The intraoperative gamma probe: basic principles and choices available

Abstract

By taking advantage of the proximity to radioactive sentinel nodes and occult tumors achievable in an operative setting, intraoperative probes are becoming increasingly important in the surgical management of cancer. This article begins with a discussion of the statistical limitations of radiation detection and measurement and of the key performance parameters (sensitivity, energy resolution, and spatial resolution) that characterize detectors. The basic design and operating principle of radiation detectors used in intraoperative probes, scintillation and semiconductor detectors, are then reviewed. Scintillation detector-based intraoperative probes, generally using a NaI(T1) or a CsI(T1) crystal connected to a photomultiplier tube by a fiberoptic cable, have the advantages of reliability, relatively low cost, and high sensitivity, especially for medium- to high-energy photons. Disadvantages include poor energy resolution and scatter rejection, and bulkiness. Semiconductor (CdZn, CdZnTe, HgI2)-based probes are compact and have excellent energy resolution and scatter rejection, but with complex energy spectra reflecting charge-carrier trapping. Their main disadvantage is lower sensitivity. The performance parameters of various commercially available intraoperative probes are then compared. The article concludes with a discussion of the practical considerations in selecting and using intraoperative probes, including ergonomic and other design features, as well as performance parameters.