT, as the conventional filtered back projection algorithm requires a complete set of data. Iterative algorithms based upon expectation maximization are most commonly used, but are extremely computationally intensive. Some manufacturers have produced practical systems using commercial GPUs to perform the reconstruction.

Mammography

Mammography is the process of using low-dose X-rays to examine the human breast. It is used to look for different types of tumors and cysts. Mammography has been proven to reduce mortality from breast cancer. No other imaging technique has been shown to reduce risk, but breast self-examination (BSE) and physician examination are essential parts of regular breast care. In some countries routine mammography of older women is encouraged as a screening method to diagnose early breast cancer. Screening mammograms were first proven to save lives in research published by Sam Shapiro, Philip Strax and Louis Venet in 1966.
Like all x-rays, mammograms use doses of ionizing radiation to create this image. Radiologists then analyze the image for any abnormal growths. It is normal to use longer wavelength X-rays (typically Mo-K) than those used for radiography of bones.

Inverse Geometry CT

Inverse geometry CT (IGCT) is a novel concept which is being investigated as refinement of the classic third generation CT design. Although the technique has been demonstrated on a laboratory proof-of-concept device, it remains to be seen whether IGCT is feasible for a practical scanner. IGCT reverses the shapes of the detector and X-ray sources. The conventional third-generation CT geometry uses a point source of X-rays, which diverge in a fan beam to act on a linear array of detectors. In multidetector computed tomography (MDCT), this is extended in 3 dimensions to a conical beam acting on a 2D array of detectors. The IGCT concept, conversely, uses an array of highly collimated X-ray sources which act on a point detector. By using a principle similar to electron beam tomography (EBCT), the individual sources can be activated in turn by steering an electron beam onto each source target.

The rationale behind IGCT is that it avoids the disadvantages of the cone-beam geometry of third generation MDCT. As the z-axis width of the cone beam increases, the quantity of scattered radiation reaching the detector also increases, and the z-axis resolution is thereby degraded - because of the increasing z-axis distance that each ray must traverse. This reversal of roles has extremely high intrinsic resistance to scatter; and, by reducing the number of detectors required per slice, it makes the use of better performing detectors more practical. Because a separate detector can be used for each 'slice' of sources, the conical geometry can be replaced with an array of fans, permitting z-axis resolution to be preserved.

Synchrotron X-ray tomographic microscopy

Synchrotron X-ray tomographic microscopy is a 3-D scanning technique that allows non-invasive high definition scans of objects with details as fine as 1,000th of a millimetre, meaning it has two to three thousand times the resolution of a traditional medical CT scan.
Synchrotron X-ray tomographic microscopy has been applied in the field of palaeontology to perform non-destructive internal examination of fossils, including fossil embryos to be made. Scientists feel this technology has the potential to revolutionize the field of paleontology.
Archaeologists are increasingly turning to Synchrotron X-ray tomographic microscopy as a non-destructive means to examine ancient specimens.

Chest CT Scan

CT is excellent for detecting both acute and chronic changes in the lung parenchyma. (parenchyma means internals, in this case, of the lungs. It is relevant here because normal two dimensional x-rays do not show up defects in the internals of the lungs). A variety of different techniques are used depending on the suspected abnormality. For evaluation of chronic interstitial processes (emphysema, fibrosis, and so forth), thin sections with high spatial frequency reconstructions are used - often scans are performed both in inspiration and expiration. This special technique is called High resolution CT (HRCT). HRCT is normally done with thin section with skipped areas between the thin sections. Therefore it produces a sampling of the lung and not continuous images. Continuous images are provided in a standard CT of the chest.

Pulmonary Angiogram

CT pulmonary angiogram (CTPA) is a medical diagnostic test used to diagnose pulmonary embolism (PE). It employs computed tomography to obtain an image of the pulmonary arteries.
It is a preferred choice of imaging in the diagnosis of PE due to its minimally invasive nature for the patient, whose only requirement for the scan is a cannula . Before this test is requested, it is usual for the referring clinician to have carried out a D-dimer blood test and requested a chest X-Ray to rule out any other possible differential diagnosis.
MDCT (multi detector CT) scanners give the optimum resolution and image quality for this test. Images are usually taken on a 0.625mm slice thickness, although 2mm is sufficient. 50 - 100 mls of contrast is given to the patient at a rate of 4 ml/s. The tracker/locator is placed at the level of the Pulmonary Arteries, which sit roughly at the level of the carina. Images are acquired with the maximum intensity of radio-opaque contrast in the Pulmonary Arteries. This is done using bolus tracking.

CT Pulmonary Angiogram

CT pulmonary angiogram (CTPA) is a medical diagnostic test that employs computed tomography to obtain an image of the pulmonary arteries. Its main use is to diagnose pulmonary embolism.

On CTPA, the pulmonary vessels are filled with contrast, and appear white. Any mass filling defects (embolus or other matter such as fat or amniotic fluid) appears darker. Generally, the scan should be complete before the contrast reaches the left side of the heart and the aorta, which could result in artifacts.

Pulmonary Embolism

Pulmonary embolism (PE) is a blockage of the pulmonary artery usually when a venous thrombus , becomes dislodged from its site of formation and embolizes to the arterial blood supply of one of the lungs. This process is termed thromboembolism.
Symptoms may include difficulty breathing, pain in the chest during breathing, and in more severe cases collapse, circulatory instability and sudden death. Treatment, usually, is with anticoagulant medication, such as heparin and warfarin, and rarely with thrombolysis or surgery. In other, rarer forms of pulmonary embolism, material other than a blood clot is responsible; this may include fat or bone , air, clumped tumor cells, and amniotic fluid (affecting mothers during childbirth).

