Toward Broader Clinical Adoption of Photon-Counting CT: Where We Stand According to High-Impact Literature

The first commercially available whole-body photon-counting CT (PCCT) system, cleared by the Food and Drug Administration in 2021, has since been adopted across an expanding range of clinical practice settings. This review article focuses on the clinical applications of PCCT, drawing insights from a carefully selected subset of the most relevant studies among 458 identified peer-reviewed publications (mean journal impact factor: 8.5). It explores the growing use of PCCT across major imaging domains, including cardiac, thoracic, neurovascular, musculoskeletal, abdominal, and pediatric imaging. The article highlights how the core technical innovations of PCCT, including improved spatial and contrast resolution, spectral capabilities, reduced electronic noise, and enhanced dose efficiency, have translated into tangible clinical benefits such as superior image quality, improved diagnostic performance, and reduced radiation dose. This article presents the collective findings within the context of broader clinical adoption. It also covers protocol optimization and emerging evidence on disease management and cost-effectiveness, as well as current workflow challenges. It highlights the progress made in the clinical adoption of PCCT and the remaining evidence gaps, particularly the need for protocol standardization to enable large-scale multicenter studies. © The Author(s) 2026. Published by the Radiological Society of North America under a CC BY 4.0 license. Supplemental material is available for this article.