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Nuclear Cardiology: its role in Cost-effective Care

Dear reader, please note that this document is the result of a Technical Meeting on: “Current Role of Nuclear Cardiology in the Management of Cardiac Diseases” held in Vienna on May 2008. It reflects the contributions of participants to the meeting and has been further expanded and updated to be published as an IAEA Human Health Series.

Contents

• 1. INTRODUCTION
  • 1.1. Background information
  • 1.2. Objective
  • 1.3. Scope
  • 1.4. Structure
• 2. EPIDEMIOLOGY OF CARDIOVASCULAR DISEASES IN DEVELOPING COUNTRIES
  • 2.1.Introduction
  • 2.2. Epidemics of obesity and diabetes in developing countries
  • 2.3. The ageing population
  • 2.4. Importance of early detection and treatment
  • Bibliography
• 3. NUCLEAR CARDIOLOGY: ONE OF THE MOST ACCEPTED TOOLS FOR MANAGEMENT OF PATIENTS WITH CARDIOVASCULAR DISEASE
  • 3.1. Introduction
  • 3.2. Myocardial perfusion scintigraphy in stable CAD
  • 3.3. Myocardial perfusion scintigraphy in acute coronary syndromes
  • 3.4. Myocardial perfusion scintigraphy before non-cardiac surgery
  • 3.5. Assessment of left ventricular function and other non-perfusion parameters in cardiac diseases
  • 3.6. Assessment of viable and hibernating myocardium in heart failure
  • 3.7. Clinical guidelines
  • Bibliography
• 4. NUCLEAR CARDIOLOGY UTILIZATION THROUGHOUT THE WORLD
  • 4.1. Introduction
  • 4.2. Analysis of available data
  • 4.3. Utilization of nuclear cardiology vs mortality rate
  • Bibliography
• 5. COST-EFFECTIVENESS
  • 5.1. Introduction
  • 5.2. Cost-effectiveness in nuclear cardiology
  • 5.3. Patients with stable angina
  • 5.4. Patients with chest pain and suspected acute coronary syndromes
  • 5.5. Special populations
• 6. NUCLEAR CARDIOLOGY AND COMPETING MODALITIES FOR THE EVALUATION OF CARDIAC PATIENTS
  • 6.1. Introduction
  • 6.2. The resting electrocardiogram (ECG)
  • 6.3. The exercise stress test (treadmill stress test, TMT)
  • 6.4. Echocardiography
  • 6.5. Magnetic Resonance Imaging (MRI)
  • 6.6. Multi-slice Computed Tomography (MSCT)
  • 6.7. Contrast coronary angiography (CA) and intravascular ultrasound (IVUS)
  • 6.8. Nuclear Cardiology
• 7. TECHNOLOGICAL ADVANCES IN NUCLEAR CARDIOLOGY
  • 7.1. Introduction
  • 7.2. Development of new pharmacologic stress agents and protocols
  • 7.3. Development of new tracers
  • 7.4. New computer algorithms and tools
  • 7.5. New gamma-camera technology
  • 7.6. Hybrid systems and image fusion
  • Bibliography
• 8. THE ROLE OF NUCLEAR CARDIOLGY IN PREVENTIVE CARE
  • 8.1. Introduction
  • 8.2. Classification and definitions
  • Bibliography
• 9. EXPANDING CLINICAL APPLICATIONS OF NUCLEAR CARDIOLOGY
  • 9.1. Introduction
  • 9.2. Beyond obstructive coronary stenosis
  • 9.3. Short-term and long-term risk assessment
  • 9.4. Pre-clinical evaluation of cardiac disease: imaging for prevention
  • 9.5. Defining effective pre-symptomatic risk assessment
  • Bibliography
• 10. EDUCATION AND TRAINING IN NUCLEAR CARDIOLOGY
  • 10.1. Introduction
  • 10.2. Training of physicians
  • 10.3. Training of technologists
  • 10.4. Training of nurses
  • 10.5. Training in medical physics
  • 10.6. Training in radiopharmacy
  • 10.7. Training in cardiac PET and hybrid techniques
  • 10.8. Education of referring physicians
  • Bibliography
• 11. RADIATION SAFETY AND CARDIAC IMAGING
  • 11.1. Introduction
  • 11.2. Concerns about diagnostic radiation exposure
  • 11.3. Optimizing radiation exposure from diagnostic procedures
  • 11.4. New developments in Nuclear Medicine Technology for Cardiac Studies
  • Bibliography
• 12. CONCLUSIONS
• 13. CONTRIBUTORS TO DRAFTING AND REVIEW