Choosing a thallium-201 or technetium 99m sestamibi imaging protocol.

During the past decade progress in the field of myocardial perfusion imaging has resulted in a myriad of choices for perfusion imaging protocols, including choices in types of stressor, imaging modality, perfusion tracer, method of analysis, and a wide range of choices of imaging protocols. This review will examine this latter aspect in the context of choices of perfusion tracers that are now available for wide use. Manipulations of thallium protocols have revolved primarily around optimizing identification of stress defect reversibility and regional myocardial viability. The high image quality and long retention time afforded by the technetium-labeled agents allow the potential for streamlining imaging protocols to maximize efficiency and cost-effectiveness, such as performing stress only imaging in a subset of patients and performing simultaneous assessment of perfusion and function.