Computed Tomography Scanner CT-Scan Pemi PDF

PT.
SIEMENS INDONESIA
Computed Tomography Scanner (CT-Scan)

(Pemindai Tomografi Komputer)
Oleh: Daniel Kartawiguna, ST., MM., M.Acc.
PT. SIEMENS INDONESIA – Medical Solutions
daniel.kartawiguna@siemens.com
DISAJIKAN DALAM RANGKA

Always Thinking Ahead.
PELATIHAN CT SCAN DOSEN ATEM
JAKARTA, 19 JUNI 2006
MATERI PELATIHAN
I. Dasar Tomografi Komputer
II. Sistem Tomografi Komputer Spiral
III. Sistem Tomografi Komputer Multi
Irisan (MSCT)
IV.Pemeliharaan dan Perbaikkan
V. Aplikasi Klinis MSCT
(c) Daniel Kartawiguna, 2006

danielk@indo.net.id 1
PT. SIEMENS INDONESIA
I. Dasar-dasar Tomografi
Komputer
Dasar-
dasar
Tomografi POKOK BAHASAN
Komputer
1. Tomografi Komputer dan Sejarah
Perkembangannya
2. Prinsip Tomografi Komputer
3. Komponen2 Tomografi Komputer
4. Sistem Tomografi Komputer yang
dikembangkan oleh SIEMENS
5. Kalibrasi
6. Pemeriksaan Kualitas Gambar

Dasar-
dasar
Tomografi POKOK BAHASAN
Komputer
Perkembangannya
5. Kalibrasi
Penemuan Sinar-X
Sinar-X ditemukan pada
tahun 1895 oleh seorang ahli
fisika Jerman yang bernama:
Wilhelm Conrad Röntgen

Sinar-X memungkinkan orang

pertama kali untuk melihat
struktur dari tubuh manusia
tanpa melakukan
operasi/pembedahan.
Keterbatasan:
• Gambar yang dihasilkan merupakan superimposisi
dari obyek yang diamati.
• Tidak dapat menggambarkan jaringan lunak.
CT memberikan solusi terhadap

keterbatasan ini...
Pada tahun 1972,
Hounsfield dan Ambrose
yang bekerja di Central
Research Labs. of EMI, Ltd
di Inggris menghasilkan
gambar klinis pertama
dengan CT Scan.

Gambar CT yang pertama

memungkinkan
pertama kali kita dapat
melihat:
- Tomographic atau
“Slice” anatomy
- Perbedaan densitas
Keterbatasan:
• Memerlukan waktu yang lama.

• Resolusi perlu ditingkatkan.
10
CT-Scanner Siemens yang pertama
SIRETOM (1974)
Waktu scan 7 min, matrix gambar 80x80 Pixel,
scan field 25 cm, resolusi spatial 1,3 mm (4LP/cm)

11
Perkembangan kualitas gambar CT

Dari tahun 1972 - 2000
SIRETOM SOMATOM Plus 4 UFC

(1974) (1996)
12
Ringkasan Sejarah Perkembangan

Tomografi Komputer
1917 J.H. Radon: Transformasi Radon, gambar dari
obyek yang tidak diketahui dapat digambarkan dari
proyeksinya.
1963 A.M. Cormack: mengembangkan teknik untuk
menentukan distribusi penyerapan tubuh manusia.
1972 G.N. Hounsfield dan J. Ambrose: menghasilkan
gambar CT pertama kali untuk keperluan klinis.
1974 60 unit CT terpasang untuk pemeriksaan kepala
1975 First whole body scanner in clinical use
1979 Hounsfield dan Cormack dianugerahi hadiah Nobel
1989 Spiral CT
1998 Multislice CT
2000 > 30000 clinical CT installations

13
POKOK BAHASAN
Perkembangannya
5. Kalibrasi
14
Prinsip Dasar Pemindai Tomografi Komputer

Pelemahan intensitas sinar-X oleh obyek yang ditembus oleh sinar-
X tersebut.
SINAR-
SINAR-X DIHAMBURKAN
Berkas sinar-X yang menembus
suatu obyek akan mengalami
pelemahan (kehilangan energi) yang
diakibatkan oleh:
Sinar-X Diteruskan
Penyerapan oleh obyek Sinar-X datang JARINGAN
TUBUH
Penyebaran
Penyerapan oleh jaringan adalah sebanding dengan densitasnya
Jaringan Jaringan
dengan Dengan
kepadatan Kepadatan
yang tinggi rendah
PERLEMAHAN LEBIH BESAR PERLEMAHAN LEBIH KECIL

15
Prinsip Dasar Pengukuran
Ι0 µ
I=I0 ·exp(- ∫ µ ds)

“Line Integral”
∫ µ ds = - ln(I/ I0)
Koefisien atenuasi, nilai CT
16
Proyeksi (Projection)

17
Projection
To be able to compute in acceptable quality a CT image, a sufficiently high number of attenuation integrals or projection values
have to be recorded.
One readout of all detector elements is a so called projection.
A CT scan for a single image (skice) requires the measurement of a high number of projections ( approx. 800 – 1400)
18
Generasi CT-Scan

