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Description
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London, UK |
Nuclear Cardiology and Heart Disease
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Coronary Heart disease is the
leading cause of death in the world.
In the United States alone more than
500,000 people die from
coronary artery disease
. In the last 20 years major
inroads have been made in the
diagnosis and treatment of heart
disease. Nuclear Cardiology is
playing an important role in
establishing the
diagnosis of heart disease
and
in the assessment of the extent of
disease extent and prediction of
outcomes.
Nuclear Cardiology
Myocardial perfusion imaging
is the most common nuclear
cardiology technique used. Usually
Nuclear cardiology studies use
noninvasive techniques to assess
blood flow, evaluate the pumping
function of the heart and to
visualize the size and location of a
heart attack .
Myocardial Perfusion Imaging:
Myocardial perfusion images
are combined with exercise to
assess the blood flow to the heart
muscle, exercise may be in the form
of walking on the treadmill or
riding a stationary bicycle. For
people who are unable to perform
exercise maximally a "chemical"
stress test using the drug
dipyridamole, adenosine or
dobutamine may be used to gather
similar information about the
heart's blood flow.
A small amount of an imaging agent
{thallium or sestamibi or
tetrofosmin (Myoview), is injected
into the blood stream during rest
and during exercise or chemical
stress then a scanning device (gamma
camera) is used to measure the
uptake by the heart of the imaging
material during (exercise or
chemical stress) and at rest. If
there is significant blockage of a
coronary artery, the heart muscle
may not get enough of a blood
supply, this decrease in blood flow
will be reflected in the images.
Myocardial perfusion studies are
able to spot areas of the heart
muscle having an inadequate blood
flow as well as the areas of heart
muscle that are damaged as a result
of a heart attack. The studies
localize the coronary artery with
atherosclerosis, quantifies the
extent of the heart muscle with a
limited blood supply and can also
provide information about the
pumping function of the heart.
Hence, it is superior to usual
exercise stress testing and provides
crucial information which helps in
identifying patients at an increased
risk for a heart attack who may be
candidates for invasive procedures
such as
coronary angiography,
angioplasty and heart surgery.
Evaluation of Cardiac Function by
means of Radionuclide
Ventriculography
Radionuclide ventriculography is a
noninvasive study, which provides
information about the pumping
capacity of the heart. In patients
with coronary artery disease, and in
those who have had a heart attack,
determination of the pumping
function of the heart (also known as
the ejection fraction) is required
for the prediction of both long term
and short-term survival. A little
amount of an imaging agent is
injected into the blood stream and
pictures of all four chambers of the
heart are taken with a special
camera (gamma camera). These
techniques also provide information
about the function of the valves of
the heart, the integrity of all the
cardiac chambers and can be applied
to monitor the effect of different
drugs on the heart muscle (in
patients with cancer who are
administered chemotherapy). The
evaluation of cardiac function with
radionuclide ventriculography is
accurate and noninvasive and plays a
very important role in predicting
outcomes in patients with heart
disease.
Assessment of Myocardial Injury,
Infarction and Infection
The basic cellular component of the
heart muscle may be affected in the
setting of a limited blood supply
and or inflammation, which cannot be
reversed. Nuclear cardiology
techniques can be used to find out
areas of the heart muscle that have
been damaged by infection, heart
attack etc. These techniques can
also be applied to monitor the
status of the heart muscle in the
patient after cardiac
transplantation.
Imaging of the Nervous System of the
Heart
The heart has a nervous system of
its own, which is essential for the
proper functioning of the heart
muscle. If there is damage to the
heart muscle, the nervous system of
the heart can be impaired resulting
in abnormal function of the
electrical system of the heart. An
abnormal heart rate and disruption
of the normal cardiac rhythm can
display this abnormality. Imaging
agents are administered into the
blood stream and then the nervous
system of the heart can be imaged
with a gamma camera. The information
acquired from these noninvasive
studies can be utilised in the
management of patients with heart
disease, especially heart failure.
