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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5255_Библиотеки_им_академика_М_И_Перельмана
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392
ray Tube
Detector
Beam Collimator
Detector
Beam Collimator
Detector
ray Tube
Detector
(b)
(d)
Computed Tomography in PET/CT
present in the system. When the number of DAS channels is less then the number of
physical detector elements, the output of the elements is summed prior to sampling by the
DAS channels. For example, as shown in figure 2a, on a four DAS channel scanner
(mistakenly called a four detector scanner) employing a detector with 16 equal detector
elements, sampling the inner four elements results in the acquisition of 4 × 1.25 millimeter
slices per rotation. Summing the elements in groups of two, three or four prior to sampling,
results in 4 × 2.5 millimeter slices (Figure 2b), 4 × 3.75 millimeter slices (Figure 2c) or 4 ×
5 millimeter slices (Figure 2d) respectfully. The number of detectors or the number of
slices obtained per rotation is dramatically increased from 4 slices to 16 slices per rotation
to 64 slices and beyond per gantry rotation. Figure 3a, shows the detector elementary
design in a 4-slice MDCT scanner. The detector array design is often categorized as uniform,
non-uniform and hybrid. In hybrid design, we have thin detectors in the center and thick
detectors adjacent to them. 4-slice MCT scanners were replaced by scanners capable of
obtaining 16-slices per gantry rotation. As shown in figure 3b, the detector elements in a 16
section MDCT scanner all have thin sections in the center and thick detectors in the adjacent
each enabling 16-simultaneous slices per gantry rotation. Figure 3c, shows the detector
array design of 64-slices MDCT scanners capable of yielding 64 thin slices per gantry
rotation.
(a)
(c)
X-ray Tube
Switching Array
X-ray Tube
Switching Array
Figure 2: Schematic diagram showing the detector configuration for the various MDCT scan
acquisition mode, a) detector configuration for 4×1.25 mm scan acquisition, b) 4 × 2.5 mm, c) 4
× 3.75 mm and d) 4 × 5 mm scan acquisition
X-
Beam Collimator
Switching Array
X-
Beam Collimator
Switching Array

Computed Tomography in PET/CT
Z-axis
20 mm
5
2.5
5
1.5
1.5
32 mm
15 mm
Uniform
(Toshiba)
axis
GE
Toshiba
20 mm
16 x 0.625 mm
4 x 1.25 mm
4 x 1.25 mm
24 mm
16 x 0.75 mm
4 x 1.5 mm
4 x 1.5 mm
16 x 0.5 mm
x 1 mm
(GE)
393
16 x 1.25 mm
2 x 1 mm
Non-uniform
(Siemens & Philips)
Hybrid
2.5
20 mm
4 × 0.5
15 mm
Figure 3(a)
Siemens/Philips
12 x 1 mm
Figure 3(b)
12
32 mm
Z-

394
4 x 1.2 mm
32 mm
Lightspeed 64
28.8 mm
6 mm
4 x 1.2 mm
Sensation 64
Brilliance 40
Computed Tomography in PET/CT
32 x 0.
Siemens
64 x 0.5 mm
Toshiba
Aquilion 64
64 x 0.625 mm
Philips
GE
40 mm
Figure 3(c)
Figure 3 a-c: Various detector array designs used in a) four section b) 16 section and c) 64
section multiple-row detector CT scanner
Pitch
The concept of pitch was introduced with helical CT scanners. The understanding of pitch
and its impact on CT image is key, since it impacts both radiation dose and image quality.
The pitch is defined as the ratio of the table feed per gantry rotation to the total x-ray beam
width (Figure 4). The total x-ray beam width is the product of the number of active DAS
channels and width of a single DAS channel. The radiation dose to the patient is inversely
proportional to the pitch and directly proportional to the mAs per rotation. Typical pitch
ratios are 0.5, 1.0, 1.5 and others. A pitch >1, implies extended imaging with the reduced
patient dose and with lower axial resolution, but, pitch <1 implies overlapping and higher
patient dose with higher axial resolution. For routine CT scans, a pitch greater than one is
quite sufficient. In PET/CT, since the CT image is reconstructed to match the PET slice
thickness, a pitch greater than one is quite sufficient.

