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August 5, 1988

Finding the High-Risk Patient With Coronary Artery Disease-Reply

Author Affiliations

San Francisco General Hospital

San Francisco General Hospital

JAMA. 1988;260(5):635. doi:10.1001/jama.1988.03410050051013

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In Reply.—  I thank Dr Williams for his kind comments. He is quite correct that positron-emitting isotopes are usually obtained at present from a cyclotron and not from a breeder reactor. My mistake.As to the relative cost of thallium 201 perfusion scanning vs that of MUGA wall-motion studies, my purpose was to put cost into relative ballpark categories. The cost of thallium has recently decreased, so that at my institution (San Francisco General Hospital) there is only a $25 difference between a dose of thallium 201 and technetium 99m ($60 for 1.11 × 108 Bq of thallium vs $25 for technetium 99m plus $10 for technician time for dose labeling). The cost of a thallium perfusion stress test with a four-hour redistribution scan is $762, whereas a resting technetium 99m MUGA study is $455. With exercise, MUGA goes up to $650; 30% of this is professional fees. At