CHAPTER 10

NON-IMAGING DETECTORS AND COUNTERS

P.B. ZANZONICO
Department of Medical Physics,
Memorial Sloan Kettering Cancer Center,
New York, United States of America

10.1. INTRODUCTION

Historically, nuclear medicine has been largely an imaging based

specialty, employing such diverse and increasingly sophisticated modalities as
rectilinear scanning, (planar) gamma camera imaging, single photon emission
computed tomography (SPECT) and positron emission tomography (PET).
Non-imaging radiation detection, however, remains an essential component of
nuclear medicine. This chapter reviews the operating principles, performance,
applications and quality control (QC) of the various non-imaging radiation
detection and measurement devices used in nuclear medicine, including survey
meters, dose calibrators, well counters, intra-operative probes and organ uptake
probes. Related topics, including the basics of radiation detection, statistics of
nuclear counting, electronics, generic instrumentation performance parameters
and nuclear medicine imaging devices, are reviewed in depth in other chapters
of this book.

10.2. OPERATING PRINCIPLES OF RADIATION DETECTORS

Radiation detectors encountered in nuclear medicine may generally

be characterized as either scintillation or ionization detectors (Fig. 10.1). In
scintillation detectors, visible light is produced as radiation excites atoms of a
crystal or other scintillator and is converted to an electronic signal, or pulse, and
amplified by a photomultiplier tube (PMT) and its high voltage (500–1500 V).
In ionization detectors, free electrons produced as radiation ionizes a stopping
material within a sensitive volume are electrostatically collected by a bias voltage
(10–500 V) to produce an electron signal. In both scintillation and ionization
detectors, the ‘unprocessed’ signal is then shaped and amplified. For some types
of detector, the resulting pulses are sorted by their amplitude (or pulse height),
which is related to the X ray or γ ray energy absorbed in the detector.

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10.2.1. Ionization detectors

Detector materials in the most common ionization detectors are gaseous

and such detectors are, therefore, often known as gas filled detectors; however,
as discussed in the following, solid state ionization detectors also exist. The
two most widely encountered gas ionization detectors in nuclear medicine are
dose calibrators and Geiger counters. The principal difference between these
detectors is the magnitude of the bias voltage between the anode and cathode, as
indicated graphically in Fig. 10.2. When the bias voltage is less than 300 V, ion
pairs (i.e. free electrons and positive ions) produced as radiation passes through
the sensitive volume may recombine, thereby preventing at least some electrons
from reaching the anode and yielding an artefactually low signal. The 0–300 V
range is, therefore, called the recombination region.

Pulses in a preset pulse height range are counted

Pulse sorted by amplitude (height)

Pulse shaped and amplified

 ‘Unprocessed’ electron signal 

(pulse)

Anode
  
Photomultiplier
High voltage   Bias voltage
tube
500–1500 V  10–500 V

  
Cathode
Photocathode Detector
material
X or  ray
Crystal

X or  ray

(a) Scintillation detector (b) Ionization detector

FIG. 10.1. Basic design and operating principles of (a) scintillation and (b) ionization
detectors.

At a bias voltage of 300 V, all of the primary electrons (i.e. the electrons
produced directly by ionization of the detector material by the incident radiation)
are collected at the anode and the detector signal is, thereby, maximized. Since

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Proportional counter region

Signal (total number of electrons per primary electron)

109

Ionization chamber region

Recombination region

106

Spontaneous discharge region

Geiger counter region
103

300 600 900 1200

Bias voltage (V)
FIG. 10.2. The signal (expressed as the amplification factor, that is, the total number of
electrons per primary electron produced in the detector material) as a function of the bias
voltage for gas filled ionization detectors. The principal difference among such detectors is the
magnitude of the bias voltage between the anode and cathode. The amplification factors and
the voltages shown are approximate.

there are no additional primary electrons to collect, increasing the bias voltage
further (up to 600 V) does not increase the signal. The 300–600 V range,
where the overall signal is equivalent to the number of primary electrons and,
therefore, proportional to the energy of the incident radiation, is called the
ionization chamber region. At a bias voltage of 600–900 V, however, the large
electrostatic force of attraction of the anode accelerates free electrons, as they
travel towards the anode, to sufficiently high speeds to eject additional orbital
electrons (i.e. secondary electrons) within the sensitive volume, contributing to
an increasing overall signal — the higher the voltage, the more energetic the
electrons and the more secondary electrons are added to the overall signal. The
number of electrons comprising the overall signal is, thus, proportional to the

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primary number of electrons and the energy of the incident radiation, and the
600–900 V range is, therefore, called the proportional counter region. As the bias
voltage is increased further, beyond 900 V (up to 1200 V), free electrons (primary
and secondary) are accelerated to very high speeds and strike the anode with
sufficient energy to eject additional electrons from the anode surface itself. These
tertiary electrons are, in turn, accelerated back to the anode surface and eject even
more electrons, effectively forming an electron ‘cloud’ over the anode surface and
yielding a constant overall signal even with further increase in the bias voltage.
The 900–1200 V range is called the Geiger counter (or Geiger–Müller) region.
Importantly, the magnitude of the charge represented by this electron cloud is
independent of the number of electrons initiating its formation. Therefore,
in contrast to ionization chamber and proportional counter signals, the Geiger
counter signal is independent of the energy of the incident radiation. Finally,
beyond a bias voltage of 1200 V, atoms within the detector material are ionized
even in the absence of ionizing radiation (i.e. undergo spontaneous ionization),
producing an artefactual signal; the voltage range beyond 1200 V is known as the
spontaneous discharge region.
Although the bias voltage is the principal difference among different types
of gas filled ionization detectors, there may be other differences. The sensitive
volume, for example, may or may not be sealed. Unsealed sensitive volumes
contain only air at atmospheric (ambient) pressure. For detectors with unsealed
volumes, the signal must be corrected by calculation for the difference between
the temperature and pressure at which the detector was calibrated (usually
standard temperature and pressure: 27°C and 760 mm Hg, respectively) and
the ambient conditions at the time of an actual measurement. For detectors with
sealed volumes, gases other than air (e.g. argon) may be used and the gas may be
pressurized, providing higher stopping power, and, therefore, higher sensitivity,
than detectors having a non-pressurized gas in the sensitive volume. In addition,
different geometric arrangements of the anode and cathode, such as parallel
plates (used in some ionization chambers), a wire along the axis of a cylinder
(used in Geiger counters), etc., may be used.
The functional properties and, therefore, the applications of the various
types of ionization detector — ionization chambers, proportional counters and
Geiger counters — are largely dictated by their respective bias voltage dependent
signal (Table 10.1). Ionization chambers are widely used in radiation therapy to
calibrate the output of therapy units and in nuclear medicine as dose calibrators
(i.e. devices used to assay radiopharmaceutical activities). The relatively
low sensitivity of ionization chambers is not a major disadvantage for such
applications, as the radiation intensities encountered are typically rather large.
The stability of the response is an important advantage, however, as it allows
the use of unconditioned AC electrical power (i.e. as provided by ordinary wall

