Phys-FRCR Vol 2

Physics
for FRCR
Simplified and edited by
Dr. Khaled Elazhry

(2013) Cairo Egypt
(Volume 2)
Dr. Khaled Elazhry
Dr. Khaled Elazhry 1
Chapter 5
DIGITAL RADIOGRAPHY

DIGITALRADIOGRAPHY
5.1 IMAGE STRUCTURE & SIZE:
In digital imaging the image is divided into a matrix of individual pixels , each pixel has
an value that related to the intensity signal of the corresponding part of the image.
As high values displayed dark and low values displayed light'
FOV
Pixel size =
No. of pixels in the matrix
As in CT may be ( 350\512 = about 0.7 mm)
The value on the pixels is stored in binary format, and the maximum value is related to
the bit depth of the pixel
8-bit pixel has a (28) 256 levels of gray, and 12-bit pixel has a (212) 4096 level of gray.
Computer memory expressed as bytes , with single byte carry up to 8 bits , so for pixels
with more than 8-bits use proportionally increased bytes.
Matrix size more than 512x512 will not improve resolution because of the limitation of
detector size and sapling frequency.
Compression ;
Compression of the images is required to reduce the storage requirements and
transmission time.
Lossless (reversible) compression: compression factor of 2 to 3 with images can be
restored to its origin value.
Lossy (irreversible) compression: compression factor up to 40 with some loss of the
details & images cannot be restored to its origin value.
Noise Reduction :
Low-pass spatial filtration: average after adding a proportion of the grayscale values of
the neighboring pixels, BUT blur small details and edges.
High-pass spatial filtration (Edge enhancement): adding a proportion of the difference
between the grayscale values of the neighboring pixels, exaggerate edge contrast BUT
increase noise, and may be create false structures.

IMAGE DISPALY:
A- Cathode ray tube :
Scanning electron beam with intensity modulation changing with the stored pixel value .
Disadvantages :
1250 scan lines only
Limited resolution in the perpendicular direction
Limited resolution by the frequency of the modulation signal
B- Flat panel monitor :

Most common type of flat panel monitor used in medical imaging is liquid crystal with
matrix sizes up to 2000 by 2500 in rectangular arrays.
Calibration :
The values of the pixels are matched to a display curve that is optimized to the imaging
task , with the optimized patterns is consistently displayed on any display monitor.
Standard display calibration is DICOM (digital imaging& communications in
medicine).
5.2 IMAGE TERMINOLOGY:

Fourier analysis:
The image signal is broken into a series of sine waves that vary in terms of spatail
resolution & amplitude.

Sampling:
A complex analogue video signal is composed of Fourier sine wave components of
many frequencies . then it is sampled before digitization with some information is
inevitably lost.
At too low sampling frequency, small structures with sharp edges information will be
lost.
Nyquist criterion : ( signal must be sampled at least twice in every cycle or period.)
Sampling frequency must be at least twice the highest frequency present in the signal
otherwise . high frequencies will be recorded erroneously as low ( Aliasing ).
Nyquist frequency : the maximum signal frequency that can be accurately sampled ,
and equal the half of the sampling frequency .
Aliasing : Under-sampling , leading to high frequencies will be recorded as low

frequencies.
Modulation transfer function ( MTF ) :

It is the relation between the output and input modulation.
It represented by curve that describe the ability of the imaging system to recode
information.
So if MTF = 1 ( 100 % ) , it is perfect system and all information recoded.
If MTF = 0 ( 0 % ) , No information recorded.
MTF works a function of spatial frequency , 100 % at low spatial frequencies
0 % at high spatial frequencies
MTF can b assessed by mathematical techniques using Fourier analysis of the image of
a sharp edges.

MTF
A : 400 speed film screen system B: Detail film screen system
C : Computed radiography ( CR ) D: Direct digital radiography
5.3 COMPUTED RADIOGRAPHY ( CR ):

Imaging Plates: ( IP )
The imaging plate is replacing the film cassette .
The imaging plate consist of photostimulable phosphor , commonly used is barium
fluorohalide doped with europium ( BaFX:Eu ) , which is the halide ( X ) consist of
barium 85 % and iodide 15 %
The phosphors is in powdered form , with thickness 0.3 mm
The plate is inserted in a tight light cassette.
Photostimulant phosphor layer become worn or scattered with time and use, leading to
desensitization and degradation of the image plate and cause artefacts.
The latent image on the plate can decay if not read promptly (about 8 hours).
High resolution imaging plates (HRIP), have lower fractional X-ray absorption
efficiency and demands higher X-ray dose.
Readers:
The imaging plate is scanned by laser beam.
Laser light gives the trapped electrons in the conduction layer enough energy to leave
traps back into the valence band , releasing light photons of the same wavelength.
The emitted light is with energy proportional to X-ray intensity.
The emitted light is directed to photomultiplier tubes by optical fibers to measure its
intensity.
Most phosphors used for CR emit light at the blue end of the spectrum and need a
scanning laser emitting red light.
Residual signal is erased by exposing to bright light.
The time to extract the image range from 30s to 45s.
Image Processing:
Dynamic range of the photostimulable phosphor is very wide ( about 10000:1).
CR raw image would be equivalent to a film screen image with film gamma 0.4
compared with 2 to 3.

Processing stages:
1- Detect the collimated edges (signal outside ignored).
2- Histogram analysis (frequency plotted against pixel value) of the light intensities
distribution. To reject very high and very low intensities.
3- Mapping the intensities to a gradation curve.
4- Edge enhancement and noise reduction.
Image Quality:
Spatial resolution
Spatial resolution of CR is limited to 5.5 lp/mm for small plates and about 3.5 lp/mm
for larger plates, (Film screen system is about 8 lp/mm and 12 lp/mm for detail
screens).
The limiting factors of reduced spatial resolution of CR:
1- Pixel size ( the main reason )
2- Pixel spacing (sampling interval).
3- Scattering of the laser light in the phosphors layer.
4- The size of the phosphors grains.
5- Phosphors layer thickening.
6- The diameter and orientation of the scanning laser beam.
Increasing the ability to detect fine details in CR by :
1- The partial volume effect.
2- Edge enhancement algorithms.
Contrast
Contrast of CR is more than film screen system and determined by the processing
techniques.
Image density is independent of the exposure factors
Noise
Arise from random flocculation in the count of the X-ray quanta absorbed.
Inversely proportional to square root of fractional x-ray absorption efficiency (n).
Inversely proportional to square root of photon fluence incident upon the image (N).
Detector Dose Indicators ( DDIs):

To control the dose received to the patient.
Are analogous to optical density of the film.
DDIs is determined from the signal from the plate averaged over a abroad region of
the plate but restricted to signal values that lie within the region of the histogram
used for mapping the signal to the gradation curve.
DDI is could be inversely proportional to the dose or are functions of the log of the
dose, depends of the manufacture.
Manufactures provide normal ranges for DDIs that may be examination-dependent.

5.4 DIGITAL RADIOGRAPHY ( DR ):
Digital radiography use imaging devices that remain in situ and produce an image with a delay
that is generally no more than about 10s.
Two types: Indirect DR & Direct DR ( DDR ).
Common DR detectors are arrays of amorphous silicon ( a- Si ) thin-film transistor ( TFT ).
Mechanism :
1. TFT amplifies the electron signal and store it as a electrical charge.
2. The charges can be released by applying a high potential.
3. In TFT arrays , each row is connected to the activating potential.
each column is connected to a charge measuring device.
4. The charges is applied row by row , and the timing of the signal determines the position
of the pixel from which it originated.
There are many transistors as there are pixels.

TFT size in the range of 100-200 m.
X-ray or light detectors are deposited above the charges collecting device on the plate.
phosphor
Two types of detectors : indirect conversion detectors ( X-ray Detected Light) &
Direct conversion detectors ( directly detected X-ray without conversion to light )
A- Indirect conversion detectors.
The most common type of flat plate detectors.
A phosphor ( caesium iodide ) is used to convert the X-ray photos to light , then the
light detected by the photodiodes incorporated into the TFT arrays.
The phosphor is laid down as a crystalline structure above the photodiode array and
perpendicular to the surface of the detector.
The elongated crystals have a very much smaller size than the pixel size.
The light produced by an crystal is internally reflected and directed to the photodiode
element which is directly below the point of interaction.
A thick layer of scintillator may be used to increase the detection efficiency (as in
intensifiers input screen.). as resolution is limited to the width of the detector
elements.
Has a dead area, which may exist within and around the edges of the detector. That
might be required for routing of wire lead

Gadolinium oxysulphide is a alternative phosphor :
Greater light spread, so thinner layer is used with reduced detection efficiency.
Cheaper to produce and robust.
More suitable for ward portable radiography.
Flat plate detectors may be produced as single detector to cover the full field or tiled
detectors which may comprise four separate detectors.
B- Direct conversion detectors: amorphous selenium ( a Se ) detectors
Amorphous selenium (a Se) is a photoconductor will pass an electrical charge on
irradiation.
It is deposited on the TFT arrays
X-ray photon interacting in the photoconductor causes ionization, with the positive
charge drawn to the charge collectors in TFT array.
Detective quantum efficiency ( DQE )

This is a parameter that reflect the efficiency of photon detection and noise added to
the detected signal.
If every X-ray photon is recorded , DQE = 100 % .
In practice , DQE for DR nay be high as 65 %
DQE for CR & film-screen systems about 30 %
So , DR can be used al lower doses without increase in quantum noise.
Disadvantages of DR :
1. More Cost & versatility (Two detectors instead of two Bucky positions in CR ).
2. Not flexible in positioning as CR plate.
Charge coupled device (CCD detector )

Light sensitive detectors, like that used in video & digital cameras.
Convert photons into an electric signal.
Can NOT is manufactured in a size that is much greater than 5 cm2.
Used for DR in conjunction with phosphors to detect X-ray, with the light emitted
from the phosphors is focused on the CCD.
Use fiber optics for better light transmission
Deeper detection than flat plate detectors.
CCD-based DR may used in mammography for biopsy localization.
Has a dead area, like flat plate detectors.

5.5 Picture Archiving & Communication Systems ( PACS ):
Benefits of PACS :
1. Images available instantaneously in any location.
2. Images viewed simultaneously in different locations.
3. Security of image storage.
4. Elimination of film storages.
5. Integration of imaging with other patient records.
6. Building teaching files of images.
Yet, PACS is not necessary cheaper than film storage facilitates , with the cost of
computer network and hardware and software management.
PACS workflow manager, the computer and associated software that control the
flow of images and information.
Imaging devices with a PACS must comply with DICOM standards.
Image archive split into two parts , Short-term archive for current cases with rapid
access and long-term archive for storage of old cases.
PACS must be connect to other information systems in the hospital , as hospital
information system & radiology information system .
HL7 , standard for the interchange of text data and integrating the healthcare
environment.
PACS broker , interface between other hospital systems and workflow manager to
ensure various information communication.
Workstations :
Modality Workstation: supplied with the imaging equipment.
Reporting Workstation: used by radiologists, supplied with high-quality display
monitors and wide range of software tools foe image manipulation and
measurements.
Review Workstation: in other hospital places as clinics, for viewing proposes only
and equipped with lower monitors specifications and limited software.
Analogue image:
Displayed on monitors.
Stored on magnetic tapes
Digital image:
Made of pixels
Higher value pixel displayed darker
Can be stored on computers and disks
##################

Chapter 6
FLUOROSCOPY

FLUOROSCOPY
Fluoroscopy is a real time X-ray imaging
Phosphor screen converts pattern of X-rays into a similar pattern of light for real
time imaging.
Intensity of light is proportional to the intensity of X-rays & = 1.
Direct vision fluoroscopy (early days)
The fluorescent material copper-activated zinc cadmium sulfide emitted
light in yellow-green spectrum.
The radiologist's eyes was protected by a sheet of lead glass.
Disadvantages:
High doses.
Low brightness, even with examination carried out in a dark room & with dark-
adaptation of eyes by wearing red goggles for 20 to 30 minutes.
So, was dependent only on the Rods "scotopic" vision & couldn't stimulate the
cones "photopic" vision.
The use of direct-vision fluoroscopy is now BANNED.

N.B. IRR99 states that no one can do fluoroscopic examination without
image intensifier or similar device.
6.1 THE IMAGE INTENSIFIER:

Used to increase the brightness of
the image, while maintaining its
proportionality with the X-ray
beam intensity
The tube itself is an evacuated glass

envelope, a vacuum tube, which
contains four basic elements:
1. input phosphor & photocathode
2. electron focusing electrodes
3. accelerating anode
4. output phosphor
Glass Tube:
2 - 4 mm thick.
Enclosed in a lead-lined metal
container shielding.
Input Phosphor Screen:
150-400 mm in diameter, 0.2 mm thick.
Small size use for applications like fracture fixation , and larger sizes are suitable for
angiography and interventional radiology , while in GIT barium studies a diameter 350
mm is typical
Coated on the inside of glass tube.

The input fluorescent phosphor Cesium Iodide (CsI).
deposited on a thin aluminum substrate by a process called "vapor deposition"
tiny needles perpendicular to substrate surface.
Phosphor absorbs about 60% of the X-ray energy converted into light.
The absorption edges of Cesium (at 36 keV) & Iodine (at 33 keV) are favorably
placed in relation to the effective energy of the X-ray spectrum "which typically
have a mean energy about 25 keV".
Fig. 4.2 Mass attenuation coefficient of cesium

iodide (Csl) and zinc-cadmium sulfide
(ZnCdS) versus photon energy with the X-ray
spectrum superimposed shows that the
greater part of the spectrum of X-rays leaving
the patient lies on the high absorption side of
the absorption edge of cesium iodide.
Cesium iodide input screens absorb approx-

imately 2/3 of the incident beam as opposed
to less than 1/3 for zinc-cadmium sulfide,
even though the cesium iodide screen is only
one third as thick.
Photocathode
Photoemissive metal "Cesium-Antimony photoelectric screen".
It is coated directly over the phosphor screen so, the light from the CsI input
phosphor passes directly & strike the photocathode emit Photoelectrons in
numbers proportional to the brightness of the screen.
(MCQ: the max. fluoroscopic tube current is mainly limited by Patient Dose)

Electron Focusing
Thelensisaseriesof+vecylindricalelectrodes"usuallyplatedontotheinsidesurface
oftheglassenvelope".
These electrodes focus the electron beam as it flows from the photocathode toward
theoutputphosphor"socalledelectronlens".
Eachpointontheinputphosphorisfocusedtoaspecificpointontheoppositesideof
theoutputphosphor.
Theimageontheoutputphosphoris:
1. Inverted and reversed due to electron focusing by point inversion "all electrons
passthroughacommonfocalpointontheirwaytotheoutputphosphor"
2. Reducedinsize,whichisoneoftheprincipalreasonswhyitisbrighter.
For undistorted focusing, all photoelectrons must travel the same distance so,
inputphosphoriscurvedtoensurethatelectronsemittedattheperipheralregionsof
thephotocathodetravelthesamedistanceasthoseemittedfromthecentralregion.
Accelerating Anode
Locatedintheneckoftheimagetube(Fig.123).
Hasapositivepotentialof25to35kVrelativetothephotocathode
Accelerateelectronsemittedfromthephotocathodetoatremendousvelocitytoward
theoutputscreen.
Output Phosphor Screen:

Typically2535mmindiameter.
The output fluorescent screen of image intensifiers is silveractivated zinccadmium
sulfide(ZnCds:Ag),thesamematerialusedinfirstgenerationinputphosphors
Outputphosphorconvertstheelectronpatternbackintooneoflight.
Crystal size and layer thickness are reduced "since it absorb electrons, not X
rays, need only be a few micrometers thick" maintain resolution in the
minifiedimage.
The number of light photons from output screen is increased
approximately50foldthanlightproducedattheinputscreenduegreatly
acceleratedelectrons.
The phosphor is covered with Thin Aluminum Film ( 0.5 m), through which the
accelerated electrons penetrate to fall on the phosphor screen. BUT, prevents light
from the output phosphor to travel backward to the input photoelectric screen and
causefurtheremissionofelectrons&ultimatelyoflight.Otherwise,reducetheimage
contrast.
In contrast to the situation in filmscreen radiography , here doubling the Xray
exposuredoublesthelightoutput(=1)
Themetalhousingprovidessomeshieldingagainstexternalmagneticfieldsaswellas
Xrayprotection(protectionagainstXraythatmightpenetratetheglassenvelopinto
thedetectortube,causingfalsesignals).

In summary:
A uniform x-ray beam passes through and attenuated by the patient passes
through the glass front of the image intensifier tube & enters the image intensifier
tube The input fluorescent screen absorbs x-ray photons converts their
energy into light photons in proportion to the intensity of incident x-ray beam
strike the photocathode emit photoelectrons immediately accelerated away
from the photocathode by the high potential difference between it and the
accelerating anode as the electrons flow from the cathode toward the anode, they
are focused by an electrostatic lens guides them to the output fluorescent
screen without distorting their geometric configuration electrons strike the output
screen emits the light photons that carry the fluoroscopic image to the eye of the
observer.
In the intensifier tube, the image is carried first by x-ray photons, then by light photons,
next by electrons, and finally by light photons.
The output phosphor image is viewed either directly through a series of lenses and
mirrors( in old systems ), or indirectly through closed-circuit television
Gain:
The image is intensified ( brighter ), minified , inverted & reverted
For each X-ray photon absorbed by the input phosphor about 400 light photons are
emitted producing 400 photoelectrons which cause the output phosphor to emit
nearly 400000 light photons.
Brightness gain : Also called intensification factor. Equals the ratio
brightness of the output phosphor
brightness of the input phosphor
The brightness gain of an image intensifier comes from two completely unrelated
sources, called "minification gain" and "flux gain".
Minification Gain
Produced by a reduction in image size.
The quantity of the gain depends on the relative areas of the input and output
screens.
d1
Minification gain = ( )2
d0
where dl is the diameter of input screen, and d0 is the diameter of output screen

Minification gain increase overall gain by about 100 times
The brightness gain from minification does not improve the statistical quality of
the fluoroscopic image as the same number of light photons makes up the image
regardless of the size of the output screen.
Theoretically, brightness can be increased indefinitely by minification, but also the
picture becomes more grainy due to magnification of the fluoroscopic crystals in
the output screen.
Minification gain is responsible for 50 % or more of the total increased brightness.
Flux Gain
It is the increase in the number of light photons due to acceleration of electrons.
It increases the brightness by a factor of typically 50
For each light photon from the input screen, as ejecting one electron from the
photocathode. The electron is accelerated to the opposite end of the tube, gaining
enough energy to produce 50 light photons at the output screen.
The total brightness gain of an image intensifier is the product of the minification
and flux gains:
Brightness gain = minification gain X flux gain
The overall brightness gain is approximately about 5000

The Brightness gain is not directly measurable , its more common to use the
Conversion factor
Conversion factor: is a ratio of the luminance of the output phosphor to the input
exposure rate
brightness of the output phosphor (candela/m2)
Equals the ratio
dose rate in air on the input surface of the intensifier ( Gy/s)
Measured with a photometer and a dosemeter employing a flat circular ionization

chamber, respectively
Typical values are in the range 25-30, but it decreases with age and use.
Magnification (Zooming)
Image quality increase as the size of the input field is decreased.
[
By changing the voltages of the intermediate

electrodes , the electron crossover point of
focus can be moved nearer to the input
screen and the intensifier operates in a
magnification mode.
Field size is changed by applying a simple
electronic principle: the higher the voltage
on the electrostatic focusing lens, the more
the electron beam is focused.

In magnification mode , the electrostatic focusing voltage is increased the elec-
trons focus farther away from the output phosphor diverge to form larger image on
the output phosphor
The central part of the input image then fills the whole of the output phosphor (zoomed )
Effect of Zooming (adv. & Disadv.)
Magnifiestheimage.
Improvesthesharpness"resolution"
But, makes the image less bright "less minification gain" exposure factors are
automatically increased to compensate for the decreased brightness increases
thepatient'sskindose.
BUTtheXraybeamisautomaticallyrecollimatedvolumeofirradiatedtissue
(sopatient'sskindoseincreasesbutthetotaldoseismoreorlessthesame)

6.2 TV System
Original TV image intensifier systems used a lens system to focus the image
from the output screen on the input screen of the camera.
The camera has an electron beam scan for that produce a voltage (video signal ) which is
proportional to the intensity on the light falling on the signal plate in its input screen
Digital Fluoroscopy: the signal from the video camera is converted to digital format
that is input into a computer before displayed.
Computer functions:
1- Image storage.
2- Image processing functions as noise reduction ,edge enhancement or black to
white reversal.
3- Geometrical conversions ( left to right or top to bottom )
4- Mapping to display look-up tables to maximize contrast.
CCD Camera :
Produce a digital signal not an analogue which is more effectively.
Its input screen is a thin layer of amorphous silicon divided into pixels ( generally 1024
x 1024) , each as a small capacitor to collect charge proportional to the intensity of the
light falling on it , then the charges measured very rapidly ( about 30 frames /s )
Has increased dynamic range ( 12-bit image depth )
The CCDs cameras are now the standard for the image intensifier based fluoroscopy.
Optics :
The traditional lens system between the output screen and the input screen on the
camera is now replaced by (Fibro- optic coupling) that provide efficient light collection
and improved geometrical integrity.

6.3 AUTOMATIC BRIGHTNESS CONTROL ( ABC )
Problem: X-ray intensity when moving from a high-attenuation to a low-
attenuation area "e.g. from the abdomen to the chest" sudden increase of brightness
the image becomes chalky, and all detail is lost due to changing of radiological
thickness without changing radiation parameters
Solution: A 'feedback' system to control the brightness of the TV monitor
automatically Automatic Brightness Control ( ABC )
The brightness of the image is monitored either by:
(a) Measuring the (average) video signal or
(b) By a sensor 'watching' the brightness of the output phosphor.
Then sending orders back to the X-ray tube & generator to modulate exposure
factors
There are three ways to change the radiation input to the input phosphor:
1. kV 2. mA 3. Both
Dose control curves :
The brightness of the image is monitored by feedback system from the output
screen or taken from the signal from the TV camera
Adjustment of the kV and/or mA is done following brightness curves
programmed into the system
Every system has many available curves allowing the user to select the
most appropriate one for the clinical task
Anti-isowatt curve : increasing the kV & mA as the radiological thickness
increases.
A variant of the anti-isowatt is used with Iodine contrast studies ,
holding the kV between 60-65 with increasing the mA as the thickness
increases.
Another variant of the anti-isowatt is used to minimize dose by
increasing the kV rapidly as the thickness increases till maximum then mA
is increased , yet the image quality is decreased ( used in pediatrics )
AUTOMATIC GAIN CONTROL

It is a simple and inexpensive way to control image brightness.
It varies the brightness of the TV system by:
1) varying the sensitivity of the TV cameras

2) varying the gain of the TV amplification system.
Disadvantages :
It does not act in changing the x-ray dose rate to the patient unnecessary
patient exposure.
Not improve quantum mottle and will increase electronic noise.

6.4 Dose Rates :
Fluoroscopy screening time vary from few seconds up to 15 min or more in complex
interventional techniques , with a potential for delivering high doses to the patient .
Fluoroscopy dose rate depends on :
The level of noise that can be accepted in clinical practice
The detective quantum efficiency ( DQE )
Low input dose rate will produce Low level of brightness at the output screen
which can display acceptable brightness on the monitor , yet the level of noise
may be unacceptable
So ,The input dose rate in mainly between 0.1-0.5 Gy/s (commonly 0.2-0.3
Gy/s)
RULE Lower input dose rate , the greater noise in the image.
In magnification there is reduced brightness and reduced dose area product

( DAP ), to retain image brightness :
1- Increase input dose rate
2- Adjust TV gain
3- Both.
Patient entrance surface dose ( ESD ) depends on the sensitivity of the
detector (intensifier) ,generally cant exceed 100 mGy/min for any FOV and 50
m Gy/min for the largest FOV ( for average patient 10-30 mGy/min )
PULSED FLUOROSCOPY :
The X-ray generator supply the voltage to the tube is switched on & off at regular
intervals ( about 25 or 30 pulses /second )
At these rates the eye cannot dedifferentiates between continues and pulsed modes, then
may be reduced by successive halving of the rate ( 30 then 15 , 7.5 , 3.75 down to 1
pulse/second )
The input dose rate reduces with reducing the pulse rate , with a proportion depends on
the equipment.
Each successive image is retained on the display until the following image displayed
Movement with low pulse rate may result in unacceptable blurring or Lag
Grid-controlled tube : instead of switching the tube , using an additional circular
electrode build into the tube between the cathode and the anode to switch the beam itself
on & off
Applying negative 2 kV voltage to the grid electrode will repel the electrons back to the
cathode
It give greater control over the intensity of the X0ray beam in each pulse.

