A decade of photon-counting CT research: Bibliometric trends and emerging themes
Keywords:
Photon-counting CT; Bibliometric analysis; Spectral imaging; Citation analysis; Medical imaging trendsAbstract
Background and aim: Photon-counting computed tomography (PCCT) represents a significant advancement in medical imaging, offering improved spatial resolution, spectral imaging capabilities, and enhanced tissue characterization. This bibliometric analysis provides a comprehensive overview of PCCT research trends.
Methods: A total of 1,390 articles were retrieved from the Scopus database without time restrictions. Articles were ranked based on citation count, and data extraction included title, authorship, publication year, journal impact, citation metrics, study design, funding sources, and subject classification.
Results: Results indicate a rapid growth in PCCT-related publications, with the highest output recorded in 2024. The United States, Germany, and Switzerland emerged as leading contributors. Original research articles dominated (62.37%), followed by conference papers (14.68%) and review articles (12.23%). Keyword co-occurrence analysis highlighted major research themes, including spectral imaging, material decomposition, image quality, and artificial intelligence applications. The citation analysis revealed that foundational research on PCCT technology, image reconstruction, and artifact reduction has shaped the field.
Conclusions: The study underscores the growing clinical relevance of PCCT, particularly in cardiovascular imaging, oncology, and musculoskeletal applications. (www.actabiomedica.it)
References
1. Willemink MJ, Persson M, Pourmorteza A, Pelc NJ, Fleischmann D Photon-counting CT: technical principles and clinical prospects. Radiology. 2018;289:293-312. doi:10.1148/radiol.2018172656
2. U.S. Food and Drug Administration September 2021 510(k) clearances [Internet]. 2021 [cited 2021 Nov 18]. Available from: https://www.fda.gov/medical-devices/510k-clearances/september-2021-510k-clearances
3. Pourmorteza A, Symons R, Henning A, Ulzheimer S, Bluemke DA Image quality assessment and dose-efficiency of quarter-millimeter photon-counting CT of humans: first in vivo experience [abstract]. In: Radiological Society of North America Scientific Assembly and Annual Meeting Program. 2017;:101. PMID:29595753
4. Kappler S, Hannemann T, Kraft E, et al. First results from a hybrid prototype CT scanner for exploring benefits of quantum-counting in clinical CT. Proc SPIE Med Imaging. 2012;8313:83130X. doi:10.1117/12.911295
5. Leng S, Yu Z, Halaweish A, et al. A high-resolution imaging technique using a whole-body, research photon counting detector CT system. Proc SPIE Med Imaging. 2016;9783:97831I. PMID:27330238
6. Zhou W, Montoya J, Gutjahr R, et al. Lung nodule volume quantification and shape differentiation with an ultra-high resolution technique on a photon counting detector CT system. J Med Imaging (Bellingham). 2017;4:043502. doi:10.1117/1.JMI.4.4.043502
7. Rössler AC, Kalender W, Kolditz D, et al. Performance of photon-counting breast computed tomography, digital mammography, and digital breast tomosynthesis in evaluating breast specimens. Acad Radiol. 2017;24:184-190. doi:10.1016/j.acra.2016.09.017
8. Reddy T, McLaughlin PD, Mallinson PI, et al. Detection of occult, undisplaced hip fractures with a dual-energy CT algorithm targeted to detection of bone marrow edema. Emerg Radiol. 2015;22:25-9. doi:10.1007/s10140-014-1249-6
9. Kuno H, Onaya H, Iwata R, et al. Evaluation of cartilage invasion by laryngeal and hypopharyngeal squamous cell carcinoma with dual-energy CT. Radiology. 2012;265:488-96. doi:10.1148/radiol.12111719
10. Wang AS, Hsieh SS, Pelc NJ Dual-energy and multienergy techniques in vascular imaging. In: Savader C, Rudin S, editors. Cardiovascular and neuromuscular imaging: physics and technology. Boca Raton (FL): CRC Press; 2015. p. 191-202.
