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'{{short description|Medical imaging procedure using X-rays to produce cross-sectional images}} {{About|X-ray computed tomography as used in medicine| cross-sectional images used in industry|Industrial computed tomography|means of tomography other than X-ray|Tomography}} {{good article}} {{Infobox medical intervention |Name = CT scan |Image = Moderní výpočetní tomografie s přímo digitální detekcí rentgenového záření.jpg |Caption = Modern CT scanner | synonyms = X-ray computed tomography (X-ray CT), computerized axial tomography scan (CAT scan),<ref name="mayoclinic">{{cite web|url=http://www.mayoclinic.org/tests-procedures/ct-scan/basics/definition/prc-20014610|publisher=mayoclinic.org|title=CT scan – Mayo Clinic|access-date=20 October 2016|url-status=live|archive-url=https://web.archive.org/web/20161015182843/http://www.mayoclinic.org/tests-procedures/ct-scan/basics/definition/prc-20014610|archive-date=15 October 2016}}</ref> computer aided tomography, computed tomography scan |ICD10 = B?2 |ICD9 = {{ICD9proc|88.38}} |MeshID = D014057 |MedlinePlus = 003330 |OPS301 = {{OPS301|3–20...3–26}} |OtherCodes = }} A '''CT scan''' or '''computed tomography scan''' (formerly known as '''computed axial tomography''' or '''CAT scan''') is a medical [[image|imaging]] [[scientific technique|technique]] used in [[radiology]] ([[x-ray]]) to obtain detailed internal images of the body noninvasively for [[Diagnosis|diagnostic]] purposes. The personnel that perform CT scans are called [[radiographer]]s or radiology technologists.<ref>{{cite web |url=https://www.arrt.org/Patient-Public/Patient-Page |title=Patient Page |website= ARRT – The American Registry of Radiologic Technologists |archive-url= https://web.archive.org/web/20141109192141/https://www.arrt.org/Patient-Public/Patient-Page |archive-date=9 November 2014 }}</ref><ref>{{cite web |url=http://www.asrt.org/main/standards-regulations/state-legislative-affairs/individual-state-licensure-info |title=Individual State Licensure Information |publisher=American Society of Radiologic Technologists |access-date=19 July 2013 |url-status=live |archive-url=https://web.archive.org/web/20130718215951/http://www.asrt.org/main/standards-regulations/state-legislative-affairs/individual-state-licensure-info |archive-date=18 July 2013}}</ref> CT scanners use a rotating [[X-ray tube]] and a row of detectors placed in the gantry to measure X-ray [[Attenuation#Radiography|attenuations]] by different tissues inside the body. The multiple [[X-ray]] measurements taken from different angles are then processed on a computer using [[Tomographic reconstruction|reconstruction]] algorithms to produce [[Tomography|tomographic]] (cross-sectional) images (virtual "slices") of a body. The use of ionizing radiation sometimes restricts its use owing to its adverse effects. However, CT can be used in patients with metallic implants or pacemakers, for whom [[Magnetic resonance imaging|MRI]] is [[contraindicated]]. Since its development in the 1970s, CT has proven to be a versatile imaging technique. While CT is most prominently used in [[Medical diagnosis|diagnostic medicine]], it also may be used to form images of non-living objects. The 1979 [[Nobel Prize in Physiology or Medicine]] was awarded jointly to South African-American physicist [[Allan M. Cormack]] and British electrical engineer [[Godfrey N. Hounsfield]] "for the development of computer-assisted tomography".<ref>{{Cite web|url=https://www.nobelprize.org/prizes/medicine/1979/summary/|title=The Nobel Prize in Physiology or Medicine 1979|website=NobelPrize.org|language=en-US|access-date=2019-08-10}}</ref> {{TOC limit|3}} == Types == {{missing information|section|dual energy/spectral, fan vs cone beam, dual source ct|date=November 2021}} === Spiral CT === [[File:Drawing of CT fan beam (left) and patient in a CT imaging system.gif|thumb|Drawing of CT fan beam and patient in a CT imaging system]] Spinning tube, commonly called [[Spiral computed tomography|spiral CT]], or helical CT, is an imaging technique in which an entire [[X-ray tube]] is spun around the central axis of the area being scanned. These are the dominant type of scanners on the market because they have been manufactured longer and offer a lower cost of production and purchase. The main limitation of this type of CT is the bulk and inertia of the equipment (X-ray tube assembly and detector array on the opposite side of the circle) which limits the speed at which the equipment can spin. Some designs use two X-ray sources and detector arrays offset by an angle, as a technique to improve temporal resolution.<ref>{{Cite book|last1=Fishman|first1=Elliot K.|url=https://books.google.com/books?id=aWlrAAAAMAAJ&q=spiral+ct|title=Spiral CT: Principles, Techniques, and Clinical Applications|last2=Jeffrey|first2=R. Brooke|date=1995|publisher=Raven Press|isbn=978-0-7817-0218-8|language=en}}</ref><ref>{{Cite book|last=Hsieh|first=Jiang|url=https://books.google.com/books?id=JX__lLLXFHkC&q=spiral+ct&pg=PA265|title=Computed Tomography: Principles, Design, Artifacts, and Recent Advances|date=2003|publisher=SPIE Press|isbn=978-0-8194-4425-7|page=265|language=en}}</ref> === Electron beam tomography === {{Main|Electron beam computed tomography}} [[Electron beam tomography]] (EBT) is a specific form of CT in which a large enough X-ray tube is constructed so that only the path of the [[electron]]s, travelling between the [[cathode]] and [[anode]] of the X-ray tube, are spun using [[Deflection yoke|deflection coils]].<ref>{{Cite book|last=Stirrup|first=James|url=https://books.google.com/books?id=SarDDwAAQBAJ&q=ebct&pg=PA6|title=Cardiovascular Computed Tomography|date=2020-01-02|publisher=Oxford University Press|isbn=978-0-19-880927-2|language=en}}</ref> This type had a major advantage since sweep speeds can be much faster, allowing for less blurry imaging of moving structures, such as the heart and arteries.<ref>{{Cite journal|last1=Talisetti|first1=Anita|last2=Jelnin|first2=Vladimir|last3=Ruiz|first3=Carlos|last4=John|first4=Eunice|last5=Benedetti|first5=Enrico|last6=Testa|first6=Giuliano|last7=Holterman|first7=Ai-Xuan L.|last8=Holterman|first8=Mark J.|date=December 2004|title=Electron beam CT scan is a valuable and safe imaging tool for the pediatric surgical patient|journal=Journal of Pediatric Surgery|volume=39|issue=12|pages=1859–1862|doi=10.1016/j.jpedsurg.2004.08.024|issn=1531-5037|pmid=15616951}}</ref> Fewer scanners of this design have been produced when compared with spinning tube types, mainly due to the higher cost associated with building a much larger X-ray tube and detector array and limited anatomical coverage.<ref>{{cite journal|last=Retsky|first=Michael|title=Electron beam computed tomography: Challenges and opportunities |journal=Physics Procedia |date=31 July 2008|volume=1|issue=1|pages=149–154|doi=10.1016/j.phpro.2008.07.090|bibcode = 2008PhPro...1..149R |doi-access=free}}</ref> ===Dual source CT=== Dual source CT is an advanced scanner with a two xray tube detector system, unlike conventional single tube systems.<ref>{{Cite book |last=Carrascosa |first=Patricia M. |url=https://books.google.co.in/books?id=wJ2oCgAAQBAJ&printsec=frontcover&dq=dual+source+ct&hl=en&sa=X&ved=2ahUKEwicnqmthN_2AhWGIbcAHbnCCKIQ6AF6BAgLEAM#v=onepage&q=dual%20source%20ct&f=false |title=Dual-Energy CT in Cardiovascular Imaging |last2=Cury |first2=Ricardo C. |last3=García |first3=Mario J. |last4=Leipsic |first4=Jonathon A. |date=2015-10-03 |publisher=Springer |isbn=978-3-319-21227-2 |language=en}}</ref> <ref>{{Cite journal |last=Schmidt |first=Bernhard |last2=Flohr |first2=Thomas |date=2020-11-01 |title=Principles and applications of dual source CT |url=https://www.sciencedirect.com/science/article/pii/S112017972030257X |journal=Physica Medica |series=125 Years of X-Rays |language=en |volume=79 |pages=36–46 |doi=10.1016/j.ejmp.2020.10.014 |issn=1120-1797}}</ref>These two detector systems are mounted on a single gantry at 90° in the same plane.<ref>{{Cite book |last=Seidensticker |first=Peter R. |url=https://books.google.co.in/books?id=oUtHea3ZnJ0C&printsec=frontcover&dq=dual+source+ct&hl=en&sa=X&redir_esc=y#v=onepage&q=dual%20source%20ct&f=false |title=Dual Source CT Imaging |last2=Hofmann |first2=Lars K. |date=2008-05-24 |publisher=Springer Science & Business Media |isbn=978-3-540-77602-4 |language=en}}</ref> === CT perfusion imaging === CT perfusion imaging is a specific form of CT to assess flow through [[blood vessel]]s whilst injecting a [[contrast agent]].<ref name=":0">{{Cite journal|date=2008-01-01|title=CT-perfusion imaging of the human brain: Advanced deconvolution analysis using circulant singular value decomposition|journal=Computerized Medical Imaging and Graphics|language=en|volume=32|issue=1|pages=67–77|doi=10.1016/j.compmedimag.2007.09.004|issn=0895-6111|last1=Wittsack|first1=H.-J.|last2=Wohlschläger|first2=A.M.|last3=Ritzl|first3=E.K.|last4=Kleiser|first4=R.|last5=Cohnen|first5=M.|last6=Seitz|first6=R.J.|last7=Mödder|first7=U.|pmid=18029143}}</ref> Blood flow, blood transit time, and organ blood volume, can all be calculated with reasonable [[sensitivity and specificity]].<ref name=":0" /> This type of CT may be used on the [[heart]], although sensitivity and specificity for detecting abnormalities are still lower than for other forms of CT.<ref>{{Cite journal|date=2016-08-01|title=CT myocardial perfusion imaging: current status and future directions|journal=Clinical Radiology|language=en|volume=71|issue=8|pages=739–749|doi=10.1016/j.crad.2016.03.006|issn=0009-9260|last1=Williams|first1=M.C.|last2=Newby|first2=D.E.|pmid=27091433}}</ref> This may also be used on the [[brain]], where CT perfusion imaging can often detect poor brain perfusion well before it is detected using a conventional spiral CT scan.<ref name=":0" /><ref name=":1">{{Cite journal|date=2015-02-01|title=Perfusion CT and acute stroke imaging: Foundations, applications, and literature review|journal=Journal of Neuroradiology|language=en|volume=42|issue=1|pages=21–29|doi=10.1016/j.neurad.2014.11.003|issn=0150-9861|last1=Donahue|first1=Joseph|last2=Wintermark|first2=Max|pmid=25636991}}</ref> This is better for [[stroke]] diagnosis than other CT types.<ref name=":1" /> == Medical use == Since its introduction in the 1970s,<ref>{{Cite book|last1=Curry|first1=Thomas S.|url=https://books.google.com/books?id=W2PrMwHqXl0C|title=Christensen's Physics of Diagnostic Radiology|last2=Dowdey|first2=James E.|last3=Murry|first3=Robert C.|date=1990|publisher=Lippincott Williams & Wilkins|isbn=978-0-8121-1310-5|pages=289|language=en}}</ref> CT has become an important tool in [[medical imaging]] to supplement [[X-ray]]s and [[medical ultrasonography]]. It has more recently been used for [[preventive medicine]] or [[screening (medicine)|screening]] for disease, for example, [[Ct colonography|CT colonography]] for people with a high risk of [[colon cancer]], or full-motion heart scans for people with a high risk of heart disease. Several institutions offer [[full-body scan]]s 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.<ref>{{cite web|url=http://hps.org/documents/ctscreening_ps018-0.pdf|title=CT Screening|website=hps.org|access-date=1 May 2018|url-status=dead|archive-url=https://web.archive.org/web/20161013203907/http://hps.org/documents/ctscreening_ps018-0.pdf|archive-date=13 October 2016}}</ref> The use of CT scans has increased dramatically over the last two decades in many countries.<ref name="Smith2009">{{cite journal|vauthors=Smith-Bindman R, Lipson J, Marcus R, Kim KP, Mahesh M, Gould R, Berrington de González A, [[Diana Miglioretti|Miglioretti DL]]|date=December 2009|title=Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer|journal=Arch. Intern. Med.|volume=169|issue=22|pages=2078–86|doi=10.1001/archinternmed.2009.427|pmc=4635397|pmid=20008690}}</ref> An estimated 72 million scans were performed in the United States in 2007 and more than 80 million in 2015.<ref name="Berrington2009">{{cite journal|vauthors=Berrington de González A, Mahesh M, Kim KP, Bhargavan M, Lewis R, Mettler F, Land C|date=December 2009|title=Projected cancer risks from computed tomographic scans performed in the United States in 2007|journal=Arch. Intern. Med.|volume=169|issue=22|pages=2071–7|doi=10.1001/archinternmed.2009.440|pmc=6276814|pmid=20008689}}</ref><ref>{{cite web|title=Dangers of CT Scans and X-Rays – Consumer Reports|url=https://www.consumerreports.org/cro/magazine/2015/01/the-surprising-dangers-of-ct-sans-and-x-rays/index.htm|access-date=16 May 2018}}</ref> === Head === {{Main|Computed tomography of the head}} [[File:Computed tomography of human brain - large.png|thumb|Computed tomography of [[human brain]], from [[base of the skull]] to top. Taken with intravenous contrast medium. {{noprint|[[Commons: Scrollable computed tomography images of a normal brain]]}}]] CT scanning of the head is typically used to detect [[infarction]] ([[stroke]]), [[Neoplasm|tumors]], [[calcification]]s, [[haemorrhage]], and bone [[Major trauma|trauma]].<ref>{{Cite book|last1=Surgeons (AAOS)|first1=American Academy of Orthopaedic|url=https://books.google.com/books?id=pUVwDwAAQBAJ&q=CT+scanning+of+the+head+is+typically+used+to+detect&pg=PA389|title=Critical Care Transport|last2=Physicians (ACEP)|first2=American College of Emergency|last3=UMBC|date=2017-03-20|publisher=Jones & Bartlett Learning|isbn=978-1-284-04099-9|page=389|language=en}}</ref> 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. CT scanning of the head is also used in CT-[[image guided surgery|guided]] [[stereotactic surgery]] and [[radiosurgery]] for treatment of intracranial tumors, [[arteriovenous malformation]]s, and other surgically treatable conditions using a device known as the [[N-localizer]].<ref>{{cite book|last1=Galloway|first1=RL Jr.|url=https://books.google.com/books?id=ioxongEACAAJ|title=Image-Guided Neurosurgery|publisher=Elsevier|year=2015|isbn=978-0-12-800870-6|editor1-last=Golby|editor1-first=AJ|location=Amsterdam|pages=3–4|chapter=Introduction and Historical Perspectives on Image-Guided Surgery}}</ref><ref>{{cite book|last1=Tse|first1=VCK|url=https://books.google.com/books?id=uEghr21XY6wC|title=Principles and Practice of Stereotactic Radiosurgery|last2=Kalani|first2=MYS|last3=Adler|first3=JR|publisher=Springer|year=2015|isbn=978-0-387-71070-9|editor1-last=Chin|editor1-first=LS|location=New York|page=28|chapter=Techniques of Stereotactic Localization|editor2-last=Regine|editor2-first=WF}}</ref><ref>{{cite book|last1=Saleh|first1=H|chapter-url=https://books.google.com/books?id=Pm3RBQAAQBAJ&q=Developing+Stereotactic+Frames+for+Cranial+Treatment&pg=PA153|title=Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy|last2=Kassas|first2=B|publisher=CRC Press|year=2015|isbn=978-1-4398-4198-3|editor1-last=Benedict|editor1-first=SH|location=Boca Raton|pages=156–159|chapter=Developing Stereotactic Frames for Cranial Treatment|editor2-last=Schlesinger|editor2-first=DJ|editor3-last=Goetsch|editor3-first=SJ|editor4-last=Kavanagh|editor4-first=BD}}</ref><ref>{{cite book|last1=Khan|first1=FR|url=https://books.google.com/books?id=mAN3MAEACAAJ&q=0444534970|title=Brain Stimulation|last2=Henderson|first2=JM|publisher=Elsevier|year=2013|isbn=978-0-444-53497-2|editor1-last=Lozano|editor1-first=AM|volume=116|location=Amsterdam|pages=28–30|chapter=Deep Brain Stimulation Surgical Techniques|journal=Handbook of Clinical Neurology|doi=10.1016/B978-0-444-53497-2.00003-6|pmid=24112882|editor2-last=Hallet|editor2-first=M}}</ref><ref>{{cite book|last=Arle|first=J|url=https://books.google.com/books?id=cnF-2KCeR1sC&q=Textbook+of+Stereotactic+and+Functional+Neurosurgery|title=Textbook of Stereotactic and Functional Neurosurgery|publisher=Springer-Verlag|year=2009|isbn=978-3-540-69959-0|editor1-last=Lozano|editor1-first=AM|location=Berlin|pages=456–461|chapter=Development of a Classic: the Todd-Wells Apparatus, the BRW, and the CRW Stereotactic Frames|editor2-last=Gildenberg|editor2-first=PL|editor3-last=Tasker|editor3-first=RR}}</ref><ref>{{cite journal |vauthors=Brown RA, Nelson JA |title=Invention of the N-localizer for stereotactic neurosurgery and its use in the Brown-Roberts-Wells stereotactic frame |journal=Neurosurgery |volume=70 |issue=2 Supplement Operative |pages=173–176 |date=June 2012 |pmid=22186842 |doi=10.1227/NEU.0b013e318246a4f7|s2cid=36350612 }}</ref> === Neck === [[Contrast CT]] is generally the initial study of choice for [[neck mass]]es in adults.<ref name=UpToDate>{{cite web|url=https://www.uptodate.com/contents/evaluation-of-a-neck-mass-in-adults|title=Evaluation of a neck mass in adults|author=Daniel G Deschler, Joseph Zenga|website=[[UpToDate]]}} This topic last updated: Dec 04, 2017.</ref> [[Computed tomography of the thyroid|CT of the thyroid]] plays an important role in the evaluation of [[thyroid cancer]].<ref name=Saeedan2016>{{cite journal|last1=Bin Saeedan|first1=Mnahi|last2=Aljohani|first2=Ibtisam Musallam|last3=Khushaim|first3=Ayman Omar|last4=Bukhari|first4=Salwa Qasim|last5=Elnaas|first5=Salahudin Tayeb|title=Thyroid computed tomography imaging: pictorial review of variable pathologies|journal=Insights into Imaging|volume=7|issue=4|year=2016|pages=601–617|issn=1869-4101|doi=10.1007/s13244-016-0506-5|pmid=27271508|pmc=4956631}}</ref> CT scan often incidentally finds thyroid abnormalities, and so is often the preferred investigation modality for thyroid abnormalities.