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While X-ray photon-counting detectors (PCDs) promise to revolutionize medical imaging, theoretical frameworks to evaluate them are commonly limited to incident fluence rates sufficiently low that the detector response can be considered linear. However, typical clinical operating conditions lead to a significant level of pile-up, invalidating this assumption of a linear response. Here, we present a framework that aims to evaluate PCDs, taking into account their non-linear behavior.
Approach
We employ small-signal analysis to study the behavior of PCDs under pile-up conditions. The response is approximated as linear around a given operating point, determined by the incident spectrum and fluence rate. The detector response is subsequently described by the proposed perturbation point spread function (pPSF). We demonstrate this approach using Monte-Carlo simulations of idealized direct- and indirect-conversion PCDs.
Results
The pPSFs of two PCDs are calculated. It is then shown how the pPSF allows to determine the sensitivity of the detector signal to an arbitrary lesion. This example illustrates the detrimental influence of pile-up, which may cause non-intuitive effects such as contrast/contrast-to-noise ratio inversion or cancellation between/within energy bins.
Conclusions
The proposed framework permits quantifying the spectral and spatial performance of PCDs under clinically realistic conditions at a given operating point. The presented example illustrates why PCDs should not be analyzed assuming that they are linear systems. The framework can, for example, be used to guide the development of PCDs and PCD-based systems. Furthermore, it can be applied to adapt commonly used measures, such as the modulation transfer function, to non-linear PCDs.
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We aim to compare the low-contrast detectability of a clinical whole-body photon-counting-detector (PCD)-CT at different scan modes and image types with an energy-integrating-detector (EID)-CT.
Approach
We used a channelized Hotelling observer (CHO) previously optimized for quality control purposes. An American College of Radiology CT accreditation phantom was scanned on both PCD-CT and EID-CT with 10 phantom positionings. For PCD-CT, images were generated using two scan modes, standard resolution (SR) and ultra-high-resolution (UHR); two image types, virtual monochromatic images at 70 keV and low-energy threshold (T3D); both filtered-back-projection (FBP) and iterative reconstruction (IR) reconstruction methods; and three reconstruction kernels. For each positioning, three repeated scans were acquired for each scan mode, image type, and CTDIvol of 6, 12, and 24 mGy. For EID-CT, images acquired from scans (10 positionings × 3 repeats × 3 doses) were reconstructed using the closest counterpart FBP and IR kernels. CHO was applied to calculate the index of detectability (d′) on both scanners.
Results
With the smooth Br44 kernel, the d′ of UHR was mostly comparable with that of the SR mode (difference: −11.4% to 8.3%, p=0.020 to 0.956), and the T3D images had a higher d′ (difference: 0.7% to 25.6%) than 70 keV images on PCD-CT. Compared with the EID-CT, UHR-T3D of PCD-CT had non-inferior d′ (difference: −2.7% to 12.9%) with IR and non-superior d′ (difference: 0.8% to 11.2%) with FBP using the Br44 kernel. PCD-CT produced higher d′ than EID-CT by 61.8% to 247.1% with the sharper reconstruction kernels.
Conclusions
The comparison between PCD-CT and EID-CT was significantly influenced by the reconstruction method and kernel. With a smooth kernel that is typically used in low-contrast detection tasks, the PCD-CT demonstrated low-contrast detectability that was comparable to EID-CT with IR and showed no superiority when using FBP. With the use of sharper kernels, the PCD-CT significantly outperformed EID-CT in low-contrast detectability.
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We aim to reduce image noise in high-resolution (HR) virtual monoenergetic images (VMIs) from photon-counting detector (PCD) CT scans by developing a prior knowledge-aware iterative denoising neural network (PKAID-Net) that efficiently exploits the unique noise characteristics of VMIs at different energy (keV) levels.
Approach
PKAID-Net offers two major features: first, it utilizes a lower-noise VMI (e.g., 70 keV) as a prior input; second, it iteratively constructs a refined training dataset to improve the neural network’s denoising performance. In each iteration, the denoised image from the previous module serves as an updated target image, which is included in the dataset for the subsequent training iteration. Our study includes 10 patient coronary CT angiography exams acquired on a clinical dual-source PCD-CT (NAEOTOM Alpha, Siemens Healthineers). The HR VMIs were reconstructed at 50, 70, and 100 keV, using a sharp vascular kernel (Bv68) and thin (0.6 mm) slice thickness (0.3 mm increment). PKAID-Net’s performance was evaluated in terms of image noise, spatial detail preservation, and quantitative accuracy.
