Radionuclide myocardial perfusion imaging (MPI) using single photon emission computed tomography (SPECT) or positron emission tomography (PET) for the detection of ischemia in patients with known or suspected coronary artery disease (CAD) has widespread clinical utilization and has been shown to have high accuracy and incremental prognostic value. Amidst the recent publicity regarding the increasing use of all types of ionizing radiation in the United States, patients and medical professionals are scrutinizing the need for diagnostic testing and how radiation exposure can be reduced. There are three critical questions that physicians must consider and answer with regard to radiation exposure and performing MPI in a particular patient:

  • Is MPI testing appropriate and necessary in this patient?
  • How can the MPI protocol be optimized to give the lowest possible radiation dose while maintaining diagnostic accuracy?
  • How can new technologies be utilized to provide the lowest possible radiation dose while maintaining diagnostic accuracy?

Lowering the radiation dose while maintaining or improving image quality should be considered an improvement in quality of care; the lower the radiation and the higher the image quality, the greater the improvement in the quality of patient care. In general, all MPI studies should be performed in appropriate patients using relatively short-lived radionuclides, and using all possible measures to minimize radiation exposure. Under such circumstances, the benefits of the diagnostic and prognostic information outweigh the risks of radiation exposure.

This document identifies the best practice methods to optimize the benefits of MPI testing by obtaining the highest quality diagnostic images while minimizing radiation exposure. The focus will be on the appropriate selection of patients, the use of protocols that lessen total radiation exposure, and the use of equipment and processing methods that achieve the best image quality at the lowest possible radiation dose.

Cerqueira et al, ASNC Information Statement. 2010 May
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