<ref name=Saeedan2016 /> === Feet === Fuck you === Lungs === {{Main|Computed tomography of the chest}} A CT scan can be used for detecting both acute and chronic changes in the [[Parenchyma#Lung parenchyma|lung parenchyma]], the tissue of the [[lung]]s.<ref>{{Cite book|url=https://www.google.co.in/books/edition/Computed_Tomography_of_the_Lung/rQlDDwAAQBAJ?hl=en&gbpv=1&dq=ct+of+lungs&printsec=frontcover|title=Computed Tomography of the Lung|publisher=Springer Berlin Heidelberg|year=2007|isbn=978-3-642-39518-5|pages=40, 47}}</ref> 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 [[Pneumatosis#Lungs|emphysema]], and [[Pulmonary fibrosis#|fibrosis]],<ref>{{Cite book|url=https://www.google.co.in/books/edition/High_resolution_CT_of_the_Lung/VKATAQAAMAAJ?hl=en&gbpv=1&bsq=ct+of+lungs&dq=ct+of+lungs&printsec=frontcover|title=High-resolution CT of the Lung|publisher=Lippincott Williams & Wilkins|year=2009|isbn=978-0-7817-6909-9|pages=81,568}}</ref> 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.<ref>{{Cite book|last1=Martínez-Jiménez|first1=Santiago|url=https://books.google.com/books?id=QjouDwAAQBAJ&q=HRCT|title=Specialty Imaging: HRCT of the Lung E-Book|last2=Rosado-de-Christenson|first2=Melissa L.|last3=Carter|first3=Brett W.|date=2017-07-22|publisher=Elsevier Health Sciences|isbn=978-0-323-52495-7|language=en}}</ref> [[File:High-resolution computed tomographs of a normal thorax (thumbnail).jpg|thumb|left|link=Commons:Scrollable high-resolution computed tomography images of a normal thorax|[[High-resolution computed tomography|HRCT]] images of a normal thorax in [[Axial plane|axial]], [[Coronal plane|coronal]] and [[sagittal plane]]s, respectively. {{noprint|[[Commons:Scrollable high-resolution computed tomography images of a normal thorax|Click here to scroll through the image stacks.]]}}|120x120px]] [[File:Bronchial wall thickness (T) and diameter (D).svg|thumb|110px|Bronchial wall thickness (T) and diameter of the bronchus (D)]] [[Peribronchial cuffing|Bronchial wall thickening]] can be seen on lung CTs and generally (but not always) implies inflammation of the [[bronchus|bronchi]].<ref>{{cite web|url=https://radiopaedia.org/articles/bronchial-wall-thickening|title=Bronchial wall thickening|author=Yuranga Weerakkody|website=[[Radiopaedia]]|access-date=2018-01-05|url-status=dead|archive-url=https://web.archive.org/web/20180106063640/https://radiopaedia.org/articles/bronchial-wall-thickening|archive-date=2018-01-06}}</ref> An [[Incidental medical findings|incidentally]] found nodule in the absence of symptoms (sometimes referred to as an [[incidentaloma]]) may raise concerns that it might represent a tumor, either [[Benignity|benign]] or [[cancer|malignant]].<ref>{{cite journal |vauthors=Wiener RS, Gould MK, Woloshin S, Schwartz LM, Clark JA | title="What do you mean, a spot?": A qualitative analysis of patients' reactions to discussions with their doctors about pulmonary nodules | journal = Chest | volume = 143 | issue = 3 | pages = 672–677 | year = 2012 | pmid = 22814873 | pmc = 3590883 | doi = 10.1378/chest.12-1095 }}</ref> 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.<ref name="ACCPandATSfive">{{Citation |author1 = American College of Chest Physicians |author1-link = American College of Chest Physicians |author2 = American Thoracic Society |author2-link = American Thoracic Society |date = September 2013 |title = Five Things Physicians and Patients Should Question |publisher = American College of Chest Physicians and American Thoracic Society |work = [[Choosing Wisely]] |url = http://www.choosingwisely.org/doctor-patient-lists/american-college-of-chest-physicians-and-american-thoracic-society/ |access-date = 6 January 2013 |url-status = live |archive-url = https://web.archive.org/web/20131103063427/http://www.choosingwisely.org/doctor-patient-lists/american-college-of-chest-physicians-and-american-thoracic-society/ |archive-date = 3 November 2013 }}, which cites *{{cite journal |vauthors=MacMahon H, Austin JH, Gamsu G, Herold CJ, Jett JR, Naidich DP, Patz EF, Swensen SJ | s2cid = 14498160 | title = Guidelines for Management of Small Pulmonary Nodules Detected on CT Scans: A Statement from the Fleischner Society1 | journal = Radiology | volume = 237 | issue = 2 | pages = 395–400 | year = 2005 | pmid = 16244247 | doi = 10.1148/radiol.2372041887 | url = https://semanticscholar.org/paper/17a0414758896116c70742b8ac97743d9c655986 }} *{{cite journal | vauthors = Gould MK, Fletcher J, Iannettoni MD, Lynch WR, Midthun DE, Naidich DP, Ost DE | title = Evaluation of Patients with Pulmonary Nodules: When is It Lung Cancer?* | journal = Chest | volume = 132 | issue = 3_suppl | pages = 108S–130S | year = 2007 | pmid = 17873164 | doi = 10.1378/chest.07-1353 | author8 = American College of Chest Physicians | s2cid = 16449420 | url = https://semanticscholar.org/paper/8920416977ecef65c152f8ca3b6885e9f2a24df7 }} *{{cite journal |vauthors=Smith-Bindman R, Lipson J, Marcus R, Kim KP, Mahesh M, Gould R, Berrington de González A, [[Diana Miglioretti|Miglioretti DL]] | title = Radiation Dose Associated with Common Computed Tomography Examinations and the Associated Lifetime Attributable Risk of Cancer | journal = Archives of Internal Medicine | volume = 169 | issue = 22 | pages = 2078–2086 | year = 2009 | pmid = 20008690 | pmc = 4635397| doi = 10.1001/archinternmed.2009.427 }} *{{cite journal |vauthors=Wiener RS, Gould MK, Woloshin S, Schwartz LM, Clark JA | title="What do you mean, a spot?": A qualitative analysis of patients' reactions to discussions with their doctors about pulmonary nodules | journal = Chest | volume = 143 | issue = 3 | pages = 672–677 | year = 2012 | pmid = 22814873 | pmc = 3590883 | doi = 10.1378/chest.12-1095 }}</ref> 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.<ref name="ACCPandATSfive" /> 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.<ref name="ACCPandATSfive" /> === Angiography === [[File:SADDLE PE.JPG|thumb|Example of a CTPA, demonstrating a saddle [[pulmonary embolism|embolus]] (dark horizontal line) occluding the [[pulmonary artery|pulmonary arteries]] (bright white triangle)]] {{Main|Computed tomography angiography}} [[Computed tomography angiography]] (CTA) is a type of [[contrast CT]] to visualize the [[arteries]] and [[vein]]s throughout the body.<ref>{{Citation|last1=McDermott|first1=M.|title=Chapter 10 – Critical care in acute ischemic stroke|date=2017-01-01|journal=Handbook of Clinical Neurology|volume=140|pages=153–176|editor-last=Wijdicks|editor-first=Eelco F. M.|series=Critical Care Neurology Part I|publisher=Elsevier|language=en|doi=10.1016/b978-0-444-63600-3.00010-6|last2=Jacobs|first2=T.|last3=Morgenstern|first3=L.|pmid=28187798|editor2-last=Kramer|editor2-first=Andreas H.}}</ref> This ranges from arteries serving the [[brain]] to those bringing blood to the [[lung]]s, [[kidney]]s, [[arm]]s and [[leg]]s. An example of this type of exam is [[CT pulmonary angiogram]] (CTPA) used to diagnose [[pulmonary embolism]] (PE). It employs computed tomography and an [[iodinated contrast|iodine-based contrast agent]] to obtain an image of the [[pulmonary artery|pulmonary arteries]].<ref>{{Cite web|title=Computed Tomography Angiography (CTA)|url=https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/computed-tomography-angiography-cta|access-date=2021-03-21|website=www.hopkinsmedicine.org|language=en}}</ref><ref>{{Cite journal|last1=Zeman|first1=R K|last2=Silverman|first2=P M|last3=Vieco|first3=P T|last4=Costello|first4=P|date=1995-11-01|title=CT angiography.|journal=American Journal of Roentgenology|volume=165|issue=5|pages=1079–1088|doi=10.2214/ajr.165.5.7572481|pmid=7572481|issn=0361-803X|doi-access=free}}</ref><ref>{{Cite book|last1=Ramalho|first1=Joana|url=https://books.google.com/books?id=FKdMAgAAQBAJ&q=cta+is+an+imaging|title=Vascular Imaging of the Central Nervous System: Physical Principles, Clinical Applications, and Emerging Techniques|last2=Castillo|first2=Mauricio|date=2014-03-31|publisher=John Wiley & Sons|isbn=978-1-118-18875-0|page=69|language=en}}</ref> === Cardiac === A CT scan of the heart is performed to gain knowledge about cardiac or coronary anatomy.<ref>{{Cite web|url=https://www.nhlbi.nih.gov/health/health-topics/topics/ct|title=Cardiac CT Scan – NHLBI, NIH|website=www.nhlbi.nih.gov|access-date=2017-11-22|url-status=live|archive-url=https://web.archive.org/web/20171201032800/https://www.nhlbi.nih.gov/health/health-topics/topics/ct|archive-date=2017-12-01}}</ref> Traditionally, cardiac CT scans are used to detect, diagnose, or follow up [[coronary artery disease]].<ref name="Wichmann">{{Cite web|url=https://radiopaedia.org/articles/cardiac-ct-1|title=Cardiac CT {{!}} Radiology Reference Article {{!}} Radiopaedia.org|last=Wichmann|first=Julian L.|website=radiopaedia.org|access-date=2017-11-22|url-status=dead|archive-url=https://web.archive.org/web/20171201040626/https://radiopaedia.org/articles/cardiac-ct-1|archive-date=2017-12-01}}</ref> More recently CT has played a key role in the fast-evolving field of [[Interventional cardiology|transcatheter structural heart interventions]], more specifically in the transcatheter repair and replacement of heart valves.<ref>{{Cite journal|last1=Marwan|first1=Mohamed|last2=Achenbach|first2=Stephan|date=February 2016|title=Role of Cardiac CT Before Transcatheter Aortic Valve Implantation (TAVI)|journal=Current Cardiology Reports|volume=18|issue=2|pages=21|doi=10.1007/s11886-015-0696-3|issn=1534-3170|pmid=26820560|s2cid=41535442}}</ref><ref>{{Cite journal|last1=Moss|first1=Alastair J.|last2=Dweck|first2=Marc R.|last3=Dreisbach|first3=John G.|last4=Williams|first4=Michelle C.|last5=Mak|first5=Sze Mun|last6=Cartlidge|first6=Timothy|last7=Nicol|first7=Edward D.|last8=Morgan-Hughes|first8=Gareth J.|date=2016-11-01|title=Complementary role of cardiac CT in the assessment of aortic valve replacement dysfunction|journal=Open Heart|volume=3|issue=2|pages=e000494|doi=10.1136/openhrt-2016-000494|pmid=27843568|pmc=5093391|issn=2053-3624}}</ref><ref>{{Cite journal|last1=Thériault-Lauzier|first1=Pascal|last2=Spaziano|first2=Marco|last3=Vaquerizo|first3=Beatriz|last4=Buithieu|first4=Jean|last5=Martucci|first5=Giuseppe|last6=Piazza|first6=Nicolo|date=September 2015|title=Computed Tomography for Structural Heart Disease and Interventions|journal=Interventional Cardiology Review|volume=10|issue=3|pages=149–154|doi=10.15420/ICR.2015.10.03.149|issn=1756-1477|pmc=5808729|pmid=29588693}}</ref> The main forms of cardiac CT scanning are: *[[Coronary CT angiography]] (CCTA): the use of CT to assess the [[coronary artery|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 to diagnose coronary artery disease.<ref>{{Cite book|last=Passariello|first=Roberto|url=https://books.google.com/books?id=eR5USB6sRU4C&q=ct+angiography|title=Multidetector-Row CT Angiography|date=2006-03-30|publisher=Springer Science & Business Media|isbn=978-3-540-26984-7|language=en}}</ref><ref>{{Cite web|last=Radiology (ACR)|first=Radiological Society of North America (RSNA) and American College of|title=Coronary Computed Tomography Angiography (CCTA)|url=https://www.radiologyinfo.org/en/info.cfm?pg=angiocoroct|access-date=2021-03-19|website=www.radiologyinfo.org|language=en}}</ref> *[[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 a heart attack.<ref name=mayo>{{cite web|title=Heart scan (coronary calcium scan)|url=http://www.mayoclinic.org/tests-procedures/heart-scan/basics/definition/prc-20015000|publisher=Mayo Clinic|access-date=9 August 2015|url-status=live|archive-url=https://web.archive.org/web/20150905084216/http://www.mayoclinic.org/tests-procedures/heart-scan/basics/definition/prc-20015000|archive-date=5 September 2015}}</ref> 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.<ref name="van der BijlJoemai2010">{{cite journal|last1=van der Bijl|first1=Noortje|last2=Joemai|first2=Raoul M. S.|last3=Geleijns|first3=Jacob|last4=Bax|first4=Jeroen J.|last5=Schuijf|first5=Joanne D.|last6=de Roos|first6=Albert|last7=Kroft|first7=Lucia J. M.|title=Assessment of Agatston Coronary Artery Calcium Score Using Contrast-Enhanced CT Coronary Angiography|journal=American Journal of Roentgenology|volume=195|issue=6|year=2010|pages=1299–1305|issn=0361-803X|doi=10.2214/AJR.09.3734|pmid=21098187}}</ref> To better visualize the anatomy, post-processing of the images is common.<ref name="Wichmann" /> 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.<ref>{{Cite journal|last1=Vukicevic|first1=Marija|last2=Mosadegh|first2=Bobak|last3=Min|first3=James K.|last4=Little|first4=Stephen H.|date=February 2017|title=Cardiac 3D Printing and its Future Directions|journal=JACC: Cardiovascular Imaging|volume=10|issue=2|pages=171–184|doi=10.1016/j.jcmg.2016.12.001|issn=1876-7591|pmc=5664227|pmid=28183437}}</ref><ref>{{Cite journal|title=Innovative Mitral Valve Treatment with 3D Visualization at Henry Ford|url=http://www.materialise.com/en/blog/innovative-mitral-valve-treatment-3d-visualization-at-henry-ford|url-status=dead|archive-url=https://web.archive.org/web/20171201043336/http://www.materialise.com/en/blog/innovative-mitral-valve-treatment-3d-visualization-at-henry-ford|archive-date=2017-12-01|access-date=2017-11-22|journal=JACC: Cardiovascular Imaging|year=2016|doi=10.1016/j.jcmg.2016.01.017|pmid=27209112|last1=Wang|first1=D. D.|last2=Eng|first2=M.|last3=Greenbaum|first3=A.|last4=Myers|first4=E.|last5=Forbes|first5=M.|last6=Pantelic|first6=M.|last7=Song|first7=T.|last8=Nelson|first8=C.|last9=Divine|first9=G.|last10=Taylor|first10=A.|last11=Wyman|first11=J.|last12=Guerrero|first12=M.|last13=Lederman|first13=R. J.|last14=Paone|first14=G.|last15=O'Neill|first15=W.|volume=9|issue=11|pages=1349–1352|pmc=5106323}}</ref><ref>{{Cite journal|last1=Wang|first1=Dee Dee|last2=Eng|first2=Marvin|last3=Greenbaum|first3=Adam|last4=Myers|first4=Eric|last5=Forbes|first5=Michael|last6=Pantelic|first6=Milan|last7=Song|first7=Thomas|last8=Nelson|first8=Christina|last9=Divine|first9=George|date=November 2016|title=Predicting LVOT Obstruction After TMVR|journal=JACC: Cardiovascular Imaging|volume=9|issue=11|pages=1349–1352|doi=10.1016/j.jcmg.2016.01.017|issn=1876-7591|pmc=5106323|pmid=27209112}}</ref><ref>{{Cite journal|last1=Jacobs|first1=Stephan|last2=Grunert|first2=Ronny|last3=Mohr|first3=Friedrich W.|last4=Falk|first4=Volkmar|date=February 2008|title=3D-Imaging of cardiac structures using 3D heart models for planning in heart surgery: a preliminary study|journal=Interactive Cardiovascular and Thoracic Surgery|volume=7|issue=1|pages=6–9|doi=10.1510/icvts.2007.156588|issn=1569-9285|pmid=17925319|doi-access=free}}</ref> === Abdomen and pelvis === [[File:CT of a normal abdomen and pelvis, thumbnail.png|link=Commons:Scrollable computed tomography images of a normal abdomen and pelvis|thumb|CT scan of a normal abdomen and pelvis, in [[sagittal plane]], [[Coronal plane|coronal]] and [[Axial plane|axial]] planes, respectively. {{noprint|[[Commons:Scrollable computed tomography images of a normal abdomen and pelvis|<small>Click here to scroll through the image stacks.</small>]]}}|160x160px]] {{Main|Computed tomography of the abdomen and pelvis}} CT is an accurate technique for diagnosis of [[Human abdomen|abdominal]] diseases like [[Crohn's disease]],<ref>{{Cite journal|last1=Furukawa|first1=Akira|last2=Saotome|first2=Takao|last3=Yamasaki|first3=Michio|last4=Maeda|first4=Kiyosumi|last5=Nitta|first5=Norihisa|last6=Takahashi|first6=Masashi|last7=Tsujikawa|first7=Tomoyuki|last8=Fujiyama|first8=Yoshihide|last9=Murata|first9=Kiyoshi|last10=Sakamoto|first10=Tsutomu|date=2004-05-01|title=Cross-sectional Imaging in Crohn Disease|journal=RadioGraphics|volume=24|issue=3|pages=689–702|doi=10.1148/rg.243035120|pmid=15143222|issn=0271-5333|doi-access=free}}</ref> GIT bleeding, and diagnosis and staging of cancer, as well as follow-up after cancer treatment to assess response.<ref>{{Cite book|url=https://www.google.co.in/books/edition/CT_of_the_Acute_Abdomen/r3uK7sSZUmcC?hl=en&gbpv=1&dq=CT+of+abdominal+diseases&printsec=frontcover|title=CT of the Acute Abdomen|publisher=Springer Berlin Heidelberg|year=2011|isbn=978-3-540-89232-8|pages=37}}</ref> It is commonly used to investigate [[acute abdominal pain]].<ref>{{Cite book |author=Jay P Heiken |author2=Douglas S Katz |chapter=Emergency Radiology of the Abdomen and Pelvis: Imaging of the Nontraumatic and Traumatic Acute Abdomen |editor=J. Hodler |editor2=R. A. Kubik-Huch |editor3=G. K. von Schulthess |editor4=Ch. L. Zollikofer |url=https://www.google.co.in/books/edition/Diseases_of_the_Abdomen_and_Pelvis/CSy5BQAAQBAJ?hl=en&gbpv=1&dq=ct+abdomen+for+acute+pain&pg=PA3&printsec=frontcover |title=Diseases of the Abdomen and Pelvis |publisher=Springer Milan |year=2014 |isbn=9788847056596 |page=3}}</ref> Non-enhanced computed tomography is today the gold standard for diagnosing urinary stones. <ref>Türk C, Knoll T, Petrik A, Sarica K, Skolarikos A, Straub M, et al. Guidelines on Urolithiasis. Arnhem, The Netherlands: EAU Guidelines Office; 2013.Türk C, Knoll T, Petrik A, Sarica K, Skolarikos A, Straub M, et al. Guidelines on Urolithiasis. Arnhem, The Netherlands: EAU Guidelines Office; 2013.