6.5 Recorded Images :
Fluorography : recording the image produced by an image intensifier .
Recent intensifiers record image in digital format using the signal from the TV camera.
Last image hold : the last image of the sequence before switching the x-ray beam off
is still displayed allowing the operator to inspect it.
Fluoro grab : when the fluoroscopy image is used for diagnosis and permanently
stored for reporting .
Digital Spot Image : single shot images taken with a single pulse at high mA to
produce low noise images ( dose range 0.1-0.5 Gy )
Systems can recode sequences of images like in angiography , number of stored images
depend on of the computer memory size ( RAM ) reaching up to few hundred images.
6.6 Image Quality :

Spatial Resolution:
The image intensifier itself has a spatial resolution of about 4-5 lp/mm (or better in the
magnification mode).
It is principally affected by
The blurring caused by light spread in the input phosphor.
Less significantly in the much thinner output phosphor.
The resolution is always stated in relation to the size of the X-ray image on the face of
the input screen of the intensifier.
CCD camera , theoretically may give a resolution of 1.7 lp/mm for 350 mm FOV , but
the monitor used for displayed has a limited resolution , generally no better than 1.2
lp/mm ( improved to 3 lp/mm in magnified image )
Noise:
The information in the image also suffers from statistical fluctuations in all the other
discrete 'events' occurring in the image chain:
Light photons emitted by the input phosphor
Photoelectrons emitted by the photocathode
Light photons emitted by the output phosphor
Electrons constituting the video signal, etc.
The noise produced in each of the above stages is relatively low since the number of
light photons and electrons involved is very large.
The Quantum Sink is It is the weakest link in the imaging chain
2
The part of the system where the number of photons or electrons/mm of the image
field is lowest the relative noise the largest and the SNR the lowest.
In TV system, it lies in the absorption of X-rays in the input phosphor.
In radiography, it lies in the absorption of X-rays in the intensifying screens.
No increase of the gain of the intensifier or camera will improve SNR

Reducing noise :
Increasing input dose rate, yet it will increase patient dose.
Using (frame averaging) which is successive images added together pixel by pixel
and the average value then displayed, yet movement will blur the image.
Veiling glare
It is due to
5- Scattering of light in the output window of the image intensifier
6- Scattering of X-ray & light in the input phosphor
7- Electron scattering in the tube.
Leading to contrast of the image , and cause vignetting
It is worse with the larger sizes of intensifier.
Vignetting : means that the center of the final image is brighter than its edges.
Geometrical distortion :
Pincushion distortion : Magnification towards the edges of the image , due to
curvature of the input screen.
S-type distortion : Impose curvature on straight line features , due to ambient
magnetic fields influencing the path of the electrons from input screen to output screen.
Both insignificant when imaging complex body structures.
Testing Image Quality :

Spatial resolution : tested with ( grid test object ) , as described before.
Contrast : tested with a low contrast test object as ( Leeds test objects ) , flat disks
about 6 mm thick and 200-300 mm in diameter and contains circles of high atomic
number material that produce varying levels of contrast in the final image , and the
contrast is tested by the count of the details that can be seen.
6.7 Digital Subtraction Angiography : ( DSA )

a) The mask image : Non contrast image is taken before contrast reaches target
area that visualize normal anatomy
b) Second frame: a contrast image with the vessels filled with contrast media,
superimposed on the normal anatomy.
c) Third frame: subtracting the mask image from the second frame pixel by
pixel, the result image shows only contrast filled vessels.
The misregistration of images caused be movement between frames, can be minimizing
by adjustment of the mask image (Pixel shifting) manually or automatically.
Because of the exponential nature of the attenuation, the signals in the contrast images
and the mask are first converted into their logarithms before subtraction and then
converted back into intensity values for display.
Subtracting images causes decrease SNR and the image appears noisier (adverse
action of frame averaging), Increased mA needed to counteract this effect.

For long FOV ( like in femoral angiography ) :
I. A multiple separate sequences may be needed with separate contrast
administration
II. Single contrast administration with longitudinal movement of the table to track the
progress of the contrast , ( reduced time and contrast needed , yet increased
chances of movement between mask and contrast images).
Rotating Angiography : mask images taken at several angels for a 90 rotation of the X
ray tube and intensifier then contrast images acquired at the same angles , subtracted
images may be used for 3D reconstruction .
Dual Energy Subtraction :

Images taken with Rapid succession of LOW & HIGH kV
Low kV : high contrast between bone and soft tissue.
High kV : Improve soft tissue contrast
Subtracting the Low kV images from the HIGH kV images : Improve soft tissue
contrast and minimize bone visualization ( of value in chest radiography )
Subtracting the HIGH kV images from the LOW kV images : display bony
structures
6.8 Flat Plate Detectors :

Most of the detectors used in fluoroscopy , are like that used in digital radiography , uses
amorphous silicon detectors with cesium iodide scintillators
Has detective quantum efficiency ( DQE ) about 65 % like the image intensifier , yet has
increased dynamic range and improved spatial resolution .
Image quality :
Contrast ratio of the image intensifier is about 30:1 because of high background
signal and veiling glare, and the overall image contrast is limited even with use of
12-bit CCD camera.
Contrast ratio of the flat plate detectors is much greater with full use of 14-bit
depth.
Spatial resolution of the image intensifier is about 1 1.2 lp/mm for the largest
FOV with equivalent pixel size about 400 m, improvement with magnification
giving like a flat plate detectors resolution in the smallest fields.
Spatial resolution of the flat plate detectors is about 3 lp/mm with typically
used pixel size 150 m , yet no improvement with magnification because pixel
size remain the same.
No image distortion with flat plate detectors like image intensifiers, which
generally not of clinical significance
Fluoroscopic angiography with flat plat detectors can be used as a Multislice computed
tomography using a single 180 rotation of the C-arm , yet the image quality is reduced
due to greater beam divergence effect & increased scatter radiation.

Chapter 7
COMPUTED TOMOGRAPHY

COMPUTED TOMOGRAPHY (CT)
In CT scanning:
(a) A transverse slice of the patient "say 10 mm thick" is imaged avoiding the
superposition of adjacent structures.
(b) The slice is defined by a 'sheet' of X-rays, produced by a narrow fan beam rotated
around the patient scatter.
(c) The slice is subdivided into a matrix usually of 512 x 512 volume elements (voxels),
each typically 0.5 x 0.5 x 10 mm. The image is reconstructed by a digital computer as a
corresponding matrix of 512 x 512 picture elements (pixels).
(d) The computer allows the use of 'windowing' to selectively display a restricted range of
tissues.
Matrixoftissuevoxels,correspondingmemory
PrincipleofCTimaging locationsinthecomputerorimagepixels.
From steps (a), (b), & (d) contrast is more than conventional radiography
From step (c) the spatial resolution is less good.
N.B. contrast resolution = the ability to display low contrast structures.
The image is displayed as a matrix of pixels, each 0.5 x 0.5 mm.
The brightness or grey scale value of each pixel in the image = the average linear
attenuation coefficient of the contents of the corresponding voxel
7.1 PRINCIPLE OF COMPUTED TOMOGRAPHY IMAGING
CT numbers
The average linear attenuation coefficient t of each tissue within the voxel.
Compared with that w of water by the formula:
(t - w)
CT number ( CTn) = 1000
w

Water is used as the reference material because:
1) Its attenuation coefficient is close to those of soft tissues.
2) It is a reproducible material for machine calibration.
The multiplier (1000) is used to obtain whole numbers.
The CT number (or Hounsfield number) is defined as -1000 for air & 0 for water
For tissues CT number is depends on the kV employed and filtration.
For example;
If, at 80 keV the linear attenuation coefficient of typical bone and water are 0.38
and 0.19 cm-1, respectively the CT number of the bone is +1000.
Tissue CT number Range
Bone 500-1500
Muscle 40-60
Grey matter 35-45
White matter 20-30
Fat -60 to -150
Lung -300 to -800
Partial volume effect
CTcannotrevealdetailsmallerthanthevoxel.
CTnumbermeasurestheaverage(notadded)CTnumberofthecontentsof
eachvoxel.
A highcontrast object occupying only part of a voxel will raise the CT
numberforthecorrespondingpixelandsoappearlargerthanitis(Partial
volume effect) e.g. tiny calcifications and small traces of contrast
medium.
Thepartialvolumeeffectisreducedbyusingthinnerslices&smallerpixels.

Windowing
Although the scanner can distinguish different CT numbers ( 1000 to 3000 )
about4000shadesofgray,BUTtheeyecannotdistinguishmorethan50.
Awindowischosenwhichjustembracesallthetissuesofinterest,andonlythese
aredisplayedasshadesofgreywithintherangeblacktomaximumwhiteonthe
monitor.
PixelswithCTnumbersoutsidethiswindowareundifferentiated,beingdisplayed
aseitherblackorwhite.
Windowlevelandwindowwidthcanbesetindependentlyatthecontrolpanel,
forexampletodifferentiatelungtissues.
Theyonlyaffectthedisplayedimage.

7.2 THE COMPUTED TOMOGRAPHY SCANNER
Faster continuous rotation of the tube is achieved in modern scanners by
mountingahighvoltagegenerator,operatingathighfrequency(upto100kHz)
ontherotatinggantryringitselfandsupplyingitwithpowerthroughsliprings.
1stgeneration 2ndgeneration 3rdgeneration 4thgeneration

Beam Singlepencil Narrowfan Widefan Widefan
Largearray(100s) Completering
Detectors Single Smallcurvedarray rotateopposite (1000s)ofstationary
tube detectors
1atatime Through360with Continuousfor Tubealonerotate
Rotation
through360 lessangularsteps 360 360
Scantime 35min 20sec 1sec 1sec
Betterpredetector avoidringartifact
Adv.
collimation easycalibration
Higherpt.dose
Disadv. Ringartifact
(Tubeisclosetopt.)
Fifthgenerationscanner:increaseofscanspeedispossiblebysimultaneoususeof
multiple Xray tubes or by inserting the patient into a huge funnelshaped Xray
tubeinwhichanelectronbeamscansrapidlyroundalargesemicirculartarget.
Multiple stationary detector rings allow multiple slices to be scanned
simultaneously.
Ascantimeof50100msusedmainlyforcardiacimaging.
XRAYTUBE:
Anode cathode axis is parallel to the axis of rotation to minimize the anode heel
effect.
Capableofproducinghighmilliamperageforlongexposuretimes.
Twofocalspotsizes,withthesmallerbeingabout0.6mm.
Haveheatexchangestomaintainhighheatcapacities.
kVrangebetween80to140.

COLLIMATION:
Generally,scannershavetotaltubefiltrationofabout6mmaluminum.
Prepatientcollimatorshasafixedwidthgenerally50cm.effectivelylimittheamount
ofxraysthatreachthepatientbylimitingthebeamsizeandreducescatterradiation
Prepatientcollimatorforsingleslicescannersdefinestheslicethickness,whichfixed
thicknesswidthsettingbetween1and10mm.
Postpatient collimator , in single slice scanners only , its purpose to reduce scatter
radiation to reach the detectors if the slice thickness less than the width of the
detectorsandtogetaccuratethicknessforsmallestslicewidth.
PostpatientcollimatorinMSCTisnotnecessary orpossiblebecausethefullwidthof
thedetectorsisusedtoformtheimage,soshieldingwillpreventdirectradiation.

FILTRATION:
Beam Filtration: Removes low energy xrays from beam by removing of low energy
photonscontributetodose,notimageandreducesbeamhardeningartifacts
Because the patient shape is generally elliptical, the noise levels are poorly matched
overtheareaofthetransaxialsection,soadditionalfiltersareusedBowtiefilters
with thin centers and progressively thicker towards the edges , to equalize the
transmittedintensities,theyalsoevenoutbeamhardeningeffect.

DETECTORS
Thedetectorsneedtohave:
1. Highdetectionefficiency;
2. Fastresponse(shortafterglow)tokeepupwithfastscanning;
3. Widedynamicrangeabletocopewithboththehighintensitybeamineither
side of the patient and the highly attenuated beam passing through the
patient(intensityratio5000:1);
4. LinearitysignalaccuratelyproportionaltotheXrayintensity;
5. Stabilityinfaceofvoltageandtemperaturefluctuations;
6. Smallsizetoallowclosepacking,givingbetterspatialresolution.

IONIZATIONCHAMBERSDETECTORS.
Features:
Highdetectionefficacy,about60%
Lesssensitivebutmoreeasilymatchedforsensitivity.
Theyareverystableunaffectedbyvoltagefluctuations.
Haveawidelinearresponsewithnolag.
Theyarenarrow(andcloselypacked).
NOTsuitableformultislicescanners,Sonolongermanufactured
Tocompensateforthelowersensitivity,ionizationchampersare:
Filled with a high atomic number gas (xenon , Z=54 , Kshell binding energy 35
KeV)ratherthanair&athighpressure(20atm,2MPa).
Maderelativelydeep&thick(e.g.6cm).
SOLIDSTATEDETECTORSSCINTILLATORS
Usescintillatewithembeddedsiliconphotodiodetodetectthelightoutput.
Scintillatemaybecadmiumtungstate,bismuthgerminateorrareearthceramic.
Features:
Detectionefficiencyisveryhigh,about98%.
Negligibleafterglow.
2
Verysmall(downto1x0.5mm )
A small gap between detector elements is necessary to reduce crossover
betweenadjacentdetectorswillreducingthehighefficiencyto80%.

7.3 IMAGE RECONSTRUCTION.

Inprinciple,ifwehave512x512voxels&800(detectorsno.)x300(pulsesno.)
raysumsenoughdatafortheCTnumbersofallthevoxels.
TheCTnumberssocomputedarestoredinthecomputermemorylocations,each
ofwhichcorrespondstoavoxelandthereforetoapixel.
SUM of linear attenuation coefficients of the voxels X average path length =
logarithm of the ratio of the intensity of the unattenuated pencil beam
For purpose of reconstruction , a complex mathematical techniques referred as

algorithmsarerequired,e.g.backprojection&filteredbackprojection.

Backprojection:
Illustration(1)

(a) : Imagine a cylindrical uniform body

withaholerunningthroughitscentre.
(b):abeampassingthroughthistarget
from one direction will have a
transmittedprofileinitscentre
(c):theimagecombinedwithasecond
orthogonal beam , because single
measurement cant determine the
positionofthehole.
(d):thereconstructedimageforeight
beam , yet With number of stripes
blurringofedgesoftheimage.
Illustration(2)
(a):Twoprojectionspresentedbythe
summed values in each row and in
each column , with the summed
values are projected back as the
averagevalueineachrow.

(b) & (c) : Two back projections

images are summed to give the final
representation.
(d) : Final representation , which is
not an accurate reproduction of the
original image but with approximate
relativevalues.

Filteredbackprojection:
Theblurringintroducedbythebackprojectionprocessofthepencilbeamcan
becompensatedbyamathematicalprocesscarriedoutbythecomputercalled
'filtering'usingthedatanotjustfromthepencilbeamitselfbutalsofromthe
neighboringpencilbeamsbysubtractionoraddingmodifiesthebrightness
neartheedgeofeachbackprojectedbeam.

Data may be reconstructed from a reduced arc down to 180 , not full 360
rotation.AsinCTfluoroscopy.
There are different filters and back projection algorithms may be applied
dependsontheimagingtask.
Filteringalgorithms
'Bone'algorithmenhancefinedetailbutincreasenoise.
'Softtissue'filterimprovecontrastbysmoothingoutnoise,butimpairs
thespatialresolution.
Scannedprojectionradiographs:ScanogramScoutview
Scanned projection with a fixed projection angle with the collimator set at
narrowestslicewidth.
The image is different from the conventional radiograph because there is no
beamdivergencealongtheZaxis.
Computedtomographyfluoroscopy:CTfluoroscopy
DisplayofaCTimageinrealtime.
Donebycontinuousrotationofthegantrywithouttablemovement
Usingfastreconstructiontechniques,generallyfrom180datasets.
Usedforbiopsyneedleplacement.
Lesseffectivedose,BUThighpatientskindose,becausescanningisconfined
tonarrowregion.
7.4 HELICAL & MULTISLICE SCANNING.
SPIRAL(HELICAL)SCANNING
The couch moves continuously at a steady speed while the tube and detectors
makeanumberofrevolutionsaroundthepatient.
The tube receives its power supply through slipring technology, and the
detectorssendtheirsignalsbyradio.
Thedataareacquiredintheformofacontinuousribbonofcontiguousslices.

Thedataarereconstructedasaseriesofverticalslices.
Interpolationallowsslicestobeimagedatanylevelandwithanyincrementation.
Forexample,aseriesofoverlappingslices,each10mmthickatincrementsof2
mm,couldbereconstructedthroughavolumeofinterest.
Notethattheslicethicknesscannotbechangedretrospectively.
ComparedwithsequentialCTscanning(step&shoot),inwhichthetubereverses
andthepatientcouchisindexedbetweensliceswithseparatebreathholds,spiral
scanninghasthefollowingadvantagesanddisadvantages:
Advantages:
1. Itisfasterallowingagreaternumberofpatientsandalsotheuseofasmaller
volumeofcontrastmedium.

2. It overcomes the problem of slicetoslice misregistration, particularly in the
region of the diaphragm, caused by variations in inspiration between the
separatebreathholdsneededinsequentialscanning.
3. It reduces partial volume artefacts since the reconstructed slices can be
incrementedinsmallsteps.
4. Because of the volume acquisition of data, resolution in the axial direction is
good,andreformattingintootherplanesisimproved.
Disadvantages:
1. Nocoolingperiodsbetweensliceshighheatloadingofthetube.
2. EventhoughahighcapacitytubeandsensitivedetectorsareusedalowermA
must be employed patient dose but noise, particularly with thicker
patients.
3. Thereissomelossofspatialresolutionduetotheinterpolationprocess.
4. Ahighspeedcomputerwithalargedatastoreisnecessary.
Pitch
Def.: the distance (millimeters) moved by the table during one rotation of the
tubedividedbytheslicethickness(millimeters)

Increasingthepitch,byincreasingthetablespeed,islikestretchingthespring;
Speedsupscanning.
Reducesdose,
BUTresolutionmaybelost"greaterinterpolationneeded".
Decreasingthepitch,willbeoverlap

Aboveapitchof2therearegapsinthevolumebeingscanned,andartefactsmay
ariseandgivesunacceptableimages.

MULTISLICESCANNERS
Thesescannersusemultiplerowsofsolidstatedetectors.
Theyarethekeyfortruethreedimensionalimages.
True3Dimagesrequiresisotrophyvoxelsizemusebeequalinalldimensions,
whichitistypicallyabout1mm.
Reconstructed slice width in multislice scanners depends the length of the
detectorsinthezaxis(w0),notthecollimatedwidthofthefanbeamasinsingle
slicescanners.
Theoretically , single slice scanners have the capability of true 3D because the
collimation can be down to 1 mm slice width , but it is restricted to scan time which is
maximum 90s allowing only 90mm reconstruction of the target.
A minimal possible gap between detector rows is necessary to prevent light

crossover.
Thesizeofthedetectors(w0)inthemultiplerowsaredifferent,downto0.5to
1mminthecentralrowsandincreasingintheperipheralrows.
Differentcombinationsofthedetectorsrowsgivesdifferentpossibilitiesofslice
width.
for example;
In 8 slice scanner , we have 12 rows of detectors with central 8 rows of w0 = 0.5
1 mm and 2 peripheral rows in each side with w0 = 1-2 mm , giving up four
combinations ( 8x1 mm , 8x2 mm , 4x4 mm , 2 x 8 mm slices).
MultislicePitch
Beampitch:thedistance(millimeters)movedbythetableduringonerotation
ofthetubedividedbythecollimatorlengthtotaldetectorlengthused
Roworslicepitch:theratiooftabletopmovementstoslicewidth.
for example;
In 8 slice scanner used for 8x1 mm slices , beam pitch is 1 & slice pitch is 8

MultisliceReconstruction:
Principally , it is the same as single slice helical reconstruction , with the
interpolationofthemeasureddatabetweenadjacentdatasets.

ConeBeamEffect:itistheeffectofbeamdivergence,havealittlevaluein
single slice scanners, BUT in multislice scanners the reconstruction is
complicated because of this effect which increases with increased number of
slicesandwithincreasingoftotaldetectorlength.
Correctionofconebeameffect,isdonebespecialalgorithmstominimizethe
influenceofthiseffect.

Threedimensionaldisplaytechniques
Different types of imaging process and display techniques are available with
multislicethreedimensionalscanningas:

Multiplanarimaging(sagittal,coronal,andobliquesections)
Threedimensionalsurfacerenderingshadedsurfacedisplay(SSD)
Maximumintensityprojection(MIP)&Minimumintensityprojection(MinIP)
Virtualendoscopy.

7.5 IMAGE QUALITY.

SpatialResolution:
ThemaximumhighcontrastspatialresolutionthatmaybeachievedbyCTscanis
about20lp\cm2lp/mm(inCTweusecm,notmmlikeinconventional&
fluoroscopy),generallyitisfrom6lp\cmto10lp\cm0.6to1lp\mm
HighcontrastspatialresolutionisdeterminedmainlybyPixelSize.
Byincreasingmatrixsizeorreducingfieldofviewdecreasingpixelsize.
(matrix512x512usedwith40cmFOV,haspixelsizeabout0.8mmleadingto
resolutionabout6lp\mm)

Highcontrastspatialresolutionislimitedby:
1) PixelSize.

2) Theusedalgorithm.
(certainalgorithmsdesignedspecially,likeinbonystructuresenhancement)

3) Thesamplingfrequencynumberofprojectionsampledineachrotation.
(withinlimits,increasingsamplingwillincreasespatialresolution)

4) ThewidthoftheprojectpathoftheXraybeam:
Whichisfurtheraffectedby:
Focalspotsize.
Thegeometryofthescanner.
Physicalsizeofthesensitiveareaofthedetector.

5) Spatialresolutioninthezaxisalsodependsonslicethickness.
(increasingthepitch,willreducespatialresolutioninzdirection)

Noise:
Types:
A)Quantumnoise:causedbyrandomvariationsinthenumberofXrayphotons
absorbed.
B)Electronicnoise:producedinmeasuringsystem,notsignificant.
C)Structuralnoise:thatisaffectedbythereconstructionalgorithm.

Quantumnoise:
Thiscanbetestedbyimagingawaterphantom.
TheCTnumbersofthepixelswillnotbeallthesame,duetostatisticalvariations
in the number of Xray photons absorbed in each voxel the image is not
uniformbutappearsmottledorgrainy.
ThequantumnoiseisafundamentallimittothequalityoftheCTimagesinceit
both 1)reducescontrastresolutionofsmallobjectsand
2)Worsensthespatialresolutionoflowcontrastobjects.
Noisemaybereducedby:

1. Increasingthenumberofphotonsabsorbedineachvoxel,byincreasingtheslice
thicknessorwidth.
Improving contrast resolution due to less noise , BUT reduce spatial resolution
andincreasepartialvolumeeffect.

2. IncreasingeitherthemAorthescantime.
Bothoftheseinvolveincreasingthepatientdose.

3. IncreasingofkV.
due to increasing of penetration and number of photons detected ( even if mA
reducedtorestorepatientdose).

4. IncreasingFOVorsmallmatrixsize.
leadingtolargerdetectorareaineachpixelwithmorephotonsperpixel.

IncreasingPITCHdoesntaffectnoiseinsingleslicescanners: becausedataare

interpolated between successive rotations for 360 scan and the same number of

detectedphotonsiseffectivelyusedinthereconstruction.

YET ,increasing pitchwill increase slice width , leading to reduce spatial resolution

andincreasepartialvolumeeffect.

IncreasingPITCHwillincreasenoiseinmultislicescanners:becauseofthecone

beam effect , the interpolation algorithms will produce a net effect with minimal

boardingofthescansliceinthezdirection,increasingpoise.

IncreasingWindowWidth,willNOTincreasenoiseorSNRbutwillmakeitmore
apparent.
Contrast:
ContrastresolutionistiedtotheSNR
InCT,softtissuecontrastisbetterthanfilmradiographyatleast10timesbecause:
o Notobscuredbyoverlyingbone.
o SmallerScatter.
o WindowingallowsquitesmalldifferencesofCTnumbers

7.6 IMAGE ARTEFACTS
i. Motionartefacts
Cardiacmotionproducesstreakartefacts(blackandwhitebands).
The reconstruction process is misled by a moving structure occupying different
voxelsduringthescan.
Mechanicalmisalignmentandmovementofthepatienthavesimilareffects.

ii. Highattenuationobjects
Neurosurgical clips, dental amalgam, Small areas of bone or contrast medium
etc.,giverisetostarartefactswhichmayobscuretheareaofinterest.
Theeffectisaccentuatedbymotion.

iii. Photonstarvation
Variantofstreakartefacts,asinCTscanofthepelvisofpatientwithbilateralhip
implants , the tissue between the hips are poorly represented due to high
attenuation.

iv. Beamhardening
HardeningofthebeamasitpenetratesthepatientresultsintheCTnumberof
thesamekindoftissuedecreasingalongtheray.
ThereconstructionprocessassumesahomogeneousXraybeam,withtheresult
thatCTnumbersarelowerinthecenterofthepatient(knownas'cupping').

