Strategies for defining an optimal risk-benefit ratio for stress myocardial perfusion SPECT.

Tremendous growth in medical imaging has prompted a re-focusing on the appropriateness of testing and the rationale for exposure to ionizing radiation for large segments of the adult population at intermediate to high likelihood for coronary artery disease (CAD). Part I of this series addressed the technical or methodological approaches to measuring radiation exposure and laboratory approaches to reducing exposure including the clinical utility of stress only imaging. In the current statement, we present a clinical approach for defining the risk:benefit ratio of myocardial perfusion imaging (MPI) focusing on the appropriate use of single photonemission computed tomography (SPECT) or positron emission tomography (PET) MPI. We also review the concept of ‘‘patient-centered imaging’’ and discuss methods for effectively addressing patient concerns regarding procedural risk.