Computed Tomography in PET/CT
Multiple Detector Array
I
T
W
I
W
I
N*T
I
395
Pitch =
Pitch =
Radiation dose
Typical pitch ratio: 0.3 – 1.5
Pitch
I - Table feed (mm)/rotation
W - Beam width (mm)
T - Single DAS channel width (mm)
N - Number of active DAS channels
Figure 4: Pitch is defined as the ratio of the table feed per gantry rotation to the total x-ray beam
width. In MDCT, the total x-ray beam width is the product of the number of active data acquisition
system (DAS) channels and width of a single DAS channel.
Scan Parameters for PET-CT
In a PET/CT scanner, CT and PET/CT scanners are assembled adjacently. The patient is
transported through the x-ray CT gantry, where CT scan is performed initially and is followed
by a PET scan. The CT information is used for two purposes. One to register the anatomical
images obtained with CT fused with the PET images to display as PET/CT images. Second,
the CT information is used for scatter correction or attenuation correction, which is used in
the PET reconstruction. PET/CT images are displayed for the users convenience both as an
axial, coronal, sagittal, or a fused image and both PET and CT images can be displayed side
by side and in any format user wishes. This enables the clinicians to look at both the CT
and also the PET image to make a suitable diagnosis.
voltage (140 kVp) is used for better penetration through the thicker portion of the body such
as the pelvis or shoulder. Also a weight based tube current (mA) is typically used, so as to
minimize the radiation dose from CT. The typical mA settings for a whole body PET/CT
along with other scan parameters are shown in table 1.
A typical whole body PET/CT scan parameters are as follows. Normally a higher tube

396
Table 1: Typical CT parameters for a whole body PET-CT scan
Scan Parameters Techniques
Tube voltage 110-140 (to penetrate uniformly through thick portion of the body)
Tube Current (weight based techniques) 80 mA for 150-200 lbs
60 mA for 100-150 lbs
40 mA for < 100 lbs
120 mA for > 200 lbs
CT gantry rotation time 1 sec rotation
Pitch 1 to 1.5
Computed Tomography in PET/CT
The other key technical features for the PET/CT protocols are that a uniform large field
of view is used for all patients and for all parts of the body, and the CT slices are reconstructed
to thickness similar to PET slice thickness in order to facilitate fusion. Also, it is important
to make sure that the CT reconstruction interval matches PET slice spacing for accurate
image fusion. Even though the MDCT can provide highest patient resolution, when the
scanner is used in conjunction with the PET/CT scanners, the CT images are basically
reconstructed to the slice thicknesses of the PET images in order to enable proper fusion of
the PET and CT images. Typical PET/CT study, such as a whole body, involves scanning of
a subject from mid-ear region to mid-thigh. The CT scan typically takes from 30 to 35
seconds while a PET scan of the same region can take from 15 to 30 minutes. Generally, no
contrast is used for the CT part during PET/CT scan since introduction of contrast can affect
attenuation maps. Typically shallow breathing is allowed to match the breathing nature
during the PET scans. Even though MDCT scanner have faster gantry rotation time (less
than 0.4 second), still the scan time chosen during PET/CT protocol is slightly greater than
half a second in order to minimize motion artifacts. The CT axis scans are reconstructed
such that to match the PET section for accurate attenuation correction.
Quality Control and Shielding Requirements
Regarding quality control for CT scanners, the daily quality control for CT scanners
involves scanning of the water phantom. The water phantom is positioned in the center of
the CT gantry and a single section is obtained through the center of the water bottle of the
phantom. The CT number at the center is measured and is compared on a day-to-day basis.
The CT number of water is zero and it should not vary more than 3-5 CT numbers. If the
CT number of water is not within the set limits, it warrants the need for air calibration of the
CT scanner. The technologists are supposed to perform air calibration on the CT scanner
and in spite of that, if the CT number of water does not match or does not fall within the
allowed limits, there is a need for service call, and needs to be resolved prior to scanning the
patients. On an annual basis, depending on regulatory requirements applicable to that site,
there are rigorous quality controls to be performed by a qualified medical physicist. It is
also essential to have a qualified medical physicist perform acceptance testing at the start of