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outlets). Proportional counters, because of their need for a stable bias voltage
and, therefore, specialized power supplies, are restricted to research applications
(e.g. in radiobiology) where both higher sensitivity and the capability of energy
discrimination may be advantageous. Proportional counters often employ an
unsealed, gas flow-through sensitive volume. Geiger counters, because of their
high sensitivity and stability with respect to voltage (allowing the use of a portable
power supply such as an ordinary battery), are widely used as survey meters to
measure ambient radiation levels and to detect radioactive contamination. For
such applications, sensitivity, and not energy discrimination, is critical. As with
dose calibrators, Geiger counters have sealed sensitive volumes, avoiding the
need for temperature–pressure corrections.
In addition to the more familiar gas filled ionization detectors, solid state
ionization detectors are now available. Such detectors are based on a family of
materials known as semiconductors. The pertinent difference among (crystalline)
solids — conductors, insulators and semiconductors — is related to the widths of
their respective electron ‘forbidden’ energy gaps. In a semiconductor, the highest
energy levels occupied by electrons are completely filled but the forbidden
gap is narrow enough (<2 eV) to allow radiative or even thermal excitation at
room temperature, thereby allowing a small number of electrons to cross the
gap and occupy energy levels among the otherwise empty upper energy levels.
Such electrons are mobile and, thus, can be collected by a bias voltage, with the
amplitude of the resulting signal being equivalent to the number of electrons
produced by the radiation and, therefore, proportional to the radiation energy.
Although many semiconductor materials have suitably large energy gaps (~2 eV),
techniques must be available to produce crystals relatively free of structural
defects. Defects (i.e. irregularities in the crystal lattice) can trap electrons
produced by radiation and, thus, reduce the total charge collected, degrading
the sensitivity and overall detector performance of semiconductors. Practical,
reasonably economical crystal growing techniques have been developed
for cadmium telluride (CdTe), cadmium zinc telluride (CZT) and mercuric
iodide (HgI2), and these detectors have been incorporated into commercial
intra-operative gamma probes and, on a limited basis, small field of view gamma
cameras.

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TABLE 10.1. PROPERTIES OF GAS FILLED IONIZATION DETECTORS

Ionization Proportional Geiger
detector counter counter
Bias voltage operating range 300–600 V 600–900 V 900–1200 V
Response stable with respect to
Yes No Yes
voltage?a
Sensitivityb Low Intermediate High
Capable of energy
Yes Yes No
discrimination?c
Applications Dose calibrator Research Survey meter
a
The stability with respect to the bias voltage corresponds to a constant signal over the
respective detector’s operating voltage range. In contrast to ionization detectors and Geiger
counters, proportional counters are unstable with respect to the bias voltage and, thus,
require specialized, highly stable voltage sources for constancy of response.
b
The sensitivity of a detector is related to its amplification factor (see Fig. 10.2).
c
If the total number of electrons comprising the signal is proportional to the number of
electrons directly produced by the incident radiation and, therefore, proportional to its
energy, as in ionization detectors and proportional counters, radiations of different energies
can be discriminated (i.e. separated) on the basis of the signal amplitude.

10.2.2. Scintillation detectors

In scintillation detectors, radiation interacts with and deposits energy in a

scintillator, most commonly, a crystalline solid such as thallium-doped sodium
iodide (NaI(Tl)). The radiation energy thus deposited is converted to visible light.
As the light is emitted isotropically (i.e. in all directions), the inner surface of
the light-tight crystal housing is coated with a reflective material so that light
emitted towards the sides and front of the crystal are reflected back towards a
PMT (Fig. 10.3); this maximizes the amount of light collected and, therefore,
the overall sensitivity of the detector. Interposed between the back of the crystal
and the entrance window of the PMT is the light pipe, nowadays simply a thin
layer of transparent optical gel. The light pipe optically couples the crystal to the
PMT and, thus, maximizes the transmission (>90%) of the light signal from the
crystal into the PMT. When struck by light from the crystal, the photocathode
coated on the inner surface of the PMT emits electrons. Immediately beyond the
photocathode (which is at ground, that is, 0 V) is the focusing grid, maintained at
a relatively low positive voltage on the order of 10 V. As electrons pass through
the focusing grid, they are attracted by a relatively large positive voltage, ~300 V,
on the first of a series of small metallic elements called dynodes. The resulting
high speed impact of each electron results in the ejection from the dynode surface
of an average of three electrons. The electrons thus ejected are then attracted by

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the even larger positive voltage, ~400 V, on the second dynode. The impact of
these electrons on the second dynode surface ejects an additional three electrons,
on average, for each incident electron. Typically, a PMT has 10–12 such dynodes
(or stages), each ~100 V more positive than the preceding dynode, resulting in
an overall electron amplification factor of 310–312 for the entire PMT. At the last
anode, an output signal is generated. The irregularly shaped PMT output signal
is then shaped by a preamplifier and further amplified into a logic pulse that
can be further processed electronically. The resulting electrical pulses, whose
amplitudes (or ‘heights’) are proportional to the number of electrons produced
at the PMT photocathode are, therefore, also proportional to the energy of the
incident radiation. These pulses can then be sorted according to their respective
heights by an energy discriminator (also known as a pulse height analyser) and
those pulses with a pulse height (i.e. energy) within the preset photopeak energy
window (as indicated by the pair of dashed horizontal lines overlying the pulses
in Fig. 10.3) are counted by a timer/scaler.
Advantageous features of scintillation detectors include:

—— High electron density (determined by mass density ρ and effective atomic

number Zeff);
—— High light output;
—— For certain applications such as PET, speed of light emission.

