Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), dual radiotracer (eg, myocardial viability); with concurrently a

CPT4 code

#### Name of the Procedure:
Myocardial Imaging, Positron Emission Tomography (PET), Combined Perfusion with Metabolic Evaluation Study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), Dual Radiotracer (e.g., Myocardial Viability)

#### Summary
Myocardial imaging using PET is a non-invasive procedure that assesses the blood flow and metabolic activity in the heart muscle. This procedure uses dual radiotracers to determine areas of the heart that may lack proper blood supply but are still viable and could benefit from medical treatment.

#### Purpose
This procedure is used to diagnose coronary artery disease, evaluate myocardial viability, assess the effectiveness of treatments, and guide further therapeutic interventions. The main goal is to identify parts of the heart muscle that can be saved or improved with appropriate treatments.

#### Indications
- Symptoms of chest pain or discomfort
- Diagnosed or suspected coronary artery disease
- Previous heart attack or myocardial infarction
- Poor response to other treatments for heart disease
- Assessment before coronary revascularization procedures

#### Preparation
- The patient may need to fast for 6-8 hours before the procedure.
- Certain medications might need to be adjusted or stopped as advised by the healthcare provider.
- Blood sugar levels may need to be managed, especially for diabetic patients.
- Initial diagnostic tests, including blood tests or electrocardiograms (ECG), might be required.

#### Procedure Description
1. The patient is positioned on a scanning table.
2. An intravenous (IV) line is started for radiotracer injection.
3. The first radiotracer is injected to evaluate blood flow (perfusion).
4. After a brief waiting period, images are taken using the PET scanner.
5. The second radiotracer is injected to assess metabolic activity.
6. Additional images are captured to compare perfusion and metabolism.
7. The entire process may include evaluating ventricular wall motion and ejection fraction through advanced imaging techniques.

#### Duration
The procedure typically takes about 1-2 hours to complete.

#### Setting
This procedure is usually performed in a hospital's radiology or nuclear medicine department or a specialized outpatient imaging center.

#### Personnel
- Nuclear medicine physician/radiologist
- Nuclear medicine technologist
- Cardiologist (potentially involved in interpretation)

#### Risks and Complications
- Rare allergic reactions to radiotracers
- Discomfort or bruising at the IV site
- Minimal radiation exposure
- Rarely, false-positive or false-negative results

#### Benefits
- Accurate detection of heart disease and viable heart muscle
- Information to guide further treatment strategies
- Non-invasive nature with quick recovery
- No significant downtime, allowing patients to resume normal activities soon

#### Recovery
- Patients can usually go home shortly after the procedure.
- They are advised to drink plenty of fluids to help flush out the radiotracers.
- There are typically no significant restrictions post-procedure, but follow-up appointments might be necessary to discuss results.

#### Alternatives
- Stress tests (e.g., treadmill or pharmacological stress test)
- Cardiac MRI or CT scans
- Coronary angiography
- Each alternative has its own benefits and limitations. For example, stress tests are less detailed but may be sufficient for initial evaluations, while angiography is more invasive.

#### Patient Experience
- During the procedure, patients may feel a slight sting from the IV insertion.
- The imaging process itself is generally painless.
- Some patients may experience mild discomfort from lying still for an extended period.
- Pain management strategies and comfort measures are employed as needed.