Brief view of Computed Tomography and its uses in Veterinary

Medicine

Computed tomography ( CT ) is originally known as Computerized Axial Tomography or body

section retenography. It is a medical imaging method employing tomography where digital
geometry processing is used to solve the multiple X- ray projection for the construction of cross-
sectional as well as 3 dimensional images of the patient.

The word “tomography” is derived from the greek word Tomos ( slice ) and Graphein ( to
write ) . CT produces a volume of data which can be manipulated through a processing known as
windowing, in order to demonstrate various structures based on their ability to block the X-Ray
beam.

The 1st commercially viable CT scanners was invented by Godfrey Newbold Hounsfield in
Hayes, England at Thorn EMI Central Research Laboratories using X-rays ( idea was conceived
in 1967, and it was publicly announced in 1972 ). In 1979 , G.N Hounsfield shared the Nobel
prize in physiology and Medicine with Allan Macleod Cormack, physics professor who
developed solution to mathematical problems involved in CT.

Basic Principle of CT: The internal structure of an object can be reconstructed from multiple
projection of the object . It means it is the systematic collection and representation of projection
data. To Carry out the reconstruction , the linear attenuation coefficient (µ) of the object is
considered as the base. For eg. Fat- 0.194 , water – 0.222, CSF- 0.227 etc

Equipment for computed tomography :

In general, scanner possess a ,

a) Control console
b) Computer
c) Gantry

Computer console : It is used for operation of the imaging system, post processing, filming and
filing, and available for the physicians to view the images and manipulate image contrast, size
and general visual appearance.

Computer : The computer is used to solve more than 2,50,000 equations with the help of
microprocessor/ Array processor ( Array is used most ) and has a primary memory. The
softwares includes a plot of CT numbers, mean and standard deviation of CT values of ROI,
substraction techniques, planner and volumetric quantitative analysis and reconstruction of
images in coronal , saggital, and oblique planes.

Gantry: CT gantry has following gadgets,

i) X- ray tube – Is a radiation source for a CT and supply a monochromatic X-Ray beam
ii) Collimators and filters – One or two collimators are used ( Pre- patient and pre-
detector ), which reduces patient dose and improves a image contrast, by limiting
scatter radiation
iii) Detectors – Detects informative radiation. Ionization chamber and solid state
detectors are mainly used .
iv) High voltage generators – They are mounted on the gantry and provides a suitable
tube current and voltage that is controlled by a microprocessor.
v) Patient Couch – It is motor driven,and used for patient position and is made up of low
Z-materials such as carbon fibre.
vi) And mechanical support for each

Uses of CT in Veterinary :
Although computed tomography (CT) is used primarily for diagnosis in humans, it can also
be used to diagnose disease in veterinary patients. CT provide X-rays of internal organs and
bones to enable your vet to prescribe the best internal medicine, orthopedics, soft tissue, ear
nose and throat and dentistry treatments. CT and associated three-dimensional reconstruction
have a role in diagnosis of a range of illnesses in a variety of animals. The applications in
veterinary medicine are continually being explored, and accessible CT imaging centers are
emerging. In many cases, CT imaging can provide valuable information that cannot be obtained
with ultrasound and radiography. It is important for veterinarians to know the indications for CT
imaging so this modality can be incorporated into a case when financially feasible.

Indications for computed tomography:

Nasal and sinus : CT can usually discriminate between most classes of nasal disease. Bacterial
rhinitis will generally have diffuse exudate between turbinates and a small amount of sinus fluid.
Fungal rhinitis will have the same findings as rhinitis, but in addition, regions of turbinate lysis
and sloughing will be seen. Neoplasia will usually present as a focal, destructive mass. For all
forms of nasal disease, CT provides more information than radiography for prognosis and
treatment planning, and it also guides biopsy procedures. Because of its greater bone imaging
capabilities, CT is preferred mainly.

