Summary
Since the emergence of the first photon-counting computed tomography (PCCT) system in late 2021, its advantages and a
wide range of applications in all fields of radiology have been demonstrated. Compared to standard energy-integrating
detector-CT, PCCT allows for superior geometric dose efficiency in every examination. While this aspect by itself is
groundbreaking, the advantages do not stop there. PCCT facilitates an unprecedented combination of ultra-high-resolution
imaging without dose penalty or field-of-view restrictions, detector-based elimination of electronic noise, and ubiquitous
multi-energy spectral information. Considering the high demands of orthopedic imaging for the visualization of minuscule
details while simultaneously covering large portions of skeletal and soft tissue anatomy, no subspecialty may benefit more
from this novel detector technology than musculoskeletal radiology. Deeply rooted in experimental and clinical research, this
review article aims to provide an introduction to the cosmos of PCCT, explain its technical basics, and highlight the most
promising applications for patient care, while also mentioning current limitations that need to be overcome.