Small Animal/Exotics
EMERGING TECHNOLOGY
Three-Dimensional Computed
Tomography: User-Friendly Images
Jeryl C. Jones, DVM, PhD
Diplomate, ACVR
Department of Small Animal
Clinical Sciences
Virginia-Maryland Regional College
of Veterinary Medicine
Blacksburg, Virginia
C
omputed tomography (CT) is
an imaging technique that
uses x-ray energy and com-
puter processing to create cross-sec-
tional (transverse) slices of internal
structures (e.g., within the head, tor-
so).1,2 One of the main advantages of
CT over conventional radiography is
the ability to eliminate superimposi-
tion; CT images are not only clearer
but can isolate a specific internal re-
gion. A disadvantage of CT is that
transverse sectional anatomy is often
unfamiliar and, therefore, difficult to
interpret. New computer processing
(reformatting) techniques are now
available that can create three-dimen-
sional (3-D) CT images. Because the
images that are created more closely
resemble the way anatomic structures
look during physical examination or
surgery, the information gleaned from
3-D CT images is often easier to in-
terpret than that from transverse CT
images.
Background
Each CT slice is formed from mul-
tiple x-ray exposures captured as the
scan completes a 360˚ rotation. Trans-
mitted x-ray energy is recorded by
detectors positioned opposite the pa-
V
tient. The x-ray energy is converted
to an electric signal and sent to the
CT computer for processing. The
CT computer translates the electric
signal to numeric (digital) informa-
tion, which in turn is used to display
images on a computer monitor. To
perform 3-D CT reformatting, the
computer first combines all digital in-
formation from a set of transverse
CT images.3–6 The outside picture el-
ements (pixels) of each transverse slice
are selected to create a surface display
of the volume image.
Although the images are actually
shown in two dimensions, depth is
perceived through the use of surface
shading. The volume image appears
to be illuminated by a single source
of light, with objects closest to the
observer displayed in white and those
farthest away in black. The operator
can select which tissue densities are to
be shown and which viewing angle is
to be used. By selecting sequential 3-
D viewing angles, a videotape anima-
tion in which the image appears to be
rotating in space can be created. The
operator can also remove unwanted
overlying structures from the image,
select only certain structures to be
displayed, assign colors to selected
structures, and measure the volume
of a specific region.
One limitation of 3-D CT is the
appearance of reconstruction arti-
facts.2,7–10 Artificial bone defects (pseu-
doforamina) may occur in areas with
low tissue density. Reconstruction arti-
facts can be minimized by reducing the
threshold for the range of displayed
bone densities. Comparisons with the
Compendium June 2000
opposite side may help differentiate
pseudoforamina from true lytic lesions.
Another limitation is the “stair-step”
pattern (raster effect) that can occur on
the surface of 3-D images. This prob-
lem is primarily caused by inaccurate
computer interpolation at the junc-
tions between adjacent transverse slices.
This effect can be minimized by using
thinner slices, increasing slice overlap-
ping, or using oblique slice planes.
Uses
The most common uses for 3-D CT
are clarifying spatial relationships for
surgical planning, determining volume
and extent of involvement for tumor
staging, and facilitating client commu-
nication.11–14 Some of the more ad-
vanced 3-D CT computer programs
also perform virtual endoscopy,12,15–17
surgical simulations,18–23 and radiation
therapy planning.12,24–26
Virtual endoscopy is a noninvasive
method for evaluating the interior of
hollow organs. A movie that sequen-
tially displays color 3-D CT images al-
lows viewers to “fly through” such
structures as the trachea, bronchi,
stomach, and bowel. Surgical simula-
tion is a technique in which color 3-D
CT images are used to “rehearse” oper-
ations. The surgeon can compare dif-
ferent approaches by rotating the com-
puter-generated images and using
electronic cursors to selectively remove
or replace tissue. Some promising new
applications for 3-D CT in veterinary
medicine include evaluation of the ab-
domen (Figure 1), spine, thorax, pelvis
(Figure 2), skull, and brain (Figure 3;
Table I).27–31
Compendium June 2000 Small Animal/Exotics