</ref> The size, volume and density of stones can be estimated to help clinicians guide further treatment; size is especially important in predicting spontaneous passage of a stone. <ref> Miller OF, Kane CJ. Time to stone passage for observed ureteral calculi: a guide for patient education. J Urol. 1999;162(3 Pt 1):688-90. [PubMed]Miller OF, Kane CJ. Time to stone passage for observed ureteral calculi: a guide for patient education. J Urol. 1999;162(3):688–690. Pt 1</ref> === Axial skeleton and extremities === For the [[axial skeleton]] and [[Limb (anatomy)|extremities]], CT is often used to image complex [[fracture (bone)|fractures]], especially ones around joints, because of its ability to reconstruct the area of interest in multiple planes. Fractures, ligamentous injuries, and [[Dislocation (medicine)|dislocations]] can easily be recognized with a 0.2&nbsp;mm resolution.<ref>{{cite web| url=http://orthoinfo.aaos.org/topic.cfm?topic=A00391| title=Ankle Fractures| publisher=American Association of Orthopedic Surgeons| website=orthoinfo.aaos.org| access-date=30 May 2010| url-status=dead| archive-url=https://web.archive.org/web/20100530103553/http://orthoinfo.aaos.org/topic.cfm?topic=A00391| archive-date=30 May 2010}}</ref><ref>{{cite journal| title=Musculoskeletal Imaging with Multislice CT| author= Buckwalter, Kenneth A. | journal=American Journal of Roentgenology| volume=176| issue=4| pages=979–986| date=11 September 2000|display-authors=etal| doi=10.2214/ajr.176.4.1760979| pmid=11264094}}</ref> With modern dual-energy CT scanners, new areas of use have been established, such as aiding in the diagnosis of [[gout]].<ref>{{Cite journal|last1=Ramon|first1=André|last2=Bohm-Sigrand|first2=Amélie|last3=Pottecher|first3=Pierre|last4=Richette|first4=Pascal|last5=Maillefert|first5=Jean-Francis|last6=Devilliers|first6=Herve|last7=Ornetti|first7=Paul|date=2018-03-01|title=Role of dual-energy CT in the diagnosis and follow-up of gout: systematic analysis of the literature|journal=Clinical Rheumatology|volume=37|issue=3|pages=587–595|doi=10.1007/s10067-017-3976-z|pmid=29350330|s2cid=3686099|issn=0770-3198}}</ref> === Biomechanical use === CT is used in [[biomechanics]] to quickly reveal the geometry, anatomy, [[density]] and [[Modulus of elasticity|elastic moduli]] of biological tissues.<ref>{{Cite journal|last=Keaveny|first=Tony M.|date=March 2010|title=Biomechanical computed tomography-noninvasive bone strength analysis using clinical computed tomography scans|journal=Annals of the New York Academy of Sciences|volume=1192|issue=1|pages=57–65|doi=10.1111/j.1749-6632.2009.05348.x|issn=1749-6632|pmid=20392218|bibcode=2010NYASA1192...57K|s2cid=24132358}}</ref><ref>{{Cite book|last1=Barber|first1=Asa|url=https://books.google.com/books?id=shSMDwAAQBAJ&q=CT+is+used+in+biomechanics+to|title=Computed Tomography Based Biomechanics|last2=Tozzi|first2=Gianluca|last3=Pani|first3=Martino|date=2019-03-07|publisher=Frontiers Media SA|isbn=978-2-88945-780-9|page=20|language=en}}</ref> == Other uses == === Industrial use === [[Industrial CT scanning]] (industrial computed tomography) is a process which utilizes X-ray equipment to produce 3D representations of components both externally and internally. Industrial CT scanning has been utilized in many areas of industry for internal inspection of components. Some of the key uses for CT scanning have been flaw detection, failure analysis, metrology, assembly analysis, image-based finite element methods<ref>{{Cite journal|last1=Evans|first1=Ll. M.|last2=Margetts|first2=L.|last3=Casalegno|first3=V.|last4=Lever|first4=L. M.|last5=Bushell|first5=J.|last6=Lowe|first6=T.|last7=Wallwork|first7=A.|last8=Young|first8=P.|last9=Lindemann|first9=A.|date=2015-05-28|title=Transient thermal finite element analysis of CFC–Cu ITER monoblock using X-ray tomography data|url=https://www.researchgate.net/publication/277338941|url-status=live|journal=Fusion Engineering and Design|volume=100|pages=100–111|doi=10.1016/j.fusengdes.2015.04.048|archive-url=https://web.archive.org/web/20151016091649/http://www.researchgate.net/publication/277338941_Transient_thermal_finite_element_analysis_of_CFCCu_ITER_monoblock_using_X-ray_tomography_data|archive-date=2015-10-16|doi-access=free}}</ref> and reverse engineering applications. CT scanning is also employed in the imaging and conservation of museum artifacts.<ref>{{cite journal|author=Payne, Emma Marie|year=2012|title=Imaging Techniques in Conservation|url=http://discovery.ucl.ac.uk/1443164/1/56-566-2-PB.pdf|journal=Journal of Conservation and Museum Studies|volume=10|issue=2|pages=17–29|doi=10.5334/jcms.1021201|doi-access=free}}</ref> CT scanning has also found an application in transport security (predominantly [[airport security]]) where it is currently used in a materials analysis context for explosives detection [[CTX (explosive-detection device)]]<ref>{{cite book|author1=P. Babaheidarian|title=Anomaly Detection and Imaging with X-Rays (ADIX) III|author2=D. Castanon|date=2018|isbn=978-1-5106-1775-9|pages=12|chapter=Joint reconstruction and material classification in spectral CT|doi=10.1117/12.2309663|s2cid=65469251}}</ref><ref name="jin12securityct">{{cite book|author1=P. Jin|title=Second International Conference on Image Formation in X-Ray Computed Tomography|author2=E. Haneda|author3=K. D. Sauer|author4=C. A. Bouman|date=June 2012|chapter=A model-based 3D multi-slice helical CT reconstruction algorithm for transportation security application|access-date=2015-04-05|chapter-url=https://engineering.purdue.edu/~bouman/publications/orig-pdf/CT-2012a.pdf|archive-url=https://web.archive.org/web/20150411000659/https://engineering.purdue.edu/~bouman/publications/orig-pdf/CT-2012a.pdf|archive-date=2015-04-11|url-status=dead}}</ref><ref name="jin12securityctprior">{{cite book|author1=P. Jin|title=Signals, Systems and Computers (ASILOMAR), 2012 Conference Record of the Forty Sixth Asilomar Conference on|author2=E. Haneda|author3=C. A. Bouman|date=November 2012|publisher=IEEE|pages=613–636|chapter=Implicit Gibbs prior models for tomographic reconstruction|access-date=2015-04-05|chapter-url=https://engineering.purdue.edu/~bouman/publications/pdf/Asilomar-2012-Pengchong.pdf|archive-url=https://web.archive.org/web/20150411025559/https://engineering.purdue.edu/~bouman/publications/pdf/Asilomar-2012-Pengchong.pdf|archive-date=2015-04-11|url-status=dead}}</ref><ref name="kisner13securityct">{{cite book|author1=S. J. Kisner|title=Security Technology (ICCST), 2013 47th International Carnahan Conference on|author2=P. Jin|author3=C. A. Bouman|author4=K. D. Sauer|author5=W. Garms|author6=T. Gable|author7=S. Oh|author8=M. Merzbacher|author9=S. Skatter|date=October 2013|publisher=IEEE|chapter=Innovative data weighting for iterative reconstruction in a helical CT security baggage scanner|access-date=2015-04-05|chapter-url=https://engineering.purdue.edu/~bouman/publications/pdf/iccst2013.pdf|archive-url=https://web.archive.org/web/20150410234541/https://engineering.purdue.edu/~bouman/publications/pdf/iccst2013.pdf|archive-date=2015-04-10|url-status=dead}}</ref> and is also under consideration for automated baggage/parcel security scanning using [[computer vision]] based object recognition algorithms that target the detection of specific threat items based on 3D appearance (e.g. guns, knives, liquid containers).<ref name="megherbi10baggage">{{cite book|author1=Megherbi, N.|title=Proc. International Conference on Image Processing|author2=Flitton, G.T.|author3=Breckon, T.P.|date=September 2010|publisher=IEEE|isbn=978-1-4244-7992-4|pages=1833–1836|chapter=A Classifier based Approach for the Detection of Potential Threats in CT based Baggage Screening|citeseerx=10.1.1.188.5206|doi=10.1109/ICIP.2010.5653676|access-date=5 November 2013|chapter-url=http://www.durham.ac.uk/toby.breckon/publications/papers/megherbi10baggage.pdf|s2cid=3679917}}</ref><ref name="megherbi12baggage">{{cite book|author1=Megherbi, N.|title=Proc. International Conference on Image Processing|author2=Han, J.|author3=Flitton, G.T.|author4=Breckon, T.P.|date=September 2012|publisher=IEEE|isbn=978-1-4673-2533-2|pages=3109–3112|chapter=A Comparison of Classification Approaches for Threat Detection in CT based Baggage Screening|citeseerx=10.1.1.391.2695|doi=10.1109/ICIP.2012.6467558|access-date=5 November 2013|chapter-url=http://www.durham.ac.uk/toby.breckon/publications/papers/megherbi12baggage.pdf|s2cid=6924816}}</ref><ref name="flitton13interestpoint">{{cite journal|author1=Flitton, G.T.|author2=Breckon, T.P.|author3=Megherbi, N.|date=September 2013|title=A Comparison of 3D Interest Point Descriptors with Application to Airport Baggage Object Detection in Complex CT Imagery|url=http://www.durham.ac.uk/toby.breckon/publications/papers/flitton13interestpoint.pdf|journal=Pattern Recognition|volume=46|pages=2420–2436|doi=10.1016/j.patcog.2013.02.008|access-date=5 November 2013|number=9|bibcode=2013PatRe..46.2420F|hdl=1826/15213}}</ref> === Geological use === X-ray CT is used in geological studies to quickly reveal materials inside a drill core.<ref>{{Cite web|url=http://www.jamstec.go.jp/chikyu/e/about/laboratory.html|title=Laboratory {{!}} About Chikyu {{!}} The Deep-sea Scientific Drilling Vessel CHIKYU|website=www.jamstec.go.jp|access-date=2019-10-24}}</ref> Dense minerals such as pyrite and barite appear brighter and less dense components such as clay appear dull in CT images.<ref>{{Cite journal|last1=Tonai|first1=Satoshi|last2=Kubo|first2=Yusuke|last3=Tsang|first3=Man-Yin|last4=Bowden|first4=Stephen|last5=Ide|first5=Kotaro|last6=Hirose|first6=Takehiro|last7=Kamiya|first7=Nana|last8=Yamamoto|first8=Yuzuru|last9=Yang|first9=Kiho|last10=Yamada|first10=Yasuhiro|last11=Morono|first11=Yuki|date=2019|title=A New Method for Quality Control of Geological Cores by X-Ray Computed Tomography: Application in IODP Expedition 370|journal=Frontiers in Earth Science|language=English|volume=7|doi=10.3389/feart.2019.00117|s2cid=171394807|issn=2296-6463|doi-access=free}}</ref> === Cultural heritage use === X-ray CT and [[X-ray microtomography|micro-CT]] can also be used for the conservation and preservation of objects of cultural heritage. For many fragile objects, direct research and observation can be damaging and can degrade the object over time. Using CT scans, conservators and researchers are able to determine the material composition of the objects they are exploring, such as the position of ink along the layers of a scroll, without any additional harm. These scans have been optimal for research focused on the workings of the [[Antikythera mechanism]] or the text hidden inside the charred outer layers of the [[En-Gedi Scroll]]. However, they are not optimal for every object subject to these kinds of research questions, as there are certain artifacts like the [[Herculaneum papyri]] in which the material composition has very little variation along the inside of the object. After scanning these objects, computational methods can be employed to examine the insides of these objects, as was the case with the virtual unwrapping of the [[En-Gedi Scroll#Recovery|En-Gedi scroll]] and the [[Herculaneum papyri#Virtual unrolling|Herculaneum papyri]].<ref>{{cite journal|last1=Seales|first1=W. B.|last2=Parker|first2=C. S.|last3=Segal|first3=M.|last4=Tov|first4=E.|last5=Shor|first5=P.|last6=Porath|first6=Y.|title=From damage to discovery via virtual unwrapping: Reading the scroll from En-Gedi|journal=Science Advances|volume=2|issue=9|year=2016|pages=e1601247|issn=2375-2548|doi=10.1126/sciadv.1601247|pmid=27679821|pmc=5031465|bibcode=2016SciA....2E1247S}}</ref> Micro-CT has also proved useful for analyzing more recent artifacts such as still-sealed historic correspondence that employed the technique of [[letterlocking]] (complex folding and cuts) that provided a "tamper-evident locking mechanism".<ref>{{cite web |title=A Letter Sealed for Centuries Has Been Read—Without Even Opening It |url= https://www.wsj.com/articles/a-letter-sealed-for-centuries-has-been-readwithout-even-opening-it-11614679203 |last=Castellanos |first= Sara |date=2 March 2021 |access-date=2 March 2021 |work= The Wall Street Journal }}</ref><ref>{{cite journal |title=Unlocking history through automated virtual unfolding of sealed documents imaged by X-ray microtomography |url= |last1=Dambrogio |first1=Jana |last2=Ghassaei |first2=Amanda |last3=Staraza Smith |first3=Daniel |last4=Jackson |first4=Holly |last5=Demaine |first5=Martin L.|date=2 March 2021 |journal=Nature Communications |volume=12 |issue=1 |page=1184 |doi=10.1038/s41467-021-21326-w |pmid=33654094 |pmc=7925573 |bibcode=2021NatCo..12.1184D }}</ref> == Interpretation of results == === Presentation === [[File:CT presentation as thin slice, projection and volume rendering.jpg|thumb|300px|Types of presentations of CT scans: <br />- Average intensity projection<br />- [[Maximum intensity projection]]<br />- Thin slice ([[median plane]])<br />- [[Volume rendering]] by high and low threshold for [[radiodensity]]]] The result of a CT scan is a volume of [[voxel]]s, which may be presented to a human observer by various methods, which broadly fit into the following categories: *Slices (of varying thickness). Thin slice is generally regarded as planes representing a thickness of less than 3 [[Millimetre|mm]].<ref name="Goldman2008">{{cite journal|last1=Goldman|first1=L. W.|title=Principles of CT: Multislice CT|journal=Journal of Nuclear Medicine Technology|volume=36|issue=2|year=2008|pages=57–68|issn=0091-4916|doi=10.2967/jnmt.107.044826|pmid=18483143|doi-access=free}}</ref><ref name=":2">{{Cite journal|last1=Reis|first1=Eduardo Pontes|last2=Nascimento|first2=Felipe|last3=Aranha|first3=Mateus|last4=Mainetti Secol|first4=Fernando|last5=Machado|first5=Birajara|last6=Felix|first6=Marcelo|last7=Stein|first7=Anouk|last8=Amaro|first8=Edson|date=29 July 2020|title=Brain Hemorrhage Extended (BHX): Bounding box extrapolation from thick to thin slice CT images v1.1|journal=PhysioNet|language=en|volume=101|issue=23|pages=215–220|doi=10.13026/9cft-hg92}}</ref> Thick slice is generally regarded as planes representing a thickness between 3&nbsp;mm and 5&nbsp;mm.<ref name=":2" /><ref>{{Cite journal|date=2020-09-01|title=Differentiating autoimmune pancreatitis from pancreatic ductal adenocarcinoma with CT radiomics features|journal=Diagnostic and Interventional Imaging|language=en|volume=101|issue=9|pages=555–564|doi=10.1016/j.diii.2020.03.002|issn=2211-5684|last1=Park|first1=S.|last2=Chu|first2=L.C.|last3=Hruban|first3=R.H.|last4=Vogelstein|first4=B.|last5=Kinzler|first5=K.W.|last6=Yuille|first6=A.L.|last7=Fouladi|first7=D.F.|last8=Shayesteh|first8=S.|last9=Ghandili|first9=S.|last10=Wolfgang|first10=C.L.|last11=Burkhart|first11=R.|last12=He|first12=J.|last13=Fishman|first13=E.K.|last14=Kawamoto|first14=S.|pmid=32278586|s2cid=215751181}}</ref> *Projection, including [[maximum intensity projection]]<ref name="FishmanNey2006">{{cite journal|author-link1=Elliot K. Fishman|last1=Fishman|first1=Elliot K.|last2=Ney|first2=Derek R.|last3=Heath|first3=David G.|last4=Corl|first4=Frank M.|last5=Horton|first5=Karen M.|last6=Johnson|first6=Pamela T.|title=Volume Rendering versus Maximum Intensity Projection in CT Angiography: What Works Best, When, and Why|journal=RadioGraphics|volume=26|issue=3|year=2006|pages=905–922|issn=0271-5333|doi=10.1148/rg.263055186|pmid=16702462|doi-access=free}}</ref> and ''average intensity projection'' *[[Volume rendering]] (VR)<ref name="FishmanNey2006" /> Technically, all volume renderings become projections when viewed on a [[Display device#Full-area 2-dimensional displays|2-dimensional display]], making the distinction between projections and volume renderings a bit vague. The epitomes of volume rendering models feature a mix of for example coloring and shading in order to create realistic and observable representations.<ref name="SilversteinParsad2008">{{cite journal|last1=Silverstein|first1=Jonathan C.|last2=Parsad|first2=Nigel M.|last3=Tsirline|first3=Victor|title=Automatic perceptual color map generation for realistic volume visualization|journal=Journal of Biomedical Informatics|volume=41|issue=6|year=2008|pages=927–935|issn=1532-0464|doi=10.1016/j.jbi.2008.02.008|pmid=18430609|pmc=2651027}}</ref><ref>{{Cite book|last=Kobbelt|first=Leif|url=https://books.google.com/books?id=zndnSzkfkXwC|title=Vision, Modeling, and Visualization 2006: Proceedings, November 22-24, 2006, Aachen, Germany|date=2006|publisher=IOS Press|isbn=978-3-89838-081-2|pages=185|language=en}}</ref> Two-dimensional CT images are conventionally rendered so that the view is as though looking up at it from the patient's feet.<ref name="auto" /> Hence, the left side of the image is to the patient's right and vice versa, while anterior in the image also is the patient's anterior and vice versa. This left-right interchange corresponds to the view that physicians generally have in reality when positioned in front of patients.