CT scan

CT scan
UPMCEast CTscan.jpg
Modern CT scanner
Other namesX-ray computed tomography (X-ray CT), computerized axial tomography scan (CAT scan),[1] computer aided tomography, computed tomography scan
ICD-10-PCSB?2
88.38
D014057
3–20...3–26
003330

A CT scan or computed tomography scan (formerly computerized axial tomography scan or CAT scan)[2] makes use of computer-processed combinations of many X-ray measurements taken from different angles to produce cross-sectional (tomographic) images (virtual "slices") of specific areas of a scanned object, allowing the user to see inside the object without cutting. The 1979 Nobel Prize in Physiology or Medicine was awarded jointly to Allan M. Cormack and Godfrey N. Hounsfield "for the development of computer assisted tomography."[3]

Digital geometry processing is used to further generate a three-dimensional volume of the inside of the object from a small series of two-dimensional radiographic images taken around a single axis of rotation.[4] Medical imaging is the most common application of X-ray CT. Its cross-sectional images are used for diagnostic and therapeutic purposes in various medical disciplines.[5] The rest of this article discusses medical-imaging X-ray CT; industrial applications of X-ray CT are discussed at industrial computed tomography scanning.

The term "computed tomography" (CT) is often used to refer to X-ray CT, because it is the most commonly known form. But, many other types of CT exist, such as positron emission tomography (PET) and single-photon emission computed tomography (SPECT). X-ray tomography, a predecessor of CT, is one form of radiography, along with many other forms of tomographic and non-tomographic radiography.

CT produces data that can be manipulated in order to demonstrate various bodily structures based on their ability to absorb the X-ray beam. Although, historically, the images generated were in the axial or transverse plane, perpendicular to the long axis of the body, modern scanners allow this volume of data to be reformatted in various planes or even as volumetric (3D) representations of structures. Although most common in medicine, CT is also used in other fields, such as nondestructive materials testing. Another example is archaeological uses such as imaging the contents of sarcophagi or ceramics.[6] Individuals responsible for performing CT exams are called radiographers or radiologic technologists.[7][8]

Use of CT has increased dramatically over the last two decades in many countries.[9] An estimated 72 million scans were performed in the United States in 2007 and more than 80 million a year in 2015.[10][11] One study estimated that as many as 0.4% of current cancers in the United States are due to CTs performed in the past and that this may increase to as high as 1.5 to 2% with 2007 rates of CT use;[12] however, this estimate is disputed,[13] as there is not a consensus about the existence of damage from low levels of radiation. Lower radiation doses are often used in many areas, such as in the investigation of renal colic.[14] Side effects from intravenous contrast used in some types of studies include the possibility of exacerbating kidney problems in the setting of pre-existing kidney disease.[15]

Medical use

Since its introduction in the 1970s, CT has become an important tool in medical imaging to supplement X-rays and medical ultrasonography. It has more recently been used for preventive medicine or screening for disease, for example CT colonography for people with a high risk of colon cancer, or full-motion heart scans for people with high risk of heart disease. A number of institutions offer full-body scans for the general population although this practice goes against the advice and official position of many professional organizations in the field primarily due to the radiation dose applied.[16]

Head

Computed tomography of human brain, from base of the skull to top. Taken with intravenous contrast medium.

CT scanning of the head is typically used to detect infarction, tumors, calcifications, haemorrhage, and bone trauma. Of the above, hypodense (dark) structures can indicate edema and infarction, hyperdense (bright) structures indicate calcifications and haemorrhage and bone trauma can be seen as disjunction in bone windows. Tumors can be detected by the swelling and anatomical distortion they cause, or by surrounding edema. Ambulances equipped with small bore multi-slice CT scanners respond to cases involving stroke or head trauma. CT scanning of the head is also used in CT-guided stereotactic surgery and radiosurgery for treatment of intracranial tumors, arteriovenous malformations, and other surgically treatable conditions using a device known as the N-localizer.[17][18][19][20][21][22]

Magnetic resonance imaging (MRI) of the head provides superior information as compared to CT scans when seeking information about headache to confirm a diagnosis of neoplasm, vascular disease, posterior cranial fossa lesions, cervicomedullary lesions, or intracranial pressure disorders.[23] It also does not carry the risks of exposing the patient to ionizing radiation.[23] CT scans may be used to diagnose headache when neuroimaging is indicated and MRI is not available, or in emergency settings when hemorrhage, stroke, or traumatic brain injury are suspected.[23] Even in emergency situations, when a head injury is minor as determined by a physician's evaluation and based on established guidelines, CT of the head should be avoided for adults and delayed pending clinical observation in the emergency department for children.[24]