High mass density and effective atomic number maximize the crystal
stopping power (i.e. linear attenuation coefficient μ) and, therefore, sensitivity.
In addition, a higher atomic number crystal will have a higher proportion of
photoelectric than Compton interactions, thus facilitating energy discrimination
of photons which underwent scatter before entering the crystal. High light output
reduces statistical uncertainty (noise) in the scintillation and associated electronic
signal and, thus, improves energy resolution and scatter rejection. Other detector
considerations include:

—— Transparency of the crystal to its own scintillations (i.e. minimal

self-absorption);
—— Matching of the index of refraction η of the crystal to that of the
photodetector (specifically, the entrance window (η ≈ 1.5) of the PMT);
—— Matching of the scintillation wavelength to the light response of the
photodetector (the PMT photocathode, with maximum sensitivity in the
390–410 nm, or blue, wavelength range);
—— Minimal hygroscopic behaviour.

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To date, the most widely used scintillators in nuclear medicine include:

NaI(Tl), bismuth germanate (BGO), cerium-doped lutetium oxyorthosilicate
(LSO(Ce) or LSO) and cerium-doped gadolinium oxyorthosilicate (GSO(Ce) or
GSO). NaI(Tl) is used in γ cameras/SPECT systems, well counters and organ
uptake probes, and remains the most widely used scintillator in clinical practice;
BGO, LSO and GSO are the scintillators of choice in PET scanners because
of their higher stopping power for the 511 keV positron–negatron annihilation
photons. Thallium- and sodium-doped caesium iodide (CsI(Tl) and CsI(Na),
respectively) and cadmium tungstate as well as NaI(Tl), BGO and LSO have also
been used in intra-operative probes.

10.3. RADIATION DETECTOR PERFORMANCE

Radiation detectors may be quantitatively characterized by many different

performance parameters, particularly for those detectors such as γ cameras which
localize (image) as well as count radiation. For non-imaging radiation detectors
and counters, however, the most important performance parameters are sensitivity
(or efficiency), energy resolution and count rate performance (or ‘speed’).

10.3.1. Sensitivity

Sensitivity (or efficiency) is the detected count rate per unit activity (e.g. in
counts per minute per megabecquerel). As the count rate detected from a given
activity is highly dependent on the source–detector geometry and intervening
media, characterization of sensitivity can be ambiguous. There are two distinct
components of overall sensitivity, geometric sensitivity and intrinsic sensitivity.
Geometric sensitivity is the fraction of emitted radiations which intersect, or strike,
the detector, that is, the fraction of the total solid angle subtended at the detector
by the source. It is, therefore, directly proportional to the radiation-sensitive
detector area and, for a point source, inversely proportional to the square of the
source–detector distance. Intrinsic sensitivity is the fraction of radiation striking
the detector which is stopped within the detector. Intrinsic sensitivity is directly
related to the detector thickness, effective atomic number and mass density, and
decreases with increasing photon energy, since higher energy photons are more
penetrating and are more likely to pass through a detector without interacting.
Characteristic X rays and γ rays are emitted from radioactively decaying
atoms with well defined discrete energies. Even in the absence of scatter, however,
output pulses from absorption of these radiations will appear to originate over a
range of energies, reflecting the relatively coarse energy resolution of the detector.
For this reason, many radiation detectors employ some sort of energy-selective

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counting using an energy range, or window, such that radiations are only counted
if their detected energies lie within that range (Figs. 10.3 and 10.4(a)). At least
for scintillation detectors, a so-called ‘20% photopeak energy window’, Eγ ± 10%
of Eγ, (e.g. 126–154 keV for the 140 keV γ ray of 99mTc) is employed, where Eγ
is the photopeak energy of the X ray or γ ray being counted. For such energy-
selective counting, overall sensitivity appears to increase as the photopeak energy
window is widened. However, this results in acceptance of more scattered as well
as primary (i.e. unscattered) radiations.
For each radionuclide and energy window (if applicable) for which a
particular detector is used, the detector should be calibrated, that is, its sensitivity
(e.g. in cpm/MBq) S determined, at installation and periodically thereafter:

Rg − R b
S= (10.1)
A 0e −∆t

where

Rg is the gross (i.e. total) count rate (cpm) of the radionuclide source (RS);
Rb is the background (BG), or blank, count rate (cpm);
A0 is the activity (MBq) of the radionuclide source at calibration;
λ is the physical decay constant (in month–1 or a–1, depending on the half-life)
of the calibration radionuclide;

and ∆t is the time interval (in months or years, respectively, again depending
on the half-life) between the calibration of the radionuclide and the current
measurement.

As noted, sensitivity is highly dependent on the source–detector counting

geometry (including the size and shape of the source and the source–detector
distance), and the measured value, thus, applies exactly only for the geometry
used for the measurement.

10.3.2. Energy resolution

Energy resolution quantifies the ability of a detector to separate, or

discriminate, radiations of different energies. As illustrated in Fig. 10.4(b),
energy resolution is generally given by the width of the bell shaped photopeak,
specified as the full width at half maximum (FWHM = ∆E) height expressed as
∆E
a percentage of the photopeak energy Eγ, FWHM (%) = 100%. It is related
E

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Output
Preamplifier
signal
+ 1200 V
Anode
106:1e
+ 1100 V Amplifier
Photomultiplier tube

Magnetic
+ 1000 V
shielding
High ×106
+ 600 V
voltage
Dynodes + 500 V supply Energy
discriminator
+ 400 V
Focusing
+ 300 V Energy E0
grid
e
Photocathode
Timer/scaler
Entrance
window
Light Light pipe
photon Display
Reflective
inner surface Scintillator
of crystal housing crystal

X or  ray
FIG. 10.3. The basic design and operating principle of photomultiplier tubes and scintillation
detectors.

to the Poisson ‘noise’, or statistical uncertainty, inherent in the detection process.

