The current Japanese Ministry of Health, Labor, and Welfare (JMHLW) approvals of cardiac single photon emission computed tomography (SPECT) include myocardial perfusion, cardiac function, sympathetic nervous activity and fatty metabolism imaging. ^99mTc-pyrophosphate (PYP), ²⁰¹Tl, ^99mTc-sestamibi, ^99mTc-tetrofosmin, ¹²³I-metaiodobenzylguanidine (MIBG) and ¹²³I-beta-methyl-p-iodophenylpentadecanoic acid (BMIPP) are widely used with a uniform delivery system in Japan. The numbers of myocardial perfusion scan are decreasing but myocardial sympathetic nerve imaging using ¹²³I-MIBG is increasing.