Correctionby:

Usinga'BeamHardeningAlgorithm'bythecomputer
'Bow Tie" compensating copper filter is used. diminishing patient thickness
towardtheedgesofthefanbeam.producesarelativelyhomogeneousbeam.

v. RingartefactDetectormalfunction

In a thirdgeneration scanner even a small

imbalance in the sensitivity of the scintillation
detectorscanproduceringartefacts.
Cause: the Xray pencil associated with each
detector traces out a 'data ring' a ring of
tissuewhichis'seen'bythatdetectoralone.
This ring can be seen on the image as an
artefactifthatdetectormalfunctions.
The problem is reduced by frequent recalibration of the detectors, and is less
noticeablewithgasdetectors,whicharemoreeasilymatched.

vi. Partialvolumeorvolumeaveragingartefacts(discussedbefore..)
vii. Conebeamartefact.(discussedbefore..)

7.7 DOSE
CTrepresentonlyabout4%ofionizingradiation,yetitisresponsibleforabout
40%oftotalpopulationmedicalexposureinUK.

Although the detector collimators are set to the nominal slice thickness, the
actualXraybeamsoverlap,astheirwidthismuchgreater,beingdeterminedby
thecollimationnearthetube.

TheCTdoseindex(CTDI):
Itisthemeasureofdosefromsinglerotation.
Usedforcalculatingspreadofdoseoutsideanominalslice.

It is theintegralof the dose along the axisof the patientfromasingle

slicedividedbythenominalthicknessoftheslice.
OR the dose at specific position is integrated over the complete dose

profileanddividedbythenominalthicknessoftheslice.
D z dz
CTDI =
T
where: = the integral sign
D(z) = the dose at position z
dz = complete dose profile
T = nominal thickness of the slice.
It can be measured by 10 cm pencil ionization chamber inserted along the

axisofacylindricalphantomandimagingoneslicethroughitsmiddle.
DosepeakinthealldoseprofileisdependsonfiltrationandkV&mAssetting.
CTDIdoesntvarywithslicewidth,becausetheintegrationofthedoseprofileis
normalizedtoslicewidth.
CTDIw istheweightvalueofthedoseindex,andcalculatedfrommeasurement
of the dose in several location of a cylindrical Perspex phantom , and equals
about1040mGyformoststandardscanningprotocols.
CTDIvol is an approximate to the average absorbed dose within the scanned
volume.

CTDIw
CTDIvol
pitch
Maximum skin dose is approximately equal to CTDIw for head scan and 20%
higherforbodyscans.

Doselengthproduct(DLP):mGy.cm
ItcanbeuseddescribingthedoseefficiencymoreaccuratelythanCTDI,because
ittakeinconsiderationthelengthofthescan&thenumberoftimeofrepeated
scansforparticularregion.
DLPisconstantwithchangesinslicewidth.
DLP = CTDIvolxL
L = the total scan time = number of rotations x collimated length x pitch
Effective Dose ( E ) mSv , can be derived from DLP depending on the body
regionandonthescannerdesign.

E/DLP
Head 0.0023
Chest 0.018
Liver 0.015
Abdomen & Pelvis 0.017
The difference of E/DLP between body regions is due to the distribution of the
organs and tissue having the highest tissue weighting factor wT used for
calculatingeffectivedose.
Effectivedoseisdirectlyproportionaltothetubecurrentandtotalscanlength.
CTDIW DLP E
Head 60 700 1.5
Chest 14 400 7
Liver 16 350 5.5
Abdomen & Pelvis 16 500 8.5
Factorsinfluencingpatientdose:
1) kV:increasingkVincreasesthedose,butreducingmAmayreducethedosefor
thesameimagequalityandnoise.
2) mA&scamtime(mAs):increasingmAsincreasesthedose,andreducingthe
noise(noiseininverselyproportionaltosquarerootofmAs).
3) Reconstructedslicewidth:
In few single slice scanner slice width identified by post patient collimation ,
usingnarrowestslicewidth,significantlyincreasethedose.
In both single & multislice scanners , using narrower reconstructed slices
increasesthedose,duetoassociatedincreaseinmAs.

4) Helicaloraxialacquisition:forthesamebodyregionbothhelicalandaxialgive
almostthesamedose,yethelicalscanningmaycauseincreaseinthedosedue
tooverscanningatthestartandtheendofthescanequalingonemorerotation
dose.
5) Pitch: pitch is inversely proportional to the dose , so increasing the pitch to 1.5 leads to 33%
decrease in the dose.
6) Numberofdetectorsrows(inmultislice):hasnoinfluenceondose,butsome
scannershasmoregeometricalefficiencymaycausedosereduction.
7) Reconstruction algorithm & FOV: has no influence on dose , but will influence
themAwhichwillaffectthedose.
##########################

Chapter 8
GAMMA IMAGING

GAMMA IMAGING
8.1 RADIOACTIVITY
Stable nuclei
Nearly all the nuclides extant in the world are stable.
Apart from the nucleus of ordinary hydrogen, which consists of a single proton;
All the stable lighter nuclei contain nearly equal numbers of protons and neutrons.
For example, the nucleus of a helium atom (alpha particle) is a very stable combination of
two neutrons and two protons.
The heavier nuclei contain a greater proportion of neutrons.
Isotopes
Isotopes of an element are nuclides which
Similar in Different in

The number of protons. The number of neutrons.

Atomic number. Mass number.

Position in the periodic table. Density

Chemical and metabolic properties. Other physical properties
The nuclei of all carbon atoms contain six protons.
99% of stable carbon nuclei are carbon-12 (12C) with six neutrons;
1% is carbon-13 (13C) with seven neutrons.
Carbon-11 (11C) with only 5 neutrons "neutron deficit", and carbon-14 (14C) with 8
neutrons "neutron excess" both artificially produced, unstable & radioactive
All 4 nuclides are isotopes of carbon.
Radionuclides
Unstable nuclei, having a neutron excess or deficit, are radioactive 'decay' to become stable
nuclei, with the emission of any combination of alpha, beta, and gamma radiation.
Production of radionuclides:
Natural radionuclides: few, sufficiently long lived, e.g. uranium, radium, and radon.
Radionuclides in medical imaging produced artificially, in the following ways:
Radionuclides produced by Radionuclides produced by additional
additional neutron forced into a proton forced into a stable nucleus
stable nucleus: knocking out a neutron:
Nucleus has a neutron deficit unstable.
Nucleus has a neutron excess unstable. In a cyclotron which accelerates positively charged
In a nuclear reactor ions: e.g. protons or alpha particles.
e.g. with Boron (B):
e.g. with Molybdenum (Mo): 11
98 99 B + p 11C + n
Mo + n Mo
Atomic number increased by 1.
Same atomic number. Same mass number.
Mass number increased by 1. Can be obtained carrier-free.
Radionuclides produced have same Short lived only possible to use them near
chemical properties "an isotope" cannot to the cyclotron.
be made 'carrier-free'.
Radioactive fission products may be extracted from the spent fuel rods of nuclear reactors.
Radionuclides are obtained from generators (see later ..)

Decay of nuclides with a neutron excess:
-
Decay
Neutron change into a proton & an electron the electron is ejected from the nucleus with
high energy -ve beta particle
np+-
For example,
Iodine-131 (131I, Z= 53) Xenon-131 (131Xe, Z= 54).
Same mass number.
Atomic number increased by 1 .
The daughter nucleus mostly produced with excess energy immediate loss with the
emission of one or more photons daughter nucleus in ground state'.
Isomeric transition (IT)
In isomeric transformation: ray is not emitted immediately, but after appreciable time from
emission of particle.
For example,
- - ,
99 Mo , 99mTc 99Tc
42 43 43
Stable nuclide
67 h 6 h 0.2 Ma
The daughter nucleus technetium-99 (99Tc) remains in the excited state for 6 hours.
It is said to be metastable, and is written technetium-99m (99mTc).
Technetium-99m decays to the ground state 99Tc, with the emission of a -ray of
energy 140 keV.
Isomeric transition here result in rays only "no ray emission"
99Tc & 99mTc are said to be ISOMERS:
Def. of isomers: nuclei having different energy states but otherwise
indistinguishable as regards A number, Z number and other properties.
Another isomeric transformation used in nuclear imaging occurs when rubidium-81 (81Rb)
decays to kryplon-81 (81Kr)
81
Rb 81mKr 81Kr
Decay of nuclides with a neutron deficit:

+
Decay
A proton change into a neutron and a positive electron the latter is ejected from the
nucleus with high energy "+ve particle".
p n + +
For example,
Carbon-11 (11C, Z= 6) Boron-11 (11B, Z= 5).
Same Mass and charge.

The atomic number decreased by 1 .
The daughter nucleus, if excited loses excess energy by the emission of gamma
photons till reaches the ground state.

K-electron capture (EC)
The nucleus capturing an extra-nuclear electron from the nearest (K) shell increase its
number of neutrons relative to the number of protons.
p+en
Same Mass and charge.
The atomic number decreased by 1 .
The daughter nuclide will emit characteristic X-rays when the hole so created in the K-
shell is filled by an electron from an outer shell gamma rays if still excited.
Iodine-123 (123I) decays by electron capture and emits 160 keV gamma and 28 keV X-
rays, but no -particles.
Gamma Rays:
GammarayshaveidenticalpropertiestoXrays.
Thegammaraysemittedduringradioactivedecayhaveatmostalinespectrumwhich
ischaracteristicofthenuclidewhichemitsthem.
Forexample,131Iemitsmostly360keVgammarays.

Internal conversion (IC)
The rays emitted by nuclei photoelectrically absorbed in its Kshell emit both
photoelectronsandcharacteristicXrays,usuallyoffairlylowenergy.
Beta rays
HaveacontinuousspectrumofenergiesuptoamaximumEmaxwhichischaracteristic
oftheradionuclide.
TheiraverageenergyisaboutEmax/3.
When positive and negative beta particles travel through a material excitation &
ionizationofatoms"trackoftheparticleisdottedwithionpairs"tillthelossofthe
wholeinitialenergystop"endofitsrange".
The range of beta particles is greater with initial energy of particle &
densityofthematerial"inverselyproportional".
Themostenergeticbetarayshavearangeofabout2mmintissue.
Positron emitters
Positron(=positiveelectrons)isantimatterverybriefexistence.
FATE:Whena+vebetaparticlecomestotheendofitsrangeitcombineswithave
electronthechargesneutralizeeachother,andthemassesofthetwoelectronsare
whollyconvertedintotwophotonsofannihilationradiation(eachof511keV)&travel
inoppositedirections
AccordingtoEinstein'sformula
E=mc2
Positronemittersareusedinpositronemissiontomography(PET)imaging.

8.2 Radioactive Decay :
Radioactive disintegration is a stochastic process.
Activity:
= The rate of disintegration = the number of nuclei disintegrating per second
The SI unit is Becquerel (Bq) = 1 disintegration per second Bq is a very low activity.
The natural radioactive content of the human body = 2 kBq (2000 Bq).
The activity of radionuclide administrations in imaging are measured in Megabecquerels
(1 MBq = 106Bq)
and the activity of radionuclide generators in Gegabecquerels (1 GBq = 109 Bq)
The older unit is the Curie Ci (1 mCi = 37 MBq) ci = 37 x 109 Bq

Counts = number of or rays enter a detector
The count rate = number of counts per second, cps
Count rate is measured by a detector is less than the activity because the greater proportion of
the rays usually miss the detector "undetected".
However,
Count rate activity number or mass of radioactive atoms in sample
The fundamental law of radioactive decay states that:
The activity of a radioactive sample decreases by equal fractions (%) in equal time intervals.
The Exponential Law
Physical Half-Life:
The half-life (t 1/2) of a radionuclide
= the time taken for its activity to decay to 1/2 of its original value.
For example,
2 successive half-lives reduce the activity of a radionuclide by a factor of 2 x 2 = 4.
10 half-lives reduce the activity by a factor of 210 = 1000.
This half-life is more properly called the physical half-life.
Characteristic for the radionuclide.
Unaffected by any agency such as heat, pressure, electricity, or chemical reactions.
Examples for the physical half-lives:
Nuclide Half-life
Krypton -81m 13 s
Rubidium -62 1 min
Nitrogen -13 10 min
Carbon -11 20 min
Gallium -68 68 min
Fluorine -18 11 min
Technetium -99m 6h
Iodine -123 13 h
Molybdenum-99 67 h
Indium -111 67 h
Thallium -201 73 h
Gallium -67 78 h
Xenon -133 5 days
Iodine -131 8 days
Technetium-99 200 000 years

Exponential Decay:
Activity of a radioactive sample never falls to Zero.
The graph of activity versus time, both being plotted
on linear scales exponential curve.
If, the activity is plotted on a logarithmic scale,
straight-line (Fig. 5.1).
Such graphs are useful in calculating:
1. The activity of prepared sample at a particular
time; and
2. Time necessary to store radionuclide waste.
Effective Half-Life:
For imaging: the pharmaceutical is 'labeled' with the radionuclide forming the
radiopharmaceutical
The metabolic properties of the pharmaceutical ensure that it concentrates in the tissues or
organofinterest.
The pharmaceutical alone is eliminated from the tissues, organ, and whole body by metabolic
processes&excretionbiologicalhalflifetbiol
Theradionuclideactivityalonedecayswithitsphysicalhalflifetphys.
Theactivityoftheradiopharmaceuticaladministeredinbodydecreasesduetothesimultaneous
effectsof:
a) Radioactivedecay
b) Metabolicturnoverandexcretion.

The activity can be regarded as having an effective halflife teff which is shorter
thaneitherthebiologicalorphysicalhalflives.
1/teff=1/tboil+1/tphys
Theeffectivehalflifedependson:
a) Theradiopharmaceutical. c) Personalvariations.
b) Theorganinvolved. d) Healthstateoftheorgan.
8.3 RADIOPHARMACEUTICALS
Desirable properties of a radionuclide for imaging are:
1. A physical half-life of a few hours, similar to the time from preparation to injection.
If the half-life is too short, much more activity must be prepared than is actually injected.
2. Decay to a stable daughter or one with a very long half-life (e.g. 200 000 yrs for 99Tc).
3. Emit rays (which produce the image) but no or particles or very low-energy photons.
Decay by isomeric transition or electron capture is preferred.
4. Emit gamma rays of energy 50-300 keV (ideally 150 keV)
high enough to exit the patient but low enough to be easily collimated and easily measured,
being largely absorbed in the collimator septa and the crystal.
5. Ideally emit monoenergetic gamma rays so that scatter can be eliminated by energy
discrimination with the pulse height analyzer.
6. Be easily and firmly attached to the pharmaceutical at room temperature & not affect its
metabolism.
7. Be readily available on the hospital site.
8. Have a high specific activity.

In addition, the radiopharmaceutical should:
1. localize largely and quickly in the 'target';
2. be eliminated from the body with an effective half-life similar to the duration of the
examination patient dose;
3. have a low toxicity;
4. form a stable product both in vitro and in vivo
5. Be readily available and cheap per patient dose.
Technetium generator:
99m
Tc is used in 90% of radionuclide imaging as it
fulfills most of the above criteria:
1. With its gamma energy of 140 keV easily
collimated and easily absorbed in thin crystal
good spatial resolution.
2. With its short half-life and pure gamma emission
a reasonably large activity can be administered
reducing noise.
99m
Tc is supplied in a generator shielded with lead.
The generator contains an alumina exchange
column on which has been absorbed a compound of
the parent 99Mo (produced in nuclear reactor & it's
half-life = 67 h).
At the time of arrival, the activity of the
'daughter' 99mTc has built up to its
maximum, equal to that of the parent 99Mo.
The daughter is decaying as quickly as it is being formed by the decay of its parent
transient equilibrium with the parent.
The daughter and parent decay together with the half-life of the parent, 67 h
The technetium is washed off (eluted) as sodium pertechnetate with sterile saline
solution flows under pressure from a reservoir through the column into a rubber-capped
sterile container.
Elution takes few minutes leaves behind Molybdenum "firmly attached to column"
The eluent decays with its own half-life of 6 h.
The 99mTc in the column regrows with the same half-life of 6 h.
After 24 h (4 x 6 hours) the activity has grown again to a new maximum (equilibrium)
value. (After 6 h it has reached 50% of the maximum; after 12 h, 75% and so on.)
Figure 5.10 plots the activity of 99Mo (dashed line) and 99mTc (solid line) against time,
following the first elution (1) at time 0.
Fig. 5.10
Decay of activity of 99Mo and growth and
regrowth of activity of 99mTc in a generator which
is eluted daily.

Elution can be made daily (& if necessary, the column can be eluted twice daily) - though it
will be seen that the strength of successive eluents (2, 3, . . .) diminishes in line with the decay
of 99Mo
after a week, the generator is replaced and the old one is returned for recycling.
Uses of Technetium-99m
Sodium pertechnetate-99m "have similarity to iodide and chloride ions":
1. Thyroid (trapped but not fully metabolized).
2. Gastric emptying studies (mixed with bran porridge)
3. Gastric mucosa (localization of Meckel's diverticulum)
4. Testicular imaging.
5. Salivary glands.
6. Cerebral blood flow.
Technetium can easily be labelled to a wide variety of useful compounds:
1. Hexamethyl propylene amine oxime (HMPAO) cerebral imaging;
2. Dimercaptosuccinic acid (DMSA) - Mercaptoacetyletriglycine (MAG3) renal study
3. Iminodiacetic acid (HIDA) biliary studies;
4. Human serum albumin (HSA) colloidal particles, 0.5 m in size, phagocytosed in
reticulo-endothelial cells imaging of liver, spleen and red bone marrow;
5. HSA Macroaggregates - 15-100 m microspheres temporarily block a small fraction of
the capillaries in lung perfusion imaging;
6. Diethylene Triamine Pentacetic Acid (DTPA) aerosol (5 m particles) lung ventilation
studies
7. Diphosphonates bone imaging, being taken up in sites of bone repair;
8. Autologous red cells cardiac function;
9. Heat-damaged autologous red cells imaging the spleen;
10. Sestamibi or tetrofosmin cardiac perfusion imaging.
Positron emitters are needed for PET , the commonest PET radionuclide is 18F (half-life
110 min) and often used in the form 18F 2-fluoro-2-deoxyglucose (2-FDG ) for brain & heart.
Other radionuclide are 11C , nitrogen-13,oxygen-15 and rubidium-82 82Rb , these have very
short half-life 20 min , 10 min , 2 min , 75s respectively
82Rb produced from strontium-82 generator and last about 1 month. Used for myocardial
perfusion imaging
Technetium-94m produced by cyclotron with half life 50 min , and used to label many
pharmaceuticals already available for 99mTc imaging.
Preparation of radiopharmaceuticals
By simple mixing at room temperature:
Radionuclide (e.g. 99mTc) + Pharmaceutical (e.g. MDP) + other necessary chemicals
Shielded syringes transfer the components between sterile vials.
Manipulations under sterile conditions in a 'workstation' glove box or laminar downflow
cabinet.
Room is under a positive pressure of filtered sterile air.
Impervious surfaces: continuous floors- gloss-painted walls- Formica-topped benches.
Entry is via an air lock and changing room.
The pharmacy must meet the conditions of both the Medicines Act and the Ionising Radiations
Regulations in the UK.

Other radionuclides and their uses
Iodine Trapped and metabolized by the thyroid, which was the organ first imaged.
131I, is the first radionuclide used for imaging:
Cheap.
Highly reactive.
Excellent label.
It is produced in a reactor and has a long shelf life (half-life 8 days).
Disadv. Emits beta rays as well as rather energetic (mainly 364 keV) rays.
123I has largely been replaced iodine-131 (131I):
More expensive.
Cyclotron produced.
Has a half-life of 13 h.
Decays by electron capture, emitting 159 keV gamma rays.
125
I is cheaper than 123I, but have:
Long half-life (60 days).
Low photon energy (around 30 keV).
Iodine may be labeled to Hippuran for renal studies, being cleared by both
glomerular nitration and tubular secretion.
Xenon-133 Reactor produced.
(133Xe) Half-life = 5.2 days.
Emits beta rays and rather low-energy (81 keV) gamma rays.
It is an inert gas, although somewhat soluble in blood and fat.
Used, with rebreathing, in lung ventilation imaging.
Krypton- Another inert gas.
81m (8lmKr) Generator produced the generator is eluted with compressed air.
Half-life = 13 s.
Emits 190 keV gamma rays.
The patient inhales the air-81mKr mixture in pulmonary ventilation studies.
The short life of the parent (81Rb, 4.7 h) presents transport difficulties and means
it must be used the day it is delivered
Gallium-67 Cyclotron produced.
(67Ga) Half-life = 78 h.
Decays by electron capture, emitting gamma rays of three main energies.
Gallium citrate used to detect tumors & abscesses as it binds to plasma proteins.
Indium-111 Cyclotron produced.
(111In) Half-life = 67 h.
Decays by electron capture, emitting 173 and 247 keV gamma rays.
used to label white blood cells and platelets for locating abscesses and
thromboses, respectively.
Indium- Sometimes used instead of 111In.
113m Generator produced.
113m
( In) Half-life = 100 min.
Emits only gamma rays, but they have a high energy (390 keV).
Thallium- Cyclotron produced.
201 (201Th) Half-life = 73 h.
Decays by electron capture, emitting 80 keV X-rays.
As an analog of potassium used as Thallous chloride in myocardial perfusion
imaging, where its half-life is well suited to repeated imaging over a few hours

Quality control includes testing for:
1. Radionuclide purity:
Testing for contamination with 99Mo, which give unnecessary dose to the patient
By measuring radiation after blocking off the gamma rays from 99mTc with 6mm lead;
2. Radiochemical purity:
Testing for free pertechnetate in a labeled compound by chromatography;
3. Chemical purity:
Spot colour test for alumina, "which would interfere with labeling";
4. Sterility testing and pyrogens testing: available only retrospectively;
5. Response of the radionuclide calibrator: (see later).
8.4 GAMMA ( PLANAR ) IMAGING

The patient is given an appropriate radiopharmaceutical, usually by intravenous
injection.
(a) Thefunctionofthepharmaceuticalistoconcentrateintheorganortissuesof
interest.
(b) Theroleoftheradionuclideistosignalthelocationoftheradiopharmaceutical
bytheemissionofgammarays.
Theradionuclidemostcommonlyused,99mTc,emits140keVgammarays.
raysarecollectedbyagammacameraimageoftheradioactivedistributionona
monitorscreen.
SincegammarayscannotbefocusedMultiholecollimatorisused.
Agammacamerahasheavyleadshieldingattenuatebackgroundgammaradiation.

The Multihole Collimator

Thisconsistsof:
1. Leaddisk:25mmthickand400mmindiameter.
2. Itisdrilledwith20000circularorhexagonalholes,each2.5mmindiameter.
3. Theyareseparatedbysepta0.3mmthickwhichabsorbtheraysattemptingtopass
throughthemobliquely.
(Thehalfvaluelayer(HVL)ofleadfor99mTcgammaraysis0.3mm.)
Each hole only accepts gamma rays from a narrow channel, thus locating any
radioactivesourcealongitslineofsight.
The crystal
Instead of a large number of tiny detectors, behind the collimator there lies a single
largephosphorcrystal500mmindiameterand912mmthick.
ItismadeofSODIUMIODIDE(activatedwithatraceofthallium).
NaIhaveahighatomicnumber(Z=53)anddensityitabsorbsabout90%of 99mTc
gammarays,principallybythephotoelectricprocess;butonly30%of131Irays.
Itisfragile,hygroscopicandeasilydamagedbytemperaturechanges.
ToprotectitisencapsulatedinanaluminumcylinderwithoneflatPyrexface.

Mechanism:
The crystal absorbs photon (photon a) flash of light "dashed lines".

The flash contains say 5000 light photons travel in all directions and last less than a
microsecond about 4000 emerge from the farther flat surface.
The distribution of light leaving the face of the crystal depends upon which collimator hole
the gamma ray passed through.
Light photons are measured by up to 91 matched photomultipliers, closely packed in a
hexagonal array.
A flat transparent plate "light guide" maximizes transfer of light from the crystal to the
photomultipliers.

