The photon-counting method is one of several useful image-detection methods for digital X-ray imaging. The direct-type photon-counting method [1][2][3] has higher X-ray-to-charge conversion efficiency and position resolution compared with the indirect-type detection method [4]. Therefore, direct-type detection is more suitable for medical imaging applications for which the dose efficiency and the image quality are especially important. Figure 6.1.1 shows a lateral view of a direct-type X-ray photon-counting image sensor and the conceptual diagram of a unit pixel. When the X-ray-to-charge conversion occurs in the photoconductor, a charge packet drifts toward the input pad of the unit pixel. Then, the CMOS circuit generates a voltage signal corresponding to the received charge amount, and the voltage is compared with a certain threshold so as to determine its validity for X-photon counting. The grayscale X-ray image is generated using all pixels' counted data. Figure 6.1.1 also shows a conventional charge preamplifier [5], which converts the charge information into voltage (V out ) via C FB . The DC-feedback loop resets V out slowly for subsequent signal processing. One major drawback of this circuit is that the sensitivity and the reset speed must be traded off, because fast DC feedback impedes the amplification operation, while slow DC feedback slows down the photon counting rate. Moreover, the DC feedback makes circuit design difficult due to the loop stability issue and PVT variations due to sub-nA bias current design.In this paper, we present a direct X-ray photon-counting image sensor with 3 energy bins for high-quality color X-ray medical imaging. A sampling-based charge preamplifier operates with high charge-to-voltage gain and a fast hardreset scheme. The successive-approximation-like (SAL) ADC discriminates three levels of X-photon energy with high spatial resolution and low power consumption. Figure 6.1.2 shows the circuit diagram of the X-photon-counting pixel. Unlike the preamplifier in Fig. 6.1.1, this preamplifier works on the sampling base with a reset switch, M 1 . The charge packet (-Q) transmitted from the photoconductor is trapped on the feedback capacitor, C FB , without any charge loss owing to not having DC feedback. All the disadvantages related to DC feedback, such as loop instability and PVT sensitivity issues, are eliminated in the circuit. This samplingbased operation enhances the reliability of the circuit function because V OUT stays constant at its peak value until reset. After the energy discrimination period is complete, C FB can be reset quickly by switch M 1 in order to prepare the next signal detection. This fast hard-reset scheme enables the enhancement of the photon-counting rate. For high charge-to-voltage conversion gain, a small C FB of 1.5fF was chosen, which corresponds to a gain of 107mV/ke -. Since C FB is very small, charge-injection from switch M 1 must be kept as small as possible. In addition to the dummy switch M 2 , an optimized switching-level generator was implem...