The importance of energy resolution lies in scatter rejection, particularly for
imaging detectors. Radiation loses energy when undergoing Compton scatter
within the source and the lower energy scattered radiations may, therefore, be
discriminated from the primary radiations. However, the finite energy resolution
of radiation detectors (i.e. the width of the photopeak in the energy spectrum)
means that there will be overlap of scattered and primary radiations, as illustrated
in Fig. 10.4(a). As energy resolution improves (i.e. the FWHM (%) decreases and
the photopeak becomes narrower), the separation of unscattered and scattered
radiations increases and more counts corresponding to scattered radiation may be
eliminated, while discarding fewer counts corresponding to unscattered radiation.

10.3.3. Count rate performance (‘speed’)

Radiation detectors have a finite dead time or pulse resolving time τ —

typically 5–10 μs for modern scintillation detectors — and associated count
losses. The dead time is the length of time required for a counting system to

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20% photopeak
energy window

(a) 99mTc 140 keV

10
Relative number of counts
8
Primary photons
6 Scattered photons
Total photons
4

20 40 60 80 100 120 140 160

Photon energy E (keV)

662 keV
(b) 137Cs
100
Relative number of counts

80
Maximum height
60
DE 46
FWHM(%) = = ´ 100 = 7% FWHM
E = 46 keV

Eg 662
40
½ maximum
20 height

100 200 300 400 500 600 700

Photon energy E (keV)

FIG. 10.4. (a) Energy spectrum for the 662 keV γ rays emitted by 137Cs, illustrating the
definition of energy resolution as the percentage full width at half maximum (FWHM) of the
photopeak energy Eγ. (b) Energy spectrum for the 140 keV γ rays emitted by 99mTc, illustrating
the contributions of primary (unscattered) and scattered radiation counts. In (a) and (b), the
energy spectra were obtained with a thallium-doped sodium iodide (NaI(Tl)) scintillation
detector.

record an event, during which additional events cannot be recorded. As a result,

the measured count rate is lower than the actual count rate. Radiation detectors
are characterized in terms of count rate performance as either non-paralysable
or paralysable (Fig. 10.5). In non-paralysable systems, only radiation which is
actually counted prevents the counting of subsequent radiation interacting with
the detector during the dead time of that preceding radiation. In a paralysable

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detector, however, even radiation which is not counted (i.e. which interacts
with the detector during the dead time of a previous event) prevents counting
of subsequent incoming radiations during the time interval corresponding to
its dead time. Geiger counters (with quenching gas) behave as non-paralysable
systems but most detectors, including scintillation detector based systems,
such as well counters, γ cameras and PET scanners, are paralysable. Modern
scintillation detectors generally incorporate automated algorithms to yield count
rates corrected for dead time count losses.

Ideal: no dead time

count losses
Observed count rate

Non-paralysable

Paralysable

True count rate

FIG. 10.5. The observed versus true count rates for paralysable and non-paralysable radiation
detectors. For paralysable detectors, the observed count rate increases to a maximum value
with increasing true count rate (e.g. with increasing activity) and then decreases as the true
count rate is further increased. For non-paralysable detectors, the observed count rate also
increases with increasing true count rate, asymptotically approaching a maximum value as the
true count rate is further increased. In both cases, the maximum observed count rate is directly
related to the detector’s dead time τ.

10.4. DETECTION AND COUNTING DEVICES

10.4.1. Survey meters

Survey meters, an essential component of any radiation safety programme,

are portable, battery operated, gas filled ionization detectors (or, to a much
more limited extent, solid state scintillation detectors) used to monitor ambient
radiation levels, that is, exposure rates (e.g. in coulombs per kilogram of air per
hour (C · kg–1· h–1)) or count rates (e.g. in cpm). Among ionization detector survey
meters, so-called ‘cutie-pies’ are relatively low sensitivity ionization chambers

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(i.e. are operated at a relatively low potential difference between the anode
and cathode) and are designed for use where relatively high fluxes of X rays
and γ rays are encountered. The more familiar Geiger counters are operated at
a high potential difference (Fig. 10.2), providing a high electron amplification
factor and, thus, high sensitivity. Geiger counters are, therefore, well suited for
low level surveys, for example, checking for radioactive contamination. Both
cutie-pies and Geiger counters are generally calibrated in terms of exposure rate.
As an ionization chamber, the cutie-pie’s electron signal depends on the energy
of the detected X rays or γ rays and is, therefore, directly related to the exposure
for all radionuclides. For Geiger counters, on the other hand, signal pulses have
the same amplitude regardless of the energy of the incoming radiation. Thus,
Geiger counter calibration results apply only to the particular radionuclide(s)
used to calibrate the counter (see below). Solid state detectors employ a
non-air-equivalent crystal as the detection medium and, thus, cannot measure
exposure rates, only count rates.

10.4.2. Dose calibrator

The dose calibrator, used for assaying activities in radiopharmaceutical

vials and syringes and in other small sources (e.g. brachytherapy sources),
is a pressurized gas filled ionization chamber with a sealed sensitive volume
configured in a ‘well’-type geometry. While the intrinsic sensitivity of the dose
calibrator, as that of other gas filled detectors, is relatively low, the well-type
configuration of its sensitive volume provides high geometric efficiency1, making
the overall sensitivity entirely adequate for the relatively high radiopharmaceutical
activities (of the order of 10–100 MBq) typically encountered in clinical nuclear
medicine. Dose calibrators are equipped with isotope specific push-buttons
and/or a potentiometer (with isotope-specific settings provided) to adjust for
differences in energy dependent response and to thereby yield accurate readouts
of activity (i.e. kBq or MBq) for any radioisotope.

10.4.3. Well counter

Well counters are used for high sensitivity counting of radioactive

specimens such as blood or urine samples or ‘wipes’ from surveys of removable
contamination (i.e. ‘wipe testing’). Such counting results can be expressed in

1
The solid angle subtended at the centre of a sphere by the total surface of the sphere
is 4π steradians; a steradian is the unit of solid angle. A well-type detector configuration
approximates a point source completely surrounded by a detector, yielding a per cent geometric
efficiency of 100%, and is, therefore, referred to as a ‘4π’ counting geometry.

