The ECAT HRRT is a three-dimensional (3-D) only dedicated brain tomograph employing the new scintillator lutetium-oxy-orthosilicate (LSO) and using depth of interaction (DOI) information to achieve uniform isotropic resolution across a 20-cm diameter volume. With its unique technological innovations it represents the prototype of a new generation of high-resolution brain tomographs. The physical performance with respect to count rate, live time, scatter, sensitivity, and resolution was evaluated with phantom studies and measurements with a point source. The HRRTs imaging performance was tested with phantoms and fluorodeoxyglucose (FDG) scans performed in animal and human brains. We find that due to the significantly improved resolution and the large solid angle covered by the panel detectors, several issues that have been adequately solved for older generation scanners demand new attention for the HRRT, like acquiring and handling large amounts of data effectively, strategies for optimal reconstruction, shielding, and correction of random coincidences.