(MPI) The myocardial perfusion scan is the most common nuclear medicine procedure in cardiac imaging and allows assessing the blood-flow patterns to the heart muscles. The comparison of the radiopharmaceutical distribution after stress and at rest provides information on myocardial viability and cardiac perfusion abnormalities. ECG-gated myocardial perfusion imaging allows the assessment of global and regional myocardial function such as wall motion abnormalities.
The diagnostic accuracy of myocardial perfusion scintigraphy (also abbreviated MPS) allows reliable risk stratification and guides the selection of patients for further interventions, such as revascularization. MPI also has particular advantages over alternative techniques in the management of a number of patient subgroups, including women, the elderly, and those with diabetes. The use of this type of cardiac scintigraphy is associated with greater cost effectiveness of treatment, in terms of life-years saved, particularly in these special patient groups.
Myocardial perfusion scintigrams are acquired with a gamma camera. Single photon emission computed tomography (SPECT) is preferred over planar imaging because of the three dimensional nature of the images and their superior contrast resolution.
Common MPI radiopharmaceuticals, approved by the U.S. Food and Drug Administration (FDA) include: Tl-201 and the Tc-99m-labeled radiopharmaceuticals, such as sestamibi, tetrofosmin, and teboroxime for single-photon imaging. Rb-82 is used for positron emission tomography (PET) imaging.

See also Gated Blood Pool Scintigraphy, Myocardial Late Enhancement, Cardiac MRI and Echocardiography.

Radiographic contrast media (RCM) contributes important information to the diagnostic process. Actual contrast agents are safe drugs. Adverse reactions are rare, the incidence and severity of side effects decrease with the use of nonionic and low-osmolar contrast media. Adverse reactions are diverse, ranging from mild physiological disturbances to very rare life-threatening anaphylactic or anaphylactoid reactions. Users of contrast agents must be aware of the risk factors and be prepared to promptly manage adverse effects.
Side effects that may occur with intravascular administration of contrast agents are also possible after administration by other paths. Increased risk to an adverse reaction includes patients with a history of a previous reaction to a contrast medium, a known sensitivity to iodine, or a known clinical hypersensitivity (bronchial asthma, hay fever, and food allergies).

See also Contrast-Induced Nephropathy, Iodide-Induced Hyperthyroidism and Idiosyncratic Reactions.

The absorbed dose is the average energy absorbed per unit mass.

The tissue absorbed energy in a small mass volume:
D = (dW/dm) [ Gy ]
D = absorbed dose in Gray (Gy); dW = in the tissue energy absorbed; DM = small volume of the mass.

The SI unit of absorbed dose is the joule per kilogram and its special name is the gray (Gy). In units often used by federal and state agencies, absorbed dose is given in rad; 1 rad = 0.01 Gy.

Absorbed dose is a feature that should increase dose awareness and help users in dose optimization. Absorbed dose in CT is quoted using the CTDI (computed tomography dose index)

CTDIvol (volume-averaged CT dose index) and the dose-length product (DLP) give an indication of the average absorbed dose and relative radiation risk to a standard patient. The user is being warned to scan parameter settings that may lead to high doses, and can adjust the protocol if appropriate. It should be noted that CTDIvol and DLP do not take patient size into account, and will give overestimates and underestimates for large and small patients, respectively.

The x-ray absorption is the uptake of energy or the decrease of the number of photons by the tissue or matter through which the radiation travels.
Absorption in nuclear reactions and particulate radiation is a process of taking up kinetic energy of particles or the combination of particles with an atom, a nucleus, or another particle.
Absorption characteristics of imaged tissues are represented by their linear attenuation coefficients.

See also Absorber.

Three tissue layers called tunicae, or coats, surround the lumen of an artery. The adventitia (outer coat) is the outermost layer of an arterial wall and is composed of connective tissue containing elastic fibers and another layer of protein called the external basement membrane. Smooth muscle cells comprise the tunica media, or middle coat. The muscle cells contract or relax to constrict or dilate the artery.

See also Coronary Angiogram, Angiography, Angioplasty, and Cardiac Catheterization.