“…Beyond the use of ECG gating (to corroborate regional wall motion abnormalities with regions of apparent fixed defect), 8 one of the simplest approaches involves the use of positional proning of patients during standard SPECT acquisition, usually following stress supine imaging. 9 Direct correction for attenuation can be achieved using either line sources or CT. 10 More recently, solid-state cadmium zinc telluride (CZT) cameras, some with upright imaging capability, 11 have allowed improved image resolution and higher count rate, enabling improved diagnostic accuracy with lower effective radiation dose, even in obese patients. 12 Given that one or more of these techniques is widely available and endorsed for best practices, 13 a contemporary comparison of the clinical performance of cardiac PET/CT vs SPECT, especially in obese patients, would ideally utilize some form of attenuation correction for SPECT.…”