Emerging CT Technology to Advance Clinical Care at MGB
In This Article
- Mass General Brigham is leading the charge in implementing photon-counting computed tomography (PCCT), an emerging imaging technology
- With more efficient detection of X-ray photons, PCCT offers a range of benefits over conventional CT, including vastly improved spatial, contrast and sometimes temporal resolution
- Clinical implementation of the technology will both advance existing applications of CT and open the doors to new ones
After 25 years of development, photon-counting computed tomography (PCCT) imaging technology is set to provide myriad improvements in disease diagnosis.
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Mass General Brigham (MGB) researchers and physicians have always worked at the forefront of the development of the technology. Now they are also leading the way in its clinical implementation.
"MGB has a comprehensive plan for validating and deploying PCCT," says Rajiv Gupta, MD, PhD, vice chair for clinical operations in the Department of Radiology at Massachusetts General Hospital and medical director for MGB Enterprise Neuroradiology. "We currently have two full-body PCCT scanners operational at Brigham and Women's Hospital for Emergency and Cardiac imaging. We also have a portable head-only PCCT scanner that is being tested in the Neuro ICU for patients deemed too risky for transportation to a fixed CT scanner in the radiology suite. Many newer installations are planned."
Advantages of PCCT
PCCT offers many advantages, including significantly improved spatial, contrast, and sometimes temporal resolution for the current generation of energy-integrating detectors (EID)-CT systems. With the conventional systems, as with any approach to capturing X-ray information since Röntgen's discovery of the X-ray in 1895, the collection of X-ray photons is largely an indirect process, with noise accumulating at each step along the way, resulting in substantial dose inefficiency. PCCT overcomes this limitation by counting the photons individually and sorting them into distinct energy bins at the detector level—a capability that simply wasn't available before the introduction of the technology.
In a review paper in preparation, Dr. Gupta describes the many applications that will benefit from PCCT. These include both existing applications of EID-CT, which will see improvements with the implementation of PCCT, and applications that were not previously possible.
For existing applications, the enhanced spatial resolution of PCCT—approximately 0.11 mm, compared to the 0.25-0.5 mm currently available with state-of-the-art EID-CT systems—will aid in the detection of subtle disease processes such as the formation of cerebrospinal fluid (CSF)-venous fistulas, a potential cause of spontaneous intracranial hypotension.
Similarly, the improved soft tissue visualization afforded by the technology's superior contrast resolution will advance a host of applications: not least, chest imaging, where studies have demonstrated its potential for assessing pulmonary vasculature, ventilation, and perfusion using spectral post-processing, and cancer imaging, including in the detection of multiple myeloma.
New Horizons
Just as exciting is the potential for new applications that otherwise wouldn't be feasible with CT. As examples, in both interventional and diagnostic imaging, Dr. Gupta points to the possibility of portable PCCT systems contributing to improved intra-operative imaging or facilitating affordable yet precise bedside imaging in intensive care units or in the field as part of mobile stroke units, for instance.
PCCT could also play a role in the emerging field of personalized precision medicine, including in opportunistic screening. Studies have already demonstrated the promise of the technology in several areas. For example, more precise breast tissue characterization with PCCT could facilitate breast cancer screening outside routine mammography. Similarly, improved characterization of bone structure with the technology could play a role in advancing opportunistic screening of bone mineral density and fracture risk.
All of which underscores the potential for improvements in clinical care, both at MGB and elsewhere. "With its intrinsic and fundamental advantages over conventional CT scanners," Dr. Gupta says, "PCCT technology has the potential to open a new window on visualization of many pathologies that have traditionally required MRI or other invasive techniques for diagnosis."
Learn more about Imaging at Massachusetts General Hospital
Learn more about Imaging at Brigham and Women's Hospital