title: Implementation of technetium-99m MIBI SPECT imaging guidelines: optimizing the two day stress-rest protocol.
abstract: OBJECTIVE
  In a previous study in 460 patients, we found that in patients with suspected or known coronary artery disease undergoing stress-rest technetium-99m sestamibi (MIBI) SPECT myocardial perfusion imaging, rest SPECT imaging could be withhold in approximately 20% of patients because of a completely normal stress study. The present study was set up to evaluate the consequences of the implementation of this finding in a subsequent population of patients, and to set standards for the variety of protocols now used for MIBI SPECT imaging.
  
  
  METHODS
  Within a period of 4 months, 235 consecutive patients referred for MIBI SPECT scintigraphy were studied. All patients had stable cardiac chest pain and underwent symptom-limited exercise MIBI SPECT perfusion imaging. The stress SPECT images were reconstructed and evaluated immediately after acquisition of the images. In case of a clearly normal stress SPECT study, rest imaging was cancelled.
  
  
  RESULTS
  Twenty-six of 235 patients (11%) had a completely normal stress MIBI SPECT study and the rest SPECT imaging procedure could be subsequently cancelled. In 20 patients (9%) the stress SPECT was inconclusive, and in 189 (80%) of patients stress imaging was clearly abnormal. In the first month of the study, the nuclear medicine physicians and cardiologists would interprete only 6% of the stress images as normal, while this number increased to 13% after 9 weeks, with a mean of 11% for the whole investigation period of 4 months.
  
  
  CONCLUSIONS
  In patients undergoing stress MIBI SPECT imaging, it was found justified to cancel rest MIBI SPECT imaging in at least 11% of patients because of a completely normal stress SPECT. As 9% of the images were inconclusive, the number of normal stress images could theoretically increase to 20% if reliable measures are taken to improve reading accuracy. This number is in close agreement with the number of normal stress studies previously reported by our institution and would lead to a considerable reduction of radiation dose, costs, and increased convenience for an important subset of patients.
authors.affiliation: Department of Nuclear Medicine, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Lavalaye
authors.forename: J M
authors.initials: JM
authors.lastname: Schroeder-Tanka
authors.forename: M M
authors.initials: MM
authors.lastname: Tiel-van Buul
authors.forename: E E
authors.initials: EE
authors.lastname: van der Wall
authors.forename: K I
authors.initials: KI
authors.lastname: Lie
authors.forename: E A
authors.initials: EA
authors.lastname: van Royen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D003937:Diagnosis, Differential; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D017410:Practice Guidelines as Topic; D012146:Rest; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D003287:Contrast Media; D017256:Technetium Tc 99m Sestamibi