Figure 1A Figure 1B
Figure 1—(A) Transverse, postcontrast CT image of a dog with a left adrenal mass (M). Surgical landmarks are the right kidney (RK),
left kidney (LK), aorta (A), caudal vena cava (C), and portal vein (P). (B) Three-dimensional CT image of the same dog demonstrates
the adrenal mass and landmarks in color, without superimposed structures. The kidneys and ureters are in yellow, adrenal glands in
dark pink, and blood vessels in blue.

Figure 2A Figure 2B
Figure 2—(A) Color 3-D CT image of a dog with a right gluteal sarcoma. Overlying soft tissue structures have been removed to
permit visualization of the mass (blue) relative to the pelvis. The mass and pelvis appear to have multiple “stair steps” because of a
reconstruction artifact caused by computer misinterpretation of the margins between two adjacent slices. (B) The pelvis has been
removed to permit 3-D volume measurement for tumor staging. The calculated volume of the mass is displayed at the top of the
image in green text (82.97 ml).

Access and Cost Considerations
In practices anticipating client de-
mand for fewer than 10 scans per
week, access to 3-D CT may best be
achieved by using tertiary veterinary
referral centers or local medical imag-
ing facilities. Costs per scan may
range from $200 to $1200, depend-
ing on geographic location and indi-
vidual imaging center policies. In
practices anticipating client demand
for 10 or more scans per week, pur-
chasing the equipment may be a vi-
able option (Table II). Many manu-
facturers provide installment plans.
Yearly maintenance contracts are
highly recommended and may be ob-
tained at a cost of approximately
Small Animal/Exotics Compendium June 2000

from $200,000 to $400,000. Multi-

slice (spiral) scanners acquire data
from the entire volume of tissue at
one time and then retrospectively
create the transverse slices. This capa-
bility permits rapid examinations, of-
ten in less than 1 minute.6 The cost
of multislice scanners ranges from
$500,000 to $1,200,000.
Advanced 3-D image manipula-
tion (e.g., color enhancement, virtual
endoscopy) requires a reformatting
computer workstation that performs
more complex image manipulations
(interactive creation and viewing of
images). 27,29,31,32 Workstations can
also be used to convert CT images
into formats that can be transferred
over the Internet and viewed at any
personal computer. Reformatting
Figure 3—Color CT images of a dog with a rostral cerebral meningioma. On the workstations may be added to a con-
right are transverse, sagittal, and dorsal planar views of the brain mass (purple). On ventional or spiral CT scanner sys-
the left is a 3-D view of the head, with a cube-shaped tissue section removed to per- tem for $80,000 to $120,000. Ob-
mit visualization of the mass relative to such surgical landmarks as the eye (E), cribri- taining a workstation made by the
form plate (C), and frontal sinus (F). same company as the CT scanner
minimizes the risk of software in-
10% of the equipment purchase Single-slice (third- or fourth-genera- compatibilities and associated down-
price. Most of the newer CT scan- tion) CT scanners acquire one trans- time. Most manufacturers include
ners can produce basic 3-D images. verse slice at a time. The costs range the cost of applications training for

TABLE I
Some Disease Indications for Three-Dimensional Computed Tomography
Disease Uses

