ee studies listed below) and it would reduce the amount of radiation given to the patient as

well as those who are around the patient (health care personnel, family, friends, people walking next to the person who has received the radiation and now is a source of radiation themselves).  Wouldn't it be better to admit that only one dose is needed (Sestamibi Redistributes-moves around) and improve the results (see our work as well as UCLA and Harvard's work noted below) and reduce the amount of radiation used; that is for everyone except the pharmaceutical industry who profits from selling more radiation and can produce a scare that we don't have enough sources and we need to build more generators.

 

I am enclosing a bibliography and several publications regarding nuclear isotope redistribution, showing that single radioactive injection redistribution is preferable to two radioactive injection methods advanced by the pharmaceutical industry.  This single radioactive injection method not only is more accurate; but, reduces patient and health care worker radiation exposure.   What is the appropriate remedy to this patient and health care worker risk?

 

1. Pace L, Catalano L, Del Vecchio S, et al.  Washout of [99mTc] sestamibi in predicting response to chemotherapy in patients with multiple myeloma.  Q J Nucl Med Mol Imaging 2005;49:281-5.

 

2. Hurwitz GA, Ghali SK, Husni M, et al.  Pulmonary uptake of Technetium-99m-Sestamibi induced by dipyridamole-based stress or exercise. J Nucl Med 1998;39:339-45. 

 

3. Hurwitz GA, Fox SP, Driedger AA, Willems C, Powe JE.  Pulmonary uptake of sestamibi on early post-stress images:  angiographic relationships, incidence and kinetics.  Nucl Med Commun 1993;14;15-22. . 

 

4. Saha M, Forrest TF, Brown KA.  Lung uptake of technetium-99m-sestamibi: relation to clinical, exercise, hemodynamic, and left ventricular function variables.  J Nucl Cardiol 1994;1:52-6. 

 

5. Giubbinni R, Campini R, Milan E, et al.  Evaluation of technetium-99m-sestamibi lung uptake:  correlation with left ventricular function.  J Nucl Med 1995;36:58-63. 

 

6. Sugiura T, Takase H, Toriyama T, et al.  Usefulness of Tc-99m methoxyisobutylisonitrile scintigraphy for evaluating congestive heart failure.  J Nucl Cardiol 2006;13:64-8.

 

7. Kumita S, Seino Y, Cho K, et al.  Assessment of myocardial washout of Tc-99m-sestamibi in patients with chronic heart failure:  comparison with normal control.  Ann Nucl Med 2002;16:237-42.

 

8. Matsuo S, Nakae I, Tsutamoto T, Okamoto N, Horie M.  A novel clinical indicator using Tc-99m sestamibi for evaluating cardiac mitochondrial function in patients with cardiomyopathies.  J Nucl Cardiol 2007;14:215-20.

 

9. Sugiura T, Takase H, Toriyama T, Goto T, Ueda R, Dohi Y.  Usefulness of Tc-99m methoxyisobutylisonitrile scintigraphy for evaluating congestive heart failure. J Nucl Cardiol 2006;13:64-8. 

 

10. Ikawa M, Kawai Y, Arakawa K, et al.  Evaluation of respiratory chain failure in mitochondrial cardiomyopathy by assessments of 99mTc-MIBI washout and 123I-BMIPP/99mTc-MIBI mismatch.  Mitochondrion 2007;7:164-70.

 

11. Meissner K, Sperker B, Karsten C, et al.  Expression and localization of P-glycoprotein in Human Heart:  Effects of Cardiomyopathy.  J Histochem Cytochem 2002;50:1351-6.

 

12. Ono S, Yamaguchi H, Takayama S, Kurabe A, Heito T.  Rest delayed images on 99mTc-MIBI myocardial SPECT as a noninvasive screen for the diagnosis of vasospastic angina pectoris.  Kaku Igaku 2002;39:117-24. 

 

13. Ono S, Yakeishi Y, Yamaguchi H, et al.  Enhanced regional washout of technetium-99m-sestamibi in patients with coronary spastic angina.  Ann Nucl Med 2003;17:393-8.

 

14. Fukushima K, Momose M, Kondo C, et al.  Myocardial kinetics of (201) Thallium, (99m) Tc-tetrofosmin, and (99m) Tc-sestamibi in an acute ischemia-reperfusion model using isolated rat heart.  Ann Nucl Med 2007;21:267-73.

 

15. VanBrocklin HF, Hanrahan SM, Enas JD, et al.  Mitochondrial avid radioprobes.  Preparation and evaluation of 7'(Z)-[125I]iodorotenone and 7'(Z)-[125I]iodorotenol.  Nucl Med Biol 2007;34:109-16. 

