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This review article offers an overview of the differences between traditional energy integrating (EI) X-ray imaging and the new technique of X-ray photon counting spectral imaging (x-CSI). The review is motivated by the need to image gold nanoparticles (AuNP) in vivo if they are to be used clinically to deliver a radiotherapy dose-enhancing effect (RDEE). The aim of this work is to familiarise the reader with x-CSI as a technique and to draw attention to how this technique will need to develop to be of clinical use for the described oncological applications. This article covers the conceptual differences between x-CSI and EI approaches, the advantages of x-CSI, constraints on x-CSI system design, and the achievements of x-CSI in AuNP quantification. The results of the review show there are still approximately two orders of magnitude between the AuNP concentrations used in RDEE applications and the demonstrated detection limits of x-CSI. Two approaches to overcome this were suggested: changing AuNP design or changing x-CSI system design. Optimal system parameters for AuNP detection and general spectral performance as determined by simulation studies were different to those used in the current x-CSI systems, indicating potential gains that may be made with this approach.

An Overview of X-ray Photon Counting Spectral Imaging (x-CSI) with a Focus on Gold Nanoparticle Quantification in Oncology