Spectral CT Today: Clinical benefits, AI, and the Future of CT imaging

Computed tomography (CT) continues to evolve at a pace that challenges long-held assumptions about what the modality can deliver clinically, operationally, and economically. To examine the current state of CT and the technologies shaping its future, Applied Radiology spoke with two leaders representing complementary perspectives: Ali H. Dhanaliwala, MD, PhD, Assistant Professor of Radiology and Medical Director of CT at Penn Medicine, and Dan Xu, Business Leader for Computed Tomography at Philips.

Their conversation reinforced a clear theme: while innovation in CT is ongoing, spectral CT imaging has emerged as a mature, clinically proven solution that is already reshaping diagnostic confidence, workflow efficiency, and patient care.

From Innovation to Implementation

Spectral CT is an advanced CT imaging technique that captures multiple X-ray energy levels during a single scan. This allows radiologists to better characterize tissues, create virtual non-contrast images, and improve diagnostic confidence without requiring additional imaging.

From an industry standpoint, Xu framed spectral CT not as a recent breakthrough, but as the result of sustained, long-term investment. Detector-based spectral imaging has undergone more than a decade of development, with increasing clinical experience and evidence supporting its integration into routine practice.

“What matters now is not just innovation for innovation’s sake,” Xu noted, “but making sure the technology is accessible and easily usable in real clinical environments. That responsibility sits with us as manufacturers, we can’t leave complexity for the customer to solve.”

That emphasis on usability aligns closely with the clinical perspective. Dr. Dhanaliwala emphasized that radiologists ultimately judge technology by outcomes, not labels. “From the clinical side, it should be invisible,” he said. “If the images look good, help me make the diagnosis, or allow me to avoid additional imaging, that’s what matters.”

Where the Rubber Meets the Road

For Dr. Dhanaliwala, spectral CT’s value is most apparent in everyday decision-making. One of the most impactful advances, he explained, is the ability to generate virtual non-contrast images from a single enhanced acquisition, reducing dose, shortening protocols, and often eliminating the need for follow-up studies.

“In one case, we identified a liver lesion that initially appeared concerning,” he said. “Using virtual non-contrast, we were able to show it wasn’t enhancing. That meant no additional MRI, no ultrasound examination, no biopsy, and most importantly, no prolonged anxiety for the patient.” These moments, he noted, represent the real power of spectral imaging. “Sometimes the biggest win isn’t diagnosing disease, it’s confidently telling a patient they don’t need further testing.”

Managing Volume, Complexity, and Workflow

As CT has become the first-line imaging modality in many emergency and inpatient settings, both speakers acknowledged the growing strain of volume and complexity. “CT is increasingly the baseline exam,” Dr. Dhanaliwala said. “That means more images, more protocols, and greater pressure on radiologists and technologists alike.”

Xu connected these realities to Philips’ broader development philosophy. “We’re focused on making advanced imaging scalable,” he explained. “That means improving workflow, reducing clicks, shortening reconstruction times, and integrating tools into existing PACS and reporting environments so they don’t disrupt care.”

Artificial intelligence (AI) plays a supporting, but essential, role in that effort. Rather than positioning AI as a standalone solution, both speakers emphasized its function as an enabler: improving image reconstruction, reducing noise and dose, and helping standardize increasingly complex protocols. “The number of CT protocols has proliferated,” Dr. Dhanaliwala noted. “AI can help ensure we’re getting the right scan the first time, without calling patients back or repeating exams.”

Photon Counting: Promise With Perspective

The conversation also touched on photon-counting CT, a technology generating considerable interest across the imaging community. Both speakers took a measured view. “Photon counting holds promise, higher resolution, spectral capabilities, potential dose reduction,” Xu said. “But it’s still early. It has to deliver on all those pillars simultaneously, and it has to be wrapped into a workflow that clinicians can actually use.”

From the clinical side, Dr. Dhanaliwala echoed that caution. “I don’t care about the label,” he said. “Photon counting can improve noise and energy resolution, but there are other ways to achieve that. What matters is whether it’s ready for daily clinical use.” In contrast, spectral CT, he emphasized, is already delivering those benefits today.

A Patient-Centered Imperative

Ultimately, the discussion returned to patient care. “Patients don’t care about the technology,” Dr. Dhanaliwala said. “They care about answers, about getting from uncertainty to clarity as quickly as possible.” Xu framed that goal as central to Philips’ mission. “Better images, faster insights, and usable workflows all serve one purpose: helping clinicians make confident decisions while improving the patient experience.”

As the conversation about CT continues to advance, distinguishing technological innovation from demonstrated clinical value becomes increasingly important. Spectral CT, supported by years of development and real-world deployment, is no longer an experimental add-on; it is a practical, scalable solution shaping how radiologists practice today. For imaging professionals navigating increasing demand, complexity, and expectations, that maturity matters.

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