Results
PKAID-Net achieved a noise reduction of 96% compared to filtered back projection and 65% relative to iterative reconstruction, all while preserving spatial and spectral fidelity and maintaining a natural noise texture. The iterative refinement of PCD-CT data during the training process substantially enhanced the robustness of deep learning-based denoising compared to the original method, which resulted in some spatial detail loss.
Conclusions
The PKAID-Net provides substantial noise reduction while maintaining spatial and spectral fidelity of the HR VMIs from PCD-CT.
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Photon counting CT (PCCT) provides spectral measurements for material decomposition. However, the image noise (at a fixed dose) depends on the source spectrum. Our study investigates the potential benefits from spectral optimization using fast kV switching and filtration to reduce noise in material decomposition.
Approach
The effect of the input spectra on noise performance in both two-basis material decomposition and three-basis material decomposition was compared using Cramer-Rao lower bound analysis in the projection domain and in a digital phantom study in the image domain. The fluences of different spectra were normalized using the CT dose index to maintain constant dose levels. Four detector response models based on Si or CdTe were included in the analysis.
Results
For single kV scans, kV selection can be optimized based on the imaging task and object size. Furthermore, our results suggest that noise in material decomposition can be substantially reduced with fast kV switching. For two-material decomposition, fast kV switching reduces the standard deviation (SD) by ∼10%. For three-material decomposition, greater noise reduction in material images was found with fast kV switching (26.2% for calcium and 25.8% for iodine, in terms of SD), which suggests that challenging tasks benefit more from the richer spectral information provided by fast kV switching.
Conclusions
The performance of PCCT in material decomposition can be improved by optimizing source spectrum settings. Task-specific tube voltages can be selected for single kV scans. Also, our results demonstrate that utilizing fast kV switching can substantially reduce the noise in material decomposition for both two- and three-material decompositions, and a fixed Gd filter can further enhance such improvements for two-material decomposition.
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Evaluation of iodine quantification accuracy with varying iterative reconstruction level, patient habitus, and acquisition mode on a first-generation dual-source photon-counting computed tomography (PCCT) system.
Approach
A multi-energy CT phantom with and without its extension ring equipped with various iodine inserts (0.2 to 15.0 mg/ml) was scanned over a range of radiation dose levels (CTDIvol 0.5 to 15.0 mGy) using two tube voltages (120, 140 kVp) and two different source modes (single-, dual-source). To assess the agreement between nominal and measured iodine concentrations, iodine density maps at different iterative reconstruction levels were utilized to calculate root mean square error (RMSE) and generate Bland–Altman plots by grouping radiation dose levels (ultra-low: <1.5; low: 1.5 to 5; medium: 5 to 15 mGy) and iodine concentrations (low: <5; high: 5 to 15 mg/mL).
Results
Overall, quantification of iodine concentrations was accurate and reliable even at ultra-low radiation dose levels. RMSE ranged from 0.25 to 0.37, 0.20 to 0.38, and 0.25 to 0.37 mg/ml for ultra-low, low, and medium radiation dose levels, respectively. Similarly, RMSE was stable at 0.31, 0.28, 0.33, and 0.30 mg/ml for tube voltage and source mode combinations. Ultimately, the accuracy of iodine quantification was higher for the phantom without an extension ring (RMSE 0.21 mg/mL) and did not vary across different levels of iterative reconstruction.
Conclusions
The first-generation PCCT allows for accurate iodine quantification over a wide range of iodine concentrations and radiation dose levels. Stable accuracy across iterative reconstruction levels may allow further radiation exposure reductions without affecting quantitative results.