Pulmonary artery

The pulmonary arteries carry blood from the heart to the lungs. They are the only arteries (other than umbilical arteries in the fetus) that carry deoxygenated blood.
In the human heart, the pulmonary trunk (pulmonary artery or main pulmonary artery) begins at the base of the right ventricle. It is short and wide - approximately 5 cm (2 inches) in length and 3 cm (1.2 inches) in diameter. It then branches into two pulmonary arteries (left and right), which deliver deoxygenated blood to the corresponding lung.

Pulmonary hypertension occurs alone and as a consequence of a number of lung diseases. It can be a consequence of heart disease (Eisenmenger's syndrome) but equally a cause (right-ventricular heart failure); it also occurs as a consequence of pulmonary embolism and scleroderma. It is characterised by reduced exercise tolerance. Severe forms, generally, have a dismal prognosis.

Bolus tracking

Bolus tracking is a technique used in computed tomography imaging, to visualise vessels more clearly. A bolus of radio-opaque contrast media is injected into a patient via a peripheral intravenous cannula. Depending on the vessel being imaged, the volume of contrast is tracked using a region of interest at a certain level and then followed by the CT scanner once it reaches this level. Images are acquired at a rate as fast as the contrast moving through the blood vessels.

Coronary Catheterization

A coronary catheterization is a minimally invasive procedure to access the coronary circulation and blood filled chambers of the heart using a catheter. It is performed for both diagnostic and interventional purposes.
Coronary catheterization is one of the several cardiology diagnostic tests and procedures. Specifically, coronary catheterization is a visually interpreted test performed to recognize occlusion, stenosis, restenosis, thrombosis or aneurysmal enlargement of the coronary artery lumens; heart chamber size; heart muscle contraction performance; and some aspects of heart valve function. Important internal heart and lung blood pressures, not measurable from outside the body, can be accurately measured during the test. The relevant problems that the test deals with most commonly occur as a result of advanced atherosclerosis -atheroma activity within the wall of the coronary arteries. Less frequently, valvular, heart muscle, or arrhythmia issues are the primary focus of the test.

Abdominal and Pelvic

CT is a sensitive method for diagnosis of abdominal diseases. It is used frequently to determine stage of cancer and to follow progress. It is also a useful test to investigate acute abdominal pain (especially of the lower quadrants, whereas ultrasound is the preferred first line investigation for right upper quadrant pain). Renal stones, appendicitis, pancreatitis, diverticulitis, abdominal aortic aneurysm, and bowel obstruction are conditions that are readily diagnosed and assessed with CT. CT is also the first line for detecting solid organ injury after trauma.

Oral and/or rectal contrast may be used depending on the indications for the scan. A dilute suspension of barium sulfate is most commonly used. The concentrated barium sulfate preparations used for fluoroscopy e.g. barium enema are too dense and cause severe artifacts on CT. Iodinated contrast agents may be used if barium is contraindicated (for example, suspicion of bowel injury). Other agents may be required to optimize the imaging of specific organs, such as rectally administered gas for a colon study, or oral water for a stomach study.

CT has limited application in the evaluation of the pelvis. For the female pelvis in particular, ultrasound and MRI are the imaging modalities of choice. Nevertheless, it may be part of abdominal scanning , and has uses in assessing fractures.

CT is also used in osteoporosis studies and research alongside dual energy X-ray absorptiometry . Both CT and DXA can be used to assess bone mineral density (BMD) which is used to indicate bone strength, however CT results do not correlate exactly with DXA (the gold standard of BMD measurement). CT is far more expensive, and subjects patients to much higher levels of ionizing radiation, so it is used infrequently.

Fluoroscopy

Fluoroscopy is an imaging technique commonly used by physicians to obtain real-time images of the internal structures of a patient through the use of a fluoroscope. In its simplest form, a fluoroscope consists of an x-ray source and fluorescent screen between which a patient is placed. However, modern fluoroscopes couple the screen to an x-ray image intensifier and CCD video camera allowing the images to be played and recorded on a monitor. The use of x-rays, a form of ionizing radiation, requires that the potential risks from a procedure be carefully balanced with the benefits of the procedure to the patient. While physicians always try to use low dose rates during fluoroscopy procedures, the length of a typical procedure often results in a relatively high absorbed dose to the patient. Recent advances include the digitization of the images captured and flat-panel detector systems which reduce the radiation dose to the patient still further.

Dual energy X-ray absorptiometry

Dual energy X-ray absorptiometry (DXA, previously DEXA) is a means of measuring bone mineral density (BMD). Two X-ray beams with differing energy levels are aimed at the patient's bones. When soft tissue absorption is subtracted out, the BMD can be determined from the absorption of each beam by bone. Dual energy X-ray absorptiometry (DXA) is the most widely used and most thoroughly studied bone density measurement technology. A T-score of -2.5 or less is indicative of osteoporosis.
DXA scans can also be used to measure total body composition and fat content.

Radiation Exposure

CT is regarded as a moderate to high radiation diagnostic technique. While technical advances have improved radiation efficiency, there has been simultaneous pressure to obtain higher-resolution imaging and use more complex scan techniques, both of which require higher doses of radiation. The improved resolution of CT has permitted the development of new investigations, which may have advantages; compared to conventional angiography for example, CT angiography avoids the invasive insertion of an arterial catheter and guidewire; CT colonography may be as useful as a barium enema for detection of tumors, but may use a lower radiation dose.

The radiation dose for a particular study depends on multiple factors: volume scanned, patient build, number and type of scan sequences, and desired resolution and image quality. Additionally, two helical CT scanning parameters that can be adjusted easily and that have a profound effect on radiation dose are tube current and pitch. The radiation from current CT-scan use may cause as many as 1 in 50 future cases of cancer.