Photon-counting computed tomography – clinical application in oncological, cardiovascular, and pediatric radiology

Florian Hagen; Martin Soschynski; Meike Weis; Muhammad Taha Hagar; Patrick Krumm; Isabelle Ayx; Jana Taron; Tobias Krauss; Manuel Hein; Philipp Ruile; Constantin von zur Muehlen; Christopher L. Schlett; Jakob Neubauer; Ilias Tsiflikas; Maximilian Frederik Russe; Philipp Arnold; Sebastian Faby; Matthias F. Froelich; Jakob Weiß; Thomas Stein; Daniel Overhoff; Malte Bongers; Konstantin Nikolaou; Stefan O. Schönberg; Fabian Bamberg; Marius Horger

doi:10.1055/a-2119-5802

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, Table of Contents

Rofo 2024; 196(01): 25-35
DOI: 10.1055/a-2119-5802

Review

Photon-Counting Computertomographie – klinische Anwendungen in der onkologischen, kardiovaskulären und pädiatrischen Radiologie

Article in several languages: English | deutsch

Authors

Florian Hagen

¹Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
Martin Soschynski

²Department of Diagnostic and Interventional Radiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Meike Weis

³Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
Muhammad Taha Hagar

²Department of Diagnostic and Interventional Radiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Patrick Krumm

¹Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
Isabelle Ayx

³Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
Jana Taron

²Department of Diagnostic and Interventional Radiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Tobias Krauss

²Department of Diagnostic and Interventional Radiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Manuel Hein

⁴Department of Cardiology & Angiology, University Heart Center Freiburg – Bad Krozingen, University Hospital Freiburg, Faculty of medicine, 79106 Freiburg, Germany
Philipp Ruile

⁴Department of Cardiology & Angiology, University Heart Center Freiburg – Bad Krozingen, University Hospital Freiburg, Faculty of medicine, 79106 Freiburg, Germany
Constantin von zur Muehlen

⁴Department of Cardiology & Angiology, University Heart Center Freiburg – Bad Krozingen, University Hospital Freiburg, Faculty of medicine, 79106 Freiburg, Germany
Christopher L. Schlett

²Department of Diagnostic and Interventional Radiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Jakob Neubauer

²Department of Diagnostic and Interventional Radiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Ilias Tsiflikas

¹Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
Maximilian Frederik Russe

²Department of Diagnostic and Interventional Radiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Philipp Arnold

²Department of Diagnostic and Interventional Radiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Sebastian Faby

⁵Computed Tomography, Siemens Healthcare GmbH, Forchheim, Germany
Matthias F. Froelich

³Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
Jakob Weiß

²Department of Diagnostic and Interventional Radiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Thomas Stein

²Department of Diagnostic and Interventional Radiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Daniel Overhoff

³Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
Malte Bongers

¹Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
Konstantin Nikolaou

¹Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
Stefan O. Schönberg

³Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
Fabian Bamberg

²Department of Diagnostic and Interventional Radiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Marius Horger

¹Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany

Abstract

Zusammenfassung

Hintergrund Die Technologie der photonenzählenden Computertomografie (PCD-CT) hat Einzug in die klinische Praxis gehalten und wird erstmals in der klinischen Routine eingesetzt. Während die ersten Erfahrungen mit diesem Verfahren in bestimmten Patientengruppen gemacht werden, hat die Technologie das Potenzial, bestehende Arbeitsabläufe zu verändern und neue Möglichkeiten in der diagnostischen Bildgebung zu öffnen.

Methode Der Inhalt dieser Übersicht basiert auf einer uneingeschränkten Literaturrecherche in den Datenbanken PubMed und Google Scholar unter der Verwendung der Suchwörter „Photon-Counting CT“, „Photon-Counting detector“, „spectral CT“, „Computed Tomography“ sowie auf den Erfahrungen der Autoren.

