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Journal of nuclear cardiology nuclear cardiology news update
JOURNAL OF NUCLEAR CARDIOLOGY NUCLEAR CARDIOLOGY NEWS UPDATE ASNC N e w s
The report of the Institute of Medicine (IOM) Committee for Review and Evaluation of the Medical Use Program of the Nuclear Regulatory Commission was made public in December 1995. The report is 255 pages, and among its 16 faculty members is Barry L. Zaret, MD, Editor-in-Chief of the JOURNAL.The report recommends removing the regulatory authority from the NRC, shifting federal guidance to the DHHS (Department of Health and Human Services), and delegating regulatory responsibility for byproduct materials to the states with the proviso that only licensed users would have access to byproduct materials. ASNC, SNM, and ACNP endorsed the report. The report by the Quality Assurance Committee (Ernest Garcia, PhD, Chairman) on the standardization of imaging protocols will be published in the May/June issue of the JOURNAL. Dr. Garcia's committee is already working on the second part of the report, which will include guidelines on interpretation and reporting. This will be my last message as president; the next message will be written by my longtime friend, Mario S. Verani, MD. I will attempt to summarize the highlights of the accomplishments of ASNC during the past year in my message in the Newsletter. At this time I would like to thank Bill Nelligan, Dawn Edgerton, and Diana Lee, all of whom have done a tremendous job for us during my tenure as the chief officer of ASNC. Similarly I also acknowledge the staff of the JOURNAl, the ASNC Executive Committee, the Board of Directors, the members of the various committees and task forces, and the members at large, both in the United States and abroad. Thank you very much for your advice, suggestions, and efforts on behalf of ASNC. It is this unique blend of selfless sacrifices that has spurred the rapid growth of ASNC over such a short period of time. I am honored to have served as the third president, and I know that I will look back at this year with pride and satisfaction. I wish you all and my successor continued growth and progress. May God bless you all! Ami S. Iskandrian, MD President International N e w s
China. Last year, an IAEA '95 National Training Course for physicians of nuclear medicine was held in Shanghai and another IAEA training course for nuclear medicine technicians was held in Suzhou. Nuclear cardiology was one of the major programs. Xiujie Liu France. We have launched three European nuclear cardiology trials - - E N C D 1, 2, and 3. Numbers 1 and 2 190
address myocardial perfusion imaging with MIBI and GBR respectively. They concern the processing of data (30 patients x 30 centers). Results will be obtained by February 15, 1996, and published as abstracts at the Copenhagen EANM meeting. Number 3, on more than 100 normal myocardial SPECT studies, has also been launched, with a deadline later in the year. Michel H. Bourguignon Germany. A new system has been introduced in Germany; for the first time, stress echocardiography can now be reimbursed. There is an immense interest among cardiologists to use this new technique, and new courses to teach stress echocardiography are being established every day throughout the country. The requirements for certification are quite stringent and include a 20-hour course and performance of 100 stress ECHO studies, which must be presented on CD-ROM to the course director. The course director is then responsible for reviewing the cases and confirming their technical accuracy. The effects of this surge of stress echocardiography on the number of cardiac radionuclide studies in Germany are not yet known. Udo Sechtem QUESTION Is gated technetium perfusion imaging to evaluate regional flow and wall motion a popular option in your geographic area? Does it have the potential to adequately address issues of wall motion/perfusion and viability in a single study as well as provide an important adjunct to routine imagining? If not, then when should this type of study be performed? ANSWERS Argentina. Gated technetium perfusion imaging to evaluate regional flow and wall motion is not a popular optign in Argentina. This is because we lack the equipment with the necessary software developed to do it. However, it is occasionally used to evaluate myocardial viability. Overall, it has the potential to adequately address issues of wall motion/perfusion and viability in a single study and provide an important adjunct to routine imaging. Nestor Perez Balino and Nester A. Vita Australia. Gated technetium perfusion imaging is not used very commonly in Australia. It certainly has the potential to address issues of wall motion and perfusion and viability in a single study, although I believe that, for viability questions, technetium is inferior to thallium. Ben Freedman JOURNAL OF NUCLEARCARDIOLOGY