<ref>{{Cite journal|last1=Schmidt|first1=Derek|last2=Odland|first2=Rick|date=September 2004|title=Mirror-Image Reversal of Coronal Computed Tomography Scans|journal=The Laryngoscope|language=en|volume=114|issue=9|pages=1562–1565|doi=10.1097/00005537-200409000-00011|pmid=15475782|s2cid=22320649|issn=0023-852X}}</ref> ==== Grayscale ==== [[Pixel]]s in an image obtained by CT scanning are displayed in terms of relative [[radiodensity]]. The pixel itself is displayed according to the mean [[attenuation]] of the tissue(s) that it corresponds to on a scale from +3,071 (most attenuating) to −1,024 (least attenuating) on the [[Hounsfield scale]]. A [[pixel]] is a two dimensional unit based on the matrix size and the field of view. When the CT slice thickness is also factored in, the unit is known as a [[voxel]], which is a three-dimensional unit.<ref>{{cite book |title=Brant and Helms' fundamentals of diagnostic radiology |publisher=Lippincott Williams & Wilkins |isbn=978-1-4963-6738-9 |pages=1600 |edition=Fifth |url=https://books.google.com/books?id=63xxDwAAQBAJ |access-date=24 January 2019|date=2018-07-19 }}</ref> Water has an attenuation of 0 [[Hounsfield units]] (HU), while air is −1,000&nbsp;HU, cancellous bone is typically +400&nbsp;HU, and cranial bone can reach 2,000&nbsp;HU.<ref>{{Cite book |title=Brain mapping : the methods|date=2002|publisher=Academic Press |editor=Arthur W. Toga |editor2=John C. Mazziotta |isbn=0-12-693019-8 |edition=2nd |location=Amsterdam |oclc=52594824}}</ref> The attenuation of metallic implants depends on the atomic number of the element used: Titanium usually has an amount of +1000&nbsp;HU, iron steel can completely extinguish the X-ray and is, therefore, responsible for well-known line-artifacts in computed tomograms. Artifacts are caused by abrupt transitions between low- and high-density materials, which results in data values that exceed the dynamic range of the processing electronics.<ref name="...">{{Cite book |author=Jerrold T. Bushberg |author2=J. Anthony Seibert |author3=Edwin M. Leidholdt |author4=John M. Boone |title=The essential physics of medical imaging |date=2002 |publisher=Lippincott Williams & Wilkins |isbn=0-683-30118-7 |edition=2nd |location=Philadelphia |page=358 |oclc=47177732}}</ref> ==== Windowing ==== CT data sets have a very high [[dynamic range]] which must be reduced for display or printing. This is typically done via a process of "windowing", which maps a range (the "window") of pixel values to a grayscale ramp. For example, CT images of the brain are commonly viewed with a window extending from 0 HU to 80 HU. Pixel values of 0 and lower, are displayed as black; values of 80 and higher are displayed as white; values within the window are displayed as a grey intensity proportional to position within the window.<ref>{{Cite journal|date=2016-01-01|title=Computed tomography imaging and angiography – principles|journal=Handbook of Clinical Neurology|language=en|volume=135|pages=3–20|doi=10.1016/B978-0-444-53485-9.00001-5|issn=0072-9752|last1=Kamalian|first1=Shervin|last2=Lev|first2=Michael H.|last3=Gupta|first3=Rajiv|pmid=27432657|isbn=978-0-444-53485-9}}</ref> The window used for display must be matched to the X-ray density of the object of interest, in order to optimize the visible detail.<ref>{{Cite book|last=Stirrup|first=James|url=https://books.google.com/books?id=SarDDwAAQBAJ&q=windowing+in+ct&pg=PA136|title=Cardiovascular Computed Tomography|date=2020-01-02|publisher=Oxford University Press|isbn=978-0-19-880927-2|page=136|language=en}}</ref> ==== Multiplanar reconstruction and projections{{anchor|Multiplanar_reconstruction}} ==== [[File:Ct-workstation-neck.jpg|thumb|Typical screen layout for diagnostic software, showing one volume rendering (VR) and multiplanar view of three thin slices in the [[axial plane|axial]] (upper right), [[sagittal plane|sagittal]] (lower left), and [[coronal plane]]s (lower right)]] [[File:CT of spondylosis causing radiculopathy.png|thumb|left|Special planes are sometimes useful, such as this oblique longitudinal plane in order to visualize the neuroforamina of the vertebral column, showing narrowing at two levels, causing [[radiculopathy]]. The smaller images are axial plane slices.|148x148px]] Multiplanar reconstruction (MPR) is the process of converting data from one [[anatomical plane]]s (usually [[Transverse plane|transverse]]) to other planes. It can be used for thin slices as well as projections. Multiplanar reconstruction is possible as present CT scanners provide almost [[isotropy|isotropic]] resolution.<ref name="ref3">{{Cite book|last1=Udupa|first1=Jayaram K.|url=https://books.google.com/books?id=aR6PHYluq4oC&q=3D+Imaging+in+Medicine%2C+2nd+Edition|title=3D Imaging in Medicine, Second Edition|last2=Herman|first2=Gabor T.|date=1999-09-28|publisher=CRC Press|isbn=978-0-8493-3179-4|language=en}}</ref> MPR is used almost in every scan, however the spine is frequently examined with it.<ref>{{Cite journal|last1=Krupski|first1=Witold|last2=Kurys-Denis|first2=Ewa|last3=Matuszewski|first3=Łukasz|last4=Plezia|first4=Bogusław|date=2007-06-30|title=Use of multi-planar reconstruction (MPR) and 3-dimentional (3D) CT to assess stability criteria in C2 vertebral fractures|url=http://www.jpccr.eu/Use-of-multi-planar-reconstruction-MPR-and-3-dimentional-3D-CT-to-assess-stability,71238,0,2.html|journal=Journal of Pre-Clinical and Clinical Research|language=english|volume=1|issue=1|pages=80–83|issn=1898-2395}}</ref> Images of the spine in axial plane can only show one vertebral bone at a time and can not show their relation with other vertebral bones. By reformatting the data in other planes, visualization of the relative position can be achieved in sagittal and coronal plane.<ref>{{Cite journal|last=Tins|first=Bernhard|date=2010-10-21|title=Technical aspects of CT imaging of the spine|journal=Insights into Imaging|volume=1|issue=5–6|pages=349–359|doi=10.1007/s13244-010-0047-2|issn=1869-4101|pmc=3259341|pmid=22347928}}</ref> New software allow the reconstruction of data in non-orthogonal (oblique) which help in the visualization of organs which are not in orthogonal planes.<ref>{{Cite web|title=CT imaging: Where are we going? (Proceedings)|url=https://www.dvm360.com/view/ct-imaging-where-are-we-going-proceedings|access-date=2021-03-21|website=DVM 360}}</ref><ref>{{Cite book|last1=Wolfson|first1=Nikolaj|url=https://books.google.com/books?id=8Y5FDAAAQBAJ&q=Modern+software+allows+reconstruction+in+non-orthogonal&pg=PA373|title=Orthopedics in Disasters: Orthopedic Injuries in Natural Disasters and Mass Casualty Events|last2=Lerner|first2=Alexander|last3=Roshal|first3=Leonid|date=2016-05-30|publisher=Springer|isbn=978-3-662-48950-5|language=en}}</ref> It is better suited for visualization of the anatomical structure of the bronchi as they do not lie orthogonal to the direction of the scan.<ref>{{Cite journal|last1=Laroia|first1=Archana T|last2=Thompson|first2=Brad H|last3=Laroia|first3=Sandeep T|last4=van Beek|first4=Edwin JR|date=2010-07-28|title=Modern imaging of the tracheo-bronchial tree|journal=World Journal of Radiology|volume=2|issue=7|pages=237–248|doi=10.4329/wjr.v2.i7.237|issn=1949-8470|pmc=2998855|pmid=21160663}}</ref> Curved-plane reconstruction is performed mainly for the evaluation of vessels. This type of reconstruction helps to straighten the bends in a vessel, there by helping to visualise whole vessel in a single image, or multiple images. After a vessel has been "straightened", measurements like cross sectional area, length can be made. It is very helpful in preoperative assessment of a surgical procedure.<ref>{{Cite journal|last1=Gong|first1=Jing-Shan|last2=Xu|first2=Jian-Min|date=2004-07-01|title=Role of curved planar reformations using multidetector spiral CT in diagnosis of pancreatic and peripancreatic diseases|journal=World Journal of Gastroenterology|volume=10|issue=13|pages=1943–1947|doi=10.3748/wjg.v10.i13.1943|issn=1007-9327|pmc=4572236|pmid=15222042}}</ref> For 2D projections used in [[radiation therapy]] for the quality assurance and planning of [[External beam radiotherapy]] treatments, including [[Digitally Reconstructed Radiographs]], see [[Beam's eye view]]. {| class="wikitable" |+Examples of different algorithms of thickening multiplanar reconstructions<ref>{{Cite journal|last1=Dalrymple|first1=Neal C.|last2=Prasad|first2=Srinivasa R.|last3=Freckleton|first3=Michael W.|last4=Chintapalli|first4=Kedar N.|date=September 2005|title=Informatics in radiology (infoRAD): introduction to the language of three-dimensional imaging with multidetector CT|journal=Radiographics |volume=25|issue=5|pages=1409–1428|doi=10.1148/rg.255055044|issn=1527-1323|pmid=16160120}}</ref> !Type of projection !Schematic illustration !Examples (10&nbsp;mm slabs) !Description !Uses |- |Average intensity projection (AIP) |[[File:Average intensity projection.gif|frameless]] |[[File:Coronal average intensity projection CT thorax.gif|frameless|118x118px]] |The average attenuation of each voxel is displayed. The image will get smoother as slice thickness increases. It will look more and more similar to conventional [[projectional radiography]] as slice thickness increases. |Useful for identifying the internal structures of a solid organ or the walls of hollow structures, such as intestines. |- |[[Maximum intensity projection]] (MIP) |[[File:Maximum intensity projection.gif|frameless]] |[[File:Coronal maximum intensity projection CT thorax.gif|frameless|118x118px]] |The voxel with the highest attenuation is displayed. Therefore, high-attenuating structures such as blood vessels filled with contrast media are enhanced. |Useful for angiographic studies and identification of pulmonary nodules. |- |[[Minimum intensity projection]] (MinIP) |[[File:Minimum intensity projection.gif|frameless]] |[[File:Coronal minimum intensity projection CT thorax.gif|frameless|117x117px]] |The voxel with the lowest attenuation is displayed. Therefore, low-attenuating structures such as air spaces are enhanced. |Useful for assessing the lung parenchyma. |} ==== {{anchor|3D}} Volume rendering ==== {{Main|Volume rendering}} [[File:12-06-11-rechtsmedizin-berlin-07.jpg|thumbnail|3D human skull from computed tomography data]] A threshold value of radiodensity is set by the operator (e.g., a level that corresponds to bone). With the help of [[edge detection]] image processing algorithms a 3D model can be constructed from the initial data and displayed on screen. Various thresholds can be used to get multiple models, each anatomical component such as muscle, bone and cartilage can be differentiated on the basis of different colours given to them. However, this mode of operation cannot show interior structures.<ref>{{Cite journal|last1=Calhoun|first1=Paul S.|last2=Kuszyk|first2=Brian S.|last3=Heath|first3=David G.|last4=Carley|first4=Jennifer C.|last5=Fishman|first5=Elliot K.|date=1999-05-01|title=Three-dimensional Volume Rendering of Spiral CT Data: Theory and Method|url=https://pubs.rsna.org/doi/full/10.1148/radiographics.19.3.g99ma14745|journal=RadioGraphics|volume=19|issue=3|pages=745–764|doi=10.1148/radiographics.19.3.g99ma14745|pmid=10336201|issn=0271-5333}}</ref> Surface rendering is limited technique as it displays only the surfaces that meet a particular threshold density, and which are towards the viewer. However, In [[volume rendering]], transparency, colours and [[Phong shading|shading]] are used which makes it easy to present a volume in a single image. For example, Pelvic bones could be displayed as semi-transparent, so that, even viewing at an oblique angle one part of the image does not hide another.<ref>{{Cite journal|last1=van Ooijen|first1=P. M. A.|last2=van Geuns|first2=R. J. M.|last3=Rensing|first3=B. J. W. M.|last4=Bongaerts|first4=A. H. H.|last5=de Feyter|first5=P. J.|last6=Oudkerk|first6=M.|date=January 2003|title=Noninvasive Coronary Imaging Using Electron Beam CT: Surface Rendering Versus Volume Rendering|url=http://www.ajronline.org/doi/10.2214/ajr.180.1.1800223|journal=American Journal of Roentgenology|language=en|volume=180|issue=1|pages=223–226|doi=10.2214/ajr.180.1.1800223|pmid=12490509|issn=0361-803X}}</ref> === Image quality === [[File:CT-Low-Dose-2.5-LUNG.ogg|thumb|Low-dose CT scan of the thorax.]] [[File:Standard dose high resolution chest CT (HRCT).ogg|thumb|Standard-dose CT scan of the thorax.]] ==== Dose versus image quality ==== An important issue within radiology today is how to reduce the radiation dose during CT examinations without compromising the image quality. In general, higher radiation doses result in higher-resolution images,<ref name=Crowther>{{cite journal|title=The Reconstruction of a Three-Dimensional Structure from Projections and its Application to Electron Microscopy|year=1970|author1=R. A. Crowther |author2=D. J. DeRosier |author3=A. Klug |journal=Proc. Roy. Soc. Lond. A|volume=317|issue=1530|pages=319–340|doi=10.1098/rspa.1970.0119|bibcode=1970RSPSA.317..319C|s2cid=122980366}}</ref> while lower doses lead to increased image noise and unsharp images. However, increased dosage raises the adverse side effects, including the risk of [[radiation-induced cancer]] – a four-phase abdominal CT gives the same radiation dose as 300 chest X-rays.<ref>{{Cite journal|last1=Nickoloff|first1=Edward L.|last2=Alderson|first2=Philip O.|date=August 2001|title=Radiation Exposures to Patients from CT: Reality, Public Perception, and Policy|url=http://www.ajronline.org/doi/10.2214/ajr.177.2.1770285|journal=American Journal of Roentgenology|language=en|volume=177|issue=2|pages=285–287|doi=10.2214/ajr.177.2.1770285|pmid=11461846|issn=0361-803X}}</ref> Several methods that can reduce the exposure to ionizing radiation during a CT scan exist.<ref name="ata">Barkan, O; Weill, J; Averbuch, A; Dekel, S. [http://www.cv-foundation.org/openaccess/content_cvpr_2013/papers/Barkan_Adaptive_Compressed_Tomography_2013_CVPR_paper.pdf "Adaptive Compressed Tomography Sensing"] {{webarchive|url=https://web.archive.org/web/20160313133222/http://www.cv-foundation.org/openaccess/content_cvpr_2013/papers/Barkan_Adaptive_Compressed_Tomography_2013_CVPR_paper.pdf |date=2016-03-13 }}. In Proceedings of the IEEE Conference on Computer Vision and Pattern Recognition 2013 (pp. 2195–2202).</ref> # New software technology can significantly reduce the required radiation dose. New [[Iterative reconstruction|iterative]] [[tomographic reconstruction]] algorithms (''e.g.'', [[SAMV (algorithm)|iterative Sparse Asymptotic Minimum Variance]]) could offer [[Super-resolution imaging|super-resolution]] without requiring higher radiation dose.<ref>{{Cite book|url=https://books.google.com/books?id=hclVAAAAMAAJ&q=iterative+construction+gives+super+resolution|title=Proceedings|date=1995|publisher=IEEE|page=10|language=en}}</ref> # Individualize the examination and adjust the radiation dose to the body type and body organ examined. Different body types and organs require different amounts of radiation.<ref>{{Cite web|title=Radiation – Effects on organs of the body (somatic effects)|url=https://www.britannica.com/science/radiation|access-date=2021-03-21|website=Encyclopedia Britannica|language=en}}</ref> # Higher resolution is not always suitable, such as detection of small pulmonary masses.<ref>{{cite journal | author = Simpson G | year = 2009 | title = Thoracic computed tomography: principles and practice | journal = Australian Prescriber | volume = 32 | issue = 4| page = 4 |doi=10.18773/austprescr.2009.049 |doi-access=free }}</ref> ==== Artifacts ==== Although images produced by CT are generally faithful representations of the scanned volume, the technique is susceptible to a number of [[artifact (error)#Medical imaging|artifacts]], such as the following:<ref name="ref1" /><ref>{{cite journal|last=Bhowmik|first=Ujjal Kumar |author2=Zafar Iqbal, M. |author3=Adhami, Reza R. |title=Mitigating motion artifacts in FDK based 3D Cone-beam Brain Imaging System using markers|journal=Central European Journal of Engineering|date=28 May 2012|volume=2|issue=3|pages=369–382|doi=10.2478/s13531-012-0011-7|bibcode = 2012CEJE....2..369B |doi-access=free}}</ref>^{Chapters 3 and 5} ;{{Visible anchor|Streak artifact}}: Streaks are often seen around materials that block most X-rays, such as metal or bone. Numerous factors contribute to these streaks: under sampling, photon starvation, motion, beam hardening, and [[Compton scatter]]. This type of artifact commonly occurs in the posterior fossa of the brain, or if there are metal implants. The streaks can be reduced using newer reconstruction techniques.<ref name="P. Jin and C. A. Bouman and K. D. Sauer 2013">{{cite journal |author1=P. Jin |author2=C. A. Bouman |author3=K. D. Sauer |title=A Method for Simultaneous Image Reconstruction and Beam Hardening Correction |journal=IEEE Nuclear Science Symp. & Medical Imaging Conf., Seoul, Korea, 2013 |year=2013 |url=https://engineering.purdue.edu/~bouman/publications/pdf/mic2013.pdf |url-status=dead |archive-url=https://web.archive.org/web/20140606234132/https://engineering.purdue.edu/~bouman/publications/pdf/mic2013.pdf |archive-date=2014-06-06 |access-date=2014-04-23 }}</ref> Approaches such as metal artifact reduction (MAR) can also reduce this artifact.