Ergebnisse Der grundlegende Unterschied zu den derzeit etablierten energieintegrierenden CT-Detektoren besteht darin, dass die PCD-CT die Zählung jedes einzelnen Photons auf Detektorebene ermöglicht. Basierend auf der identifizierten Literatur haben PCD-CT-Phantommessungen und erste klinische Studien gezeigt, dass die neue Technologie eine verbesserte räumliche Auflösung, ein reduziertes Bildrauschen, Potenzial zur erheblichen Dosisreduktion und neue Möglichkeiten für quantitative Bildnachbearbeitung ermöglicht.

Schlussfolgerung PCD-CT ist eine neuartige, innovative Technologie mit dem Potenzial, viele der derzeitigen Einschränkungen der CT-Bildgebung in der klinischen Praxis zu überwinden. Insbesondere kritische Patientengruppen, wie onkologische, kardiovaskuläre, pneumologische als auch pädiatrische Patientenkollektive profitieren von den klinischen Vorteilen.

Kernaussagen:

Die PCD-CT wird erstmals in der klinischen Routine eingesetzt und ermöglicht in kritischen Patientenkollektiven, wie der Onkologie, Kardiologie, Pulmonologie und Pädiatrie eine signifikante Dosisreduktion.
Im Vergleich zur herkömmlichen CT ermöglicht die PCD-CT eine Reduzierung des elektronischen Bildrauschens.
Durch die spektralen Datensätze ermöglicht das PCD-CT vollumfängliche Nachbearbeitungs-Applikationen.

Zitierweise

Hagen F, Soschynski M, Weis M et al. Photon-counting computed tomography – clinical application in oncological, cardiovascular, and pediatric radiology. Fortschr Röntgenstr 2024; 196: 25 – 35

Key words

photon-counting - computed tomography - diagnostic imaging - photon-counting detector - spectral computed tomography - energy-integrating detector