Photomultipliers ( PMT )
Each photomultiplier consists of:

An evacuated glass envelope.
Photocathode coated with a material which absorbs light and emits photoelectrons: one
electron per 5 or 10 light photons.
Electrons are accelerated toward a positive anode.
En route electrons impinge on a series of dynodes "connected to progressively increasing
positive potentials".
When each electron strikes a dynode it knocks out 3-4 electrons accelerated to strike the
next dynode.
After 10 stages, the electrons have been multiplied by a factor 410 106 .
Thus each initial flash of light produces a pulse of charge or voltage large
enough to be measured electronically.
The amplification factor is very sensitive to changes in the overall voltage across the PMT
(about 1 kV) has to be highly stabilized.
Pulse arithmetic (position logic)
the light pulse illuminates differentially the array of photomultiplier tubes. It produces the
largest electrical pulse in photomultiplier (No. 2) nearest to the collimator hole through which
ray "a" passed - and smaller pulses in adjacent photomultipliers.
The 'pulse arithmetic circuit' is a microprocessor chip, which combines the pulses from all the
photomultipliers according to certain equations yields three voltage pulses (X, Y, Z) which
are proportional to:
1. The horizontal "X" and vertical "Y" coordinates of the light flash in the crystal
the hole through which the gamma ray has passed and so the position in the body of the
radioactive atom that has emitted it (X, Y).
2. The photon energy of the original gamma ray (Z).
The pulses from all the photomultipliers are summed measuring all the light produced
by the gamma ray in the phosphor crystal.
The size or 'height' of the Z-pulse (in volts) is proportional to the ray energy absorbed
(in keV).
The pulse height is generally stated in kiloelectronvolts.
Pulse height spectrum:
The account so far ignores two facts:
1. Scattered Gamma rays gamma rays originated outside the line of sight of the collimator
can enter a collimator hole.
Scattered rays will have reduced energy (ray "c" )
2. Gamma rays may lose energy through Compton interactions in the crystal before being
absorbed photoelectrically pulses of reduced height.

Z-pulses vary in height.
For 99mTc, Fig. 5.4 illustrates a sequence

of such pulses; it plots the height
(kiloelectronvolts) of pulses coming in
succession from a photomultiplier
coupled to a phosphor crystal against
time.
Figure 5.5 plots the relative number of

pulses having various heights or energies,
in a given period of time.
FWHM, full width at half maximum.

PHA, pulse height analyzer
This pulse height spectrum is made up of:
Photopeak: on the right,

Comprising pulses produced by complete photoelectric absorption in the crystal
of gamma ray photons which have come from within the patient without
suffering Compton scattering.
They vary in height, within a 'window' shown by horizontal dashed lines in Fig. 5.4.
This range of energies in the photopeak is due to statistical fluctuations in both:
1. Number of light photons produced in the crystal by each gamma ray

photon.
2. Number of electrons produced in the photomultiplier by each light photon.
This also causes the short tail on the right.
Tail, on the left,

Containing pulses of lower energy
producedbyrayssufferedComptoninteractionsinthepatientorthe
crystal.
Subsidiary 'iodine escape peak'
At 30 keV below the photopeak.
Due to some of the K-characteristic rays from iodine escaping from the crystal.
Only pulses in the photopeak are of use in locating the source of the radioactivity
in the patient, A pulse height analyzer is used to reject those in the Compton tail

Pulse height analyzer:
TheZpulsesenterapulseheightanalyzerrejectpulseswhichare(a)lowerthana
presetvalueor(b)higherthananotherpresetvalue.
Itallowsonlypulseswhichliewithinawindowof,say,10%ofthephotopeakenergy.
Anyhighenergybackgroundradiationisalsorejected.
Thepulsessoselectedarereferredtoas'counts'.
In the case of 99mTc the window might be set at 126-154 keV, centered on 140 keV.
Because a 140 keV photon will lose only 10 keV of energy even when scattered through
45 some scattered photons may 'pass through' the window & produce counts
degrade the image.
For 67Ga or 111In 2 or 3 windows must be used each selecting one ray energy.
TheX,Y,andZpulsesarenextapplied:
1. Directlytoamonitorforvisualinterpretation"inoldermachines",or
2. Newersystemsanalogtodigitalconverters(ADCs)intoacomputer,enables:
Dynamicandgatedstudies.
Imageprocessing.
The monitor
TheXandYpulsessteertheelectronbeaminthemonitortube.
If and only if the Zpulse has passed through the window of the pulse height analyzer a
pinpointoflightappearmomentarilyonthescreenattheXandYcoordinatescorresponding
totheheightsoftheXandYpulsesandthepositionsoftheradioactiveatomemittingeach
gammaray.
Thousandsofsuchdots,equallybright,makeuptheimage.

Twotypesofmonitorareused:
1. Longpersistencescreen:
Eachdotoflightpersistsforasufficientlylongtimeforavisualimagetobuildupofthe
radioactivityinthepatient.
Theimagequalityisnotgoodenoughfordiagnosisonlyhelpfulforpositioningthe
patientandmakingsurethattheactivityhasbeentakenup.
2. Shortpersistencescreen:ofhighquality;
Eachdotquicklydiesawaybutcanbecapturedonfilm,usingafilmcamera.
Typesoffilmcamera:
1. Polaroidfilmcamera:
Adv.: highspeedhighresolutionprocessedveryquickly.
Disadv: expensivelowcontrastlimiteddynamicrange.
2. Multiformatfilmcamera:
Employs singlecoated cut transparency film, formulated for Xray automatic
processor.
Anumberofimagescanberecordedinsequencesidebysideonasinglefilm.
Ifthefilmisexposedfortoolong,itwillbesaturated;
iffortooshorttime,theimagewillbeunderexposed,faint,andgrainy.
Typically, a total of 0.5 million counts is acquired for each image,
takingabout5min.

The computer
After digitization with an ADC the X-, Y- and Z-pulses pass to a computer records each
Z-pulse as a count in a memory location corresponding to the X- and Y-coordinates.
As the pulses arrive at random, the counts build up in each location stored as a digital image
in a 128 x 128 matrix.
When complete, it is scanned by a television raster and displayed on a monitor screen as a
128 x 128 matrix of 3mm pixels.
The brightness of each pixel depends on the number of counts stored in the corresponding
memory location, i.e. to the number of gamma rays which have emanated from the
corresponding area of the patient and to the activity therein.
If counts were acquired for too long, the memory locations would become full
more or less uniformly bright monitor screen me.
If they were acquired for too short time grainy image.
Typically, a total of 0.5 or 1 million counts are acquired for each image frame
Stored image can be manipulated and improved, as described before:
Background suppression - Blurring reduction - Contrast enhancement by windowing - Noise
reduction by averaging - Pixel interpolation "to increase matrix" Extraction of Quantitative
data Image subtraction or addition for two radionuclides.
COLLIMATORS:
Fig. 5.6 Types of collimator

(a) Parallel hole, (b) divergent hole, (c)
convergent, hole, and (d) pinhole.
Parallel hole Divergent hole Convergent hole Pinhole

smaller camera
Camera 400 mm e.g. mobile
camera
Same at all
FOV Large Small
distances
Holes diverge Holes converge
holes
toward pt. toward pt.
Magnified &
Image Same size Minified Magnified
inverted
Superficial
Imaging large
Usage Children small organs
organs e.g. lung
e.g. Thyroid
Sensitivity is Both FOV & sensitivity vary with
Characteris
same at any distance.
tics
distance Both have geometrical blurring.
Resolution
with Resolution
collimator- toward edge
object distance

The sensitivity "efficiency" of collimator
Measures the proportion of gamma rays, falling on collimator from all directions
that pass through the holes.
It is only a fraction of a percent.
The sensitivity is greater with: The more holes - the wider & shorter they are.
Sensitivity radionuclide needed to be administered patient dose.
Spatial resolution:
Def.: the ability of the system to produce distinct images
of 2 small radioactive sources close together.
Figure 5.7 illustrates one of the holes in a collimator, lying between
the crystal and the surface of the patient.
rays originating between the inner dotted lines 'illuminate' the
whole of the 'visible' crystal surface produce a maximum signal.
rays originating outside the outer dashed lines cut off by the
lead septa produce no signal.
rays originating from any points along the solid lines illuminate
exactly half of the crystal face.
R is the spatial resolution of the collimator; R resolution
Factors affecting the spatial resolution:
Distance from collimator face R i.e. worse resolution.
Resolution is best close to the collimator.
Wider or shorter holes sensitivity but spatial resolution.
The better the resolution, the less the sensitivity & a compromise must be made.
This is a major limitation to the performance of a gamma camera.
Types of collimator:
Low energy collimators have thin septa (0.3 mm) & more holes.
can be used with gamma rays of up to 150 keV, e.g. with 99mTc
Medium-energy for use up to 400 keV, e.g. with 111In, 67Ga, and l31I.
have thicker septa (1.4 mm) and consequently fewer holes
lower sensitivity.
General purpose have 20000 holes each 2.5 mm diameter.
Resolution (@ 10 cm from the face) = 9 mm.
Sensitivity =150 cps/MBq.
high-resolution have more and smaller holes.
lower sensitivity amount of radioactivity and the imaging times.
high-sensitivity have fewer and larger holes.
poorer resolution.
used in dynamic imaging where short exposure times are necessary.
Types of gamma camera:

General-purpose 400 mm camera optimized for 99mTc.
A mobile gamma camera for cardiac imaging "easy to position, used ICUs"
250 mm field - 5 mm thick crystal good resolution with 80 keV rays from 201T1.
A large field of view (500 mm) camera bone and gallium imaging.
A scanning gamma camera
The head translates along the patient image matrix from 128 x 128 to 128 x 512.

Dynamic imaging
The function of kidney, lungs, heart, etc., can be studied by acquiring a series of separate
images (frames) in suitably rapid succession. The images can be retrieved from the computer
store in sequence and either (a) recorded side by side on a single film in a multiformat camera
or (b) repeatedly displayed seriatim on the screen as a cine loop.
Areas of interest (e.g. kidneys) can be defined by cursors and the total counts therein
measured on each frame and displayed as a function of time (e.g. a renogram).
An area of interest can be defined between the kidneys used for background
subtraction.
In multiple-gated cardiac studies ( MUGA ):
Separate frames, each lasting 40 ms, are acquired at 20-30 different points in each
cardiac cycle. Each sequence is initiated by the R-wave from an ECG.
At each such point, several hundred successive images are added, pixel by pixel, to improve
statistics and reduce noise.
The images multiformat mode or cine loop of the pulsating heart.
Quantitative data about heart function can be extracted.
8.5 TOMOGRAPHY WITH RADIONUCLIDES

Conventional planar gamma imaging produces a two-dimensional projection of a three-
dimensional distribution of a radiopharmaceutical , so the images of organs are
superimposed, depth information is lost and contrast is reduced.
Emission tomography, uses the same principles as X-ray or transmission computed
tomography (CT) to reconstruct the images of a series of parallel body sections. There are
two methods, single-photon emission computed tomography (SPECT or SPET) and PET.
Singlephotonemissioncomputedtomography(SPECT):
Its a gamma camera with a parallel hole collimator rotates slowly around the patient. Every
6, the camera halts for 20-30s and acquires a view of the patient; 60 views with about 3
million counts are acquired in an overall scanning time ( around 30 min ).
Acquisition time is halved or the sensitivity improved by using a dual or triple-headed camera.
Gamma ray attenuation that takes place in the patient would result in fewer counts from the
centre than from the edges, in reconstructing the image. An approximate method of attenuation
correction is to add the counts, pixel by pixel, in each pair of opposing views where the
combined counts are then more nearly the same.
A mathematical 'filtering' process uses the 60 sets of data (or two-dimensional projections) are
synthesized into a set of transverse images by methods similar to those used in X-ray CT -
filtered back-projection , YET an area of very high activity (e.g. the bladder or the injection
site) can cause streaking of the image and even hide adjacent areas of activity.
Iterative reconstruction, An alternative algorithm, whereby the image activity content is
adjusted in steps until the calculated activity in the image is as close as possible to the
measured activity (counts).
Advantages of iterative reconstruction:
- It is less sensitive to streaking artefacts.
- Can correct accurately for attenuation.
- Insensitivity to noise.
- The ability to reconstruct an image even when data acquisition is incomplete.

A stack of 20-30 parallel transverse sections can be imaged simultaneously in SPECT.
If required, sagittal, coronal and oblique sections can be derived from the transverse
sections. It is also possible to display a continuously rotating three-dimensional
representation, as in multislice X-ray CT.
Noise is high because of the limited number of counts in each voxel (The SPECT images can
be severely photon-limited). To reduce noise :
- Make the slices thicker, but that would increase partial volume artefacts.
- Limiting the pixel matrix to 64 x 64 and the number of views to 60 (30 pairs)
- Mathematical filtering, but again at the cost of reduced spatial resolution.
- Using iterative reconstruction.
Spatial resolution in the reconstructed image may be no better than 18mm. This is worse than
a conventional gamma image and much worse than X-ray CT.
Automatic balancing of the photomultipliers is desirable because the image reconstruction
process magnifies the effect of noise and also of any non-uniformity in the field.
The camera must move on a sufficiently large circular orbit to miss the patient's shoulders. An
elliptical orbit is sometimes used to minimize the gap between the collimator and the patient
and so improve resolution.
Using three or four gamma cameras equally spaced around the rotating gantry, will improve
sensitivity, and can be used for faster patient throughput or to improve the resolution.
SPECT studies can be presented either as a series of slices or as a three-dimensional display.
A applications of SPECT , includes:
- Thallium studies of myocardial infarctions and ischemia
- Quantitative cerebral blood flow.
- Detection of tumors and bone irregularities
Cardiac gated myocardial SPECT ( MUGA ) can be used to:
- Obtain quantitative information about myocardial perfusion
- Thickness of the myocardium,
- Left ventricular ejection fraction,
- Stroke volume and cardiac output.
Positronemissiontomography(PET)
ThemostcommonpositronemitterusedinPETis18F.
When 18Femitsapositivebetaparticle(positron),thistravelsforabout2mmthrough
the patient before being annihilated by a negative electron. Their combined mass
(positron plus electron) is converted into two energetic photons, each of exactly 511
keV,emittedsimultaneouslyandinpracticallyoppositedirections.
PETimagingisbasedondetectingthesetwoannihilationphotonsincoincidenceand
identifyingtheirorigininthepatienttolocatetheradioactivesource.
A positron or PET camera comprises a ring or hexagon surrounding the patient and
composedofaverylargenumberofsolidscintillationdetectors(1000020000),often
of bismuth germanate (BGO). OR lutetium oxyorthosilicate (LSO) or gadolinium
oxyorthosilicate(GSO).

Theidealchoiceofscintillationdetectormaterial,wouldbe:
- Readilyavailable.
- Cheaptoproduce,and
- Easytomanufactureintocrystalblocks
AND
- Hashighdetectionefficiency,toabsorbandconvert511keVphotonsintolight
- Hasaveryshortscintillationdecaytime.
- Hasgoodenergyresolution.
PETdetectorsaremadeinblockformat,coupledtophotomultipliertubes.
If,asinFigure8.17,theannihilationphotonsfromtheeventat(a)enterdetectorsA
and B, they produce simultaneous (coincident) pulses, which are then accepted and
combinedbytheelectronics.Anypulsesthatdonotcoincideintimeareignoredbythe
electronics, as are any single photons of background radiation. These two detectors
thereforemeasureonlythesumoftheactivitypresentalongalineAB,calledtheline
ofresponse(LOR)andsimilarlyforeachofthemanypairsofdetectorswhichisjust
theinformationrequiredfortomographicreconstruction,asinCTorSPECT.However,
asthedetectionmechanismisdifferent,soisthedataacquisition.

Figure8.17 Figure8.18
Figure8.17 Apositronemissiontomographyimagingsystemshowingsomelinesofresponse.
TheeventataisdetectedatAandBincoincidence.
Figure8.18 Differentcoincidenceevents:a,truecoincidence;b,randomcoincidence;andc,
scattercoincidence.
Therearethreetypesofcoincidencesthatcanoccurtrue,random,andscatter,
Toreducetherandomandscattereventsfromadjacent.rings,narrowleadortungsten
septacanbeusedbetweeneachringofdetectorstoactlikeaparallelantiscattergrid
inradiography.
InmodernPETscannerswithblockdetectorssetinaseriesofrings,dataacquisitionis
fastandcontiguous.TheaxialFOVisgivenbythewidthofthecompletesetofrings.As
in CT, the patient is moved along the axis of the. Scanner to obtain the next set of
sequentialtransverseslices.

Eachdetectorpairreceivingacoincidencefromthesamelocationinthepatientwill
contributetoapointonthesamehalfsinewave.Thusthecompositeintensityplot
iscalledasinogramand comprisesanumberofblurredsinewaveswith different
amplitudesandphases.
ThefanangleofLORsfromanygivendetectorisplottedasadiagonalacrossthe
sinogram.EachhorizontalrowofthesinogramcorrespondstoalltheLORs,parallel
to each other at the same angle of orientation, and can be converted into the
projectionofthesliceassociatedwiththatangle.
Eachtransverseslicethroughthepatienthasitsownsinogram,whichcomprisesall
thedataforthatsliceacrossallprojectionangles.(contrastswithSPECT).Thesetof
acquired PET sinograms is computeranalysed to give a series of projection views
likethoseacquiredforSPECT.
The reconstruction algorithm includes a correction for tissue attenuation. Because
thecombineddistancetravelledintissuebythetwophotonsisthesamewhether
theannihilationtookplace.
Attenuation depends only on the patient's dimensions and tissue structures. A
transmissionscanofthepatientenablesthiscorrectiontobemade.Thisisusually
madeimmediatelybeforeoraftertheemissionscanusingalonglivedradioactive
source(68Georcaesium137,137Cs)locatedinthescannergantry(ortheCTscanfor
PETCT).Thesourceisrotatedaroundthepatientandthepaireddetectors'response
is compared with an earlier scan made without the patient. As the attenuation
correctioniscomparativelylargeat511keV,itsignificantlyimprovesthecontrast
anddetailinthe PETimages. ,
When the detectors are in a circle, the LORs of the detector pairs are bunched
togetheratthesidesofthegantryandmoreuniformlyspacedatthecentre.Anarc
correction compensates for this effect, which is more important for large organs
wheretheLORsarelikelytobeawayfromthecentre.
Data acquisition depends on the scanner and can be in two dimensional modes,
using septa and producing sinograms. However, greater sensitivity up to 6 times
thatoftwodimensionalcanbegainedbynotusingseptaandcollectingdatafrom
all the rings at once in socalled threedimensional mode ( sometimes called a
Michelogram),althoughthisobviouslyincreasesthescatterfraction,actuallyfrom
10toabout40%.
Twodimensionalandthreedimensionalrefertothedataacquisitionmodeandnot
to image reconstruction; either mode can be used to produce threedimensional
imagesfromthesetsoftransverseslices,asforCTandMRI.
The main positron emitter used in PET imaging is 18F (halflife 110 min), primarily
usedtolabeldeoxyglucose(FDG).Otherusefulradionuclidesare 68Ga(68min)and
82
Rh(1min),andthesetwoareproducedbyradionuclidegenerators.
Theeffectivedosetothepatientismuchthesameasinroutinegammaimaging,as
the short halflife of the positron emitters compensates for the beta energy
deposition.

DualheadedconventionalgammacamerasusedforplanarimagingorSPECTcanhave
integratedcoincidencecircuitrytoenablethemtofunctionalsoasPETscanners.Data
areacquiredbyrotatingthecamerasaroundthepatient withoutthecollimators.
Disadvantages:
- Thesensitivityofthesodiumiodidecrystalsforthe511keVphotonsismuchlower
thanforBGO,soathickercrystalwillgivebetterresults.
- Higherbackgroundnoiselevelreducesoverallcontrastintheimage.
- PoorspatialresolutioncomparedwithapurposebuiltPETscanner.
IntegratedPETCTsystemsareused.Tobeabletolocateandvisualizethisinformation
within the patient's anatomy. Both detection systems are mounted on the same
support, adjacent to each other, so that the single patient table moves along the
centralaxis.OncetheCTscaniscomplete,thepatienttablemovesintopositionforthe
PETdatacollection;almostperfectmatchingoftheimagesisobtained.
ThecombinedPETCTimagesareparticularlyusefulinoncology,bothfordiagnosisand
for accurate tumor location and followup. Carefully gating image acquisition to the
cardiaccyclecanalsoproduceusefulfusedimagesin cardiology.

8.6 CHARACTERISTICS AND QUALITY ASSURANCE OF THE GAMMA IMAGE
Uniformity of field
Tested by a flood field phantom consists of a flat sealed dish, larger than the field of view
(FOV), filled with 99mTc or its longer lived analog cotalt-57 (57Co).
Should give a uniform image, with and without the collimator in place
A defective photomultiplier seen as a dark area in the image.
A cracked crystal a linear defect.
Slight differences in the performance of individual photomultipliers Non-
uniformity due to:
Isassessedbyinstructingthecomputertocomputeahistogramofthecounts
inindividualpixels.(Asufficientlylongexposureisnecessarytoreducenoise).
Itcalculatesthemean&standarddeviationtypicallytheuniformityis12%.
Modern gamma cameras can be instructed to compensate subsequent images
automaticallyforminornonuniformitiesofthefield.
The detector uniformity of PET scanner is checked using
longlivedsource(68Geor137Cs)mountedonthegantryand
rotating it around the field to expose all the detectors
uniformity, OR standard phantom with centrally located
positron source. The sinogram should be uniform, any
malfunction will appear as streak covering all the angles
witheachdetectorblock.
Spatial resolution:
Intrinsic resolution:
Refers to THE CAMERA (crystal, photomultipliers, and position logic circuits) in the absence of
the collimator and patient.

When a single photon is absorbed at a point in the crystal, the 4000 or so photons of emerging
light only eject a total of 400 or so electrons from the photocathodes of all the photomultipliers.
In Fig. 5.2, photomultipliers Nos. 1 and 3 should receive equal numbers of photons and produce
identical pulses.
BUT, because of the small numbers of light photons and electrons involved significant
statistical variations in the relative numbers and the heights of the pulses produced errors in
the X and Y coordinates assigned to the event blurring
Intrinsic resolution can be improved by using a THINNER CRYSTAL but with consequent reduction
in sensitivity (just as with intensifying screens).
System resolution:
Total blurring due to Intrinsic blurring, Collimator & Scattering of rays in the
patient (according to the same formula as for radiographic blurrings).
Resolution worsens the farther the activity from the collimator. Consequently it is
worse for fat patients than for thin.
Testing the resolution:
Resolution can be tested by imaging a line source
The computer is instructed to plot the counts along a line of pixels at right angles to a thin
tube filled with 99mTc. The graph (Fig. 5.8) is called "line spread function".
[
The line source can be placed:
Against the face of the collimator in air (solid curve).

The spread of the curve measured halfway up, called the 'full width to half maximum' or
FWHM corresponds to R in Fig. 5.7, and is typically 5 mm.
Against the crystal face after removing the collimator (dotted curve).
The FWHM of this curve measures intrinsic resolution, typically 1 - 2 mm.
At 10 cm deep in a scattering medium while using the collimator (dashed curve).

(This depth is chosen, as organs being imaged typically lie 5-10 cm deep)
The FWHM of this curve measures system resolution, typically 10 mm.

Resolution is not improved by using smaller pixel size than 3 mm in a 128 x 128 matrix.
Alternatively, spatial resolution can be tested with a bar test pattern:
It is made of either; strips of lead placed on a flood field phantom or evenly
spaced parallel line sources.
It is placed against the face of the crystal.
This measures the intrinsic resolution typically 3-6 lp \ cm.
In practice the overall system resolution is worse than 1 lp \ cm.
So, the value of imaging lies in evaluating function rather than anatomy
Linearity
Linearity (i.e. lack of distortion) can also be checked by imaging a line source.

Energy resolution
Def.: the ability to distinguish between separate gamma rays of different energies.
Importance:
Better energy resolution better scatter rejection & better spatial resolution
Calculated from FWHM of the photopeak divided by the energy of the photon & expressed
as a percentage
Typically 12% of the peak energy
The pulse height analyzer - in a sophisticated form

called Multichannel Analyzer - can be used to plot
the photopeak (see Fig. 5.5).
Setting a narrower pulse height analyzer window
improves the energy resolution but reduces the
sensitivity and increases imaging time.
The energy resolution is better for high-energy
gamma photons because they each produce more
light photons it is therefore better with 99mTc
than with 201T1.
Temporal resolution: dead time and lost counts
Flashoflightproducedbyagammaphotoninthecrystalhasadecaytimeof0.2s
About 95% of the light has been emitted in 1 s, at which point the pulse is cut off
electronically.Forthatperiodthecountingcircuitdoesnotrecognizeotherpulses,and
issaidtobe'dead'.
Duetothestochasticnatureofradioactivedecay,countsarriveatirregularintervals.
If 2 gamma photon enters the camera during the dead time (indicated by vertical
dashedlinesinthefigure)
thetwoflashesoflightoverlapandtheyaretreatedasone.
Ifthecombinedpulseistoolarge,itwillberejectedbythepulseheightanalyzer.
IftwoComptonscatteredphotons(60and80keV)enterthesystemwithin1sofeach
other recorded as a single photon (140 keV) pass through the pulse height
analyzer&produceaspuriousimageinafalselocationdeteriorationofthespatial
resolution

Lost counts:
Athighcountrates,asignificantproportionofthegammaphotonsaremissed
underestimatedcountrate
Typically there is 20% loss at 40000 cps and more at higher count rates as in cardiac
imaging.

