X-ray Computed Tomography (CT)

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X-ray Computed Tomography (CT) Haifa Sultan H00208385 BMET N410 Submitted

1 X-ray Computed Tomography (CT) Haifa Sultan H BMET N410 Submitted to: Dr. Walid Zgallai Submitted day: 15/1/2014 Dubai Women s College

2 X-ray computed tomography 2 Table of Contents Scope of the report... 4 Introduction... 6 Backgroun... 9 Computed tomography (CT) SOMATON Definition Edge Current, and future application of the CT scan Conclusion References Index of Figures Figure 1: Radiography device... 5 Figure 2: Fluoroscopy device... 5 Figure 3: Mammography device... 6 Figure 4: Computed tomography device... 6 Figure 5: The discovery of the x-ray radiation by Wilhelm Roentgen... 7 Figure 6: The procedure for emitting light... 7 Figure 7: The design of an x-ray machine... 8 Figure 8: The development of SOMATON design Figure 9: Image of the chest from conventional x-ray Figure 10: Slice of the abdomen from CT scan Figure 11: The components of the (CT) machine Figure 12: The patient entering the tunnel of the CT Figure 13: Fan shape beam of the x-ray Figure 14: sequential CT Figure 15: Spiral CT Figure 16: The technical specification of the single source CT Figure 17: Dual energy mode of SOMATOM Figure 18: Conventional, and edge technology Figure 19: Chart of dose reduction in cardiac CT Figure 20: In low KV dataset, the details improves Figure 21: The design for stellar detector, and straton tube Figure 22: Current application of the CT scan Figure 23: Stomach receiving drink contrast dye... 22

3 X-ray computed tomography 3 Figure 24: Intestine receiving barium enema Index of Tables Table 1: The configuration of the SOMATOM Definition Edge Table 2: Benefits of SOMATON Definition Edge... 20

4 X-ray computed tomography 4 X-ray computed tomography (CT) 1. Scope of the Report This report presents comprehensive information about an X-ray computer tomography device using the example of SOMATON Definition Edge, one of the latest brands manufactured by Siemens. The report gives a background on medical imaging technologies, computed tomography (CT), the market outlook for imaging technology, and finally the design specifications and benefits of SOMATON Definition Edge. 2. Introduction Often in emergency room setting, the death of a patient is imminent, and the right decision is key [1]. Doctor requires correct information as fast as possible to determine the best treatment for the patients [1]. Medical imaging technology is the key for diagnosis the patient situation by giving a clear information for a variety of injuries. Moreover, imaging technology for medical diagnostic started with the discovery of x-ray in 1895 [2]. Over the past 100 years, the range of imaging technology was developed. Such as, x-ray tubes, power generation, imaging detectors, imaging technologies, and nuclear medicine [2]. The medical imaging is defined as: The visualization of body parts, tissues, or organs, for use in clinical diagnosis, treatment, and disease monitoring [3].

X-ray computed tomography 5 Due to high technique, the use of x-ray has developed to several types that each have different technique that uses for different technology [4].

Unfortunately, these devices emit an ionization radiation, which causes damage to DNA [4]. This can develop a series disease for the patients.

5 X-ray computed tomography 5 Due to high technique, the use of x-ray has developed to several types that each have different technique that uses for different technology [4]. Some examples of these devices are: Fluoroscopy [4]. Radiography [4]. Mammography [4]. Computed tomography [4]. Unfortunately, these devices emit an ionization radiation, which causes damage to DNA [4]. This can develop a series disease for the patients. All of these devices work on the same basic principle, which includes: 1. X-ray beam is based through the body [4]. 2. A small portion of the x-ray scattered in the body [4]. 3. The remaining x-ray is transmitted to a detector [4]. 4. The computer records, and stores the images [4]. Each device has different purpose. Fig. 1, shows the radiography that generates a single image [4].Fig. 2, shows the fluoroscopy (c-arm) that generates a continuous x-ray image, which can be displayed on a monitor [4].Fluoroscopy can be used for a complex intervention procedure such as, placing devices in the body during an operation [4]. Fig. 1: Radiography device [5] Fig. 2: Fluoroscopy device [6]

X-ray computed tomography 6 Fig. 3, shows the Mammography x-ray system [4]. Mammography can be described as a special type of radiography to image the internal structures of the breasts [4].Fig. 4, shows the computed tomography.

