Nuclear Instruments and Methods in Physics Research A 477 (2002) 469–474

Current status and requirements for position-sensitive

detectors in medicine
Robert Speller*, Gary Royle
Department of Medical Physics and Bioengineering, University College London, 11–20 Capper Street, London WC1E 6JA, UK

Abstract

This review considers the current status of detector developments for medical imaging using ionising radiation. This
field is divided into two major areas; the use of X-rays for transmission imaging and the use of radioactive tracers in
emission imaging (nuclear medicine). Until recently, most detector developments were for applications in nuclear
medicine. However, in the past 5 years new developments in large area, X-ray-sensitive detectors have meant that both
application domains are equally served.
In X-ray imaging, work in CT and mammography are chosen as examples of sensor developments. Photodiode
arrays in multi-slice spiral CT acquisitions are described and for mammography the use of amorphous silicon flat panel
arrays is considered. The latter is an excellent example where new detector developments have required a re-think of
traditional imaging methods.
In gamma-ray imaging the recent developments in small area, task-specific cameras are described. Their limitations
and current proposals to overcome those limitations are considered. PET has also received attention but recent clinical
emphasis has been on the development of dual-headed gamma cameras which provides both SPECT and PET
capability. Finally, some future requirements are considered. r 2002 Elsevier Science B.V. All rights reserved.

1. Introduction anatomy. Such a system, when used in radio-

There are two techniques used for imaging
patients using ionising radiation. They are illu-
strated in Fig. 1 where the left hand panel shows
transmission imaging and the right hand panel
emission imaging. Generally, although not always,
transmission imaging is carried out with X-ray
sources and isotopes are used for emission
imaging. These two techniques are used to record
different patient-related information. The former
is used to demonstrate the normal and abnormal
*Corresponding author. Tel.: +44-20-7679-6296; fax: +44-
2-7679-6269.
E-mail address: rspeller@medphys.ucl.ac.uk (R. Speller).
graphic mode, is characterised by having a high
flux, short duration exposure to radiation and a
detector system that affords high spatial resolution
and is one usually operated in integrating mode.
Gamma imaging systems are designed to study
metabolic pathways and physiology and are rarely
capable of demonstrating anatomy to any high
precision. They operate in an event counting mode
with an energy resolution of approximately 10% in
a conventional gamma camera. The important
features of these two modalities are summarised in
Table 1.
The series of position-sensitive detector (PSD)
conferences has always addressed the application
of such devices to medicine and, due to develop-

0168-9002/02/$ - see front matter r 2002 Elsevier Science B.V. All rights reserved.
PII: S 0 1 6 8 - 9 0 0 2 ( 0 1 ) 0 1 8 6 7 - 8
470 R. Speller, G. Royle / Nuclear Instruments and Methods in Physics Research A 477 (2002) 469–474

Fig. 1. The two major imaging modalities. Transmission imaging is usually carried out with X-ray sources and emission imaging using
radioisotopes.

Table 1
Comparison of performance requirements of detectors for X- and gamma-ray imaging

Feature X-ray imaging Gamma-ray imaging

2 1 7
Photon flux at the detector surface (mm s ) 10 10 1
Dynamic range 103–104 events Upto 5  104 event/s
Photon energy 10–125 keV 70–511 keV
Spatial resolution 5–15 line pairs/mm 0.05–0.25 line pairs/mm
Exposure times 0.01–1.0 s 10–20 min

ments at the time of each meeting, the emphasis

has been on applications to gamma-ray imaging.
This year it is time to redress the balance. A survey
of the literature for the past 3 years reveals that the
publications describing application of PSDs is
divided equally between X-ray and gamma-ray
imaging. Fig. 2 gives the breakdown of these
publications. It can be seen that certain areas have
been given special attention and therefore, for the
remainder of this paper these topics will be Fig. 2. Distribution of medical detector development publica-
considered. tions over the period of 1996–1999.

2. X-ray imaging detectors to optical photons and thereby provide intensifica-

Most imaging detectors used in medicine are
analogue detectors based upon the use of radio-
graphic emulsions or conventional image intensi-
fiers. Emulsion used alone is only considered when
imaging radio-insensitive tissues or when the best
possible spatial resolution is needed. Most exam-
inations use a phosphor to convert X-ray photons
tions of the imaging process (usually called
intensifying screens). Under these circumstances,
the characteristics of the film/phosphor combina-
tion are dominated by those of the phosphor. As
the phosphor is typically 1 order of magnitude
thicker than the emulsion light spread in the
phosphor is a major contributor to image un-
sharpness and loss of spatial resolution. Despite
 R. Speller, G. Royle / Nuclear Instruments and Methods in Physics Research A 477 (2002) 469–474 471