Full Text

References

References
1 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: 855-862
2 Paul J-F, Abada HT. Strategies for reduction of radiation dose in cardiac multislice CT. Eur Radiol 2007; 17: 2028-2037
3 Nagayama Y, Oda S, Nakaura T. et al. Radiation Dose Reduction at Pediatric CT: Use of Low Tube Voltage and Iterative Reconstruction. Radiographics. Radiographics: a review publication of the Radiological Society of North America, Inc 2018; 38: 1421-1440
4 Hagen F, Hofmann J, Wrazidlo R. et al. Image quality and dose exposure of contrast-enhanced abdominal CT on a 1st generation clinical dual-source photon-counting detector CT in obese patients vs. a 2nd generation dual-source dual energy integrating detector CT. Eur J Radiol 2022; 151: 110325
5 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 (Ann Arbor, Mich.) 2022; 8: 1466-1476
6 Stein T, Rau A, Russe MF. et al. Photon-Counting-Computertomografie – Grundlagen, mögliche Vorteile und erste klinische Erfahrungen. Fortsch. Röntgenstr.: Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin 2023;
7 van der Bie J, van Straten M, Booij R. et al. Photon-counting CT: Review of initial clinical results. Eur J Radiol 2023; 163: 110829
8 Grunz J-P, Petritsch B, Luetkens KS. et al. Ultra-Low-Dose Photon-Counting CT Imaging of the Paranasal Sinus With Tin Prefiltration: How Low Can We Go?. Invest Radiol 2022; 57: 728-733
9 Willemink MJ, Persson M, Pourmorteza A. et al. Photon-counting CT: Technical Principles and Clinical Prospects. Radiology 2018; 289: 293-312
10 Hiyama T, Kuno H, Sekiya K. et al. Bone Subtraction Iodine Imaging Using Area Detector CT for Evaluation of Skull Base Invasion by Nasopharyngeal Carcinoma. AJNR 2019; 40: 135-141
11 Symons R, Reich DS, Bagheri M. et al. Photon-Counting Computed Tomography for Vascular Imaging of the Head and Neck: First In Vivo Human Results. Invest Radiol 2018; 53: 135-142
12 Pourmorteza A, Symons R, Reich DS. et al. Photon-Counting CT of the Brain: In Vivo Human Results and Image-Quality Assessment. AJNR 2017; 38: 2257-2263
13 Leng S, Bruesewitz M, Tao S. et al. Photon-counting Detector CT: System Design and Clinical Applications of an Emerging Technology. Radiographics: a review publication of the Radiological Society of North America, Inc 2019; 39: 729-743
14 Berger N, Marcon M, Wieler J. et al. Contrast Media-Enhanced Breast Computed Tomography With a Photon-Counting Detector: Initial Experiences on In Vivo Image Quality and Correlation to Histology. Invest Radiol 2022; 57: 704-709
15 Graafen D, Emrich T, Halfmann MC. 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: 315-322
16 Zhou W, Montoya J, Gutjahr R. et al. Lung nodule volume quantification and shape differentiation with an ultra-high resolution technique on a photon-counting detector computed tomography system. J Med Imaging (Bellingham, Wash.) 2017; 4: 43502
17 Inoue A, Johnson TF, Walkoff LA. et al. Lung Cancer Screening Using Clinical Photon-Counting Detector Computed Tomography and Energy-Integrating-Detector Computed Tomography: A Prospective Patient Study. J Comput Assist Tomogr 2023; 47: 229-235
18 Inoue A, Johnson TF, White D. et al. Estimating the Clinical Impact of Photon-Counting-Detector CT in Diagnosing Usual Interstitial Pneumonia. Invest Radiol 2022; 57: 734-741
19 Milos R-I, Röhrich S, Prayer F. et al. Ultrahigh-Resolution Photon-Counting Detector CT of the Lungs: Association of Reconstruction Kernel and Slice Thickness With Image Quality. Am J Roentgenol 2023; 220: 672-680
20 Jungblut L, Kronenberg D, Mergen V. et al. Impact of Contrast Enhancement and Virtual Monoenergetic Image Energy Levels on Emphysema Quantification: Experience With Photon-Counting Detector Computed Tomography. Invest Radiol 2022; 57: 359-365
