Meeting the detector challenges for pre-clinical proton and ion computed tomography

Six decades after its conception, proton computed tomography (pCT) and proton radiography have yet to be used in medical clinics. However, good progress has been made on relevant detector technologies in the past two decades, and a few prototype pCT systems now exist that approach the performance needed for a clinical device. The tracking and energy-measurement technologies in common use are described, as are the few pCT scanners that are in routine operation at this time. Most of these devices still look like detector R&D efforts as opposed to medical devices, are difficult to use, are at least a factor of five slower than desired for clinical use, and are too small to image many parts of the human body. Recommendations are made for what to consider when engineering a pre-clinical pCT scanner that is designed to meet clinical needs in terms of performance, cost, and ease of use.