<ref>{{cite journal | vauthors = Boas FE, Fleischmann D | title = Evaluation of Two Iterative Techniques for Reducing Metal Artifacts in Computed Tomography | journal = Radiology | volume = 259 | issue = 3 | pages = 894–902 | year = 2011 | pmid = 21357521 | doi = 10.1148/radiol.11101782 }}</ref><ref name="mouton13survey">{{cite journal|author1=Mouton, A. |author2=Megherbi, N. |author3=Van Slambrouck, K. |author4=Nuyts, J. |author5=Breckon, T.P. | title=An Experimental Survey of Metal Artefact Reduction in Computed Tomography| journal=Journal of X-Ray Science and Technology| year=2013|doi=10.3233/XST-130372 |url=http://www.durham.ac.uk/toby.breckon/publications/papers/mouton13survey.pdf|pmid=23694911 | volume=21 |issue=2 | pages=193–226|hdl=1826/8204 }}</ref> MAR techniques include spectral imaging, where CT images are taken with [[photons]] of different energy levels, and then synthesized into [[monochromatic]] images with special software such as GSI (Gemstone Spectral Imaging).<ref name="PessisCampagna2013">{{cite journal|last1=Pessis|first1=Eric|last2=Campagna|first2=Raphaël|last3=Sverzut|first3=Jean-Michel|last4=Bach|first4=Fabienne|last5=Rodallec|first5=Mathieu|last6=Guerini|first6=Henri|last7=Feydy|first7=Antoine|last8=Drapé|first8=Jean-Luc|title=Virtual Monochromatic Spectral Imaging with Fast Kilovoltage Switching: Reduction of Metal Artifacts at CT|journal=RadioGraphics|volume=33|issue=2|year=2013|pages=573–583|issn=0271-5333|doi=10.1148/rg.332125124|pmid=23479714|doi-access=free}}</ref> ;Partial volume effect: This appears as "blurring" of edges. It is due to the scanner being unable to differentiate between a small amount of high-density material (e.g., bone) and a larger amount of lower density (e.g., cartilage).<ref>{{Cite journal|last1=González Ballester|first1=Miguel Angel|last2=Zisserman|first2=Andrew P.|last3=Brady|first3=Michael|date=December 2002|title=Estimation of the partial volume effect in MRI|journal=Medical Image Analysis|volume=6|issue=4|pages=389–405|doi=10.1016/s1361-8415(02)00061-0|issn=1361-8415|pmid=12494949}}</ref> The reconstruction assumes that the X-ray attenuation within each voxel is homogeneous; this may not be the case at sharp edges. This is most commonly seen in the z-direction (craniocaudal direction), due to the conventional use of highly [[isotropic|anisotropic]] voxels, which have a much lower out-of-plane resolution, than in-plane resolution. This can be partially overcome by scanning using thinner slices, or an isotropic acquisition on a modern scanner.<ref>{{Cite journal|date=2000-01-01|title=Volumetric Segmentation|journal=Handbook of Medical Imaging|language=en|pages=185–194|doi=10.1016/B978-012077790-7/50016-3|last1=Goldszal|first1=Alberto F.|last2=Pham|first2=Dzung L.|isbn=978-0-12-077790-7}}</ref> ;Ring artifact:[[File:Ring-artifact.jpg|thumb|CT scan of brain in axial plane with ring artifact.]] Probably the most common mechanical artifact, the image of one or many "rings" appears within an image. They are usually caused by the variations in the response from individual elements in a two dimensional X-ray detector due to defect or miscalibration.<ref name=Jha>{{cite journal|last1=Jha|first1=Diwaker|title=Adaptive center determination for effective suppression of ring artifacts in tomography images|journal=Applied Physics Letters|volume=105|date=2014|issue=14|pages=143107|doi=10.1063/1.4897441|bibcode=2014ApPhL.105n3107J}}</ref> Ring artifacts can largely be reduced by intensity normalization, also referred to as flat field correction.<ref name=vvn15>{{cite journal|last1=Van Nieuwenhove|first1=V|last2=De Beenhouwer|first2=J|last3=De Carlo|first3=F|last4=Mancini|first4=L|last5=Marone|first5=F|last6=Sijbers|first6=J|title=Dynamic intensity normalization using eigen flat fields in X-ray imaging|journal=Optics Express|volume=23|date=2015|issue=21|pages=27975–27989|doi=10.1364/oe.23.027975|pmid=26480456|bibcode = 2015OExpr..2327975V |hdl=10067/1302930151162165141|url=http://www.zora.uzh.ch/id/eprint/120683/1/oe-23-21-27975.pdf|doi-access=free}}</ref> Remaining rings can be suppressed by a transformation to polar space, where they become linear stripes.<ref name="Jha" /> A comparative evaluation of ring artefact reduction on X-ray tomography images showed that the method of Sijbers and Postnov can effectively suppress ring artefacts.<ref name=jsap>{{cite journal|vauthors = Sijbers J, Postnov A|title=Reduction of ring artefacts in high resolution micro-CT reconstructions|journal=Phys Med Biol|volume=49|date=2004|issue=14|pages=N247–53|pmid=15357205|doi=10.1088/0031-9155/49/14/N06|s2cid=12744174|url=https://semanticscholar.org/paper/4aeed2da8e4a8bf7d25e5a777bf4b240ac7efd53}}</ref> ;Noise: This appears as grain on the image and is caused by a low signal to noise ratio. This occurs more commonly when a thin slice thickness is used. It can also occur when the power supplied to the X-ray tube is insufficient to penetrate the anatomy.<ref>{{Cite book|last1=Newton|first1=Thomas H.|url=https://books.google.com/books?id=2mxsAAAAMAAJ&q=noise+in+computed+tomography|title=Radiology of the Skull and Brain: Technical aspects of computed tomography|last2=Potts|first2=D. Gordon|date=1971|publisher=Mosby|isbn=978-0-8016-3662-2|pages=3941–3950|language=en}}</ref> ;Windmill: Streaking appearances can occur when the detectors intersect the reconstruction plane. This can be reduced with filters or a reduction in pitch.<ref>{{Cite book|last1=Brüning|first1=R.|url=https://books.google.com/books?id=ImOlZNOk25sC&q=windmill+artifact+ct&pg=PA44|title=Protocols for Multislice CT|last2=Küttner|first2=A.|last3=Flohr|first3=T.|date=2006-01-16|publisher=Springer Science & Business Media|isbn=978-3-540-27273-1|language=en}}</ref><ref>{{Cite book|last=Peh|first=Wilfred C. G.|url=https://books.google.com/books?id=sZswDwAAQBAJ&q=windmill+artifact+ct&pg=PA49|title=Pitfalls in Musculoskeletal Radiology|date=2017-08-11|publisher=Springer|isbn=978-3-319-53496-1|language=en}}</ref> ;Beam hardening: This can give a "cupped appearance" when grayscale is visualized as height. It occurs because conventional sources, like X-ray tubes emit a polychromatic spectrum. Photons of higher [[photon energy]] levels are typically attenuated less. Because of this, the mean energy of the spectrum increases when passing the object, often described as getting "harder". This leads to an effect increasingly underestimating material thickness, if not corrected. Many algorithms exist to correct for this artifact. They can be divided in mono- and multi-material methods.<ref name="P. Jin and C. A. Bouman and K. D. Sauer 2013" /><ref>{{cite journal |vauthors=Van de Casteele E, Van Dyck D, Sijbers J, Raman E |title=A model-based correction method for beam hardening artefacts in X-ray microtomography |journal=Journal of X-ray Science and Technology |volume=12 |issue=1 |pages=43–57 |year=2004 |citeseerx=10.1.1.460.6487 }}</ref><ref>{{cite journal |vauthors=Van Gompel G, Van Slambrouck K, Defrise M, Batenburg KJ, Sijbers J, Nuyts J|title=Iterative correction of beam hardening artifacts in CT |journal=Medical Physics |volume=38 |issue=1 |pages=36–49 |year=2011 |doi=10.1118/1.3577758|pmid=21978116 |bibcode = 2011MedPh..38S..36V |citeseerx=10.1.1.464.3547 }}</ref> == Advantages == CT scanning has several advantages over traditional [[two-dimensional space|two-dimensional]] medical [[radiography]]. First, CT eliminates the superimposition of images of structures outside the area of interest.<ref>{{Cite book |last1=Mikla |first1=Victor I. |url=https://books.google.com/books?id=Y81JrnVA_5sC&q=ct+scan+removes+superimposition&pg=PA37 |title=Medical Imaging Technology |last2=Mikla |first2=Victor V. |date=2013-08-23 |publisher=Elsevier |isbn=978-0-12-417036-0 |language=en |page=37}}</ref> Second, CT scans have greater [[image resolution]], enabling examination of finer details. CT can distinguish between [[tissue (biology)|tissues]] that differ in radiographic [[density]] by 1% or less.<ref>{{Cite book|url=https://www.google.co.in/books/edition/Radiology_for_the_Dental_Professional/rOppAAAAMAAJ?hl=en&gbpv=1&bsq=CT+can+distinguish+between+tissue&dq=CT+can+distinguish+between+tissue&printsec=frontcover|title=Radiology for the Dental Professional|publisher=Elsevier Mosby|year=2008|isbn=978-0-323-03071-7|pages=337}}</ref> Third, CT scanning enables multiplanar reformatted imaging: scan data can be visualized in the [[transverse plane|transverse (or axial)]], [[Coronal plane|coronal]], or [[Sagittal plane|sagittal]] plane, depending on the diagnostic task.<ref>{{Cite book |last=Pasipoularides |first=Ares |url=https://books.google.com/books?id=eMKqdIvxEmQC&q=ct+scan+enables+multiple+plane+reformatting&pg=PA595 |title=Heart's Vortex: Intracardiac Blood Flow Phenomena |date=November 2009 |publisher=PMPH-USA |isbn=978-1-60795-033-2 |pages=595 |language=en}}</ref> The improved resolution of CT has permitted the development of new investigations. For example, CT [[angiography]] avoids the invasive insertion of a [[catheter]]. CT scanning can perform a [[virtual colonoscopy]] with greater accuracy and less discomfort for the patient than a traditional [[colonoscopy]].<ref name="Heiken">{{cite journal | last=Heiken | first=JP |author2=Peterson CM |author3=Menias CO | title=Virtual colonoscopy for colorectal cancer screening: current status: Wednesday 5 October 2005, 14:00–16:00 | journal=Cancer Imaging | volume=5 | issue=Spec No A | pages=S133–S139 | publisher=International Cancer Imaging Society | date=November 2005 | pmid=16361129 | doi=10.1102/1470-7330.2005.0108 | pmc=1665314 }}</ref><ref name="pmid16106357">{{cite journal |author=Bielen DJ |title=Clinical validation of high-resolution fast spin-echo MR colonography after colon distention with air |journal=J Magn Reson Imaging |volume=22 |issue=3 |pages=400–5 |date=September 2005 |pmid=16106357 |doi=10.1002/jmri.20397 |name-list-style=vanc|author2=Bosmans HT |author3=De Wever LL |display-authors=3 |last4=Maes |first4=Frederik |last5=Tejpar |first5=Sabine |last6=Vanbeckevoort |first6=Dirk |last7=Marchal |first7=Guy J.F.|s2cid=22167728 |doi-access=free }}</ref> Virtual colonography is far more accurate than a [[barium enema]] for detection of tumors and uses a lower radiation dose.<ref>{{Cite web|title=CT Colonography|url=https://www.radiologyinfo.org/en/info.cfm?pg=ct_colo|website=Radiologyinfo.org}}</ref> CT is a moderate- to high-[[radiation]] diagnostic technique. The radiation dose for a particular examination depends on multiple factors: volume scanned, patient build, number and type of scan sequences, and desired resolution and image quality.<ref>{{Cite journal|vauthors=Žabić S, Wang Q, Morton T, Brown KM |title=A low dose simulation tool for CT systems with energy integrating detectors |journal=Medical Physics|volume=40|issue=3 |pages=031102 |date=March 2013 |doi=10.1118/1.4789628|pmid=23464282 |bibcode = 2013MedPh..40c1102Z }}</ref> Two helical CT scanning parameters, tube current and pitch, can be adjusted easily and have a profound effect on radiation. CT scanning is more accurate than two-dimensional radiographs in evaluating anterior interbody fusion, although they may still over-read the extent of fusion.<ref>Brian R. Subach M.D., F.A.C.S et al.[http://www.spinemd.com/publications/articles/reliability-and-accuracy-of-fine-cut-computed-tomography-scans-to-determine-the-status-of-anterior-interbody-usions-with-metallic-cages "Reliability and accuracy of fine-cut computed tomography scans to determine the status of anterior interbody fusions with metallic cages"] {{webarchive|url=https://web.archive.org/web/20121208184918/http://www.spinemd.com/publications/articles/reliability-and-accuracy-of-fine-cut-computed-tomography-scans-to-determine-the-status-of-anterior-interbody-usions-with-metallic-cages |date=2012-12-08 }}</ref> == Adverse effects == === Cancer === {{Main|Radiation-induced cancer}} The [[ionizing radiation|radiation]] used in CT scans can damage body cells, including [[DNA molecule]]s, which can lead to [[radiation-induced cancer]].<ref name="Brenner2007">{{cite journal|vauthors=Brenner DJ, Hall EJ|date=November 2007|title=Computed tomography – an increasing source of radiation exposure|url=http://www.columbia.edu/~djb3/papers/nejm1.pdf|url-status=live|journal=N. Engl. J. Med.|volume=357|issue=22|pages=2277–84|doi=10.1056/NEJMra072149|pmid=18046031|archive-url=https://web.archive.org/web/20160304060542/http://www.columbia.edu/~djb3/papers/nejm1.pdf|archive-date=2016-03-04}}</ref> The radiation doses received from CT scans is variable. Compared to the lowest dose x-ray techniques, CT scans can have 100 to 1,000 times higher dose than conventional X-rays.<ref name=Redberg>Redberg, Rita F., and Smith-Bindman, Rebecca. [https://www.nytimes.com/2014/01/31/opinion/we-are-giving-ourselves-cancer.html?nl=opinion&emc=edit_ty_20140131&_r=0 "We Are Giving Ourselves Cancer"] {{webarchive|url=https://web.archive.org/web/20170706163542/https://www.nytimes.com/2014/01/31/opinion/we-are-giving-ourselves-cancer.html?nl=opinion&emc=edit_ty_20140131&_r=0 |date=2017-07-06 }}, ''New York Times'', Jan. 30, 2014</ref> However, a lumbar spine x-ray has a similar dose as a head CT.<ref>{{cite web|url=https://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/MedicalX-Rays/ucm115329.htm|title=Medical X-ray Imaging – What are the Radiation Risks from CT?|first=Center for Devices and Radiological|last=Health|website=www.fda.gov|access-date=1 May 2018|url-status=live|archive-url=https://web.archive.org/web/20131105050317/https://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/MedicalX-Rays/ucm115329.htm|archive-date=5 November 2013}}</ref> Articles in the media often exaggerate the relative dose of CT by comparing the lowest-dose x-ray techniques (chest x-ray) with the highest-dose CT techniques. In general, the radiation dose associated with a routine abdominal CT has a radiation dose similar to three years of average [[background radiation]].<ref>{{cite web|last=(ACR)|first=[[Radiological Society of North America]] (RSNA) and [[American College of Radiology]]|date=February 2021|title=Patient Safety – Radiation Dose in X-Ray and CT Exams|url=https://www.acr.org/-/media/ACR/Files/Radiology-Safety/Radiation-Safety/Dose-Reference-Card.pdf|url-status=dead|archive-url=https://web.archive.org/web/20210101161039/https://www.acr.org/-/media/ACR/Files/Radiology-Safety/Radiation-Safety/Dose-Reference-Card.pdf|archive-date=1 January 2021|access-date=6 April 2021|website=acr.org}}</ref> Recent studies on 2.5 million patients<ref name="Patients undergoing recurrent CT sc">{{cite journal|title=Patients undergoing recurrent CT scans: assessing the magnitude|year=2020|doi=10.1007/s00330-019-06523-y|last1=Rehani|first1=Madan M.|last2=Yang|first2=Kai|last3=Melick|first3=Emily R.|last4=Heil|first4=John|last5=Šalát|first5=Dušan|last6=Sensakovic|first6=William F.|last7=Liu|first7=Bob|journal=European Radiology|volume=30|issue=4|pages=1828–1836|pmid=31792585|s2cid=208520824}}</ref> and 3.2 million patients<ref name="Multinational data on cumulative ra">{{cite journal|title=Multinational data on cumulative radiation exposure of patients from recurrent radiological procedures: call for action|year=2020|doi=10.1007/s00330-019-06528-7|last1=Brambilla|first1=Marco|last2=Vassileva|first2=Jenia|last3=Kuchcinska|first3=Agnieszka|last4=Rehani|first4=Madan M.|journal=European Radiology|volume=30|issue=5|pages=2493–2501|pmid=31792583|s2cid=208520544}}</ref> have drawn attention to high cumulative doses of more than 100 mSv to patients undergoing recurrent CT scans within a short time span of 1 to 5 years. Some experts note that CT scans are known to be "overused," and "there is distressingly little evidence of better health outcomes associated with the current high rate of scans."<ref name=Redberg /> On the other hand, a recent paper analyzing the data of patients who received high [[cumulative dose]]s showed a high degree of appropriate use.<ref name="Patients undergoing recurrent CT ex">{{cite journal|title=Patients undergoing recurrent CT exams: assessment of patients with non-malignant diseases, reasons for imaging and imaging appropriateness|year=2020|doi=10.1007/s00330-019-06551-8|last1=Rehani|first1=Madan M.|last2=Melick|first2=Emily R.|last3=Alvi|first3=Raza M.|last4=Doda Khera|first4=Ruhani|last5=Batool-Anwar|first5=Salma|last6=Neilan|first6=Tomas G.|last7=Bettmann|first7=Michael|journal=European Radiology|volume=30|issue=4|pages=1839–1846|pmid=31792584|s2cid=208520463}}</ref> This creates an important issue of cancer risk to these patients. Moreover, a highly significant finding that was previously unreported is that some patients received >100 mSv dose from CT scans in a single day,<ref name="Patients undergoing recurrent CT sc" /> which counteracts existing criticisms some investigators may have on the effects of protracted versus acute exposure. Early estimates of harm from CT are partly based on similar radiation exposures experienced by those present during the [[atomic bomb]] explosions in Japan after the [[World War II|Second World War]] and those of [[nuclear industry]] workers.