Eighth Annual Mario S. Verani, MD Memorial Lecture: Nuclear cardiology in the era of multimodality cardiac imaging: Can we survive?

Nuclear cardiology is the best noninvasive imaging method for measuring myocardial blood flow to diagnose coronary artery disease, assess the risk for adverse cardiac events, and identify long-term cardiac outcome. Our strengths include: reliance on physiology rather than anatomic definition; standardized and efficient techniques that can be performed in large hospitals and academic centers and in small hospitals and outpatient offices; a large body of evidence-based supporting clinical data; and profitability. We have defined training; committed to quality improvement through development of guidelines and appropriateness criteria; certified physicians and accredited laboratories; and implemented a strong payer advocacy program. Despite success, we find ourselves under attack for not being relevant within the new paradigm of atherosclerosis, being complacent, being used inappropriately, and exposing patients to radiation. We are facing cuts in reimbursement that will make it nearly impossible to provide services. By failing to develop new radiotracers and techniques, we find ourselves measuring only myocardial perfusion. Advances in echocardiography, cardiovascular magnetic resonance imaging, and computed tomography are providing alternative robust methods and redefining available options for noninvasive cardiovascular imaging. Given the attacks on nuclear cardiology and the existence of alternative methods, we have the option of becoming defensive and protective of our turf, or embracing the opportunity to build on our accomplishments and redefine the new practice of noninvasive cardiovascular imaging. It is in the best interest of nuclear cardiology and patients to pursue the latter course.