this disadvantage, and others such as non-linear-

ity, dynamic range, etc., film and film/phosphor
screen combinations are the ‘gold standard’
against which other detectors are judged.
Although advances have been made in both
radiographic emulsions and intensifying screens
the greatest area of interest lies in the use of
sensors that could provide a digital image. Such
sensors, unlike film, allow optimisation of the
detection process independently from the pro-
cesses of image display and storage. The major
areas of research in digital sensors are summarised
in Table 2.
To consider the application of some of these
sensors two medical imaging specialties are con-
sidered; mammography and CT.
Computerised tomography: CT has made its
name because of its ability to distinguish small
changes in tissue properties (changes in physical
density as low as 0.3% are possible) and its ability
to image in 3-D volumes of tissue. However, image
acquisition is relatively slow and doses are high. 1-
D digital sensors have always been used but
recently the developments in the area of spiral
imaging have meant that 2-D detector areas are
entering the market.
Fig. 3 shows a typical sensor array. Fig. 3a Fig. 3. CT detector arrays (a) shows the bare, scintillator
shows the bare array, the ceramic scintillator- covered and housed array of 16  16 elements, (b) indicates the
different combinations that can be used to achieve 4 ‘slices’ of
coated array and the complete sensor housing.
information per rotation of the gantry at different slice
Fig. 3b shows how this array can be configured to thicknesses.

Table 2
Summary of digital detectors used in diagnostic X-ray imaging

Sensor type Comments

Image intensifier with digitised output Currently the most common form of ‘digital imaging’ system in use
Photostimuable plates (Fuji plates) Usually called computed radiography and comparable to film in its applications and
use
CCDs Currently the most frequently used direct digital sensor. Finding many applications
in dental radiology and some in small area mammography
Photodiode arrays Used in CT systems
Amorphous Si-flat panel arrays The only large area option available in direct digital sensors. Finding uses in both
kV and MV imaging
MWPCs Some promising applications in low-dose radiology. Limited areas of application
due to spatial resolution
Microstrip sensors Both gaseous and silicon sensors are under investigation. No commercial
exploitation yet

Sensors indicated in bold type are discussed in the text.

472 R. Speller, G. Royle / Nuclear Instruments and Methods in Physics Research A 477 (2002) 469–474
provide up to 4 slices of data per rotation of the
scanning gantry. When used in a ‘spiral’ mode
where the patient is moved through the system as
the source and detectors rotate around the patient,
large volumes of tissue can be imaged quickly
thereby eliminating patient motion. Fig. 4 is a
clear demonstration of the system capabilities.
Here, a three-dimensional representation of renal
blood flow has been imaged in a fast spiral scan
mode.
Mammography: Mammography is one of the
most challenging of diagnostic imaging techniques.
The normal and abnormal tissues differ in such
subtle ways that demonstration of pathology is
very difficult and requires the most careful
optimisation of all elements in the imaging system.
High spatial resolution, low dose and low contrast
detectablity are all required and digital techniques
are just entering the market. CCDs have been used
in a variety of ways [1] but the most frequently
used method is ‘tiling’ a large (6  6 cm2) area
using tapered light guides between a scintillator
screen and the CCD to avoid dead areas. Such
detectors are now used in clinical mammography
for symptomatic cases when re-called for biopsies
[2]. The only large area direct digital sensor is the
am-Si flat panel array. These have been considered
for conventional radiography [3] and have recently
been evaluated for mammography [4]. The smal-
lest pixel size available is 127 mm which gives rise
to a maximum theoretical spatial resolution o4 lp/
mm. This is well below the clinical requirement as
laid down by the National Health Service Breast
Fig. 4. A rapid volume scan taken in 4-slice spiral mode.
Screening Programme in the UK. To overcome
this problem, magnification of the image is
required that in turn requires a small focal spot
to avoid image unsharpness. The requirements for
the focal spot and optimisation of the scintillator
used has been evaluated by Speller et al. [4] and
when used in this mode provides high-quality
digital mammograms.
Fig. 5 is an image of the TORMAM test object
[5] displayed with optimised windows for the
different image details. When this and other
similar test objects are ‘scored’ according to the
visibility of the different features this system
performs better than the most frequently used
film/screen combination [4].
3. Gamma-ray imaging
Three areas of activity can be identified in the
development of detector systems for imaging
gamma-emitting radioisotopes. They are conven-
tional, large area gamma cameras, task-specific,
small area cameras, and cameras for positron
imaging. All areas are attracting significant inter-
est. Five years ago the major interest was in
positron imagers but the most recent interest has
been in the small area, generally high-resolution
gamma cameras.
Conventional cameras: Recent years have seen
the use of multi-headed cameras. Firstly, these
were developed to increase the statistical quality of
data by surrounding the patient with more active
detector. A typical example has three rectangular
cameras forming an equilateral triangle of active
Fig. 5. An image of the TORMAM test object.
 R. Speller, G. Royle / Nuclear Instruments and Methods in Physics Research A 477 (2002) 469–474 473

