Optimized positron emission tomographs have begun to demonstrate an ever widening range of clinical applications for positron labelled pharmaceuticals. This potential has led to a renewed interest in the use of the more widely available Anger gamma camera detectors for imaging the 511 keV photons from the positron decay process. Two forms of detection can be considered: either the detection of the 511 keV photons as single events or the detection of coincidence events from the opposed pair annihilation photons. The widespread availability of dual, opposed-pair, large field-of-view detectors has promoted the development of coincidence detection without collimation. With detector rotation, positron emission tomography (PET) can be performed. An alternative and lower cost option has been the universal development of ultra high-energy collimators to perform single photon emission tomography (SPET) with 511 keV photons. This review outlines the currently available performance characteristics of these two approaches and compares them with those from two- and three-dimensional PET optimized systems. The limitations on the development of these systems is discussed through the analysis of the principles underlying both single photon and coincidence detection. Preliminary clinical experience indicates that limitations in the performance characteristics of these systems has implications for their potential role, although applications in cardiology and oncology are being pursued.