<ref name="Brenner2007" /> Some experts project that in the future, between three and five percent of all cancers would result from medical imaging.<ref name=Redberg /> An Australian study of 10.9&nbsp;million people reported that the increased incidence of cancer after CT scan exposure in this cohort was mostly due to irradiation. In this group, one in every 1,800 CT scans was followed by an excess cancer. If the lifetime risk of developing cancer is 40% then the absolute risk rises to 40.05% after a CT.<ref name="MathewsForsythe2013">{{cite journal|last1=Mathews|first1=J. D.|last2=Forsythe|first2=A. V.|last3=Brady|first3=Z.|last4=Butler|first4=M. W.|last5=Goergen|first5=S. K.|last6=Byrnes|first6=G. B.|last7=Giles|first7=G. G.|last8=Wallace|first8=A. B.|last9=Anderson|first9=P. R.|last10=Guiver|first10=T. A.|last11=McGale|first11=P.|last12=Cain|first12=T. M.|last13=Dowty|first13=J. G.|last14=Bickerstaffe|first14=A. C.|last15=Darby|first15=S. C.|title=Cancer risk in 680 000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians|journal=BMJ|volume=346|issue=may21 1|year=2013|pages=f2360|issn=1756-1833|doi=10.1136/bmj.f2360|pmid=23694687|pmc=3660619}}</ref><ref name="SasieniShelton2011">{{cite journal|last1=Sasieni|first1=P D|last2=Shelton|first2=J|last3=Ormiston-Smith|first3=N|last4=Thomson|first4=C S|last5=Silcocks|first5=P B|title=What is the lifetime risk of developing cancer?: the effect of adjusting for multiple primaries|journal=British Journal of Cancer|volume=105|issue=3|year=2011|pages=460–465|issn=0007-0920|doi=10.1038/bjc.2011.250|pmid=21772332|pmc=3172907}}</ref> Some studies have shown that publications indicating an increased risk of cancer from typical doses of body CT scans are plagued with serious methodological limitations and several highly improbable results,<ref>{{Cite journal|last1=Eckel|first1=Laurence J.|last2=Fletcher|first2=Joel G.|last3=Bushberg|first3=Jerrold T.|last4=McCollough|first4=Cynthia H.|date=2015-10-01|title=Answers to Common Questions About the Use and Safety of CT Scans|url=https://www.mayoclinicproceedings.org/article/S0025-6196(15)00591-1/fulltext|journal=Mayo Clinic Proceedings|language=en|volume=90|issue=10|pages=1380–1392|doi=10.1016/j.mayocp.2015.07.011|pmid=26434964|issn=0025-6196|doi-access=free}}</ref> concluding that no evidence indicates such low doses cause any long-term harm.<ref>{{Cite web|url=https://www.sciencedaily.com/releases/2015/10/151005151507.htm|title=Expert opinion: Are CT scans safe?|website=ScienceDaily|language=en|access-date=2019-03-14}}</ref><ref>{{Cite journal|last1=McCollough|first1=Cynthia H.|last2=Bushberg|first2=Jerrold T.|last3=Fletcher|first3=Joel G.|last4=Eckel|first4=Laurence J.|date=2015-10-01|title=Answers to Common Questions About the Use and Safety of CT Scans|url=https://www.mayoclinicproceedings.org/article/S0025-6196(15)00591-1/abstract|journal=Mayo Clinic Proceedings|language=English|volume=90|issue=10|pages=1380–1392|doi=10.1016/j.mayocp.2015.07.011|pmid=26434964|issn=0025-6196|doi-access=free}}</ref><ref>{{Cite web|url=https://www.medicalnewstoday.com/articles/306067.php|title=No evidence that CT scans, X-rays cause cancer|website=Medical News Today|date=4 February 2016|language=en|access-date=2019-03-14}}</ref> One study estimated that as many as 0.4% of cancers in the United States resulted from CT scans, and that this may have increased to as much as 1.5 to 2% based on the rate of CT use in 2007.<ref name="Brenner2007" /> Others dispute this estimate,<ref>{{Cite journal|last1=Kalra|first1=Mannudeep K.|last2=Maher|first2=Michael M.|last3=Rizzo|first3=Stefania|last4=Kanarek|first4=David|last5=Shephard|first5=Jo-Anne O.|date=April 2004|title=Radiation exposure from Chest CT: Issues and Strategies|journal=Journal of Korean Medical Science|volume=19|issue=2|pages=159–166|doi=10.3346/jkms.2004.19.2.159|issn=1011-8934|pmc=2822293|pmid=15082885}}</ref> as there is no consensus that the low levels of radiation used in CT scans cause damage. Lower radiation doses are used in many cases, such as in the investigation of renal colic.<ref>{{Cite journal|last1=Rob|first1=S.|last2=Bryant|first2=T.|last3=Wilson|first3=I.|last4=Somani|first4=B.K.|year=2017|title=Ultra-low-dose, low-dose, and standard-dose CT of the kidney, ureters, and bladder: is there a difference? Results from a systematic review of the literature|journal=Clinical Radiology|volume=72|issue=1|pages=11–15|doi=10.1016/j.crad.2016.10.005|pmid=27810168}}</ref> <!--Effect of age --> A person's age plays a significant role in the subsequent risk of cancer.<ref name=Furlow2010 /> Estimated lifetime cancer mortality risks from an abdominal CT of a one-year-old is 0.1%, or 1:1000 scans.<ref name=Furlow2010 /> The risk for someone who is 40 years old is half that of someone who is 20 years old with substantially less risk in the elderly.<ref name=Furlow2010 /> The [[International Commission on Radiological Protection]] estimates that the risk to a fetus being exposed to 10 [[mGy]] (a unit of radiation exposure) increases the rate of cancer before 20 years of age from 0.03% to 0.04% (for reference a CT pulmonary angiogram exposes a fetus to 4&nbsp;mGy).<ref name=Risk2011 /> A 2012 review did not find an association between medical radiation and cancer risk in children noting however the existence of limitations in the evidences over which the review is based.<ref>{{cite journal |vauthors=Baysson H, Etard C, Brisse HJ, Bernier MO | title = [Diagnostic radiation exposure in children and cancer risk: current knowledge and perspectives] | journal = Archives de Pédiatrie | volume = 19 | issue = 1 | pages = 64–73 | date = January 2012 | pmid = 22130615 | doi = 10.1016/j.arcped.2011.10.023 }}</ref> <!--Efforts to decrease risk --> CT scans can be performed with different settings for lower exposure in children with most manufacturers of CT scans as of 2007 having this function built in.<ref name=Semelka2007 /> Furthermore, certain conditions can require children to be exposed to multiple CT scans.<ref name="Brenner2007" /> Current evidence suggests informing parents of the risks of pediatric CT scanning.<ref name="pmid17646450">{{cite journal |vauthors=Larson DB, Rader SB, Forman HP, Fenton LZ | s2cid = 25020619 | title = Informing parents about CT radiation exposure in children: it's OK to tell them | journal = Am J Roentgenol | volume = 189 | issue = 2 | pages = 271–5 | date = August 2007 | pmid = 17646450 | doi = 10.2214/AJR.07.2248 | url = https://semanticscholar.org/paper/8e456d79227d238545f56ab6c485e9e7ffc42cbc }}</ref> === Contrast reactions === {{Further|Iodinated contrast#Adverse effects}} In the United States half of CT scans are [[contrast CT]]s using intravenously injected [[radiocontrast agent]]s.<ref name=Nam2006 /> The most common reactions from these agents are mild, including nausea, vomiting, and an itching rash. Severe life-threatening reactions may rarely occur.<ref name=Contrast2005>{{cite journal | author = Christiansen C | title = X-ray contrast media – an overview | journal = Toxicology | volume = 209 | issue = 2 | pages = 185–7 | date = 2005-04-15 | pmid = 15767033 | doi = 10.1016/j.tox.2004.12.020 }}</ref> Overall reactions occur in 1 to 3% with [[nonionic contrast]] and 4 to 12% of people with [[ionic contrast]].<ref name=Wang2011 /> Skin rashes may appear within a week to 3% of people.<ref name=Contrast2005 /> The old [[radiocontrast agent]]s caused [[anaphylaxis]] in 1% of cases while the newer, low-osmolar agents cause reactions in 0.01–0.04% of cases.<ref name=Contrast2005 /><ref name=Drug01>{{cite journal |vauthors=Drain KL, Volcheck GW | title = Preventing and managing drug-induced anaphylaxis | journal = Drug Safety | volume = 24 | issue = 11 | pages = 843–53 | year = 2001 | pmid = 11665871 | doi = 10.2165/00002018-200124110-00005 | s2cid = 24840296 }}</ref> Death occurs in about 2 to 30 people per 1,000,000 administrations, with newer agents being safer.<ref name=Wang2011>{{cite journal |vauthors=Wang H, Wang HS, Liu ZP | title = Agents that induce pseudo-allergic reaction | journal = Drug Discov Ther | volume = 5 | issue = 5 | pages = 211–9 | date = October 2011 | pmid = 22466368 | doi = 10.5582/ddt.2011.v5.5.211 | s2cid = 19001357 | url = https://semanticscholar.org/paper/8bc63cf067b8cb12af0a11de4da994cb035328e7 }}</ref><ref>{{cite book|editor1-last=Castells|editor1-first=Mariana C.|title=Anaphylaxis and hypersensitivity reactions|publisher=Humana Press|location=New York|isbn=978-1-60327-950-5|page=187|url=https://books.google.com/books?id=bEvnfm7V-LIC&pg=PA187|date=2010-12-09}}</ref> There is a higher risk of mortality in those who are female, elderly or in poor health, usually secondary to either anaphylaxis or [[acute kidney injury]].<ref name=Nam2006>{{cite journal |vauthors=Namasivayam S, Kalra MK, Torres WE, Small WC | title = Adverse reactions to intravenous iodinated contrast media: a primer for radiologists | journal = Emergency Radiology | volume = 12 | issue = 5 | pages = 210–5 | date = Jul 2006 | pmid = 16688432 | doi = 10.1007/s10140-006-0488-6 | s2cid = 28223134 }}</ref> The contrast agent may induce [[contrast-induced nephropathy]].<ref name=Contrast2009>{{cite journal |vauthors=Hasebroock KM, Serkova NJ | title = Toxicity of MRI and CT contrast agents | journal = Expert Opinion on Drug Metabolism & Toxicology | volume = 5 | issue = 4 | pages = 403–16 | date = April 2009 | pmid = 19368492 | doi = 10.1517/17425250902873796 | s2cid = 72557671 }}</ref> This occurs in 2 to 7% of people who receive these agents, with greater risk in those who have preexisting [[kidney failure]],<ref name=Contrast2009 /> preexisting [[diabetes mellitus|diabetes]], or reduced intravascular volume. People with mild kidney impairment are usually advised to ensure full hydration for several hours before and after the injection. For moderate kidney failure, the use of [[iodinated contrast]] should be avoided; this may mean using an alternative technique instead of CT. Those with severe [[kidney failure]] requiring [[dialysis]] require less strict precautions, as their kidneys have so little function remaining that any further damage would not be noticeable and the dialysis will remove the contrast agent; it is normally recommended, however, to arrange dialysis as soon as possible following contrast administration to minimize any adverse effects of the contrast. In addition to the use of intravenous contrast, orally administered contrast agents are frequently used when examining the abdomen.<ref>{{Cite journal|last1=Rawson|first1=James V.|last2=Pelletier|first2=Allen L.|date=2013-09-01|title=When to Order Contrast-Enhanced CT|url=https://www.aafp.org/afp/2013/0901/p312.html|journal=American Family Physician|volume=88|issue=5|pages=312–316|pmid=24010394|issn=0002-838X}}</ref> These are frequently the same as the intravenous contrast agents, merely diluted to approximately 10% of the concentration. However, oral alternatives to iodinated contrast exist, such as very dilute (0.5–1% w/v) [[barium sulfate]] suspensions. Dilute barium sulfate has the advantage that it does not cause allergic-type reactions or kidney failure, but cannot be used in patients with suspected bowel perforation or suspected bowel injury, as leakage of barium sulfate from damaged bowel can cause fatal [[peritonitis]].<ref>{{Cite book|last1=Thomsen|first1=Henrik S.|url=https://books.google.com/books?id=Bun1CAAAQBAJ&q=intravenous+contrast+in+ct|title=Trends in Contrast Media|last2=Muller|first2=Robert N.|last3=Mattrey|first3=Robert F.|date=2012-12-06|publisher=Springer Science & Business Media|isbn=978-3-642-59814-2|language=en}}</ref> Side effects from [[contrast agent]]s, administered [[Intravenous therapy|intravenously]] in some CT scans, might impair [[kidney]] performance in patients with [[kidney disease]], although this risk is now believed to be lower than previously thought.<ref>{{cite journal|last1=Davenport|first1=Matthew|year=2020|title=Use of Intravenous Iodinated Contrast Media in Patients with Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation|journal=Radiology|volume=294|issue=3|pages=660–668|doi=10.1148/radiol.2019192094|pmid=31961246|doi-access=free}}</ref><ref name="Contrast2009" /> === Scan dose === {| class="sortable wikitable" style="float: right; margin-left:15px; text-align:center" |- !Examination !Typical [[Effective dose (radiation safety)|effective <br /> dose]] ([[Sievert|mSv]])<br /> to the whole body !Typical [[Absorbed dose|absorbed <br /> dose]] ([[Gray (unit)|mGy]])<br /> to the organ in question |- |Annual background radiation |2.4<ref name="background" /> |2.4<ref name="background" /> |- |Chest X-ray |0.02<ref name=FDADose>{{cite web|title=What are the Radiation Risks from CT?|url=https://www.fda.gov/radiation-emittingproducts/radiationemittingproductsandprocedures/medicalimaging/medicalX-rays/ucm115329.htm|website=Food and Drug Administration|year=2009|url-status=live|archive-url=https://web.archive.org/web/20131105050317/https://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/MedicalX-Rays/ucm115329.htm|archive-date=2013-11-05}}</ref> |0.01–0.15<ref name="crfdr" /> |- |Head CT |1–2<ref name=Furlow2010 /> |56<ref name="nrpb2005">Shrimpton, P.C; Miller, H.C; Lewis, M.A; Dunn, M. [http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1194947420292 Doses from Computed Tomography (CT) examinations in the UK – 2003 Review] {{webarchive|url=https://web.archive.org/web/20110922122151/http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1194947420292 |date=2011-09-22 }}</ref> |- |Screening [[mammography]] |0.4<ref name=Risk2011>{{cite journal|last=Davies|first=H. E.|author2=Wathen, C. G. |author3=Gleeson, F. V. |title=The risks of radiation exposure related to diagnostic imaging and how to minimise them|journal=BMJ|date=25 February 2011|volume=342|issue=feb25 1|pages=d947|doi=10.1136/bmj.d947|pmid=21355025|s2cid=206894472}}</ref> |3<ref name="Brenner2007" /><ref name="crfdr" /> |- |Abdominal CT |8<ref name=FDADose /> |14<ref name="nrpb2005" /> |- |Chest CT |5–7<ref name=Furlow2010 /> |13<ref name="nrpb2005" /> |- |[[Virtual colonoscopy|CT colonography]] |6–11<ref name=Furlow2010 /> | |- |Chest, abdomen and pelvis CT |9.9<ref name="nrpb2005" /> |12<ref name="nrpb2005" /> |- |Cardiac CT angiogram |9–12<ref name=Furlow2010 /> |40–100<ref name="crfdr" /> |- |[[Barium enema]] |15<ref name="Brenner2007" /> |15<ref name="crfdr" /> |- |Neonatal abdominal CT |20<ref name="Brenner2007" /> |20<ref name="crfdr" /> |- |colspan=3| {{Further|Template:Effective dose by medical imaging type}} |} The table reports average radiation exposures; however, there can be a wide variation in radiation doses between similar scan types, where the highest dose could be as much as 22 times higher than the lowest dose.<ref name=Furlow2010 /> A typical plain film X-ray involves radiation dose of 0.01 to 0.15&nbsp;mGy, while a typical CT can involve 10–20&nbsp;mGy for specific organs, and can go up to 80&nbsp;mGy for certain specialized CT scans.<ref name="crfdr">{{cite journal |vauthors=Hall EJ, Brenner DJ | title = Cancer risks from diagnostic radiology | journal = The British Journal of Radiology | volume = 81 | issue = 965 | pages = 362–78 | date = May 2008 | pmid = 18440940 | doi = 10.1259/bjr/01948454 | s2cid = 23348032 | url = https://semanticscholar.org/paper/913231112637085b92ecedf9f10f4119f866b383 }}</ref> For purposes of comparison, the world average dose rate from naturally occurring sources of [[background radiation]] is 2.4&nbsp;[[mSv]] per year, equal for practical purposes in this application to 2.4&nbsp;mGy per year.<ref name="background">{{cite journal |vauthors=Cuttler JM, Pollycove M | title = Nuclear energy and health: and the benefits of low-dose radiation hormesis | journal = Dose-Response | volume = 7 | issue = 1 | pages = 52–89 | year = 2009 | pmid = 19343116 | pmc = 2664640 | doi = 10.2203/dose-response.08-024.Cuttler }}</ref> While there is some variation, most people (99%) received less than 7&nbsp;mSv per year as background radiation.<ref>{{cite book|last=Poston|first=edited by Michael T. Ryan, John W.|title=A half century of health physics|year=2005|publisher=Lippincott Williams & Wilkins|location=Baltimore, Md.|isbn=978-0-7817-6934-1|page=164|url=https://books.google.com/books?id=qCebxPjdSBUC&pg=PA164}}</ref> Medical imaging as of 2007 accounted for half of the radiation exposure of those in the United States with CT scans making up two thirds of this amount.<ref name=Furlow2010 /> In the United Kingdom it accounts for 15% of radiation exposure.<ref name=Risk2011 /> The average radiation dose from medical sources is ≈0.6&nbsp;mSv per person globally as of 2007.<ref name=Furlow2010 /> Those in the nuclear industry in the United States are limited to doses of 50&nbsp;mSv a year and 100&nbsp;mSv every 5 years.