19
Prinsip dasar akuisisi data

Tabung Parallel beam geometry
sinar-X
(1st generation scanner)
Berkas
sinar-X
Detektor sinar-X
Obyek
pemeriksaan
20
Raw data (Data Mentah)
Sequence of
attenuation profiles
1. projection
time
(projections)
attenuation profile
(channels)

21
Sequence of
2. projection
time
(projections)
attenuation profile
(channels)
22
Sequence of
Full rotation
→ CT raw data
time
(projections)
attenuation profile
(channels)

23
REKONSTRUKSI
• How do we reconstruct the image?
• One could solve more than 260.000 unknown µ by

measuring the attenuation in about 1.400 readings
with about 700 detector channels.
Disadventage: calculation can be started only after a full
revolution, spiral scan wouldn`t be
time effective
or
• We could simply add the projections by smearing them
back upon each other across the image.
• This is simple back-projection.
24
Rekonstruksi Gambar
Dasar Matematika:
Radon (1917)
Dalam praktek:
a) Fourier method
atau
Raw data CT image
b) filtered
backprojection

25
Unfiltered Backprojection
Scanned
object nice
reconstruction,
but not very
accurate...
Reconstructed object
using 128
64
32
16
8
4
3
2
1 projection(s)
26
Solution: Filter
Filter:
convolution kernels
Attenuation profile Filtered

of a cylinder attenuation profile

27
Filtered Backprojection
Scanned
This
object
reconstruction
looks much
better ...
Reconstructed object
using 128
64
32
16
8
4
3
2
1 projection(s)
28
Convolution Kernel
sharp kernel
smooth kernel

29
Convolution kernel
30
Convolution kernel
The original profile ( = 1 projection) is multiplicated with the convolution kernel; the result is the concolved projection.
Different convolution kernel provide different image sharpness.
The use of a smoothing kernel reduces the noise in the image and improves low contrast resolution.
The use of an edge enhancing kernel improves high contrast resolution, but increases the noise in the image.

31
Convolution Kernel (lanjutan)
Kernel akan menentukan

• Ketajaman Not independent:
sharp image → more noise
• Noise less noise → smoother image
• Batas
32
Simple back-projection w/o and

with convolution

33
Simple back-projection w/o and with

convolution
It is necessary to carry out measurements in all directions, i.e. at least over an angular range of 180 0, and to determine many
narrowly spaced data points for each projection.
For simple backprojection each projection value is added to all the picture elements in the computer memory along the
direction in which it has been measured.
The farreaching signal contributions due to the backprojection process lead to an unsharp image, which is insufficient for the
diagnosis of cpmplex structures.
To avoid this unsharpening each projection has to be convoluted before backprojection with a mathematical function, the
concolution kernel. This constitutes a pointwise multiplication of the convolution kernel and the attenuation profile and addition
of the resulting values. In essence, this represents a high pass filtering procedure which generates over- and undershoots at
object boundaries. For a positive signal, negative undershoots are generated.
Concolution additionally offers the possibility to influence image characteristics by the choice and design of the concolution
kernel – from soft or smoothing to sharp or edge enhancing.
34
Perangkat Keras Sistem CT-Scan
Bagian luar... Gantry

• Gantry
• Meja
• Generator Generator
• Konsol
• Komputer
Meja
Konsol
Komputer

35
Perangkat Keras Sistem CT-Scan
Bagian dalam ...

Tabung
• Tabung
• Detektor
• DAS*
DAS
Detektor
* Data Acquisitions System (Sistem Akuisisi Data)
36
CARA KERJA PESAWAT CT SCAN
Sumber
Sumber Radiasi
Radiasi Sinar-X
Sinar-X
Detektor
Detektor
Rekonstruksi
Rekonstruksi ++ post
post processing
processing

37
Overview over a CT system
Image
Image Processing
Processing
38
Overview over a CT system

A modern CT can be divided into three parts:
System Control
Runs the Operating System software (VMS, UNIX or Win NT.)
Runs the Application software to provide a user interface (SOMARIS).
Supports Scan Control by distribution of scan parameters and instructions.
Scan Control
Usually microprocessor based. Directly controls the scanner hardware via firmware routines stored
in PROM. It is responsible for the safety of the patient, operator and system hardware. It distributes
parameters from the host to the other functional groups in the system. It serves as the interface for
all communication between “system control” and the gantry.
Image Processing
This is a specialized array of computers that are responsible for the reception of data from “scan
control” and the subsequent reconstruction of an image.

39
Blockdiagram image processor
40
Blockdiagram image processor
An image processor consists on 4 functional blocks:

1: Pre- processor
2. Convolver
3. Backprojector
4. Imager
The data measurement system supplies the scan data in serial

order to the receiver module, which is a part of the pre-
processor.