March/April 1996
Joue.NAt~OF NUCI,EAR CARDIOLO(W Volume3, Number2; 190-192 China. There have been more than 100 gamma camera systems and 180 sets of SPECT that have been used for nuclear cardiology studies in China, particularly in Beijing (35 SPECTs), Shanghai, and Guangzhou. At present, 99mTc-MIBIand 2°iT1myocardial imaging (including planar and SPECT) have been widely used in routine clinical use. In a few hospitals, gated 99*~Tc-MIBImyocardial tomography has been used to evaluate myocardial perfusion and function; however, this study has not been done in routine clinical application. The quality of images of these studies is not satisfactory. Because imaging quality in nuclear medicine is limited by statistics, the imaging time is extremely important and is most often dictated by the tolerance of the patient to the procedure. Radionuclide ventriculography in China, however, is still widely used in assessment of left and right ventricular function. Echocardiography has given a challenge. Last year 42% of papers published in the Chinese Journal of Nuclear Medicine were related to its cardiovascular disease applications. Among them, most work was focused on the assessment of myocardial viability using the 2°*T1reinjection method and 99mTc-MIBIin combination with nitrates, with very few 18F-FDG PET studies. Xiujie Liu France. Gated SPECT is not yet a popular technique in France, although there is a growing interest. The main reason is that it is routinely applicable with modern dualhead systems and painful with single-head cameras. The rate of renewal of equipment is still slow in France in comparison with the United States. It is our belief that the potential is great for both routine application and for addressing the issue of wall motion/perfusion and viability in a single study, provided that you have the proper equipment. This includes the software that is used to display the data. If an effort must be made, I guess the software to manipulate the data easily and adequately is the issue. Michel H. Bourguignon Germany. Gated technetium perfusion imaging to evaluate regional flow and wall motion is not a popular option in Germany. One reason is that there is no special reimbursement for performing gated studies. The technique is not trivial to master, and a large number of data must be crunched without easily available software that would greatly ease this processing-intense technique. Although this type of study may have a role in patients with questionable perfusion defects, there are other possibilities to solve this dilemma--putting the patient in a prone position, repositioning soft tissue (i.e., breast), or simply pet'forming a PET study. Udo Sechtem India. Gated technetium perfusion imaging to evaluate regional flow and wall motion is gaining popularity because of its potential to adequately address issues of wall motion, perfusion and viability, and rest-left ventricular (LV) ejection fraction (by the image inversion protocol, when it becomes available). The existing gamma camera computers are not optimally suited for acquiring first pass; hence the information about exercise LV ejection fraction
News update 191 (during stress injection) cannot be obtained with technetium perfusion agents. Thus first-pass acquisition is not popular. Currently, 201T1 is preferred for viability studies reinjection, but because it must be imported, the shot is relatively expensive. If the use of technetium perfusion agents for viability could be validated, then it would be a major gain. With the availability of agents that permit a same-day 2-hour rest/stress SPECT study, this will become the modality of choice. R.D. Lele Israel. In Israel, this technique is still not very popular. The first reason is that sestamibi and tetrofosmin are relatively new. Sestamibi has been approved for clinical use only last year, and tetrofosmin is still under clinical investigation (and should be approved next month). The second reason is that, because this technique necessitates "strong (expensive) computers" and its processing is timeconsuming, private laboratories (where most of the studies are performed and that cannot be charged more for a gated-perfusion study) are not interested in using gated technetium perfusion as a routine technique. I strongly believe that this technique has, in many circumstances, advantages over 2°1T1imaging and that it is only a matter of time until we see gated technetium perfusion as a routine technique in our country. Pierre Chouraqui Italy. Gated