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Clinical applications of photon counting detector CT

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Abstract

The X-ray detector is a fundamental component of a CT system that determines the image quality and dose efficiency. Until the approval of the first clinical photon-counting-detector (PCD) system in 2021, all clinical CT scanners used scintillating detectors, which do not capture information about individual photons in the two-step detection process. In contrast, PCDs use a one-step process whereby X-ray energy is converted directly into an electrical signal. This preserves information about individual photons such that the numbers of X-ray in different energy ranges can be counted. Primary advantages of PCDs include the absence of electronic noise, improved radiation dose efficiency, increased iodine signal and the ability to use lower doses of iodinated contrast material, and better spatial resolution. PCDs with more than one energy threshold can sort the detected photons into two or more energy bins, making energy-resolved information available for all acquisitions. This allows for material classification or quantitation tasks to be performed in conjunction with high spatial resolution, and in the case of dual-source CT, high pitch, or high temporal resolution acquisitions. Some of the most promising applications of PCD-CT involve imaging of anatomy where exquisite spatial resolution adds clinical value. These include imaging of the inner ear, bones, small blood vessels, heart, and lung. This review describes the clinical benefits observed to date and future directions for this technical advance in CT imaging.

Key Points

• Beneficial characteristics of photon-counting detectors include the absence of electronic noise, increased iodine signal-to-noise ratio, improved spatial resolution, and full-time multi-energy imaging.

• Promising applications of PCD-CT involve imaging of anatomy where exquisite spatial resolution adds clinical value and applications requiring multi-energy data simultaneous with high spatial and/or temporal resolution.

• Future applications of PCD-CT technology may include extremely high spatial resolution tasks, such as the detection of breast micro-calcifications, and quantitative imaging of native tissue types and novel contrast agents.

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Abbreviations

CTA:

CT angiography

EID:

Energy integrating detector

ILD:

Interstitial lung disease

PCD:

Photon counting detector

SNR:

Signal-to-noise ratio

VMI:

Virtual monoenergetic image

VNC:

Virtual non-contrast

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Acknowledgements

Portions of the work presented were supported by the National Institutes of Health under award number R01 EB028590. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. In-kind support was received from Siemens Healthineers, who own the system used for image acquisition under the terms of a sponsored research agreement with the Mayo Clinic. The authors thank Mr. Kevin Kimlinger for his assistance with manuscript preparation.

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This study has received funding from the NIH and Siemens Healthineers.

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Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Cynthia H. McCollough, Kishore Rajendran, Francis I. Baffour, Felix E. Diehn, Andrea Ferrero, Katrina N. Glazebrook, Kelly K. Horst, Tucker F. Johnson, Shuai Leng, Achille Mileto, Prabhakar Shantha Rajiah, Lifeng Yu & Joel G. Fletcher

  2. Computed Tomography, Siemens Healthineers, Siemensstrasse 3, Forchheim, 91301, Germany

    Bernhard Schmidt & Thomas G. Flohr

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Correspondence to Cynthia H. McCollough.

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The scientific guarantor of this publication is Cynthia H. McCollough, PhD.

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Some authors of this manuscript declare relationships with the following companies:

• Bernhard Schmidt, PhD and Thomas Flohr, PhD are employees of Siemens Healthineers.

• Cynthia McCollough, PhD is the PI of a research grant to the Mayo Clinic from Siemens Healthineers.

• Joel G Fletcher, MD receives research support from a grant to Mayo Clinic from Siemens Healthineers.

• Kishore Rajendran, PhD, is a member of the Scientific Editorial Board of European Radiology and has not taken part in the review or selection process of this article.

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McCollough, C.H., Rajendran, K., Baffour, F.I. et al. Clinical applications of photon counting detector CT. Eur Radiol 33, 5309–5320 (2023). https://doi.org/10.1007/s00330-023-09596-y

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