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It has been debated whether photon counting detectors (PCDs) with moderate numbers of energy windows (NE) perform better than PCDs with higher NE. A higher NE results in fewer photons in each energy window, which degrades the signal-to-noise ratio of each datum. Unlike energy-integrating detectors, PCDs add very little electronic noise to measured counts; however, there exists electronic noise on the pulse train, to which multiple energy thresholds are applied to count photons. The noise may increase the uncertainty of counts within energy windows; however, this effect has not been studied in the context of spectral imaging tasks. We aim to investigate the effect of NE on the quality of the spectral information in the presence of electronic noise.
Approach
We obtained the following three types of PCD data with various NE (= 2 to 24) and noise levels using a Monte Carlo simulation: (A) A PCD with no electronic noise; (B) realistic PCDs with electronic noise added to the pulse train; and (C) hypothetical PCDs with electronic noise added to each energy window’s output, similar to energy-integrating detectors. We evaluated the Cramér–Rao lower bound (CRLB) of estimation for the following two spectral imaging tasks: (a) water–bone material decomposition and (b) K-edge imaging.
Results
For both the e-noise-free and realistic PCDs, the CRLB improved monotonically with increasing NE for both tasks. In contrast, a moderate NE provided the best CRLB for the hypothetical PCDs, and the optimal NE was smaller when electronic noise was larger. Adding one energy window to the minimum necessary NE for a given task gained 66.2% to 68.7% of the improvement NE=24 provided.
Conclusion
For realistic PCDs, the quality of the spectral information monotonically improves with increasing NE.
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We provide a comparison of X-ray fluorescence emission tomography (XFET) and computed tomography (CT) for detecting low concentrations of gold nanoparticles (GNPs) in soft tissue and characterize the conditions under which XFET outperforms energy-integrating CT (EICT) and photon-counting CT (PCCT).
Approach
We compared dose-matched Monte Carlo XFET simulations and analytical fan-beam EICT and PCCT simulations. Each modality was used to image a numerical mouse phantom and contrast-depth phantom containing GNPs ranging from 0.05% to 4% by weight in soft tissue. Contrast-to-noise ratios (CNRs) of gold regions were compared among the three modalities, and XFET’s detection limit was quantified based on the Rose criterion. A partial field-of-view (FOV) image was acquired for the phantom region containing 0.05% GNPs.
Results
For the mouse phantom, XFET produced superior CNR values (CNRs=24.5, 21.6, and 3.4) compared with CT images obtained with both energy-integrating (CNR=4.4, 4.6, and 1.5) and photon-counting (CNR=6.5, 7.7, and 2.0) detection systems. More generally, XFET outperformed CT for superficial imaging depths (<28.75mm) for gold concentrations at and above 0.5%. XFET’s surface detection limit was quantified as 0.44% for an average phantom dose of 16 mGy compatible with in vivo imaging. XFET’s ability to image partial FOVs was demonstrated, and 0.05% gold was easily detected with an estimated dose of ∼81.6cGy to a localized region of interest.
Conclusions
We demonstrate a proof of XFET’s benefit for imaging low concentrations of gold at superficial depths and the feasibility of XFET for in vivo metal mapping in preclinical imaging tasks.
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Proton radiation therapy may achieve precise dose delivery to the tumor while sparing non-cancerous surrounding tissue, owing to the distinct Bragg peaks of protons. Aligning the high-dose region with the tumor requires accurate estimates of the proton stopping power ratio (SPR) of patient tissues, commonly derived from computed tomography (CT) image data. Photon-counting detectors for CT have demonstrated advantages over their energy-integrating counterparts, such as improved quantitative imaging, higher spatial resolution, and filtering of electronic noise. We assessed the potential of photon-counting computed tomography (PCCT) for improving SPR estimation by training a deep neural network on a domain transform from PCCT images to SPR maps.
Approach
The XCAT phantom was used to simulate PCCT images of the head with CatSim, as well as to compute corresponding ground truth SPR maps. The tube current was set to 260 mA, tube voltage to 120 kV, and number of view angles to 4000. The CT images and SPR maps were used as input and labels for training a U-Net.
Results
Prediction of SPR with the network yielded average root mean square errors (RMSE) of 0.26% to 0.41%, which was an improvement on the RMSE for methods based on physical modeling developed for single-energy CT at 0.40% to 1.30% and dual-energy CT at 0.41% to 3.00%, performed on the simulated PCCT data.
