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In CT, an x-ray source and x-ray detector housed in a doughnut-shaped assembly move circularly around a patient who lies on a motorized table that is moved through the machine. Usually, multidetector scanners with 4 to 64 or more rows of detectors are used because more detectors allow quicker scanning and higher-resolution images.
Data from the detectors essentially represent a series of x-ray images taken from multiple angles all around the patient. However, the images are not viewed directly but are sent to a computer, which quickly reconstructs them into 2-dimensional images (tomograms) representing a slice of the body in any plane desired. Data can also be used to construct detailed 3-dimensional images. For some CT scans, the table moves incrementally and stops when each scan (slice) is taken. For other CT scans, the table moves continuously during scanning; because the patient is moving in a straight line and the detectors are moving in a circle, the series of images appear to be taken in a spiral fashion around the patient—hence the term helical (spiral) CT.
These same principles of tomographic imaging can also be applied to radionuclide scanning, in which the sensors for emitted radiation encircle the patient and computer techniques convert the sensor data into tomographic images; examples include single-photon emission CT (SPECT) and positron-emission tomography (PET).
Uses
Compared with plain x-rays, the tomographic slices of CT provide more spatial detail and can better differentiate between various soft-tissue densities. Because it provides so much more information, CT is preferred to plain x-rays for imaging most intracranial, head and neck, spinal, intrathoracic, and intra-abdominal structures. Three-dimensional images of lesions can help surgeons plan surgery. CT is the most accurate study for detecting and localizing urinary calculi.
CT may be done with or without IV contrast. Noncontrast CT is used to detect acute hemorrhage in the brain, urinary calculi, and lung nodules, as well as to characterize bone fractures and other skeletal abnormalities. IV contrast is used to improve imaging of tumors, infection, inflammation, and trauma in soft tissues and to assess the vascular system, as when pulmonary embolism, aortic aneurysm, or aortic dissection is suspected.
Oral or occasionally rectal contrast is used for abdominal imaging; sometimes gas is used to distend the lower GI tract and make it visible. Contrast in the GI tract helps distinguish the GI tract from surrounding structures. Standard oral contrast is barium-based, but low-osmolar iodinated contrast should be used when intestinal perforation is suspected or when risk of aspiration is high.
Variations
Virtual colonoscopy:
After gas is introduced into the rectum via a flexible, thin-diameter rubber catheter, CT of the entire colon is done. Virtual colonoscopy produces high-resolution 3-dimensional images of the colon that somewhat simulate the appearance of optical colonoscopy. This technique can show colon polyps and colon mucosal lesions as small as 5 mm. It is an alternative to conventional colonoscopy.
CT IV pyelography (CT IVP) or urography:
IV contrast is injected. The procedure produces detailed images of the kidneys, ureters, and bladder. It is an alternative to conventional IV urography.
CT angiography:
After a rapid bolus injection of IV contrast, thin-slice images are rapidly taken as the contrast opacifies arteries and veins. Advanced computer graphics techniques are used to remove images of surrounding soft tissues and to provide highly detailed images of blood vessels similar to those of conventional angiography. CT angiography is a less invasive alternative to conventional angiography.
Disadvantages
CT accounts for most diagnostic radiation exposure to patients collectively. If multiple scans are done, the total radiation dose may be high, placing the patient at potential risk (see Principles of Radiologic Imaging: Risks of Ionizing Radiation). Patients who have recurrent urinary tract stones or who have had major trauma are most likely to have multiple CT scans. The risk of radiation exposure vs benefit of the examination must always be considered because the effective radiation dose of one abdomen CT is equal to 500 chest x-rays.
Some CT scans use IV contrast, which has certain risks (see Principles of Radiologic Imaging: Radiographic Contrast Agents and Contrast Reactions). If barium extravasates outside the GI tract lumen, it can induce severe inflammation; if aspirated, barium can induce severe pneumonia. Barium can also become hard and inspissated, potentially precipitating intestinal obstruction. Gastrografin is safer, but the contrast and images of the GI tract it provides are not as good.
The CT table may not be able to accommodate very obese patients.
Last full review/revision July 2008 by Jon A. Jacobson, MD
Content last modified February 2012
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