Stress-Only SPECT Myocardial Perfusion Imaging

A review of the accuracy, patient outcomes, implementation strategies and new developments associated with stress-only myocardial perfusion imaging.

Course ID: Q00435 Category:
Modalities: , ,


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Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after May 9, 2023:

Nuclear Medicine Technology: 2.50
Procedures: 2.50
Cardiac Procedures: 2.50


  1. Introduction
  2. Features of SO Myocardial Perfusion Imaging (SO MPI
    1. Feasibility and Rationale of SO MPI
    2. Attenuation Correction in Conjunction with SO MPI
      1. Electrocardiographic gating value in SO MPI
      2. Accuracy and outcomes of patients undergoing SO MPI
    3. SO MPI in Diabetic Patients
  3. SO Protocol: Patient Selection and Protocol Choices
    1. Appropriate Patients for SO Protocol
    2. Higher Vs Lower Radiotracer Dose
  4. Definition of ìNormalî Stress-Only Result
  5. Abnormal SO Myocardial Perfusion Imaging and Decision Making
    1. Case 1
    2. Case 2
  6. Radiation Exposure and the Use of SO MPI
  7. Limitations of SO Myocardial Perfusion Imaging
  8. Future Directions/Newer Developments
    1. Stress-Only (SO) Protocol with PET Myocardial Perfusion Imaging
  9. Conclusions


Upon completion of this course, students will:

  1. provide an accurate description of SPECT-MPI
  2. identify reasons why Tc-99m tracers are superior to Tl-201
  3. understand the barriers to adopting SO SPECT-MPI
  4. learn the history of SO SPECT-MPI
  5. describe the rest rate in SO SPECT-MPI without AC or prone imaging
  6. identify physician confidence level with SO SPECT-MPI
  7. understand the benefit of CTAC over emission based AC
  8. understand the benefit of CTAC over prone imaging
  9. learn about ECG gating as it relates to SO SPECT-MPI
  10. understand the benefits of wall motion analysis
  11. describe defects in SO SPECT-MPI (non-AC) as it relates to gated data
  12. describe defects in SO SPECT-MPI (with-AC) as it relates to gated data
  13. identify diagnostic comparisons between SO SPECT-MPI and the conventional procedure
  14. describe wall thickening analysis as it relates to SO SPECT-MPI
  15. understand balanced ischemia and ways to minimize its impact
  16. identify cardiac event rates among normal SO SPECT-MPI cases
  17. be familiar with mortality rates among normal SO SPECT-MPI cases
  18. understand the relationship between SO SPECT-MPI and obesity
  19. understand outcomes of normal SO SPECT-MPI studies from the ED
  20. describe the improvement between NC SPECT-MPI and AC SPECT-MPI
  21. learn about diabetic patients (CHD equivalent) and SO SPECT-MPI
  22. identify the best group for a SO SPECT-MPI protocol
  23. understand the best pathway for patients who had other cardiac testing
  24. understand the benefit of using high dose SO SPECT-MPI
  25. understand the benefit of using low dose SO SPECT-MPI
  26. describe the impact of “shine through” and “cross talk” from radiotracers
  27. understand the minimum ratios and wait time for tracer injections
  28. know the best course of action with normal MPI and abnormal ECG
  29. understand ASNC guidelines that all labs should be striving to obtain
  30. describe the benefit of SO SPECT-MPI for in-patient clinics