Positron -Emission Tomography (PET)
PET studies are noninvasive and are
used to find out information about
the blood supply to the heart muscle
as well as the metabolic activity of
the heart. These studies can find
out the heart muscle that is not
getting enough supply of blood due
to the blockage in the arteries of
the heart. These studies spot the
heart muscle that has been damaged
from past heart attacks, and also
what has been damaged but has the
potential to recover if a bypass
surgery or an angioplasty is
performed. This ability to
distinguish irreversibly damaged
heart muscle from damaged heart
muscle with a potential to recover
its function after bypass surgery or
angioplasty is a major strength of
PET imaging and makes it
indispensable. PET studies can also
be applied to evaluate the nervous
system of the heart. These studies
can also assist in making
determinations about candidacy for
bypass surgery or angioplasty. With
increase in the availability of PET
imaging cameras, the use of PET
imaging has also increased
considerably in the last few years.
SUMMARY
Nuclear cardiology studies play an
increasingly crucial role in the new
millennium, in the noninvasive
diagnosis of coronary artery
disease, the assessment of the
pumping capacity of the heart as
well as in the prediction of
outcomes in patients suffering from
heart disease.
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What
is nuclear cardiology? |
Nuclear cardiology uses small
amounts of radioactive material to
obtain information about the heart.
With this technology, developed in
the 1960's and 1970's, the nuclear
cardiologist may assess the heart
muscle. Like a stress echo test,
nuclear cardiology studies produce
images of the heart at work (during
exercise) and at rest. During a
test, you are given an injection of
a small dose of a harmless
radioactive tracer. Then you spend
time exercising on a treadmill or
stationary bicycle and then resting.
A specialized camera (called a
"gamma camera") detects the tracer
as it passes through the chambers of
your heart, creating the pictures.
The pictures may reveal problems in
heart muscle and blood vessels,
especially when the images of the
heart at work and at rest are
compared. |
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most
commonly used test in nuclear
cardiology |
The
most commonly used test in nuclear
cardiology is called myocardial
perfusion imaging. This is a form of
stress test which makes use of
myocardial perfusion tracers and
gamma camera imaging methods to
assess the adequacy of blood flow to
the heart, as well as to find out if
how much of the heart muscle is
viable (alive) and how much is
scarred and damaged beyond repair.
It is a diagnostic tool that is
often used for the detection of
coronary artery disease (narrowing
of the heart arteries) and for the
assessment of the severity and
extent of its effects on blood flow
to the heart and myocardial
viability. |
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How it
works |
During
the stress nuclear test, a small
amount of a radioactive perfusion
tracer (such as thallium, sestamibi
or tetrofosmin) is injected into a
hand vein while the patient is
undergoing stress testing. These
tracers are taken up by heart muscle
in proportion to blood flow. Areas
of myocardium with impaired blood
flow or viability will have reduced
tracer uptake. The uptake of tracer
in the heart is then assessed by
imaging the patient with a gamma
camera, which is capable of
detecting the small amounts of
radiation emitted by the tracer. By
rotating the camera around the
patient to take multiple views from
different angles, a 3-dimensional
image of the distribution of tracer
in the heart can be reconstructed
using computerised methods (Single
photon emission computed tomography,
or SPECT). The uptake of tracer in
the heart can then be assessed in a
tomographic (3-dimensional) way,
which avoids overlap between
different parts of the heart and
allows us to localise the area and
extent of any abnormalities with
greater accuracy.
This technique is more accurate for
detecting abnormal blood flow and
heart disease than the standard ECG
stress test. |
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how to
interpret results |
A
normal scan will show uniform uptake
of tracer throughout the heart,
indicating that blood flow during
stress is increased evenly
throughout the heart. The likelihood
of significant narrowing of heart
arteries (coronary artery disease)
is low, the prognosis is good and no
further operation (angioplasty or
bypass surgery) is usually
indicated, since there is no
evidence of insufficient blood flow.
