The feasibility of Positron Annihilation Interaction-Transmission Imaging (PAITI), a novel 2D imaging modality based on positron annihilation photons, has been demonstrated through theoretical analysis and GATE Monte Carlo simulations. This system consists of two pixelated detectors on opposite sides of a point-like positron source. The object under investigation is positioned between the source and one of the detectors. By analyzing singles, coincidence, and anticoincidence counts, multiple 2D maps of the medium under investigation can be produced from a single data acquisition, such as the map of the number of occurred interactions, linear attenuation coefficient map, deposited energy map, and electron density map.Performance evaluations were conducted using simulated uniform phantoms (water, carbon, cortical bone, and titanium) and nonuniform phantoms (air and bone inside water). The average relative errors for determining the number of occurred interactions and attenuation coefficient were 4.42% and 5.0%, respectively. Additionally, the average relative errors for determining deposited energy and electron density were 3.15% and 4.7%, respectively. The system's capacity to discern fluctuations in electron density was also examined, demonstrating its capability to identify changes of 12.25% with a confidence level surpassing 95.3%, even at an absorbed dose much less than 15.14 ± 0.25 μGy.The results demonstrated the system's potential for future advancements and practical applications in medical imaging, specifically for low-dose multi-parameter anatomical imaging. In addition, the system's ability to determine electron density enables it to perform bone densitometry and ion range determination, with the latter being critical for patient-specific treatment planning for ion therapy.