Principles for combining radionuclide and echocardiographic stress imaging into a single clinical laboratory service

Stress radionuclide imaging versus stress echocardiography: a framework for comparisons

Comparisons of stress-imaging procedures require analyses based on their 2 principal applications: diagnostic and prognostic assessments. Besides comparing results reported in the literature--in which differences have been reported in the ability of stress nuclear versus stress echocardiographic imaging to predict a low risk of cardiac events-other factors often not reported may be important in discerning the relative efficacy of these tests. These include consideration of how these tests perform in specific, individualized patient scenarios; the effect of on-going technical advances on test usefulness; and evaluation of test worthiness according to such factors as cost-effectiveness and the magnitude of incremental test information that is provided. Furthermore, it is important to distinguish between a test's efficacy (ie, its intrinsic accuracy) and its effectiveness (ie, how it performs in the real world of clinical practice).