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The availability of multiple energy thresholds in PCD\u2010CT opens the possibility for unique clinical applications such as simultaneous multi\u2010contrast\u2010agent imaging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To evaluate the technical performance of a PCD\u2010CT system with four energy thresholds for conducting multi\u2010material decomposition of iodine, gadolinium, and water after a comprehensive system calibration procedure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Experiments were performed on a commercial PCD\u2010CT scanner (NAEOTOM Alpha, Siemens Healthineers) using a research mode with four energy thresholds. Material calibration was performed by scanning contrast materials with known concentration placed in various sizes of cylindrical water\u2010equivalent phantoms at various tube currents and positions. From these data, per\u2010voxel contrast models were derived for each material by multiple linear regressions up to second order, where the predictor variables were combinations of tube current, phantom diameter, and distance to isocenter. After calibration, small (20 cm diameter) and large (30\u00a0cm\u00a0\u00d7\u00a040\u00a0cm) uniform multi\u2010energy CT phantoms and an anthropomorphic thorax phantom (31\u00a0cm\u00a0\u00d7\u00a039\u00a0cm), each containing bone, soft tissue, and several quantitative inserts of iodine (0.2\u20135.0\u00a0mg\/ml), gadolinium (0.3\u20135.0\u00a0mg\/ml), and a mixture of both (5.0\u00a0mg\/ml each) were scanned using the four\u2010energy threshold mode at 140 kV with energy thresholds set at 20, 52, 75, and 82 keV. Images for each energy threshold were reconstructed with a filtered back\u2010projection algorithm and a quantitative kernel (Qr44). Subsequent image\u2010based material decomposition was performed on individual voxels of the energy threshold images using the models derived from the calibration process to generate water, iodine, and gadolinium basis images. Quantitative material concentrations and image noise magnitudes, and noise power spectra (NPS) were measured.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Iodine and gadolinium concentrations above 1.25 mg\/ml were visible in the material basis images in all phantoms. Averaged quantitative accuracy for iodine and gadolinium in the small, large, and thorax phantoms were 0.39\u00a0\u00b1\u00a00.30 mg\/ml, 0.96\u00a0\u00b1\u00a00.53 mg\/ml, and 0.53\u00a0\u00b1\u00a00.35 mg\/ml, respectively. In the water basis images, accuracy was within 24 HU in all phantoms. Noise magnitudes in iodine and gadolinium basis images were 2.91 and 3.52 times that of the lowest energy threshold image for the small phantom, and were 6.92 and 7.17 times that of the lowest threshold image for the large phantom. Noise texture did not change between the energy threshold and material basis images for either size phantom as measured by the NPS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>After a comprehensive system calibration, a commercial PCD\u2010CT with four energy thresholds performed multiple material decomposition of iodine, gadolinium, and water for concentrations above 1.25 mg\/ml in human\u2010sized phantoms. Noise amplification and quantitative accuracy from the decomposition greatly depended on object size.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mp.70063","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T08:41:13Z","timestamp":1759912873000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Technical performance of dual\u2010contrast\u2010agent K\u2010edge imaging with four energy thresholds on a commercial photon counting detector CT"],"prefix":"10.1002","volume":"52","author":[{"given":"Kevin J.","family":"Treb","sequence":"first","affiliation":[{"name":"Department of Radiology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"Jeffrey F.","family":"Marsh","sequence":"additional","affiliation":[{"name":"Department of Radiology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth R.","family":"Shanblatt","sequence":"additional","affiliation":[{"name":"Siemens Medical Solutions USA, Inc.  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