Sensitivity
Thisismeasuredwithasmallversionofthefloodfieldphantom.
ExpressedasTotalcountspersecondpermegabequerelofactivity.
Thecrystalefficiencyisratherhigh,&thecollimatordeterminesoverallefficiency.
Up to a point, using thicker crystal increases sensitivity but poorer resolution; more
importantly, so does using a collimator with larger holes.
Noise: Quantum Mottle
Usingshorterexposurethefloodfieldphantomshowsacharacteristicmottledappearance
"becausethecountsfluctuatefrompixeltopixel".
Thecomputercanbeinstructedtodrawahistogramofcountsperpixelandtocalculatethe
meanandstandarddeviation.
&dividingthemeanbythestandarddeviationgivesthesignaltonoiseratio.
Noiseingammaimagingishighbecauseoftheinherentlysmallsignalfromalimitedamount
ofradioactivity.
NoisecouldbereducedbyusingmoreradionuclideBUT,patientdose.
Theactivityisdistributedthroughthebodyandtypicallyonly20%concentratedintheorgan
ofinterest.
The gamma rays are emitted isotopically and only a small fraction passes through the
collimatorholes(cannotbemadetoowideotherwiseresolutionislost).
Thegammarayscouldbecollectedforanylengthoftimewithoutfurtherdosetothepatient
butimagingtimeislimitedbyabilityofthepatienttostaystill&workload.Theimaging
timemustbeshorterstillfordynamicstudies,especiallycardiacimaging.
Thetotalcountsacquiredperimagearefurthersubdividedamongthe128x128pixels
onlyabout100countsperpixelpixeltopixelnoise=10%.
More important is the number of counts acquired over the blur size R about 1000, with a
noise of 3% hot spots and cold spots of about 10% can detected against the
backgroundactivityinthebody.
This"ContrastResolution"canonlybeimprovedattheexpenseofeitherincreasedpatient
doseorworsenedspatialresolution.
Noiseistheprincipalfactorindeterminingthequalityofgammaimages.
Gammaimagingisthereforesaidtobenoiselimitedordoselimited.
The count rate is maximized and the patient dose minimized by a judicious choice of
radiopharmaceutical.
8.7 DOSE TO THE PATIENT

Dose to an organ
The absorbed dose delivered to an organ by the activity it has taken up increases in
proportion to:
1. the activity administered to the patient and the fraction taken up by the organ;
2. the effective half-life of the activity in the organ;
3. the energy (MeV) of beta and gamma radiation emitted in each disintegration;
4. Also depends on how much of that energy escapes from the organ & not contribute to
the absorbed dose.
All the energy of a beta ray is deposited inside the organ and none escapes.
Some of the energy of a gamma ray is deposited in the organ and some leaves it,
depending on the size of the organ and how energetic the gamma ray is.
5. The additional dose from activity in surrounding tissues.

Effective dose to the body
Unlike imaging with X-rays, the dose delivered by a radionuclide examination is unaffected
by the number of images taken
After an intravenous injection most tissues may receive some dose, but the target organ
and the organs of excretion generally receive the highest doses.
The distribution of a dose is non-uniform and specific to the examination, but an average dose
to the body as a whole can be calculated the effective dose (ED).
Typical activities and doses
Most investigations deliver an ED of 1 mSv or less no greater than the variation, from
place to place and individual to individual, in the annual dose of natural radiation.
Some, such as bone or static brain imaging, deliver doses in the region of 5 mSv.
Few examinations, such as tumor or abscess imaging with 67Ga, deliver higher doses
undertaken only when other imaging modalities are inappropriate.
Typical activities and doses
Site Agent Activity (MBq) Effective dose (mSv)

99m
Bone Tc phosphonate 600 5
99m
Lung ventilation T DTPA aerosol 80 0.6
81m
Kr gas 6000 0.1
99m
Lung perfusion T HA Macroaggregates 100 1
99m
Kidney T DTPA gluconate 80 1
99m
T MAG3 100 1
67
Tumor GaGa3+ 150 18
In order to minimize patient dose, patients should drink a good deal of water and
empty the bladder frequently to reduce the dose to the gonads and pelvic bone
marrow.
Theactivityofeachadministrationofradiopharmaceuticaliskeptwithinthelimitsset
bytheAdministrationofRadioactiveSubstancesAdvisoryCommittee(ARSAC)ofthe
UKDepartmentofHealth,andchecked&recordedbeforeadministration.
Thephialisplacedinthe"well'ofalargereentrantionizationchamber,knowas:
Theradionuclideordosecalibrator
The ionization current produced by the gamma rays is:
Proportional to the activity of the sample.
Depends on the gamma energy and half-life of the radionuclide.
The radionuclide is entered on the control panel and the activity in MBq is displayed on a
digital read-out.
The accuracy of the radionuclide calibrator must be checked regularly using a reasonably
long-lived source, such as 57Co.
The calibrator can also be used with a lead sleeve to check for the higher-energy gamma rays
from molybdenum impurity.

8.8 PRECAUTIONS TAKEN IN THE HANDLING OF RADIONUCLIDES
When handling radionuclides, in addition to the hazard from external radiation there is also a
potential hazard from internal radiation due to accidental ingestion or inhalation of the
radionuclide or its entry through wounds.
Generally, the risk from contamination is greater than that from external radiation.
It is therefore important to avoid contamination of the environment, the workplace, and
persons, and to control any spread of radioactive materials.
Segregation
A nuclear medicine facility must have separate areas for:
(a) Preparationandstorageofmaterials. (d) Imaging.
(b) Injectionofpatients. (e) Temporary storage of radioactive
(c) Patientstowait. waste.
Patients containing radioactivity are a source of external radiation should be spaced apart in
the waiting area.
Departmental layout should make use of the "inverse square law" to reduce the effect of
background radiation from other patients and sources, particularly in the imaging areas.
Personal protection
Use should be made of distance, shielding, and time.
Staff should only enter areas where there is radioactivity when it is strictly necessary; all
procedures must be carried out expeditiously and efficiently.
Departmental local rules must be followed.
Some general guidance follows.
1. Radionuclidesarecontainedinshieldedgeneratorsorinbottlesinleadpots.
2. Wherefeasible,bottlesandsyringesarehandledwithlonghandledforceps(tongs).
3. Manipulations, such as the labeling of pharmaceuticals and the loading of syringes, are
carriedoutwiththearmsbehindaleadbarrierwhichprotectsthebodyandface,andover
atray,linedwithabsorbentpaper,tocatchanydrips.
4. Syringes are protected by heavy metal or lead glasssleeves(which can reduce radiation
dosesby75%)&transportedinspecialcontainersoronakidneydish.
5. Before injection, syringes are vented into swabs or closed containers and not into the
atmosphere.
6. Leadrubberapronsareineffectiveagainstthehighenergygammaraysof99mTc.
7. Toavoidaccidentalingestionwaterproof(doublelatex)surgicalglovesarewornwhen
handingradionuclides.
Cutsandabrasionsmustbecoveredfirst.
8. Theremustbenoeating,drinking,orfacialcontact.
9. Handsandworksurfacesareroutinelymonitoredforradioactivecontamination.
10. TheairinRadiopharmaciesmayalsobesampledandmonitored.
11. Staff will be monitored for external radiation doses to the body and possibly the hands.
Theymayalsobemonitoredforinternalcontamination.
12. Swabs are taken from the workstation to monitor for radioactive and bacterial
contamination.
13. Hands should be washed regularly at special wash basins. Where necessary, and
particularlyafterspills,decontaminationmaybecarriedout.Thisnormallyinvolvestheuse
ofwater,milddetergents,andswabs,whicharethensealedinplasticbagsanddisposedof
asradioactivewasteinmarkedbins.
14. Any use of a nail brush should be gentle; if contamination is obstinate, special detergent
solutionsmaybenecessary.

Patient protection
Every radionuclide should be checked for activity before administration, using a radionuclide
('well') calibrator.
The patient's identity must he checked against the investigation to be made and the activity to
be administered, and this must be recorded.
Particular care should be taken to avoid contamination during oral administrations.
Special circumstances apply for pregnant patients and those with babies they are breast-feeding.
Dealing with a radioactive spill
In the case of a radioactive spill, vomiting, incontinence, etc.:
1. Clear the area of non-essential persons.
2. Wearing gloves, aprons, and overshoes.
3. Mop the floor with absorbent pads and seal the swabs in designated plastic bags. If
necessary, continue with wet swabs.
4. Continue until monitoring shows the activity to be at a satisfactorily low level.
5. If necessary, cordon off the area or cover it with impervious sheeting until sufficient decay
has occurred.
6. Contaminated materials are treated as waste.
Disposal of radioactive waste:
These follow the two principles of:
Containment and decay; &
Dilution by dispersal to the environment.
Special rules and authorizations cover the accumulation, storage, and disposal of radioactive
waste.
Every hospital is subject to strict limitations on the amount which can be disposed of by each of
the following routes.
Gaseous waste can be vented to the atmosphere:
In lung ventilation studies, 133Xe and 99mTc aerosols should be exhausted to the exterior of the
building; this is not necessary with the very short-lived 81mKr.
Aqueous liquid waste well diluted with water disposed of via designated sinks or
sluices with drains running direct to the foul drain.
Solid waste (swabs, syringes, bottles, etc.) placed in designated sacks for disposal by
incineration or, if suitably diluted with ordinary waste, to waste disposal sites.
Old generators are kept in a secure shielded store until they are returned to the manufacturer.
Contaminated clothing and bedding is appropriately bagged and stored in a secure protected
area until sufficiently decayed for release to the laundry.
Records must be kept, for inspection, of all deliveries, stocks, administration, stored waste, and
disposals of waste.
###########################

Chapter9

ULTRASOUNDPHYSICS



Ultrasonography
Ultrasoundwavesindiagnosticradiology:
Mechanical waves undergo reflection and refraction at the interface between two
surfaces.
Producedbyapiezoceramicdiscorrectangularplate,madeofMicrocrystallinelead
zirconatetitanate(PZT)or
Plasticpolyvinylidinedifluoride(PVDF)

9.1 PiezoelectricEffect:

In piezoelectric materials, if an electric field is applied to it in the form of a voltage

pulse,thenthematerialwillphysicallydeform(expandorcontract).
Conversely,iftheyaremechanicallydeformedbypressure(expandedorcompressed),
theyproduceanelectricfieldthattriestorestoretheshape,andthevoltageproduced
isproportionaltothepressuremade.
Whenan alternating voltage isapplied ( AC ) , the disc will alternately expandsand
contractswiththesamefrequencyoftheAC
When the disc is subjected to an alternating pressure, it will produce an AC voltage
withthesamefrequencyofthealternatingpressure.
Thesametransducercanbeusedastransmitterandreceiver.
Curietemperature:thetemperaturepointwhichabovethisthetransducerslosetheir
piezoelectric properties (about 350C for PZT), so transducers should never be
autoclaved.
TransducersareusedintomodesPulsedandContinuous.

Pulsedmode:
By applying a few hundred volts DC , leading to disc
expansion , producing a wave of compression in the
adjacent material that travels with a velocity ( ) ,
followed by a corresponding wave of decompression or
rarefaction(Figureb,c)
Continuousmode:
By applying an alternating voltage AC, the transducer
act as a piston producing successive compressions and
rarefactions.(Figured)
Wavelength (), distance between two successive
compressionsorrarefactions

Frequency(),numberofcompressionspassesatanygiven
point,equalsthefrequencyoftheAC,measuredinMHz

Remember,=

PropertiesofUltrasound:
Requiresamaterialmedium.
Longitudinalwaves.
Reflected,refractedandfocused.
Longwavelength
Velocity(propagationofspeed)isconstantforeachmaterial.
Increasedmaterialdensityorcompressibilityleadstodecreasedvelocity.
Changingtemperature(changesdensity&compressibility),changesvelocity
Material Velocity m/s Density Kg/m3

Air 330 1.29
Soft Tissue 1540 1000
Bone 3200 1650
PZT 4000 7500
*Airhaslowvelocitybecauseofitsgreatcompressibilitydespiteofitslowdensity

9.2 INTERFERENCE:

Constructive Interference: two sound

waves with same wavelength cross each
other exactly in step (in phase), their
amplitudesaddup.
(Remember,intensity amplitude )
DestructiveInterference:twosoundwaves
withsamewavelengthcrosseachotherbut
out of step (180 out of phase), their
amplitudescanceleachother.
Ifpartiallyoutofstep,reducedintensity.
Naturalorresonantfrequency:
In continues mode , control of the
ultrasoundfrequencyisdonebycontrolling
thefrequencyoftheAC
Largest output , is achieved when the
wavelengthoftheproducedwavesequalto
twicethethickness(t)ofthepiezoelectric
disc , because of the full constructive
Interference or ( resonance ) of the wave
comingfromthe front faceofthe disc and
itsreflectionatthebackface.
Natural or resonant frequency of a transducer, it is the frequency which the
transduceristhemostefficientasatransmitterandalsowhichitismostsensitiveasa
receiver.

Naturalorresonantfrequencyofatransducerdependsondiscthickness(increasing
2tincreasingdecreasing)anditsmaterial(affectsthevelocityofsoundin
it).(v=x2t)
Inpulsedmode,applyingalargeDCforabrieftimewillmakethetransducervibrates
atitsnaturalfrequencythatequals2t,becauseanyotherfrequencieswilldiequickly
becauseofdestructiveinterference.
Damping:(Reducingpulseduration)
Thecrystalisusuallypulsedforlessthan100nanoseconds.Itwillcontinuevibration
forappreciableperiodringinglikeabell,however,ifnotmechanicallystopped,or
dampened,thecrystalwillcontinuetoringinadditiontoproducingunacceptablylong
pulses,continuedringingprohibitsthetransducerfromlisteningphasewhichaccount
forabout99.4%ofthetransducerutilizationtime.
Pulseduration(length)ofthetransducerequalsthreewavelengthsorless(about1.5
mmintissues)
Dampingismademainlybythebackingblockofthetransducer.
Types:
Heavydamping,shorttimeconstant(shortringdowntimeshortringing).
Lowmechanicalcoefficient(LowQ)
Lightdamping,longtimeconstant(longringdowntimelongringing).

Highmechanicalcoefficient(HighQ)
9.3 SingleTransducerProbe:

In transmission mode, the energizing

voltageisappliedbetweenthebackfaceof
thediscbyan insulatedwire and the front
facebythemetalcasing.
Backing block , is a suspended fine
tungstenparticlesinaepoxyresin,andthe
block is cemented to the back face if the
piezoelectric disc and both must be
matched(havesameacousticimpedance)

Backingblockfunctionis,scatteringandabsorbingofthebackwardswavesproduced
bythebackfaceofthedisc,leadingtodampingofthevibration,resultingin:
Decreasethepulselength.
improvingaxialresolution
LowQ
Increasesbandwidth,causingdecreasestransducersensitivity.

Additional damping is performed by , applying a second reverse voltage pulse very

shortlyafterthefirst.
Ifnobackingblock(omittedorneglected),totalreflectionhappenswithpulselastfor
20ormoreperiodsandhighQ,withincreasedsoundoutput.

Bandwidth:
Itisuncommonforatransducertoemitasoundbeamwithasinglefrequency;rather,
thereisabroadrangeoffrequenciesemitted.
The bandwidth is the difference between the highest and the lowest frequency
emittedfromthetransducer.
Thebandwidth,isthefullwidthathalfmaximumintensity(FWHM).
Transducer bandwidth is inversely related to pulse length (duration). pulse length is
determined by the wavelength and number of cycles in the pulse. The number of
cycles, or waves, in the pulse is determined by the damping characteristics of the
transducer.
Highly damped transducers are characterized by short pulses and wide bandwidths
and poorly damped transducers are characterized by long pulses and narrow
bandwidths.Therefore,frequencybandwidthisdirectlyproportionaltodamping.
DAMPING BANDWIDTH

TheMechanicalCoefficient:Qfactor
Isaunitlessnumberthatrepresentstheabilityofthetransducertoemita"clean"or
"quality"ultrasoundfrequency.
ThehighertheQfactor,thenarrowerthetransducerbandwidthasatransmitterand
receiver.
Transducers with high Q is good for continuous mode as it produce pure note and
respondsonlytothatnote.
Transducers with low Qisgood forpulsed mode asit has short ring downtime and
producesshortpulsesandrespondstoarangeoffrequencies.

MH
Qfactor=
MH
BANDWIDTHQFACTOR
RESONSNTFREQUENCYQFACTOR

Diameterofthetransducer:
Ifthediameterequalsonewavelengthorless,soundwavewillspreadinalldirections.
Ifthediametermuchgreaterthanonewavelength,soundisprojectedforwardsasa
plane wave, due to reinforce in this direction and destructive interference in other
directions.

Nearandfarfields:
Near field: also called Fresnel zone is the proximal part of an ultrasound beam.
adjacenttothetransducersurfaceandhasaconvergingnarrowbeamshapedueto
theconstructiveanddestructiveinterferencepatternsofsoundwavelengthsemitted
fromthetransducercrystal.

2
The length of the near field is equal to D /4 ( where D is diameter of the piezoelectric
crystal&istheultrasoundwavelengthinthemediumofpropagation)
Far field: also called Fraunhofer zone is the distal part of an ultrasound beam
characterized by a diverging shape and continuous loss of ultrasound intensity with
distancefromthetransducer.
Higherfrequencytransducers,increasesthelengthofthenearfiledanddecreasesthe
divergenceofthefarfield(forthesamediscdiameter).
Largerdiametertransducers,increasesthelengthofthenearfiledanddecreasesthe
divergenceofthefarfield(forthesamefrequency).

Focusing:
Isfocusingtheintensityofthesoundbeanataparticulardepth,producingstronger
echoesandimprovingthelateralresolution.
Internalfocusing:byusingacurvedpiezoelectricelement(thegreaterthecurvature,
theshorterthefocallength)
Externalfocusing:byusingplasticacousticlenscementedtothetransducerface,or
usingcurvedmirrors.

Theshorterthefocallength,theincreaseddivergenceofthe

farfieldandthenarrowerandshorterthefocaldepth
Electronicfocusing:(annulararray)
Isarchivedbysubdividingthepiezoelectriccirculardiscintomultipleconcentricrings,
withfirstenergizingtheoutermostringthesubsequentlytheinnerrings,withapoint
(p)atwhichthepulsestravellingatdifferentpathsarrivetogetherandreinforce.

Shortening of the focal length can be made by increasing the time delay between
energizingsuccessiverings.

9.4 BEHAVIOROFABEAMATANINTERFERENCEBETWEENDIFFERENTMATERIALS:

AcousticImpedance:(Z)Kg/m2S(Rayl)

(Istheproductofthedensity()ofthematerialandthevelocity()ofthesoundinit)
Z=
Theproportionsofenergyreflectedandtransmitteddependontheacousticimpedance
ofthetwomaterialsmakingtheinterference.
The acoustic impedance depends on density and elasticity of the material and
independentoffrequency.
Z Density
Material Density Kg/m3 Acoustic impedance Kg /m2 S

Air 1.29 430

Soft Tissue ( average ) 1000 1.5 x 106
Bone 1650 5.3 x 106
PZT 7500 30 x 106

Reflection(notrefraction),dependsintheacousticimpedancemismatch
Theacousticimpedancedifferenceisveryhighbetweenairorgas(lung)andbonewith
other body tissues, with total reflection, and no information can be collected from
organsplacedbehindthem.
Couplinggelbetweentransducerandbodyisimportanttopreventreflectionbyair.
The fraction of sound energy that is reflected ( R ) at the interference between two
materialsdependsontheangleofincidence
Whentheangleonincidenceis90ornearly,RdependsontheZ

R=(Z1Z2)2/(Z1+Z2)2
R Z

Matching:whenZ1=Z2,therewillbe100%transmissionwithnoreflection
Matchingplate:usedtoreducemismatchbetweentransducerandtissues,itisa
plastic compound of wavelength thickness having an acoustic impedance
intermediatebetweenthatofthetransducerandtheskin.
Small fractions of ultrasound are reflected between different soft tissues and
reflectionlessthan0.01%isunlikelytobedetected.
Specular(mirror)reflection:

if the beam strikes a large smooth interface, the same laws of reflection and
refraction applies to it like light ray, where the incidence angle equals the
reflectionangle
therefractionangleissubmittedtoSnellslaw:

Snells Law sin 1 / sin 2 = c1/c2

Where 1 & 2 are the incidence and refraction angles and c1 & c2 the sound velocities in the two materials

Diffusereflection:

Ithappenswhenthereflectionsurfaceisroughandhasundulationsequaltothe
wavelength,sothereflectedbeamwillspreadoutoveranangle
Theshorterthewavelengthandtherougherthesurface,thewiderthespread.

Scatter:

It happens when a sound encounters a structure that is much smaller than its
wavelength(asredbloodcell),itscatteredmoreorlessinalldirections.
Thiseffectallowsevensmallstructurestobevisualizedassomescatterwillreach
thetransducer.
Bloodflowimagingdependsonscatteringbyredbloodcells.

9.5 ATTENUATIONOFULTRASOUND:

Attenuationofthesoundbeamoccursdueto:
Energy is absorbed and converted to heat by friction and viscous forces in the
material.
Energy leaves the forwards travelling beam due to scattering and to partial

reflectionbythebydifferentinterfaces.
Thehigherthefrequency,thegreatertheattenuation.
Attenuationisexpressedindecibels(dB)
Decibellosspercentimeterisproportionaltothefrequency,e.g.at3.5MHzthelossis
about3.5dB/cm,soin15cmjourneyto&frothetotallossabout(3.5x30)=100dB
Halfvaluelayer:
Thethicknessoftissuethatreducesthesoundintensitytohalfitsoriginalvalue.
Water;thereisalittleabsorptionorscatterinwater(fullbladdercanaidpenetration).
Bone;attenuationismuchgreater(about35dB/cmat2.5MHz)
Air;attenuationisgreat(inlungsabout40dB/cmat1MHz)
Penetration:Thehigherthefrequency,thelesseffectivethepenetration
Penetration=40/
((Halfvaluelayerpenetrationisinverselyproportionedtofrequency))

9.6 AMODE:(AmplitudeMode)(Echoranging)

When the ultrasound beam encounters an anatomic boundary, the received sound
impulseappearsasaverticalreflectionofapoint.Onthedisplay,itlookslikespikesof
differentheights(theamplitude).
The intensity of the returning impulse determined the height of the vertical reflection
andthetimeittookfortheimpulsetomaketheroundtripwoulddeterminethespace
betweenverticals.
Thepulseisrepeatedtypicallyabout1000times/s(PRFis1KHz),withtransmitmode
about1sandlisteningmodeabout999s
Usedin:eyeexamination,breastcysts,brainmidlinedisplacement.

TimeGainCompensation:TGC

It is the signal processing control, which allows amplifying the returning signal from
deeperstructuresinthebody.
TheTGCcontrolcompensatesfortheattenuationofsoundwaves.
Amplificationisproportionaltothetimethathaselapsed,thusthedistancethathas
been travelled by the sound, so all echoes from identical interfaces are rendered the
sameindependentfromtheirdepth.
Theoperatorcanvarythethresholdandtheslopeoftheramp,andtheresultingTGC
curve.

9.7 BMODE:(BrightnessMode)

The ultrasound signal is used to produce various points whose brightness depends on
theamplitudeinsteadofthespikingverticalmovementsintheAmode.
The vertical position of each bright dot is determined by the time delay from pulse
transmission to return of the echo and the horizontal position by the location of the
receivingtransducerelement.
ThereturningsoundpulsesinBmodehavedifferentshadesofdarknessdependingon
theirintensities.Thevaryingshadesofgrayreflectvariationsinthetextureofinternal
organs.
TGCcontrolalsocanbeusedtocompensatefortheattenuationofsoundwaves.

9.8 REALTIMEIMAGING:

To generate a rapid series of individual 2D images that show motion, the ultrasound
beamissweptrepeatedly.
DifferentfromstaticBmodethattheframesneedto
bereproducedmorethan25timespersecond.
Scanners:

(A). Mechanical(sector)scanning:
Mechanicalscannersarecharacterizedbytheuseof
anelectricmotortomovetheultrasonictransducer
and when the transducer sweeps over the area of
interest, the returning echoes are displayed as a
seriesofsinglelineBscan.
There are two basic ways in which the transducer
canbemoved,rotationoroscillation.
Mechanicaltransducersuseacombinationofsingle
elementoscillation,multipleelementrotation,ora
single element and set of acoustic mirrors to
generatethesweepingbeamfor2Dmode.
Sectorscannersaremostusefulforcardiacultrasoundexaminationswherethebeam
isdirectedbetweentheribstoimagetheheart.

(B). Electronicscanning:(steppedlineararray)

Elongated transducer , divided into a large number of separated narrow strips each
aboutawavelengthinwidth
Theyenergizedinoverlappinggroupsinsuccession(say16,27,38..)
Faultysingletransducerelementisnoticeableasadarkstreak,becauseelementsare
notenergizedsimultaneously
(C). Electronicsectorscanner:(steeredorphasedarray)

Similarto lineararray, with fewer elements and they all energized simultaneously at
smalltimedifference(phasing)
Sectralscanningisdonebychangingthetimedelaysequencebetweeneachpulse.
Steering , if they energized separately in rapid sequence, the pulse reinforce in one
directionandthebeamswingtothisdirection,ifenergizedinthereversesequence
thebeamswingtotheotherdirection.
Electronicfocusingisusedtoreinforcethepulsesinbothlinearandphasedarrays.
FocalDepth:
Inlinear&phasedarrays,focusinoneplaneonly(Azimuthatplane)paralleltothe
lengthofthearray.Inannularcirculararray,focusintwoplanes(twodimensions)
In linear & phased arrays, the greater the time delays between energizing the
successivepairsofelements,theshorterthefocallength.
Focusing in the perpendicular plane, done by shaping the transducer into curve or
usingacousticlens.
Multiplezonefocusing:threeorfourpulsesaresentinsuccession,withphasedelays
alteredtofocusindifferentdepths,andthetransducerisgatedtoreceivetheechoes
fromthedesiredfocalzoneonly.