<ref name=Furlow2010 /> [[Lead]] is the main material used by radiography personnel for [[shielding (radiography)|shielding]] against scattered X-rays. ==== Radiation dose units ==== The radiation dose reported in the [[Gray (unit)|gray or mGy]] unit is proportional to the amount of energy that the irradiated body part is expected to absorb, and the physical effect (such as DNA [[double strand breaks]]) on the cells' chemical bonds by X-ray radiation is proportional to that energy.<ref>{{cite journal |vauthors=Polo SE, Jackson SP | title = Dynamics of DNA damage response proteins at DNA breaks: a focus on protein modifications | journal = Genes Dev. | volume = 25 | issue = 5 | pages = 409–33 | date = March 2011 | pmid = 21363960 | pmc = 3049283 | doi = 10.1101/gad.2021311 }}</ref> The [[sievert]] unit is used in the report of the [[effective dose (radiation)|effective dose]]. The sievert unit, in the context of CT scans, does not correspond to the actual radiation dose that the scanned body part absorbs but to another radiation dose of another scenario, the whole body absorbing the other radiation dose and the other radiation dose being of a magnitude, estimated to have the same probability to induce cancer as the CT scan.<ref>[http://www.aapm.org/pubs/reports/RPT_96.pdf The Measurement, Reporting, and Management of Radiation Dose in CT] {{webarchive|url=https://web.archive.org/web/20170623014823/https://www.aapm.org/pubs/reports/rpt_96.pdf |date=2017-06-23 }} "It is a single dose parameter that reflects the risk of a nonuniform exposure in terms of an equivalent whole-body exposure."</ref> Thus, as is shown in the table above, the actual radiation that is absorbed by a scanned body part is often much larger than the effective dose suggests. A specific measure, termed the [[computed tomography dose index]] (CTDI), is commonly used as an estimate of the radiation absorbed dose for tissue within the scan region, and is automatically computed by medical CT scanners.<ref>{{cite journal |vauthors=Hill B, Venning AJ, Baldock C | year = 2005 | title = A preliminary study of the novel application of normoxic polymer gel dosimeters for the measurement of CTDI on diagnostic X-ray CT scanners | journal = Medical Physics | volume = 32 | issue = 6| pages = 1589–1597 | doi=10.1118/1.1925181| pmid = 16013718 | bibcode = 2005MedPh..32.1589H }}</ref> The [[equivalent dose]] is the effective dose of a case, in which the whole body would actually absorb the same radiation dose, and the sievert unit is used in its report. In the case of non-uniform radiation, or radiation given to only part of the body, which is common for CT examinations, using the local equivalent dose alone would overstate the biological risks to the entire organism.<ref>{{Cite book|chapter=Complications of Catheter Ablation of Cardiac Arrhythmias|date=2019-01-01|publisher=Elsevier|isbn=978-0-323-52356-1|language=en|doi=10.1016/b978-0-323-52356-1.00032-3|title=Clinical Arrhythmology and Electrophysiology|last1=Issa|first1=Ziad F.|last2=Miller|first2=John M.|last3=Zipes|first3=Douglas P.|pages=1042–1067}}</ref><ref>{{Cite web|title=Absorbed, Equivalent, and Effective Dose – ICRPaedia|url=http://icrpaedia.org/Absorbed,_Equivalent,_and_Effective_Dose|access-date=2021-03-21|website=icrpaedia.org}}</ref><ref>{{Cite book|last=Materials|first=National Research Council (US) Committee on Evaluation of EPA Guidelines for Exposure to Naturally Occurring Radioactive|url=https://www.ncbi.nlm.nih.gov/books/NBK230653/|title=Radiation Quantities and Units, Definitions, Acronyms|date=1999|publisher=National Academies Press (US)|language=en}}</ref> ==== Effects of radiation ==== {{See|Radiobiology}} Most adverse health effects of radiation exposure may be grouped in two general categories: *deterministic effects (harmful tissue reactions) due in large part to the killing/ malfunction of cells following high doses;<ref>{{Cite book|last1=Pua|first1=Bradley B.|url=https://books.google.com/books?id=7fpyDwAAQBAJ&q=deterministic+effects&pg=PA53|title=Interventional Radiology: Fundamentals of Clinical Practice|last2=Covey|first2=Anne M.|last3=Madoff|first3=David C.|date=2018-12-03|publisher=Oxford University Press|isbn=978-0-19-027624-9|language=en}}</ref> *stochastic effects, i.e., cancer and heritable effects involving either cancer development in exposed individuals owing to mutation of somatic cells or heritable disease in their offspring owing to mutation of reproductive (germ) cells.<ref>Paragraph 55 in: {{cite web|url=http://www.icrp.org/publication.asp?id=ICRP%20Publication%20103|title=The 2007 Recommendations of the International Commission on Radiological Protection|website=[[International Commission on Radiological Protection]]|url-status=live|archive-url=https://web.archive.org/web/20121116084754/http://www.icrp.org/publication.asp?id=ICRP+Publication+103|archive-date=2012-11-16}} Ann. ICRP 37 (2-4)</ref> The added lifetime risk of developing cancer by a single abdominal CT of 8 mSv is estimated to be 0.05%, or 1 one in 2,000.<ref>{{cite web|url=https://www.health.harvard.edu/staying-healthy/do-ct-scans-cause-cancer|title=Do CT scans cause cancer?|date=March 2013|website=[[Harvard Medical School]]|access-date=2017-12-09|url-status=dead|archive-url=https://web.archive.org/web/20171209152338/https://www.health.harvard.edu/staying-healthy/do-ct-scans-cause-cancer|archive-date=2017-12-09}}</ref> Because of increased susceptibility of fetuses to radiation exposure, the radiation dosage of a CT scan is an important consideration in the choice of [[medical imaging in pregnancy]].<ref>{{Cite web|last=CDC|date=2020-06-05|title=Radiation and pregnancy: A fact sheet for clinicians|url=https://www.cdc.gov/nceh/radiation/emergencies/prenatalphysician.htm|access-date=2021-03-21|website=Centers for Disease Control and Prevention|language=en-us}}</ref><ref>{{Citation|last1=Yoon|first1=Ilsup|title=Radiation Exposure In Pregnancy|date=2021|url=http://www.ncbi.nlm.nih.gov/books/NBK551690/|work=StatPearls|place=Treasure Island (FL)|publisher=StatPearls Publishing|pmid=31869154|access-date=2021-03-21|last2=Slesinger|first2=Todd L.}}</ref> ==== Excess doses ==== In October, 2009, the US [[Food and Drug Administration]] (FDA) initiated an investigation of brain perfusion CT (PCT) scans, based on [[radiation burn]]s caused by incorrect settings at one particular facility for this particular type of CT scan. Over 256 patients were exposed to radiations for over 18-month period. Over 40% of them lost patches of hair, and prompted the editorial to call for increased CT quality assurance programs. It was noted that "while unnecessary radiation exposure should be avoided, a medically needed CT scan obtained with appropriate acquisition parameter has benefits that outweigh the radiation risks."<ref name="Furlow2010">{{Cite book|last=Whaites|first=Eric|url=https://books.google.com/books?id=qdOSDdETuxcC&q=Typical+effective+dose&pg=PA27|title=Radiography and Radiology for Dental Care Professionals E-Book|date=2008-10-10|publisher=Elsevier Health Sciences|isbn=978-0-7020-4799-2|pages=25|language=en}}</ref><ref>{{cite journal |vauthors=Wintermark M, Lev MH | title = FDA investigates the safety of brain perfusion CT | journal = AJNR Am J Neuroradiol | volume = 31 | issue = 1 | pages = 2–3 | date = January 2010 | pmid = 19892810 | doi = 10.3174/ajnr.A1967 | pmc = 7964089 | doi-access = free }}</ref> Similar problems have been reported at other centers.<ref name=Furlow2010 /> These incidents are believed to be due to [[human error]].<ref name=Furlow2010 /> == Mechanism == [[File:ct-internals.jpg|thumb|right|CT scanner with cover removed to show internal components. Legend: <br />T: X-ray tube <br />D: X-ray detectors <br />X: X-ray beam <br />R: Gantry rotation]] [[File:Sinogram and sample image of computed tomography of the jaw.jpg|thumb|Left image is a ''sinogram'' which is a graphic representation of the raw data obtained from a CT scan. At right is an image sample derived from the raw data.<ref>{{cite journal|last1=Jun|first1=Kyungtaek|last2=Yoon|first2=Seokhwan|title=Alignment Solution for CT Image Reconstruction using Fixed Point and Virtual Rotation Axis|journal=Scientific Reports|volume=7|year=2017|pages=41218|issn=2045-2322|doi=10.1038/srep41218|pmid=28120881|pmc=5264594|arxiv=1605.04833|bibcode=2017NatSR...741218J}}</ref>]] {{Main|Operation of computed tomography}} Computed tomography operates by using an [[X-ray generator]] that rotates around the object; [[X-ray detector]]s are positioned on the opposite side of the circle from the X-ray source.<ref>{{Cite web|title=Computed Tomography (CT)|url=https://www.nibib.nih.gov/science-education/science-topics/computed-tomography-ct|access-date=2021-03-20|website=www.nibib.nih.gov}}</ref> As the X-rays pass through the patient, they are attenuated differently by various tissues according to the tissue density.<ref>{{Cite book|last1=Aichinger|first1=Horst|url=https://books.google.com/books?id=nPisjRy4LNAC&pg=PA3|title=Radiation Exposure and Image Quality in X-Ray Diagnostic Radiology: Physical Principles and Clinical Applications|last2=Dierker|first2=Joachim|last3=Joite-Barfuß|first3=Sigrid|last4=Säbel|first4=Manfred|date=2011-10-25|publisher=Springer Science & Business Media|isbn=978-3-642-11241-6|pages=5|language=en|doi=}}</ref> A visual representation of the raw data obtained is called a sinogram, yet it is not sufficient for interpretation.<ref>{{Cite book|last=Erdoğan|first=Hakan|url=https://books.google.com/books?id=ylcfAQAAMAAJ&q=A+set+of+many+such+projections+under+different+angles+organized+in+2D+is+called+sinogram|title=Statistical Image Reconstruction Algorithms Using Paraboloidal Surrogates for PET Transmission Scans|date=1999|publisher=University of Michigan|isbn=978-0-599-63374-2|language=en}}</ref> Once the scan data has been acquired, the data must be processed using a form of [[tomographic reconstruction]], which produces a series of cross-sectional images.<ref>{{Cite web|last=Themes|first=U. F. O.|date=2018-10-07|title=CT Image Reconstruction Basics|url=https://radiologykey.com/ct-image-reconstruction-basics/|access-date=2021-03-20|website=Radiology Key|language=en-US}}</ref> These cross-sectional images are made up of small units of pixels or voxels.<ref name="Cardiovascular Computed Tomography">{{Cite book|last=Stirrup|first=James|url=https://books.google.com/books?id=SarDDwAAQBAJ&q=ct+images+are+made+of+pixels&pg=PA134|title=Cardiovascular Computed Tomography|date=2020-01-02|publisher=Oxford University Press|isbn=978-0-19-880927-2|language=en}}</ref> [[Pixel]]s in an image obtained by CT scanning are displayed in terms of relative [[radiodensity]]. The pixel itself is displayed according to the mean [[attenuation]] of the tissue(s) that it corresponds to on a scale from +3,071 (most attenuating) to −1,024 (least attenuating) on the [[Hounsfield scale]]. [[Pixel]] is a two dimensional unit based on the matrix size and the field of view. When the CT slice thickness is also factored in, the unit is known as a [[voxel]], which is a three-dimensional unit.<ref name="Cardiovascular Computed Tomography" /> Water has an attenuation of 0 [[Hounsfield units]] (HU), while air is −1,000&nbsp;HU, cancellous bone is typically +400&nbsp;HU, and cranial bone can reach 2,000&nbsp;HU or more (os temporale) and can cause [[artifact (error)#Medical imaging|artifacts]]. The attenuation of metallic implants depends on the atomic number of the element used: Titanium usually has an amount of +1000&nbsp;HU, iron steel can completely extinguish the X-ray and is, therefore, responsible for well-known line-artifacts in computed tomograms. Artifacts are caused by abrupt transitions between low- and high-density materials, which results in data values that exceed the dynamic range of the processing electronics. Two-dimensional CT images are conventionally rendered so that the view is as though looking up at it from the patient's feet.<ref name="auto">[http://fitsweb.uchc.edu/ctanatomy/extrem/index.html Computerized Tomography chapter] {{webarchive|url=https://web.archive.org/web/20160304001946/http://fitsweb.uchc.edu/ctanatomy/extrem/index.html |date=2016-03-04 }} at [[University of Connecticut Health Center]].</ref> Hence, the left side of the image is to the patient's right and vice versa, while anterior in the image also is the patient's anterior and vice versa. This left-right interchange corresponds to the view that physicians generally have in reality when positioned in front of patients. Initially, the images generated in CT scans were in the [[transverse plane|transverse]] (axial) [[anatomical plane]], perpendicular to the long axis of the body. Modern scanners allow the scan data to be reformatted as images in other [[Plane (geometry)|planes]]. [[Geometry processing|Digital geometry processing]] can generate a [[three-dimensional space|three-dimensional]] image of an object inside the body from a series of two-dimensional [[radiography|radiographic]] images taken by [[rotation around a fixed axis]].<ref name="ref1">{{Cite book|last=Hsieh|first=Jiang|url=https://books.google.com/books?id=JX__lLLXFHkC&q=ct+can+have+a+number+of+artifacts&pg=PA167|title=Computed Tomography: Principles, Design, Artifacts, and Recent Advances|date=2003|publisher=SPIE Press|isbn=978-0-8194-4425-7|pages=167|language=en}}</ref> These cross-sectional images are widely used for medical [[diagnosis]] and [[therapy]].<ref name="urlcomputed tomography – Definition from the Merriam-Webster Online Dictionary">{{cite web|title=computed tomography – Definition from the Merriam-Webster Online Dictionary|url=http://www.merriam-webster.com/dictionary/computed+tomography|url-status=live|archive-url=https://web.archive.org/web/20110919202302/http://www.merriam-webster.com/dictionary/computed+tomography|archive-date=19 September 2011|access-date=18 August 2009}}</ref> === Contrast === {{Main|Contrast CT}} [[Contrast media]] used for X-ray CT, as well as for [[radiography|plain film X-ray]], are called [[radiocontrast]]s. Radiocontrasts for CT are, in general, iodine-based.<ref>{{cite book|last1=Webb|first1=W. Richard|last2=Brant|first2=William E.|last3=Major|first3=Nancy M.|title=Fundamentals of Body CT|date=2014|publisher=Elsevier Health Sciences|isbn=978-0-323-26358-0|page=152|url=https://books.google.com/books?id=lcjsAwAAQBAJ&pg=PA152}}</ref> This is useful to highlight structures such as blood vessels that otherwise would be difficult to delineate from their surroundings. Using contrast material can also help to obtain functional information about tissues. Often, images are taken both with and without radiocontrast.<ref>{{Cite book|last1=Webb|first1=Wayne Richard|url=https://books.google.com/books?id=xb-xLHTqOi0C&q=contrast+in+ct|title=Fundamentals of Body CT|last2=Brant|first2=William E.|last3=Major|first3=Nancy M.|date=2006-01-01|publisher=Elsevier Health Sciences|isbn=978-1-4160-0030-3|page=168|language=en}}</ref> == History == {{Main|History of computed tomography}} The history of X-ray computed tomography goes back to at least 1917 with the mathematical theory of the [[Radon transform]].<ref name="Radon1917">{{Cite book|last1=Thomas|first1=Adrian M. K.|url=https://books.google.com/books?id=zgezC3Osm8QC&q=info:6gaBWGuVV0UJ:scholar.google.com/&pg=PA5|title=Classic Papers in Modern Diagnostic Radiology|last2=Banerjee|first2=Arpan K.|last3=Busch|first3=Uwe|date=2005-12-05|publisher=Springer Science & Business Media|isbn=978-3-540-26988-5|language=en}}</ref><ref name="pmid 18244009">{{cite journal | author = Radon J | title = On the determination of functions from their integral values along certain manifolds | journal = IEEE Transactions on Medical Imaging | volume = 5 | issue = 4 | pages = 170–176 | date = 1 December 1986 | pmid = 18244009 | doi = 10.1109/TMI.1986.4307775 | s2cid = 26553287 }}</ref> In October 1963, [[William H. Oldendorf]] received a U.S. patent for a "radiant energy apparatus for investigating selected areas of interior objects obscured by dense material".<ref name=Oldendorf1978>{{cite journal | author = Oldendorf WH | title = The quest for an image of brain: a brief historical and technical review of brain imaging techniques | journal = Neurology | volume = 28 | issue = 6 | pages = 517–33 | year = 1978 | pmid = 306588 | doi = 10.1212/wnl.28.6.517 | s2cid = 42007208 }}</ref> The first commercially viable CT scanner was invented by [[Godfrey Hounsfield]] in 1972.<ref name=Richmond2004>{{cite journal | last = Richmond | first = Caroline | title = Obituary – Sir Godfrey Hounsfield | journal = BMJ | volume = 329 |issue=7467 |pages=687 | year=2004 | doi = 10.1136/bmj.329.7467.687| pmc = 517662 }}</ref> === Etymology === The word "tomography" is derived from the [[Ancient Greek|Greek]] ''tome'' (slice) and ''graphein'' (to write).<ref>{{Cite book|author=[[Frank Natterer]]|title=The Mathematics of Computerized Tomography (Classics in Applied Mathematics)|publisher=Society for Industrial and Applied Mathematics|year=2001|isbn=978-0-89871-493-7|pages=8}}</ref> Computed tomography was originally known as the "EMI scan" as it was developed in the early 1970s at a research branch of [[EMI]], a company best known today for its music and recording business.