title: The Benefits of Prone SPECT Myocardial Perfusion Imaging in Reducing Both Artifact Defects and Patient Radiation Exposure.
abstract: BACKGROUND
  Prone imaging has been demonstrated to minimize diaphragmatic and breast tissue attenuation.
  
  
  OBJECTIVE
  To determine the role of prone imaging on the reduction of unnecessary rest perfusion studies and coronary angiographies performed, thus decreasing investigation time and radiation exposure.
  
  
  METHODS
  We examined 139 patients, 120 with an inferior wall and 19 with an anterior wall perfusion defect that might represented attenuation artifact. Post-stress images were acquired in both the supine and prone position. Coronary angiography was used as the "gold standard" for evaluating coronary artery patency. The study was terminated and rest imaging was obviated in the presence of complete improvement of the defect in the prone position. Quantitative interpretation was performed. Results were compared with clinical data and coronary angiographic findings.
  
  
  RESULTS
  Prone acquisition correctly revealed defect improvement in 89 patients (89/120) with inferior wall and 12 patients (12/19) with anterior wall attenuation artifact. Quantitative analysis demonstrated statistically significant difference in the mean summed stress scores (SSS) of supine and mean SSS of prone studies in patients with disappearing inferior wall defect in the prone position and patent right coronary artery (true negative results). The mean difference between SSS in supine and in prone position was higher with disappearing than with remaining defects.
  
  
  CONCLUSIONS
  Technetium-99m (Tc-99m) tetrofosmin myocardial perfusion imaging with the patient in the prone position overcomes soft tissue attenuation; moreover it provides an inexpensive, accurate approach to limit the number of unnecessary rest perfusion studies and coronary angiographies performed.
authors.affiliation: Department of Nuclear Medicine, University Hospital of Heraklion, Crete, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Stathaki
authors.affiliation: Department of Nuclear Medicine, University Hospital of Heraklion, Crete, Greece.
authors.forename: Sophia
authors.initials: S
authors.lastname: Koukouraki
authors.affiliation: Department of Nuclear Medicine, University Hospital of Heraklion, Crete, Greece.
authors.forename: Emmanouela
authors.initials: E
authors.lastname: Papadaki
authors.affiliation: Department of Nuclear Medicine, University Hospital of Heraklion, Crete, Greece.
authors.forename: Angeliki
authors.initials: A
authors.lastname: Tsaroucha
authors.affiliation: Department of Nuclear Medicine, University Hospital of Heraklion, Crete, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Karkavitsas
mesh_terms: D000368:Aged; D016477:Artifacts; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D056888:Patient Positioning / Q000379:methods*; D016684:Prone Position; D000069079:Radiation Exposure / Q000517:prevention & control*; D019275:Radiopharmaceuticals; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C078700:technetium tc-99m tetrofosmin