• Low-carbohydrate diet (LCD) the day before PET suppresses myocardial FDG uptake. • LCD before PET increases liver and blood pool SUV ( max ) and SUV ( mean ). • Suppression of myocardial uptake may improve PET imaging of thoracic disease. • Suppression of myocardial uptake may help imaging cardiac inflammatory disease with PET.

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Radiographic staff in a regional cardiothoracic centre were asked to assess all pre- and post-operative chest radiographs over a 6-month period. Radiographs showing new, acute changes were noted and a red dot placed on the film. Medical staff were notified of radiographs with red dots, and these were subsequently reported by radiologists. Using reports by radiologists as the gold standard, an audit was performed of the radiographers' accuracy in identifying new abnormalities. The absence of a necessary red dot as well as inappropriate use were noted. To enhance the accuracy of radiograph interpretation, a series of lectures on the chest radiograph and a protocol for red dot use were developed by senior radiologists. During this 6-month period 8614 chest radiographs were taken; red dots were applied to 464 (5%). These red dots were considered incorrect in 100 radiographs. Radiographers misinterpreted or missed potentially important changes in 38 of the remaining 8150 radiographs without red dots (sensitivity and specificity of 90% and 99%, respectively). Radiographers appeared to err on the side of caution when confronted with an abnormal chest radiograph, especially when previous radiographs and reports were unavailable. This resulted is a relatively high false positive rate. Future audits will show whether this rate can be reduced by continued training. Subtle interpretation is crucial to distinguish between an abnormal chest radiograph needing urgent medical attention and an abnormal chest radiograph with normal post-operative changes. The opinion of the experienced and trained radiographer is immediate and may be invaluable to the diagnostic care of the patient.

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Objective: The use of stress cardiovascular MR (CMR) to evaluate myocardial ischaemia has increased significantly over recent years. We aimed to assess the indications, incidental findings, tolerance, safety and accuracy of stress CMR in routine clinical practice. Methods: We retrospectively examined all stress CMR studies performed at our tertiary referral centre over a 20-month period. Patients were scanned at 1.5 T, using a standardised protocol with routine imaging for late gadolinium enhancement. Angiograms of patients were assessed by an interventional cardiologist blinded to the CMR data. Results: 654 patients were scanned (mean age 65¡29 years; 63 inpatients; 9.6%). 14% of patients had incidental extracardiac findings, the commonest being liver or renal cysts (6%) and pulmonary nodules (4%). 639 patients (97.7%) received intravenous adenosine, 10 received intravenous dobutamine and 5 patients had both. Of the 15 patients who received dobutamine, 12 had no side-effects/complications, 2 experienced nausea and 1 chest tightness. Of the 644 patients who received adenosine, 43% experienced minor symptoms, 1% had transient heart block and 0.2% had severe bronchospasm requiring termination of infusion. There were no cases of hospitalisation or myocardial infarction. 241 patients also had coronary angiography. For detecting at least moderate stenosis of $50%, sensitivity was 86%, specificity 98% and accuracy 89%. For detecting severe stenoses of $70%, sensitivity was 91%, specificity 86% and overall accuracy 90%. These results compare very favourably with previous smaller research studies and meta-analyses. Conclusion: We conclude that stress CMR, with adenosine as the main stress agent, is well tolerated, safe and accurate in routine clinical practice. The routine use of stress cardiovascular MR (CMR) to evaluate myocardial ischaemia has increased significantly over the last few years [1,2]. Stress CMR is an attractive non-invasive technique because it does not require radiation exposure, and it can potentially play an important role in the diagnosis and management of patients with coronary artery disease. More recent studies have also demonstrated that stress CMR results have important prognostic value: a negative result predicts a 3-year event-free survival of .99% and a positive result is an independent predictor of future cardiac events [3,4].Studies are usually performed during first-pass perfusion imaging, using vasodilatory pharmacological stress with either intravenous adenosine or dipyridamole [2]. Adenosine is the most widely used, and, in the presence of coronary stenoses, flow heterogeneities result in regional perfusion defects during firstpass gadolinium contrast imaging. Alternatively, if adenosine is contraindicated, myocardial ischaemia could also be assessed by regional wall motion abnormalities with dobutamine as an inotropic stress agent.Despite the increasing use of stress CMR clinically, previous research studies have involved relatively small numbers. A recent study examined the safety an...

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