• Korean Journal of Radiology
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• v.23 no.9
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• pp.854-865
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• 2022

Photon-counting detector (PCD) CT is a new CT technology utilizing a direct conversion X-ray detector, where incident X-ray photon energies are directly recorded as electronical signals. The design of the photon-counting detector itself facilitates improvements in spatial resolution (via smaller detector pixel design) and iodine signal (via count weighting) while still permitting multi-energy imaging. PCD-CT can eliminate electronic noise and reduce artifacts due to the use of energy thresholds. Improved dose efficiency is important for low dose CT and pediatric imaging. The ultra-high spatial resolution of PCD-CT design permits lower dose scanning for all body regions and is particularly helpful in identifying important imaging findings in thoracic and musculoskeletal CT. Improved iodine signal may be helpful for low contrast tasks in abdominal imaging. Virtual monoenergetic images and material classification will assist with numerous diagnostic tasks in abdominal, musculoskeletal, and cardiovascular imaging. Dual-source PCD-CT permits multi-energy CT images of the heart and coronary arteries at high temporal resolution. In this special review article, we review the clinical benefits of this technology across a wide variety of radiological subspecialties.

• Korean Journal of Radiology
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• v.25 no.7
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• pp.662-672
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• 2024

Since the emergence of the first photon-counting computed tomography (PCCT) system in late 2021, its advantages and a wide range of applications in all fields of radiology have been demonstrated. Compared to standard energy-integrating detector-CT, PCCT allows for superior geometric dose efficiency in every examination. While this aspect by itself is groundbreaking, the advantages do not stop there. PCCT facilitates an unprecedented combination of ultra-high-resolution imaging without dose penalty or field-of-view restrictions, detector-based elimination of electronic noise, and ubiquitous multi-energy spectral information. Considering the high demands of orthopedic imaging for the visualization of minuscule details while simultaneously covering large portions of skeletal and soft tissue anatomy, no subspecialty may benefit more from this novel detector technology than musculoskeletal radiology. Deeply rooted in experimental and clinical research, this review article aims to provide an introduction to the cosmos of PCCT, explain its technical basics, and highlight the most promising applications for patient care, while also mentioning current limitations that need to be overcome.

• Nuclear Engineering and Technology
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• v.54 no.9
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• pp.3380-3389
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• 2022

We evaluated the performance of an improved hybrid median filter (IHMF) applied to X-ray computed tomography (CT) images obtained using a high-resolution photon-counting cadmium zinc telluride (CZT) detector. To study how the proposed approach improves the image quality, we measured the noise levels and the overall CT-image quality. We established a CZT imaging system with a detector length of 5.12 cm and thickness of 0.3 cm and acquired phantom images. To evaluate the efficacy of the proposed filter, we first modeled two conventional median filters. Subsequently, we were able to achieve a normalized noise power spectrum result of ~10^-8 mm², and furthermore, the proposed method improved the contrast-to-noise ratio by a factor of ~1.51 and the coefficient of variation by 1.55 relative to the counterpart values of the no-filter image. In addition, the IHMF exhibited the best performance among the three filters considered as regards the peak signal-to-noise ratio and no-reference-based image-quality evaluation parameters. Thus, our results demonstrate that the IHMF approach provides a superior image performance over conventional median filtering methods when applied to actual CZT X-ray CT images.

• Progress in Medical Physics
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• v.27 no.3
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• pp.105-110
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• 2016

Sparse angular sampling has been studied recently owing to its potential to decrease the radiation exposure from computed tomography (CT). In this study, we investigated the analytic reconstruction algorithm in sparse angular sampling using the sinogram interpolation method for improving image quality and computation speed. A prototype of the spectral CT system, which has a 64-pixel Cadmium Zinc Telluride (CZT)-based photon-counting detector, was used. The source-to-detector distance and the source-to-center of rotation distance were 1,200 and 1,015 mm, respectively. Two energy bins (23~33 keV and 34~44 keV) were set to obtain two reconstruction images. We used a PMMA phantom with height and radius of 50.0 mm and 17.5 mm, respectively. The phantom contained iodine, gadolinium, calcification, and lipid. The Feld-kamp-Davis-Kress (FDK) with the sinogram interpolation method and Maximum Likelihood Expectation Maximization (MLEM) algorithm were used to reconstruct the images. We evaluated the signal-to-noise ratio (SNR) of the materials. The SNRs of iodine, calcification, and liquid lipid were increased by 167.03%, 157.93%, and 41.77%, respectively, with the 23~33 keV energy bin using the sinogram interpolation method. The SNRs of iodine, calcification, and liquid state lipid were also increased by 107.01%, 13.58%, and 27.39%, respectively, with the 34~44 keV energy bin using the sinogram interpolation method. Although the FDK algorithm with the sinogram interpolation did not produce better results than the MLEM algorithm, it did result in comparable image quality to that of the MLEM algorithm. We believe that the sinogram interpolation method can be applied in various reconstruction studies using the analytic reconstruction algorithm. Therefore, the sinogram interpolation method can improve the image quality in sparse-angular sampling and be applied to CT applications.

