Table 6

 Advantages of different radiopharmaceutical and protocol options

Thallium-201 Technetium-99m-based agent
Huge literature and familiarity99mTc available “24/7” from generator
Better perfusion tracer physiologicallyLower radiation exposure to patient
? better viability tracerStress imaging can be delayed and repeated (e.g. for patient movement)
Need not be delivered daily (long half-life)Better images, particularly in the obese
No preparation requiredGating practical
99mTc-sestamibi 99mTc-tetrofosmin
Large literatureNo boiling required in preparation
? better perfusion tracer physiologicallyFaster gut clearance for good imaging
Two day 99mTc protocol One day 99mTc protocol
Optimal quality images for stress and restMore convenient for many patients
Second acquisition unaffected by first injection
Gating of both acquisitions possible
One day stress–rest order One day rest–stress order
Rest study avoidable if stress study normalNo delay required between injections