21 Booij R, van der Werf NR, Dijkshoorn ML. et al. Assessment of Iodine Contrast-To-Noise Ratio in Virtual Monoenergetic Images Reconstructed from Dual-Source Energy-Integrating CT and Photon-Counting CT Data. Diagnostics (Basel, Switzerland) 2022; 12
22 Byl A, Klein L, Sawall S. et al. Photon-counting normalized metal artifact reduction (NMAR) in diagnostic CT. Med Phys 2021; 48: 3572-3582
23 Jungblut L, Euler A, Spiczak von J. et al. Potential of Photon-Counting Detector CT for Radiation Dose Reduction for the Assessment of Interstitial Lung Disease in Patients With Systemic Sclerosis. Invest Radiol 2022; 57: 773-779
24 Woeltjen MM, Niehoff JH, Michael AE. et al. Low-Dose High-Resolution Photon-Counting CT of the Lung: Radiation Dose and Image Quality in the Clinical Routine. Diagnostics (Basel, Switzerland) 2022; 12
25 Jungblut L, Sartoretti T, Kronenberg D. et al. Performance of virtual non-contrast images generated on clinical photon-counting detector CT for emphysema quantification: proof of concept. Brit J Radiol 2022; 95: 20211367
26 Schmidt CS, Zellweger C, Wieler J. et al. Clinical assessment of image quality, usability and patient comfort in dedicated spiral breast computed tomography. Clin Imaging 2022; 90: 50-58
27 Volterrani L, Gentili F, Fausto A. et al. Dual-Energy CT for Locoregional Staging of Breast Cancer: Preliminary Results. Am J Roentgenol 2020; 214: 707-714
28 Wetzl M, Dietzel M, Ohlmeyer S. et al. Spiral breast computed tomography with a photon-counting detector (SBCT): The future of breast imaging?. Eur J Radiol 2022; 157: 110605
29 Decker JA, Bette S, Lubina N. et al. Low-dose CT of the abdomen: Initial experience on a novel photon-counting detector CT and comparison with energy-integrating detector CT. Eur J Radiol 2022; 148: 110181
30 Bette S, Decker JA, Braun FM. et al. Optimal Conspicuity of Liver Metastases in Virtual Monochromatic Imaging Reconstructions on a Novel Photon-Counting Detector CT-Effect of keV Settings and BMI. Diagnostics (Basel, Switzerland) 2022; 12
31 Sartoretti T, Landsmann A, Nakhostin D. et al. Quantum Iterative Reconstruction for Abdominal Photon-counting Detector CT Improves Image Quality. Radiology 2022; 303: 339-348
32 Si-Mohamed S, Thivolet A, Bonnot P-E. et al. Improved Peritoneal Cavity and Abdominal Organ Imaging Using a Biphasic Contrast Agent Protocol and Spectral Photon Counting Computed Tomography K-Edge Imaging. Invest Radiol 2018; 53: 629-639
33 Si-Mohamed S, Tatard-Leitman V, Laugerette A. et al. Spectral Photon-Counting Computed Tomography (SPCCT): in-vivo single-acquisition multi-phase liver imaging with a dual contrast agent protocol. Sci Rep 2019; 9: 8458
34 Ren L, Rajendran K, Fletcher JG. et al. Simultaneous Dual-Contrast Imaging of Small Bowel With Iodine and Bismuth Using Photon-Counting-Detector Computed Tomography: A Feasibility Animal Study. Invest Radiol 2020; 55: 688-694
35 Muenzel D, Bar-Ness D, Roessl E. et al. Spectral Photon-counting CT: Initial Experience with Dual-Contrast Agent K-Edge Colonography. Radiology 2017; 283: 723-728
36 Ren L, Huber N, Rajendran K. et al. Dual-Contrast Biphasic Liver Imaging With Iodine and Gadolinium Using Photon-Counting Detector Computed Tomography: An Exploratory Animal Study. Invest Radiol 2022; 57: 122-129
37 Kaufmann S, Horger T, Oelker A. et al. Characterization of hepatocellular carcinoma (HCC) lesions using a novel CT-based volume perfusion (VPCT) technique. Eur J Radiol 2015; 84: 1029-1035
38 Niehoff JH, Woeltjen MM, Saeed S. et al. Assessment of hepatic steatosis based on virtual non-contrast computed tomography: Initial experiences with a photon counting scanner approved for clinical use. Eur J Radiol 2022; 149: 110185
39 Marcus RP, Fletcher JG, Ferrero A. et al. Detection and Characterization of Renal Stones by Using Photon-Counting-based CT. Radiology 2018; 289: 436-442
40 Peña JA, Klein L, Maier J. et al. Dose-efficient assessment of trabecular microstructure using ultra-high-resolution photon-counting CT. Zeitschrift fur medizinische Physik 2022; 32: 403-416