The report will specifically focus on this technology. Fig. 3: Mammography device [7] Fig. 4: Computed tomography device [8] 3. Background History.

6 X-ray computed tomography 6 Fig. 3, shows the Mammography x-ray system [4]. Mammography can be described as a special type of radiography to image the internal structures of the breasts [4].Fig. 4, shows the computed tomography. The (CT) exam involves a higher radiation dose, than convention radiography [4]. This was considered a real problem, until new designs of (CT) developed. The report will specifically focus on this technology. Fig. 3: Mammography device [7] Fig. 4: Computed tomography device [8] 3. Background History. According to the medical information, the x-ray was discovered by accident [9]. The invention started while Wilhelm Roentgen experimenting with electron beam in a gas discharge tube. Suddenly, the fluorescent screen in the lap glowed, because the electrons turned on [9]. But, a heavy black board covered Roentgen s tube. Roentgen decided to place an object between the screen, and the tube. The screen glowed again. At this stage, Roentgen challenged was to place the hand between the screen, and the tube. The surprise was that a silhouetted of the Roentgen s bone was projected on to the screen [9]. However, this discovery was the most beneficial

X-ray computed tomography 7 application [9]. Fig.

5: The discovery of the x-ray radiation by Wilhelm Roentgen [10] How atoms emit light.

6, shows the steps of generating the light [9]. 1.

7 X-ray computed tomography 7 application [9]. Fig. 5, shows Wilhelm Roentgen who discovered the x-ray radiation in 1895 [10]. Fig. 5: The discovery of the x-ray radiation by Wilhelm Roentgen [10] How atoms emit light. Generating light photon is associated with collision [9]. Fig. 6, shows the steps of generating the light [9]. 1. A photon collides with another atom, which leads the particles to move [9]. 2. This resulted in moving the electron to a higher energy level [9]. 3. The electron falls back to its original energy level, causing the extra energy in the form of a light photon [9]. Fig. 6: The procedure for emitting light [9]

X-ray computed tomography 8 The x-ray machine. After the discovery of the x-ray, engineers started to think about using the x-ray in a medical diagnostic.

8 X-ray computed tomography 8 The x-ray machine. After the discovery of the x-ray, engineers started to think about using the x-ray in a medical diagnostic. So, the x-ray machine was an important technology in medical care. Fig. 7, shows the design of an x-ray machine [9]. The heart of an x-ray machine is the cathode, and anode [9]. The general design consists of the lead case, and vacuum tube. The machine generates current through the filament, which lead the electrons to move out of the filament. Then, the electron collides with a tungsten atom. This resulted in moving the electrons out of the lower orbital. After that, the higher orbital electron fills the empty position. At the end, the extra energy generates the photon (x-ray). Fig. 7: The design of an x-ray machine [9]

9 X-ray computed tomography 9 Benefits and risks of x-ray imaging. X-ray imaging is an important medical tool for testing, and procedures [4]. Types of radiation benefits are: Diagnosis disease [4]. Monitor therapy in a non-invasive and painless manner [4]. Assists doctors by supporting medical surgical, medical treatment, and planning [4]. Guides medical personnel in the insertion of catheters, and stents [4]. Remover the blood clots or other blockages [4]. Risks from exposure to ionizing radiation can include any of the following: Development of cancer in later life from continued exposure [4]. Cataracts, skin reddening, and hair loss, which occur at relatively high levels of radiation exposure [4]. The risk factors may vary between patients, because health risks dependents on: Radiation dose: the frequency of exposure, and the magnitude of dosage increase the risk of developing cancer [4]. Patient s age: the risk of cancer is higher among those who receive X-rays at a younger age, than those who receive them at an older age [4]. Patient s sex: women have higher lifetime risk, than men for developing radiation-associated cancer [4]. 4. Computed tomography (CT) Background. In 1979, GN Hounsfield, and A.M Cormack were awarded the Nobel Prize medicine for the invention of CT [10]. Computed Tomography (or CAT scan) is defined as: '' A particular type of x-ray that uses multiple x-ray beams at different angles to build up a cross section of the body's organs, and tissue '' [8].