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terms of activity (e.g. MBq) using the measured isotope specific calibration
factor (cpm/MBq) (see Eq. (10.1)). Such devices are generally comprised of a
cylindrical scintillation crystal (most commonly, NaI(Tl)) with a circular bore
(well) for the sample drilled part-way into the crystal and backed by a PMT and
its associated electronics. An alternative design for well counters is the so-called
‘through-hole’ detection system in which the hole is drilled through the entire
crystal. The through-hole design facilitates sample exchange, and because
samples are centred lengthwise in the detector, yields a more constant response
for different sample volumes as well as slightly higher sensitivity than the well
counters. In both the well and through-hole designs, the crystal is surrounded by
thick lead shielding to minimize the background due to ambient radiation.
Scintillation counters are often equipped with a multichannel analyser
for energy (i.e. isotope) selective counting and an automatic sample changer
for automated counting of multiple samples. Importantly, because of their high
intrinsic and geometric efficiencies (resulting from the use of a thick crystal and
a well-type detector configuration, respectively), well counters are extremely
sensitive and, in fact, can reliably be used only for counting activities up to
~100 kBq; at higher activities, and even with dead time corrections applied,
dead time counting losses may still become prohibitive and the measured counts
inaccurate. Modern well counters often include an integrated computer which is
used to create and manage counting protocols (i.e. to specify the isotope, energy
window, counting interval, etc.), manage sample handling, and apply background,
decay, dead time and other corrections, and, thus, yield dead time-corrected net
count rate decay corrected to the start of the current counting session.

10.4.4. Intra-operative probes

Intra-operative probes (Fig. 10.6), small hand-held counting devices,

are now widely used in the management of cancer, most commonly to more
expeditiously identify and localize sentinel lymph nodes and, thereby, reduce
the need for more extensive surgery as well as to identify and localize visually
occult disease at surgery following systemic administration of a radiolabelled
antibody or other tumour-avid radiotracer. Although intra-operative probes have
been used almost exclusively for counting X rays and γ rays, beta (electron and
positron) probes constructed with plastic scintillators have also been developed.
In addition, small (~10 cm) field of view intra-operative γ cameras have recently
become available. Intra-operative γ probes are available with either scintillation
or semiconductor (ionization) detectors. Scintillation detector based probes have
the advantages of relatively low cost and high sensitivity (mainly because of their
greater thickness, ~10 mm versus only ~1 mm in ionization detectors), especially
for medium to high energy photons.

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Side view
Detector (crystal)
Detector thickness

Detector width Collimator length

Collimator

End view

FIG. 10.6. A typical intra-operative probe (Node Seeker 900, Intra Medical Imaging LLC,
Los Angeles, CA, United States of America). (a) Hand-held detector. (b) Control and display
unit which not only displays the current count rate but also often emits an audible signal, the
tone of which is related to the count rate, somewhat analogous to the audible signal produced
by some Geiger counters. (c) A diagram of the detector and collimator assembly of a typical
intra-operative probe, illustrating that the detector (crystal) is recessed from the collimator
aperture. (Courtesy of Intra Medical Imaging LLC, Los Angeles, CA, USA.)

Disadvantages include bulkiness, and relatively poor energy resolution and

scatter rejection relative to semiconductor based probes. In some scintillation–
detector intra-operative probes, the light signal from the crystal is guided to a
remote PMT through a flexible fibre-optic cable, allowing the probe assembly
to be made relatively light and compact, and more like a surgical instrument.
However, the significant loss of light in the long cable makes it more difficult to
separate scatter from unscattered X rays and γ rays.
On the other hand, semiconductor based probes are compact and have
excellent energy resolution and scatter rejection. To minimize structural
imperfections which degrade energy resolution, semiconductor detectors are
made relatively thin (only ~1 mm), but at the cost of lower intrinsic sensitivity.
The main disadvantage of semiconductor detectors remains their limited
thickness and resulting lower sensitivity, especially for medium to high energy
X rays and γ rays. Nonetheless, while scintillation detectors can be made thicker
and, therefore, more sensitive, semiconductor detectors produce more electrons
per X ray and γ ray stopped, and, therefore, have a superior energy resolution. To

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date, the few clinical studies directly comparing scintillation and semiconductor
intra-operative probes have not provided a clear choice between the two types of
probe.

10.4.5. Organ uptake probe

Historically, organ uptake probes have been used almost exclusively for
measuring thyroid uptakes and are, thus, generally known as ‘thyroid’ uptake
probes.2 Thyroid uptake (i.e. the decay-corrected per cent of administered activity
in the thyroid) may be measured following oral administration of 131I-iodide,
123
I-iodide or 99mTc-pertechnetate. The uptake probe is a radionuclide counting
system consisting of a wide-aperture, diverging collimator, a NaI(Tl) crystal
(typically ~5 cm thick by ~5 cm in diameter), a PMT, a preamplifier, an amplifier,
an energy discriminator (i.e. an energy window) and a gantry (stand) (Figs 10.7(a)
and (b)). Commercially available thyroid uptake probes are generally supplied as
integrated, computerized systems with automated data acquisition and processing
capabilities, yielding results directly in terms of per cent uptake.
Each determination of the thyroid uptake includes measurement of the
thyroid (i.e. neck) count rate, the ‘thigh’ background count rate (measured
over the patient’s thigh and presumed to approximate the count contribution of
extra-thyroidal neck activity), the standard count rate (often counted in a neck
phantom simulating the thyroid/neck anatomy) and the ambient (i.e. ‘room’)
background, with a 1–5 min counting interval for each measurement. Based
on the foregoing measurements, and knowing the fraction of the administered
activity which is in the standard, the thyroid uptake is calculated as follows:

C neck t neck − C thigh t thigh

uptake (%) = × F × 100% (10.2)
C standard t standard − C room t room

where

C is the total counts;

t is the measurement time;

and F is the fraction of administered activity in the standard.