<ref>{{Cite book|last=Sperry|first=Len|url=https://books.google.com/books?id=NzgVCwAAQBAJ&q=Computed+tomography+was+originally+known+as+the+%22EMI+scan%22&pg=PA259|title=Mental Health and Mental Disorders: An Encyclopedia of Conditions, Treatments, and Well-Being [3 volumes]: An Encyclopedia of Conditions, Treatments, and Well-Being|date=2015-12-14|publisher=ABC-CLIO|isbn=978-1-4408-0383-3|page=259|language=en}}</ref> It was later known as ''computed axial tomography'' (''CAT'' or ''CT scan'') and ''body section röntgenography''.<ref>{{Cite journal|last=Hounsfield|first=G. N.|date=1977|title=The E.M.I. Scanner|url=https://www.jstor.org/stable/77187|journal=Proceedings of the Royal Society of London. Series B, Biological Sciences|volume=195|issue=1119|pages=281–289|doi=10.1098/rspb.1977.0008|jstor=77187|pmid=13396|bibcode=1977RSPSB.195..281H|s2cid=34734270|issn=0080-4649}}</ref> The term "CAT scan" is no longer used because current CT scans enable for multiplanar reconstructions. This makes "CT scan" the most appropriate term, which is used by [[radiologist]]s in common vernacular as well as in textbooks and scientific papers.<ref>{{Cite web|last=Miñano|first=Glenn|title=What's the difference between a CAT-Scan and a CT-Scan? - Cincinnati Children's Blog|url=https://blog.cincinnatichildrens.org//radiology/whats-the-difference-between-a-cat-scan-and-a-ct-scan|access-date=2021-03-19|website=blog.cincinnatichildrens.org|language=en}}</ref><ref>{{Cite web|title=Difference Between CT Scan and CAT Scan {{!}} Difference Between|url=http://www.differencebetween.net/science/health/difference-between-ct-scan-and-cat-scan/|access-date=2021-03-19|language=en-US}}</ref><ref>{{Cite book|url=https://www.google.co.in/books/edition/Conquer_Your_Headaches/FqDUtcmUG-UC?hl=en&gbpv=1&bsq=cat+scanner+term+was+used+earlier&dq=cat+scanner+term+was+used+earlier&printsec=frontcover|title=Conquer Your Headaches|publisher=International Headache Management|year=1994|isbn=978-0-9636292-5-8|pages=115}}</ref> In [[Medical Subject Headings]] (MeSH), "computed axial tomography" was used from 1977 to 1979, but the current indexing explicitly includes "X-ray" in the title.<ref>{{Cite web|title=Tomography, X-Ray Computed MeSH Descriptor Data 2021|url=https://meshb.nlm.nih.gov/record/ui?ui=D014057}}</ref> The term [[wikt:sinogram|sinogram]] was introduced by Paul Edholm and Bertil Jacobson in 1975.<ref>{{cite journal|last1=Edholm|first1=Paul|last2=Gabor|first2=Herman|date=December 1987|title=Linograms in Image Reconstruction from Projections|journal=IEEE Transactions on Medical Imaging|volume=MI-6|issue=4|pages=301–7|doi=10.1109/tmi.1987.4307847|pmid=18244038|s2cid=20832295}}</ref> == Society and culture == === Campaigns === In response to increased concern by the public and the ongoing progress of best practices, the Alliance for Radiation Safety in Pediatric Imaging was formed within the [[Society for Pediatric Radiology]]. In concert with the [[American Society of Radiologic Technologists]], the [[American College of Radiology]] and the [[American Association of Physicists in Medicine]], the Society for Pediatric Radiology developed and launched the Image Gently Campaign which is designed to maintain high-quality imaging studies while using the lowest doses and best radiation safety practices available on pediatric patients.<ref>{{cite web|url=http://www.pedrad.org/associations/5364/ig/?page=365 |title=Image Gently |publisher=The Alliance for Radiation Safety in Pediatric Imaging |access-date=19 July 2013 |url-status=dead |archive-url=https://web.archive.org/web/20130609063515/http://www.pedrad.org/associations/5364/ig/?page=365 |archive-date=9 June 2013 }}</ref> This initiative has been endorsed and applied by a growing list of various professional medical organizations around the world and has received support and assistance from companies that manufacture equipment used in Radiology. Following upon the success of the ''Image Gently'' campaign, the American College of Radiology, the Radiological Society of North America, the American Association of Physicists in Medicine and the American Society of Radiologic Technologists have launched a similar campaign to address this issue in the adult population called ''Image Wisely''.<ref>{{cite web | url=http://www.imagewisely.org/ | title=Image Wisely | publisher=Joint Task Force on Adult Radiation Protection | access-date=19 July 2013 | url-status=dead | archive-url=https://web.archive.org/web/20130721032437/http://imagewisely.org/ | archive-date=21 July 2013 }}</ref> The [[World Health Organization]] and [[International Atomic Energy Agency]] (IAEA) of the United Nations have also been working in this area and have ongoing projects designed to broaden best practices and lower patient radiation dose.<ref>{{cite web | url=http://new.paho.org/hq10/index.php?option=com_content&task=view&id=3365&Itemid=2164 | title=Optimal levels of radiation for patients | publisher=World Health Organization | access-date=19 July 2013 | url-status=dead | archive-url=https://web.archive.org/web/20130525051814/http://new.paho.org/hq10/index.php?option=com_content&task=view&id=3365&Itemid=2164 | archive-date=25 May 2013 }}</ref><ref>{{cite web | url=https://www.who.int/ionizing_radiation/about/GI_TM_Report_2008_Dec.pdf | title=Global Initiative on Radiation Safety in Healthcare Settings | publisher=World Health Organization | access-date=19 July 2013 | url-status=live | archive-url=https://web.archive.org/web/20131029171805/http://www.who.int/ionizing_radiation/about/GI_TM_Report_2008_Dec.pdf | archive-date=29 October 2013 }}</ref> === Prevalence === <div style="float:right; width:23em; height:20em; overflow:auto; border:0px"> {|class="wikitable" |+{{nowrap|Number of CT scanners by country (OECD)}}<br />as of 2017<ref>{{cite web |title=Computed tomography (CT) scanners|publisher=OECD|url=https://data.oecd.org/healtheqt/computed-tomography-ct-scanners.htm}}</ref><br />(per million population) !Country !! Value |- |{{flagcountry| JPN}} || 111.49 |- |{{flagcountry| AUS}} || 64.35 |- |{{flagcountry| ISL}} || 43.68 |- |{{flagcountry| USA}} || 42.64 |- |{{flagcountry| DNK}} || 39.72 |- |{{flagcountry| CHE}} || 39.28 |- |{{flagcountry| LVA}} || 39.13 |- |{{flagcountry| KOR}} || 38.18 |- |{{flagcountry| DEU}} || 35.13 |- |{{flagcountry| ITA}} || 34.71 |- |{{flagcountry| GRC}} || 34.22 |- |{{flagcountry| AUT}} || 28.64 |- |{{flagcountry| FIN}} || 24.51 |- |{{flagcountry| CHL}} || 24.27 |- |{{flagcountry| LTU}} || 23.33 |- |{{flagcountry| IRL}} || 19.14 |- |{{flagcountry| ESP}} || 18.59 |- |{{flagcountry| EST}} || 18.22 |- |{{flagcountry| FRA}} || 17.36 |- |{{flagcountry| SVK}} || 17.28 |- |{{flagcountry| POL}} || 16.88 |- |{{flagcountry| LUX}} || 16.77 |- |{{flagcountry| NZL}} || 16.69 |- |{{flagcountry| CZE}} || 15.76 |- |{{flagcountry| CAN}} || 15.28 |- |{{flagcountry| SVN}} || 15.00 |- |{{flagcountry| TUR}} || 14.77 |- |{{flagcountry| NLD}} || 13.48 |- |{{flagcountry| RUS}} || 13.00 |- |{{flagcountry| ISR}} || 9.53 |- |{{flagcountry| HUN}} || 9.19 |- |{{flagcountry| MEX}} || 5.83 |- |{{flagcountry| COL}} || 1.24 |- |} </div> Use of CT has increased dramatically over the last two decades.<ref name=Smith2009 /> An estimated 72&nbsp;million scans were performed in the United States in 2007,<ref name=Berrington2009 /> accounting for close to half of the total per-capita dose rate from radiologic and nuclear medicine procedures.<ref>{{cite journal | title = Radiologic and Nuclear Medicine Studies in the United States and Worldwide: Frequency, Radiation Dose, and Comparison with Other Radiation Sources — 1950-2007 | authors= Fred A. Mettler, Jr, Mythreyi Bhargavan, Keith Faulkner, Debbie B. Gilley, Joel E. Gray, Geoffrey S. Ibbott, Jill A. Lipoti, Mahadevappa Mahesh, John L. McCrohan, Michael G. Stabin, Bruce R. Thomadsen, Terry T. Yoshizumi | journal = Radiology | volume = 253 | number = 2 | year = 2009 }}</ref> Of the CT scans, six to eleven percent are done in children,<ref name=Risk2011 /> an increase of seven to eightfold from 1980.<ref name=Furlow2010 /> Similar increases have been seen in Europe and Asia.<ref name=Furlow2010 /> In Calgary, Canada, 12.1% of people who present to the emergency with an urgent complaint received a CT scan, most commonly either of the head or of the abdomen. The percentage who received CT, however, varied markedly by the [[emergency physician]] who saw them from 1.8% to 25%.<ref>{{cite journal |author=Andrew Skelly |title=CT ordering all over the map |journal=The Medical Post |date=Aug 3, 2010 }}</ref> In the emergency department in the United States, CT or [[Magnetic resonance imaging|MRI]] imaging is done in 15% of people who present with [[injuries]] as of 2007 (up from 6% in 1998).<ref>{{cite journal |vauthors=Korley FK, Pham JC, Kirsch TD | title = Use of advanced radiology during visits to US emergency departments for injury-related conditions, 1998–2007 | journal = JAMA | volume = 304 | issue = 13 | pages = 1465–71 | date = October 2010 | pmid = 20924012 | doi = 10.1001/jama.2010.1408 | doi-access = free }}</ref> The increased use of CT scans has been the greatest in two fields: screening of adults (screening CT of the lung in smokers, virtual colonoscopy, CT cardiac screening, and whole-body CT in asymptomatic patients) and CT imaging of children. Shortening of the scanning time to around 1 second, eliminating the strict need for the subject to remain still or be sedated, is one of the main reasons for the large increase in the pediatric population (especially for the diagnosis of [[appendicitis]]).<ref name="Brenner2007" /> As of 2007, in the United States a proportion of CT scans are performed unnecessarily.<ref name=Semelka2007>{{cite journal |vauthors=Semelka RC, Armao DM, Elias J, Huda W | title = Imaging strategies to reduce the risk of radiation in CT studies, including selective substitution with MRI | journal = J Magn Reson Imaging | volume = 25 | issue = 5 | pages = 900–9 | date = May 2007 | pmid = 17457809 | doi = 10.1002/jmri.20895 | s2cid = 5788891 | url = https://semanticscholar.org/paper/fc2c18d82af7ea7bcee9e6df03f6f42756ad2b5f }}</ref> Some estimates place this number at 30%.<ref name=Risk2011 /> There are a number of reasons for this including: legal concerns, financial incentives, and desire by the public.<ref name=Semelka2007 /> For example, some healthy people avidly pay to receive full-body CT scans as [[screening (medicine)|screening]]. In that case, it is not at all clear that the benefits outweigh the risks and costs. Deciding whether and how to treat [[incidentaloma]]s is complex, radiation exposure is not negligible, and the money for the scans involves [[opportunity cost]].<ref name=Semelka2007 /> == Manufacturers == Major manufacturers of CT Scanners Devices and Equipment are:<ref>{{cite web |title=Global Computed Tomography (CT) Scanners Devices and Equipment Market Report 2020: Major Players are GE Healthcare, Koninklijke Philips, Hitachi, Siemens and Canon Medical Systems – ResearchAndMarkets.com |publisher=Business Wire |date=November 7, 2019 |url=https://www.businesswire.com/news/home/20191107005949/en/Global-Computed-Tomography-CT-Scanners-Devices-Equipment#:~:text=Major%20players%20in%20the%20market,and%20Canon%20Medical%20Systems%20Corporation.}}</ref> *{{flagicon|USA}} [[GE Healthcare]] *{{flagicon|Germany}} [[Siemens Healthineers]] *{{flagicon|Japan}} [[Canon Medical Systems Corporation]] (Formerly Toshiba Medical Systems) *{{flagicon|Netherlands}} [[Philips|Koninklijke Philips N.V.]] *{{flagicon|Japan}} [[Fujifilm|Fujifilm Healthcare]] (Formerly Hitachi Medical Systems) *{{flagicon|China}} [[Neusoft|Neusoft Medical Systems]] *{{flagicon|China}} [[United Imaging Healthcare]] == Research == [[Photon-counting computed tomography]] is a CT technique currently under development. Typical CT scanners use energy integrating detectors; photons are measured as a voltage on a capacitor which is proportional to the x-rays detected. However, this technique is susceptible to noise and other factors which can affect the linearity of the voltage to x-ray intensity relationship.<ref>{{cite book|last1=Jenkins|first1=Ron|last2=Gould|first2=R W|last3=Gedcke|first3=Dale|title=Quantitative x-ray spectrometry|url=https://archive.org/details/quantitativexray00jenk|url-access=limited|date=1995|publisher=Dekker|location=New York|isbn=978-0-8247-9554-2|page=[https://archive.org/details/quantitativexray00jenk/page/n89 90]|edition=2nd |chapter=Instrumentation}}</ref> Photon counting detectors (PCDs) are still affected by noise but it does not change the measured counts of photons. PCDs have several potential advantages, including improving signal (and contrast) to noise ratios, reducing doses, improving spatial resolution, and through use of several energies, distinguishing multiple contrast agents.<ref>{{cite journal|last1=Shikhaliev|first1=Polad M.|last2=Xu|first2=Tong|last3=Molloi|first3=Sabee|title=Photon counting computed tomography: Concept and initial results|journal=Medical Physics|date=2005|volume=32|issue=2|pages=427–36|doi=10.1118/1.1854779|pmid=15789589|bibcode=2005MedPh..32..427S}}</ref><ref>{{cite journal|last1=Taguchi|first1=Katsuyuki|last2=Iwanczyk|first2=Jan S.|title=Vision 20/20: Single photon counting x-ray detectors in medical imaging|journal=Medical Physics|date=2013|volume=40|issue=10|pages=100901|doi=10.1118/1.4820371|pmid=24089889|pmc=3786515|bibcode=2013MedPh..40j0901T}}</ref> PCDs have only recently become feasible in CT scanners due to improvements in detector technologies that can cope with the volume and rate of data required. As of February 2016, photon counting CT is in use at three sites.<ref>{{cite web|title=NIH uses photon-counting CT scanner in patients for the first time|url=https://www.nih.gov/news-events/news-releases/nih-uses-photon-counting-ct-scanner-patients-first-time|website=National Institutes of Health|access-date=28 July 2016|date=24 February 2016|url-status=live|archive-url=https://web.archive.org/web/20160818032611/https://www.nih.gov/news-events/news-releases/nih-uses-photon-counting-ct-scanner-patients-first-time|archive-date=18 August 2016}}</ref> Some early research has found the dose reduction potential of photon counting CT for breast imaging to be very promising.<ref>{{cite web|title=Photon-counting breast CT measures up|url=http://medicalphysicsweb.org/cws/article/research/65633|website=medicalphysicsweb|access-date=28 July 2016|url-status=dead|archive-url=https://web.archive.org/web/20160727052920/http://medicalphysicsweb.org/cws/article/research/65633|archive-date=2016-07-27}}</ref> In view of recent findings of high cumulative doses to patients from recurrent CT scans, there has been a push for scanning technologies and techniques that reduce ionising radiation doses to patients to sub-[[Sievert|milliSievert]] (sub-mSv in the literature) levels during the CT scan process, a goal that has been lingering.<ref>{{Cite journal|url=https://www.physicamedica.com/article/S1120-1797(20)30051-X/abstract|title=Is it possible to kill the radiation risk issue in computed tomography?|first1=Marc|last1=Kachelrieß|first2=Madan M.|last2=Rehani|date=March 1, 2020|journal=Physica Medica: European Journal of Medical Physics|volume=71|pages=176–177|via=www.physicamedica.com|doi=10.1016/j.ejmp.2020.02.017|pmid=32163886|s2cid=212692606}}</ref><ref name="Patients undergoing recurrent CT sc" /><ref name="Multinational data on cumulative ra" /><ref name="Patients undergoing recurrent CT ex" /> == See also == {{Div col}} * [[Barium sulfate suspension]] * [[Dosimetry]] * [[Magnetic resonance imaging#MRI versus CT|MRI versus CT]] * [[Tomosynthesis]] * [[Virtopsy]] * [[X-ray microtomography]] * [[Xenon-enhanced CT scanning]] {{Div col end}} == References == {{reflist}} == External links == {{Commons category|Computed tomography}} {{Library resources box |by=no |onlinebooks=no |others=no |about=yes |label=Computed tomography }} * [https://archive.today/20160807180537/http://clinical.netforum.healthcare.philips.com/global/Explore/White-Papers/CT/Development-of-CT-imaging Development of CT imaging] * [http://www.impactscan.org/slides/impactcourse/artefacts/img0.html CT Artefacts]—PPT by David Platten * {{Cite journal|last=Filler|first=Aaron|date=2009-06-30|title=The History, Development and Impact of Computed Imaging in Neurological Diagnosis and Neurosurgery: CT, MRI, and DTI|url=https://www.nature.com/articles/npre.2009.3267.3|journal=Nature Precedings|language=en|pages=1|doi=10.1038/npre.2009.3267.3|issn=1756-0357|doi-access=free}} *{{Cite journal|title=Computed tomography turns 50|url=https://physicstoday.scitation.org/doi/full/10.1063/PT.3.4834|journal=Physics Today|year=2021|volume=74|issue=9|pages=34–40|doi=10.1063/PT.3.4834|issn=0031-9228|last1=Boone|first1=John M.|last2=McCollough|first2=Cynthia H.|bibcode=2021PhT....74i..34B|s2cid=239718717}} {{Medical imaging}} {{Authority control}} {{DEFAULTSORT:Computed Tomography}} [[Category:X-ray computed tomography| ]] [[Category:1972 introductions]] [[Category:Articles containing video clips]] [[Category:Medical tests]] [[Category:Multidimensional signal processing]] [[Category:Radiology]] [[Category:Medical imaging]]'