A comprehensive review on photon-counting computed tomography: Principles, technical hurdles and analysis of clinical applications_Journal of Biomedical Engineering

Authors：

ZHANG Haowei ¹ , LI Shuhan ¹ ,  LIU Ying ¹ ,  LU Heqing ²

1. School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, P. R. China;
2. Department of Equipment, Shanghai First Maternity and Infant Hospital, Shanghai 201204, P. R. China;

Corresponding author：

Keywords：

Photon-counting detector; Photon-counting computed tomography; Charge sharing; Pulse pileup; Clinical application

DOI：

10.7507/1001-5515.202305015

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In recent years, photon-counting computed tomography (PCD-CT) based on photon-counting detectors (PCDs) has become increasingly utilized in clinical practice. Compared with conventional CT, PCD-CT has the potential to achieve micron-level spatial resolution, lower radiation dose, negligible electronic noise, multi-energy imaging, and material identification, etc. This advancement facilitates the promotion of ultra-low dose scans in clinical scenarios, potentially detecting minimal and hidden lesions, thus significantly improving image quality. However, the current state of the art is limited and issues such as charge sharing, pulse pileup, K-escape and count rate drift remain unresolved. These issues could lead to a decrease in image resolution and energy resolution, while an increasing in image noise and ring artifact and so on. This article systematically reviewed the physical principles of PCD-CT, and outlined the structural differences between PCDs and energy integration detectors (EIDs), and the current challenges in the development of PCD-CT. In addition, the advantages and disadvantages of three detector materials were analysed. Then, the clinical benefits of PCD-CT were presented through the clinical application of PCD-CT in the three diseases with the highest mortality rate in China (cardiovascular disease, tumour and respiratory disease). The overall aim of the article is to comprehensively assist medical professionals in understanding the technological innovations and current technical limitations of PCD-CT, while highlighting the urgent problems that PCD-CT needs to address in the coming years.

Citation： ZHANG Haowei, LI Shuhan, LIU Ying, LU Heqing. A comprehensive review on photon-counting computed tomography: Principles, technical hurdles and analysis of clinical applications. Journal of Biomedical Engineering, 2023, 40(5): 1012-1018. doi: 10.7507/1001-5515.202305015 Copy