Neck

Contrast CT is generally the initial study of choice for neck masses in adults.[25] CT of the thyroid plays an important role in the evaluation of thyroid cancer.[26] Also, CT scans often incidentally find thyroid abnormalities, and thereby practically becomes the first investigation modality.[26]

Lungs

A CT scan can be used for detecting both acute and chronic changes in the lung parenchyma, the tissue of the lungs. It is particularly relevant here because normal two-dimensional X-rays do not show such defects. A variety of techniques are used, depending on the suspected abnormality. For evaluation of chronic interstitial processes such as emphysema, and fibrosis, thin sections with high spatial frequency reconstructions are used; often scans are performed both on inspiration and expiration. This special technique is called high resolution CT that produces a sampling of the lung, and not continuous images.

Bronchial wall thickness (T) and diameter of bronchus (D)

Bronchial wall thickening can be seen on lung CTs and generally (but not always) implies inflammation of the bronchi.[27] Normally, the ratio of the bronchial wall thickness and the bronchial diameter is between 0.17 and 0.23.[28]

An incidentally found nodule in the absence of symptoms (sometimes referred to as an incidentaloma) may raise concerns that it might represent a tumor, either benign or malignant.[29] Perhaps persuaded by fear, patients and doctors sometimes agree to an intensive schedule of CT scans, sometimes up to every three months and beyond the recommended guidelines, in an attempt to do surveillance on the nodules.[30] However, established guidelines advise that patients without a prior history of cancer and whose solid nodules have not grown over a two-year period are unlikely to have any malignant cancer.[30] For this reason, and because no research provides supporting evidence that intensive surveillance gives better outcomes, and because of risks associated with having CT scans, patients should not receive CT screening in excess of those recommended by established guidelines.[30]

Angiography

Example of a CTPA, demonstrating a saddle embolus (dark horizontal line) occluding the pulmonary arteries (bright white triangle)

Computed tomography angiography (CTA) is contrast CT to visualize the arteries and veins throughout the body. This ranges from arteries serving the brain to those bringing blood to the lungs, kidneys, arms and legs. An example of this type of exam is CT pulmonary angiogram (CTPA) used to diagnose pulmonary embolism (PE). It employs computed tomography and an iodine-based contrast agent to obtain an image of the pulmonary arteries.

Cardiac

A CT scan of the heart is performed to gain knowledge about cardiac or coronary anatomy.[31] Traditionally, cardiac CT scans are used to detect, diagnose, or follow up coronary artery disease.[32] More recently CT has played a key role in the fast evolving field of transcatheter structural heart interventions, more specifically in the transcatheter repair and replacement of heart valves.[33][34][35]

The main forms of cardiac CT scanning are:

  • Coronary CT angiography (CTA): the use of CT to assess the coronary arteries of the heart. The subject receives an intravenous injection of radiocontrast, and then the heart is scanned using a high-speed CT scanner, allowing radiologists to assess the extent of occlusion in the coronary arteries, usually in order to diagnose coronary artery disease.
  • Coronary CT calcium scan: also used for the assessment of severity of coronary artery disease. Specifically, it looks for calcium deposits in the coronary arteries that can narrow arteries and increase the risk of heart attack.[36] A typical coronary CT calcium scan is done without the use of radiocontrast, but it can possibly be done from contrast-enhanced images as well.[37]

To better visualize the anatomy, post-processing of the images is common.[32] Most common are multiplanar reconstructions (MPR) and volume rendering. For more complex anatomies and procedures, such as heart valve interventions, a true 3D reconstruction or a 3D print is created based on these CT images to gain a deeper understanding.[38][39][40][41]

Abdominal and pelvic

CT scan of a normal abdomen and pelvis, taken in the axial, coronal and sagittal planes, respectively.

CT is an accurate technique for diagnosis of abdominal diseases. Its uses include diagnosis and staging of cancer, as well as follow up after cancer treatment to assess response. It is commonly used to investigate acute abdominal pain.

Axial skeleton and extremities

For the axial skeleton and extremities, CT is often used to image complex fractures, especially ones around joints, because of its ability to reconstruct the area of interest in multiple planes. Fractures, ligamentous injuries, and dislocations can easily be recognised with a 0.2 mm resolution.[42][43] With modern dual-energy CT scanners, new areas of use have been established, such as aiding in the diagnosis of gout.[44]