(2025) Opitz | First assessment of photon-counting CT for virtual bronchoscopic navigation

Daniel Stromer

In 40 patients (20 PCCT vs 20 BMI- and sex-matched EID-CT), PCCT successfully provided the high-resolution datasets required for virtual bronchoscopic navigation (VBN) and could be transferred into the navigation system for procedural planning.

PCCT achieved an approximately 5–6× radiation-dose reduction: CTDIvol 1.5 vs 8.3 mGy, DLP 52.9 vs 284.0 mGy·cm, and effective dose 0.8 vs 4.6 mSv (−83%).

Despite the substantially lower dose, PCCT showed better overall image quality, greater sharpness, lower noise and higher lung SNR than conventional EID-CT.

Clinical takeaway: PCCT may allow a single low-dose examination to serve both as lung-cancer-screening/follow-up CT and the high-resolution dataset for subsequent VBN planning—potentially avoiding an additional dedicated CT.

Access publication

FIGURE 1. a) Relative distribution of the radiologists' assessments regarding image quality, sharpness and noise on a Likert scale from 1 (insufficient) to 5 (very good). b) Bar chart showing the average radiation dose in radiation-sensitive thoracic organs for both computed tomography modalities, along with the corresponding radiation dose reduction factor achieved by the use of photon-counting detector computed tomography (PCCT), with a five-fold reduction benchmark indicated by a red dashed line. c) Representative axial slices of lesions obtained using the virtual navigation bronchoscopy protocol, with energy-integrating detector computed tomography (EID-CT) (top) and PCCT (bottom) shown for different subjects. Lesions are located in the right upper lobe (left column) and the right lower lobe (right column), emphasising improved image quality, enhanced sharpness and reduced noise, as assessed by radiologists.

Source: Opitz M, Funke F, Darwiche K, et al. First assessment of photon-counting CT for virtual bronchoscopic navigation. Eur Respir J. 2025;65(4):2402476. doi:10.1183/13993003.02476-2024.