41 Bette SJ, Braun FM, Haerting M. et al. Visualization of bone details in a novel photon-counting dual-source CT scanner-comparison with energy-integrating CT. Eur Radiol 2022; 32: 2930-2936
42 Grunz J-P, Heidenreich JF, Lennartz S. et al. Spectral Shaping Via Tin Prefiltration in Ultra-High-Resolution Photon-Counting and Energy-Integrating Detector CT of the Temporal Bone. Invest Radiol 2022; 57: 819-825
43 Wehrse E, Sawall S, Klein L. et al. Potential of ultra-high-resolution photon-counting CT of bone metastases: initial experiences in breast cancer patients. NPJ breast cancer 2021; 7: 3
44 Rajendran K, Baffour F, Powell G. et al. Improved visualization of the wrist at lower radiation dose with photon-counting-detector CT. Skelet Radiol 2023; 52: 23-29
45 Baffour FI, Rajendran K, Glazebrook KN. 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: 7079-7086
46 Chappard C, Abascal J, Olivier C. et al. Virtual monoenergetic images from photon-counting spectral computed tomography to assess knee osteoarthritis. Eur Radiol Exp 2022; 6: 10
47 Tortora M, Gemini L, D’Iglio I. et al. Spectral Photon-Counting Computed Tomography: A Review on Technical Principles and Clinical Applications. J Imaging 2022; 8
48 Baffour FI, Glazebrook KN, Ferrero A. et al. Photon-Counting Detector CT for Musculoskeletal Imaging: A Clinical Perspective. Am J Roentgenol 2023; 220: 551-560
49 Gosangi B, Mandell JC, Weaver MJ. et al. Bone Marrow Edema at Dual-Energy CT: A Game Changer in the Emergency Department. Radiographics: a review publication of the Radiological Society of North America, Inc 2020; 40: 859-874
50 Narula J, Chandrashekhar Y, Ahmadi A. et al. SCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr 2021; 15: 192-217
51 Arbab-Zadeh A, Miller JM, Rochitte CE. et al. Diagnostic accuracy of computed tomography coronary angiography according to pre-test probability of coronary artery disease and severity of coronary arterial calcification. The CORE-64 (Coronary Artery Evaluation Using 64-Row Multidetector Computed Tomography Angiography) International Multicenter Study. J Am Coll Cardiol 2012; 59: 379-387
52 Song YB, Arbab-Zadeh A, Matheson MB. et al. Contemporary Discrepancies of Stenosis Assessment by Computed Tomography and Invasive Coronary Angiography. Circ Cardiovasc Imaging 2019; 12: e007720
53 Puchner SB, Liu T, Mayrhofer T. et al. High-risk plaque detected on coronary CT angiography predicts acute coronary syndromes independent of significant stenosis in acute chest pain: results from the ROMICAT-II trial. J Am Coll Cardiol 2014; 64: 684-692
54 Hoffmann U, Ferencik M, Cury RC. et al. Coronary CT angiography. J Nucl Med: official publication, Society of Nuclear Medicine 2006; 47: 797-806
55 Rotzinger DC, Racine D, Becce F. et al. Performance of Spectral Photon-Counting Coronary CT Angiography and Comparison with Energy-Integrating-Detector CT: Objective Assessment with Model Observer. Diagnostics (Basel, Switzerland) 2021; 11
56 Si-Mohamed SA, Boccalini S, Lacombe H. et al. Coronary CT Angiography with Photon-counting CT: First-In-Human Results. Radiology 2022; 303: 303-313
57 Symons R, Bruecker de Y, Roosen J. et al. Quarter-millimeter spectral coronary stent imaging with photon-counting CT: Initial experience. J Cardiovasc Comput Tomogr 2018; 12: 509-515
58 Mannil M, Hickethier T, Spiczak von J. et al. Photon-Counting CT: High-Resolution Imaging of Coronary Stents. Invest Radiol 2018; 53: 143-149
59 Sigovan M, Si-Mohamed S, Bar-Ness D. et al. Feasibility of improving vascular imaging in the presence of metallic stents using spectral photon counting CT and K-edge imaging. Sci Rep 2019; 9: 19850
60 Sartoretti T, Racine D, Mergen V. et al. Quantum Iterative Reconstruction for Low-Dose Ultra-High-Resolution Photon-Counting Detector CT of the Lung. Diagnostics (Basel, Switzerland) 2022; 12
