First experimental results with energy-resolved computed tomography (CT) are reported. The contrast-to-noise ratio (CNR) in CT has been improved with x-ray energy weighting for the first time. Further, x-ray energy weighting improved the CNR in material decomposition CT when applied to CT projections prior to dual-energy subtraction. The existing CT systems use an energy (charge) integrating x-ray detector that provides a signal proportional to the energy of the x-ray photon. Thus, the x-ray photons with lower energies are scored less than those with higher energies. This underestimates contribution of lower energy photons that would provide higher contrast. The highest CNR can be achieved if the x-ray photons are scored by a factor that would increase as the x-ray energy decreases. This could be performed by detecting each x-ray photon separately and measuring its energy. The energy selective CT data could then be saved, and any weighting factor could be applied digitally to a detected x-ray photon. The CT system includes a photon counting detector with linear arrays of pixels made from cadmium zinc telluride (CZT) semiconductor. A cylindrical phantom with 10.2 cm diameter made from tissue-equivalent material was used for CT imaging. The phantom included contrast elements representing calcifications, iodine, adipose and glandular tissue. The x-ray tube voltage was 120 kVp. The energy selective CT data were acquired, and used to generate energy-weighted and material-selective CT images. The energy-weighted and material decomposition CT images were generated using a single CT scan at a fixed x-ray tube voltage. For material decomposition the x-ray spectrum was digitally spilt into low- and high-energy parts and dual-energy subtraction was applied. The x-ray energy weighting resulted in CNR improvement of calcifications and iodine by a factor of 1.40 and 1.63, respectively, as compared to conventional charge integrating CT. The x-ray energy weighting was also applied to low- and high-energy CT projections used for material decomposition. This improved the CNR in images of decomposed calcification and iodine by a factor of 1.57 and 1.46, respectively, as compared to conventional charge integrating CT. Some limitations were observed due to hole trapping in CZT and charge sharing between the detector pixels. First experimental results demonstrate that energy-resolved CT is coming close to its practical applications. Although hole trapping and charge sharing in CZT deteriorates x-ray spectrum and limits CNR improvement with energy weighting and detector count rate, this problem has a feasible solution, which is discussed in this paper and is a matter of ongoing research.

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.

The feasibility of computed tomography (CT) with energy-resolved x-ray detection has been investigated. A breast CT design with multi slit multi slice (MSMS) data acquisition was used for this study. The MSMS CT includes linear arrays of photon counting detectors separated by gaps. This CT configuration allows for efficient scatter rejection and 3D data acquisition. The energy-resolved CT images were simulated using a digital breast phantom and the design parameters of the proposed MSMS CT. The phantom had 14 cm diameter and 50/50 adipose/glandular composition, and included carcinoma, adipose, blood, iodine and CaCO3 as contrast elements. The x-ray technique was 90 kVp tube voltage with 660 mR skin exposure. Photon counting, charge (energy) integrating and photon energy weighting CT images were generated. The contrast-to-noise (CNR) improvement with photon energy weighting was quantified. The dual energy subtracted images of CaCO3 and iodine were generated using a single CT scan at a fixed x-ray tube voltage. The x-ray spectrum was electronically split into low- and high-energy parts by a photon counting detector. The CNR of the energy weighting CT images of carcinoma, blood, adipose, iodine, and CaCO3 was higher by a factor of 1.16, 1.20, 1.21, 1.36 and 1.35, respectively, as compared to CT with a conventional charge (energy) integrating detector. Photon energy weighting was applied to CT projections prior to dual energy subtraction and reconstruction. Photon energy weighting improved the CNR in dual energy subtracted CT images of CaCO3 and iodine by a factor of 1.35 and 1.33, respectively. The combination of CNR improvements due to scatter rejection and energy weighting was in the range of 1.71-2 depending on the type of the contrast element. The tilted angle CZT detector was considered as the detector of choice. Experiments were performed to test the effect of the tilting angle on the energy spectrum. Using the CZT detector with 20 degrees tilting angle decreased the tailing of the measured x-ray spectrum as compared to a conventional CZT detector. It was concluded that the energy-resolved MSMS CT with tilted angle CZT detector is potentially feasible and could provide a unique combination of photon counting, energy weighting, scatter rejection and single kVp dual energy subtraction CT imaging.