 

16. Tanaka R, Nakamura T, Chiba S, et al.  Clinical implication of reverse redistribution on 99mTc-sestamibi images for evaluating ischemic heart disease.  Ann Nucl Med 2006;20:349-56.

 

17. Liu Z, Johnson G 3^rd, Beju D, Okada RD.  Detection of myocardial viability in ischemic-reperfused rat hearts by Tc-99m sestamibi kinetics.  J Nucl Cardiol 2001;8:677-86. 

 

18. Shin WJ, Miller K, Stipp V, Mazour S.  Reverse redistribution on dynamic exercise and dipyridamole stress technetium-99m-MIBI myocardial SPECT.  J Nucl Med 1995;36:2053-5

 

19. Takeishi Y, Sukekawa H, Fujiwara S, et al.  Reverse redistribution of technetium-99m-sestamibi following direct PTCA in acute myocardial infarction. J Nucl Med 1996;37:1289-94.

20. Fujiwara S, Takeishi Y, Atsumi H, et al.  Prediction of functional recovery in acute myocardial infarction: comparison between sestamibi reverse redistribution and sestamibi/BMIPP mismatch.  J Nucl Cardiol 1998;5:119-27.

 

21. Ayalew A, Marie PY, Menu P, et al.  A comparison of the overall first-pass kinetics of thallium-201 and technetium-99m MIBI in normoxic and low-flow ischaemic myocardium.  Eur J Nucl Med 2000;27:1632-40

 

22. Richter WS, Cordes M, Calder D, Eichstaedt H, Felix R.  Washout and redistribution between immediate and two-hour myocardial images using technetium-99m sestamibi.  Eur J Nucl Med 1995;22:49-55.

 

23. Meerdink DJ, Leppo JA.  Myocardial transport of hexakis(2-methosyisobutyl isonitrile) and thallium before and after coronary reperfusion.  Circulation Research 1990;66:1738-46. 

 

24. Ayalew A, Marie PY, Menu P, et al.  201 Tl and 99m Tc-MIBI retention in an isolated heart model of low-flow ischemia and stunning:  Evidence of negligible impact of myocyte metabolism on tracer kinetics. J Nucl Med 2002;43:566-74.

 

25. Takahashi N, Reinhardt CP, Marcel R, Leppo JA.  Myocardial uptake of 99m Tc-tetrofosmin, Sestamibi, and 201 Tl in a model of acute coronary reperfusion.  Circulation 1996;94:2605-13.

 

26. Reiner Z, and the European Atherosclerosis Society.  2009 Position Paper incorporating:   (1) Fleming RM, Harrington GM.  "What is the Relationship between Myocardial Perfusion Imaging and Coronary Artery Disease Risk Factors and Markers of Inflammation?" Angiology 2008;59:16-25. (2) Fleming RM, Harrington GM, Baqir R, Jay S, Sridevi Challapalli, Avery K, Jim Green.  The Evolution of Nuclear Cardiology takes Us Back to the Beginning to Develop Today’s “New Standard of Care” for Cardiac Imaging:  How Quantifying Regional Radioactive Counts at 5 and 60 Minutes Post-Stress Unmasks Hidden Ischemia.  Methodist DeBakey Cardiovascular Journal (MDCVJ) 2009;5(3):42-48.

 

27. Fleming RM, Harrington GM, Jay S, Avery K.  Case 20 – Cardiac viability measured using resting FH Washout of Sestamibi.  Sestamibi is not superglue.  ASNC Best Cases 23 March 2009, http://www.asnc.org/section_62.cfm

 

28. Fleming RM, Harrington GM, Baqir R, Jay S, Sridevi Challapalli, Avery K, Green J.  The Evolution of Nuclear Cardiology takes Us Back to the Beginning to Develop Today’s “New Standard of Care” for Cardiac Imaging:  How Quantifying Regional Radioactive Counts at 5 and 60 Minutes Post-Stress Unmasks Hidden Ischemia.  Methodist DeBakey Cardiovascular Journal (MDCVJ) 2009;5(3):42-48.

 

29. Fleming RM, Harrington GM, Baqir R, Jay S, Challapalli S, Avery K, Green J.  Renewed Application of an Old Method Improves Detection of Coronary Ischemia.  A Higher Standard of Care.  Federal Practitioner 2010;27:22-31.