1.	刘峰, 朱月香, 崔书君, 等. 双能量CT的基本原理与研究进展. 中国医学物理学杂志, 2022, 39(2): 198-202.
2.	Flohr T, Petersilka M, Henning A, et al. Photon-counting CT review. Phys Med, 2020, 79: 126-136.
3.	陈海燕, 杨永波, 刘璐璐, 等. 光子计数探测器CT初步临床应用的研究进展. 中华放射学杂志, 2022, 56(2): 213-216.
4.	Wang S, Yu H, Xi Y, et al. Spectral-image decomposition with energy-fusion sensing for spectral CT reconstruction. IEEE Trans Instrum Meas, 2021, 70: 1-11.
5.	Willemink M J, Persson M, Pourmorteza A, et al. Photon-counting CT: technical principles and clinical prospects. Radiology, 2018, 289(2): 293-312.
6.	Leng S, Bruesewitz M, Tao S, et al. Photon-counting detector CT: system design and clinical applications of an emerging technology. RadioGraphics, 2019, 39(3): 729-743.
7.	Flohr T G, Stierstorfer K, Süss C, et al. Novel ultrahigh resolution data acquisition and image reconstruction for multi-detector row CT. Med Phys, 2007, 34(5): 1712-1723.
8.	Saeed A M, Lotfy K, El-Bary A A. Hall current effect of magnetic-optical-elastic-thermal-diffusive semiconductor model during electrons-holes excitation processes. J Math, 2022, 2022: e6597924.
9.	Greffier J, Frandon J. Spectral photon-counting CT system: toward improved image quality performance in conventional and spectral CT imaging. Diagn Interv Imaging, 2021, 102(5): 271-272.
10.	Flohr T, Schmidt B. Technical basics and clinical benefits of photon-counting CT. Invest Radiol, 2023, 58(7): 441.
11.	Taguchi K, Iwanczyk J S. Assessment of multi-energy inter-pixel coincidence counters for photon-counting detectors at the presence of charge sharing and pulse pileup: a simulation study. Med Phys, 2021, 48(9): 4909-4925.
12.	Wang A S, Pelc N J. Spectral photon counting CT: imaging algorithms and performance assessment. IEEE Trans Radiat Plasma Med Sci, 2021, 5(4): 453-464.
13.	Cheng Xu, Danielsson M, Bornefalk H. Evaluation of energy loss and charge sharing in cadmium telluride detectors for photon-counting computed tomography. IEEE Trans Nucl Sci, 2011, 58(3): 614-625.
14.	Shikhaliev P M, Fritz S G, Chapman J W. Photon counting multienergy X-ray imaging: effect of the characteristic X rays on detector performance. Med Phys, 2009, 36(11): 5107-5119.
15.	Taguchi K. Multi-energy inter-pixel coincidence counters for charge sharing correction and compensation in photon counting detectors. Med Phys, 2020, 47(5): 2085-2098.
16.	Danielsson M, Persson M, Sjölin M. Photon-counting X-ray detectors for CT. Phys Med Biol, 2021, 66(3): 03TR01.
17.	Jenkins P J B, Schmidt T G. Experimental study of photon-counting CT neural network material decomposition under conditions of pulse pileup. J Med Imaging, 2021, 8(1): 013502.
18.	Jeon B, Lim S, Lee E, et al. Deep learning-based pulse height estimation for separation of pile-up pulses from NaI(Tl) detector. IEEE Trans Nucl Sci, 2022, 69(6): 1344-1351.
19.	Pickford Scienti O L P, Bamber J C, Darambara D G. CdTe based energy resolving, X-ray photon counting detector performance assessment: the effects of charge sharing correction algorithm choice. Sensors, 2020, 20(21): 6093.
20.	Ji X, Treb K, Li K. Anomalous edge response of cadmium telluride-based photon counting detectors jointly caused by high-flux radiation and inter-pixel communication. Phys Med Biol, 2021, 66(8): 085006.
21.	Sidky E Y, Paul E R, Gilat-Schmidt T, et al. Spectral calibration of photon-counting detectors at high photon flux. Med Phys, 2022, 49(10): 6368-6383.
22.	Taguchi K, Polster C, Segars W P, et al. Model-based pulse pileup and charge sharing compensation for photon counting detectors: a simulation study. Med Phys, 2022, 49(8): 5038-5051.
23.	Kreisler B. Photon counting detectors: concept, technical challenges, and clinical outlook. Eur J Radiol, 2022, 149: 110229.
24.	马丽媛, 王增武, 樊静, 等. 《中国心血管健康与疾病报告2021》要点解读. 中国全科医学, 2022, 25(27): 3331-3346.
25.	Vecsey-Nagy M, Jokkel Z, Jermendy Á L, et al. The impact of novel reconstruction algorithms on calcium scoring: results on a dedicated cardiac CT scanner. Diagnostics, 2023, 13(4): 789.
26.	Koons E, VanMeter P, Rajendran K, et al. Improved quantification of coronary artery luminal stenosis in the presence of heavy calcifications using photon-counting detector CT. Proc SPIE Int Soc Opt Eng, 2022, 12031: 120311A.
27.	Sandfort V, Persson M, Pourmorteza A, et al. Spectral photon-counting CT in cardiovascular imaging. J Cardiovasc Comput Tomogr, 2021, 15(3): 218-225.
28.	Petritsch B, Petri N, Weng A M, et al. Photon-counting computed tomography for coronary stent imaging: in vitro evaluation of 28 coronary stents. Invest Radiol, 2021, 56(10): 653.
29.	Mannil M, Hickethier T, Von Spiczak J, et al. Photon-counting CT. Invest Radiol, 2018, 53(3): 143-149.
