The introduction of photon-counting detectors is expected to be the next major breakthrough in clinical x-ray computed tomography (CT). During the last decade, there has been considerable research activity in the field of photon-counting CT, in terms of both hardware development and theoretical understanding of the factors affecting image quality. In this article, we review the recent progress in this field with the intent of highlighting the relationship between detector design considerations and the resulting image quality. We discuss detector design choices such as converter material, pixel size, and readout electronics design, and then elucidate their impact on detector performance in terms of dose efficiency, spatial resolution, and energy resolution. Furthermore, we give an overview of data processing, reconstruction methods and metrics of imaging performance; outline clinical applications; and discuss potential future developments.

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Photon-counting detectors are expected to bring a range of improvements to patient imaging with x-ray computed tomography (CT). One is higher spatial resolution. We demonstrate the resolution obtained using a commercial CT scanner where the original energy-integrating detector has been replaced by a singleslice, silicon-based, photon-counting detector. This prototype constitutes the first full-field-of-view silicon-based CT scanner capable of patient scanning. First, the pixel response function and focal spot profile are measured and, combining the two, the system modulation transfer function is calculated. Second, the prototype is used to scan a resolution phantom and a skull phantom. The resolution images are compared to images from a state-ofthe-art CT scanner. The comparison shows that for the prototype 19 lp∕cm are detectable with the same clarity as 14 lp∕cm on the reference scanner at equal dose and reconstruction grid, with more line pairs visible with increasing dose and decreasing image pixel size. The high spatial resolution remains evident in the anatomy of the skull phantom and is comparable to that of other photon-counting CT prototypes present in the literature. We conclude that the deep silicon-based detector used in our study could provide improved spatial resolution in patient imaging without increasing the x-ray dose.

Summing of counts after digitization may be a simpler alternative to summing of charge prior to digitization due to the relative complexity of analog circuit design. Over most conditions studied, it provides roughly half the benefit of ACS and may offer certain implementation advantages.