Adrenal masses Determine relationship of mass to adjacent blood vessels for treatment planning and
prognosis
Lateral disk herniation Plan approach for removal of disk fragment
Vertebral osteomyelitis Determine extent of involvement for treatment planning and prognosis
Vertebral trauma Determine locations and origins of fracture fragments and demonstrate subluxation/luxations
Rib masses Determine extent of involvement and margins for surgical excision
Mediastinal masses Determine relationship of mass to adjacent vital structures for surgical planning and
prognosis
Pelvic masses Determine extent of involvement and margins for surgical excision
Craniofacial masses Determine extent of involvement and margins for surgical excision
Craniofacial trauma Determine extent of involvement for treatment planning and prognosis
Nasal masses Determine tumor volume and extent of involvement for staging and radiation therapy
planning
Brain masses Determine tumor volume and extent of involvement for staging and radiation therapy
planning; plan surgical approach for removing mass
Compendium June 2000
TABLE II
Estimated Costs
Equipment Purchase Price
Single-slice CT $200,000–$400,000
scanner
Multislice CT $400,000–$1,000,000
scanner
Single-slice CT $280,000–$520,000
scanner and
workstation
Multislice CT scanner $580,000–$1,320,000
and workstation
a
Assumes 10 years of use and 300% markup to cover employee time, utilities, site preparation, film, camera costs, and software upgrades.
CT = computed tomography.
up to two staff members with the
purchase of a new scanner and work-
station system. Applications training
may be completed at an off-site center
and often involves 2 to 3 days of in-
tensive workshops. An alternative is
to schedule three to four on-site vis-
its. Veterinarians or radiologic tech-
nologists would be the most suitable
candidates for 3-D CT training.
References
1. Wiesen EJ, Miraldi F: Imaging principles
in computed tomography, in Haaga JR,
Lanzieri CF, Sartoris DJ, Zerhouni EA
(eds): Computed Tomography and Magnet-
ic Resonance Imaging of the Whole Body, ed
3. St. Louis, Mosby, 1994, pp 3–22.
2. Anderson DJ, Berland L: CT techniques,
in Lee KT, Sagel SS, Stanley RJ (eds):
Computed Body Tomography with MRI
Correlation, ed 2. New York, Raven Press,
1989, pp 31–60.
3. Marsh JL, Vannier MW: Surface imaging
from computerized tomographic scans.
Surgery 94:159–165, 1983.
4. Hemmy DC, Zonneveld FW, Lobregt S,
et al: A decade of clinical three-dimensional
imaging: A review. Part I. Historical devel-
opment. Invest Radiol 29:489–496, 1994.
5. Alder ME, Deahl ST, Matteson SR: Clini-
cal usefulness of two-dimensional reformat-
ted and three-dimensionally rendered com-
puterized tomographic images: Literature
review and a survey of surgeons’ opinions.
J Oral Maxillofac Surg 53:375–386, 1995.
Yearly Maintenance
Contract
$20,000–$40,000
$40,000–$100,000
$28,000–$52,000
$58,000–$132, 000
6. Brink JA, McFarland EG, Heiken JP: Re-
view: Helical/spiral computed body to-
mography. Clin Radiol 52:489–503, 1997.
7. Hemmy DC, Tessier PL: CT of dry skulls
with craniofacial deformities: Accuracy of
three-dimensional reconstruction. Radiol-
ogy 157:113–116, 1985.
8. Covino SW, Mitnick RJ, Shprintzen RJ,
et al: The accuracy of measurements of
three-dimensional computed tomography
reconstructions. J Oral Maxillofac Surg
54:982–990; discussion 990–991, 1996.
9. Wang G, Vannier MW: Stair-step arti-
facts in three-dimensional helical CT: An
experimental study. Radiology 191:79–83,
1994.
10. Yune HY: Two-dimensional–three-dimen-
sional reconstruction computed tomogra-
phy techniques. Dent Clin North Am 37:
