Background: Soft tissue attenuation artifacts are the most common cause of misinterpretation
in myocardial perfusion Imaging (MPI). Few studies assessing the value of prone imaging
in women have been published. Breast attenuation artifacts can be present in up to 40% of the MPI
studies in women.
Objectives: This study aimed at evaluating the potential impact of prone MPI on breast attenuation,
with a critical analysis of activity optimization and breast size influence.
Methods: MPI of an Anthropomorphic Torso Phantom with silicone breast prostheses and
equivalent adipose tissue was compared to a standard MPI database.
Results: A medical qualitative and semiquantitative analysis demonstrated higher uptake in the LV
anterior segments in the prone position for all injected activities. An artificial myocardium lesion
was diagnosable in the right segment in all images, which shows that prone positioning would not
mask a true lesion and it assists the cardiologist with a more accurate analysis. These results
showed that it is possible to optimize the activity to be injected by up to 55.6% when using combined
Conclusion: Prone position has a high impact on the interpretation of MPI in female patients since
it reduces the breast attenuation artifacts, and optimizes the radiation protection of the patient and
all staff involved in the procedure, making it more cost-effective.