perfusion imaging with sestamibi is possible but not popular in my area; very few centers do it and not routinely. I personally think it has a least some potential to adequately address issues of wall motion and perfusion and provide important additional information. Gianfranco Mazzotta Thailand. The popularity of gated myocardial perfusion cannot be accurately judged in Thailand. This is because only two or three institutes are capable of doing gated SPECT, and only one is doing a gated planar myocardial perfusion study. However, in my experience, I think that it is advantageous to gain additional information on wall motion. This is true because it does help in excluding the presence of significant defects when normal wall contraction is evident in the myocardial segments that are suspected to be slightly abnormal. The issue of viability is also a difficult subject because relatively few patients undergo CABG or PTCA. Most of those who go for revascularization have conventional SPECT myocardial perfusion study rather than gated SPECT or gated planar myocardial perfusion studies. In response to the routine use of gated SPECT, I really agree with this new method as a standard addition to testing since there is only additional time and effort required to obtain more information. Moreover, gated SPECT can be useful when intact wall motion is demonstrated in regions having suspicious defects. However, as mentioned above, because only two or three institutes can perform this new methodology, it practically means that routine gated SPECT cannot be generally recommended here. Piyamitr Sritara
192 News update
JOURNALOFNUCLEARCARDIOLOGY March/April 1996
The Netherlands. Regarding gated perfusion imaging, I need to mention that the combination of flow and wall motion is, at the moment, not a very popular option in The Netherlands. Of course, we are aware of its great potential in some patients, but the major limitations for routine use are of a technical and logistic nature. For instance, you must have a second ECG apparatus, it requires some changes in time scheduling, and most important, adequate computer programs for both acquisition and analysis must stillbe installed in most centers. Other drawbacks that must be resolved are the added time for processing and interpretation and the added data storage required. It will also be important how to implement stress in the gated SPECT procedure because all patients must be injected twice. When all those practical and technical questions have more or less been solved, then we believe that every patient should undergo gated SPECT in a standard fashion. One may then later decide whether additional analysis should be performed in the individual patient (e.g., to discriminate between artifacts and real perfusion defects). :
Ernst E. van der Wall
UPCOMING MEETINGS
April 18-20, 1996. The European Society of Cardiology will hold an educational and training program, "Nuclear Cardiology: Evolution from 1976-1996," at The European Heart House in France. For more information, contact: ECOR, ETP Services, The European Heart House, 2035 Route des Colles, Les Templiers-BP 179, 06903 Sophia Antipolis Cedex, France, +33.92,94.76.00 phone, +33.92.94.76.01 fax. May 1-4, 1996. Congress of the Argentine Federation of Cardiology, Cordoba. Dr. Mario Verani is the invited speaker. For more information, contact Dr. Nestor Perez Balino, 54-1-805-1048 fax. May 23-25, 1996. The International Nuclear Cardiology Symposium Will be held in Cesena, Italy. Dr. Pierluigi Pieri has announced that a symposium entitled "Nuclear Cardiology Today: Role in Clinical Decision Making" will be held. The conference will feature stateof-the-art lectures by an international faculty focusing on the impact of nuclear imaging on patient management as
well as proferred papers and poster sessions highlighting new work in the field. The president of the symposium is H. William Strauss, MD, Stanford University, Calif.; copresidents are Pierluigi Pieri, MD, and Pietro Rive, MD, both of the M. Bufalini Hospital, Cesena, Italy (+39-54630-40-10 fax/phone). For more information, contact: Organizing Secretariat, Manuzzi Congress, +39-547-61-1458 phone, +39-547-25522 fax. June 2-6, 1996. The 43rd Annual Meeting of the Society of Nuclear Medicine will take place in Denver, Colorado. For more information, contact: Society of Nuclear Medicine, 1850 Samual Morse Drive, Reston VA 220905316, 703-708-9000 phone, 703-708-9015 fax. June 24-26, 1996. The 1996 International Symposium on Cardiovascular Imaging will be held in Leiden, The Netherlands. Abstracts are due March 1, 1996. For more information, contact: Mrs. B. Smit, Leiden University Hospital, Department of Diagnostic