Stress Echocardiography: A Historical and Societal Perspective

Stress echocardiography is a popular cardiac imaging technique that provides similar diagnostic and prognostic accuracy to radionuclide stress perfusion imaging. Similar accuracy, however, is not synonymous with being “clinically interchangeable.” Because of the economic cost, environmental impact, and individual biohazard exposure, a nuclear examination should be performed only when it cannot be replaced by other techniques that do not employ ionizing radiation. Nuclear medical imaging procedures, of which cardiological procedures are an important part, account for 20% of the annual effective radiation dose received by the average person in the United States. At the individual level, the radiological exposure of a single nuclear cardiology procedure conveys a low, but non-negligible, risk of cancer, which varies from 1 in 500 to 1 in 1,000, depending on the type of examination (higher for thallium scans; lower for technetium 99m methoxyisobutylisonitrile scans). Because the information provided by stress echocardiography and stress radionuclide perfusion imaging is similar, the choice of test should be made in the context of the environmental, biological, and economic effects of that choice.2