Photon-counting detector CT versus cone-beam CT for postoperative cochlear implant imaging

Purpose To compare image-quality and radiation dose between photon-counting CT (PCD CT) and cone-beam CT (CBCT) for postoperative cochlear implantation (CI) imaging.Methods and materials This retrospective study included 224 postoperative CI datasets from July 2019 to February 2026, including 112 PCD CT scans using three dosage protocols (regular dose [RD], low dose [LD], ultra-low dose [ULD]) and 112 120-kV CBCT scans. Two radiologists independently assessed image-quality using 5-point Likert scales. Objective image-quality was assessed using contrast-to-noise ratio (CNR). Groups were compared using Mann-Whitney U and Kruskal-Wallis tests. Predictors of image-quality were analyzed with linear mixed-effects models.Results Among 224 datasets from 196 patients (mean age, 58.8 ± 16.5  years; 118 women), PCD CT showed higher subjective overall image-quality than CBCT (median: 4.5 vs. 2.5; p 2_H = 0.10), with higher ratings for RD, while LD and ULD did not differ. CNR was higher across all PCD CT protocols than for CBCT (p Conclusion PCD CT was associated with higher image-quality and fewer artifacts than CBCT. ULD PC DCT retained higher image-quality ratings at a numerically similar dose, and may be advantageous for more precise postoperative evaluation, personalized device adjustments, and follow-up for radiosensitive or immobile patients.