30.	Polacin M, Templin C, Manka R, et al. Photon-counting computed tomography for the diagnosis of myocardial infarction with non-obstructive coronary artery disease. Eur Heart J Case Rep, 2022, 6(2): ytac028.
31.	Symons R, Sandfort V, Mallek M, et al. Coronary artery calcium scoring with photon-counting CT: first in vivo human experience. Int J Cardiovasc Imaging, 2019, 35(4): 733-739.
32.	Fink N, Schoepf U J. Photon counting detectors – not only a technical breakthrough, but also a new era in patient care?. Eur J Radiol, 2022, 154: 110435.
33.	Hagen F, Walder L, Fritz J, et al. Image quality and radiation dose of contrast-enhanced chest-CT acquired on a clinical photon-counting detector CT vs. second-generation dual-source CT in an oncologic cohort: preliminary results. Tomography, 2022, 8(3): 1466-1476.
34.	Tugwell-Allsup J, Owen B W, England A. Low-dose chest CT and the impact on nodule visibility. Radiography, 2021, 27(1): 24-30.
35.	Tækker M, Kristjánsdóttir B, Graumann O, et al. Diagnostic accuracy of low-dose and ultra-low-dose CT in detection of chest pathology: a systematic review. Clin Imaging, 2021, 74: 139-148.
36.	Wrazidlo R, Walder L, Estler A, et al. Radiation dose reduction in contrast-enhanced abdominal CT: comparison of photon-counting detector CT with 2nd generation dual-source dual-energy CT in an oncologic cohort. Acad Radiol, 2023, 30(5): 855-862.
37.	Bartlett D J, Koo C W, Bartholmai B J, et al. High-resolution chest computed tomography imaging of the lungs: impact of 1024 matrix reconstruction and photon-counting detector computed tomography. Invest Radiol, 2019, 54(3): 129.
38.	Jungblut L, Blüthgen C, Polacin M, et al. First performance evaluation of an artificial intelligence-based computer-aided detection system for pulmonary nodule evaluation in dual-source photon-counting detector CT at different low-dose levels. Invest Radiol, 2022, 57(2): 108.
39.	Inoue A, Johnson T F, White D, et al. Estimating the clinical impact of photon-counting-detector CT in diagnosing usual interstitial pneumonia. Invest Radiol, 2022, 57(11): 734.
40.	Sotoudeh-Paima S, Segars W P, Samei E, et al. Photon-counting CT versus conventional CT for COPD quantifications: intra-scanner optimization and inter-scanner assessments using virtual imaging trials// Medical Imaging 2022: Physics of Medical Imaging. San Francisco: SPIE, 2022: 120312I-1-120312I-9.
41.	Klintström B, Henriksson L, Moreno R, et al. Photon-counting detector CT and energy-integrating detector CT for trabecular bone microstructure analysis of cubic specimens from human radius. Eur Radiol Exp, 2022, 6(1): 31.
42.	Peña J A, Klein L, Maier J, et al. Dose-efficient assessment of trabecular microstructure using ultra-high-resolution photon-counting CT. Z Für Med Phys, 2022, 32(4): 403-416.
43.	Bhattarai A, Honkanen J T J, Myller K A H, et al. Quantitative dual contrast CT technique for evaluation of articular cartilage properties. Ann Biomed Eng, 2018, 46(7): 1038-1046.
44.	Michael A E, Boriesosdick J, Schoenbeck D, et al. Photon counting CT angiography of the head and neck: image quality assessment of polyenergetic and virtual monoenergetic reconstructions. Diagnostics, 2022, 12(6): 1306.
45.	Graafen D, Emrich T, Halfmann M C, et al. Dose reduction and image quality in photon-counting detector high-resolution computed tomography of the chest: routine clinical data. J Thorac Imaging, 2022, 37(5): 315.
46.	Mergen V, Sartoretti T, Baer-Beck M, et al. Ultra-high-resolution coronary CT angiography with photon-counting detector CT: feasibility and image characterization. Invest Radiol, 2022, 57(12): 780.
47.	Zhou W, Michalak G J, Weaver J M, et al. A universal protocol for abdominal CT examinations performed on a photon-counting detector CT system: a feasibility study. Invest Radiol, 2020, 55(4): 226.
48.	Baffour F I, Rajendran K, Glazebrook K N, et al. Ultra-high-resolution imaging of the shoulder and pelvis using photon-counting-detector CT: a feasibility study in patients. Eur Radiol, 2022, 32(10): 7079-7086.
49.	Rajendran K, Baffour F, Powell G, et al. Improved visualization of the wrist at lower radiation dose with photon-counting-detector CT. Skeletal Radiol, 2023, 52(1): 23-29.
50.	Decker J A, Huber A, Senel F, et al. Anemia detection by hemoglobin quantification on contrast-enhanced photon-counting CT data sets. Radiology, 2022, 305(3): 650-652.
51.	Sharma S, Pal D, Abadi E, et al. Can photon-counting CT improve estimation accuracy of morphological radiomics features? A simulation study for assessing the quantitative benefits from improved spatial resolution in deep silicon-based photon-counting CT. Acad Radiol, 2023, 30(6): 1153-1163.