An abnormal scan will show one or
more areas of reduced tracer uptake
following stress injection, and this
can either be due to reduced blood
flow to the heart or damaged heart
muscle due to a previous heart
attack (or a mixture of the two). A
rest study (which may involve a
second scan with or without a second
injection of tracer at rest) is
needed to distinguish between the
two. The detection of a large amount
of heart muscle with insufficient
blood flow during stress indicates
that the patient is likely to
benefit from balloon angioplasty or
bypass surgery. With the use of
certain tracers, additional
information on heart function can
also be obtained by using a special
method of imaging called ECG-gated
SPECT. |
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When
are stress nuclear scans used? |
Stress
nuclear scans are useful in the
detection of coronary artery
disease, particularly when standard
ECG stress testing is not possible
or non-diagnostic. For instance,
when the patient is unable to
exercise or achieves an inadequate
level of exercise on a treadmill,
when the resting ECG is difficult to
intepret or when the result of
stress testing is borderline, then a
stress nuclear scan is helpful. The
overall sensitivity of the stress
nuclear scan (83% to 98%) is higher
than that of the standard ECG stress
test (average 68%).
For patients who are unable to
exercise, stress testing can be
performed using drugs such as
dipyridamole, adenosine or
dobutamine which have been shown to
have high accuracy for detection of
coronary artery disease when used in
combination with nuclear cardiac
imaging. In patients with known
coronary artery disease on
angiography, nuclear scans are often
used to assess the effect of a
narrowing in the arteries and to
help decide if bypass surgery or
balloon angiogioplasty is needed.
A normal stress perfusion study
indicates a good prognosis and a low
likelihood of sudden heart attack
(approximately <1% cardiac event
rate per year), even in the presence
of known disease of the heart
arteries, and in most cases, allows
the patient to avoid having an
angiogram, which is a test which
involves inserting a tube(catheter)
into the heart and injecting dye to
outline the arteries.
In patients with damaged hearts due
to a previously heart attack
(myocardial infarction), perfusion
imaging is often used to assess the
risk that the patient may develop
further heart attacks and help
decide whether an angiogram, bypass
surgery or balloon angioplasty is
indicated.
In patients with known or suspected
heart disease who are due for
general (non-heart) surgery,
myocardial perfusion imaging using
pharmacologic stress is also used
for assessment of risk before
operation, particularly in patients
due for surgery on their leg
arteries who are unable to exercise. |
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Practical aspects of stress nuclear
scanning |
On the
day of the test, patients are
advised to bring jogging shoes and
attire. For those who cannot
exercise, pharmacologic (drug)
stress will be employed. Patients
are advised not to take caffeine
containing drinks (coffee, tea,
colas) on the day of the test, since
this can interfere with the action
of dipyridamole, which is often used
in stress testing with drugs. A
light breakfast is allowed. Patients
who are taking medications such as
beta-blockers are also advised to
stop these for 3 to 5 days before
the test, depending on the half-life
of the drug, and provided their
physicians are agreeable.
