Energy-Resolved CNR Performance in Dense-Breast and Implant X-Ray Mammography Using a CdTe Photon-Counting Detector: A Monte Carlo Study

X-ray imaging of dense breasts and breast implants often suffers from reduced lesion visibility because strong attenuation lowers contrast, while conventional rhodium (Rh) K-edge filtering suppresses part of the high-energy spectral tail. This study presents a Monte Carlo framework for spectroscopic mammography using a voxelated 1 mm thick cadmium telluride (CdTe) sensor and a first-order detector interaction model to evaluate energy-dependent image quality. The model reproduces fluorescence and inter-voxel energy redistribution in CdTe, but not the full detector chain, and remains idealized with respect to charge transport, carrier collection, threshold dispersion, and pile-up. Energy-resolved simulations in the 10–50 keV range were used to compute spectroscopic contrast-to-noise ratio (CNR) curves and to form integrated-spectrum (IS) images for four tested spectra. For the dense-breast calcium hydroxyapatite (HA) speck detection task considered here, and under the present simulation assumptions, replacing the standard 28 kVp + 50 μm Rh spectrum with 28 kVp + 1 mm Al increased the simulated IS image CNR by 23.11%, with an approximately 5% increase in estimated primary-incident air kerma at the phantom entrance plane. Preliminary experimental implant-phantom images were included as a qualitative feasibility check, showing a trend consistent with simulations. Within the limits of this task-specific simulation, the results suggest that preserving the transmitted high-energy tail can improve HA speck visibility for the present 1 mm CdTe photon-counting detector, with the 28 kVp + 1 mm Al spectrum outperforming the other tested cases.