1. 刘峰, 朱月香, 崔书君, 等. 双能量CT的基本原理与研究进展. 中国医学物理学杂志, 2022, 39(2): 198-202.
2. Flohr T, Petersilka M, Henning A, et al. Photon-counting CT review. Phys Med, 2020, 79: 126-136.
3. 陈海燕, 杨永波, 刘璐璐, 等. 光子计数探测器CT初步临床应用的研究进展. 中华放射学杂志, 2022, 56(2): 213-216.
4. Wang S, Yu H, Xi Y, et al. Spectral-image decomposition with energy-fusion sensing for spectral CT reconstruction. IEEE Trans Instrum Meas, 2021, 70: 1-11.
5. Willemink M J, Persson M, Pourmorteza A, et al. Photon-counting CT: technical principles and clinical prospects. Radiology, 2018, 289(2): 293-312.
6. Leng S, Bruesewitz M, Tao S, et al. Photon-counting detector CT: system design and clinical applications of an emerging technology. RadioGraphics, 2019, 39(3): 729-743.
7. Flohr T G, Stierstorfer K, Süss C, et al. Novel ultrahigh resolution data acquisition and image reconstruction for multi-detector row CT. Med Phys, 2007, 34(5): 1712-1723.
8. Saeed A M, Lotfy K, El-Bary A A. Hall current effect of magnetic-optical-elastic-thermal-diffusive semiconductor model during electrons-holes excitation processes. J Math, 2022, 2022: e6597924.
9. Greffier J, Frandon J. Spectral photon-counting CT system: toward improved image quality performance in conventional and spectral CT imaging. Diagn Interv Imaging, 2021, 102(5): 271-272.
10. Flohr T, Schmidt B. Technical basics and clinical benefits of photon-counting CT. Invest Radiol, 2023, 58(7): 441.
11. Taguchi K, Iwanczyk J S. Assessment of multi-energy inter-pixel coincidence counters for photon-counting detectors at the presence of charge sharing and pulse pileup: a simulation study. Med Phys, 2021, 48(9): 4909-4925.
12. Wang A S, Pelc N J. Spectral photon counting CT: imaging algorithms and performance assessment. IEEE Trans Radiat Plasma Med Sci, 2021, 5(4): 453-464.
13. Cheng Xu, Danielsson M, Bornefalk H. Evaluation of energy loss and charge sharing in cadmium telluride detectors for photon-counting computed tomography. IEEE Trans Nucl Sci, 2011, 58(3): 614-625.
14. Shikhaliev P M, Fritz S G, Chapman J W. Photon counting multienergy X-ray imaging: effect of the characteristic X rays on detector performance. Med Phys, 2009, 36(11): 5107-5119.
15. Taguchi K. Multi-energy inter-pixel coincidence counters for charge sharing correction and compensation in photon counting detectors. Med Phys, 2020, 47(5): 2085-2098.
16. Danielsson M, Persson M, Sjölin M. Photon-counting X-ray detectors for CT. Phys Med Biol, 2021, 66(3): 03TR01.
17. Jenkins P J B, Schmidt T G. Experimental study of photon-counting CT neural network material decomposition under conditions of pulse pileup. J Med Imaging, 2021, 8(1): 013502.
18. Jeon B, Lim S, Lee E, et al. Deep learning-based pulse height estimation for separation of pile-up pulses from NaI(Tl) detector. IEEE Trans Nucl Sci, 2022, 69(6): 1344-1351.
19. Pickford Scienti O L P, Bamber J C, Darambara D G. CdTe based energy resolving, X-ray photon counting detector performance assessment: the effects of charge sharing correction algorithm choice. Sensors, 2020, 20(21): 6093.
20. Ji X, Treb K, Li K. Anomalous edge response of cadmium telluride-based photon counting detectors jointly caused by high-flux radiation and inter-pixel communication. Phys Med Biol, 2021, 66(8): 085006.