Alternatively, the patient can still
be tested, by using drugs. Patients
are then either exercised on a
treadmill or undergo stress testing
using drugs such as dipyridamole,
adenosine or dobutamine, and the
tracer is injected into a hand vein
at the time of peak stress. Imaging
with the gamma camera is performed
half to one hour later, and takes 20
minutes to complete. If a rest scan
is needed, this is performed 3-4
hours later, or on another day,
depending on convenience. |
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Safety
and radiation concerns |
The
total radiation exposure for
patients undergoing stress nuclear
scans is well within the level of
what is considered safe. Considering
that the nuclear test is being used
to determine if the patient needs to
undergo an angiogram or an
angioplasty (or bypass surgery),
this low amount of radiation
exposure from stress nuclear scans
appears to be quite acceptable. |
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Summary |
In
summary, stress nuclear scans have a
important role to play in the
management of patients with coronary
artery disease by providing more
accurate detection of disease than
the standard stress ECG and
additional useful information about
blood flow and function which is
usually not available from the
coronary angiogram alone. This
information, particularly the
accurate assessment of the severity
and extent of abnormal blood flow,
is often critical in deciding
whether the patient should be
undergo coronary angiography, bypass
surgery or balloon angioplasty. |
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London,
UK |
What is Nuclear
Cardiology? |
Nuclear cardiology
uses small amounts of radioactive
material to obtain information about
the heart. With this technology,
developed in the 1960's and 1970's
in UK,
the nuclear cardiologist may assess
the heart muscle. Nuclear cardiology
procedures are performed by
cardiologists in hospitals, clinics,
and private offices. |
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England |
Myocardial Perfusion
Imaging SPECT
(MPI SPECT)
|
Although nuclear
cardiology is both time consuming
and expensive, MPI SPECT is valuable
for the clarification of a suspected
false positive (or negative)
exercise ECG. MPI SPECT is also
valuable for the management of
patients with cardiac disease. A
radiologist and cardiologist examine
the series of SPECT images. |
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UK |
Nuclear Cardiology
Test |
Like a stress echo
test, nuclear cardiology studies
produce images of the heart at work.
A specialized camera detects the
tracer as it passes through the
chambers of your heart, creating the
pictures. The pictures may reveal
problems in heart muscle and blood
vessels, especially when the images
of the heart at work and at rest are
compared. |
Click Here |
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England |
Nuclear Cardiology
Procedures |
Nuclear Cardiology is
a branch of cardiology and medical
imaging which uses small amounts of
radioactive substances for the
diagnosis of heart disease. Nuclear
Cardiology provides a powerful tool
in the field of heart disease
detection. Myocardial Perfusion (MPI)
and Thallium scanning are Nuclear
Cardiology procedures used in the
diagnosis of heart disease in UK. |
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London,
UK |
Nuclear Cardiology
and Other Cardiac Scans |
There is a growing
body of evidence to support
myocardial perfusion imaging is a
clinically effective and cost
effective method of managing
patients with cardiac disease.
Myocardial perfusion scintigraphy
with SPECT uses a
radio-pharmaceutical that is taken
up into heart muscle in proportion
to localised blood flow and stays in
myocardial cells whilst scan is
performed. Most use either
thallium-201, technetium-99m in
proprietary compounds. |
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England |
Practical Applications of Nuclear
Cardiology - Article |
Nuclear cardiology studies allow for
the detection of abnormal blood flow
to the heart muscle, as well as the
assessment of the pumping function
of the heart. The most common
procedure is myocardial perfusion
imaging (MPI) or single-photon
emission computed tomography (SPECT).
Small amounts of radioactive
material are injected intravenously
and these tracers are taken up and
retained in the heart tissue in
proportion to regional blood supply. |
Click Here |
|
London |
Heart
Disease - Cardiology Articles,
Statistics and Information on |
Cardiac arrest is uncommon among
pediatric patients. Prehospital data
demonstrate differences in care
processes between children and
adults receiving cardiopulmonary
resuscitation and advanced life
support. We sought to evaluate
whether children receiving
in-hospital cardiopulmonary
resuscitation would attain superior
24-hour survival in hospitals with a
higher level of pediatric physician
staffing, greater intensity of
pediatric care services, and higher
pediatric patient volume in UK. |
Click Here |
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United
Kingdom |
AHA
Journals -- Subspecialty Collections
: Nuclear cardiology and PET |
Circulating endothelial progenitor
cells (EPCs) are known to be
involved in vasculogenesis and
mobilized after acute myocardial
infarction (AMI). To test the
hypothesis that the angiogenic
function of EPCs affects
post-myocardial infarction (MI)
myocardial salvage, we evaluated the
number and potential differentiation
of EPCs and compared these data with
clinical parameters 6 months after
MI.