Photon counting x-ray imaging provides efficient rejection of the electronics noise, no pulse height (Swank) noise, less noise due to optimal photon energy weighting and the possibility of energy resolved image acquisition. These advantages apply also to CT when projection data are acquired using a photon counting detector. However, photon counting detectors assign a weighting factor of 1 to all detected photons whereas the weighting factor of a charge integrating detector is proportional to the energy of the detected photon. Therefore, data collected by photon counting and charge integrating detectors represent the 'hardening' of the photon beam passed through the object differently. This affects the beam hardening artefacts in the reconstructed CT images. This work represents the first comparative evaluation of the effect of photon counting, charge integrating and energy weighting photon detectors on beam hardening artefacts in CT. Beam hardening artefacts in CT images were evaluated for 20 cm and 14 cm diameter water cylinders with bone and low contrast inserts, at 120 kVp and 90 kVp x-ray tube voltages, respectively. It was shown that charge integrating results in 1.8% less beam hardening artefacts from bone inserts (i.e., CT numbers in the 'shadow' of the bone are less by 1.8% as compared to CT numbers over the periphery of the image), as compared to photon counting. However, optimal photon energy weighting, which provides highest SNR, results in 7.7% higher beam hardening artefacts from bone inserts as compared to photon counting. The magnitude of the 'cupping' artefacts was lower by 1% for charge integrating and higher by 6.1% for energy weighting acquisitions as compared to photon counting. Only the photon counting systems provide an accurate representation of the beam hardening effect due to its flat energy weighting. Because of their energy dependent weighting factors, the charge integrating and energy weighting systems do not provide accurate representation of the beam hardening effect.

The delivery accuracy of radiation therapy for pulmonary and abdominal tumors suffers from tumor motion due to respiration. Respiratory gating should be applied to avoid the use of a large target volume margin that results in a substantial dose to the surrounding normal tissue. Precise respiratory gating requires the exact spatial position of the tumor to be determined in real time during treatment. Usually, fiducial markers are implanted inside or next to the tumor to provide both accurate patient setup and real-time tumor tracking. However, current tumor tracking systems require either substantial x-ray exposure to the patient or large fiducial markers that limit the value of their application for pulmonary tumors. We propose a real-time tumor tracking system using implanted positron emission markers (PeTrack). Each marker will be labeled with low activity positron emitting isotopes, such as 124I, 74As, or 84Rb. These isotopes have half-lives comparable to the duration of radiation therapy (from a few days to a few weeks). The size of the proposed PeTrack marker will be 0.5-0.8 mm, which is approximately one-half the size of markers currently employed in other techniques. By detecting annihilation gammas using position-sensitive detectors, multiple positron emission markers can be tracked in real time. A multimarker localization algorithm was developed using an Expectation-Maximization clustering technique. A Monte Carlo simulation model was developed for the PeTrack system. Patient dose, detector sensitivity, and scatter fraction were evaluated. Depending on the isotope, the lifetime dose from a 3.7 MBq PeTrack marker was determined to be 0.7-5.0 Gy at 10 mm from the marker. At the center of the field of view (FOV), the sensitivity of the PeTrack system was 240-320 counts/s per 1 MBq marker activity within a 30 cm thick patient. The sensitivity was reduced by 45% when the marker was near the edge of the FOV. The scatter fraction ranged from 12% (124I, 74As) to 16% (84Rb). In addition, four markers (labeled with 124I) inside a 30 cm diameter water phantom were simulated to evaluate the feasibility of the multimarker localization algorithm. Localization was considered successful if a marker was localized to within 2 mm from its true location. The success rate of marker localization was found to depend on the number of annihilation events used and the error in the initial estimate of the marker position. By detecting 250 positron annihilation events from 4 markers (average of 62 events per marker), the marker success rates for initial errors of +/-5, +/-10, and +/-15 mm were 99.9%, 99.6%, and 92.4%, respectively. Moreover, the average localization error was 0.55 (+/-0.27) mm, which was independent of initial error. The computing time for localizing four markers was less than 20 ms (Pentium 4, 2.8 GHz processor, 512 MB memory). In conclusion, preliminary results demonstrate that the PeTrack technique can potentially provide real-time tumor tracking with low doses associated with the marker's activity. Furthermore,...

