RADIONUCLIDE GUIDELINES Procedure guidelines for radionuclide myocardial perfusion imaging

Correspondence to: Dr Constantinos Anagnostopoulos, Royal Brompton Hospital, Sydney St, London SW3 6NP, UK; c.anagnostopoulos@ rbh.nthames.nhs.uk . . . . . . . . . . . . . . . . . . . . . . . 1 BACKGROUND Radionuclide myocardial perfusion imaging uses an intravenous radiopharmaceutical to image myocardial perfusion during stimulation of the perfusion system and at rest. The images are acquired using a gamma camera. Tomographic imaging is preferred over planar imaging because of the three dimensional nature of the images and their superior contrast resolution. Comparison of the myocardial distribution of the radiopharmaceutical after stress and at rest provides information on myocardial viability, inducible perfusion abnormalities, and, when ECG gated imaging is used, global and regional myocardial function. Radionuclide myocardial perfusion imaging is an established and non-invasive imaging technique with diagnostic and prognostic efficacy in the investigation of coronary artery disease. It is the only widely available test for assessing myocardial perfusion directly, but there are variations in the way it is performed in different centres. Harmonisation of practice, at least at a national level, is therefore essential, and clinical governance now makes it mandatory for practice to be based upon evidence whenever possible. This is best achieved by expert analysis of the evidence, and to this end the British Nuclear Cardiology Society (BNCS), in association with the British Cardiac Society (BCS) and the British Nuclear Medicine Society (BNMS), have developed procedure guidelines for tomographic myocardial perfusion imaging. The guidelines are intended to assist medical practitioners and other healthcare professionals in recommending, performing, interpreting, and reporting single photon emission computed tomography (SPECT) of myocardial perfusion. They do not cover the benefits or drawbacks of the technique in specific circumstances; neither do they address its cost–effectiveness in clinical diagnosis and management or its potential impact on clinical outcomes.