10 X-ray computed tomography 10 Today, CT is one of the most important device for radiological diagnosis [11]. The earlier types of CT scanner were sequential CT's until the development of spiral CT allows the gantry to continuously rotate [10]. The first spiral CT scanner was a Siemens SOMATOM plus system, which was in the nineties [10]. Nevertheless, SOMATON started to develop more through the years. Fig. 8, shows the development of SOMTON designs during the years [10]. Fig. 8: The development of SOMATON design [10] Computed tomography (CT), sometimes called computerized tomography [12]. Computed tomography has the ability to create 3-D images of internal structures [8]. However, doctors mostly use CT scan, which shows a clear information about the human body. Fig. 9, shows an image that produced by a conventional x-ray [12]. Fig. 10, shows an image that produced by a CT scanner [12]. This describes clearly the big advance of the CT machine (3D).

X-ray computed tomography 11 Fig. 9: Image of the chest from conventional x-ray [12] Fig.

region of the body [15]. Components of the CT machine.

11 X-ray computed tomography 11 Fig. 9: Image of the chest from conventional x-ray [12] Fig. 10: Slice of the abdomen from CT scan [12] In addition, CT scan can be performed on every region of the body [15]. Components of the CT machine. The CT system is basically contains of two sections, the scanning area, and the operator s area [10]. The scanning area contains the imaging system, while the operator s area contains the display, recording, and storage device [10]. Fig. 11, shows the components of the (CT) machine. Fig. 11: The components of the (CT) machine [10]

12 X-ray computed tomography 12 The setup of the imaging system comprises four basic components, namely: 1. The scanning unit made up of the gantry with x-ray tube, and detector system [10]. 2. The patient table [10]. 3. The image processor for image reconstruction [10]. 4. The console [10]. Moreover, the components of the x-ray unit are: The gantry that functions as a transmitter, and the data acquisition unit which functions as a receiver [10]. An x-ray tube that comes with variable focal spot size [10]. The detector, which converts the x-ray of varying intensity to electric signal [10]. The processor that functions to record the shadow image produced by the scanning process [10]. The console represents the man-machine that control unit for all examination, and evaluate the examination results [10]. In addition, the CT scanner is a large square with a tunnel through the center. The moveable ring shape called the gantry [10]. How a CT system works. During an examination of the computed tomography (CT). The doctor will ask the patient to lie on the table. The motorized table moves the patient through the tunnel to the (CT) imaging system [16]. Fig. 12, shows the patient entering the tunnel. Then, a source of the x-ray rotates around the patient, and an x-ray beam passes through the body of the patient [16]. Fig. 13, shows the x-ray source produces a narrow, fan-shaped beam of x-ray [11]. A single rotating typically takes a second or less.

X-ray computed tomography 13 Fig. 12: The patient entering the tunnel of the CT [11] Fig.

In the end, the data are sent to a computer for reconstruct the snapshots into a cross sectional images (slices) of the internal orangs.

In sequential CT, a cross sectional image is produced from different angular positions, while the tube and the detector rotates 360 degree [10].

13 X-ray computed tomography 13 Fig. 12: The patient entering the tunnel of the CT [11] Fig. 13: Fan shape beam of the x-ray [11] After that, the detector records the x-ray that passed through the patient body by different angles [11]. In the end, the data are sent to a computer for reconstruct the snapshots into a cross sectional images (slices) of the internal orangs. CT in general clinical use. In sequential CT, a cross sectional image is produced from different angular positions, while the tube and the detector rotates 360 degree [10]. However, the table in this situation is stationary [10]. Unfortunately, if the patient moved during the sequential CT scan, the data will not be accurate. This will cause limited diagnostic value [10]. Fig. 14, shows the sequential CT. In spiral CT, the patient on the table moves continuously through the scan field in the z-direction [10]. Fig. 14: sequential CT [10]

X-ray computed tomography 14 Fig. 15, shows the spiral CT in a z-direction [10]. The spiral CT is more effective, because this procedure takes less time, and less dose affect the patient. Fig. 15: Spiral CT [10] Spiral CT offers the following advantages: Short scan time [10].

