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Endovascular procedures performed in the angio suite have gained considerable popularity for treatment of ischemic stroke as well as aneurysms. However, new intracranial hemorrhage (ICH) may develop during these procedures, and it is highly desirable to arm the angio suite with real-time and reliable ICH monitoring tools. Currently, angio suites are equipped with scintillator-based flat panel detector (FPD) imaging systems for both planar and cone beam CT (CBCT) imaging applications. However, the reliability of CBCT for ICH imaging is insufficient due to its poor low-contrast detectability compared with MDCT and lack of spectral imaging capability for differentiating between ICH, calcifications, and iodine staining from periprocedural contrast-enhanced imaging sequences. To preserve the benefits of the FPD for 2D imaging and certain high-contrast 3D imaging tasks while adding a high quality, quantitative, and affordable CT imaging capability to the angio room for intraoperative ICH monitoring, a hybrid detector system was developed that includes the existing FPD on the C-arm gantry and a strip photon-counting detector (PCD) that can be translated into the field-of-view for high quality PCD-CT imaging at a given brain section-of-interest. The hybrid system maintains the openness and ease of use of the C-arm system without the need to remodel the angio room and without installing a slidinggantry MDCT (aka Angio CT) with orders of magnitude higher costs. Additionally, the cost of the strip PCD is much less than the cost of a large-area PCD. To demonstrate the feasibility and potential benefits of the hybrid PCD-FPD system, a series of physical phantom studies, and human cadaver studies were performed at a gantry rotation speed (7 s) and radiation dose level that closely match those of clinical CBCT acquisitions. The experimental images of C-arm PCD-CT demonstrated MDCT-equivalent low-contrast detectability of PCD-CT and significantly reduced artifacts compared with FPD-based CBCT.
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