The American Society of Nuclear Cardiology has published an updated practice standard for cardiac stress testing with SPECT and PET myocardial perfusion imaging, replacing the 2016 guideline. It is written as beginning-to-end guidance rather than a set of recommendations: patient selection and preparation, the available stress modalities and their protocols, safety considerations, and interpretation and reporting.
The framing is explicitly practical — the document is built to allow protocol adaptation by patient characteristics, special populations and site-specific logistics rather than prescribing one pathway. Stress protocols are addressed separately for each available stressor, and the intended audience is everyone involved in performing, interpreting and overseeing the test, not only nuclear cardiologists.
For a department, the useful step is not to read it end to end but to pull the preparation and protocol sections against your own standard operating procedures. Ten years is long enough that local practice will have drifted in at least one direction — caffeine and beta-blocker holds, vasodilator selection, and what gets recorded in the report are the usual places.
- Compare your written preparation instructions against the updated guidance, particularly holds before vasodilator stress
- Check that protocol selection is documented per stressor rather than assumed
- Review what your reports state about stress adequacy and safety events
- Agree the protocol adaptations your site actually uses, and write them down
- Involve the technologists — most of what changed sits in preparation and acquisition
Why it matters
Local stress protocols have had a decade to drift from the standard they were written against.
Don't overread it
This is a practice standard rather than a comparative-evidence document — it does not report new outcome data.
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