Radiology, RO. Box 9600, 2300 RC Leiden, The Netherlands, +3171-526-3935/2133 phone, +31-71-526-8147/8256 fax, smith @lkeb.medfac.leidenuniv.nl e-mail. June 27-July 3, 1996. The Australian and New Zealand SNM annual meeting will take place in Alice Springs, Australia. For more information, contact Dr. R.G. McLean, Wollongong Nuclear Medicine, RO. Box 5094, Wollongong, NSW, 2500 Australia, [email protected] e-mail September 14-18, 1996. The European Association of Nuclear Medicine Congress will be held in Copenhagen, Denmark. For more information, contact: CONGREX Holland by, Keizersgracht 782, 1017 EC Amsterdam, +3120-626-13-72 phone, +31-20-625-95-74 fax. September 29, 1996. Symposium on Nuclear Cardiology in the Argentine Congress of Cardiology, Buenos Aires. Dr. Abdulmassih S. Iskandrian is the invited speaker. For more information, contact Dr. Nestor Perez Balino, 54-1-805-1048 fax. October 2, 1996. Symposium on Nuclear Cardiology, lbero American Society of Nuclear Cardiology, Pucon, Chile. For more information, contact Dr. Nestor Perez Balino, 54-1-805-1048 fax. November 23-30, 1996. Argentine Association of Nuclear Cardiology Meeting. For more information, contact Dr. Nestor Perez Balino, 54-1-805-1048 fax.
The report of the Institute of Medicine (IOM) Committee for Review and Evaluation of the Medical Use Program of the Nuclear Regulatory Commission was made public in December 1995. The report is 255 pages, and among its 16 faculty members is Barry L. Zaret, MD, Editor-in-Chief of the JOURNAL.The report recommends removing the regulatory authority from the NRC, shifting federal guidance to the DHHS (Department of Health and Human Services), and delegating regulatory responsibility for byproduct materials to the states with the proviso that only licensed users would have access to byproduct materials. ASNC, SNM, and ACNP endorsed the report. The report by the Quality Assurance Committee (Ernest Garcia, PhD, Chairman) on the standardization of imaging protocols will be published in the May/June issue of the JOURNAL. Dr. Garcia's committee is already working on the second part of the report, which will include guidelines on interpretation and reporting. This will be my last message as president; the next message will be written by my longtime friend, Mario S. Verani, MD. I will attempt to summarize the highlights of the accomplishments of ASNC during the past year in my message in the Newsletter. At this time I would like to thank Bill Nelligan, Dawn Edgerton, and Diana Lee, all of whom have done a tremendous job for us during my tenure as the chief officer of ASNC. Similarly I also acknowledge the staff of the JOURNAl, the ASNC Executive Committee, the Board of Directors, the members of the various committees and task forces, and the members at large, both in the United States and abroad. Thank you very much for your advice, suggestions, and efforts on behalf of ASNC. It is this unique blend of selfless sacrifices that has spurred the rapid growth of ASNC over such a short period of time. I am honored to have served as the third president, and I know that I will look back at this year with pride and satisfaction. I wish you all and my successor continued growth and progress. May God bless you all! Ami S. Iskandrian, MD President International N e w s
China. Last year, an IAEA '95 National Training Course for physicians of nuclear medicine was held in Shanghai and another IAEA training course for nuclear medicine technicians was held in Suzhou. Nuclear cardiology was one of the major programs. Xiujie Liu France. We have launched three European nuclear cardiology trials - - E N C D 1, 2, and 3. Numbers 1 and 2 190
address myocardial perfusion imaging with MIBI and GBR respectively. They concern the processing of data (30 patients x 30 centers). Results will be obtained by February 15, 1996, and published as abstracts at the Copenhagen EANM meeting. Number 3, on more than 100 normal myocardial SPECT studies, has also been launched, with a deadline later in the year. Michel H. Bourguignon Germany. A new system has been introduced in Germany; for the first time, stress echocardiography can now be reimbursed. There is an immense interest among cardiologists to use this new technique, and new courses to teach stress echocardiography are being established every day throughout the country. The requirements for certification are quite stringent and include a 20-hour course and performance of 100 stress ECHO studies, which must be presented on CD-ROM to the course director. The course director is then responsible for reviewing the cases and confirming their technical accuracy. The effects of this surge of stress echocardiography on the number of cardiac