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Getting Started with Photon-counting CT: Optimizing Your Setup for Success

RADIOGRAPHICS(2025)

Brigham & Womens Hosp

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Abstract
As photon-counting CT (PCCT) gains wider clinical acceptance and is implemented in more practice settings, guidance for implementing this cutting-edge imaging modality in its currently clinically available form (NAEOTOM Alpha; Siemens Healthineers) is needed. Understanding the core physics of PCCT, particularly the nuances in detector technology, is paramount for achieving optimal imaging system setup and proficient image acquisition. Through a comprehensive overview of PCCT physics and real-life case examples to highlight the technologic differences from conventional energy-integrating detector CT systems, the radiologist will be able to effectively implement PCCT in clinical practice. The key steps taken when starting a successful PCCT imaging practice across radiology subspecialties includes (a) imaging system setup; (b) protocol development, emphasizing the critical role of tailored protocols in achieving diagnostic precision and radiation dose optimization and introducing new terminology; (c) the imaging process, highlighting the importance of optimizing scan modes to suit clinical requirements; and (d) postimaging considerations, including the interpretation of system outputs and the judicious selection of images for routine transmission to the picture archiving and communication system. This article serves as a reference for radiologists, technologists, medical physicists, and informatics teams seeking to harness the full potential of PCCT. By optimizing workflow and facilitating adept image interpretation, this guidance aims to augment diagnostic capabilities and elevate the standard of patient care in the era of PCCT.
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