Nuclear Cardiology Tests Questions? Contact Us Ron Schwartz MD MS FACC FAHA ABNM FASNC Director of URMC Nuclear Cardiology and PET CT Laboratories URMC Cardiology at Strong URMC Cardiology at Clinton Crossings Science Park (PET CT) (585) 273-4340 Office Direct (585) 748-5803 Cell (585) 220-1953 Pager Maria Mackin BS MS, CNMT ARRT(N) Chief Technologist, Nuclear Cardiology Laboratory Supervisor URMC Cardiology at Strong URMC Cardiology at Clinton Crossings Science Park (PET CT) (585) 273-3228 Office Direct (585) 220-0594 Pager (585) 355-0333 Cell Types of Nuclear Cardiology Tests SPECT: Single Photon Emission Computed Tomography: The “Standard” nuclear stress test which provides rest and stress myocardial perfusion imaging, automated calculations of LV volume indices, ejection fraction. Radiation exposures: 3 – 10 mSv. Multiple studies in large study populations confirm the value of revascularization in patients with extensive (>10% LV mass) stress induced ischemia with non-extensive (<10%) or no myocardial scar present. (Hachamovitch R, et al. European Heart Journal, January 21, 2011). Role for cost effectiveness of SPECT for “gatekeeping” role of referral to coronary angiography has been extensively validated (Shaw L et al., Economics of Noninvasive Diagnosis, J Am Coll Cardiol 1999;33:661-669). PET: Positron Emission Tomography (Science Park): “Gold Standard Test” for myocardial perfusion imaging, LV EF, LV volume indices, active cardiac sarcoidosis, myocardial viability and hibernation. Radiation exposures: 1.5 - 3 mSv. (higher for sarcoid and viablility studies). Performed with calcium scanning to detect relatively early coronary atherosclerosis, PET (and SPECT) imaging provide incremental prognostic information compared to calcium scanning alone (SPARC Trial J Nucl Cardiol 2009 Nov-Dec;16(6):935-48; Rozanski JACC March 27, 2007). PET eliminates some artifacts that may be seen with SPECT images. Potential use for measurement of absolute myocardial blood flow measurements in vivo. MUGA: Multigated Acquisition: Classic radionuclide ventriculogram by labeling red blood cells to provide highly accurate and precise measurements of LV ejection fraction. Can be done as a first pass study to provide temporal and spatial resolution of RV and LV to quantify cardiac function. Evidence based standard of care for measurement of risk of cardioxicity and risk of clinical heart failure in patients receiving cancer chemotherapy. Expediting Insurance Approval for Nuclear Studies Online or iPhone/iPad interactive AUC (Appropriate Use Criteria) Application To Expediate Pre-Authorization of Radionuclide Stress Testing ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009: Appropriate Use Criteria for Cardiac Radionuclide Imaging From Table 8 identify the appropriateness criterion that best justifies the radionuclide stress testing of your patient. Specify that Guideline with the pre-authorization request to Excellus. Include "Ref: ACC Appropriate Use Criteria for Cardiac Radionuclide Imaging, Table 8: Hendel R et al JACC 2009;53;2201-2229" (full reference last slide). For any questions or problems with pre-authorization, please feel free to contact Ronald G. Schwartz, MD MS at (585) 273-4340 or (585) 748-5803.