Computed Tomography

JUNE 2022

What is a computed tomography (CT) scan?

The term “computed tomography,” or CT, refers to a computerized x-ray imaging procedure in which a narrow beam
of x-rays is aimed at a patient and quickly rotated around the body, producing signals that are processed by the
machine’s computer to generate cross-sectional images, or “slices.” These slices are called tomographic images and
can give a clinician more detailed information than conventional x-rays. Once a number of successive slices are
collected by the machine’s computer, they can be digitally “stacked” together to form a three-dimensional image of
the patient that allows for easier identification of basic structures as well as possible tumors or abnormalities.

How does CT work?

Unlike a conventional x-ray—which uses a fixed x-ray tube—a CT scanner uses a motorized x-ray source that rotates
around the circular opening of a donut-shaped structure called a gantry. During a CT scan, the patient lies on a bed
that slowly moves through the gantry while the x-ray tube rotates around the patient, shooting narrow beams of x-
rays through the body. Instead of film, CT scanners use special digital x-ray detectors, which are located directly
opposite the x-ray source. As the x-rays leave the patient, they are picked up by the detectors and transmitted to a
computer.
Each time the x-ray source completes one full rotation, the CT
computer uses sophisticated mathematical techniques to
construct a two-dimensional image slice of the patient. The
thickness of the tissue represented in each image slice can vary
depending on the CT machine used, but usually ranges from 1-
10 millimeters. When a full slice is completed, the image is
stored and the motorized bed is moved forward incrementally
into the gantry. The x-ray scanning process is then repeated to
produce another image slice. This process continues until the
desired number of slices is collected.
Image slices can either be displayed individually or stacked
together by the computer to generate a 3D image of the
A CT machine. Credit: iStock
patient that shows the skeleton, organs, and tissues as well as
any abnormalities the physician is trying to identify. This method has many advantages including the ability to rotate
the 3D image in space or to view slices in succession, making it easier to find the exact place where a problem may be
located.

When would I get a CT scan?

CT scans can be used to identify disease or injury within various regions of the body. For example, CT has become a
useful screening tool for detecting possible tumors or lesions within the abdomen. A CT scan of the heart may be
ordered when various types of heart disease or abnormalities are suspected. CT can also be used to image the head to
locate injuries, tumors, clots leading to stroke, hemorrhage, and other conditions. It can image the lungs to reveal the
presence of tumors, pulmonary embolisms (blood clots), excess fluid, and other conditions such as emphysema or
pneumonia. A CT scan is particularly useful when imaging complex bone fractures, severely eroded joints, or bone
tumors since it usually produces more detail than would be possible with a conventional x-ray.

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 Computed Tomography, page 2

What is a CT contrast agent?

As with all x-rays, dense structures within the body—such as bone—are
easily imaged, whereas soft tissues vary in their ability to stop x-rays and
therefore may be faint or difficult to see. For this reason, contrast agents
have been developed that are highly visible in an x-ray or CT scan and are
safe to use in patients. Contrast agents contain substances that can stop x-
rays and are therefore more visible on an x-ray image. For example, to
examine the circulatory system, an intravenous (IV) contrast agent based
on iodine is injected into the bloodstream to help illuminate blood vessels.
This type of test is used to look for possible obstructions in blood vessels,
including those in the heart. Oral contrast agents, such as barium-based CT scan of the abdomen. Credit: iStock
compounds, are used for imaging the digestive system, including the
esophagus, stomach, and gastrointestinal (GI) tract.

Are there risks?