Masses
In general, CT is very useful to provide the following information about masses:
1. What is the origin of the mass?
2. Where are the margins of the mass?
3. Is the mass invading important structures?
4. Is underlying bone destruction present?
5. Is surgical resection possible?
If these questions are answered and a biopsy is obtained, an accurate prognosis can be given.
Studies have shown that the gross margin of tumors often extends beyond palpable limits. By
accurately mapping the margins of a mass, surgery and radiation therapy have a greater chance
of success.

Ear Diseases
CT can depict the anatomy of the ear with great detail. The main indication for imaging the ear
with CT is to document that there is middle or inner ear involvement and to determine which
surgical procedure is indicated (ear canal ablation, bulla osteotomy, etc.). In cases of otitis
media, fluid is visible in the osseous bulla. If chronic, the osseous bulla becomes thick and
sclerotic. Rarely, tumors of the ear are encountered and are often differentiated from otitis by
destruction of the bulla.

Orthopedics
CT is relatively insensitive at detecting soft tissue injuries. Ultrasound and MRI have much
greater soft tissue imaging capabilities and are preferred. CT is useful for confirming medial
coronoid process fractures in the elbow. These fractures are very difficult to visualize
radiographically, but are easily detected with CT.

Head Trauma
For imaging of the head, CT has great advantage over radiographs. Small fractures can be
difficult to see on radiographs, but are easy to visualize with CT.

Ureters
CT excretory urography is useful for confirming and localizing the presence of ureteroliths or
other causes of ureteral obstruction. It can also be utilized to evaluate for ectopic ureters and is
preferred over standard radiographic techniques at this time, though studies need to be done to
determine if it has greater accuracy.

Chest
CT of the chest has been revolutionized by two new developments in scanning. These are the
ability to scan quickly with the new spiral scanners and the ability to acquire very thin slices
(high resolution CT). With spiral CT scanners, the entire chest can be scanned during a single
breath. This also means that small intrapulmonary abnormalities such as a pulmonary metastasis
will not be missed because of variations in inspiratory effort.
Contrast enhanced CT of the chest is usually used for staging lung cancer and for assessing
masses in the mediastinum. High resolution CT is used to image the lung parenchyma. The thin
slices (1.5 mm) improve the resolution, making it possible to diagnose and assess the extent of
diseases. Pulmonary diseases can be characterized with greater clarity than radiographs, but at
this time the added information does not add great value to prioritizing differentials or changing
the diagnostic plan.

Abdomen
Ultrasound is the preferred modality to assess the abdomen in animals. As a diagnostic tool, CT
provides no advantage for the diagnosis of most conditions (there are a few exceptions). The
pelvis inlet is one place in the abdomen that is difficult to visualize with ultrasound, so CT is
useful to stage tumors in this area.

Spine
In general, MRI is the preferred modality to assess problems of the spinal chord. With CT
imaging, contrast in the subarchnoid space (such as with myelography) is necessary to outline
the spinal chord and visualize lesions around the chord. The exception to this generalization is
with the lumbosacral region. A large amount of epidural fat around the nerve roots in this region
facilitates visualization of lesions at this site without contrast. Tumors involving the vertebral
bodies can also be well characterized with CT.

Brain
As with the spine, MRI is preferred over CT for detecting brain diseases. MR has much greater
contrast resolution for soft tissues and has higher sensitivity for detecting smaller neoplastic,
inflammatory, and vascular lesions. The tradeoff is a higher expense and longer image
acquisition times (~30-40 minutes for MRI vs. 5 minutes for CT). With contrast enhancement,
CT can detect most lesions that are larger than 1 in size. CT is very sensitive at detecting
pituitary macroadenomas since the pituitary gland does not have a bloodbrain barrier and will
readily contrast enhance.

Advantages of computed tomography :

Conventional radiographs depict a three dimensional object as a two dimensional image. Their
main limitation is that overlying tissues are superimposed on the image. Computed tomography
overcomes this problem by scanning thin slices of the body with a narrow x-ray beam which
rotates around the body. Another limitation of the conventional radiograph is its inability to
distinguish between two tissues with similar density, such as soft tissue and fluid. Computed
tomography can differentiate between tissues of similar density because of the narrow x ray
beam and the use of "windowing".