41
Blockdiagram pre- processor
42
Blockdiagram pre- processor
A pre- processor has to compensate the measured data for :

1) Electrical drifts
2) Dose variations
3) X-ray attenuation law
4) Beam hardening
5) Mechanical deviations of the scanning system
The input (measured data from the aquisition system) is called

a reading, the output a projection.

43
44
PGA decoding
The signals from the detector have a very wide range. To cover the whole dynamic range of input
signals, a
„Programmable Gain Amplifier“ (PGA) is used (also called FPA, floating point amplifier).
PGA: The PPA is an amplifier which selects its gain automatically. The selected gain can be 1, 8 or 64.
The gain used is indicated by the two bits called `PGA Bits´.
PGA Decoding:In order to calculate the actual attenuation, the PGA bits are decoded in the SMI. This
is done in the preprocessing step „PGA decoding“ (also called „FPA decoding“).
Amplification 64:If the signal from the detector was very small (i.e., high absorption in the scanfield),
the amplifier will have used a factor of 64. The resulting data in the SMI will be the 14 bit from the
ADC, preceeded by many zeroes, in other words, a rather small numerical value.
Amplification 8:If the amplification was 8, the signal was larger. In the SMI, the 14 bit are shifted 3 bit
to the left, equaling a multiplication by 8, or a larger numerical value.
Amplifiaction 1: If the signal from the detector was large (e.g., only air in the scanfield), the
PGA will have used an amplification of 1. This will result in a large number in the SMI, because
Always Thinking Ahead. the 14 bit are shifted 6 bit to the left, equaling a multiplication by 64 or a rather large numerical
value.

45
Offset correction
46
Offset correction
Offset voltage :
In the DMS, ADCs are used that can´t measure negative voltages. This would
falsify the measurement, if very small detector signals ( = high
absorptions ) have to be measured. To avoid this, in the DMS an offset
voltage is added to the signal, the signal is measured, and in the SMI
the offset signal subtracted again, leaving the true value only.
Offsets are channel specific: Because the analogue offset may be slightly
different for each ADC, or, to be precise, even for every integrator board
channel, the actual offset has to be measured prior to the scan for every
channel.
Offset measurement:
With each scan start, a measurement is started without X-ray and the
data are stored in the image processor as offset data.

47
Logarithmation
48
Logarithmation
Logarithmation is done because the attenuation of an X-ray beam

follows an exponential law.
I = Io e - µ d
The calculation of the object attenuation „A“ requires the calculation

of the logarithmic value of the measured radiation intensities I
and I 0:
A= ln I 0 – ln I
The logarithmation is done using a table of log values.

49
Normalization
50
Normalization
During the measurement, the intensity Io of the X-ray beam

varies (exaggerated in the picture for clear visualization).
Monitor value: A monitor element measures the

unattenuated radiation as a reference value.This value is
called “Monitor value”.
Normalization : During the preprocessing step

“Normalization” , this monitor value IM is substracted from
each channel value I:
In 1/I – In 1/IM

51
Calibration
52
Calibration
Each detector has a different sensitivity. This can vary with the time and must
be compensated.
The channel specific sensitivity differences are compensated by calibration.

Technically, that means taking an air scan and then subtracting the
channel values obtained in air from the normalized channel values.
Then preprocessing step calibration requires the base calibration tables,
that are measured during the last calibration.
During the last tune up, the differences of each combination of kV, mA, slice
width etc. were measured, so that only the base calibration is required
on a daily basis.
The other calibration tables for different settings of kV, mA etc are calculated
from the difference tables and the base calibration table.

53
Channel Correction
54
Channel Correction
Technically, the preprocessing step „channel correction“ is a

multiplication of each channel value with a correction factor.
Because a correction is needed for many reasons, several individual
tune- up tables contribute to the resulting one factor in the pre-
processing.
Channel correction includes:
- Beam hardening correction
- Cosine correction
- Channel coefficient correction and
- Water scaling

55
Beam – Hardening Correction
56
Beam – Hardening Correction
X-ray spectrum:
Tubes generate polychromatic radiation, i.e.different wavelength are
contained in the spectrum.
Just as with visible light, the higher energies or shorter wavelength
can penetrate the objects better than the softer part of the
spectrum.
Beam hardening causes in homogenous objects (e.g. a water
phantom) an inhomogeneity. That means, the CT values in the
center are different from the outer values.
The correction is done by taking data of a reference phantom (mostly
a 20cm water phantom) and the correction data are used during
preprocessing step „beam hardening“ for the correction of the
scan data.

57
Cosine - Correction
58
Cosine - Correction
Measured attenuation:
The Cosine – Correction considers that the x-ray beam is fan
shaped.
The length of the path of the radiation through an object depends on

the angle alpha between the central beam and
any other beam.
Corrected attenuation:
The correction of the different channel outputs is done by using the
cosine function. For each channel, the table contains the cosine-
value of the corresponding fan angle „alpha“.
The measured attenuation is multiplied with the table values.

