Can the Past Inform the Future of Nuclear Cardiology?

Excerpt

In the four decades since the first clinical myocardial perfusion scan, the field of nuclear cardiology has become ubiquitous and its techniques widely utilized in the care of patients with heart disease.1 Despite affectionate epithets like “unclear cardiology,” its strengths and weaknesses are well recognized, and both practitioners and subscribers are equally comfortable with its applications. The extraordinary growth in the utilization of single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in the last two decades has attracted intense regulatory scrutiny and accusations of profit-driven utilization. Similar patterns of growth in healthcare environments that do not operate on a fee-for-service basis suggests that it would be cynical to attribute all overutilization to a profit motive.2 Nonetheless, a perfect storm of regulatory scrutiny, reimbursement cuts, sensationalistic debate about radiation risk, and the burgeoning of newer and seemingly more alluring modalities for stress imaging has challenged the preeminence of nuclear cardiology. …