21. Sidky E Y, Paul E R, Gilat-Schmidt T, et al. Spectral calibration of photon-counting detectors at high photon flux. Med Phys, 2022, 49(10): 6368-6383.
22. Taguchi K, Polster C, Segars W P, et al. Model-based pulse pileup and charge sharing compensation for photon counting detectors: a simulation study. Med Phys, 2022, 49(8): 5038-5051.
23. Kreisler B. Photon counting detectors: concept, technical challenges, and clinical outlook. Eur J Radiol, 2022, 149: 110229.
24. 马丽媛, 王增武, 樊静, 等. 《中国心血管健康与疾病报告2021》要点解读. 中国全科医学, 2022, 25(27): 3331-3346.
25. Vecsey-Nagy M, Jokkel Z, Jermendy Á L, et al. The impact of novel reconstruction algorithms on calcium scoring: results on a dedicated cardiac CT scanner. Diagnostics, 2023, 13(4): 789.
26. Koons E, VanMeter P, Rajendran K, et al. Improved quantification of coronary artery luminal stenosis in the presence of heavy calcifications using photon-counting detector CT. Proc SPIE Int Soc Opt Eng, 2022, 12031: 120311A.
27. Sandfort V, Persson M, Pourmorteza A, et al. Spectral photon-counting CT in cardiovascular imaging. J Cardiovasc Comput Tomogr, 2021, 15(3): 218-225.
28. Petritsch B, Petri N, Weng A M, et al. Photon-counting computed tomography for coronary stent imaging: in vitro evaluation of 28 coronary stents. Invest Radiol, 2021, 56(10): 653.
29. Mannil M, Hickethier T, Von Spiczak J, et al. Photon-counting CT. Invest Radiol, 2018, 53(3): 143-149.
30. Polacin M, Templin C, Manka R, et al. Photon-counting computed tomography for the diagnosis of myocardial infarction with non-obstructive coronary artery disease. Eur Heart J Case Rep, 2022, 6(2): ytac028.
31. Symons R, Sandfort V, Mallek M, et al. Coronary artery calcium scoring with photon-counting CT: first in vivo human experience. Int J Cardiovasc Imaging, 2019, 35(4): 733-739.
32. Fink N, Schoepf U J. Photon counting detectors – not only a technical breakthrough, but also a new era in patient care?. Eur J Radiol, 2022, 154: 110435.
33. Hagen F, Walder L, Fritz J, et al. Image quality and radiation dose of contrast-enhanced chest-CT acquired on a clinical photon-counting detector CT vs. second-generation dual-source CT in an oncologic cohort: preliminary results. Tomography, 2022, 8(3): 1466-1476.
34. Tugwell-Allsup J, Owen B W, England A. Low-dose chest CT and the impact on nodule visibility. Radiography, 2021, 27(1): 24-30.
35. Tækker M, Kristjánsdóttir B, Graumann O, et al. Diagnostic accuracy of low-dose and ultra-low-dose CT in detection of chest pathology: a systematic review. Clin Imaging, 2021, 74: 139-148.
36. Wrazidlo R, Walder L, Estler A, et al. Radiation dose reduction in contrast-enhanced abdominal CT: comparison of photon-counting detector CT with 2nd generation dual-source dual-energy CT in an oncologic cohort. Acad Radiol, 2023, 30(5): 855-862.
37. Bartlett D J, Koo C W, Bartholmai B J, et al. High-resolution chest computed tomography imaging of the lungs: impact of 1024 matrix reconstruction and photon-counting detector computed tomography. Invest Radiol, 2019, 54(3): 129.