59
Channel Coefficient Correction
60
Channel Coefficient Correction
Just like „Calibration“, the pre-processing step ´Channel Correction´

compensates for sensitivity differences of the detector. The difference is
that the Channel correction compensates for nonlinearities in the area of
attenuated radiation, i.e., with an object is in the scan field.
Parameter:
The parameters which determine the detected radiation energy are:
Tube Voltage
Slice Thickness
Object Attenuation (Head or body)
Correction tables:
The sensitivity compensation is done with values which are determined
during the tune-up.

61
Water Scaling
62
Water Scaling
The water scaling sets CT value of water to 0 HU.
This factor depends on the energy received by the

detector; the parameters for the scaling are:
- tube voltage
- tube current
- slice thickness

63
Generasi Tomografi Komputer

“Generasi” digunakan untuk membedakan rancangan
konfigurasi tabung-detektor pada CT.
64
Generasi ke-1: Pencil Beam

65
Generasi ke-1
• Gerakan translasi dan rotasi
• Berkas sinar-X berbentuk pensil (pencil beam)
• Geometri berkas sinar paralel.
• FOV (field of view) 24 cm.
• Menggunakan 2 buah detektor sehingga sekali scan dapat
menghasilkan 2 irisan.
• 160 berkas paralel/proyeksi.
• 180 proyeksi dengan interval 1 derajat.
• Detektor tidak dapat mendeteksi perbedaan intensitas sinar-X
yang sangat besar, oleh karena itu kepala yang diperiksa harus
dikelilingi oleh kantong berisi air.
• Kristal NaI yang digunakan sebagai detektor memiliki waktu
“afterglow” yang nyata.
• Keuntungan: pengaruh hamburan radiasi pada detektor
ditiadakan karena berkas sinar-X yang berbentuk pensil.
66
Generasi ke-2: Partial Fan Beam

67
Generasi ke-2
• Menggunakan 30 linear array detector.

• Kerugian: adanya pengaruh radiasi hamburan dan
meningkatnya intensitas kearah tepi dari berkas sinar-X
yang berbentuk kipas. Hal ini diatasi dengan penambahan
filter dasi kupu-kupu pada jendela tabung sinar-X.
• Keuntungan: waktu scan lebih singkat, yaitu antara 18
hingga 30 detik/irisan.
68
Generasi ke-3: Fan Beam

69
Konstruksi CT Generasi ke-3
70
Generasi ke-3: Rotasi/Rotasi, Fan Beam
• Konfigurasi rotasi/rotasi.
• Berkas sinar-x berbentuk kipas (fan beam).
• Menggunakan detektor array.
• Waktu scan 1 detik.
• Kekurangan: kemungkinan terjadinya ring artefact karena
adanya kerusakan kanal detektor.

71
Generasi ke-4: Fan Beam + Detector Ring
72
Generasi ke-4: Rotasi/Diam
• Tabung sinar-X berputar dan detektor diam.

• Detektor tersusun melingkar berbentuk lingkaran.
• Sekitar 8000 buah detektor diperlukan.
• Waktu scan 1 detik.
• Kerugian: harga mahal, dosis radiasi pada pasien lebih
tinggi.
• Keuntungan: tidak terjadi ring artefact.
• Masalah: jarak antara tabung sinar-X dan elemen detektor
tidak semuanya sama -> diatasi dengan kalibrasi dan
normalisasi saat scan.

73
Generasi ke-5: Electron Beam Technique
Always Thinking Ahead. Electron Beam Computed Tomography Scanner, waktu scan 50ms
Digunakan untuk scan jantung.
74
EBT Electron Beam Technique

In a conventional CT scanner, the x-ray tube moves round the patient, the x-
ray beam is attenuated by the patient and the differences of the emergent
beam are registered by a bank of detectors. This information is digitised and
converted into a cross-sectional image. The exposure time for each slice is
restricted by the time it takes physically to move the x-ray tube.
The Imatron CT Scanner has no x-ray tube but an electron gun which
produces a beam of electrons at 130kV which is accelerated along a tube.
The beam of electrons is focused, by an electro-magnetic coil, onto a small
focal spot on a tungsten ring. This target area is then moved along the ring.
The x-rays are generated by this deceleration process and collimators define
them into a fan-beam which ‘sweeps’ the patient. The x-ray density
differences are registered by a bank of solid-state detectors and the output is
digitised by the Data Acquisition System. Data is stored in the bulk memory
and the transferred to disc storage which is then converted into a cross-
sectional image. There are no moving parts therefore exposure times can be
reduced to 50ms per slice. Up to 17 slices per second can be taken, enabling
Always Thinking Ahead. the CT Scanner Unit to image moving structures such as the heart.

