This course includes learner self-assessment by reading 25 planar and 25 SPECT Tc-99m cardiac amyloid imaging studies, with image interpretation data collected for analysis. Each case has one question to be answered. Following the initial case reading assessment, participants will listen to a discussion of best practices and comparisons of Tc-99m PYP image acquisition and interpretation using planar, SPECT, SPECT/CT and CZT imaging systems, 1- versus 3-hour imaging, quantification of tracer uptake, and use of Tc-99m HMDP, led by three imaging experts. The final part of this initiative will involve a follow-up assessment with participants reading an additional 25 planar and 25 SPECT Tc-99m cardiac amyloid imaging studies, to measure post-intervention learning.

The overall goal of the Diagnostic Precision for Tc-99m Cardiac Amyloid Imaging: Master the Latest Techniques for Improved Patient Care initiative is to improve the diagnostic skills of physicians performing, interpreting, and reporting technetium-99m cardiac amyloid imaging studies, including Tc-99m pyrophosphate (Tc-99m PYP).  Optimized image analysis and informative reporting can affect multiple levels of patient management. Accurate image interpretation leads to a timely diagnosis, early initiation of transthyretin amyloidosis (ATTR) therapy, more specific heart failure treatment and thus improves both short- and long-term patient outcomes. Furthermore, reading physician confidence will improve through better understanding of the nuances of cardiac amyloid scintigraphy and will result in enhanced communication with referring clinicians.

There is a lag between older guidelines for acquisition and interpretation of Tc-99m cardiac amyloid studies and current best practices. Planar imaging still plays a large role and can result in false positive and false negative studies. Based on early studies, planar imaging was a simple, non-invasive approach to diagnosing transthyretin amyloid cardiomyopathy (ATTR-CM). With more labs performing these studies, and a real-world population, planar imaging was associated with false positive studies potentially subjecting the patient to unnecessary treatment.

New studies have shown adding SPECT to planar imaging increases diagnostic accuracy. The use of SPECT imaging is crucial to distinguishing myocardial retention from blood pooling.  A planar-derived visual score can misclassify a small number of patients and use of H/CL ratio decreases the diagnostic certainty of planar imaging. Clinicians need to understand the importance of SPECT Tc-99m cardiac amyloid scintigraphy in their diagnostic workup of ATTR-CM.

This program will, through case-based self-analysis and a recorded discussion led by experts, demonstrate that SPECT and SPECT/CT are the methods of choice for diagnosing ATTR-CM. 

Evaluation Deadline: AMA PRA Category 1 Credits™= July 8, 2025
The American Society of Nuclear Cardiology is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.  



Physicians: The American Society of Nuclear Cardiology designates this Enduring Materials activity for a maximum of 5 AMA PRA Category 1 Credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

As an accredited provider of the Accreditation Council for Continuing Medical Education (ACCME), The American Society of Nuclear Cardiology (ASNC) adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education. In compliance with these standards, it is ASNC’s policy to ensure balance, independence, objectivity, and scientific merit in its educational activities through the disclosure of all financial relationship with ineligible companies and mitigation of conflicts of interest. The financial interest or relationships requiring disclosure are outlined in ASNC’s CME Conflict of Interest Policy. All planners, reviewers, and presenters involved with this activity were required to disclose all financial relationships. The American Society of Nuclear Cardiology has reviewed these disclosures and mitigated or managed all identified conflicts of interest through a peer review process.

The American Society of Nuclear Cardiology has reviewed this activity’s faculty disclosures and resolved or managed all identified conflicts of interest through a peer-review process.

The following planners, presenters, reviewers, and staff reported no financial relationships:

Ronald G. Schwartz, MD, MS, MASNC
Linda Giering, PhD (ASNC staff)
Dawn Edgerton (ASNC staff)

The following planners, presenters, reviewers, and staff reported financial relationships:

Gary R. Small, MBChB, PhD, MRCP: Research Grant - Pfizer
Prem Soman, MD, PhD, MASNC: Research Grant - Pfizer; Consultant - Alnylam, Eidos, Pfizer, Spectrum Dynamics