14 X-ray computed tomography 14 Fig. 15, shows the spiral CT in a z-direction [10]. The spiral CT is more effective, because this procedure takes less time, and less dose affect the patient. Fig. 15: Spiral CT [10] Spiral CT offers the following advantages: Short scan time [10]. Additional diagnostic information due to improved resolution, thinner slices, and 3D visualization [10]. Effective applications [10]. Market outlook. The CT scanner equipment is expected to show the highest growth among all market segment [13]. In 2012, the market for (CT) scanners was valued at USD 4.35 billion [13]. According to a new market report published by transparency market research entitled, x-ray, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) and nuclear imaging equipment, the global equipment market was valued at USD billion in 2012, and is expected to grow at constant annual growth rate of 5.4% [13].

X-ray computed tomography 15 5. SOMATON Definition Edge. Background. Due to the variety of products, and manufactures, this report focuses on Definition Edge.

15 X-ray computed tomography SOMATON Definition Edge. Background. Due to the variety of products, and manufactures, this report focuses on Definition Edge. For several years, Siemens has been the first leader in computed tomography imaging [14]. The health care was looking for an improvement image quality. As a result, Siemens designed the stellar detector which functions to reduce the electronic noise [14]. For the sake accuracy, the following information on SOMTON Definition Edge was adopted from information provided by the manufacturer. Description. SOMATOM Definition Edge is defined as: A single source CT to use the recently developed stellar detector in high image quality, and does reduction [15]. During an examination with Siemens, the structures are visible up to 0.33mm [15]. The rotational speed of the SOMTOM is 0.28 seconds. In addition, the physician can examine the abdomen of the patient in two seconds [15]. This is a modern technology that eliminates the need for patient breath holding during the scan [19]. Fig. 16, shows the single source CT, with a technical specification [14]. Fig. 16: The technical specification of the single source CT [14]

X-ray computed tomography 16 Another new development of the Siemens is dual energy mode [14]. In this development two different tube voltages can be used to give different tissue types [14]. Fig.

16 X-ray computed tomography 16 Another new development of the Siemens is dual energy mode [14]. In this development two different tube voltages can be used to give different tissue types [14]. Fig. 17, shows the dual energy mode of the SOMATOM Definition Edge [14]. Fig. 17: Dual energy mode of SOMATOM [16] The features, and properties of the SOMATOM Definition Edge sourced out from the manufactures are: 1. See the unseen with edge technology [17]. The main point of this stage is to get more information to specify the unspecific parts of the patient body with less does [16]. This technology is the key to give high spatial resolution, decrease electronic noise, and cross talk [18]. However, this a high development that serves the human body from disease. Fig. 18, shows the difference between the conventional technology (high cross-talk), and the edge technology (low cross-talk) [16]. Conventional Technology Cross-talk Fig. 18: Edge Technology Cross-talk Conventional, and edge technology [17]

17 X-ray computed tomography More from less with true signal technology [17]. Large number of people considered obese [19]. So, it was difficult to scan an obese person. Until the SOMATOM Definition Edge answer the challenge by creating a table load capacity with more than 307kg with high image quality [11]. Moreover, the stellar detector with Safire, and Siemens gives low does image. Fig. 19, shows the does reduction in cardiac CT [19]. Fig. 19: Chart of dose reduction in cardiac CT [19] 3. Specify the unspecific with hidynamics [17]. The hidaynamic, and stellar detector improves the detail in low KV datasets. Fig.20, shows the hidaynamic increased to give sensitive visualizing finer structures [19].

Stellar Detector STRATON Tube Fig. 21: The design for stellar detector, and straton tube [17] Market outlook.