11. Dong J, Wang X, Jiang X, et al. Low-contrast agent dose dual-energy CT monochromatic imaging in pulmonary angiography versus routine CT. J Comput Assist Tomogr. 2013;37:618-25. doi:10.1097/RCT.0b013e31828f5020
12. Mongan J, Rathnayake S, Fu Y, et al. In vivo differentiation of complementary contrast media at dual-energy CT. Radiology. 2012;265:267-272. doi:10.1148/radiol.12120692
13. Taguchi K, Iwanczyk JS Vision 20/20: single photon counting x-ray detectors in medical imaging. Med Phys. 2013;40:100901. doi:10.1118/1.4820371
14. van Eck NJ, Waltman L Software survey: VOSviewer, a computer program for bibliometric mapping. Scientometrics. 2010;84:523-38. doi:10.1007/s11192-009-0146-3
15. Ahmi A, Mohamad R Bibliometric analysis of global scientific literature on web accessibility. Int J Recent Technol Eng. 2019;7:250-8. PMID: Not available
16. Boas F, Fleischmann D CT artifacts: causes and reduction techniques. Imaging Med. 2012;4:229-40. doi:10.2217/iim.12.13
17. Rajendran K, Petersilka M, Henning A, et al. First clinical photon-counting detector CT system: technical evaluation. Radiology. 2022;303:130-8. doi:10.1148/radiol.212579
18. Perera Molligoda Arachchige AS, Catapano F, Lisi C, et al. Trends in clinical cardiac photon-counting detector CT research: a comprehensive bibliometric analysis. Diagnostics (Basel). 2025;15:504. doi:10.3390/diagnostics15040504
19. Nehra AK, Rajendran K, Baffour FI, et al. Seeing more with less: clinical benefits of photon-counting detector CT. Radiographics. 2023;43:e220158. doi:10.1148/rg.220158
20. Fletcher JG, Inoue A, Bratt A, et al. Photon-counting CT in thoracic imaging: early clinical evidence and incorporation into clinical practice. Radiology. 2024;310:e231986. doi:10.1148/radiol.231986
21. Douek PC, Boccalini S, Oei EHG, et al. Clinical applications of photon-counting CT: a review of pioneer studies and a glimpse into the future. Radiology. 2023;309:e222432. doi:10.1148/radiol.222432
22. Schwartz FR, Sodickson AD, Pickhardt PJ, Sahani DV, Lev MH, Gupta R Photon-counting CT: technology, current and potential future clinical applications, and overview of approved systems and those in various stages of research and development. Radiology. 2025;314:e240662. doi:10.1148/radiol.240662
23. Pontone G, Mushtaq S, Pizzi C, Maurovich-Horvat P, Leipsic J, Serruys P Photon-counting computed tomography: a revolution in cardiac imaging. Eur Heart J. 2026;:ehaf1118. doi:10.1093/eurheartj/ehaf1118
24. Cademartiri F, Maffei E, Cau R, et al. Current and future applications of photon-counting computed tomography in cardiovascular medicine. Heart. 2025;111:1109-1118. doi:10.1136/heartjnl-2025-325790
25. Wang R, Zhao W, Lv B, et al. Diagnostic accuracy of photon-counting computed tomography for detecting coronary artery stenosis: a systematic review and meta-analysis. Heart. 2026;:heartjnl-2025-327108. doi:10.1136/heartjnl-2025-327108
26. Koetzier LR, Mastrodicasa D, Szczykutowicz TP, et al. Deep learning image reconstruction for CT: technical principles and clinical prospects. Radiology. 2023;306:e221257. doi:10.1148/radiol.221257
27. Mese I, Taslicay CA, Sivrioglu AK Synergizing photon-counting CT with deep learning: potential enhancements in medical imaging. Acta Radiol. 2024;65:159-66. doi:10.1177/02841851231217995
28. Mileto A, Yu L, Revels JW, et al. State-of-the-art deep learning CT reconstruction algorithms in abdominal imaging. Radiographics. 2024;44:e240095. doi:10.1148/rg.240095
29. Yu L, Chen GH, Fletcher JG, et al. Deep learning in CT image reconstruction and processing: techniques, performance evaluation, radiation dose, and future perspective. Br J Radiol. 2025;98:1775-87. doi:10.1093/bjr/tqaf260
30. Zhang R, Szczykutowicz TP, Toia GV Artificial intelligence in computed tomography image reconstruction: a review of recent advances. J Comput Assist Tomogr. 2025;49:521-30. doi:10.1097/RCT.0000000000001734
31. Hagar MT, Soschynski M, Saffar R, et al. Accuracy of ultrahigh-resolution photon-counting CT for detecting coronary artery disease in a high-risk population. Radiology. 2023;307:e223305. doi:10.1148/radiol.223305
32. Shiyovich A, Singh A, Blair CV, et al. Photon-counting computed tomography in cardiac imaging. JACC Cardiovasc Imaging. 2026;19:94-117. doi:10.1016/j.jcmg.2025.07.022
33. Ren L, Duan X, Ahn R, et al. Photon-counting detector CT: technology overview and radiation dose reduction. Br J Radiol. 2025;98:1788-801. doi:10.1093/bjr/tqaf116
34. Klambauer K, Flohr T, Moser LJ, et al. Contrast media and radiation dose optimization with task-based automatic keV selection: a proof-of-concept study with photon-counting detector CT. Eur Radiol. 2025;35:7975-84. doi:10.1007/s00330-025-11738-3