2
At one time, organ uptake probes were also used to measure kidney time–activity data
for the evaluation of renal function. In addition, organ uptake probes have been adapted to such
well counter applications as counting of blood samples and wipes.

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 nOn-IMAGInG DEtECtORs AnD COUntERs

FIG. 10.7. (a) A typical organ (‘thyroid’) uptake probe system, including an integrated
computer, set-up for a thyroid uptake measurement (AtomLab 950™ Thyroid Uptake System,
Biodex Medical Systems, Shirley, NY, USA). The rather large neck to collimator aperture
distance (typically of the order of 30 cm) should be noted. Although this reduces the overall
sensitivity of the measurement of the neck count rate, it serves to minimize the effect of the
exact size, shape and position of the thyroid, and the distribution of radioisotope within the
gland. (b) A diagram (side view) of the open, or ‘flat-field’, diverging collimator typically used
with thyroid uptake probes. (Courtesy of Biodex Medical Systems, Inc, Shirley, NY, USA.)

by including measurement of a standard activity with each uptake

determination, corrections for radioactive decay and day to day variation in
system sensitivity are automatic. This approach is sometimes known as the
‘two-capsule’ method, since one 131i capsule is administered to the patient while
a second, identical capsule serves as the standard and is counted with each
uptake measurement. alternatively, the patient capsule itself can be measured
immediately before it is administered and then each subsequent uptake value for
radioactive decay can be corrected from the time of measurement to the time of
administration (by multiplying the right side of eq. (10.2) by eλ∆t where λ is the
physical decay constant of the administered isotope and ∆t is the administration
to measurement time interval). This is sometimes known as the ‘one-capsule’
method. for either the one- or two-capsule method, the fraction of administered
activity in the standard is unity. some centres administer radioiodine as a solution,
which is more cost effective, rather than as a capsule. The standard is typically
some dilution of the administered solution and the fraction of administered
activity in the standard is, therefore, an independently determined value less than
unity; for example, if the activity in the standard solution were 1/100th of the
value in the administered solution, the value would equal 0.01.

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Thyroid uptake measurements are now often performed by region of

interest analysis of planar scintigraphic images of the neck and of a standard
(i.e. phantom) acquired with a γ camera with parallel-hole collimation.
Organ uptake probes have also been used to measure total body activity,
for example, as part of individualized dosimetry based radioiodine treatment
of thyroid cancer. For this application, the patient may serve as his or her own
standard by measuring the patient’s total body count rate shortly (30–60 min) after
administration of the radioisotope — to allow it to disperse somewhat throughout
the body — but before the patient has voided or otherwise excreted any of the
administered activity; in Eq. (10.3) below, this is designated time zero. Whole
body measurements are performed with the collimator removed from the probe,
the crystal oriented horizontally and at a height above the floor corresponding to
the mid-height of the patient, either seated or standing, at a distance of ~3 m from
the crystal. Further, anterior and posterior (i.e. conjugate-view) measurements are
performed by having the patient facing towards and then away from the crystal
for the respective measurements. The whole body activity (i.e. the per cent of
administered activity in the body) is then calculated based on the geometric mean
of the anterior and posterior count rates:

 A B   P B  1/2
 − × − 
   
Total body activity (%) =  t A t B   t P t B  × 100% (10.3)
     1/2

 A(0) − B(0) × P(0) − B(0)  
   
 t A(0) t B(0)   t P(0) t B(0) 

where

A and P are the anterior and posterior total body counts, respectively;
B is the room (background) counts;
tA, tP and tB are the counting intervals for anterior, posterior and room counts,
respectively;

and (0) indicates the same quantities at time zero.

As above, the total body activity may be corrected for radioactive decay
from the time of measurement to the time of administration (by multiplying
the right side of Eq. (10.3) by eλ∆t where λ is the physical decay constant of the
administered isotope and ∆t is the administration to measurement time interval).

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10.5. QUALITY CONTROL OF DETECTION AND COUNTING DEVICES

QC, which may be defined as an established set of ongoing measurements

and analyses designed to ensure that the performance of a procedure or instrument
is within a predefined acceptable range, is a critical component of routine nuclear
medicine practice. The following is a brief review of routine QC procedures for
non-imaging nuclear medicine instrumentation.
Documenting of QC procedures and organized, retrievable records of
the results of such procedures are requirements of a sound, compliant QC
programme. A written description of all QC procedures, including the acceptable
(or tolerance) range of the results of each such procedure and the corrective
action for an out of tolerance result, should be included in the facility’s procedure
manual. For each procedure, the written description should be signed and dated
by the facility director, physicist or other responsible individual. For each QC test
performed, the following data, as well as the initials or signature of the individual
performing the test, should be recorded on a structured and suitably annotated
form:

—— The test performed;

—— The date and time of the test;
—— The make, model and serial number of the device tested;
—— The make, model, serial number, activity at calibration and date of
calibration of any reference source(s) used;
—— The result(s) of the test;
—— A notation indicating whether the test result was or was not acceptable
(i.e. was or was not within the specified tolerance range).

Such records should be archived in chronological order in a secure but

reasonably accessible location. It is generally helpful to track the results of QC
tests longitudinally (e.g. in the form of a graph of the numerical result versus the
date of the test). In this way, long term trends in instrument performance, often
imperceptible from one day to the next, may become apparent. Increasingly, of
course, such records are maintained in electronic form. It is advisable, however,
to also maintain records in hard copy form, both as a backup and for convenient
review by regulators and other inspectors.

10.5.1. Reference sources

QC tests of nuclear medicine instrumentation are often performed not

with the radionuclides that are used clinically but with longer lived surrogate
radionuclides in the form of so-called reference sources. Such standards are

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commercially available in various activities and geometries, depending on the

application. Importantly, in the USA, the certified activities of such reference
sources must be traceable to the National Institute of Standards and Technology
(NIST), formerly the National Bureau of Standards. NIST traceability helps
ensure the accuracy of the calibrated activity. As such reference sources are
long lived, a single standard may be used for months to years, avoiding the need
to prepare sources on a daily or weekly basis and, thereby, avoiding possible
inaccuracies in dispensing activity as well as the possibility of radioactive
contamination. On the other hand, as with all sealed sources, reference sources
must be checked for leakage of radioactivity (i.e. ‘wipe-tested’) periodically and
an up to date inventory of such standards must be maintained. Reference sources
are still radioactive at the end of their useful lifespan and must, therefore, be
returned to the vendor or a third party or otherwise disposed of as radioactive
waste.
A long lived radionuclide comprising a reference source must match, in
terms of the frequency and energy of its X ray and γ ray emissions, the clinical
radionuclide for which it acts as a surrogate in order to ensure that instrument
responses to the clinical radionuclide and to its surrogate are comparable.
Surrogate radionuclides commonly used in nuclear medicine and their physical
properties and applications are summarized in Table 10.2.