18 X-ray computed tomography 18 Fig. 20: In low KV dataset, the details improves [19] 4. The stellar detector [21]. The stellar detector with true signal, and Edge technology generates the next generation in detector technology [21].Fig. 21, shows the design of stellar detector, and straton tube. Stellar Detector STRATON Tube Fig. 21: The design for stellar detector, and straton tube [17] Market outlook. Siemens healthcare announced the completion of an AED 22 million contracts to bring computed tomography (CT) technology to the UAE [20]. However, these devices reached to the NMC specialty in Dubai, and Al-Ain [20]. Moreover, the NMC hospital is the first facilities in the gulf to get the Siemens SOMATOM Definition dual source CT system [20].

19 X-ray computed tomography 19 System Configuration. System configuration of the SOMATOM Definition Edge includes: Table 1: The configuration of the SOMATOM Definition Edge [21] System Hardware Standard Workplaces Standard System Software Standard FAST Applications Standard CARE Applications Standard Applications on syngo 0.28 s rotation time 0 MHU STRATON X-ray tube z-sharp Technology Adaptive Dose Shield Multislice Stellar Detector 100 kw generator CT patient table 60 fps image reconstruction Syngo Acquisition Workplace 19-in. (48-cm) flat screen monitor CD/DVD storage Syngo Examination Syngo Viewing Syngo Filming Syngo Archiving & Network FAST Adjust FAST Scan Assistant FAST Planning FAST Cardio Wizard FAST Spine CARE Filter CARE Bolus CT CARE Topo CARE Dose4D CARE kv CARE Child Pediatric Protocols CARE Profile CARE Dashboard Syngo 3D Real-Time MPR Syngo 3D SSD (Surface Shaded Display) Syngo Volume Calculation Syngo Dynamic Evaluation Syngo VRT (Volume Rendering Technique) CT Angiography Neuro BestContrast Adaptive Signal Boost WorkStream4D (3D-Recon)

20 X-ray computed tomography 20 Benefits. The following shows the benefits of SOMATON Definition Edge: Table 2: Benefits of SOMATON Definition Edge [21] Patients 78-cm gantry for imaging of larger patients Dose protection based on industry unique CARE kv and SAFIRE* as well as new Stellar Detector Clinician Fast acquisition that reduces the need for breath hold temporal resolution enabling cardiac imaging at a higher heart rate 14 cm of perfusion coverage with Adaptive 4D Spiral for excellence in stroke imaging Throughput Administrator Dose-optimized single source dual energy, tissue characterization without dose increase Real-time imaging and 8 simultaneous Reconstructions enabling fast throughput 60 images per second reconstruction speed in combination with WorkStream4D raw-data-based reconstruction technique Low space requirements and flexibility of water or air cooling Service offering optimized for challenging Emergency Department environment Lower power requirements in the standby mode due to new Stellar Detector

X-ray computed tomography 21 6.Current, and future applications of the CT scan. The doctor may recommend the CT scan for studying different areas of the body.

21 X-ray computed tomography 21 6.Current, and future applications of the CT scan. The doctor may recommend the CT scan for studying different areas of the body. Moreover, the current applications of the computed tomography are: Chest [22]. Ø Diagnosis problems with the lungs, major blood vessel (aorta), lung cancer, and aneurysm [22]. Urinary tract [22]. Ø Diagnosis problems with the kidney stone, and bladder stone [22]. Liver [22]. Ø Diagnosis problems with the liver tumors, bleeding from the liver, and other liver disease [22]. Pelvis [22]. Ø For a women, the diagnosis includes, uterus, ovaries, and fallopian tubes. While for the men, prostate gland, and the seminal vesicles [22]. Blood clot [22]. Broken bone [22]. Brain tumor [22]. Sinus infection [22]. Heart, and vascular disease [22]. Fig. 22, shows some examples of the current application of the computed tomography. Fig. 22: Current application of the CT scan [23]