38. Jungblut L, Blüthgen C, Polacin M, et al. First performance evaluation of an artificial intelligence-based computer-aided detection system for pulmonary nodule evaluation in dual-source photon-counting detector CT at different low-dose levels. Invest Radiol, 2022, 57(2): 108.
39. Inoue A, Johnson T F, White D, et al. Estimating the clinical impact of photon-counting-detector CT in diagnosing usual interstitial pneumonia. Invest Radiol, 2022, 57(11): 734.
40. Sotoudeh-Paima S, Segars W P, Samei E, et al. Photon-counting CT versus conventional CT for COPD quantifications: intra-scanner optimization and inter-scanner assessments using virtual imaging trials// Medical Imaging 2022: Physics of Medical Imaging. San Francisco: SPIE, 2022: 120312I-1-120312I-9.
41. Klintström B, Henriksson L, Moreno R, et al. Photon-counting detector CT and energy-integrating detector CT for trabecular bone microstructure analysis of cubic specimens from human radius. Eur Radiol Exp, 2022, 6(1): 31.
42. Peña J A, Klein L, Maier J, et al. Dose-efficient assessment of trabecular microstructure using ultra-high-resolution photon-counting CT. Z Für Med Phys, 2022, 32(4): 403-416.
43. Bhattarai A, Honkanen J T J, Myller K A H, et al. Quantitative dual contrast CT technique for evaluation of articular cartilage properties. Ann Biomed Eng, 2018, 46(7): 1038-1046.
44. Michael A E, Boriesosdick J, Schoenbeck D, et al. Photon counting CT angiography of the head and neck: image quality assessment of polyenergetic and virtual monoenergetic reconstructions. Diagnostics, 2022, 12(6): 1306.
45. Graafen D, Emrich T, Halfmann M C, et al. Dose reduction and image quality in photon-counting detector high-resolution computed tomography of the chest: routine clinical data. J Thorac Imaging, 2022, 37(5): 315.
46. Mergen V, Sartoretti T, Baer-Beck M, et al. Ultra-high-resolution coronary CT angiography with photon-counting detector CT: feasibility and image characterization. Invest Radiol, 2022, 57(12): 780.
47. Zhou W, Michalak G J, Weaver J M, et al. A universal protocol for abdominal CT examinations performed on a photon-counting detector CT system: a feasibility study. Invest Radiol, 2020, 55(4): 226.
48. Baffour F I, Rajendran K, Glazebrook K N, et al. Ultra-high-resolution imaging of the shoulder and pelvis using photon-counting-detector CT: a feasibility study in patients. Eur Radiol, 2022, 32(10): 7079-7086.
49. Rajendran K, Baffour F, Powell G, et al. Improved visualization of the wrist at lower radiation dose with photon-counting-detector CT. Skeletal Radiol, 2023, 52(1): 23-29.
50. Decker J A, Huber A, Senel F, et al. Anemia detection by hemoglobin quantification on contrast-enhanced photon-counting CT data sets. Radiology, 2022, 305(3): 650-652.
51. Sharma S, Pal D, Abadi E, et al. Can photon-counting CT improve estimation accuracy of morphological radiomics features? A simulation study for assessing the quantitative benefits from improved spatial resolution in deep silicon-based photon-counting CT. Acad Radiol, 2023, 30(6): 1153-1163.

Journal of Biomedical Engineering

A comprehensive review on photon-counting computed tomography: Principles, technical hurdles and analysis of clinical applications

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