Aspectsofrealtimeimaging:
Pulserepetitionfrequency(PRF):isthenumberofpulsespersecond.
Scanlinedensity:

Eachframemustbemadeupofasufficientlylargenumberofscanlines.
Patients tissues are sampled along a number of scan lines depending on the
numberofelementsinamultielementarray.
IncreasedbyincreasingPRF

FrameRate:(Framerepetitionfrequency)(FRF):
Dependsonthenumberoflinesperframe.
IncreasedbyincreasingPRFFramerate

Depthofview:
IncreasedbydecreasingPRF
NOTpossibletoachievehighframerateandhighscanlinedensitywithlarge
depthofview.
.
Depthofview

Depthofviewxframeratexlinesperframe=0.5xsoundvelocity

PRF=Frameratexlinesperframe=velocityofsoundintissue/2xdepthofview

ContrastAgents:

Improveimagequality;mainlybeincreasingthesoundreflections.
Musthavelowtoxicityandreadilyeliminatedbythebody.
Generally,aremicrobubbles(lessthan4m)ornanoparticles(lessthan1m).
Normal static diffusion leads to total bubble destruction with few hours after the
examination.
Although, microbubbles are destroyed by high intensity ultrasound, this effect can
beusedtostudysubsequentrefilldynamicsallowerpowerforreperfusionimaging.
Types:
o Airfilledmicrospheresencapsulatedinathinshellofalbumin:forcardiac
imagingandDVTdiagnosis.
o Lowsolubility gas encapsulated in a lipid shell : used for all vascular
applicationsincludingtumorvasculature.
o Perfluorocarbonnanoparticles:stayinthebloodfoemanyhours,usedfor
metastasesimaging.
o Goldboundcolloidalmicrotubes:immunologicallytarget.

Harmonicimaging:

In conventional imaging, the transducer transmits and receives sound waves of a

givenfrequency.Thereceivedsignalislowerinintensitybecauseitisattenuatedby
thetissue.
InHarmonicImaging,thereturningsignalisactuallyacombinationoffrequencies.It
containsnotonlythefundamentalsignalthatwasoriginallytransmitted,butalsothe
harmonic signal, which are twice the frequency. (Harmonic imaging listens and
receives a sound profile greater than the transmitted frequency with increased
intensityandtheultrasoundsystemprocessesthesesignalsseparately.)

TypesofHarmonicImaging:

1. Tissue harmonic imaging (THI) (negative harmonic imaging): does not use
contrastagent.Usestheharmonicgeneratedwithinthebodytissue.
2. Harmonicimagingusingcontrastagent(positiveharmonicimaging):
Injects contrast agents into blood vessels to increase the generation of
harmonics,thentheharmonicsignalgeneratedinthebloodvesselisusedto
obtaintheimage.

The fundamental frequency: the first

harmonic. created by transducer and has
themostdistortionbybodytissues.
Harmonic signals: do not come from the
ultrasound system itself. These signals are
generated in the body as a result of
interactions with tissue or contrast agents
anditismoreintensityasitundergoesless
distortion,therearemultipleotheoriginal(e.g.originalis3,2ndis6,3rdis9)

Tissueharmonicimaging(THI):ifthesecondharmoniccanreachausefulmagnitude
,ifisolated,thiscanbeusedtoformanimageinsteadofthefundamentalfrequency,
with the transducer bandwidth must cover both the transmitting and the receiving
beams(broadbandwidth,heavilydampedtransducer),thisisdonebytwomethods:

A Harmonicbandfiltering:
The fundamental frequency is removed using a filter, leaving the tissue
generatedharmonicstobeprocessed.
The pulse is stretched to produce a narrow transmission band to eliminate
thehigherfrequencies
Decrease the axial resolution, with partial compensation by improved
detectionofsecondharmonic.

B PulseInversion:
Every other transmitted pulse will has its polarity reversed and the echoes
receivedfromeachpairoftransmittedpulsesaresummed.
Then,alltheoddharmonicsdisappearfromthesignalincludingtheinitial=ly
transmittedfrequency.
At the same time, the amplitude of every even harmonic is doubled, which
willenhancestheSNRforthesecondharmonic.
Preserve axial resolution, yet takes longer time with possible motion
artefacts.

BenefitsofTissueHarmonicImaging:

1. Reduced reverberation artefacts (the sound wave is reflected back into the body
from the transducer-skin interface), as low amplitude echoes dont produce
harmonics.
2. Distortion & scattering from fatty tissues are reduced, as these are at the
fundamentalfrequencysosuppressedalso,socontrastresolutionisimproved.
3. Lowcontrastlesionsandliquidfilledcavitiesarebettervisualized,asthereisa
reducedacousticnoise.

ThreeDimensionalImaging:

Threedimensionalimagesareobtainedfromasetoftwodimensionalscans.
The movement of the probe in controlled either electrically so that orientation and
positionarelikenedwithdatacollection,orwithmanuallyoperatormovementswith
orientationandpositionareconstantlyregistered.
Imagesaresetofparallelslicesoraseriesofwedgeshapes
Imagereconstructionandinterpretationarenoteasy
Veryusefulinvascularstudiesandfetalimaging.
If acquisition and display of volume images are in real time, this is called
(Fourdimensionalimaging).

9.9 IMAGEACQUISITIONANDRECONSTRUCTION:

Digital converter is used to improve the gray scale images, enable freeze frame, to
manipulatedataandarchiveit.
{Write}mode:afterdigitizingthesuccessivearrivingechoes,itenteredinthecomputer
memorylocationsalongthecorrespondingscanlinesofthevoxelsofthebody.
{Read}mode:afterpassingthroughdigitaltoanalogueconverter,thesignalisusedto
modulatethebrightnessofpixelsonthemonitor.
Imagescanbestoredintheusualways,inthecomputer memory,orasahardcopy
usingcameraorlaserimager.
DynamicRangingofsignals:
Is the range between the minimum low intensity and maximum high intensity
signalsthatasystemiscapableofdisplaying.
Typically7080dB,andafterTGCtypically4050dB.
A logarithmic amplifier is used to electronically compress the signal amplitudes,
because the grayscale monitor can only display about 25 dB, and the eye can
distinguishonlysome30graylevels.
Edgeenhancementisusedtoincreasethechangeinsignallevel.
Rejectcontrolisusedtoeliminatelowamplitudenoiseandscatter(signalfiltering)

9.10 RESOLUTION:

(A). Axial(longitudinalDepthRange)Resolution:
The ability to distinguish two objects parallel to the beam (objects above and
beloweachother)sothattheycanbeimagedastwodifferentinterfaces.
Axial resolution can be improved by higher frequency transducers, yet less
penetration.
Axialresolutioncanbeimprovedbyreducingthepulselength(duration).
Axial resolution is reduced by omitting the backing block which will increase Q
factor.

(B). Lateral(TransverseAzimuthalAngular)Resolution:
The ability to distinguish two objects perpendicular to the ultrasound beam at
thesamedepth,(objectsthataresidebyside)sothattheycanbeimagedastwo
differentinterfaces.
Lateral resolution can be improved by higher frequency transducers, yet less
penetration.
Lateralresolutionapproximatelyequalstothebeamwidthatthatdepth,socan
beimprovedbyusingsmallerbeamdiameter.
Theshorterthefocallengthoftransducer,thenarrowerandshorterthefocalregion.
In the focal Zone, both axial & lateral resolution are best, axial resolution may be
aboutonewavelengthandBUTlateralresolutionaboutthreetimesworsebecausethe
beamismaybenarrowerthanthegapbetweenobjects.

9.11 ARTEFACTS:

Speckle:interferencebetweenthewavesscatteredfrommanysmallstructureswithin
tissues,produceatexturedappearance.
Reverberation: strongly reflection interface near the surface, produce a series of
delayedechoesequallyspacedintimeandfalselyappearasdistantstructure.
Doublereflection:likethediaphragmactsasamirrorwithreflectingimagesfromthe
liverintothelung,alsomayhappenwiththepleuraorpacemakerwires.
Acousticshadowing:strongattenuationstructures(bowelgas,lung,bones,gallstones
andkidneystones),castshadowsintheregionbehindthem,MadeworsebyTGC
Acoustic enhancement : fluid filled structures ( cyst or full bladder ) , increase the
intensityofechoesbehindthem,producingnegativeshadow,MadeworsebyTGC
Refraction:likerefractionofabeamfallingobliquelyontwosurfacesofbone,displace
thebeamandtheimagesofthestructuresbehindthem.
Ringdown: caused by small gas bubble or air in the stomach, it resonates emitting
ultrasoundsignalscontinuouslyresultinginatrackthroughoutthescan.
Sidelobes:areformednearthetransducerduetismallvibrationsatthelateraledges
ofthepiezoelectric disc,they areoflowintensitycomparedtotheprimarybeam
butcancauseartifacts.
P
9.12 MMODE(TIMEMOTION):

Ultrasoundisusedforanalyzingmovingbody,commonlyincardiacandfetalcardiac
imaging.
VisualizationofthestructuresasafunctionofdepthandmotionontheYaxisandtime
onXaxis.
A single beam in an ultrasound scan is used to produce the onedimensional Mmode
picture, where movement of a structure such as a heart valve can be depicted in a
wavelikemanner.

9.13 DOPPLER:

DopplerEffectorshift:
the effect of motion of sound sources and the
frequencychangeofthesoundtotheobserver.
Proceeding:wavelengthfrequency.
Receding:wavelengthfrequency.
(Constantsoundvelocity).
The change in frequency (f f)is directly
proportional to the change of velocity of the
interface and the orginal transducer
frequency.

=2x


Motionatangletothedirectionofthesound:hasareducedeffect.

=2x xcos

So,atrightangleofinsonation90,NODOPPLEREFFECT(COS90is0)
When=0(paralleltothesounddirection),MAXIMUMDOPPLEREFFECT(COS0is1)

ContinuousWaveDoppler:

ADopplermode,whichrecordsbloodflowvelocitiesalongthelengthofthebeamby
usingdifferentcrystalstosendandreceivethesignal(twoprobesinthetransducer).
Utilizing one half of the elements continuously sending sound waves of a single
frequencywhiletheotherhalfiscontinuouslyreceivingthereflectedsignals.
HighQisnecessary&Nobackingblockisused(omitted)
Originalf(equalsfofAC),issuppressedandtheDopplersignal(ff)isextracted
electrically.
Frequency analyzer is used to produce a spectrum of Doppler frequencies
correspondingtotherangeofvelocitiesdetected.
Ausefulaudiblesignalcanbeheardbyspeaker,thehigherthepitch,thegreaterthe
velocityandtheharsherthesound,thegreatertheturbulence.
MostimportantinDopplerechocardiography.
Advantagesofacontinuouswavetransducerare:
Highsensitivity
NoNyquistlimit(twicesamplingeveryperiod)
Noaliasing
Disadvantagesofacontinuouswavetransducerare
Nopossibletolocatemovingreflector
Nodepthprecision(distinguishbetweenflowintwooverlyingvessels)

PulsedDoppler(rangegating):(depthprecision)

A Doppler mode, which evaluates blood flow velocities in a range specific area
measuringthechangesinthereceivedfrequencyduetorelativemotion(flow):
UsingDuplexscanningofthevessels(Bmode+Doppler),Bmodehelpinchoosing
alineofsitefortheDopplerbeamandessentialfordirectionassessment
Asamplingvolumeisplacedoverthevesseltomeasuretheflow.
The normal short imaging pulses are interspersed with bursts of the Doppler
ultrasound, and a ranging gate is set to accept only those Doppler echoes which
cameonlyfromtheselectedsamplingvolume.
Thedepthofthetissuedependsonthetimewhichtheranginggateisopened,and
thethicknessdependsonthehowlongtheranginggatewasopened.
ThewidthofthesamplingvolumeisthewidthoftheDopplerbeam.
Theangleofinsonationisclearlydefinedbythesystemtoallowaccuratereadof
thefrequencyshifttobeconvertedintoflowvelocities.
Thediameterofthevesselisalsoestimatedtoallowvolumeflowratecalculation.

Theintervalsbetween pulses must be long enough forthe successive Doppler signals
not to overlap, so a high PRF is used for superficial vessels and low PRF for deeper
vessels.
Theanalyzedfrequencyaredisplayedasarealvelocityspectrumorsonogram
Sonogram:

ItisagraphofDopplerfrequencyagainsttime.
Displaysthevariationsofbloodflowvelocityand
directionduringheartcycle.
Each pixel has a grey level representing the
numberofredbloodcellsinthesamplingvolume
thathavethevelocityatthatinstantoftime.
Pressuremeasurement:
Pressureinstenosedvesselorinthejetofbloodcomingfromdiseasedheartvalve
canbeestimatedbyDopplermeasurementofflow.
The velocity of the flow increased within any constriction , and the increase in
2
pressurecanbeestimatedbymodifiedBernoulliformulaP=4v
Aliasing:
With pulsed Doppler only , very high flow velocities will shown in the wrong
directionandunderestimated,likeawarproundtop&bottominthesonogram.
It is a consequence of the sampling requirement, that the wave form being
measuredmustbesampledtwiceeveryperiod,sothefastestflowcanbemeasured
withaccuracymustbePRF,otherwisealiasingoccursduetoundersampling.

The depth of the sampling volume gate, determines the PRF needed, and the PRF
determinesthemaximumvelocitycanbemeasuredwithoutaliasing.

Maximum velocity ( cm/s ) x range ( cm ) x transducer frequency ( MHz ) 4000

Toreducealiasing:
Useoflowerfrequencyprobe(f).
Increasetheinsonationangle().
IncreasethePRF(PRF)

HighPulseRepetitionfrequencymode:(HighPRF)

DoublingorquadruplingPRF,willfurtherimprovethemeasurementofthemaximum
velocity,intheexpanseofsuperimposingvelocitydatafrommultiplegatedvolumes.
When PRF becomes very high, the pulses merge and we have reinvented continuous
waveDopplerwithnoaliasingbutnorangedata.

Realtimecolourflowimaging:

Color flow imaging is based on pulsed ultrasound Doppler technology. With this
technique multiple sample volumes among multiple planes are detected and a color
mapfordirectionandvelocityflowdataisdisplayed.
CommonmappingformatsareBART(BlueAway,RedTowards).Enhancedorvariance
flow maps show saturations and intensities that indicate higher velocities and
turbulenceoracceleration.Somemapsutilizeathirdcolor(greenoryellow)toindicate
acceleratingvelocitiesandturbulence.
ColorflowDopplerimagingisnotaspreciseasconventionalDopplerandisbestused
toscanalargerareaandthenuseotherDopplermodestoobtainmoreprecisedata.
Compared with normal Bmode imaging, the color Doppler pulse is longer, being a
compromisebetweenaccuratedepthinformationrequiresashortpulseandaccurate
velocityinformationrequireslongerpulse.
Aliasing is also a feature of colour scans, with exchange of red & blue direction and
mosaiccoloredappearance
Colourfactorsthatcanbevaried:
Framerate:shouldbefastenoughtofollowvelocitychanges.
Penetrationdepth:whichisinverselyproportionaltoPRF.
Fieldwidth:orsectorsize
Linedensity:scanlinesperframe,shouldbehighenoughforgoodspatialresolution.
Numberofpulsesinatrain:shouldbehigh,togiveaccuratevelocityinformation.

PowerDoppler:

PowerDopplerisshowingtheamplitudeoftheDopplersignalswithoutanyindication
ofvelocityordirection.
Itsmainadvantageistodifferentiatebetweenareasofflowornoflow.
Lessdependedontheinsonationangle.
MoresensitivetoweaksignalsthancolourDoppler.
Noaliasing.
9.14 QUALITYASSURANCE:

Usefulperiodictests,includethefollowing:
1) Resolution: tested by imaging a test rig composed of parallel wires mounted on a
frameandimmersedinaPerspexbathcontainsfluid.
2) Sensitivity & Dynamic range and accuracy of the A scan caliper: Tested using a
Perspexblockmachinedwithanumberofequallyspacedverticalrods.
3) GrayscaleperformanceandDopplerfunction:
o Testedwithcomplexequipment,basedongelatinortissuemimickingphantoms.
o Themaximumacceptabledistancemeasurementerrorshouldnotexceed2%.

4) Thepoweroutput:testedbyweighingthesoundpressurewithaforcebalanceorby
measuringtheheatingeffectusingacalorimeter.

9.15 SAFETYCONSIDERATIONS:
Ultrasoundislowriskaswellaslowcostmethod.
Harmfulbioeffectshavebeenidentifiedathighexposurelevelsusuallywithultrasound
therapy.
Safetyguidelines:
Thetimeaveragedintensityshouldnotexceed100mW/cm2
Totalsoundenergy(intensityxdwelltime),shouldnotexceed50J/cm2.
Possiblerisks:
Localheating:duetofriction,viscousandmolecularrelaxationprocessesleadingto
chemicaldamage.
Acousticstreaming:ofcellularcontentsinthedirectionofthebeam,affectingcell
membranepermeability.
Cavitation: the high peak pressure changes cause microbubbles in the liquid ( or
near liquid ) medium to expand ,there might be a much rise in temperature with
consequentprofoundchemicaldamagetocells
Mechanicaldamage:tocellmembranescausedbyviolentaccelerationofparticles.

Thermalindex(TI):
Istheratioofthepoweremittedtothatrequiredtoincreasethetemperatureby
1Candgivesanindicationofthetemperatureriseintissues.

TI=

Indexvalueshouldntexceedvalue1,andbelow0.5isconsideredsafe.
TheexposuretimeshouldbereducedappropriatelyastheTIincreaseabovethe
value1.(e.g.about30minutesforfetalscanning).
Inapyrexialadult,atTIvalue2,examinationtimecanbesafefor10minutes.
Themechanicalindex(MI):
Isameasureofthemaximumamplitudeofthepressurepulse.
Calculated by, the peak rarefaction pressure divided by the square root of the
ultrasoundfrequency.
MI=
f
Potentialriskofcavitationwithuseofcontrastmediumatmorethan0.7value
MIshouldntexceed0.3valuefornondiagnosticandfetalscans,duetopossible
riskofminordamagetoneonatallungsorintestine


Chapter10

Magneticresonanceimaging



MRI

Nuclearmagneticresponse,ispropertyatomscontainsanoddnumber
ofprotons
HydrogenprovidesbestMRIsignals:
Hassingleproton,thuslargemagneticmoment
Abundantinthebody,inwaterandfat.
10.1 THESPINNINGPROTON:

Every proton has a positive charge and spins continuously

aroundanaxiscalledthespinvector.
Eachprotonactlikeamagnetbarordipoleduethecirculation
charge.
Its magnetic moment m is representing by a vector joining the
northandsouthpoles
Normally, all the individual dipoles point in a random fashion,
butequallyineverydirection.SothenetmagneticeffectisZERO
withignoringthetinyeffectofearthsmagneticfieldofabout50T.
Thepatientliesinasolenoidcoilcarryingadirectcurrent
(DC) , and this produce a very uniform and strong
magnetic field inside the coil. Represented by vector B
along the axis of the coil the length of the patient and
thisistakenasZaxis.
YaxisrunsverticallyfromtoptobottomandXaxisruns
horizontallyacrossthemachine.
Magneticfieldstrengthhasavaluebetween0.15to3T
Inside the coil, the patient becomes very slightly
magnetizedbythestaticmagneticfieldB,whichcauses
the magnetic dipoles (protons) to turn and point along the axis Z in the two ways
direction.
Some dipoles take the direction of the field (parallel or spin up) or the opposite
direction(antiparallelorspindown).
Asittakeslessenergytoalignwiththemagneticfieldthantoopposeit,aslightlymore
dipoles point spin up than spin down, and MRI depends on detection of this small
difference.
This difference is proportional to the strength of the magnetic field B, and amount to
3ofeachmillionat1Tfield.
Because,eachofthedipolecanceleachotheroutinpairs,leavingthosenotpairedto
produceacombinedlongitudinalnetmagneticvectorMzinthedirectionofB(Zaxis).
Incubicmillimeterofwater,7x1019protons,whichonly2x1014willbedetected.

Precession:

Thestaticfieldalsocausesthespinningprotonstowobblein
theregularmannercalledprecession.
Thedirectionofthespinaxistiltsandspinrotatesaroundthe
directionofthemagneticfieldBwithfixedfrequency.
ThefrequencyofprecessioncalledLarmorfrequency.
The tilting of the spin axis splits its magnetic vector m into a
longitudinalcomponentmzthatpointintheZdirection,anda
transversecomponentmxythatrotatesintheXYplane.
All the mz vectors of all detectable protons, add up to a
combinednetlongitudinalmagnetismMz,butthismagnetism
cant be measured directly because it points in the same
directionasfieldB.
Themxyvectorsofthedetectableprotonsrotatesandprocess
independently and cancel each other with net transverse
magnetismMxy=0
Thefrequencyofprecession(Larmorfrequency)isproportionaltotheproductofthe
magneticfieldstrengthandthegyromagneticratioofthenucleus(constant).
for hydrogen nuclei in a field of 1T, the f =42.6 MHz , and according to quantum theory , this
frequency equals a quantum energy of 0.2 eV , and this is the energy difference between spin up
and spin down diploes.
Radiofrequencycoils:

Are set of coils surrounding the patient , that inject an RF pulse in a direction
perpendiculartoB,whichresultintwoeffects:
o Some or all spin up protons pick up energy and excited and turn spin down and this
affecttheMzvectorthatitmaybereducedordisappearorreversed.
o Theprotonsarepulledinsynchronism,andtheyprecessinphasewiththeirmxyvectors
adduptotransversemagneticfieldMxywhichrotatesintheXYplanewiththeLarmor
frequency.
The frequency of the RF generator, must be very accurately match the Larmor
frequency ( the photon energy of the radiowaves must be exactly the same as the
energydifferencebetweenspinupandspindownprotons0.2eV)
TypesofRFpulses:
180pulse:aRFpulseofcertaintotalenergywhichwillgiveeachandeverydipole
exactlytheenergy0.2eVrequiredtotipthemthrough180
90pulse: apulseofhalfofthatcertaintotalenergywilltiphalfofthedipolesso
equalnumbers pointspin upand spin down, and make them move into thesame
phaseandprecesstogether(phasecoherence)
Conclusion:180pulsetemporaryreverseMzvector
90 pulse reduce Mz to zero & instead produce Mxy with equal
magnetismtoMzbutperpendiculartoBconvertimmeasurableMzto
measurableMxy

10.2 THEMAGNETICRESONANCESIGNAL:

StepsforproducingaMRIimage:
1) After a 90 pulse, The magnetic vector Mxy continue rotating for while in the
transverse plane XY, inducing in the RF coil a alternating RF voltage of few
microvolts.
2) RFamplifierisusedtoamplifythissignal.
3) Theamplitudeofthissignalissampled,digitizedandcomputeranalyzed.
4) Spatialencodingandsignalprocessingforthesignalfromeachindividualvoxel
inthescanmatrix,willproducethepixelgreyorcolourlevelintheMRimage.

Thesignalpeakandtheproportionalpixelbrightnessdependson:
Protonorspindensity(PD):thenumberofprotonspercubicmillimeteronthe
voxel.
Thegyromagneticratioofthenucleus.
ThestaticfieldstrengthB:becauseincreasedBstrengthwillincreasemorethe
initialdifferenceofspinupandspindownprotons.

Onlymobileprotonsgivesignal,thoseinlargemoleculesoreffectivelyimmobilizedin
bone,donotgivesignal.
Thegreaterpartfromsignalisduetobodywater(freeorbounded)
Airhasnohydrogen,willgivenosignalandappearblackintheimages.
FAThasgreaterPDthanothertissueswhichvaryintheirprotondensities.

FreeInductionDecay:((FID))

After the 90 pulse has been switched off, the dipoles

arefreetoreturntotheiroriginalorientation.
Mz will regrow recover and Mxy will decrease
decay,andaccordingly,thesignaloftheMRinduced
in the received coil also decrease but the frequency
remainthesame
ThesumvectorM( combinedMz&Mxy),willtip back
fromthetransverseplaneXYtothelongitudinalplaneZ
spiralinginabeehivefashion,andthisiscausedbytwo
independentmethodsofenergyloss:
Spinlatticerelaxation
Spinspinrelaxation.

