Clinical competence in myocardial perfusion scintigraphic stress testing: general training guidelines and assessment.

The suggestion by the National Institute for Clinical Excellence (NICE) to more than triple the number of myocardial perfusion scintigraphy (MPS) procedures carried out by the NHS each year is a challenge both in terms of numbers of gamma cameras available to carry out the scans and qualified staff to supervise stress tests. In the past, exercise and pharmacological stress testing have been supervised only by doctors but, increasingly, this is taken on by suitably trained non-medical professionals such as nurses, radiographers and clinical technologists. The expansion of the numbers of non-medical professionals qualified to supervise stress testing will be key to meeting NICE's recommendations. This paper sets out how potential new stressors should be identified, what their training should cover and discusses the standards of competence they should meet. It provides guidelines for training non-medical stressors to perform a safe and efficient stress test during MPS and advice for maintaining competency.

Detection of defects in myocardial perfusion imaging in patients with early breast cancer treated with radiotherapy.

BACKGROUND AND PURPOSE: To evaluate radiation-induced defects in myocardial perfusion imaging in early breast cancer patients treated with modern technique radiotherapy. PATIENTS AND METHODS: Twenty-four patients with left-breast tumours and 12 control patients with right-breast tumours, relapse-free since treatment for primary disease, who had undergone radiotherapy at least 5 years previously and with no history of ischaemic heart disease prior to radiotherapy underwent study. In left-breast patients, at least 1 cm of heart was required to have been in the treatment field. Patients underwent cardiac assessment and single photon emission computerized tomography myocardial perfusion imaging. RESULTS: Myocardial perfusion tracer uptake was abnormal in 17 (70.8%) left-breast and two (16.7%) right-breast patients (P = 0.002). Of the 17 abnormal scans in left-breast patients, abnormalities were confined to the cardiac apex in 16 patients, and perfusion defects were reversible (n = 7), fixed (n = 7) or mixed (n = 3). Reversible perfusion defects that were not confined to the cardiac apex were observed in two right-breast patients. Left ventricular ejection fraction was normal in all 33 patients in whom it was measured, and no myocardial perfusion abnormalities were judged to require treatment or follow-up. CONCLUSIONS: In this selected study population modern technique radiotherapy to the left breast was associated with a significantly greater number of myocardial perfusion abnormalities than radiotherapy to the right breast. These abnormalities were both reversible and irreversible, suggesting that radiotherapy can lead to both myocardial damage and to epicardial coronary disease. With a minimum of 5 years follow-up since treatment, no abnormalities were considered to be clinically significant.