Photon counting spectral CT versus conventional CT: comparative evaluation for breast imaging application.

Spectral CT systems with photon counting detectors have more advantages compared to conventional CT systems. However, clinical applications have been hampered for a long time due to the high demands of clinical systems and limitations of spectroscopic x-ray detectors. Photon counting detector technology has gained considerable improvements in the past decade, and spectral CT has become a hot topic. Several experimental spectral CT systems are under investigation. The purpose of this work was to perform the first direct, side-by-side comparison of existing spectral CT technology with a mature clinical CT system based on a conventional energy integrating detector. We have built an experimental spectral CT system whose main parameters are similar to the parameters of a clinical CT system. The system uses a spectroscopic cadmium zinc telluride (CZT) detector. The detector includes two rows of CZT pixels with 256 pixels in each row. The pixel size is 1 × 1 mm(2), and the maximum count rate is 2 Mcounts/pixel/s. The spectral CT system has a magnification factor of 1.62 and the source to detector and source to image distances of 85 and 53 cm, respectively. The above parameters are similar to those of the clinical CT system, Siemens Sensation 16, used for comparison. The two systems were compared by imaging spatial resolution and contrast resolution phantoms made from acrylic cylinders with 14 cm diameters. The resolution phantom included Al wires with 0.3, 0.6, and 1 mm diameters, and 0.25 g cc(-1) CaCO(3) contrast. The contrast phantom included contrast elements with 1.7, 5, and 15 mg cc(-1) iodine, and 1.1, 3.3, and 10 mg cc(-1) gadolinium. The phantoms were imaged with the two systems using 120 kVp tube voltage and 470 mR total skin exposure. The spectral CT showed CT numbers, image noise, and spatial and contrast resolutions to be similar within 10% compared to the Siemens 16 system, and provided an average of 10% higher CNR. However, the spectral CT system had a major advantage in that the iodine, gadolinium, and CaCO(3) contrasts were decomposed by dual-energy and K-edge subtraction methods using energy selective CT data acquired in a single CT scan and fixed tube voltage. It is concluded that photon counting spectral CT technology is close to feasibility for routine clinical applications. Furthermore, it is ready for some clinical applications such as dedicated breast CT which has relatively lower demands on photon counting detectors.