{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T22:45:51Z","timestamp":1788389151077,"version":"build-2803163510"},"posted":{"date-parts":[[2025,12,29]]},"group-title":"Radiology and Imaging","reference-count":32,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T00:00:00Z","timestamp":1766966400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,12,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To evaluate the dose efficiency of cadmium-zinc-telluride (CZT) based photon-counting CT (PCCT) compared to energy-integrating detector CT (EID-CT) across phantom sizes.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>\n                    A patient-specific 3D-printed pancreas phantom and a phantom with tissue mimicking inserts were placed in extension rings corresponding to the 50\n                    <jats:sup>th<\/jats:sup>\n                    , 75\n                    <jats:sup>th<\/jats:sup>\n                    , 85\n                    <jats:sup>th<\/jats:sup>\n                    , and 95\n                    <jats:sup>th<\/jats:sup>\n                    percentile adult waist circumferences. Phantoms were scanned on both PCCT and EID-CT with CTDI\n                    <jats:sub>vol<\/jats:sub>\n                    ranging from 0.5 to 19.4 mGy. Noise was measured in both phantoms to evaluate dose efficiency. Non-Poisson noise at low doses (&lt;2 mGy) was quantified using root mean square error from linear fits of the noise-dose relationship. Potential dose reduction was then assessed by matching noise levels between scanners across phantom sizes.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>\n                    PCCT demonstrated reduced noise compared to EID-CT across all phantom sizes and doses with average noise reductions of 22%, 23%, 25%, and 28% for the 50\n                    <jats:sup>th<\/jats:sup>\n                    , 75\n                    <jats:sup>th<\/jats:sup>\n                    , 85\n                    <jats:sup>th<\/jats:sup>\n                    , and 95\n                    <jats:sup>th<\/jats:sup>\n                    percentile phantoms, respectively. Noise reduction intensified at lower doses and larger phantom sizes, reaching 88 HU at 1 mGy for the 95\n                    <jats:sup>th<\/jats:sup>\n                    percentile phantom. Non-Poisson noise decreased significantly with PCCT compared to EID-CT for all phantom sizes (p &lt; 0.013). At matched noise levels, PCCT enabled dose reductions of 33% and 44% for the 50\n                    <jats:sup>th<\/jats:sup>\n                    and 95\n                    <jats:sup>th<\/jats:sup>\n                    percentile phantoms, respectively.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>PCCT exhibited superior dose efficiency compared to EID-CT across a range of phantom sizes. The enhanced dose efficiency enables both noise reduction and potential dose reduction for the imaging of obese patients and low-dose imaging applications.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Key Points<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Question<\/jats:title>\n                    <jats:p>Photon-counting CT (PCCT) enables improved quantum detection and eliminates electronic noise, but its benefits have not been evaluated for obese patient sizes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Compared to EID-CT, PCCT enhanced dose efficiency with noise reduction and potential dose reduction across all phantom sizes and doses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance<\/jats:title>\n                    <jats:p>The improved dose efficiency of PCCT facilitates noise reduction that enables diagnostic image quality, and thereby the diagnostic accuracy, for obese patients.<\/jats:p>\n                  <\/jats:sec>\n                <\/jats:sec>","DOI":"10.64898\/2025.12.22.25342398","type":"posted-content","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T03:55:11Z","timestamp":1767066911000},"source":"Crossref","is-referenced-by-count":2,"title":["Obese patient imaging: improved dose efficiency with photon-counting CT"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0560-5394","authenticated-orcid":false,"given":"Leening P.","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Radiology, University of Pennsylvania, Philadelphia, 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