Computed Tomography in PET/CT
397
the installation. This provides an opportunity to examine the scanner capability and how it
is performing compared to its specifications. The tests also provide data that can be compared
with performances at a later date. More detailed tests are recommended for an annual
evaluation of the CT scanner according to American College of Radiology practice standards
and accreditation programs.
During installation of the new PET/CT requires careful analysis of the required regulations
of that particular region such as city or state or country. The location where CT scanner is
intended for installation needs to be analyzed closely for lead shielding. Depending on the
type of the regulations existing in the particular state or country it requires careful analysis
from a qualified medical physicist to examine the requirement of shielding for a particular
PET/CT Scanner. The significant radiation is usually observed in the uptake room adjacent
to the PET/CT scanner. The uptake room shielding becomes a lot more significant compared
to the PET/CT scanner. In the PET/CT scanner location itself the major contributor of
scatter radiation is from the CT scanner whereas in the uptake room the patient acts as a
radiation source for which the room has to be well shielded to protect the adjacent areas.
The manufactures of the PET/CT scanner usually provide a scatter diagram of the radiation
present during a CT scan under typical scanning condition. The scatter profile can then be
used to determine the lead requirement for all the surrounding walls of a PET/CT scanner.
Depending on the location of the PET/CT scanner room it is important to analyze the
thickness of the floor and the ceiling, along with the floors, to make sure the adjacent areas
are well protected. The qualified medical physicist can assist in the evaluation of shielding
requirement and also performing acceptance test of a PET-CT scanner.
Radiation Dose
The number of CT procedures performed is dramatically increasing from past few years.
From past ten years, the number of CT procedures in US alone is increasing at a rate greater
than 10% every year. This dramatic increase in CT procedures is raising concerns about the
increased risk for radiation-induced cancer for the whole population. In general, the average
risk of radiation-induced cancer in the general population is 5% per Sv or 5% per 0.01 rem.
Even though the risk is exhibited uniform across the age, the children are at 2-3 times higher
risk than adults. It is as high as 15% per Sv. For persons age <50 years, risk falls to 1/5
to 1/10th of that for younger adults. Therefore, the CT doses in the PET/CT scanner needs to
be carefully evaluated so as to reduce the overall radiation dose to the patient. A patient
undergoing PET/CT receives radiation dose from both PET and CT. Since the CT part of
PET/CT doesn’t require high image quality, the technical factors can be set such that the
radiation dose is according to ‘as low as reasonably achievable (ALARA)’ principle. With
the typical PET/CT scan parameters for a whole body PET/CT scan, such as 140 kVp, 80
mA (average size patient) and pitch of 1.5 can yield a CT dose of about 10 mSv (5-15 mSv
range). This is in addition to a PET dose which depends on the quantity of administered
activity. In a 2D PET, true count rate can be increased by injecting more activity. In 3D PET,
th

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Computed Tomography in PET/CT
there is no gain of true counts beyond certain quantity due to high increase in randoms
which are proportional to the square of injected activity. This quantity is normally 8-10 mCi
(~370 MBq) with high sensitivity systems. With such a quantity of administered activity to
the patient the effective dose from PET is around 7 mSv. This would be nearly double in 2D
PET if the injected activity is 20 mCi instead of 10 mCi. With modern high sensitivity PET
systems and using lower exposure factors in CT the effective dose from whole body PET/CT
may be brought down to <20 mSv. Still PET/CT scans may be treated as a high dose
procedure. Table 2 shows effective dose values for typical diagnostic CT scans along with
the PET/CT scans.
Table 2: Typical effective dose values from CT scan
CT Procedure Effective dose (mSv)
Head CT 1 - 2
Chest CT 5 - 7
Abdomen CT 5 - 7
Pelvis CT 3 - 4
Abd & Pelvis CT 8 - 11
PET-CT* 5 – 15
Average U.S. background radiation per year is approximately 3.0 mSv
* PET-CT scan includes scanning from mid-ear to mid-thigh on an average size adult.
The effective dose values listed above is for the CT scan only.
Examining the results of the radiation doses in an oncological FDG PET/CT protocol,
the CT dose is higher than that of PET in 3D systems but in 2D systems the PET dose
depends upon the amount of activity administered.
Future Developments
We continue to see improvement in the CT technology enabling faster and faster scanners
and much thinner and thinner slice CT scanners. Even though the faster scanners and the
thin slices may not be preferred for the PET/CT images, however, when examined
independently the thin slice CT scanners with the fast acquisition are equally important
when doing cardiac CT. The other developments include fast scintillators, such as LSO,
LYSO and GSO for PET have reduced imaging time from 35 minutes to around 15 minutes
allowing dynamic whole body scans and the use of short-lived isotopes.
Conclusion
PET/CT is changing not just the use of PET but also the use of CT. Precise localization of
pathology can drastically change the patient’s management and prognosis. PET/CT has the
potential to become the ultimate planning device for cancer patients.

