Practical Atlas of Computed Tomography Hariqbal Singh, Sushil Kachewar
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1Practical Atlas of Computed Tomography2
3Practical Atlas of Computed Tomography
(Brig) Hariqbal Singh MD DMRD Professor and Head Department of Radiology Shrimati Kashibai Navale Medical College Pune, Maharashtra (India) Sushil Kachewar MD DNB Assistant Professor Shrimati Kashibai Navale Medical College Pune, Maharashtra (India)
4Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Practical Atlas of Computed Tomography
© 2010, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the authors and the publisher.
This book has been published in good faith that the material provided by the authors is original. Every effort is made to ensure accuracy of material, but the publisher, printer and authors will not be held responsible for any inadvertent error (s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only.
First Edition: 2010
9789380704920
Typeset at JPBMP typesetting unit
Printed at
5
To
Our Loving Children Amandeep, Jassim, Major Hamitesh Singh and Nimeesh Kachewar
6
7Contributors
8
9Preface
The value of radiology cannot be measured, it can only be treasured.
Take it as a fun key.
Images are like a face, corroborate it with patients’ state, the diagnosis is made.
The treatment is concocted.
Vigor and strength revivify, all is fine and vivify.
—Hariqbal Singh
The advent of Computed Tomography (CT) has revolutionized the field of medicine. This book provides a large bank of CT images. It includes normal anatomy and a wide range of pathology. With these images in mind, it will help residents, radiologists and practioners to interpret the possible diagnosis during their routine practice. However, they are advised to always correlate with the clinical picture. This book Practical Atlas of Computed Tomography also includes a chapter on PET-CT and CT Quiz to make it more interesting to the readers.
This book is meant for radiology residents, radiologists, general practitioners, other specialists, CT technical staff and those who have a special interest in CT imaging. It is meant for medical colleges and institutional libraries, departmental and stand-alone CT scan unit libraries.
Hariqbal Singh
Sushil Kachewar10
11Acknowledgments
We express our gratitude to Prof MN Navale, Founder President, Sinhgad Technical Educational Society and Dr Arvind V Bhore, Dean, Smt Kashibai Navale Medical College for their kind permission in this endeavor.
Our special thanks to the CT Scan Technicians Mr More Rahul, Mr Demello Thomas, Mr Balasaheb Musmade, Mr Raghvendra Gangoor and Mrs Manjusha Chikale nursing sister and receptionist of the CT unit for their untiring help in retrieving the data.
Dr Anand Kamat, Prashant Naik, Amol Sasane, Rajlaxmi Sharma, Sheetal Dhote, Mrunalini Shah, Amol Nade and Rahul Tupe have genuinely helped in building up this educational entity.
We thank our Artist Sanjay Raut for developing on certain images and Ms Snehal Nikalje, Sunanda Jangalagi and Anna Bansode for their clerical help.
The response from Mr Tarun Duneja (Director-Publishing) and Ms Chetna Malhotra (Senior Manager), M/s Jaypee Brothers Medical Publishers (P) Ltd and their entire team are laudable for their tolerance, with earnest and industrious effort to complete this project.
We are grateful to GOD and mankind who have allowed us to have this wonderful experience.
23Introduction  
CT was invented in 1972 by British engineer Sir Godfrey Newbold Hounsfield in Hayes, United Kingdom at EMI Central Research Laboratories using X-rays. About the same time South Africa born American physicist Allan McLeod Cormack of Tufts University in Massachusetts independently invented a similar process and both shared the 1979 Nobel Prize.
The first clinical CT scan was installed in1974. The initial systems were dedicated only to head scanning due to small gantry, but soon this was overcome and whole body CT systems with larger gantry became available in 1976.
 
CT Scan
Basic principle is to obtain a tomogram having thickness in millimeters of the region of interest using pencil beam X-radiation. The radiation transmitted through the patient is counted by scintillation detector. This information is analyzed by mathematical algorithms and reconstructed as a tomographic image by the computer so as to provide a peep into the structure being studied.
 
Developments in CT Technology
  1. Conventional Axial CT:
    Generation of CT scan
    Motion of X-ray tube - Detector system
    Stationary detectors
    X-ray beam type
    First
    Translate-Rotate
    Two detectors
    Pencil beam
    Second
    Translate-Rotate
    Multiple detectors up to 30
    Narrow fan beam (10°)
    Third
    Rotate-Rotate
    Multiple detectors up to 750
    Wide fan beam (50°)
    Fourth
    Rotate-Fixed
    Ring of 1500–4500
    Fan beam
  2. Spiral CT: Spiral CT uses the conventional technology in conjunction with slip ring technology, which simultaneously provides high voltage for X-ray tube, low voltage for control unit and transmits digital data from detector array. Slip ring is a circular instrument with sliding bushes that enables the gantry to rotate continuously while the patient table moves into the gantry simultaneously, thus three dimensional volume rendered image can be obtained. The advantages over the conventional scanner are the reduced scan time, reduced radiation exposure and reduced contrast requirement with superior information.
  3. Electron beam CT (EBCT): In EBCT both the X-ray source and the detectors are stationary. High energy focused electron beam is magnetically steered on the tungsten target to emit X-rays which pass through the subject on to the detectors and image is acquired. EBCT is particularly used for faster imaging in cardiac studies.
  4. Multislice/Multi-detector CT (MDCT): Spiral CT uses single row of detectors, resulting in a single slice per gantry rotation. In multislice CT, multiple detector arrays are used resulting in multiple slices per gantry rotation. In addition, fan beam geometry of spiral CT is replaced by cone beam geometry. The major advantages over spiral CT are improved spatial and temporal resolution, reduced image noise, faster and longer anatomic coverage and increased concentration of intravenous contrast.
  5. Dual source CT: Two X-ray sources are used as against single X-ray source in multislice CT scanner for faster imaging specially for structure like heart.
The enduring continuity of research in CT imaging aims to provide superior resolution, reduced noise, faster imaging, minimize radiations and quantum of contrast medium.