Technical foundations of spiral CT

CT scanning is a relatively high dose procedure that is becoming much more common worldwide. In the mid-1990s, CT scanning accounted for about 4% of procedures and about 40% of the collective dose in diagnostic radiology. With the advent of helical, fluoroscopic, and multi-slice techniques the dose per procedure has not diminished and the use of CT has increased even more. In large hospitals, CT scanning now accounts for about 15% of procedures and 75% of the diagnostic radiation dose received by patients. When multiple CT scans are conducted on the same patient, the absorbed doses are in the range at which small but statistically significant increases in cancer have been found in the atomic bomb survivors.

Advances in computer technology have permitted development of virtual reality images of the tracheobronchial tree using data sets derived from helical CT of the chest. To determine the relevance of these images to actual bronchoscopic findings, we compared "virtual bronchoscopy" images with videotaped bronchoscopy results in 20 patients who had undergone both helical chest CT and fiberoptic bronchoscopy during clinical evaluation of their thoracic problems. Suboptimal endobronchial simulations in ten patients identified important, readily-addressed technical requirements for this imaging procedure. In the ten patients with technically suitable renderings of the airway, virtual bronchoscopy simulations accurately demonstrated endobronchial obstructions by tumor in five, airway distortion and/or ectasia in four, and accessory bronchi in another. These preliminary observations suggest that virtual bronchoscopy simulations accurately represent major endobronchial anatomic findings. This technique may have a role in prebronchoscopy planning, endoscopy training, and/or endobronchial therapy, and merits further study.