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The authors wish to congratulate Winchester et al1 for their recognition of increasing the use of a stress-only approach to myocardial perfusion imaging (MPI). Prior to the introduction of technetium-99m (Tc-99m) isotopes, it was common to inject a single dose of isotope and conduct serial images to look for redistribution to determine if ischaemia or infarction was present.
With the introduction of Tc-99m isotopes in the late 1980s, clinicians were told that the era of redistribution had passed and two doses of isotope would be required to conduct stress-rest2 imaging. With the development of quantitative3 MPI (figure 1), it has become clear that even Tc-99m isotopes redistribute, making it possible to compare serial images following a single dose of Tc-99m isotopes given after stress.
Work by Winchester et al1 demonstrates how we can further reduce the radiation dose United States patients and staff are exposed to achieving parity with the worldwide practice of MPI.4 5 The incorporation of lower stress isotope dose and quantification of redistribution as shown in figure 1, provide optimal MPI with the least amount of radiation exposure.
Contributors RMF, MRF, TKC and AMK all participated in the preparation and writing of this paper.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Acorn Funding Group, LLC of Denver, CO, USA provided funding support for publication costs.
Competing interests FMTVDM was issued to the primary author. Figure reproduced with expressed consent.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; internally peer reviewed.
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