• Korean Journal of Radiology
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• v.24 no.10
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• pp.1006-1016
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• 2023

Objective: Computed tomography (CT) is an established method for the diagnosis, staging, and treatment of multiple myeloma. Here, we investigated the potential of photon-counting detector computed tomography (PCD-CT) in terms of image quality, diagnostic confidence, and radiation dose compared with energy-integrating detector CT (EID-CT). Materials and Methods: In this prospective study, patients with known multiple myeloma underwent clinically indicated whole-body PCD-CT. The image quality of PCD-CT was assessed qualitatively by three independent radiologists for overall image quality, edge sharpness, image noise, lesion conspicuity, and diagnostic confidence using a 5-point Likert scale (5 = excellent), and quantitatively for signal homogeneity using the coefficient of variation (CV) of Hounsfield Units (HU) values and modulation transfer function (MTF) via the full width at half maximum (FWHM) in the frequency space. The results were compared with those of the current clinical standard EID-CT protocols as controls. Additionally, the radiation dose (CTDIvol) was determined. Results: We enrolled 35 patients with multiple myeloma (mean age 69.8 ± 9.1 years; 18 [51%] males). Qualitative image analysis revealed superior scores (median [interquartile range]) for PCD-CT regarding overall image quality (4.0 [4.0-5.0] vs. 4.0 [3.0-4.0]), edge sharpness (4.0 [4.0-5.0] vs. 4.0 [3.0-4.0]), image noise (4.0 [4.0-4.0] vs. 3.0 [3.0-4.0]), lesion conspicuity (4.0 [4.0-5.0] vs. 4.0 [3.0-4.0]), and diagnostic confidence (4.0 [4.0-5.0] vs. 4.0 [3.0-4.0]) compared with EID-CT (P ≤ 0.004). In quantitative image analyses, PCD-CT compared with EID-CT revealed a substantially lower FWHM (2.89 vs. 25.68 cy/pixel) and a significantly more homogeneous signal (mean CV ± standard deviation [SD], 0.99 ± 0.65 vs. 1.66 ± 0.5; P < 0.001) at a significantly lower radiation dose (mean CTDIvol ± SD, 3.33 ± 0.82 vs. 7.19 ± 3.57 mGy; P < 0.001). Conclusion: Whole-body PCD-CT provides significantly higher subjective and objective image quality at significantly reduced radiation doses than the current clinical standard EID-CT protocols, along with readily available multi-spectral data, facilitating the potential for further advanced post-processing.

• Journal of the Korean Society of Radiology
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• v.13 no.4
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• pp.523-530
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• 2019

The purpose of this study was to obtain the K-edge images using a spectral CT system based on a photon-counting detector and implement the 3D fusion imaging using the conventional and spectral CT images. Also, we evaluated the clinical feasibility of the 3D fusion images though the quantitative analysis of image quality. A spectral CT system based on a CdTe photon-counting detector was used to obtain K-edge images. A pork phantom was manufactured with the six tubes including diluted iodine and gadolinium solutions. The K-edge images were obtained by the low-energy thresholds of 35 and 52 keV for iodine and gadolinium imaging with the X-ray spectrum, which was generated at a tube voltage of 100 kVp with a tube current of $500{\mu}A$. We implemented 3D fusion imaging by combining the iodine and gadolinium K-edge images with the conventional CT images. The results showed that the CNRs of the 3D fusion images were 6.76-14.9 times higher than those of the conventional CT images. Also, the 3D fusion images was able to provide the maps of target materials. Therefore, the technique proposed in this study can improve the quality of CT images and the diagnostic efficiency through the additional information of target materials.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2002.09a
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• pp.411-414
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• 2002

