MDCT Technology
Kalpana M. Kanal, Ph.D., DABR
Assistant Professor
Department of Radiology
University of Washington
Seattle, Washington
ACMP Annual Meeting 2008 - Seattle, WA
Educational Objectives
Historical Development of CT
Why has the frequency of CT increased?
Multi-Row Detector CT and Pitch
Advantages of Multi-Row Detector CT
Automatic Exposure Control in CT
Cardiac CT
Future of CT
Kanal 2
Historical Development of CT
64 slice
scanners
Dual Source
CT
2004- 2005
Slow scan time Fast scan time
Dr. Mahesh, John Hopkins, MD, AAPM Handout.
Kanal 3
Historical Development of CT
Seventh Generation CT (late 1990’s – 2000)
Multi-Row Detector Systems
Radiographics 2000: 20-
20-1787-
1787-1806
Kalendar WA, Computed Tomography,
Second Edition, 2005, pg 58.
Kanal 4
Historical Development of CT
PET/CT Scanners (2001)
Kalendar WA, Computed Tomography, 2nd ed., 2005, pg 74.
Kanal 5
Historical Development of CT
Dual-Source CT (2005)
A scanner using two
X-ray sources and two
detectors at the same
time
Enables scanning a
heart at any heart rate
and at the lowest
radiation dose
possible
[Link]
Kanal 6
Fast Scanning, 0.3 sec
Kanal 7
Why has the frequency of CT exams
increased?
New
UNSCEAR 2000 technology
Faster scans
New exams
done with CT
More
screening
exams
More like 60%
ICRP Publication 87 (2001)
Kanal 8
Single-Row Detector versus Multi-Row
Detector CT
Kanal Radiographics 2000: 20-
20-1787-
1787-1806 9
Single-row Detector vs. Multi-row Detector
CT
Seeram, Computed Tomography, 2nd ed., 2001, pg 258.
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Multiple Detector Arrays
Bushberg, et al. The Essential Physics of Medical Imaging, 2nd ed., p. 341.
Kanal 11
Slice Width Selection
GE 64 MDCT
(40 mm
detector)
64 x 0.625 mm
32 x 1.25 mm
16 x 2.5 mm
8 x 5 mm
[Link]
Kanal 12
32/40/64 Slice CT Systems
[Link]
Kanal 13
Pitch in Multi-slice CT
Two pitch definitions seen in MSCT
Collimator pitch = table travel_____
x-ray beam width
Detector pitch = table travel
detector width
Collimator pitch = Detector pitch
N
Kanal c.f. [Link] 14
Multi-Row Detector CT - Advantages
Same acquisition in shorter times (fewer motion artifacts)
Seeram, Computed Tomography, 2nd ed., 2001, pg 263.
Kanal 15
Multi-Row Detector CT - Advantages
Reconstruction in different slice widths
[Link]
Kanal 16
Multi-Row Detector CT - Advantages
Efficient use of x-ray beam with increasing slices
Reduction of radiation dose
Kalendar WA, Computed Tomography, 2nd ed., 2005, pg 168.
Kanal 17
Multi-Row Detector CT - Advantages
Thinner slices for better z-axis resolution
Isotropic Imaging
Improved Spatial
Resolution
All sides of the voxel
have equal dimensions
Seeram, Computed Tomography, 2nd ed., 2001, pg 264.
Kanal 18
Multi-Row Detector CT - Advantages
Better Multiplanar Reconstruction & 3D Display
Radiographics 2002: 22-
22-1255-
1255-1268
Kanal 19
Regarding Multiple Detector CT
scanners:
14% 1) A scanner with a 16-detector array employs a total of 16x16
detectors
14% 2) Detectors used are the non-radioactive xenon-gas detectors
3) The slice width is determined by width of detectors in slice
29%
thickness dimension
43% 4) The slice width selected can be smaller than the physical
size of the detector
0% 5) The spatial resolution is worse than that of a single-detector
CT scanners
Kanal 20
Answer
The slice width is determined by width of detectors in
slice thickness dimension
Kanal 21
Multi-Row Detector CT - Advantages
Cardiac CT
40 mm detector
(Pitch ~0.25)
12.5 cm in 5 sec
20 mm detector
(Pitch ~0.25)
6.2 cm in 5 sec
Kanal Kalendar WA, Computed Tomography, 2nd ed., 2005, Video. 22
For a 16-detector row CT scanner, the x-ray beam
width is 20 mm, detector width is 5 mm and the
table travel per rotation is 20 mm. Calculate the
detector pitch and collimator pitch?
