Photon-Counting Computed Tomography Enables Image-Guided Navigation of the Paranasal Sinuses at Ultra-Low Radiation Dose: An Initial Cadaveric Study

Background/Objectives: Photon-counting computed tomography (PCCT) enables substantial radiation dose reduction while preserving high spatial resolution. Its potential for image-guided navigation in endoscopic sinus surgery (ESS), particularly at ultra-low dose levels, remains insufficiently explored. This study aimed to evaluate the feasibility of PCCT for four different surgical navigation systems at progressively reduced radiation doses.

Methods

PCCT datasets of the paranasal sinuses were acquired from two cadaveric specimens using a standard protocol followed by stepwise dose reductions down to 5% of the reference dose. The datasets were used for image-guided navigation with four systems (one optical, three electromagnetic). Registration success, navigation accuracy, and user satisfaction (visual analog scale) were assessed at 100% and 5% dose levels using linear mixed-effects models.