The CdTe semiconductor detector has a higher detection efficiency for x-rays and $\square$amma rays and a wider energy band gap compared with Si and Ge semiconductor detectors. Therefore, the size of the detector element can be made small, and can be operated at room temperature. The interaction between a CdTe detector and incident x-rays is mainly photoelectric absorption in the photon energy range of up to 100 keV. In this energy range, Compton effects are almost negligible. We have developed a 256 channel CdTe array detector system for monochromatic x-ray CT using synchrotron radiation. The CdTe array detector system, the element size of which is 1.98 mm (h) x 1.98 mm (w) x 0.5 mm (t), was operated in photon counting mode. In order to improve the spatial resolution, we tilted the CdTe array detector against the incident parallel monochromatic x-ray beam. The experiments were performed at the BL20B2 experimental hutch in SPring-8. The energy of incident monochromatic x-rays was set at 55 keV. Phantom measurements were performed at the detector angle of 0, 30 and 45 degrees against the incident parallel monochromatic x-rays. The linear attenuation coefficients were calculated from the reconstructed CT images. By increasing the detector angle, the spatial resolutions were improved. There was no significant difference between the linear attenuation coefficients which were corrected by the detector angle. It was found that this method was useful for improving the spatial resolution in a parallel monochromatic x-ray CT system.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2002.09a
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• pp.379-381
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• 2002

A single CdZnTe detector is tested for suitability in a prototype CT/ SPECT system designed to acquire both emission and transmission data. The detector has the size of 1${\times}$l-cm$^2$ with 4${\times}$4 1.5${\times}$l.5mm$^2$ pixellated anodes. Since the detector is smaller than imaged object, we translated it in an arc centered at the x-ray tube to image larger objects. Pulse counting electronics with very short shaping time (50 ns) are used to satisfy high photon rates in x-ray imaging, and response linearity up to 3${\times}$10$\^$5/ counts per second per detector element is achieved. The energy resolution of 122-keV gamma-ray is measured to be 14%. We have characterized the system performance by scanning a radiographic resolution phantom .and the Hoffman brain phantom. The spatial resolution of CT and SPECT are about 1 mm and 7 mm, respectively.

• Korean Journal of Radiology
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• v.25 no.1
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• pp.86-102
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• 2024

Early diagnosis, accurate assessment, and localization of peritoneal metastasis (PM) are essential for the selection of appropriate treatments and surgical guidance. However, available imaging modalities (computed tomography [CT], conventional magnetic resonance imaging [MRI], and 18fluorodeoxyglucose positron emission tomography [PET]/CT) have limitations. The advent of new imaging techniques and novel molecular imaging agents have revealed molecular processes in the tumor microenvironment as an application for the early diagnosis and assessment of PM as well as real-time guided surgical resection, which has changed clinical management. In contrast to clinical imaging, which is purely qualitative and subjective for interpreting macroscopic structures, radiomics and artificial intelligence (AI) capitalize on high-dimensional numerical data from images that may reflect tumor pathophysiology. A predictive model can be used to predict the occurrence, recurrence, and prognosis of PM, thereby avoiding unnecessary exploratory surgeries. This review summarizes the role and status of different imaging techniques, especially new imaging strategies such as spectral photon-counting CT, fibroblast activation protein inhibitor (FAPI) PET/CT, near-infrared fluorescence imaging, and PET/MRI, for early diagnosis, assessment of surgical indications, and recurrence monitoring in patients with PM. The clinical applications, limitations, and solutions for fluorescence imaging, radiomics, and AI are also discussed.

• Progress in Medical Physics
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• v.13 no.4
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• pp.229-233
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• 2002

We have tested a combined CT/SPECT system with a single CZT detector for x-ray and gamma-ray medical imaging. The size of detector is 10$\times$10$\times$5 ㎣, and the anodes are pixellated as a 4$\times$4 array with a pixel dimension of $1.5\times$1.5 $\textrm{mm}^2$. The cathode was coated with a continuous Au-plated. We have characterized the system performance by scanning a radiographic resolution phantom and the Hoffman Brain phantom. Pulse counting electronics with very short shaping time (50 ㎱) are used to satisfy high photon rates in x-ray imaging, and response linearity up to 3$\times$10$^{5}$ counts per second per detector element is achieved. Energy resolution of 10.4% and 5.3% FWHM at Tc-99m 140 keV peak are obtained for the 50 ㎱ and 2 $mutextrm{s}$ shaping times, respectively. The spatial resolutions of CT and SPECT are about 1mm and 9mm, respectively. Photopeak efficiency of detector systems are 41.0% for 50㎱ and 72.5% for 2 $mutextrm{s}$ shaping time.