The present invention provides radiation detectors and methods, including radiation detection devices having beam-oriented scintillators capable of high-performance, high resolution imaging, methods of fabricating scintillators, and methods of radiation detection. A radiation detection device includes a beam-oriented pixellated scintillator disposed on a substrate, the scintillator having a first pixel having a first pixel axis and a second pixel having a second pixel axis, wherein the first and second axes are at an angle relative to each other, and wherein each axis is substantially parallel to a predetermined beam direction for illuminating the corresponding pixel.