75
EBT Electron Beam Technique 2
76
EBT Electron Beam Technique 3
Front
view
Side
view

77
Generasi ke-6: Spiral atau Helical CT
• Teknologi Slip-Ring sekitar tahun 1990-an.

• Akuisisi data dilakukan dengan meja yang bergerak
sementara tabung sinar-X berputar sehingga gerakan
tabung sinar-X membentuk pola spiral terhadap pasien
saat dilakukan akuisisi data.
• Diterapkan pada konfigurasi rancangan CT generasi ke-3
dan ke-4.
78
Teknologi Slip-ring
Aliran listrik disalurkan melalui sejumlah konduktor
berbentuk cincin yang disusun secara paralel,
sehingga tidak menggunakan kabel lagi.
Ë Rotasi Gantry yang kontinu

Ë Merupakan syarat untuk CT-Scan spiral/helical
Always Thinking Ahead. Non Slip-

Slip-ring Slip-
Slip-ring Scanner
Scanner

79
Apakah yang dimaksud dengan “Spiral Scan” ? --

jawaban 4“C”
Continuously rotating tube/detector system

Continuously generating X-ray
Continuously table feed
Continuously data acquisition

CT Spiral dikelompokkan ke dalam CT generasi ke-6.
80
Akuisisi Data
secara kontinu
Volum Data
A B
Memungkinkan rekonstruksi
gambar pada sembarang posisi
(baik berurutan atau tumpang
tindih) dalam daerah volum yang
di-scan.
Jarak antar irisan disebut

dengan “Increment”

81
Rekonstruksi Gambar Secara Berurutan
}
Tebal Irisan
Increment = Tebal Irisan

Ë Tidak ada tumpang tindih
Ë Tidak ada sela {
Increment
82
Rekonstruksi Gambar secara Tumpang

Tindih
}}
SliceThickness
Overlap
}
Increment < Slice Thickness

Ë Overlap of slices
Ë Closer image interval
Ë More images created {
Increment

83
Rekonstruksi Gambar dengan Antara/Sela
}
Slice Thickness
Increment > Slice Thickness

Ë Sela antara 2 potongan
Ë Images are further apart
Ë Jumlah gambar yang
lebih sedikit.
Always Thinking Ahead. sedikit.
{
Increment
84
Shallow Inspiration
Deep Inspiration
Standard CT / Slice Imaging

Misregistration due to different
respiratory levels between slices
Unable to resconstruct images at
arbitrary position
Partial Volume Effect Slice imaging is slow

85
Spiral CT / Volume Imaging
Scan the whole region of

interest in one breath hold
No gaps since radiation always
transmits the whole volume
Reconstruction of overlapping
images without additional dose
Retrospective reconstruction
of slices in arbitrary position
within the scanned volume
86
Kuntungan Spiral CT
Melakukan scan satu bagian volume dengan

sekali tahan nafas.
Mengurangi efek partial volume.
Tidak ada celah.
Rekonstruksi gambar secara tumpang tindih
dapat dilakukan tanpa tambahan dosis radiasi.
Meningkatkan kualitas data untuk keperluan
rekonstruksi 3D (3D-rendering)

87
Mengapa pemeriksaan Spiral CT

dilakukan?
Waktu scan yang cepat terhadap valume yang besar.
Akuisisi data tanpa celah dlm satu kali tahan napas.
Mengoptimalkan penggunaan media kontras.
Dapat dilakukan rekonstruksi dengan menentukan
nilai increment yang dikehendaki.
CT Scan Konvensional CT Scan Spiral
Rekonstruksi secara tumpang tindih

akan memberikan resolusi sumbu-z yang
lebih baik.
88
Kapan pemeriksaan Spiral CT dilakukan?
Pemeriksaan dengan kontras.

Pemeriksaan seluruh bagian tubuh.
Pemeriksaan anak dan pasien trauma, yang
memerlukan pemeriksaan secara cepat.
Pemeriksaan anatomi yang panjang.
Spiral selalu digunakan untuk melakukan

3D postprocessing (contoh CTA) !

89
Generasi ke-7: Multi Detector Array CT

• Tabung sinar-X memiliki kapasitas panas yang terbatas.
Hanya 1% dari energi yang dikonversi menjadi sinar-X.
• Dengan detektor multi array maka apabila kolimator dibuka
lebih lebar akan diperoleh data proyeksi lebih banyak.
Dengan demikian maka penggunaan energi sinar-X lebih
efisien.
• Pada detektor array tunggal, apabila kolimator dibuka lebih
lebar maka akan diperoleh irisan yang lebih tebal yang
akan mengurai resolusi spatial.
• Masalah: cone beam artefact.
• Keuntungan: meningkatkan waktu scan hingga 0,33 detik,
resolusi dalam arah sumbu-Z hingga < 0,4 mm, dan dosis
radiasi lebih rendah.
90
Pembentukan Gambar - Irisan

Sinar-X dilewatkan pada kolimator sehingga
hanya menembus bagian potongan aksial dari
obyek, yang disebut dengan irisan atau "slice"

91
Image Generation - „The Slice“
The geometry of a slice -

Imagine a line emanating from the top center of one’s
head and extending through the body toward the feet.
This is known as the “long axis” of the body (like a
chicken on a rotisserie). When speaking of scanner
geometry, the long axis of the patient is aligned to the
“Z” axis of the gantry. It is shown as going into the
gantry, the same direction as table feed.The picture
above also shows that the X-ray source and detector
system rotate around this same Z axis. The slice shown
then represents a “transaxial” section, that is
perpendicular to the long axis.
92
Patient Orientation
Z = caudo-cranial
X = left-right
Y = posterior-anterior