613–626, 1993.
11. Carls FR, Schuknecht B, Sailer HF: Val-
ue of three-dimensional computed to-
mography in craniomaxillofacial surgery.
J Craniomaxillofac Surg 5:282–288, 1994.
12. Remy J, Remy-Jardin M, Artaud D, et al:
Multiplanar and three-dimensional re-
construction techniques in CT: Impact
on chest diseases. Eur Radiol 8:335-351,
1998.
13. Tacke J, Klein HM, Bertalanffy H, et al:
Clinical significance of three-dimensional
helical CT in neurosurgery. Minim Inva-
sive Neurosurg 40:30–35, 1997.
14. Eggli KD, Close P, Dillon PW, et al:
Three-dimensional quantitation of pedi-
atric tumor bulk. Pediatr Radiol 25:1–6,
1995.
15. Lee DH, Ko YT: Gastric lesions: Evalua-
tion with three-dimensional images using
Small Animal/Exotics
Cost per Scan Cost per Scan
(10 scans/week)a (20 scans/week)a
$308–$616 $154–$308
$616–$1538 $308–$770
$431–$800 $216–$400
$892–$2031 $446–$1015
helical CT. Am J Roentgenol 169:787–
789, 1997.
16. Royster AP, Fenlon HM, Clarke PD, et
al: CT colonoscopy of colorectal neo-
plasms: Two-dimensional and three-di-
mensional virtual-reality techniques with
colonoscopic correlation. Am J Roentgenol
169:1237–1242, 1997.
17. Ferretti GR, Vining DJ, Knoplioch J, et
al: Tracheobronchial tree: Three-dimen-
sional spiral CT with bronchoscopic per-
spective. J Comput Assist Tomogr 20:777–
781, 1996.
18. Altobelli DE, Kikinis R, Mulliken JB, et
al: Computer-assisted three-dimensional
planning in craniofacial surgery. Plast Re-
constr Surg 92:576–585, 586–587, 1993.
19. Klein HM, Bertalanffy H, Mayfrank L, et
al: Three-dimensional spiral CT for neu-
rosurgical planning. Neuroradiology 36:
435–439, 1994.
20. Nagata Y, Okajima K, Murata R, et al:
Three-dimensional treatment planning
for maxillary cancer using a CT simulator.
Int J Radiat Oncol Biol Phys 30:979–983,
1994.
21. Riley SM, Miller CW, Dobson H, et al:
Surgical procedure simulation via three-
dimensional computer aided reconstruc-
tion of dysplastic canine hips. Vet Comp
Orthop Traumatol 9:152–157, 1996.
22. Southard TE, Morris JH, Southard KA,
et al: A three-dimensional system for
planning orthognathic surgery. A case re-
port. J Am Dent Assoc 125:452–460, 1994.
23. Stephenson JA, Wiley AL Jr: Current
techniques in three-dimensional CT sim-
ulation and radiation treatment planning.
Oncology (Huntingt) 9:1225–1232, 1235–
1240, 1995.
Small Animal/Exotics
24. Kuszyk BS, Ney DR, Fishman EK: The current state of the art in
three dimensional oncologic imaging: An overview. Int J Radiat On-
col Biol Phys 33:1029–1039, 1995.
25. Magid D: Two-dimensional and three-dimensional computed tomo-
graphic imaging in musculoskeletal tumors. Radiol Clin North Am
31:425–447, 1993.
26. Somigliana A, Zonca G, Loi G, et al: How thick should CT/MR
slices be to plan conformal radiotherapy? A study on the accuracy of
three-dimensional volume reconstruction. Tumori 82:470–472,
1996.
27. Jones JC: New techniques in spinal CT. 17th Annu Vet Med Forum:
289–290, 1999.
28. Jones JC, Smith MM, Sponenberg DP, et al: Orbital multilobular
Compendium June 2000
tumor of bone in a basset hound. Vet Comp Ophthalmol 7:111–116,
1997.
29. Tidwell AS, Jones JC: Advanced imaging concepts: A pictorial glos-
sary of CT and MRI technology. Clin Tech Small Anim Pract 14:
65–111, 1999.
30. Oakley R, Shores A, Walshaw R, et al: Computed tomography as an
aid to diagnosing vertebral osteomyelitis. Prog Vet Neurol 6:95–99,
1995.
31. Shores A: New and future advanced imaging techniques. Vet Clin
North Am Small Anim Pract 23:461–469, 1993.
32. Kirchgeorg MA, Prokop M: Increasing spiral CT benefits with post-
processing applications. Eur J Radiol 28:39–54, 1998.