Positron Emission Mammography (PEM) is a valuable molecular imaging technique for breast studies using pharmaceuticals labeled with positron emitters and dual-panel detectors. PEM scanners normally use large scintillation crystals coupled to sensitive photodetectors. Multiple interactions of the 511 keV annihilation photons in the crystals can result in event mispositioning leading to a negative impact in radiopharmaceutical uptake quantification. In this work, we report the study of crystal scatter effects of a large-area dual-panel PEM system designed with either monolithic or pixelated lutetium yttrium orthosilicate (LYSO) crystals using the Monte Carlo simulation platform GATE. The results show that only a relatively small fraction of coincidences (~20%) arise from events where both coincidence photons undergo single interactions (mostly through photoelectric absorption) in the crystals. Most of the coincidences are events where at least one of the annihilation photons undergoes a chain of Compton scatterings: approximately 79% end up in photoelectric absorption while the rest (<1%) escape the detector. Mean positioning errors, calculated as the distance between first hit and energy weighted (assigned) positions of interaction, were 1.70 mm and 1.92 mm for the monolithic and pixelated crystals, respectively. Reconstructed spatial resolution quantification with a miniDerenzo phantom and a list mode iterative reconstruction algorithm shows that, for both crystal types, 2 mm diameter hot rods were resolved, indicating a relatively small effect in spatial resolution. A drastic reduction in peak-to-valley ratios for the same hot-rod diameters was observed, up to a factor of 14 for the monolithic crystals and 7.5 for the pixelated ones.
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