61 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: 780-788
62 Taylor CA, Fonte TA, Min JK. Computational fluid dynamics applied to cardiac computed tomography for noninvasive quantification of fractional flow reserve: scientific basis. J Am Coll Cardiol 2013; 61: 2233-2241
63 Eldevik K, Nordhøy W, Skretting A. Relationship between sharpness and noise in CT images reconstructed with different kernels. Radiat Prot Dosim 2010; 139: 430-433
64 Chaosuwannakit N, Aupongkaroon P, Makarawate P. Determine Cumulative Radiation Dose and Lifetime Cancer Risk in Marfan Syndrome Patients Who Underwent Computed Tomography Angiography of the Aorta in Northeast Thailand: A 5-Year Retrospective Cohort Study. Tomography (Ann Arbor, Mich.) 2022; 8: 120-130
65 Higashigaito K, Mergen V, Eberhard M. et al. CT Angiography of the Aorta Using Photon-counting Detector CT with Reduced Contrast Media Volume. Radiology: Cardiothoracic Imaging 2023; 5: e220140
66 Sandfort V, Persson M, Pourmorteza A. et al. Spectral photon-counting CT in cardiovascular imaging. J Cardiovasc Comput Tomogr 2021; 15: 218-225
67 Decker JA, Bette S, Scheurig-Muenkler C. et al. Virtual Non-Contrast Reconstructions of Photon-Counting Detector CT Angiography Datasets as Substitutes for True Non-Contrast Acquisitions in Patients after EVAR-Performance of a Novel Calcium-Preserving Reconstruction Algorithm. Diagnostics (Basel, Switzerland) 2022; 12
68 Nasirudin RA, Mei K, Penchev P. et al. Reduction of metal artifact in single photon-counting computed tomography by spectral-driven iterative reconstruction technique. PLoS one 2015; 10: e0124831
69 Weidman EK, Plodkowski AJ, Halpenny DF. et al. Dual-Energy CT Angiography for Detection of Pulmonary Emboli: Incremental Benefit of Iodine Maps. Radiology 2018; 289: 546-553
70 Sandfort V, Palanisamy S, Symons R. et al. Optimized energy of spectral CT for infarct imaging: Experimental validation with human validation. J Cardiovasc Comput Tomogr 2017; 11: 171-178
71 Ohta Y, Kitao S, Yunaga H. et al. Myocardial Delayed Enhancement CT for the Evaluation of Heart Failure: Comparison to MRI. Radiology 2018; 288: 682-691
72 Mergen V, Sartoretti T, Klotz E. et al. Extracellular Volume Quantification With Cardiac Late Enhancement Scanning Using Dual-Source Photon-Counting Detector CT. Invest Radiol 2022; 57: 406-411
73 Dangelmaier J, Bar-Ness D, Daerr H. et al. Experimental feasibility of spectral photon-counting computed tomography with two contrast agents for the detection of endoleaks following endovascular aortic repair. Eur Radiol 2018; 28: 3318-3325
74 Miglioretti DL, Johnson E, Williams A. et al. The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr 2013; 167: 700-707
75 Hauptmann M, Byrnes G, Cardis E. et al. Brain cancer after radiation exposure from CT examinations of children and young adults: results from the EPI-CT cohort study. The Lancet. Oncology 2023; 24: 45-53
76 Esser M, Tsiflikas I, Kraus MS. et al. Wertigkeit der Thorax-CT bei Kindern: Befunde in Abhängigkeit der klinischen Fragestellung. Fortsch. Röntgenstr.: Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin 2022; 194: 281-290
77 Rapp JB, Biko DM, White AM. et al. Spectral imaging in the pediatric chest: past, present and future. Pediatr Radiol 2022; 52: 1910-1920
78 Tsiflikas I, Thater G, Ayx I. et al. Low dose pediatric chest computed tomography on a photon counting detector system – initial clinical experience. Pediatr Radiol 2023;
79 McCollough CH, Rajendran K, Baffour FI. et al. Clinical applications of photon counting detector CT. Eur Radiol 2023;
80 Rajendran K, Petersilka M, Henning A. et al. First Clinical Photon-counting Detector CT System: Technical Evaluation. Radiology 2022; 303: 130-138
81 Cao J, Bache S, Schwartz FR. et al. Pediatric Applications of Photon-Counting Detector CT. Am J Roentgenol 2023; 220: 580-589