Photon-counting detectors differ from energy-integrating ones in five ways that matter at the scanner: higher spatial resolution, less image noise, fewer metal artefacts, lower radiation dose, and spectral data from a single acquisition with less iodine.
In the head and neck those combine usefully. Fine structures — ossicles, small vessels, laryngeal cartilage — are resolved better, which changes preoperative planning rather than simple detection. The metal artefact gain is the one a reporting radiologist notices first: soft tissue adjacent to cochlear implants, dental restorations and postoperative hardware becomes assessable instead of being described as obscured. Spectral reconstructions add iodine maps, virtual non-contrast and virtual non-calcium series, which bear on plaque characterisation and on post-treatment necks where enhancement is ambiguous.
The dose and contrast reductions matter most in the two groups that get scanned repeatedly: children, and cancer patients in surveillance. This is a narrative review rather than a comparative study, so it describes capability and not measured diagnostic gain.
- Where the scanner is available, prioritise it for necks with implants or dental hardware rather than for routine studies.
- Ask for virtual non-contrast series before ordering a separate unenhanced acquisition.
- Reduce iodine load deliberately in surveillance patients; the capability is only a benefit if the protocol uses it.
- Record protocol changes at the department level, or the dose advantage is never realised.
- Do not quote a diagnostic accuracy figure from this review; none is established.
Why it matters
It turns 'obscured by artefact' from an accepted report line into a scanner-selection decision.
Don't overread it
A narrative review of capability, not a comparative study showing better patient outcomes.
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