Nuclear medicine remains a vibrant and dynamic medical specialty because it so adeptly marries advances in basic science research, technology, and medical practice in attempting to solve patients' problems. As a physicist, it is my responsibility to identify or design new instrumentation and techniques, and to implement, validate, and help apply these new approaches in the practice of nuclear medicine. At Johns Hopkins, we are currently in the process of purchasing both a single-photon/coincidence tomographic imaging system and a dedicated positron emission tomography (PET) scanner. Given the exciting advances that have been made, but the conflicting opinions of manufacturers and colleagues alike regarding "best" choices, it seemed useful to review what is new now, and what is on the horizon, to help identify all of the important considerations in the design and selection of an imaging system. It is important to note that many of the "advances" described here are in an early stage of development, and may never make it to routine clinical practice. Further, not all of the advances are of equal importance, or have the same degree of general clinical applicability. Please also note that the references contained herein are for illustrative purposes and are not all-inclusive; no implication that those chosen are "better" than others not mentioned is intended.