# Photon-Counting Computed Tomography in Thoracic Surgery: A Narrative Review of Current and Future Applications

## TL;DR

Photon-counting CT improves thoracic surgery by offering clearer images, lower radiation, and better detection of complications.

## Contribution

This paper reviews how photon-counting CT enhances thoracic surgery planning, intraoperative guidance, and postoperative monitoring.

## Key findings

- Photon-counting CT provides ultra-high resolution and reduced noise for better thoracic imaging.
- It enables accurate bronchovascular mapping and iodine-based perfusion imaging for surgical planning.
- PCCT improves postoperative complication detection and artifact reduction near metallic implants.

## Abstract

Photon-counting computed tomography (PCCT) is an innovative CT technology that detects individual X-ray photons, producing images with much higher sharpness and less noise than conventional CT, while also reducing radiation exposure. These features make PCCT particularly valuable in thoracic surgery, where precise imaging is crucial before, during, and after an operation. This review summarizes how PCCT can improve surgical planning, intraoperative guidance, and postoperative follow-up in patients with thoracic diseases. By providing detailed three-dimensional views of airways and blood vessels, PCCT supports accurate and safer lung resections. It also helps detect early postoperative complications and differentiates scar tissue from tumor recurrence in follow-up scans. Although its use is currently limited by high costs and the need for specialized training, PCCT has the potential to transform the way thoracic surgeons plan and monitor their procedures, contributing to safer and more personalized surgical care.

Photon-counting computed tomography (PCCT) introduces a new era in thoracic imaging by offering ultra-high spatial resolution, reduced noise, spectral imaging capabilities, and lower radiation dose compared to conventional CT. These features are particularly relevant in thoracic surgery, where precise anatomical and functional assessment is essential throughout the perioperative period. This narrative review outlines the clinical potential of PCCT in surgical planning, intra- and postoperative evaluation, and follow-up of both oncologic and non-oncologic thoracic conditions. PCCT enables accurate bronchovascular mapping and iodine-based perfusion imaging, supporting sublobar resection planning and risk stratification in patients with complex anatomy or reduced lung function. Postoperatively, it enhances detection of subtle complications—such as air leaks or hematomas—and improves image quality near metallic implants through advanced artifact reduction techniques. The ability to combine high-resolution imaging with functional data allows for comprehensive evaluation in a single scan and may aid in differentiating fibrosis from local recurrence. Despite its promises, PCCT adoption is currently limited by high cost, restricted availability, and the need for training and system integration. Furthermore, prospective clinical studies are still needed to determine its impact on surgical outcomes. As technological and infrastructural challenges are addressed, PCCT may become a valuable component of image-guided thoracic surgery, contributing to safer, more personalized care.