Spinlatticerelaxation:(T1recovery)

The excited protons give up their energy to the molecular lattice. One by one, the
dipolestipbackparalleltotheZaxis,andMzslowlyreappears(longitudinalrelaxation)
In the graph, curve a represent the Mz recover slowly and exponentially with time
constantT1,whichdependsonthetypeoftissue.

T1, is the time for Mz to recover
to63%ofitsmaximumvalue,itis
tissuedependant.
After1timeT1,recoveryis63%
After2timesT1,recoveryis87%
After3timesT1,recoveryis95%
With stronger magnetic field B ,

protons precess faster and Mz
reappears more slowly and T1
increases.

FactorsaffectingT1recovery:

Jostling ( pushing ) by large molecules , which are slow moving and near the
resonantfrequencyismosteffectiveatremovingenergyfromexciteddipoles.
e.g. fat and water bounded to proteins surface are large molecules , can absorb
energy easy and so have a relatively short T1.
Jostlingbysmall,lightweightmolecules,whicharerapidandrelativelyineffective
atremovingenergyfromexciteddipoles.
e.g. free water, urine, amniotic fluid, CSF and other solutions have a long T1, the
greater proportion of free water in tissues, the longer is T1
Theatomsinsolidsandrigidmacromolecules,arerelativelyfixedandtheyleast
effectiveatremovingenergy
e.g. Compact bone, teeth, calculi and metallic clips have a very long T1
Spinspinrelaxation:(T2decay)

Lossofphasecoherenceduetoenergytransferbetweennuclei,resultinaexponential
decayofthetransversemagneticvectorMxy
Asthedipolesareprogressivelydephasing,somerotatesfasterorslowerthanothers
withdecreasingnetstrengthofmagneticvectorMxy
In the graph, curve b represent the Mxy decays exponentially & rapidly with time
constantT2,andsodecreasingtheinducedMRsignal(curvec)
MostofthedephasingeffectisduetofieldBinhomogeneitiesfrommachineexternal
factors,yetanimportantfactoristissuerelatedcalledT2decay(transverserelaxation)
T2,isthetimeforMRsignaltofallto37%ofitsmaximumvalue.
After1timeT2,signalis37%
After2timesT2,signalis14%
After3timesT2,signalis5%

The dephasing occurs, because a spinning proton experiences a tiny additional

magneticfield(about1T)producedbyeachneighboringproton,andthisisvariable
betweendifferentprotons,thereforethemagneticfieldBvariesalittlefromplaceto
placeandfromtimetotime.

FactorsaffectingT2decay:

Theatomsinsolidsandrigidmacromolecules,thelocalvariationofmagneticfield
isgreatestandtheydephasequickly.TheyhaveaveryshortT2anddonotproduce
lastingsignal
Theatomsinlightermolecules,arerapidinthermalmotionwhichsmoothesout
thelocalfieldresultinginalongT2
The greater proportion of free water in tissues, the longer is T2

Fat and water bounded to proteins surface and other large molecules, has a
shorter T2 than free water.
TissueCharacteristics:
T2isalwaysshorterthanT1
T1isaffectmorethanT2byincreasestrengthofmagneticfield.
AbnormaltissuestendstohaveahigherPD,T1andT2thannormaltissuebecauseof
increasedwatercontentorincreasedvascularity
Typical relaxation times of tissues in a field 1T
Material T1 (ms) T2 (ms)
fat 250 80
liver 400 40
kidney 550 60
spleen 400 60
White matter 650 90
Grey matter 800 100
CSF 2000 150
water 3000 3000
Bone, teeth Very long Very short
10.3 SPINECHOSEQUENCE:

Freeinductiondecay(FID)signalisrarelymeasuredbecauseitdecaysveryrapidlywith
timeconstantT2*(T2star),whichismuchshorterthanT2becauseofStaticfieldB
inhomogeneitiesdueto:
Themagneticfieldproducedbygradientcoilsacrossthevoxel.
Unavoidableimperfectionsintheengineeringofthemagnet.
Theintroductionofthepatientwhichunavoidablydistortsthestaticfield.


Spinecho pulse sequence is used to remove the associated effect of the static field
leavingonlytissuecharacteristicT2effect.
Sequencefeventsofspinechopulse:
1) Immediatelyafterthe90pulse,thedipolesareallprecessingexactlyinphase.Mxy
isamaximumandsoistheFIDsignalbutitisnotmeasuredatthisstage,becauseit
decayssorapidly.
2) The individual mxy vectors begin to dephase, the faster precessing ones (leaders)
gettingaheadoftheslowerones(laggers).MxyandtheFIDsignaldecaywithtime
constantT2*

3) Aftertime(t),the180pulseisappliedandtipsallthedipolesfromspinuptospin
down , this turns the individual mxy vectors through 180 in the Xdirection , so
laggersbecomeleadersandviceversa.
Mxy and the signal are still the same as mxy vectors continue to rotate in the XY
plane.Theynowrephase.ThefasteronescatchupwiththesloweronesandMxyand
MRsignalregrow.
4) After afurthertime (t),they areagaininphaseand MxyandtheMR signalare at
theirpeak.
Thereafter,theygrowoutofphaseagainandMxyandthesignaldecay.
180 pulse is called the rephasing or refocusing pulse, because is reverse and
eliminatesthedephasingeffectofthesystemicmagneticfieldinhomogeneities.
TheMRsignalreappearsasanechooftheinitialsignal,andcomposedessentiallyfrom
twosignalsbacktoback.
ThesignalismeasuredattimeTE=2t,itwillbereducedinamplitudebyT2decay.
(ThelongerTE,thesmallertheMRsignals.)

Tissuecontrast

MRsignaliscontrolledbytwoparametersTR&TE:
TR(timetorepeat):thetimetorepeatthesecondpulse.
TE(timetoecho):equals2t.Thetimefortheechotoform.

ThestrengthoftheMRsignalfromeachvoxelandthebrightnessofthecorresponding
pixeldependson:
T1 contrast
1) How many protons there are in the
pixel (PD): the greater PD the larger
thesignal.
2) How far Mz has recovered from the
previous90pulsewhenthenext90
pulse tips it : the length of T1
comparedwithTR
Shorter T1 or longer TR, the larger
MRsignalandbrighterthepixeland
betterSNR.
3) How far Mxy has decayed when the T2 contrast
echo is formed : the length of T2
comparedtoTE
ThelongerT2orshorterTE,thelarger
MR signal and brighter the pixel and
betterSNR.

FairlyshortTR=maximumT1contrast
FairlylongTE=maximumT2contrast
FairlylongTR=maximumPDcontrast
WeightedImages:

The TE and TR are chosen so that pixel brightness depends on one of three
combinationsofPD,T1andT2
T1-weighted image:
ShortTR(300800ms)isusedtoproducemaximumT1contrast.
ShortTE(15ms)isusedtoreducetheeffectofT2,shortertimewontgivethe
systemtimetoapplythe180pulseandthegradientpulses.

TheresultedimageisprincipallyduetotheT1recoverypropertiesofthetissues,
withthetissueshasshorterT1morebright(fatisbright,waterandCSFaredark)

T2-weighted image:
LongTR(10002000ms)isusedtoreducetheeffectofT1.
LongTE(90140ms)isusedtoproducemaximumT2contrast..

The resulted image is principally due to the T2 decay properties of the tissues ,
withthetissueshaslongerT2morebright(waterandCSFmorebrightthanfat)

PD-weighted image:
LongTR(10003000ms)isusedtoreducetheeffectofT1.
ShortTE(15ms)isusedtoreducetheeffectofT2.

The resulted image is principally due to difference in proton densities of the

tissues,withthetissueshasgreaterPDmorebright(CSFandfatmorebright)
T1,T2 and PD weighting effects
Weighting Properties Result
T1-weighted Short TR & TE Shorter T1 tissues, more bright
T2-weighted Long TR & TE Longer T2 tissues, more bright
PD-weighted Long TR & Short TE Higher PD tissues, more bright
Air and cortical bone appear black in all images, because they have no hydrogen.
White & grey matter, grey matter is brighter and white matter in PD and T2 weighted
images. in T1 weight images, white matter is brighter but its shorter T1 is
counteracted by its lower PD.
Generally, tissues with long T1 also have long T2 and those with short T1 have a
short T2, this why images cannot be weighted for both T1 & T2.
Injudicious selection of TR & TE (not carefully selected), will lead to that tissues
with different relaxations times can produce equal signals showing no contrast and
indistinguishable.
10.4 SPATIALENCODING:
Includethreebasicprocesses:
Slicesection
Phaseencoding
Frequencyencoding

Sliceselection:

Simultaneously with the 90 RF

pulse,DCissentforashorttime
throughapairofgradientcoils.
Thiscurrentproduceacontrolled
magneticfieldgradientalongthe
Zaxis,withinthestaticfiledB.
ThetotalBwillbediminishedatoneendofthepatient(head),andaugmentedatthe
otherside(feet),varyingbetweenbothendswithconstantgradientoffewmillitesla
permeter(mT/m).
Accordingly, protons at the augmented end will precess faster than the others with
corresponding gradient of resonant frequencies in the Z direction, so the specific
narrowrangeoffrequenciescanbeusedtolocalizethesignalfromtheselectedslice.

Then, the RF transmitter is turned on to generate an RF pulse that contain a small
range of frequencies(narrow bandwidth of the desired frequencies ) , that will excite
theprotonsinathinselectedslicewithonlythemagneticvectorsoftheseprotonswill
tipandgoonduecoursetoproducetheMRsignal.
Different slices are selected by simply altering the central frequency of the RF pulse
withouthavingtomovethepatient.
Slicethickness:
Theslicethicknessmaybereducedby:
Increase the gradient controlled magnetic field ( more variable difference
betweenfrequencies)

DecreasetheRFbandwidth.
A thinner slice produce better anatomical detail reduced partial volume effect but is
takeslongertoexcite.
TheRFbandwidth,maybeslightlyhigherorlowerofthedesiredfrequencies,andto
preventthisCrosstalk,agababout10%oftheslicethicknessisleftbetweenslices.
Sliceorientationdependsonthephysicalgradient axis,Zaxisgivestransverseslice,
Xaxis gives sagittal slice and Yaxis gives coronal slice. And any other oblique
orientationispossiblebycombinationofgradients.
Inslicelocalization:
Thisisdonebyapplyingphaseencodingandfrequencyencoding,eachinorthogonal
planetotheselectedslice.
PhaseEncoding:

Immediately after the 90 RF

pulse, but before applying the
180pulse,aDCcurrentissentfor
a short time through a second set
of gradient coils, that will produce a magnetic field gradient in Ydirection from the
fronttothebackofthepatient(orintheXdirectionfromsidetoside).
The gradient magnetic field, will cause variable increase in the precessing frequency
gradulating from the front to the back of the patient ( if used in Ydirection ) , and
whenthegradientpulseisover,allthedipolesprecessatthesameratebutthephase
differencehappenedbetweenthemwillremain.
Zero spatial frequency, that is when no gradient used, and all dipoles spin in phase
andthesignalwillbemaximum.(withsteepergradient,signalwillbezero)
Inordertomapthesignalinthematrix,thephaseencodingpulsemustberepeated
thesamenumberofthematrixpixels,everytimewithgradientincreasedalittle.Thus
steppingupthephaseshifts.

Pixelsize=

So, if the phase encoding steps made smaller increased FOV

FrequencyEncoding:

At the same time of pulse echo

formation, a DC current is sent
through a third set of gradient coils,
that will produce a magnetic field
gradient in Xdirection from side to
sideofthepatient.
(OrintheYdirectionfromfronttoback,ifXdirectionwasusedinphaseencoding).
The gradient magnetic field, will cause variable increase in the precessing frequency
gradulatingfromsidetosideofthepatient(ifusedinXdirection),
So,theMRsignalproducedbytheexcitedslice,consistofarangeofRFfrequencies
eithersideofthefrequencyoftheappliedgradientpulse.
FieldofView(FOV):
The receiver is tuned to accept only certain range of frequencies called the receive
bandwidth,comingfromtheselectedFOV
TheFOVincreasedby:
Makingphaseencodingstepssmaller.
Increasingthereceivingbandwidth

FOV=PixelsizexNumberofphaseencodingsteps
or
FOV=voxelsizexNumberofcomponentsintoofthesampledfrequency
Because phase angels repeat themselves every 360, there will be a several phase
cyclesacrossthewholeFOVsay,the10isrepeatedat370,730andsoon.
ImageTime:
Itisthetimeneededtoacquireanimage,itequals;
NexxphaseencodingstepsxTR
WhereNexisthenumberofsignalaveragesorexcitations
IncreasingtheNexwillreducethenoise,butwillincreaseimagetime.

Kspace:
Kspace is a temporary memory of the spatial frequency
informationintwoorthreedimensionsofanobject,storedas
greyscalevalues.
Kspace does not correspond to the image, but has axes
correspondingtofrequencyandphaseencodingdata.
Each data point in the Kspace matrix is a spatial frequency
componentofthesignal.
The central part of the Kspace contains data from shallow encoding gradients and
lowspatialfrequencies(lessdetailsbutstrongersignals),whiletheupperandlower
partsarefilledwithdatafromsteepergradientsandhighspatialfrequencies(better
detailsbutlowsignalsintensity).
Kspacehastobecompletelyfilledwithdatabeforethesignalscanbeprocessed.

FourierTransform:
o It is the relation between Kspace
dataandimagedata.
o It is a mathematical procedure to
separate out the frequency
components of a signal from its
amplitudesasafunctionoftime.
o EveryverticalcolumnofKspacehassamefrequency,withincreasingphasestep.
EveryhorizontalrowofKspacehassamephasestep,increasingfrequency.
o Fourieranalysisisdonebytwomethods:
Using the analysis along the phaseencoding axis (horizontal), and measure
thefrequencyinthisaxis(TRhereiscalledpseudotime).
Usingtheanalysisalongthefrequencyencodingaxis(vertical),andmeasure
thephasesignalinthisaxis(TRhereiscalledpseudofrequency).
o Onceallthesignalsanalysed,acompleximageisproducedwhichmayhaverealand
imaginaryparts.
o If any tissues move during the repetitions, they will be misregistered in the wrong
pixel of the phase encoding axis of KSpace, while any chemical artefact will be
reveledinthefrequencyencodingaxis).

SummaryofGradients:
- One gradient defines the slice
selection, appliedwhentheRF
pulseisturnedon.
- Secondorthogonalgradientis
used for phase encoding,
appliedbrieflybetweenthe90
and180pulses.
- Third orthogonal gradient is
used for frequency encoding
applied with echo formation,
during which the signal is
measured.

- GradientareusedtocontrolslicethicknessandtheFOV.
o Thesteeperthesliceselectiongradient,thethinnertheslice.
o Thesteeperthephaseandfrequencyencodinggradients,thesmallertheFOV

- Increasing the matrix size, makes no difference to scan time in the frequency
encodingdirectionasitisdonebysamplingasingleecho.Whileitwillincreasescan
timeinthephaseencodingdirectionasthespatialinformationinnotcompleteduntil
allthegradientsstepshavebeencompleted.

10.5 OTHERPULSESEQUENCEANDIMAGINGTECHNIQUES:

Multislicetechniques:
o MostoftheTRwastedifwehavetowait2sbeforerepeatingpulsesonagivenslice.
o This time can be used to deliver a succession of 90 and 180 pulses, each of a
differentfrequency,excitingaseriesofupto32separateslicesbeforerepeatingthe
firstslice.
o ShorterTEcomparedtoTR,willgivemoreslicescouldbeinterleavedinthisway(if
TR1000msandTE60ms,1000/60=16slicescouldinterleaved)

Multiechotechniques:
o Long TR can be used, after the 90
pulse a series of rapidly applied 180
rephasing pulses and multiple echoes
withincreasingTE.
o Theirpeakamplitudesdeceasewiththe
timeconstantT2
o The first echo may be produce a PD
weighted image, while following
successiveechoesproduceT2weighted
images.
o Dualechosequencecanbewrittenas90,180,180andproducetwoimagesperslice.
The first echo has short TE and long TR (PDweighted), second echo has longer TE
(T2weighted).
Fast(turbo)Spinecho:FSEorTSE
o TheMultiechosequence90,180,180,canbemodifiedbyphaseencodingeachof
the 4 16 echoes ( each echoes spaced by 20 ms ), with different phase encoding
gradient,withreducedfactorof416time(numberofTRintervals)
o FATisextremelyhigh(bright)signalinfastSET2weightedimages,becausetherapid
successionof180pulsesreducesthespinspininteractions.
o Muscle, is often darker than single SE sequence, due to increase the transfer of
magnetismwithresultinsaturation.
o Matrixsizecanbeincreased,toimprovespatialresolutionwhichwasaffectedbythe
reducedscantime.
o FSE is incompatible with respiratory compensation mechanism unless a powerful
gradientusedtoproduceimagefromsinglebreathhold.
InversionRecovery:(180,90,180)
o IsusedtoaccentuateT1weightedimages.
1) Initial180pulseisusedtotipthespinsantiparalleltotheZaxis(reverseMz).
2) Mzrecovers,passingthroughzeroandreversingdirectionaftertime(069xT1).
3) After a variable time (TI, time to inversion), a 90 pulse is applied, tilting the
availableMz

4) theMxyvectorrotatesinthe
XY transverse plane,
producinganMRsignal
5) Asecond180pulse,isthen
used to develop an echo
signal.
6) Then, the whole cycle (180,
90,180)isrepeatedafterTR
(typically TR=1000 ms, TE =
20ms).
o ThetissueswithlongT1willbesuppressedinT1weightedimages,becausetherewill
benoavailableMztoconvertasTI=0.69xT1.
o TI is used to control T1 contrast, TE controls T2 decay and must be short, and TR is
about3xT1toensurenearlytotalrecoverybetweenpulses.
o Thistechniqueistimeconsuming,butgivesgoodgreywhitematterdiscriminationas
in(FLAIR)
FatSuppressionshortTIinversionrecovery(STIR)(180,90)

o Simply , it is a SE sequence combined

with inversion recovery to suppress the
highsignaloffat.
o An initial 180 pulse, tips both fat and
water protons , but fat protons recover
morequicklywithitsshortT1
o After certain time (TI, about 125 ms),
half the spins in fat have reversed to
parallel and its Mz = 0 , with only few
spins of water have reversed with still
availableMz.
o A 90 pulse is used this instance, will produce a signal water and other tissues but
nonefromFAT.

Tipangle:
o OnewaytoreducescantimeistoreduceTRto200msoreven20ms,butthiswont
giveMztimetorecover.
o This is fixed by using RF of small strength (result in smaller tip angle or flip angle),
whichinvertsonlyasmallfractionofdipoles.
o 30 pulse, produce only half (50%) of the usual Mxy and the consequence MR signal,
butleavesabout87%oftheMz,whichrecoversquicklywithgoodsignalfollowingthe
nextRFpulse.
o 15pulse,produce(25%)oftheusualMxyandtheconsequenceMRsignal,butleaves
about97%oftheMz.
o ThesmallerinitialRF,thesmallerthetipangle,thesmallertheT1weighting.

o Optimumtipangle,whichleavesthegreatestsignalwithabalancebetweenleaving
sufficientMzandproducingsufficientMxy(theshorterTRcomparedtoT1,thesmaller
theoptimumangle)

TR/T1 3 1 0.14 0.03

Optimaltipangle 87 68 30 15

Gradientecho(GRE):(recalledecho)
o Compared with SE , GRE use a RF pulse of a reduced strength and tips the magnetic
vectorthroughasmalleranglethan90,allowingshortTR
o Rephasingisachievedbyagradientecho,withthegradientfieldidreversedtorefocus
theoutofphasespins,whichcompensateforthedephasingcausedbythechangeof
magneticfield.
o Itdoesnoteliminatestaticfiledinhomogeneities,sotheimagesareT2*weighted.
o Itdoesnotcompensateformagneticfieldsusceptibilityeffects.
o A reversed (negative) frequency encoding pulse X is used to dephase the spins,
followedbetwicelongnormal(positive)pulseXtorephasethem,withthepeakofthe
MRsignalinthemiddleofthepositivepulseX.
o InGRE,Movingbloodappearsbright.

Echoplanarimaging(EPI)(fastGRE)
o AnultrafastformofGRE,withsnapshotstakeninabout50mseach.
1) Following stranded SE (90, 180) sequence and the slice selection gradient, the
polarity of the frequency encoding gradient is continually reversed each time
inducingagradientecho.
2) The phase encoding gradient is also switched on and off briefly just before each
echo. Thus, encoding each of the echoes is done with a different phase encoding
gradient.
3) MultipleechoescanbecollectedbeforeMxyhasdecayedtoofar,togiveacomplete
imageinthe50msfollowingtheSEsequencepulses.

o PDandT2weightedimages,areobtainedbyusingshortorlongeffectiveTE
o T1 weighted image is possible if an inverting pulse is applied before the excitation
pulsetoproducesaturation.
o Superconductingmagnetisnecessaryandveryhighgradientsandveryfastswitchers.
o EPI, can be used for functional imaging, real time cardiac imaging and perfusion or
diffusionimaging.

Imaginginotherplanes
o Anydesiredimageplanecouldbeselectedwithoutmovingthepatient.
o Coronal plane, Ygradient used for slice selection & the other two for phase and
frequencyencoding.Insagittalplane,Xgradientisusedforsliceselection.
o Generally,phaseencodinggradientbestusedalongshorterdimensionofthepatient.

ThreedimensionalFourierimaging(Volumeimaging)
o AshallowZgradientisusedtoselectathickslice,thickenoughtoincludethewhole
volumetobeimaged.
o Frequencyencodingisusedasusualalongoneaxis,butphaseencodingisusedalong
theothertwoaxesincludingsliceselectiondirection.
o Scantimeincreased,butthiscanbereducedbyusingGREwithshortTE.
o 3DFouriertransformisusedtodecodeinformation.
o 3D data can be reformatted to produce images of very thin contiguous slices in any
orientationwithnocrosstalk
Parallelimaging
o Itisareduceddatasetinthephaseencodingdirectionacquiredtoshortenacquisition
time,combiningthesignalofseveralcoilarrays.
o Simultaneousacquisitionofspatialharmonics(SMASH)&sensitivityencoding(SENSE),
both use an array of RF detection coils to perform some of the phase encoding that
usuallydonebymagneticfieldgradients.
o EachcoilinanarrayisconnectedtoaseparateRFreceiver,resultinginparallelstream
ofdata,eachproducesaseparateimage.
o SMASH & SENSE use the information from both the localized sensitivities and their
independent signals. Thus, the produced images are obtained with fewer phase
encodingsteps,whicharethelimitingfactorinMRI.
o MostoffastimagingtechniquesasEPIcanbeusedwithSMASH&SENSEtoreduce
thenormalimageacquisitiontime.
o IfeachRFcoiltransmitsaswellasreceives,betterseparationofsignalisobtained.

10.6 SPECIALIZEDIMAGINGTECHNIQUES:
Magneticresonanceangiography:
TheeffectontheMRimageoftheflowofblooddependsonmanyfactorsincluding;
Velocity&Flowprofile.
Directionrelativetotheslice(greatestifperpendicular)
Thepulsesequenceanditsparameters.

o RegardingbloodflowwithSEsequence:
Vesselscontainingslowflowingblood(e.g.veins),mayappearbright,because
bloodentersthesliceunexcitedduringthe90pulse,makinghimmoreaffected
and producestronger echo than other tissues in which their Mz has not yet fully
recoveredfromtheprevious90pulse.
Vessels containing fastflowing blood ( e.g. aorta), may appear dark or void ,
becausesomeofthebloodexcitedbythe90pulsealreadylefttheslicebeforethe
180,andsoproducenosignal.AndinconventionalT1imagesthebloodappear
asblackflow,soanybrightsignalsmayindicatestagnantfloworocclusion.
Turbulentflowproducesarapidlossofcoherence,thusreducingMxyandusually
appearsblack,asinturbulencedownstreamofstrictureinavessel.

o InGREscan,flowingbloodandCSFusuallyappearbright.
Because the RF pulses are repeated rapidly exciting only spins in the selected slice,
but the gradient pulses will rephase all spins in and out the slice affecting also the
excited blood has already left the slice making him still producing a signal (unlike
180 in SE which rephase the in slice spins only), so the inflowing blood will give a
largersignalandappearbrighterthanstationarytissues.
o ToimageonlythebloodvesselsinGRE,movingbloodinrecognizedeitherby:
Itsincreasedbrightness,whichcalledtimeofflightangiography
Thephasechangecausedbymovementalongthemagneticfieldgradient,which
calledphasecontrastangiography.
No contrast medium is required, because the large difference in the MR signal from
flowingbloodandtissues.
Forgood3D(volume)angiographywithhighsignaltonoiseratio,highvelocityflow
isneeded(e.g.intracranialflow).