detector surrounding the patient’s brain. However,

most recently has seen the introduction of the dual
purpose, double-headed camera. Used as a con-
ventional camera, the two heads increase the active
detector area, but when operated in coincidence
without a collimator such cameras can be used as
positron imagers. An interesting development has
arisen with the advent of rectangular or square
cameras. The scintillation crystals of these cameras
are best viewed by square photomultiplier tubes.
This has enabled a re-design of the position
sensing electronics that no longer operates on the
conventional Anger principle but now uses a
technique closer in design to that employed in
strip detectors. In this way, more ‘useful’ signal is
used to determine position. The other significant
development in conventional cameras has been the
introduction of transmission and emission imaging
in a single camera. The transmission data, usually
collected using an isotope whose gamma energy is Fig. 6. Design of wavelength-shifting fibre camera. Fibres are
placed orthogonally on the top and bottom surfaces of a layer
well away from that of the patient delivered
of scintillator (CsI(Na)). The fibres are matched on to a
isotope, is used to correct for attenuation in the position-sensitive photomultiplier tube for spatial information.
SPECT image. A PMT at the base measures the total light for an event to
Small area gamma cameras: There has been produce an energy signal.
much interest in building gamma cameras capable
of high spatial resolution over small areas.
Applications in animal experiments, scintimam- cameras can handleFremoval of the collimator
mography and sentinel node surgery all require increases the count rate by up to 4 orders of
spatial resolution better than current gamma magnitude. Compromises are made that lead to
cameras over areas from 4 to 100 cm2. Different inferior performance in all applications [10],
approaches have been tried. Structured scintilla- however, these changes are small and do not alter
tion crystals viewed by position-sensitive photo- the diagnostic quality in a large range of imaging
multipliers (PSPMT) or silicon diodes [6,7] and tasks.
wavelength shifting fibres organised to read out
position from patient-shaped scintillators [8] are
all under consideration. Fig. 6 shows the principle 4. Future requirements
of the wavelength-shifting fibre camera. Instrinsic
spatial resolutions better than 1 mm are possible The most likely areas to be considered for future
with small gamma cameras [6]. developments in gamma-ray imaging are:
Positron emission tomography systems: Develop-
ments continue in the use of different scintillators * Improved energy resolution: Although the trade-
for improved time-of-flight measurements that off between energy resolution and spatial
ultimately lead to an improved spatial resolution resolution in different imaging tasks remains
[9]. However, the biggest impact on clinical PET an unknown quantity, there is general agree-
has been the development of the dual-headed, ment that the removal of scattered photons
dual-purpose gamma cameras discussed pre- would be a significant advance. Solid state
viously. This is a major achievement in terms of cameras using compound semi-conductors are
the dynamic range of count rates that these the preferred solution although cost may be
474 R. Speller, G. Royle / Nuclear Instruments and Methods in Physics Research A 477 (2002) 469–474
prohibitive. Current research in CdZnTe gam-
ma cameras looks promising [11].
* Better collimation: For planar and SPECT
imaging developments in collimators are
needed. The work on Compton cameras [12]
aims to provide the solution. Such devices have
only recently had any realistic hope of achieving
clinical performance due to the advances of
microstrip detector technology.
* Portability: Taking gamma-ray imaging devices
to the patient in the ward or in the operating
theatre is becoming increasingly important.
Small area, lightweight devices are needed that
can be placed in close contact with the patient
surface. Such devices are being developed and
will form a major activity in nuclear medicine
departments in the coming years.
For X-ray imaging the future need is to be able
to characterise tissue rather than just identify its
presence. Such procedures are being developed for
example in bone [13] and breast imaging [14] and
will continue to become the future requirement of
imaging systems. All these applications require
digital sensors. With this in mind the major needs
are:
* Photon counting: High-rate photon counting
systems are needed. Work in the use of silicon
microstrip sensors [15] is well advanced and
demonstrates some of the challenges to be
overcome in achieving the clinical requirements.
* High spatial resolution: Resolution to match
that achieved with film or film/screen combina-
tions is needed. This puts significant demand
upon all aspects of image recording and
storage. Without high spatial resolution the
ability to diagnose and characterise the tissue in
a single exposure is unlikely to be achieved.
* Large areas: Small area sensors can have
applications in some investigations. Dental
work and breast biopsy systems are good
examples. However, for more general clinical
applications large sensors are required. Only
amorphous silicon arrays currently achieve the
areas required but other techniques and materi-
als are being investigated.
The future medical applications for new sensors
are endlessFalmost any new developments could
potentially have medical uses.
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