Photon-counting CT: The art of transition

In its half-century of existence, CT has been one of the most transformative innovations in modern medicine, noninvasively yielding invaluable information regarding injury and disease. And since its clinical debut four years ago, photon-counting CT (PCCT) has been as significant an advance over the solid-state scintillator CT systems that preceded it as digital radiography was an evolutionary leap over film-screen methods.

Matthew Dedman of Siemens Healthineers North America.Siemens Healthineers

PCCT’s high energy resolution, high spatial resolution, and reduced image noise deliver high-quality images at low patient radiation doses. In cardiovascular imaging, where the search for ever-greater levels of image detail is constant, PCCT’s impact has been particularly dramatic. For example, its contrast differentiation and spatial resolution can reveal noncalcified or “vulnerable” plaque in coronary arteries that had been so difficult to detect previously.

Also, its ability to visualize fast-moving structures provides high-resolution cardiac images that can aid in the treatment of structural heart disease. In pediatrics, photon counting can visualize tiny cardiac and pulmonary structures as well as reveal subtle abnormalities in oncology that could lead to earlier diagnosis of some childhood cancers -- quickly and often without sedation.

With nearly 1,000 scientific papers detailing these and other applications, we believe that photon counting will be the dominant form of CT by 2040. But technology alone does not equal transformation, and PCCT’s success won’t hinge on the physics and performance of its scanners. Rather, it will realize its full potential when hospitals and radiology groups master the human, organizational, and workflow changes associated with it.

Consider that the last 30 years of the full 50 years of CT practice have been built on conventional solid-state scintillator scanners. The result is deeply ingrained workflows. Adjusting to new workflows associated with photon counting takes time. Also, PCCT represents a major capital investment, and because CT scanners have 12- to 15-year lifecycles, adoption of these new scanners will be gradual. 

A hybrid reality

For this reason, the next decade will see a hybrid reality, with photon-counting and conventional CT scanners operating side-by-side. And this hybrid environment will present an additional set of challenges beyond the need to standardize CT protocols.

Framing PCCT adoption as a hospital-wide change rather than merely a radiology upgrade is a foundational first step to a successful transition. Yes, radiologists must master new PCCT protocols. They also must learn to interpret PCCT images in a way that maximizes the high level of visual and quantitative information they provide. 

And yes, radiologic technologists must receive training on new scanning protocols. But parties beyond radiology are also affected.

Referring physicians must learn new reporting language and familiarize themselves with PCCT’s new capabilities. Hospital IT departments must grapple with PCCT’s larger and more complex data sets, which raise issues related to data handling and storage, PACS integration, and protocol management. 

Biomedical engineers must adopt new maintenance and service models. And at the top of the managerial pyramid, hospital administrators must be able to identify PCCT’s return on investment (ROI) and detail how it will positively impact the institution.

Up for the challenge

The magnitude of change associated with PCCT may sound daunting, but healthcare institutions are up to the challenge. After all, they’ve faced many such disruptions in recent decades: the aforementioned shift from film to digital, the adoption of PACS, and the rise of electronic health records. With each challenge, they’ve emerged on the other side, stronger than before.

The resistance that some stakeholders express regarding this latest paradigm shift centers less around the technology of PCCT and more around its disruption of established roles, processes, and perceived competencies. Surmounting this resistance requires clear and consistent communication, education, and incremental implementation. In each of these areas, identifying internal radiologist and technologist champions who can advocate for photon counting can have a dramatic impact.

Specific strategies for moving forward with PCCT include not only structured training and education programs for radiologists and technologists but also the establishment of multidisciplinary committees in radiology, relevant clinical areas, information technology, and administration. These committees can provide clear governance and guide PCCT’s integration in the healthcare institution. 

Demonstrating value

They can also engage in transparent discussion regarding ROI, goals, and the institution’s long-term vision for PCCT. Additionally, pilot programs that begin with targeted use cases for PCCT (i.e., cardiology, oncology) can demonstrate value to stakeholders across the health system prior to scaling. And during this transition from conventional CT to PCCT, celebrating early wins is a must: Highlighting cases where photon-counting has added clear clinical value will build buy-in across the hospital and throughout the enterprise.

Photon-counting CT has the potential to redefine the standard of patient care. But a successful transition won’t come from hardware installation alone. Strong, decisive leadership in change management will make the difference. Hospitals and radiology groups must see themselves not merely as technology adopters, but as navigators of change -- preparing staff, workflows, and work culture for the next 50 years of CT.

Matthew Dedman is the head of the Computed Tomography business at Siemens Healthineers North America.

The comments and observations expressed are those of the author and do not necessarily reflect the opinions of AuntMinnie.com.