93
Patient Orientation
Scanner Geometry
All the directions in a CT scanner follow a medical
coordinate system rather than a mathematical one.
94
Pembentukan Gambar - “Voxel”

Irisan dari suatu obyek
terbagi dalam elemen
volum yang kecil yang
disebut dengan
“voxels”.
Masing2 voxel memiliki
suatu nilai tertentu
yang menyatakan
atenuasi rata-rata
sinar-X oleh obyek
pada posisi tersebut.
Nilai tersebut dikenal
Elemen gambar dalam
dengan nama
bidang 2 dimensi disebut
Houndsfield Unit.
Always Thinking Ahead. “pixels”

95
Image Generation - The Voxel

About the VOXEL or Volume Element...
A voxel is an “intangible object”. The operator of the CT has some
control over its size, yet never really thinks about. The width of a single
detector element plays a primary role in setting the “face” dimensions
(length and width) of a voxel. But a voxel is three dimensional, so it also
has depth which runs in the direction of the “Z” plane. This dimension is
determined by the thickness of the chosen slice - typically a whole
number between 1 to 10 mm. This is selected by the operator. In theory,
we can calculate the attenuation of the X-ray beam by a single voxel.
This is carried out by making many measurements at different angular
positions around the object. The “Image Processor” will take this
information and process it further until it has a single numerical value
that represents the density of a tiny piece of the object scanned. It then
assigns a luminance value and position of where this data is to be
deposited in an “image matrix”.
96
CT image
CT image

97
CT image
CT image
CT = Computed tomography - perception in slices.
CT provides transverse slice images of the human body in digital form.
A coordinate system then results which basically conforms to the anatomical main axes and planes.
One volume part of the reconstructed image ( = voxel) is represented by the pixel size in (x, y)-plane and
the slice thickness (s) in z-axis.
98
Bilangan CT
Ι0 µ
I=I0 ·exp(- ∫ µ ds)

“Line Integral”
∫ µ ds = - ln(I/ I0)
Koefisien atenuasi, nilai CT

99
Dari µ ke Bilangan CT (CT number)
The distribution of µ was originally measured.
To get rid from the energy dependency of the linear attenuation coefficient, one takes
the adventage that most of the coefficients for different tissues show the same relative
dependence from energy.
S‘o a quotient of the 2 coefficients of 2 tissues should be energy independent in first

order.
Mr. Hounsfield had the great idea to scale the µ values relative to water by
CT number = µtissue - µwater

X 1000
µwater
100
Houndsfield Unit
& Houndsfield Unit didefinisikan :
µ obj − µ wat
HU = × 1000
µ wat
HU = Houndsfield Unit (-1000 HU sampai +3000 HU)
µobj = koefisien pelemahan objek
µwat = koefisien pelemahan air

101
CT numbers
Ct numbers
•Water has CT number 0
•tissues more dense than water have a positive CT

number
•tissues less dense than water have a negative CT

number.
Water = 0 HU
Bone = +3000 HU
Air = - 1000 HU
102
Houndsfield Unit
3000
Blood Liver
60 Tumor
Spleen Kidneys Heart
Pancreas Bladder
40 Bone Adrenal
Gland Intestine
Water
0
Rule
Ruleofofthumb:
thumb:
-100
Mamma Nilai
Nilai CTair
CT airadalah
adalah00dan
danudara
udara
1000.
1000. The relative valuesof
The relative values ofthe
the
-200
Fat
other tissues are calculated
other tissues are calculated
-900 Air Lung relative
relativeto
tothat
thatofofwater
water
-1000
HU * HU = Hounsfield Unit, also known as CT number


103
CT number flexibility
CT number flexibility
• We can change the appearance of the image by varying the

window width and level.
• This can spread a small range of CT numbers over a larger
range of grey scale values.
• This makes it easy to detect very small changes in CT
number.
104
Pembentukan Gambar - “Matrix”
Nilai koefisien pelemahan radiasi diukur kemudian

dikodekan dan ditransfer ke komputer.
Oleh komputer akan ditampilkan dalam gambar 2
dimensi yang disebut dengan matriks.
35 36 34 39 33
31 34 33 35 32
31 78 80 85 90
Ukuran matriks gambar : 80x80, 256x256,

512x512

105
Image Generation - The Matrix
Image Processing -
This illustration implies the metamorphosis of a voxel
into a pixel. It starts out as a three dimensional volume
of matter. We measure it’s ability to attenuate X-ray.
This information then is sent to a special computer
where it is processed along with other data and
becomes a “number” that will specify a “light intensity”
or luminance value on a CRT display. The area that is
filled by this “light” is known as a pixel and it has only
two dimensions - length and width. A group of pixels
placed in a specific order, side by side, result in the
image that we see it displayed on the monitor.
106
Pembentukan Gambar - A>D>A*
Nilai masing2 elemn matriks dikonversikan kedalam

gambar hitam putih sesuai dengan grey scale-nya.
35 36 34 39 33
31 3433 35 32
31 78 80 85 90
*Analog - Digital - Analog


