🛏️ Want more stress-only SPECT? Turn the patient over.
JNC, Houston Methodist: 14,274 patients with normal stress images.
Share of stress-only studies:
⚪ No AC, no prone → 43.6%
🟢 AC + prone → 76%
📉 Tracer dose −35.6%
🔍 Why prone works
Attenuation shifts or fades when the patient lies prone. A real defect stays put.
Supine + prone quantification (Cedars-Sinai): specificity 65% → 86%.
📊 Is stress-only safe?
In the JNC cohort, normal stress-only scans carried a similar prognosis to normal stress–rest scans, with or without AC or prone.
The gain was largest in women, obese and older patients, and with EF ≥55%.
⚠️ Caveats
Single centre, observational, not randomized.
Prone has its own anterior artifacts: read it with supine and gated images, never alone.
💭 My take
Stress-only is the cheapest radiation cut we have.
Prone and AC are what make the "no rest scan needed" call safe to make.
🗳️ Poll below 👇
📄 Alwan M, … Al-Mallah MH. J Nucl Cardiol 2025. Nishina H, … Berman DS. J Nucl Med 2006.
@MyASNC @JNCjournal #CVNuc #NuclearCardiology