| CPC A61B 6/12 (2013.01) [A61B 6/4441 (2013.01); A61B 6/52 (2013.01)] | 15 Claims |

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1. A spectral X-ray imaging system comprising:
an X-ray source and an X-ray detector configured to generate spectral image data representing attenuation of X-rays traversing an imaging region between the X-ray source and the X-ray detector, for each of three or more energy intervals of the X-rays;
a support structure is configured to rotate the X-ray source and the X-ray detector around two or more orthogonal axes; and
one or more processors configured to:
generate a spectral image based on the spectral image data,
identify, in the spectral image, a position of a first fiducial marker comprising a first material, based on a first X-ray absorption k-edge energy value of the first material, and
identify, in the spectral image, a position of a second fiducial marker comprising a second material, based on a second X-ray absorption k-edge energy value of the second material, the second X-ray absorption k-edge energy value being different to the first X-ray absorption k-edge energy value.
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