Imaging and Heart and Vascular Institutes, Cleveland Clinic (Jb3), 9500 Euclid Ave., Cleveland, OH 44195, USA.
J Nucl Cardiol. 2010 Apr;17(2):177-87. doi: 10.1007/s12350-010-9203-9.
Nuclear cardiology is the best noninvasive imaging method for measuring myocardial blood flow to diagnose coronary artery disease, assess the risk for adverse cardiac events, and identify long-term cardiac outcome. Our strengths include: reliance on physiology rather than anatomic definition; standardized and efficient techniques that can be performed in large hospitals and academic centers and in small hospitals and outpatient offices; a large body of evidence-based supporting clinical data; and profitability. We have defined training; committed to quality improvement through development of guidelines and appropriateness criteria; certified physicians and accredited laboratories; and implemented a strong payer advocacy program. Despite success, we find ourselves under attack for not being relevant within the new paradigm of atherosclerosis, being complacent, being used inappropriately, and exposing patients to radiation. We are facing cuts in reimbursement that will make it nearly impossible to provide services. By failing to develop new radiotracers and techniques, we find ourselves measuring only myocardial perfusion. Advances in echocardiography, cardiovascular magnetic resonance imaging, and computed tomography are providing alternative robust methods and redefining available options for noninvasive cardiovascular imaging. Given the attacks on nuclear cardiology and the existence of alternative methods, we have the option of becoming defensive and protective of our turf, or embracing the opportunity to build on our accomplishments and redefine the new practice of noninvasive cardiovascular imaging. It is in the best interest of nuclear cardiology and patients to pursue the latter course.
核医学是测量心肌血流以诊断冠状动脉疾病、评估不良心脏事件风险和确定长期心脏预后的最佳无创成像方法。我们的优势包括：依赖生理学而非解剖定义；标准化和高效的技术，可在大型医院和学术中心以及小型医院和门诊进行；大量基于证据的支持临床数据；以及盈利能力。我们已经定义了培训；通过制定指南和适宜性标准、认证医生和认可实验室，致力于质量改进；并实施了强有力的支付方倡导计划。尽管取得了成功，但我们发现自己在动脉粥样硬化的新范式下不相关，自满，不恰当地使用，以及使患者暴露于辐射中而受到攻击。我们面临着报销削减的问题，这将使我们几乎无法提供服务。由于未能开发新的放射性示踪剂和技术，我们发现自己只能测量心肌灌注。超声心动图、心血管磁共振成像和计算机断层扫描的进步提供了替代的强大方法，并重新定义了无创心血管成像的现有选择。鉴于对核医学的攻击和替代方法的存在，我们可以选择采取防御和保护自己的立场，也可以选择利用我们的成就并重新定义无创心血管成像的新实践。这符合核医学和患者的最大利益。