22 X-ray computed tomography 22 In addition, Siemens medical solutions introduced a new future application of the computed tomography. This new application is called syngo colonography with PEV (Polyp enhanced viewing) software. The FDA approved this application for future CT imaging. This new application advanced bone removal, and CT respiratory gating for radiation therapy planning [24]. However, the new system designed as a second-reader tool for automated identification of problems in colon [28]. As earlier noted, Siemens advance bone removal technology. This will help doctors in planning before the operation. In addition, the system works automated workflow tool for fast segmentation. So, that may be used for fast removal of bony structures, and complex fractures [24]. In some cases, doctor may recommend the patient to take contrast dye before using CT device. These contrast dye includes drink, injection, and barium enema [23]. This makes easier for the doctor to see a certain area of the body [23].Fig. 23, shows the patient receiving a drink with contrast dye, the stomach will be highlighted [23].Fig. 24, shows the patient receiving a barium enema, the intestine will be highlighted [23]. Fig. 23: Stomach receiving drink contrast dye [23] Fig. 24: Intestine receiving barium enema [23]

23 X-ray computed tomography Conclusion The technology of the medical imaging is constantly growing, making health care patient friendly. In summary, the main idea of the report is to achieve high quality images with the lowest possible does. So, minting human life from extra dose will serves the society from disease. The conclusion that can be drown are as follows: 1-The new designing of SOMATOM Definition Edge that the point to generate ultra-thin slices, delivering very high spatial resolution of the images, and reduction of dose [20]. 2-The concept of generating the stellar detector depends on fully combines the electronic components of the detector element with photon diodes. This is the main reason for reducing the dose [20]. The recommendation in this report can be set as: 1-If the woman was pregnant, the doctor must be notified before the CT scan [8]. 2-Jewelary, hats, belts, clips must be removed to prevent any effect on the image [8]. 3-The patient must drink plenty of water after taking contrast agent to remove the dye from the body [8].

24 X-ray computed tomography 24 References [1] Medical imaging, aging&hl=de&sa=x&ei=ql3fuqd1im3esga9sidgaq&ved=0cd4q6aewaa#v=onepage&q =medical%20imaging&f=false. [Accessed on 1/1/2014] [2] One hundred years of medical diagnostic imaging, [Accessed on 1/1/2014] [3] Medical imaging, [Accessed on 1/1/2014] [4] Radiation-emitting products, EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/ucm htm. [Accessed on 2/1/2014] [5] Radiography X-Ray system, Accessed on 2/1/2014] [6] C-arm fluoroscopy, Accessed on 2/1/2014] [7] Mammography, Accessed on 3/1/2014] [8] CT scan or CAT scan, Accessed on 3/1/2014] [9] X-ray, Accessed on 4/1/2014] [10] Computed Tomography, tory_and_technology.pdf. [Accessed on 5/1/2014]

25 X-ray computed tomography 25 [11] Radiation emitting products, [Accessed on 5/1/2014] [12] Computed tomography, EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/MedicalX- Rays/ucm htm. [Accessed on 5/1/2014] [13] Global medical imaging market, on 5/1/2014. [Accessed on 5/1/2014] [14] SOMATOM Definition Edeg, Accessed on 5/1/2014] [15] Siemens, es/2011/pdf/11_28_11_edge_ct.pdf. Accessed on 7/1/2014] [16] Dual source CT, Accessed on 7/1/2014] [17] SOMATOM Definition Edge, Accessed on 8/1/2014] [18] The reference in single CT source, OM_Definition_Edge_Brochure.pdf. Accessed on 9/1/2014] [19] The reference in signal source CT, yx/~edisp/somatom_definition_edge_brochure pdf. Accessed on 10/1/2014] [21] SOMATOM Definition Edge, somatom_edge pdf. Accessed on 10/1/2014]

26 X-ray computed tomography 26 [20] Siemens healthcare, Accessed on 11/1/2014] [22] Computed tomography (CT) Scan of the body, Accessed on 12/1/2014] [23] Nucleus/ health, Accessed on 13/1/2014] [24] Siemens launches PEV software, Accessed on 13/1/2014]

Arteriogram An X-ray of an artery after the injection of dye.

Arteriogram An X-ray of an artery after the injection of dye. A Abscess A localized collection of pus in any part of the body, usually surrounded by inflamed tissue. Anesthetic An agent that causes loss of sensation with or without the loss of consciousness. Angiography,