The principle of scintillation detectors has been among the first realizations of radiation detectors. Despite ongoing attempts to switch to direct converting detectors, scintillators have shown great persistence in the field of medical imaging. In radiography, computer tomography and nuclear medicine, a variety of scintillating devices are the ‘workhorses’ of the clinician today. For radiography, flat X-ray detectors (FDs) with evaporated scintillation layers are at the level of product introduction. However, X-ray image intensifier tubes (XIIs) are competitive and still have features that will be hard to beat in the near future. Although XIIs have disadvantages, they have experienced a significant evolution in robust image quality and cost reduction over the decades. The so-called ‘offline’ detectors from film to storage phosphors seemed to have reached a plateau since the late 1970s. However, the distinction between on- and offline may soften in the future, because of new readout concepts. Detectors in computer tomography (CT) have evolved from scintillators to gaseous direct converters back to scintillators. Extreme timing requirements and detector modularity have ruled out designs that would rank as `high performance’ in other fields. Modern ultra-fast ceramic scintillation detectors are a prerequisite of subsecond CT and leave breathing room for future scan times even below 0.5s. The field of nuclear medicine is a good example of how difficult it is, to replace a cheap and reliable technology. Since many years, direct converters like CdTe and the likes are discussed to overthrow the regime of NaI:Tl in combination with photomultipliers (PMTs). Both components are well known since the 1950s and have shown remarkable staying power. Still the scintillator with the highest light output, NaI:Tl in combination with the basically noiseless PMT is almost unbeatable in low cost. In combination with modern digital electronics, drawbacks of analog circuitry like temperature drift and energy dependence can be made practically invisible to the user. New ultra-compact PMT designs could drive the design of the gamma camera towards more compactness, even without direct converting detectors.
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