An adaptive opto-emission imaging device includes a detector having a detector face and a back surface. The detector detects radiation emanating from an object positioned in the direction of the detector face, and produces a radiopharmaceutical distribution profile of the detected radiation. An image capturing device such as a video camera provided at the detector face of the detector produces a live visual image of the object. A display device provided at the back surface of the detector displays the radiopharmaceutical distribution profile and/or the live visual image of the object. The adaptive opto-emission imaging device greatly reduces the amount of computation and time to provide real time image guidance, for example to physicians using the device to perform an image-guided surgical procedure.