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Diagnostics
Volume 15
Issue 21
10.3390/diagnostics15212777
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Photon-Counting Computed Tomography of the Paranasal Sinuses Improves Intraoperative Accuracy of Image-Guided Surgery

by
Benjamin Philipp Ernst
1,*,†,
Iris Burck
2,†,
Stefanie Schliwa
3,
Sven Becker
4,
Tobias Albrecht
4,
Thomas J. Vogl
2,
Jan-Erik Scholtz
2,
Anna Levi
1,
Andreas German Loth
1,
Friederike Bärhold
4,
Sebastian Strieth
5,
Matthias F. Froelich
6,
Alexander Hertel
6,
Yannik Christian Layer
7,
Daniel Kuetting
7,† and
Jonas Eckrich
8,†
1
Department of Otorhinolaryngology, Goethe-University Frankfurt, University Medical Center, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
2
Department of Radiology and Nuclear Medicine, Goethe-University Frankfurt, University Medical Center, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
3
Institute of Anatomy and Cell Biology, University of Bonn, Nussallee 10, 53115 Bonn, Germany
4
Department of Otorhinolaryngology, Head and Neck Surgery, University of Tübingen Medical Center, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, Germany
5
Department of Otorhinolaryngology, University Medical Center Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
6
Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
7
Department of Radiology, University Medical Center Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
8
Department of Otorhinolaryngology, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Diagnostics 2025, 15(21), 2777; https://doi.org/10.3390/diagnostics15212777 (registering DOI)
Submission received: 1 October 2025 / Revised: 29 October 2025 / Accepted: 31 October 2025 / Published: 31 October 2025
(This article belongs to the Special Issue Innovations in Medical Imaging for Precision Diagnostics)
Versions Notes

Abstract

Background: Computed tomography (CT)-based image-guided surgery (IGS) is of great importance in functional endoscopic sinus surgery (FESS) and requires IGS-specific imaging protocols to ensure high intraoperative accuracy. This study aimed to compare photon-counting CT (PCCT), dual-energy dual-source CT (DECT), and spectral detector CT (SDCT) of the paranasal sinuses with respect to image quality, IGS accuracy and radiation dose. Methods: A formalin-fixed cadaver skull was examined using PCCT, DECT and SDCT at 100 kV tube voltage with descending tube currents (mAs). The setup of electromagnetic IGS was evaluated using a visual analog scale. Accuracy was analyzed endoscopically using defined anatomical landmarks. Diagnostic image quality as well as bone and soft tissue noise were assessed qualitatively using a 5-point Likert scale and quantitatively by determination of signal-to-noise ratio. Radiation dose was evaluated using the dose length product. Results: While PCCT datasets could be registered and navigated accurately down to 10 mAs (1.5 mm error at 10 mAs), both DECT and SDCT exhibited significantly increased inaccuracies below 40 mAs (4.35/5.15 mm for DECT/SDCT at 25 mAs). Using PCCT therefore enabled a 45% radiation dose reduction at the minimally required dose length product using PCCT. Quantitative and qualitative image quality were superior for PCCT compared to DECT and SDCT. Conclusions: PCCT provides excellent accuracy of anatomical landmarks in IGS with superior image quality of the paranasal sinuses in low-mA scans and substantially reduced radiation exposure.
Keywords: head and neck; chronic rhinosinusitis; photon-counting CT; image-guided surgery; accuracy head and neck; chronic rhinosinusitis; photon-counting CT; image-guided surgery; accuracy

Share and Cite

MDPI and ACS Style

Ernst, B.P.; Burck, I.; Schliwa, S.; Becker, S.; Albrecht, T.; Vogl, T.J.; Scholtz, J.-E.; Levi, A.; Loth, A.G.; Bärhold, F.; et al. Photon-Counting Computed Tomography of the Paranasal Sinuses Improves Intraoperative Accuracy of Image-Guided Surgery. Diagnostics 2025, 15, 2777. https://doi.org/10.3390/diagnostics15212777

AMA Style

Ernst BP, Burck I, Schliwa S, Becker S, Albrecht T, Vogl TJ, Scholtz J-E, Levi A, Loth AG, Bärhold F, et al. Photon-Counting Computed Tomography of the Paranasal Sinuses Improves Intraoperative Accuracy of Image-Guided Surgery. Diagnostics. 2025; 15(21):2777. https://doi.org/10.3390/diagnostics15212777

Chicago/Turabian Style

Ernst, Benjamin Philipp, Iris Burck, Stefanie Schliwa, Sven Becker, Tobias Albrecht, Thomas J. Vogl, Jan-Erik Scholtz, Anna Levi, Andreas German Loth, Friederike Bärhold, and et al. 2025. "Photon-Counting Computed Tomography of the Paranasal Sinuses Improves Intraoperative Accuracy of Image-Guided Surgery" Diagnostics 15, no. 21: 2777. https://doi.org/10.3390/diagnostics15212777

APA Style

Ernst, B. P., Burck, I., Schliwa, S., Becker, S., Albrecht, T., Vogl, T. J., Scholtz, J.-E., Levi, A., Loth, A. G., Bärhold, F., Strieth, S., Froelich, M. F., Hertel, A., Layer, Y. C., Kuetting, D., & Eckrich, J. (2025). Photon-Counting Computed Tomography of the Paranasal Sinuses Improves Intraoperative Accuracy of Image-Guided Surgery. Diagnostics, 15(21), 2777. https://doi.org/10.3390/diagnostics15212777

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