CT scans can diagnose possibly life-threatening conditions such as hemorrhage, blood clots, or cancer. An early
diagnosis of these conditions could potentially be lifesaving. However, CT scans use x-rays, and all x-rays produce
ionizing radiation. Ionizing radiation has the potential to cause biological effects in living tissue. This is a risk that
increases with the number of exposures added up over the life of an individual. However, the risk of developing
cancer from x-ray radiation exposure is generally small.
A CT scan in a pregnant woman poses no known risks to the baby if the
area of the body being imaged isn’t the abdomen or pelvis. In general, if
imaging of the abdomen and pelvis is needed, doctors prefer to use
exams that do not use radiation, such as magnetic resonance imaging
(MRI) or ultrasound. However, if neither of those can provide the
answers needed, or there is an emergency or other time constraint, CT
may be an acceptable alternative imaging option.
In some patients, contrast agents may cause allergic reactions, or in rare
cases, temporary kidney failure. IV contrast agents should not be
administered to patients with abnormal kidney function since they may
CT images of the heart and coronary artery. Credit: induce a further reduction of kidney function, which may sometimes
iStock become permanent.
Because children are more sensitive to ionizing radiation and have a longer life expectancy, they have a higher
relative risk for developing cancer from such radiation compared with adults. Parents may want to ask the
technologist or doctor if their machine settings have been adjusted for children.

What are examples of NIBIB-funded projects using computed tomography?

Imaging for acute ischemic stroke: Stroke, which can have lasting
neurological injuries, is also a leading cause of death worldwide. To mitigate
damage to the brain, patients may receive endovascular treatment, where the
clot blocking the blood supply is either removed or dissolved. However,
identifying patients who will benefit from endovascular therapy, such as those
with only a small volume of irreversibly injured brain tissue, remains
challenging, and time is a critically important factor for a successful clinical
outcome.

A patient inside a CT machine. Credit: iStock NIBIB-funded researchers have developed an image reconstruction technique
to more efficiently triage patients who present with symptoms of a stroke. This

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 Computed Tomography
JUNE 2022

CT-based method can be used to rule out the presence of a hemorrhage; to find the site of the blood clot; and to
identify the extent of damaged brain tissue. Such a technique could significantly shorten the time from the diagnosis
of a stroke to the start of endovascular therapy, and could also guide the endovascular treatment. Following
evaluation in animal models, researchers plan to validate this CT imaging technique in human studies.
Accounting for metal implants in CT imaging: Metal objects, such as implants and prostheses, can introduce
‘artifacts’ that may appear as streaks or shadows on a CT scan. These artifacts can obscure anatomical structures or
affect calculations necessary for planning radiation therapy. While techniques exist to reduce such artifacts, they do
not fully mitigate the artifacts and may even introduce new ones. In this project, NIBIB-funded researchers have
developed an algorithm to reduce metal artifacts in CT imaging, without requiring knowledge of the implant material.
The researchers plan to optimize their algorithm and then evaluate their technique as a potential method to improve
radiation therapy planning for prostate cancer among those with hip protheses.
Leveraging CT images to guide treatments for COVID-19 and beyond: Artificial intelligence is increasingly being
used with medical imaging, such as CT, to help improve diagnoses and guide treatment decisions. By using medical
images and patient outcomes, clinicians can “train” machine learning-based technologies to recognize patterns and
predict responses. During the COVID-19 pandemic, NIBIB created a collaborative imaging initiative called the Medical
Imaging and Data Resource Center (MIDRC). This initiative collected and analyzed thousands of CT images from
patients with COVID-19 for the development of artificial intelligence and machine learning tools to guide the
treatment and monitoring of the disease. These datasets contribute to the development of algorithms for detection,
prognosis, and optimization of therapy in acute COVID-19 patients and have the potential to contribute to the
understanding of Post-Acute Sequelae of SARS-CoV-2 infection (PASC, otherwise known as “Long COVID”). Further,
this initiative paves the way for new tools that leverage imaging for other medical conditions, such as cancer, liver
disease, or other infectious diseases, among others.
For more information about CT, watch our video here.

NIBIB Contacts
National Institute of Biomedical Imaging and Bioengineering
6707 Democracy Blvd., Suite 200
Bethesda, MD 20892
Phone: 301-496-8859
info@nibib.nih.gov
www.nibib.nih.gov

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