The advent of photon-counting detectors (PCDs) promises a significant shift in clinical x-ray imaging by capturing individual x-ray photon's intensity and energy, unlike traditional detectors. This enables energy discrimination, which has the potential to improve image quality, reduce radiation dose, and enable new diagnostic applications. PCDs can significantly improve spectral x-ray imaging systems for tissue characterization and material separation, paving the way for CT color and quantitative imaging. Most major CT companies have recently been developing prototype PCD CT systems. Two CT systems incorporating a PCD were FDA cleared within the last two years. Furthermore, PCDs empower novel acquisition techniques beyond conventional x-ray transmission, including coherent scatter and phase contrast imaging. This abstract outlines key advancements in spectral imaging via PCDs, emphasizing studies and assessments conducted at the FDA's Office of Science and Engineering Laboratories (OSEL) and Division of Imaging, Diagnostics, and Software Reliability (DIDSR). The focus is on the transformative potential of PCD-equipped spectral x-ray systems in enhancing diagnostic imaging.
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