35. Heismann B, Kreisler B, Fasbender R Photon counting CT versus energy-integrating CT: a comparative evaluation of advances in image resolution, noise, and dose efficiency. Med Phys. 2025;52:1526-35. doi:10.1002/mp.17591
36. Sawall S, Klein L, Amato C, et al. Iodine contrast-to-noise ratio improvement at unit dose and contrast media volume reduction in whole-body photon-counting CT. Eur J Radiol. 2020;126:108909. doi:10.1016/j.ejrad.2020.108909
37. McCollough CH, Yu L CT radiation dose reduction with preserved diagnostic performance: how far have we come over 25 years? AJR Am J Roentgenol. 2026;226:e2534450. doi:10.2214/AJR.25.34450
38. Daniels AA, Pinkney LP, Strubel NA, Druhan SM, El-Ali AM Pediatric photon-counting chest CT enables iodinated contrast dose reduction with preserved image quality. Pediatr Radiol. 2025;55:2779-91. doi:10.1007/s00247-025-06394-0
39. Wrazidlo R, Walder L, Estler A, et al. Radiation dose reduction in contrast-enhanced abdominal CT: comparison of photon-counting detector CT with 2nd generation dual-source dual-energy CT in an oncologic cohort. Acad Radiol. 2023;30:855-62. doi:10.1016/j.acra.2022.05.021
40. Willemink MJ, Noël PB The evolution of image reconstruction for CT-from filtered back projection to artificial intelligence. Eur Radiol. 2019;29:2185-95. doi:10.1007/s00330-018-5810-7
41. Leng S, Bruesewitz M, Tao S, et al. Photon-counting detector CT: system design and clinical applications of an emerging technology. Radiographics. 2019;39:729-43. doi:10.1148/rg.2019180115
42. Flohr T, Petersilka M, Henning A, Ulzheimer S, Ferda J, Schmidt B Photon-counting CT review. Phys Med. 2020;79:126-36. doi:10.1016/j.ejmp.2020.10.030
43. Iwanczyk JS, Nygård E, Meirav O, et al. Photon counting energy dispersive detector arrays for X-ray imaging. IEEE Trans Nucl Sci. 2009;56:535-42. doi:10.1109/TNS.2009.2013709
44. Gutjahr R, Halaweish AF, Yu Z, et al. Human imaging with photon counting-based computed tomography at clinical dose levels: contrast-to-noise ratio and cadaver studies. Invest Radiol. 2016;51:421-9. doi:10.1097/RLI.0000000000000251
45. Yu Z, Leng S, Jorgensen SM, et al. Evaluation of conventional imaging performance in a research whole-body CT system with a photon-counting detector array. Phys Med Biol. 2016;61:1572-95. doi:10.1088/0031-9155/61/4/1572
46. Symons R, Krauss B, Sahbaee P, et al. Photon-counting CT for simultaneous imaging of multiple contrast agents in the abdomen: an in vivo study. Med Phys. 2017;44:5120-7. doi:10.1002/mp.12301
47. Pourmorteza A, Symons R, Sandfort V, et al. Abdominal imaging with contrast-enhanced photon-counting CT: first human experience. Radiology. 2016;279:239-45. doi:10.1148/radiol.2016152601
48. Si-Mohamed SA, Boccalini S, Lacombe H, et al. Coronary CT angiography with photon-counting CT: first-in-human results. Radiology. 2022;303:303-13. doi:10.1148/radiol.211780
49. Danielsson M, Persson M, Sjölin M Photon-counting x-ray detectors for CT. Phys Med Biol. 2021;66:03TR01. doi:10.1088/1361-6560/abc5a5
50. Dong YC, Hajfathalian M, Maidment PSN, et al. Effect of gold nanoparticle size on their properties as contrast agents for computed tomography. Sci Rep. 2019;9:14912. doi:10.1038/s41598-019-50332-8
51. Symons R, Reich DS, Bagheri M, et al. Photon-counting computed tomography for vascular imaging of the head and neck: first in vivo human results. Invest Radiol. 2018;53:135-42. doi:10.1097/RLI.0000000000000418
52. Cormode DP, Si-Mohamed S, Bar-Ness D, et al. Multicolor spectral photon-counting computed tomography: in vivo dual contrast imaging with a high count rate scanner. Sci Rep. 2017;7:4784. doi:10.1038/s41598-017-04659-9
53. Muenzel D, Bar-Ness D, Roessl E, et al. Spectral photon-counting CT: initial experience with dual-contrast agent K-edge colonography. Radiology. 2017;283:723-8. doi:10.1148/radiol.2016160890
54. Greffier J, Villani N, Defez D, Dabli D, Si-Mohamed S Spectral CT imaging: technical principles of dual-energy CT and multi-energy photon-counting CT. Diagn Interv Imaging. 2023;104:167-77. doi:10.1016/j.diii.2022.11.003
55. Mannil M, Hickethier T, von Spiczak J, et al. Photon-counting CT: high-resolution imaging of coronary stents. Invest Radiol. 2018;53:143-9. doi:10.1097/RLI.0000000000000420
56. Leng S, Zhou W, Yu Z, et al. Spectral performance of a whole-body research photon counting detector CT: quantitative accuracy in derived image sets. Phys Med Biol. 2017;62:7216-32. doi:10.1088/1361-6560/aa8103
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