2017 Volume 3 Issue 1 Pages 157-162
While single photon emission computed tomography (SPECT) is by far the predominant modality for radionuclide myocardial perfusion imaging in the United States in 2017, there has been impressive growth in positron emission tomography (PET) and especially hybrid PET/computed tomography (CT) utilization. Advantages, clinical indications, and procedural standards have been documented by professional society publications. FDA clearances exist and payments are defined for governmental and commercial contractors. Current efforts are underway to standardize training and education for physicians and technologists who will perform PET perfusion studies, and to advance standards for performance, quality control, and reporting of myocardial blood flow quantification. Industry appears heavily invested in the future of PET perfusion, with recent FDA approval of a second Rubidium-82 generator and elution system, a new production facility capable of substantially increasing Rubidium-82 availability, and a novel fluorine-based perfusion tracer undergoing Phase 3 studies. Current paradigms appear to favor SPECT for less complicated patients who are able to exercise, and PET for more complicated or higher-risk patients who require pharmacologic stress.