An article in this issue of the Journal of Nuclear Cardiology examines whether one should acquire cardiac single photon emission computed tomography (SPECT) projection images using a camera that rotates 180? around the patient or one that collects the full 360? of data.1 It is the most recent of many such articles that have examined this issue. Although the present article does not put the issue to rest, reading it (or any of its predecessors) makes one reflect on some of the fundamental issues about how SPECT works. When one does so it seems rather amazing that SPECT myocardial perfusion imaging works at all, let alone with the excellent sensitivity and specificity that the method is known to possess. The images one acquires in a SPECT study, especially those predating attenuation correction, violate one of the basic assumptions needed to perform image reconstruction.
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