10.5.2. Survey meter

QC tests of survey meters generally include a daily battery check, with

a display indicating whether the voltage supplied by the battery is within the
acceptable operating range. In order to confirm that the survey meter has not been
contaminated (i.e. yields a reproducibly low exposure or count rate in the absence
of radioactivity), the background exposure or count rate should be measured daily
in an area remote from radioactive sources within the nuclear medicine facility,
if such an area is reasonably accessible. In addition, survey meters should be
checked daily for constancy of response by measuring the exposure or count
rate of a long lived reference source in a reproducible measurement geometry.
Aside from the short term decay of the reference source, the measured day to
day exposure or count rates should agree within 10%; if not, the meter should be
recalibrated.
Survey meters should be calibrated — that is, checked for accuracy —
using suitable long lived reference sources at installation, annually and after any
repair. If the source is ‘small’ (compared to the mean free path of its emitted
X rays and γ rays within the material comprising the source) and the distance
between the source and meter ‘large’ (compared to the dimensions of the source),

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then a point-source geometry is approximated and the expected dose rate D in

air is given by the inverse square law:

− ∆t
 = A 0e Γ
D 2
(10.4)
d

where

A0 is the activity of the reference source at calibration;

λ is the physical decay constant of the radionuclide comprising the reference
source;
Dt is the time interval between the calibration of the reference source and the
current measurement;
Gd is the air kerma rate constant (the subscript d indicates that only photons
with energies greater than d, typically set at 20 keV, are included) of the
radionuclide comprising the reference source;

and d is the distance between the reference source and the meter (Table 10.2).

The dose rates should be measured on each scale and, by appropriate

adjustment of the source–meter distance, with two readings (~20% and ~80% of
the maximum) on each scale. For all readings, the expected and measured dose
rates should agree within 10%.
Many nuclear medicine facilities have their survey meters calibrated by
the institutional radiation safety office or by a commercial calibration laboratory.
In addition to a calibration report (typically, a one page document) specifying
the reference source(s) used, the measurement procedure, and the measured
and expected exposure rates, a dated sticker summarizing the calibration results
should be affixed to the meter itself.

10.5.3. Dose calibrator

Among routine dose calibrator QC tests3, constancy must be checked

daily and accuracy and linearity at least quarterly; daily checks of accuracy
are recommended. For the constancy test, an NIST-traceable reference source,
such as 57Co, 68Ge or 137Cs (Table 10.2), is placed in the dose calibrator and the

3
At the installation of a dose calibrator, the geometry dependent response for 99mTc
must be measured and volume dependent (2–25 mL) correction factors relative to the ‘standard’
volume (e.g. 10 mL) derived. This procedure is required periodically following installation.

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 TABLE 10.2. LONG LIVED RADIONUCLIDES COMPRISING REFERENCE SOURCES FOR INSTRUMENTATION

308
QUALITY CONTROL

Physical Photopeak energy Eγ

Air kerma rate
decay and frequency Geometry Quality control
Radionuclide Half-life constant Γδ
of principal and activity application
constant λ (mGy · m2 · h–1 · GBq–1)a
X ray or γ ray
Test tube-size rod, Well counter
~37 kBq constancy and accuracy
57
Co 272 d 0.00254/d 122 keV (86%) 14.1
Vial/small bottle, Dose calibrator
185–370 MBq accuracy and constancy
Test tube-size rod, Well counter
37 kBq constancy and accuracy
68
Geb 287 d 0.00241/d 511 keV (178%) 129
Vial/small bottle, Dose calibrator
185–370 MBq accuracy and constancy
CHAPTER 10

Test tube-size rod, Well counter

37 kBq constancy and accuracy
137
Cs 30 a 0.0231/a 662 keV (86%) 82.1
Vial/small bottle, Dose calibrator
185–370 MBq accuracy and constancy
a
The air kerma rate constant Γδ is equivalent to the older specific γ ray constant Γ.
b
Germanium-68 in a sealed source is in secular equilibrium with its short lived, positron emitting daughter 68Ga (half-life: 68 min).
 nOn-IMAGInG DEtECtORs AnD COUntERs

activity reading on each scale recorded; day to day readings should agree within
10%. for the accuracy test (sometimes also known as the energy linearity test), at
least two of the foregoing NisT-traceable reference sources are separately placed
in the dose calibrator and the activity reading on each scale recorded. for each
source, the measured activity on each scale and its current actual activity should
agree within 10%.

FIG. 10.8. Set of lead-lined plastic sleeves (CalicheckTM Dose Calibrator Linearity Test Kit,
Calicheck, Cleveland, OH, USA) for evaluation of dose calibrator linearity by the shield
method. The set is supplied with a 0.64 cm thick lead base, a colour coded unlined sleeve (to
provide an activity measurement equivalent to the zero time point measurement of the decay
method) and a six colour coded lead-lined sleeve providing attenuation factors nominally
equivalent to decay over 6, 12, 20, 30, 40 and 50 h, respectively. (Courtesy of Calicheck,
Cleveland, OH, USA.)

