Several studies have described nonuniform blurring of myocardial perfusion imaging (MPI) due to respiration. This article describes a technique for correcting the respiration effect and assesses its effectiveness in clinical studies. Methods: Simulated phantoms, physical phantoms, and patient scans were used in this study. A heart phantom, which oscillated back and forth, was used to simulate respiration. The motion was measured on a g-camera supporting list-mode functionality synchronized with an external respiratory strap or resistor sensor. Eight clinical scans were performed using a 1-d 99m Tc-sestamibi protocol while recording the respiratory signal. The list-mode capability along with the strap or sensor signals was used to generate respiratory bin projection sets. A segmentation process was used to detect the shift between the respiratory bins. This shift was further projected to the acquired projection images for correction of the respiratory motion. The process was applied to the phantom and patient studies, and the rate of success of the correction was assessed using the conventional bull's eye maps. Results: The algorithm provided a good correction for the phantom studies. The shift after the correction, measured by a fitted ellipsoid, was ,1 mm in the axial direction. The average motion due to respiration in the clinical studies was 9.1 mm in the axial direction. The average shift between the respiratory phases was reduced to 0.5 mm after correction. The maximal change in the bull's eye map for the clinical scans after the correction was 6%, with a mean of 3.75%. The postcorrection clinical summed perfusion images were more uniform, consistent, and, for some patients, clinically significant when compared with the images before correction for respiration. Conclusion: Myocardial motion generated by respiration during MPI SPECT affects perfusion image quality and accuracy. Motion introduced by respiration can be corrected using the proposed method. The degree of correction depends on the patient respiratory pattern and can be of clinical significance in certain cases. Duri ng cardiac SPECT, the myocardial wall is constantly moving relative to the scanner detectors. Patient motion, respiration, and myocardial contraction are among the major contributors to this motion. Acquired projections are therefore blurred, image resolution is decreased, and artifacts can be introduced. Each of these 3 sources of motion needs to be addressed according to its unique characteristics.The reported range of myocardial respiration motion is between 4 and 18 mm in the cranial-caudal direction and has a much lower magnitude in the horizontal and vertical directions (1,2). Several articles have attempted to measure the respiration-related myocardial motion for several imaging modalities (1-10), including SPECT (9,11,12) and PET (13,14). In PET all projections are acquired simultaneously, whereas in SPECT they are acquired sequentially. Therefore, respiratory-gated SPECT acquisition may result in inconsistency between project...