Conclusions
These early results show promise for using a combination of PCCT and deep learning for estimating SPR, which in extension demonstrates potential for reducing the beam range uncertainty in proton therapy.
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Photon counting detectors offer promising advancements in computed tomography (CT) imaging by enabling the quantification and three-dimensional imaging of contrast agents and tissue types through simultaneous multi-energy projections from broad X-ray spectra. However, the accuracy of these decomposition methods hinges on precise composite spectral attenuation values that one must reconstruct from spectral micro-CT. Errors in such estimations could be due to effects such as beam hardening, object scatter, or detector sensor–related spectral distortions such as fluorescence. Even if accurate spectral correction is done, multi-material separation within a volume remains a challenge. Increasing the number of energy bins in material decomposition problems often comes with a significant noise penalty but with minimal decomposition benefits.
Approach
We begin with an empirical spectral correction method executed in the tomographic domain that accounts for distortions in estimated spectral attenuation for each voxel. This is followed by our proposed iterative clustering material decomposition (ICMD) where clustering of voxels is used to reduce the number of basis materials to be resolved for each cluster. Using a larger number of energy bins for the clustering step shows distinct advantages in excellent classification to a larger number of clusters with accurate cluster centers when compared with the National Institute of Standards and Technology attenuation values. The decomposition step is applied to each cluster separately where each cluster has fewer basis materials compared with the entire volume. This is shown to reduce the need for the number of energy bins required in each decomposition step for the clusters. This approach significantly increases the total number of materials that can be decomposed within the volume with high accuracy and with excellent noise properties.
Results
Utilizing a (cadmium telluride 1-mm-thick sensor) Medipix detector with a 55-μm pitch, we demonstrate the quantitatively accurate decomposition of several materials in a phantom study, where the sample includes mixtures of soft materials such as water and poly-methyl methacrylate along with contrast-enhancing materials. We show improved accuracy and lower noise when all five energy bins were used to yield effective classification of voxels into multiple accurate fundamental clusters which was followed by the decomposition step applied to each cluster using just two energy bins. We also show an example of biological sample imaging and separating three distinct types of tissue in mice: muscle, fat, and bone. Our experimental results show that the combination of effective and practical spectral correction and high-dimensional data clustering enhances decomposition accuracy and reduces noise in micro-CT.
Conclusions
This ICMD allows for quantitative separation of multiple materials including mixtures and also effectively separates multi-contrast agents.
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High soft-tissue contrast imaging is essential for effective radiotherapy treatment. This could potentially be realized using both megavoltage and kilovoltage x-ray sources available on some therapy treatment systems to perform “MV-kV” dual-energy (DE) computed tomography (CT). However, noisy megavoltage images obtained with existing energy-integrating detectors (EIDs) are a limiting factor for clinical translation. We explore the potential for non-spectral photon-counting detectors (PCDs) to improve MV-kV image quality simply by equally weighting all MV photons rather than up-weighting the less informative, lower contrast high-energy photons as in an EID.
Approach
Three computational methods were applied to compare non-spectral PCDs with EIDs in MV-kV DE imaging. A single-line integral estimation theory approach was used to calculate the basis material signal-to-noise ratio (SNR) of tissue (1 to 50 cm) and bone (0.1 to 10 cm). CT images of a tissue cylinder with seven bone inserts (densities 1.0 to 2.2g/cm3) were simulated to assess material decomposition accuracy. Multiple noisy simulations of an anthropomorphic phantom were performed to generate pixel-by-pixel noise profiles.
Results
PCDs yielded a 15% to 45% improvement in single-line integral SNR for both materials. In CT simulations, similar material decomposition accuracy was achieved, with both EIDs and PCDs slightly underestimating bone density. However, PCDs yield a higher contrast-to-noise ratio and more uniform noise texture than EIDs in virtual monoenergetic images.
Conclusions
We demonstrate the potential for improved MV-kV DE CT imaging using non-spectral PCDs and quantify the degree of improvement in a range of object compositions. This work motivates the experimental assessment of PCDs for megavoltage imaging and the potential clinical translation of PCDs to radiotherapy imaging.
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