The quarterly check of linearity by the so-called ‘decay method’ begins

with a high activity (~37 Gbq), independently calibrated 99mTc source and its
activity is assayed at 12 h intervals over three consecutive days. over that time,
equivalent to twelve half-lives of 99mTc, the activity decays to ~10 Mbq. The
measured activities are then plotted versus time on a semi-logarithmic graph and
the best fit straight line drawn through the data points thus plotted (either ‘by
eye’ or using a least squares curve-fitting algorithm). for each data point, the
difference between the measured activity and the activity on the best fit straight
line at that point should be less than 10%. an alternative approach to checking
linearity is the ‘shield method’ in which lead sleeves of increasing thickness
are placed in the dose calibrator with a 99mTc source (fig. 10.8). by interposing
increasing ‘decay-equivalent’ thicknesses (as specified by the manufacturer for

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the set of lead sleeves) between the source and the dose calibrator’s sensitive
volume, a decay-equivalent activity is measured for each sleeve. While the shield
method is much faster than the decay method for checking linearity (taking
minutes instead of days), an initial decay based calibration of the set of sleeves
is recommended to accurately determine the actual decay equivalence of each
shield.

10.5.4. Well counter

The routine QC tests for well counters include checks of the photopeak
energy window (i.e. energy peaking) if the counter is equipped with a
multichannel analyser, background, constancy and efficiency (or sensitivity).
Prior to counting samples containing a particular radionuclide, the energy
spectrum should be checked to verify that the counter is properly ‘peaked’,
that is, that the radionuclide’s photopeak coincides with the preset photopeak
energy window4. For each photopeak energy window used, the background
count rate should be checked daily. Importantly, electronic noise as well as
ambient radiation levels, which may be relatively high and variable in a nuclear
medicine facility, will produce a non-zero and potentially fluctuating background
count rate. Furthermore, even trace contamination of the counting well will
produce inaccurately high count rate values. Accordingly, a ‘blank’ (i.e. an
empty counting tube or vial) should always be included to determine the current
background count. To check constancy, at least one NIST-traceable reference
source (Table 10.2) should likewise be counted each day; day to day net (i.e. gross
minus background) count rates should agree within 10%.
In addition, as noted above, for each radionuclide for which a particular
well counter is used, the counter should be calibrated — that is, its efficiency
(sensitivity) (in cpm/kBq) determined — at installation, annually and after any
repair (Eq. (10.1)).

10.5.5. Intra-operative probe

In addition to daily battery and background checks (as done for survey
meters), QC tests of intra-operative probes should include a daily bias check
for both the primary and any backup battery to verify that bias voltage (or
high voltage) is within the acceptable range. As intra-operative probes may not
provide a display of the energy spectrum, it may not be possible to visually check

4
Isotope specific radionuclide counting or imaging with a scintillation detector is
commonly performed using a 20% photopeak energy window, equivalent to an energy range of
Eγ ± 10% where Eγ is the X ray or γ ray energy of the radionuclide.

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 NON-IMAGING DETECTORS AND COUNTERS

that the probe is properly peaked, that is, that the photopeak coincides with the
preset photopeak energy window. The lower counts or count rates resulting from
an inappropriate energy window may, therefore, go unnoticed. Thus, a long lived
reference source or set of reference sources (such as 57Co, 68Ge and/or 137Cs
(Table 10.2)) should be available for daily checks of count rate constancy; a
marked change (e.g. >±10%) in the net count rate from one day to the next may
indicate an inappropriate energy window setting or some other technical problem.
Ideally, the reference sources should each be incorporated into some sort of cap
that fits reproducibly over the probe so that spurious differences in count rates
due to variations in source–detector geometry are avoided.

10.5.6. Organ uptake probe

Aside from differences in counting geometry and sensitivity, uptake probes

and well counters actually have very much in common and the QC procedures
— checks of the photopeak energy window, background, constancy and
efficiency — are, therefore, analogous. Importantly, however, efficiency should
be measured more frequently — for each patient — than for a well counter, so
that the probe net count rates can be reliably converted to thyroid uptakes for
individual patients.

BIBLIOGRAPHY

CHERRY, S.R., SORRENSON, J.A., PHELPS, M.E., Physics in Nuclear Medicine, 3rd edn,
Saunders, Philadelphia, PA (2003).
NINKOVIC, M.M., RAICEVIC, J.J., ANDROVIC, A., Air kerma rate constants for γ emitters
used most often in practice, Radiat. Prot. Dosimetry 115 (2005) 247–250.
ZANZONICO, P., Routine quality control of clinical nuclear medicine instrumentation: A brief
review, J. Nucl. Med. 49 (2008) 1114–1131.
ZANZONICO, P., HELLER, S., “Physics, instrumentation, and radiation protection”, Clinical
Nuclear Medicine (BIERSACK, H.J., FREEMAN, L.M., Eds), Springer Verlag, Berlin
Heidelberg (2007) 1–33.

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 CHAPTER 11

NUCLEAR MEDICINE IMAGING DEVICES

M.A. LODGE, E.C. FREY

Russell H. Morgan Department of Radiology and Radiological Sciences,
Johns Hopkins University,
Baltimore, Maryland, United States of America

11.1. INTRODUCTION

Imaging forms an important part of nuclear medicine and a number of

different imaging devices have been developed. This chapter describes the
principles and technological characteristics of the main imaging devices used
in nuclear medicine. The two major categories are gamma camera systems and
positron emission tomography (PET) systems. The former are used to image
γ rays emitted by any nuclide, while the latter exploit the directional correlation
between annihilation photons emitted by positron decay. The first section of this
chapter discusses the principal components of gamma cameras and how they
are used to form 2‑D planar images as well as 3‑D tomographic images (single
photon emission computed tomography (SPECT)). The second section describes
related instrumentation that has been optimized for PET data acquisition. A major
advance in nuclear medicine was achieved with the introduction of multi-modality
imaging systems including SPECT/computed tomography (CT) and PET/CT. In
these systems, the CT images can be used to provide an anatomical context for
the functional nuclear medicine images and allow for attenuation compensation.
The third section in this chapter provides a discussion of the principles of these
devices.

11.2. GAMMA CAMERA SYSTEMS

11.2.1. Basic principles

The gamma camera, or Anger camera [11.1], is the traditional workhorse of

nuclear medicine imaging and its components are illustrated in Fig. 11.1. Gamma
camera systems are comprised of four basic elements: the collimator, which
defines the lines of response (LORs); the radiation detector, which counts incident
γ photons; the computer system, which uses data from the detector to create 2‑D

312