Computed Tomography in PET/CT
399
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MR Imaging - Basic Concepts
S. Senthil Kumaran
Magnetic Resonance Imaging (MRI) evolved from the concept of Nuclear Magnetic
Resonance (NMR), which deals with the interaction of electromagnetic radiation with matter.
Resonant absorption of radio frequency (RF) energy by a nuclear spin system induces
transitions between the Zeeman energy levels of the nuclear spins. The relaxation processes
among these spins tend to establish the Boltzmann equilibrium between the populations,
which induces a detectable electromotive force (emf) in a receiving coil.
The first nuclear resonance signals were detected from protons (1H) of solid paraffin in
1945. E.M. Purcell, H.C. Torrey and R.V. Pound at Harvard University observed the nuclear
magnetic resonance absorption spectrum of the protons by applying continuous
electromagnetic radiation (1). Almost simultaneously, F. Bloch, W.W. Hansen and M. Packard
at Stanford University detected the nuclear induction signal of the proton resonance in water
(2). Many variations of the original experiments soon followed and the phenomenon was
termed as Nuclear Magnetic Resonance. Since its inception, NMR is being widely used in
various fields of science, viz., to study molecular motion and dynamics in physics, structure
of molecules and polymers in chemistry, the conformation and interaction of biomolecules
in biophysical chemistry, regulation of metabolism in cell biology, etc.
An application of NMR in medicine is termed as Magnetic Resonance Imaging (MRI),
which is used for studying morphology, metabolism and function of organs. MRI is based
upon different relaxation and chemical properties of tissues (esp. soft tissues), which can be
distinguished spatially and spectrally. This gives a contrast that can readily be applied to
identify any abnormal tissue pattern in the organ of study. MRI has established itself as a
non-invasive means of obtaining clinical images with several advantages over other medical
imaging modalities like computerized tomography (CT), ultrasound and nuclear medicine
techniques, namely, single photon emission computed tomography (SPECT) and positron
emission tomography (PET). It can produce high-resolution images in any plane of the
human body with unmatched soft tissue contrast without the use of ionizing radiation. In
recent years, MRI is rapidly progressing beyond its conventional role of providing only
40 0

MR Imaging - Basic Concepts
401
anatomical images, and has gained importance to explore the metabolic and functional
aspects of biological systems through magnetic resonance spectroscopy (MRS) and functional
MRI (fMRI). Field of magnetic resonance has yielded several Nobel laureates, namely, Felix
Bloch and Edward Mills Purcell in 1952 (Physics), Richard Ernst in 1991 (Chemistry), Kurt
Wutherich in 2002 (Chemistry), Paul Lauterbaur and Peter Mansfield in 2003 (Medicine).
Initial NMR experiments were the continuous wave experiments followed by development
of the pulsed NMR experiments, which is more widely used at present (1-5). In continuous
wave NMR, the nuclear absorption spectrum is obtained by exciting the sample continuously
by radio frequency power and sweeping the magnetic field through a range of field strengths
(or by varying the radio frequency while keeping the magnetic field constant) to obtain the
spectrum, where signal amplitude is plotted as a function of field strength or frequency. In
pulsed NMR, radio frequency field is applied in short powerful pulses, with bandwidth
sufficiently large to excite all resonances in the spectra, to yield a temporally varying signal
or Free Induction Decay (FID).
Basic Principles of NMR
The nuclei of atoms or their isotopes with an odd number of protons or neutrons exhibit
an intrinsic property called “spin”, associated with a spin quantum number I. In a sample,
these nuclei are randomly oriented in the absence of a field and hence, there is no net
magnetization present in the sample. In presence of a magnetic field, B0, the nucleus behaves
like a small bar magnet, due to an interaction energy of the nucleus. Also the spins precess
around the magnetic field axis, in a conical fashion. This precessional motion has a frequency
called Larmor’s precessional frequency. Resonance occurs according to the following
condition,
= B
0
0
(1)
where is the gyromagnetic ratio, 0 is termed as the Larmor frequency or resonance
frequency. It defines the precessional frequency of the nuclei around the external magnetic
field, due to the torque experienced by magnetic moment. For protons (1H), the Larmor
precessional frequency is 42.58 MHz at 1 Tesla.
Interactions within spin systems in the presence of magnetic field B
0
In an interacting spin system, additional relaxation mechanisms arise due to various
interactions. The major interactions are given below.
A. Dipolar interaction is the most common inter-nuclear interaction encountered in
NMR. The spin component of the magnetic moment, M, parallel to the static field, B0,
produces a static dipolar field, while the perpendicular component produces fields rotating
at the Larmor frequency. If the dipole responding to this field has the same gyromagnetic
ratio as that producing it, then it will experience an on-resonance oscillating field, which
can cause it to change its orientation. The net field experienced by any nuclei is thus, not
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