A concept of a photon counting cone beam CT is proposed. The system uses a new Multi Slit Multi Slice (MSMS) cone beam acquisition geometry utilizing a linear array photon counting detectors. The MSMS cone beam acquisition is a direct analogy of the scanning multislit acquisition used in projection x-ray imaging. This geometry provides a CT imaging with dose efficient scatter rejection and allows for using available photon counting detectors. The microchannel plate (MCP) detector is proposed as a linear array photon counting detector for MSMS cone beam CT system. Initial testing of the MCP detector for CT application was performed. The field of view of the prototype MCP detector is 60 mm. A delay line position encoding electronics was used. The electronics has a single channel input for evaluation of events from the entire detector field of view. This limits the system count rate at 2 x 10(5) count/s. The spatial resolution of this detector is 80 microm FWHM at 40 kVp and 200 microm FWHM at 90 kVp tube voltages. The detector noise in CT projections is less than 1 count/pixel for the 80 microm pixel size. The CT projections contain quantum-limited and scatter free signal. Images of a contrast phantom and a small animal were acquired at 50 kVp and 80 kVp tube voltages. The CT numbers for different contrast elements were calculated for a given x-ray spectrum and compared with experimental values. The quantum efficiency of the current detector is 56% at 90 kVp, which is suboptimal because of the large channel diameter (25 microm) of these MCPs. The MCPs with smaller channels and higher efficiencies are being tested. The quantum efficiency was measured to be 70% for a new MCP with 5 microm channel diameter. Design parameters of a clinically applicable photon counting MSMS cone beam CT for breast imaging was evaluated. System uses 20 cm field of view MCP detectors based on 5 microm channel MCPs and high count rate ASIC electronics. It was concluded that the MSMS cone beam CT with a photon counting MCP detector is feasible for volume breast imaging.

Characteristic x-ray escape deteriorates energy and spatial resolution, particularly for small pixel sizes. Correction methods should be developed based on the results of the simulations and experimental study.

X-ray imaging with a photon counting/energy weighting detector can provide the highest signal to noise ratio (SNR). Scanning slit/multi-slit x-ray image acquisition can provide a dose-efficient scatter rejection, which increases SNR. Use of a photon counting/energy weighting detector in a scanning slit/multi-slit acquisition geometry could provide highest possible dose efficiency in x-ray and CT imaging. Currently, the most advanced photon counting detector is the cadmium zinc telluride (CZT) detector, which, however, is suboptimal for energy resolved x-ray imaging. A tilted angle CZT detector is proposed in this work for applications in photon counting/energy weighting x-ray and CT imaging. In tilted angle configuration, the x-ray beam hits the surface of the linear array of CZT crystals at a small angle. This allows the use of CZT crystals of a small thickness while maintaining the high photon absorption. Small thickness CZT detectors allow for a significant decrease in the polarization effect in the CZT volume and an increase in count rate. The tilted angle CZT with a small thickness also provides higher spatial and energy resolution, and shorter charge collection time, which potentially enables fast energy resolving x-ray image acquisition. In this work, the major performance parameters of the tilted angle CZT detector, including its count rate, spatial resolution and energy resolution, were evaluated. It was shown that for a CZT detector with a 0.7 mm thickness and 13 degrees tilting angle, the maximum count rate can be increased by 10.7 times, while photon absorption remains >90% at photon energies up to 120 keV. Photon counting/energy weighting x-ray imaging using a tilted angle CZT detector was simulated. SNR improvement due to optimal photon energy weighting was 23% and 14% when adipose contrast element, inserted in soft tissue with 10 cm and 20 cm thickness, respectively, was imaged using 5 energy bins and weighting factors optimized for the adipose. SNR improvement was 42% and 31% when CaCO(3) contrast element, inserted in soft tissue with 10 cm and 20 cm thickness, respectively, was imaged using 5 energy bins and weighting factors optimized for CaCO(3). The SNRs of the photon counting single-kVp dual-energy subtracted images of CaCO(3) and adipose were higher by 2.04 and 2.74 times, respectively, as compared to currently used dual-kVp dual-energy subtracted images. Experiments with a CZT crystal with 2 mm thickness have shown significant decrease in the tailing effect of the CZT pulse spectrum at 59 keV and 122 keV photon energies, when the tilting angle configuration was used. Finally, feasibility of the tilted angle CZT detector for photon counting cone beam breast CT imaging was demonstrated.