15% 1. 1, 4
62% 2. 4, 1
15% 3. 5, 20
8% 4. 4, 4
0% 5. 20, 5
Kanal 23
Answer
4, 1
Pitchd = 20 = 4 = Detector pitch
5
Pitchx = 20 = 1 = Collimator pitch
20
Kanal 24
Dose Reduction
Current Modulation or AEC in CT
Modern CT scanners are capable of modulating the mA
(current) during the scan
Rationale: it takes fewer photons (lower mA) to penetrate
thinner tissue, and more x-ray photons (higher mA) to
penetrate thicker projections through the body
Benefits
Consistent image quality
Dose reduction potential
Reduced tube loading
Extended scan runs
Reduction in photon starvation artifact
Kanal 25
Automatic Exposure Control (AEC) in CT
Patient size AEC
Patient size AEC: higher mA used for larger patients
[Link]
Kanal MHRA Report 05016, February 2005 [Link] 26
Automatic Exposure Control (AEC)
Z-axis AEC
Z-axis AEC: higher mA used at more attenuating
positions along the z-axis (patient)
Kanal MHRA Report 05016, February 2005 Radiographics, 2006, 26:503-512 27
Automatic Exposure Control (AEC) in CT
Angular AEC
Angular AEC: the degree of modulation depends on the
asymmetry of the patient
Kanal MHRA Report 05016, February 2005 Radiology, 2004, 233:649-657 28
Dose Reduction
Cardiac ECG dose modulation
It is possible to vary the mA based on R-R interval phase %
This can lead to a dose decrease of up to 50% in low stable
heart rates
70% 80% interval used
for image
reconstruction
mA dose not given to patient
550
200
t
Kanal 29
Dose Reduction - ECG dose modulation
90
HR 30-74 BPM (One
80 Segment)
70
Exposure CTDI (mGy)
60
50
40
30
Coverage during
20 scan
Segment mode, no ECG
10
0
0 50 100 150 200 250 240o
Heart rate (BPM)
Kanal Paul Kinahan and Kelly Branch, UWMC 30
Dose Reduction - ECG dose modulation
HR 30-74 BPM
90
(One Segment),
80 TR 175 msec
70
Exp o su re C T D I (m G y)
60 42%
50
decrease
in dose
40
30 Needed coverage
20 Segment mode, no ECG during scan
Segment mode [65-85%], w/ECG
10
Segment mode [70-80%], w/ECG
0
240o
0 50 100 150 200 250
Kanal
Heart rate (BPM) Paul Kinahan and Kelly Branch, UWMC 31
Regarding automatic tube current
modulation in CT:
0% 1. It gives inconsistent image quality
0% 2. It increases the scan time for the exam
0% 3. It generates more heat in the x-ray tube
4. The tube current is automatically adjusted according to
100% patient size
0% 5. It causes an increase in photon starvation artifact
Kanal 32
Answer
The tube current is automatically adjusted according to
patient size
Kanal 33
Reducing Cardiac Dose – Prospective
Gating
No functional information
Kanal Mahesh, et al. Radiographics, 2007; 27:1495-
27:1495-1509.
Retrospective Gating
Kanal Mahesh, et al. Radiographics, 2007; 27:1495-
27:1495-1509.
Prospective vs. Retrospective Gating
University of Washington Study
Retrospective Prospective
Gating Gating
Effective 26.4 ±6.2 6.2 ± 2.0
Dose (mSv)
77% lower radiation dose with prospective study
This study concluded that the “64 channel cardiac CT
performed with prospective ECG gating may have similar
subjective image quality and substantially lower patient
radiation dose compared to retrospective ECG gating”
Kanal Shuman, et al. submitted for publication, 2007
Regarding prospective ECG triggering
for cardiac CT exams
0% 1. Projection data has to be collected through out the cardiac
cycle
0% 2. The temporal resolution is about 350 ms
3. The radiation dose is reduced compared to retrospective
100%
ECG gating
0% 4. Functional information of the heart is available with this
exam
0% 5. Increase in motion artifacts occurs
Kanal 37
Answer
The radiation dose is reduced compared to
retrospective ECG gating
Kanal 38
Future of CT
Kanal Kalendar WA, Computed Tomography, 2nd ed., 2005, pg 235. 39
Future of CT
Other Developments
Kanal Kalendar WA, Computed Tomography, 2nd ed., 2005, pg 72. 40
TAKE HOME POINTS
MDCT scanners are becoming common and have several
advantages over SDCT
CT utilization has increased significantly
AEC or Automatic Tube Current Modulation and ECG
modulation available on modern scanners which helps
reduce dose
Cardiac CT is becoming popular with MDCT scanners
Always keep ALARA in mind!
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THANK YOU
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