 

30. Fleming RM, Harrington GM, Avery K, Baqir R, Jay S, Challapalli S, Green J.  Sestamibi kinetics may distinguish between viable and infracted myocardium.  Medscape Radiology 2010 WebMD, LLC.  October 2010. (http://www.medscape.com/viewarticle/729277)

 

31. Fleming RM.  Reducing patient radiation exposure AND answering the question of “Does the patient actually have heart disease?”  Ann Intern Med 13 October 2010.  http://www.annals.org/letters/?first-index=&hits=25&days=&submit=Go http://www.annals.org/content/153/7/425.abstract/reply#annintmed_el_125906

 

32. Fleming RM.  The Nuclear Imaging Uncertainty Principle.  Do Nuclear Cameras Really Work?  Nature Precedings 14 October 2010 (18:33 GMT).  Posted to Biotechnology, Chemistry.  http://precedings.nature.com/documents/5013/version/1

 

33. Fleming RM.  Inflammation and Heart Disease.  The Wisdom of listening to our Colleagues!  Ann Intern Med 19 October 2010.  http://www.annals.org/letters/ http://www.annals.org/content/153/8/499.abstract/reply#annintmed_el_125941

 

34. Fleming RM, Harrington GM.  Sestamibi Redistribution Identifies Vulnerable Coronary Plaques.  The State of the Art!  Ann Intern Med 21 October 2010.

http://www.annals.org/letters/  http://www.annals.org/content/153/6/387 

 

35. Fleming RM, Harrington GM, Baqir R, Jay S, Sridevi Challapalli, Avery K, Green J.  The Evolution of Nuclear Cardiology takes Us Back to the Beginning to Develop Today’s “New Standard of Care” for Cardiac Imaging:  How Quantifying Regional Radioactive Counts at 5 and 60 Minutes Post-Stress Unmasks Hidden Ischemia.  Methodist DeBakey Cardiovascular Journal (MDCVJ) 2009;5(3):42-48. [reprinted by permission, ANZ Nuc Med 2010;41(4):6-11.

 

36. Fleming RM, Harrington GM.  FHRWW stress SPECT protocol reduces radioactive dosage and increases ischemia detection.  ANZ Nuclear Medicine 2010;41(4):18-26.

 

37. Fleming RM, Harrington GM, Avery K.  Case 18 - Vulnerable coronary plaques.   ASNC Best Cases.  8 December 2008 http://www.asnc.org/section_62.cfm

 

38. Fleming RM, Harrington GM, Jay S, Avery K.  Case 20 - Cardiac viability measured using resting FH Washout of Sestamibi:  Sestamibi is not superglue.  ASNC Best Cases 23 March 2009, http://www.asnc.org/section_62.cfm

 

39. “Study:  Nuclear stress tests need to be simplified.”  SNM SmartBrief, July 23,2010.

 

40. WEB EXCLUSIVES Feature:  “Single sestamibi injection may suffice for ischemic detection”.  HealthImaging.com  4 August 2010.

 

41. “Innovations in myocardial perfusion imaging reveal potential life-saving strategy.”  By: Brian Ellis, Cardiology Today, Feature story. 2010;13(9).

(http://www.cardiologytoday.com/view.aspx?rid=68069)

 

42. Fleming RM, Harrington GM, Avery K, Baqir R, Jay S, Challapalli S, Green J.  Sestamibi kinetics may distinguish between viable and infracted myocardium.  Medscape Radiology 2010 WebMD, LLC. (http://www.medscape.com/viewarticle/729277)

 

43. “Lessons learned from the Moly shortage:  Is the crisis over?”  Molecular Imaging for Physicians & Executives in Molecular Imaging & Nuclear Medicine.  By:  Manjula Puthenedam, Molecular Imaging. 2010;4:12-13.  http://www.molecularimaging.net/index.php?option=com_articles&view=article&id=24421:lessons-learned-from-the-moly-shortage-is-the-crisis-over

 

44. Fleming RM, Harrington GM, Baqir R. Heart Disease in Men.  Chapter 3.  Using Multiple Images Post-Stress to Enhance diagnostic Accuracy of Myocardial Perfusion Imaging: The Clinical Importance of Determining Washin and Washout Indicates a Parabolic Function between Coronary Perfusion (Blood Flow) and Cellular ("Uptake/Release") Function.  Alice B. Todd and Margo H. Mosley Editors, Nova Publishers, 2009, pp. 75-100. (https://www.novapublishers.com/catalog/product_info.php?products _id=8409)

 

45. Fleming RM, Harrington GM, Baqir R.  Use of Parabolic Model in Tomographic Diagnosis of Infarction and Stenosis.  The 1^st Congress on Controvesies in Cardiovascular Diseases:  Diagnosis, Treatment and Intervention (C-Care), Berlin, Germany, July 4-5, 2008.

 

46. Sheikine Y, Berman DS, DiCarli MF.  Technetium-99m-sestamibi redistribution after exercise stress test identified by a novel cardiac gamma camera:  Two case reports.  Clin Cardiol. 2010;33:E39-E45.

 

 

Respectfully yours,

 

Dr. Fleming

Richard M. Fleming, M.D.

Board Certified Nuclear Cardiologist

Cell:  775-770-4328

rmfmd7@hotmail.com

Dec. 16, 2010