Digital detectors based on complementary metal-oxide-semiconductors (CMOS) active pixel sensor (APS) technology have been introduced recently in many scientific applications. This work is focused on the X-ray performance evaluation of a novel CMOS APS detector in low energy medical imaging applications using monochromatic synchrotron radiation (i.e., 17-35 keV), which also allows studying how the performance varies with energy. The CMOS sensor was coupled to a Thallium-activated structured cesium iodide (CsI:Tl) scintillator and the detector's X-ray performance evaluation was carried out in terms of sensitivity, presampling modulation transfer function (pMTF), normalized noise power spectrum (NNPS) and the resulting detective quantum efficiency (DQE). A Monte Carlo simulation was used to validate the experimentally measured low frequency DQE. Finally, the effect of iodine's secondary generated K-fluorescence X-rays on pMTF and DQE results was evaluated. Good agreement (within 5%) was observed between the Monte Carlo and experimentally measured low frequency DQE results. A CMOS APS detector was characterized for the first time over a wide range of low energies covering the mammographic spectra. The detector's performance is limited mainly by the detectability of the scintillator. Finally, we show that the current data could be used to calculate the detector's pMTF, NNPS and DQE for any mammographic spectral shape within the investigated energies.