107
Image Generation - A>D>A*

Data Acquisition, Processing and Image Display -
Here the process continues, hiding the magic of “image
reconstruction”, but revealing the desired end result - an image.
This slide also illustrates the conversion process that takes place,
beginning with the acquisition of data in the gantry, where it is an
analog signal. The “data” measured can be very small in amplitude.
In order to maintain it’s integrity, it is converted to a digital value
before it is sent over to the image processor (SMI5). The SMI5 uses
this digital data to calculate an image. But before an image can be
displayed on a monitor, it is necessary to convert the data back into
analog form.
108
Image matrix size affects resolution
8 by 8 25 by 25
looks like this is closer
square! to a circle!

109
Image matrix size affects resolution

The image matrix mostly is a 1024x1024 matrix, which represents the object, measured in the scan field.
The FOV ( field of view), selected by the operator, shows either the full scan field or just a part of it. The FOV
is displayed with the image matrix.
When the FOVis equal to the scan fiel, e.g. 500mm, than each pixel of the matrix represents approx. 1mm2 of
the FOV (> pixel size ~1mm2).
With a smaller FOV, e.g. 50mm, the same image matrix is used; therefore the pixel size becomes smaller (>
pixel size ~0.1mm2).
The result of the variation of the pixel size effects the resolution of the system:
the smaller the pixel size, the better.
110
Reconstructed matrix
imaging
image matrix:
1024 2 pixel
(interpolated)
measured data
backprojection
preprocessing
reconstructed
matrix: 512 2 pixel
convolution

111
Reconstructed matrix
The image processor writes all backprojected data into a 5122 matrix, which is the so called reconstructed
matrix.
It is on most CT- system a 5122 matrix.
The pixel size, mentioned on previous page, is a function of the reconstructed matrix.
The imager, responsible for windowing and calculation of HU values, is supplied from the backprojector with
the 5122 reconstructed matrix.
A linear interpolation from 5122 to 10242 pixels is done, before the digital data of the matrix are converted to
analog and connected as RGB to the monitor.
112
Displayed matrix
imaging
image matrix:
1024 2 pixel
(interpolated)

113
Displayed matrix
The displayed matrix is on most CT systems a 10242 interpolated matrix.
There are some systems working with smaller matrix sizes like 5122 or 3602, especially economic systems, to
keep the price low.
114
Penampilan Gambar - Windowing
Hounsfield
Gray scale
unit
+3000 display
White
Window Window
width W center C
0
Black
-1000 CT Windowing
Window width (W): the density range represented within the gray scale.

Window center (C): the center of the density range.

115
Image Display - Windowing

Close the window - I can’t see anything...
The human eye can only resolve about 40 shades of gray at best. The human body is made up of tissue containing
mostly water, but also calcium, phosphorous, as well as other minerals. However, all soft tissue is not the same,
even though it consists of the same basic building blocks. There is a difference in density between muscle and the
liver, for example. The same goes for bone - you have a variety of bone density in your body from the cartilage in
your nose to the calcium rich bone of your pelvis. All of these organs attenuate X-rays differently, so they appear
to us as different gray levels in the reconstructed image. Remember, each shade or intensity value correlates to
how effectively an object attenuates X-rays. Bright white means a very effective attenuater, such as dense bone.
Black means the opposite or virtually no attenuation, such as air.
Our image display system is designed to display no more than 256 gray shades at one time, but the HU scale
extends from -1000 to 3096 or 4096 values in total! You could say that each value corresponds to a unique
intensity or “gray level”. When a doctor is looking for details in the liver, he may be looking for small density
changes. In order to see these small changes, we use a device called “windowing”. Since the liver only represents
a very small portion of the HU scale, we choose a “center value” that corresponds to about the mean value of that
organ and “open” the window just enough to see the desired detail. The maximum number of gray shades will not
exceed 256 regardless of the window setting!
116
Pengaruh Windowing pada gambar

Nilai densitas CT didefinisikan berkisar antara -1000
hingga +3000, tetapi mata manusia paling baik hanya dapat
membedakan 30 - 40 tingkat terang gelap saja.
Lung Window Mediastinum Window
Dengan demikian pengatruan pilihan windwos

harus disesuaikan dengan struktur yang akan
dilihat.

117
Image Display - Windowing
Narrow Window Width Broad Window Width
Lebar window Sempit : Lebar window Luas :

Gambar memiliki tingkat kontras Perbedaan densitas yang
yang baik, tetapi struktur diluar
kecil akan nampak homogen
daerah window tidak terlihat
dan mungkin akan
dengan jelas.
tersamar/tidak terlihat.
118
Teknik Double Window
Hounsfield
Gray Width
Broad Window scale
Narrowunit
Window Width
+3000 display
White
Window 1
Window 2 Black
-1000 CT Windowing
Digunakan untuk menampilkan dua jenis jaringan
yang memiliki nilai densitas sangat berbeda, seperti
paru2 & mediastinum.