|
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Here |
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Europe |
Nuclear cardiology in the UK 1994:
activity relative to Europe |
Nuclear cardiology is an important
investigation for cardiovascular
disease in the USA, UK and much of
mainland Europe.1,2 Previous surveys
of nuclear cardiology suggest that utilisation of these techniques is
lagging behind in the UK.3 This
survey was conducted to ascertain
the trends and changes in nuclear
cardiology practice since 1988.3-6
In 1994, a survey was mailed to 219
nuclear medicine centres in the UK
identified from radiopharmaceutical
supply lists. A useful response was
obtained from 192 centres (88%).
These were categorised into district
hospitals (n = 130), regional
hospitals (n = 54), and
private/military hospitals (n = 8).
|
Click Here |
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London,
UK |
Nuclear cardiology in the UK:
British Nuclear Cardiology Society
|
This
study surveyed practice in nuclear
cardiology in the UK in 1994. A
questionnaire was sent to 219
centres performing nuclear imaging
asking for details of current
practice in nuclear cardiology.
Replies were received from 192
centres (88%). Activity in
performance of myocardial perfusion
imaging (MPI) and radionuclide
ventriculography (RNV), anticipated
changes in activity, differences
between regional and district
general hospitals, technical imaging
parameters and referral sources were
surveyed. Of the responding centres,
125 (65%) performed nuclear
cardiology. |
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Europe |
British Nuclear Cardiology Society |
BCS PEER REVIEW SCHEME
A committee to define appropriate
professional and clinical standards
for individual workloads and to
agree the workforce requirements for
Nuclear Cardiology is to be set
up.... |
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London,
UK |
Leading hospitals - London, UK for
heart and lung disease |
Royal
Brompton Hospital is situated just
off the Kings Road, in the Royal
Borough of Kensington and Chelsea.
Our central London location is ideal
for those wishing to experience the
sights and sounds of our capital
city, with its shops, restaurants,
bars, theatres, royal parks and
tourist attractions in UK. |
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Europe |
British nuclear medicine society,
BNMS. |
The
main role of the Nuclear
Cardiologist is, in common with all
medical specialities, the assessment
of the patient but also whether the
appropriate nuclear medicine
technique can add to the patient's
clinical management. Techniques that
are used for diagnosis, include
perfusion imaging and radionuclide
ventriculography. Perfusion imaging
is usually performed following
stress, which may be dynamic (using,
for example a treadmill), or by
employing various pharmacological
agents.
|
Click Here |
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London,
UK |
American Society of Nuclear
Cardiology (ASNC) |
The
American Society of Nuclear
Cardiology (ASNC) is a professional
society, international in scope,
which provides its members with a
variety of continuing medical
education programs related to
nuclear cardiology and
cardiovascular computed tomography
(CT), promotes accreditation and
certification in nuclear cardiology
and is the principal advocacy voice
for the profession. |
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United
Kingdom |
Certification Board of Nuclear
Cardiology - Welcome |
The
Certification Board of Nuclear
Cardiology (CBNC) is committed to
the certification of Nuclear
Cardiology practitioners.
Certification will provide
practice-based requirements against
which members of the profession can
be assessed. The purposes of the
CBNC Certification Program are as
follows:
to establish the domain of the
practice of Nuclear Cardiology for
certification;
to assess the level of knowledge
demonstrated by Nuclear Cardiology
specialists in a valid manner;
to encourage professional growth in,
and enhance the quality of, the
practice of Nuclear Cardiology;
to recognize formally individuals
who meet the requirements set by
CBNC; and
to serve the public by encouraging
quality patient care in the practice
of Nuclear Cardiology.
|
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London,
UK |
Nuclear Cardiology Systems, Inc. |
Nuclear cardiology uses small
amounts of radioactive material to
obtain information about the heart.