PerfusionImaging:
o It is measurement of the rate at which blood is delivered to the capillary bed, thus
measuringmetabolicactivity.
o DoneusuallywithEPItechnique,usingaparamagneticcontrastagent,ineitherway:
BolusofcontrastagentArterialspinlabelling.
o Gadolinium as in ion Gd3+ , is highly suitable as contrast agent having 7 unpaired
electrons, but being very toxic is must be chelated with diethyl lenetriaminepenta
aceticacid(DTPA),butstillcontraindicatedinpatientwithrenaldysfunction.
o GdDTPA itself not visible in the MR images, but tumbling around the Larmor
frequency,itwillshortenbothT1&T2ofthehydrogennucleiintheirvicinity.butthe
effect on T1 is greater than T2, so called positive contrast agent and used mainly
withT1weightedimages
o T2*isalsosensitivetothechangesofthesusceptibilityeffectsofGdDTAPinperfused
vessels,butfastimagingtechniquesneededasthesechangeslastfewsecondsonly.
o Measurementofperfusion,intermsofmillilitersofbloodper100gtissueperminute.
o GdDTPA,iswatersolublesoitmayproduceincreasedcontrastbetweenpathological
andnormaltissue,andisdoesntcrossthenormalbloodbrainbarrier.
o Fatsuppressiontechniquesmaybeneededasfatmayappearsequallybrightaswater.
o GdDTPAconcentrationmustnotbesogreat,whichwillshortentherelaxationtimes
makingtheT2effect,cancelsouttheT1effect.
o Inarterialspinlabelling,perfusionimageobtainedbysubtractingthetwoimagesare
generallyobtained,
Oneinwhichthebloodwatermagnetizationisdifferent,obtainedbyspininversion
spinlabelledimage.
Secondisthecontrolimageinwhichtheyareinthesamestatewithnoinversion.
AnoffresonanceRFpulseisusuallyappliedbeforeacquisitionofthecontrolimage
to cancel the effect of magnetic transfer between free and bounded water which
willdecreasetheagentcontrast.

DiffusionImaging:
o Diffusion images require combing EPI or fast GRE sequence with two large gradient
pulsesappliedafterRFexcitation.
o Gradientpulseswillmakemovingspinsundergoesphaseshift(phasedispersed),while
havenoeffectonspinsdonotmovestatic
o Tissuewaterwithnormalrandomthermalmotion(diffusion)willattenuatesthesignal
due to destructive interference of all the phasedispersed spins, while a high signal
appearsfromtissueswithrestrictedmovementordiffusion.
o Signalattenuationisdirectlyrelatedto:
Effective(apparent)diffusioncoefficientxsensitivityweightingfactor
(Sensitivityweightingfactordependsontime&amplitudeofthegradientpulses)
o DiffusiongradientsmustbestrongandareappliedinXYandZdirectionstoobtain
thediffusionimages.
o Diffusion images gives visual information in damaged tissues , but more information
could be obtained by post processing of the data to provide parameters to enable
quantitativeassessmentoftissueintegrityandconnectivity.

FunctionalImaging:(FunctionalMRI)
o Itdepends oncomparingofnormal brain rest images and activity(stimulus) images,
andthechangesbetweenthemareduetobloodoxygenationlevel.
o Oxyhaemoglobin is diamagnetic (weak compared to the main field), while
deoxyhaemoglobin is paramagnetic and produce magnetic filed inhomogeneities in
theneighboringtissuesandwillincreaseT2*
o Atrest,tissueshavealmostequalamountsofoxyanddeoxyhaemoglobin.
o Atactivity,therewillbeincreasedbloodflowwithincreaseddeoxyhaemoglobin,thus
increasedMRsignal.
o Veryrapidsequencesrequired(EPIorfastGRE),astheeffectlastforveryshorttime,
producing lowresolution volume images with the areas of subtracted images that
showincreasedsignalintensitycorrespondstoactivatedbrainareasbythisstimulus.
o The subtracted images can be overlaid on normal highresolution images to provide
thefunctionalmap.

Magneticresonancespectroscopicimaging:
o Magnetic resonance spectroscopy provides a frequency spectrum fingerprint of the
tissuesbasedonitsmolecularandchemicalcomposition.
o Mostclinicalspectroscopystudieshydrogen,butotherMRclinicalnucleiarepossible.
o Peakintensitiesandposition;indicatehowanatomisbondedtoamolecule.
o OnlynucleiwithoddnumbersofprotonsorneutronscangiveMRsignal.Anddifferent
nucleihavedifferentgyromagneticratios.
o Abundantelementsinthehumanbody:
1Hhasoneprotonandhighgyromagneticration.
16O,14Nand12Careabundantbuthasnonuclearmagnetism(evennumbers)
13Chasoddnumberofneutronsbutaccountsonlyfor1%ofcarbonatomsinbody.

13
o P is abundant but has low gyromagnetic ratio, but it can be imaged using strong
magneticfieldandappropriatesurfacecoils.
o 13P, gives less magnitude and lower resolution than 1H, but the metabolism of
phosphorusisofsignificantinterestasanindicatorofenergymetabolismandisalso
usedasmonitoroftherapyoutcome.

o Becauseofchemicalshift,phosphorus
nuclei have different resonant
frequencies when bound in different
compounds (inorganic phosphorus,
adenosine triphosphate ATP, phospho
monoester, phospho diester and
phosphocreatine)
o Using a broadband RF, all these
compounds can be made to resonate
and theMR signalfromdefined tissue
can be analysed as a frequency
spectrum.
o Ahighmagneticfieldisneeded(2Tormore)andthefieldmustbeuniformtobetter
than1ppm,togivesufficientsignalstrengthandgoodspectralresolution
o Only phaseencoding gradients can be used in imaging, because spectroscopy
dependsonfrequency.
o Toreduceimagingtime,amatrixof1cmmustbeused.

Dixonmethodforchemicalshiftimaging
o The resonant frequency of protons is affected by its chemical environment and
measurementofthischemicalshiftcangiveinformationaboutmolecularstructure.
o The valence electrons in HO bond in water produce a slightly smaller magnetic field
thandothoseinHObondinlipids,andasresultthefrequencyoftheprotonisabout
3ppmgreaterinfatthaninwater.Andthisdifferenceandbeusedtoproduceseparate
imagesofwaterandfat.
o WaterplusfatimagesobtainedbysettingTEwhentheyareexactlyinphase.
WaterminusfatimagesobtainedbydelayingTE,tomakethemexactlyoutofphase.
o Subtractingtheseimageswillgivefatonlyimage.
Addingtheseimageswillgiveaugmentedwateronlyimage.

10.7 MAGNETICRESONANCEIMAGEQUALITY
Signaltonoiseratio(SNR):
o ItisrandomvariationintheMRsignaloccurringatallfrequenciesallthetime,dueto:
1) Patient : random thermal movements of hydrogen atoms in the tissues, induces
currentsofwiderangeofRFinthereceivercoilscalled"whitenoise"
2) Scanner:electronicnoisefromelectronsincurrentsflowingintheelectroniccircuits.
3) Environment:comefromRFinterferencefromoutsideorinsidetheroom.

o Allnoisereducescontrastbetweentissues,itappearsworstintheareasoflowPDand
lowsignal.
o 3DimagingcangivebetterSNR,butwithincreasedimagingtime.
o SNRcanbeimprovedby:
(A). Increasingthesignal,by:
Increasingvoxelsize,by
increasingtheFOVorslicethickness
Deceasingphaseencodingsteps
DecreasingTE
IncreasingTRorthetipangle
Usingmachineswithhigherfieldstrength.
UsingSEgivesbettersignalthanGRE.

(B). Reducingthenoise,by:
IncreasingNex(thenumberofexcitations).
Reducing the bandwidth of the receiver, so it can picks up less of the
spectrumofnoisefrequencies,althoughthisincreasesthechemicalshift
andmotionartefacts
Reducingcrosstalk,byhavinglargergapsorusingmultislicetechniques.
Reducingthevolumeoftissues,bygoodwellpositionedsurfacecoils.

Contrast:
o ItisthedifferenceintheSNRbetweenadjacenttissues.
o Contrastcanbeenhancedby:
1) Magnetization transfer contrast, using offresonant frequency RF pulses to
transfermagnetizationtofreeprotonstosuppressthesignalfromprotonsbound
tomacromolecules.
2) Fatsuppression,byusingSTIRsequence.
3) T2 weighting, specifically increase contrast between normal and abnormal
tissueswhicharebrighterasitcontainsmorewater.
4) Paramagneticcontrastmedium:
GdDTPA, shorten T1 of nearby hydrogen nuclei, thus enhancing the
inherentcontrast.
Manganese (as in ion Mn3+) and iron (as ion Fe2+) , can be also used as
positivecontrastagents.
5) Superparamagneticcontrastmedia:
AppeardarkinMRI"negativecontrastagentsorbulksusceptibility"
Asminuteparticles(30nm)oftheironoxideFe3O4withaninertcoating,
anddysprosium(DyDTPA).
TheyproducelocalmagneticfieldgradientslargeenoughtoshortenT2*
andT2,withareasofuptakeappearblack
6) Hyperpolarizedgas,newcontrastagentofhyperpolarized(bylaser)Xenon(129Xe)
that dissolves in blood and shows a large chemical shift, used with low fields
givinggoodSNR,suitableforlungMRIandlowfieldangiography.

Spatialresolution:
o Dependsonthepixelsize,whichdependsonFOVandthematrix
o Improveresolutionby:
Largermatrix(increasephasesteps)
ReduceFOV
Usinglocalsurfacecoil.
Usingthinnerslice,butincreasepartialvolumeeffect.
Using3Ddataacquisition,butincreasesscantime.
Scantime:
itequals;NexxphaseencodingstepsxTR
improvedby:
ReducingNex:ButitwillreduceSNRandincreasemotionartefacts.
Reducingphasematrix:Butitwillreduceresolution
ReducingTR:ButitwillreduceSNR,numberofslices&increaseT1weighting.

10.8 ARTEFACTS

Aliasing:
Partoftheimageisshiftedbodilytotheoppositesidedirection.
ItisasignoftoosmallFOV.
Imagewarproundinthephaseencodingdirectionbecauseelectroniccircuits
suppressaliasinginthefrequencyencodingdirection
ReducedBy:
Doubling the FOV in the phaseencoding direction and doubling the
phaseencoding steps to keep the same pixel size and resolution and
HalvingNextokeepimagingtimeandSNR.
Using a surface coil more closely matches the FOV or increase FOV to
matchthecoil.
Motionartefacts:phasemismapping
Appearsasghostimages
Apparentonlyinthephaseencodingdirection,evenifthemotionthroughthe
sliceorinthefrequencyencodingdirection.
Cyclicalmotion,asinheartmotionorbreathing.Alsocausemotionartefacts.
But cardiac triggering is possible by making TR equal Rwave to Rwave
intervalECG,andrespiratorytriggeringisalsopossiblebutmoredifficultand
timeconsuming.
Pulsatileflowaspulsationsofabdominalaorta,alsocausemotionartefacts,
but using techniques as motion artefact suppression removes these
artefactsbymodifyingthefieldgradientsgradientmomentrephasing
ReducedBy:
Immobilizationofsedationofthepatient
Exchangephaseandfrequencyencodingdirections.

Magneticsusceptibility:
Susceptibility artifacts are caused by materials with magnetic susceptibility
wheninornearthemagneticfieldorbyimplantsofthepatient.
Ferromagneticmaterials(iron,nickeletc.)withastronginfluence
Paramagnetic(aluminium,platinumetc.)
Diamagnetic(gold,water,mostorganiccompoundsetc.)
These materials with magnetic susceptibility distort the linear magnetic field
gradients,whichresultsinbrightareas(misregisteredsignals)anddarkareas
(nosignal)nearbythemagneticmaterial.
ReducedBy:
Removemetallicobjects
UsingSEnotGRE

Chemicalshiftartefacts:
Duringfrequencyencoding,fatprotonsprecessslowerthanwaterprotonsin
the same slice because of their magnetic shielding. Through the difference in
resonancefrequencybetweenwaterandfat,protonsatthesamelocationare
misregistrated(dislocated)bytheFouriertransformation.
This chemical shift misregistration cause accentuation of any fatwater
interfacesalongthefrequencyencodingdirection.
Thisartifactcanbeseenasabrightordarkbandattheedgeoftheanatomy
as in kidney and perinephric fat, around optic nerve & at the margins of the
vertebrabodies.
ReducedBy:
Usingasteepergradient.
Widerreceiverbandwidth.
Superimpositionoftwochemicalshits

CentrallineZipperartefact:
When RF leaks from the transmitter to the receiver or RF interference from
outsideiftheshieldeddoorispartiallyopen
Producedacrossmiddleoftheimage,inthephaseencodingdirection.
ReducedBy:
LargerFOV

Propershielding
Truncationringingartefact:
Itisaparallelstriationsappearathighcontrastinterfaces(fat&muscleorCSF
&spinalcord)
Morelikelyinthephaseencodingdirection.Butalsoinfrequencydirection.
ReducedBy:
Increasephaseencodingsteps(Increasethematrix)
ReduceFOV

10.9 MAGNETSANDCOILS

Typesofmainmagnet:
1) Apermanentmagnet:
Composedoftwoopposingflatfacedhighlymagnetizedpole pieces(ironwith
alloysofaluminumornickelorcobalt)fixedtoironframe.
Verylargeandheavy.
Expensive,butcheapertorun.
Nopowerrequired,butcantbeshutdown.
Lowstrength,verticalfields,onlyupto0.3Tesla.
Suitable for claustrophobic patients, children, obese adults & interventional
procedures.

2) Aresistiveelectromagnet:
ItisasetofDCcoilswithcopperoraluminumconductors.
Consumeabout55100kW
Heatproducedremovedbycoolingwater
Heatproducedlimitstheverticalorhorizontalmagneticfieldto0.5Tesla
Ithassignificantfringefields
Itcanbeswitchedonandoff,buttakesabout1530mintorampup.
Itisthecheapestandthesmallest.

3) Asuperconductingelectromagnet:
ItisaDCsolenoid,about1mindiameter,withconductorsmadeofaniobium
titaniumalloyinacoppermatrix.
Itissupercooledbyacryogenliquidhilumat4K(269C).
Atthistemperature,largeDCcurrentscanbeusedwithnegligibleresistanceto
producehorizontalfieldupto3Tesla.
Ithassignificantfringefields
Largeandveryexpensiveandheavy.
Ittakesseveralhoursforthecoiltocooldownandthecurrenttobuildup.
Theexpensiveliquidhilumiscontainedwithinafragilecryostatandreplenished
periodically.Witharefrigeratorsystemusedtoreduceheliumlosses.
Ifthemachineisshutdown,theelectromagneticenergy(about20kWh)stored
withinthesuperconductingcoilhastoberemovedcarefullytoavoidhilumleak.
If the temperature rises, the liquid gas boils off rapidly and must be vented
outsidethebuilding.
Themagneticfield:
Themainfieldmustbestableanduniformto5ppm(1ppmforspectroscopy).
Fringe fields (magnetic lines form closed crowed loops within a solenoid but
spread widely outside it),reducedbyadditionalshimcoilsorironshroud.
Optimum field strength is large enough to produce adequate signal, but not so
largetoexceedssafetyguidelines.

Advantagesofhighstrengthfield:
LargerMRsignal.
ImprovedSNRwithoptimumimages.
Suitableforspecialapplications.
Disadvantagesofhighstrengthfield:
IncreasedT1,thuslongerTRandimagingtime(NoeffectonT2)
Greatercostofmagnet
Hardertomakeuniform
Strongfringefields.
Increasedchemicalshiftartefacts(unlesshighergradientfieldalsoused).
Worsemotionandsusceptibilityartefacts.
GreaterRFpotentialhazardofheating.

Coils:
Arrangedfromoutsidetoinside:
1) Theshimcoils:
CarryingDC,finetunedtomakethemainmagneticfieldmoreuniform.
2) Threesetsofgradientcoils:
Carrying DC, and varied to alter the
slopeofthemagneticfield
Typically20mT/m.
The currents must be switched off
rapidlyin1msorless,whichcausesthe
coilstoemitaloudrepeatedbangs.
The steeper the slice gradient, the
thinnertheslice.
The steeper the phaseencoding
gradient,thefinephasematrix
Steeper the frequencyencoding
gradient,neededforsmallFOV.
3) RF(transmitter/receiver)coils:
Tunedlikearadiototheresonantfrequency.
Producemagneticfieldatrightangelofthemainfield.
Types:
1) Standardbodycoil:permanentpartofthescanner,transmittheRFinallscan
typesandreceivesonlywhenimaginglargeparts(e.g.abdomen).
2) Headcoil:transmitandreceiveasapartofthehelmetusedinbrainscan.
3) Surfacecoils:receivers,asseparatecoilsappliedclosetotheimagedpart,they
allowsmallervoxelsandgivebetterresolutionastheypickupalargersignal
andlessnoise,thusimprovingSNR.
4) Phased array coils: multiple individual receiver coils, they receive signals
individuallythencombinedtogivebetterSNRwithlargeFOV.
5) Transmitphasedarraycoil:produceacurrentoneachelementswithspecial
amplifierneededtodefinethiscurrent.

Thecompletemagneticresonancesystem:

o Magnets&coils.
o Pulsecontrollerunit:synchronize
the gradient and RF pulses for
theselectedparameters.
o Main computer: with an array
processor for Fourier transform
andalsoimageprocessor.
o The machine setting: With steel
grindersandreinforcedconcrete.
o Liftsandpowercablesshielding:
as it may cause RF interference
anddistorttheimagewithlinear
artefacts.
o Roomwallsanddoorsshielding:
with wire mesh to prevent
externalRFinterference.

10.10 QUALITYASSURANCE

Thehomogeneityofthemagneticfieldiscrucial,andbemeasured:
DirectlybyaspecialnuclearMRprobeatdifferentpositions.
Indirectlybyusingimagingspecialdevices.
Qualityassurancechecklist:
Signal:SNR,uniformityandghosting
Geometrical:distortion,slicewidthandpositionandresolution.Usingphantoms
Functional:T1&T2,imagingspeed,stabilityandflow
Hardware:Magnet,fieldcontoursandgradientcalibration.

10.11 HAZARDSANDSAFEPRACTICE

MedicinesandHealthcareProductsRegulatoryAgency(MHRA)guidelines:
Staticmagneticfield:
Normalmode:lessthan2.5T
Controlledmode:between2.5Tand4T(Panic button must be available with visual
contact and verbal if possible)
Researchorexperimentalmode:morethan4T
Pregnantwomen:notmorethan2.5T
Staff:notmore2Tforwholebody&5Tforlimbs&over24hournotmorethan0.2T
(200mT)&0.6Tin8hours.
Usingpulseoximeterisrecommended(ECGisnormallyaffectedabove0.3T).
Ethicscommitteeapprovalisrequiredabove4T.
MRIiscontraindicatedifthepatienthasimplantedpacemaker.

TimeVaryinggradientsfields(dB/dt)
Electricfieldsareproducedperpendiculartothegradientfieldinducingeddycurrents
inconductivetissuescausingsomeeffects:
Peripheralnervestimulation:mostcommonwithlowthresholdabout60T/s.
Involuntary muscle contraction, breathing difficulties and even ventricular
fibrillation.
Others:flashesoflight,vertigo,nauseaandmetallictastesensation.
Notlikelyoccurbelow20T/s.
Asaprecaution,MRIusuallynotcarriedinthefirsttrimester.
MRcompatibledevices,areunaffectedbyMRanddonotaffecttheimage.

Acousticnoise:duetofastswitchingmagneticfields,withmachineslimitis
140dB,andhearingprotectionisrequiredtopreventirreversibledamageat
90db(earplugsreducenoiseby1030dB).
Radiofrequencyfields:
Microwaveheating:
Mayoccurathigherfrequenciesassociatedwithstrongstaticfields.
Compensatedbyvasodilation.
Cornea(nobloodsupply)andtestesmaybeatrisk.
Metallicimplantsheatingalsomaycauseproblems.
Skinandrectaltemperatureriseshouldnotexceed1C

Specificabsorptionratio(SAR):
ItistheRFenergydepositedpermassoftissue.
Expressedaswattsperkilogram(W/Kg)
1W/kgwholebodySARwillrisebodytemperature0.5C
Lessthan15minutesexposuremustnotexceed2.0w/KgSAR(1.0C)
SARisgreaterfor:
Largebodypatient,morethansmall
Highstaticfield,morethanlowerfields
180pulse,morethan90pulses.
InSEmorethanGRE
Highconductivitytissues(brain,blood,liverandCSF)morethan
lowconductivitytissues(fatandbonemarrow)
Otherhazards:
Mechanicalattractionofferromagneticobjectsduetofringefield:
o Whichcanextendtofewmetersmayattractoxygentanks,patientbeds,
firefightingapparatusmayhavethemallcausemajoraaccidents.
o Mayconvertscissorsandscalpelsintopotentiallylethalprojectiles
o Aneurysmclipsmaybedisplacedorrotated.
o Fringefieldalsaffectsomewatches,destroydataoncomputerdisksand
creditcards
o Controlled area around the magnet must be carefully supervised with
areasoutsidenotexceed0.5mT

Safetyprocedures:
Patientscreening:patientmustbeinterviewedbeforeanyMRIexaminationand
safetyquestionsmustcover:
Implants
Surgicalhistory
Allergies
Protheses
Weight
Metallicforeignbodies.
Beforeprocedure,metallicobjectsshouldberemoved,includinghairpins,jewellery
andelectronicdevices.
Requirementforsafeimaging:
Appropriatepositioningoftheequipmentleads
UsingMRcompatiblefoampads
Providingmusic,humancontactorevenlight
Hearingprotection
Visualmonitoring
Ifnecessary,experiencedanesthetistsshouldattendthepatient.

Emergencies:
Cardiacarrest:
RemovethepatientfromthemagnettoMRcompatibletrolley
Keepairway
Cardiacmassage
Quicklytakentoresuscitationarea.
Fire:
Resistivemagnetsshouldbeswitchedoff
Nonferrous carbon dioxide fire extinguishers devices should be used from
distance1meterormore
Superconducting magnets should be quenched only if firemen need to enter
thecontrolledarea.
Quench:
Allscanroomsshouldcontainanoxygenmonitorandgasventingsystem.
In controlled quench in case of fire or trapped person in the magnet, fixed
opendoorshouldbemaintainedtopreventbuilduppressure.
Cleartheroomincaseofaccidentalquenchandreleasingofheliumgasinthe
roomthatmaycausesuffocationorfrostbite.

********************************

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Physics

Dr. Khaled Elazhry

Dr. Khaled Elazhry 2

As high values displayed dark and low values displayed light'

As in CT may be ( 350\512 = about 0.7 mm)

Dr. Khaled Elazhry 4

B- Flat panel monitor :

5.2 IMAGE TERMINOLOGY:

Dr. Khaled Elazhry 5

Aliasing : Under-sampling , leading to high frequencies will be recorded as low

Modulation transfer function ( MTF ) :

Dr. Khaled Elazhry 6

5.3 COMPUTED RADIOGRAPHY ( CR ):

Dr. Khaled Elazhry 7

Detector Dose Indicators ( DDIs):

Dr. Khaled Elazhry 8

There are many transistors as there are pixels.

Dr. Khaled Elazhry 9

Detective quantum efficiency ( DQE )

Charge coupled device (CCD detector )

Dr. Khaled Elazhry 10

Dr. Khaled Elazhry 11

Dr. Khaled Elazhry 12

The use of direct-vision fluoroscopy is now BANNED.

6.1 THE IMAGE INTENSIFIER:

The tube itself is an evacuated glass

Dr. Khaled Elazhry 14

Fig. 4.2 Mass attenuation coefficient of cesium

Cesium iodide input screens absorb approx-

Dr. Khaled Elazhry 15

Output Phosphor Screen:

Dr. Khaled Elazhry 16

Dr. Khaled Elazhry 17

The overall brightness gain is approximately about 5000

Measured with a photometer and a dosemeter employing a flat circular ionization

By changing the voltages of the intermediate

Dr. Khaled Elazhry 18

Dr. Khaled Elazhry 19

AUTOMATIC GAIN CONTROL

1) varying the sensitivity of the TV cameras

Dr. Khaled Elazhry 20

In magnification there is reduced brightness and reduced dose area product

Dr. Khaled Elazhry 21

6.6 Image Quality :

Dr. Khaled Elazhry 22

Testing Image Quality :

6.7 Digital Subtraction Angiography : ( DSA )

Dr. Khaled Elazhry 23

Dual Energy Subtraction :

6.8 Flat Plate Detectors :

Dr. Khaled Elazhry 24

Dr. Khaled Elazhry 26

7.1 PRINCIPLE OF COMPUTED TOMOGRAPHY IMAGING

Dr. Khaled Elazhry 28

Dr. Khaled Elazhry 29

1stgeneration 2ndgeneration 3rdgeneration 4thgeneration

Dr. Khaled Elazhry 30

Dr. Khaled Elazhry 31

SUM of linear attenuation coefficients of the voxels X average path length =

logarithm of the ratio of the intensity of the unattenuated pencil beam

For purpose of reconstruction , a complex mathematical techniques referred as

(a) : Imagine a cylindrical uniform body

(b) & (c) : Two back projections

Dr. Khaled Elazhry 32