119
Hasil Penggunaan Double Windows
Narrow Window Width
Untuk melihat
Lung Window paru2
Mediastinum dan
Window
mediastinum
secara bersama-
sama dalam satu
gambar.
*Penggunaan Double window tidak direkomendasikan untuk

Always Thinking Ahead. diagnosa.
120
Pengaruh Windowing pada Gambar
Narrow Window Width

Double Window Lung Window Mediastinum Window
Gambar 1: Gambar 2: Gambar 3:

Paru2, dinding Hanya Hanya dinding
toraks & paru2 yang thorax &
mediastinum terlihat. mediastinum
terlihat. Yang dapat
Always Thinking Ahead. terlihat.

121
Extended CT Scale
Secara normal bilangan CT yang dapat diukur berkisar -1024
sampai +3071, tetapi dengan SOMATOM Plus 4 dapat
diperluas (x10) dari -10240 sampai +30710 untuk dapat
menampilkan benda logam. Sehingga dimungkinkan untuk
menampilkan bilangan CT yang nyata tidak tergantung dimana
dan bagaimana window diposisikan.
Post operative femural

head replacement – nilai
bilangan CT = 6000 HU
122
Extended CT Scale
What’s the real value?
Besides just looking at an image to gain information, doctors will often request a quantitative measurement of an
area of interest on the image. This can be performed by drawing an “ROI” (region of interest) over the object to
be measured. The computer software then evaluates all of the data confined to that area and reports several
statistics about it. The key one is called the mean value and it is expressed as HU’s. This is a representation of the
X-Ray absorption characteristic of that object expressed in a numerical value. Remember, we normally only have
about 4071 values to represent all objects in the human body. Also realize that anything very dense is displayed as
white and if the density of that object is beyond 3071 HU - it is still going to be displayed at the maximum
brightness level. In addition, if a quantitative measurement is taken - the result will be false, because the scale
ends at 3071! This is where the value of being able to multiply the normal CT scale by a factor of ten comes into
play. We now have over 30,000 values to choose from making very high density objects visible and measurable.
This feature of expanding the Hounsfield Unit scale is also available on the Somatom AR product line.
Note:
Extended windowing is only useful if the data is there to begin with. Depending on scanning parameters chosen
and limitation of the scanning equipment, it may not be possible to accurately represent extremely dense objects.

123
POKOK BAHASAN
Perkembangannya
5. Kalibrasi
124
POKOK BAHASAN
Perkembangannya
5. Kalibrasi

125
POKOK BAHASAN
Perkembangannya
5. Kalibrasi
126
POKOK BAHASAN
Perkembangannya
5. Kalibrasi

127
128


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DISAJIKAN DALAM RANGKA

Always Thinking Ahead.

(c) Daniel Kartawiguna, 2006

Always Thinking Ahead.

Always Thinking Ahead.

(c) Daniel Kartawiguna, 2006

Always Thinking Ahead.

Wilhelm Conrad Röntgen

Always Thinking Ahead.

(c) Daniel Kartawiguna, 2006

Sinar-X memungkinkan orang

Always Thinking Ahead.

CT memberikan solusi terhadap

Always Thinking Ahead.

(c) Daniel Kartawiguna, 2006

Gambar CT yang pertama

Always Thinking Ahead.

CT-Scanner Siemens yang pertama

(c) Daniel Kartawiguna, 2006

Perkembangan kualitas gambar CT

SIRETOM SOMATOM Plus 4 UFC

Ringkasan Sejarah Perkembangan

(c) Daniel Kartawiguna, 2006

Always Thinking Ahead.

Prinsip Dasar Pemindai Tomografi Komputer

(c) Daniel Kartawiguna, 2006

Prinsip Dasar Pengukuran

I=I0 ·exp(- ∫ µ ds)

Always Thinking Ahead.

(c) Daniel Kartawiguna, 2006

One readout of all detector elements is a so called projection.

Always Thinking Ahead.

Always Thinking Ahead.

(c) Daniel Kartawiguna, 2006

Prinsip dasar akuisisi data

Always Thinking Ahead.

Raw data (Data Mentah)

(c) Daniel Kartawiguna, 2006

Raw data (Data Mentah)

Raw data (Data Mentah)

(c) Daniel Kartawiguna, 2006

• How do we reconstruct the image?

• One could solve more than 260.000 unknown µ by

Always Thinking Ahead.

Always Thinking Ahead.

(c) Daniel Kartawiguna, 2006

Always Thinking Ahead.

Attenuation profile Filtered

Always Thinking Ahead.

(c) Daniel Kartawiguna, 2006

Always Thinking Ahead.

Always Thinking Ahead.

(c) Daniel Kartawiguna, 2006

Always Thinking Ahead.

Different convolution kernel provide different image sharpness.

Always Thinking Ahead.

(c) Daniel Kartawiguna, 2006

Convolution Kernel (lanjutan)

Kernel akan menentukan

Always Thinking Ahead.

Simple back-projection w/o and