With this technology, developed in
the 1960's and 1970's, the nuclear
cardiologist may assess the heart
muscle. Nuclear cardiology
procedures are performed by
cardiologists in hospitals, clinics,
and private offices. Such a facility
must have a license from the
government, which is only issued
after a thorough evaluation of the
facility and the physician's
training. |
Click Here |
|
Europe |
Cardinal Health Nuclear Cardiology
Solutions |
Cardiology Solutions, from Cardinal
Health, takes the worry out of
owning and operating your own
nuclear imaging lab and provides a
resource for everything from clinic
start-up to daily management,
assisting you with equipment
purchasing, staffing options,
regulatory requirements, medical and
health physics, reimbursement,
department management systems, and
more. We have several start-up
options to choose from: LABStart™,
LABComplete™, and LABManage™.
|
Click Here |
|
London,
UK |
Welcome to the Nuclear Cardiology |
One of
the output screens from INSPECT TM
.The normal files (left column); the
patient data (second column from
left), the standard deviation map
(second from right), and the patient
data with abnormal area indicated by
the yellow region ( at 2.5 S.D. from
the normal file) are shown. Row 1 is
the Stress data; Row 2 shows the
Reinjection data while Row 3 shows
the reversibility data. |
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UK, London |
The Role of Nuclear
Cardiologist in Heart Disease |
Heart disease is the
leading cause of
death in the western
world. Each year in
the U.S.A, more than
500,000 men and
women die from
coronary artery
disease nuclear
cardiologist said. During the
past two decades,
nuclear cardiologist
major strides have
been made in the
diagnosis and
treatment of heart
disease. Nuclear
Cardiologist has
played a pivotal
role in establishing
the diagnosis of
heart disease and in
the assessment of
disease extent and
the prediction of
outcomes in the
setting of coronary
artery disease,
nuclear cardiologist.
|
Click Here |
|
Europe |
Nuclear Cardiology |
Nuclear Cardiologist
studies use
noninvasive
techniques to assess
myocardial blood
flow, evaluate the
pumping function of
the heart as well as
visualize the size
and location of a
heart attack. Among
the techniques of
nuclear cardiology,
nuclear
cardiologist,
myocardial perfusion
imaging is the most
widely used. Nuclear
cardiologist
Myocardial perfusion
images are combined
with exercise to
assess the blood
flow to the heart
muscle. Exercise can
be in the form of
walking on the
treadmill or nuclear
cardiologist, riding
a stationary
bicycle. A
"chemical" stress
test using the drug
dipyridamole,
adenosine or
dobutamine be
performed in
patients who are not
able to exercise
maximally,nuclear
cardiologist
providing similar
information about
the heart's blood
flow. |
Click Here |
|
United
Kingdom |
Nuclear Cardiologist |
Nuclear Cardiologist
studies continue to
play an increasingly
important role in
the new millennium,
in the noninvasive
diagnosis of
coronary artery
disease, the
assessment of the
pumping function of
the heart and
nuclear cardiologist
in the prediction of
outcomes in patients
with heart disease.
Nuclear cardiologist
procedures are
performed by
cardiologists in
hospitals, clinics,
and private offices.
Such a facility must
have a license from
the government,
nuclear cardiologist
which is only issued
after a thorough
evaluation of the
facility and the
physician's
training, nuclear
cardiologist. |
Click Here |
.jpg "Services - CT Coronary Angiogram")
Echocardiography
Heart-Scan Advantage
l amounts of radioactive
substances for the diagnosis of heart disease. Radioactive substances
are administered and the amount of radiation emitted measured to assess
abnormalities in its structure and function. Nuclear Cardiology
provides a powerful and precise tool in the field of heart disease
detection. Myocardial Perfusion (MPI) and Thallium scanning are
Nuclear Cardiology procedures used in the diagnosis of heart disease.
