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Quantitative stress-redistribution sequential imaging optimises MPI with the lowest dose of radiation per patient
  1. Richard M Fleming1,
  2. Matthew R Fleming1,
  3. Tapan K Chaudhuri2,
  4. Andrew McKusick3
  1. 1Cardiology, FHHI-OmnificImaging-Camelot, El Segundo, California, USA
  2. 2Radiology, Eastern Virginia Medical College, Norfolk, Virginia, USA
  3. 3Nuclear Imaging, Sebec Consulting & Media, Rock Hill, South Carolina, USA
  1. Correspondence to Dr Richard M Fleming; rmfmd7{at}

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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.

Figure 1

Quantification of Tc-99m isotope redistribution from 5 to 60 min post-stress allows a single dose of isotope to be given post-stress. Figure reproduced with the permission of the authors. Tc-99m, technetium-99m.

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.


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  • 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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