1 INTRODUCTION AND OVERVIEW

Myocardial perfusion scintigraphy (MPS) has been available as a valuable tool in the investigation of patients with known or suspected coronary artery disease (CAD) for more than two decades. However, in notable contrast to the situation in the USA and parts of mainland Europe, MPS has been slow to establish itself in routine clinical practice in the UK. The National Institute for Health and Clinical Excellence (NICE) has recently completed a technology appraisal of MPS, with positive findings. The implication is that there ought to be an approximately fourfold increase in the provision of nuclear cardiology in England and Wales, with an estimated capital cost of £18 million and an annual revenue cost of £27 million.

MPS is an effective and cost effective investigation, but requires appropriate expertise and resources. The purpose of this document is to provide clinicians and managers who have little or no experience of MPS with the basic information required to begin planning a service. In all cases, advice should be sought from an experienced clinician and medical physics expert before any practical steps are taken.

In addition to MPS, several other non-invasive imaging modalities may be used to investigate patients with known or suspected CAD. In centres with expertise in other well established non-invasive techniques such as stress echocardiography (echo), it may be more appropriate to expand the existing service rather than attempt to set up a nuclear cardiology service “from scratch”.

Nuclear medicine is probably the most regulated area of medicine, and several pieces of legislation apply. Involvement of a medical physics expert is mandatory. He/she will also provide scientific support for the non-clinical aspects of the service, including selection of acquisition protocols, data processing and analysis, and quality assurance (QA) for the gamma camera and other equipment.

MPS is indicated for the investigation …