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Obese patient imaging: improved dose efficiency with photon-counting CT

Liu, L. P.; Mei, K.; Sharma, S.; Ross, S.; Halliburton, S. S.; Thompson, R.; Akino, N.; Dhanaliwala, A. H.; Roshkovan, L.; Litt, H. I.; Noël, P. B.

2025-12-29 radiology and imaging
10.64898/2025.12.22.25342398 medRxiv
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ObjectiveTo evaluate the dose efficiency of cadmium-zinc-telluride (CZT) based photon-counting CT (PCCT) compared to energy-integrating detector CT (EID-CT) across phantom sizes. MethodsA patient-specific 3D-printed pancreas phantom and a phantom with tissue mimicking inserts were placed in extension rings corresponding to the 50th, 75th, 85th, and 95th percentile adult waist circumferences. Phantoms were scanned on both PCCT and EID-CT with CTDIvol ranging from 0.5 to 19.4 mGy. Noise was measured in both phantoms to evaluate dose efficiency. Non-Poisson noise at low doses (<2 mGy) was quantified using root mean square error from linear fits of the noise-dose relationship. Potential dose reduction was then assessed by matching noise levels between scanners across phantom sizes. ResultsPCCT demonstrated reduced noise compared to EID-CT across all phantom sizes and doses with average noise reductions of 22%, 23%, 25%, and 28% for the 50th, 75th, 85th, and 95th percentile phantoms, respectively. Noise reduction intensified at lower doses and larger phantom sizes, reaching 88 HU at 1 mGy for the 95th percentile phantom. Non-Poisson noise decreased significantly with PCCT compared to EID-CT for all phantom sizes (p < 0.013). At matched noise levels, PCCT enabled dose reductions of 33% and 44% for the 50th and 95th percentile phantoms, respectively. ConclusionsPCCT exhibited superior dose efficiency compared to EID-CT across a range of phantom sizes. The enhanced dose efficiency enables both noise reduction and potential dose reduction for the imaging of obese patients and low-dose imaging applications. Key PointsO_ST_ABSQuestionC_ST_ABSPhoton-counting CT (PCCT) enables improved quantum detection and eliminates electronic noise, but its benefits have not been evaluated for obese patient sizes. FindingsCompared to EID-CT, PCCT enhanced dose efficiency with noise reduction and potential dose reduction across all phantom sizes and doses. Clinical RelevanceThe improved dose efficiency of PCCT facilitates noise reduction that enables diagnostic image quality, and thereby the diagnostic accuracy, for obese patients.

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