radionuclide studies in Germany are not yet known. Udo Sechtem QUESTION Is gated technetium perfusion imaging to evaluate regional flow and wall motion a popular option in your geographic area? Does it have the potential to adequately address issues of wall motion/perfusion and viability in a single study as well as provide an important adjunct to routine imagining? If not, then when should this type of study be performed? ANSWERS Argentina. Gated technetium perfusion imaging to evaluate regional flow and wall motion is not a popular optign in Argentina. This is because we lack the equipment with the necessary software developed to do it. However, it is occasionally used to evaluate myocardial viability. Overall, it has the potential to adequately address issues of wall motion/perfusion and viability in a single study and provide an important adjunct to routine imaging. Nestor Perez Balino and Nester A. Vita Australia. Gated technetium perfusion imaging is not used very commonly in Australia. It certainly has the potential to address issues of wall motion and perfusion and viability in a single study, although I believe that, for viability questions, technetium is inferior to thallium. Ben Freedman JOURNAL OF NUCLEARCARDIOLOGY
March/April 1996
Joue.NAt~OF NUCI,EAR CARDIOLO(W Volume3, Number2; 190-192 China. There have been more than 100 gamma camera systems and 180 sets of SPECT that have been used for nuclear cardiology studies in China, particularly in Beijing (35 SPECTs), Shanghai, and Guangzhou. At present, 99mTc-MIBIand 2°iT1myocardial imaging (including planar and SPECT) have been widely used in routine clinical use. In a few hospitals, gated 99*~Tc-MIBImyocardial tomography has been used to evaluate myocardial perfusion and function; however, this study has not been done in routine clinical application. The quality of images of these studies is not satisfactory. Because imaging quality in nuclear medicine is limited by statistics, the imaging time is extremely important and is most often dictated by the tolerance of the patient to the procedure. Radionuclide ventriculography in China, however, is still widely used in assessment of left and right ventricular function. Echocardiography has given a challenge. Last year 42% of papers published in the Chinese Journal of Nuclear Medicine were related to its cardiovascular disease applications. Among them, most work was focused on the assessment of myocardial viability using the 2°*T1reinjection method and 99mTc-MIBIin combination with nitrates, with very few 18F-FDG PET studies. Xiujie Liu France. Gated SPECT is not yet a popular technique in France, although there is a growing interest. The main reason is that it is routinely applicable with modern dualhead systems and painful with single-head cameras. The rate of renewal of equipment is still slow in France in comparison with the United States. It is our belief that the potential is great for both routine application and for addressing the issue of wall motion/perfusion and viability in a single study, provided that you have the proper equipment. This includes the software that is used to display the data. If an effort must be made, I guess the software to manipulate the data easily and adequately is the issue. Michel H. Bourguignon Germany. Gated technetium perfusion imaging to evaluate regional flow and wall motion is not a popular option in Germany. One reason is that there is no special reimbursement for performing gated studies. The technique is not trivial to master, and a large number of data must be crunched without easily available software that would greatly ease this processing-intense technique. Although this type of study may have a role in patients with questionable perfusion defects, there are other possibilities to solve this dilemma--putting the patient in a prone position, repositioning soft tissue (i.e., breast), or simply pet'forming a PET study. Udo Sechtem India. Gated technetium perfusion imaging to evaluate regional flow and wall motion is gaining popularity because of its potential to adequately address issues of wall motion, perfusion and viability, and rest-left ventricular (LV) ejection fraction (by the image inversion protocol, when it becomes available). The existing gamma camera computers are not optimally suited for acquiring first pass; hence the information about exercise LV ejection fraction
News update 191 (during stress injection) cannot be obtained with technetium perfusion agents. Thus first-pass acquisition is not popular. Currently, 201T1 is preferred for viability studies reinjection, but because it must be imported, the shot is relatively expensive. If the use of technetium perfusion agents for viability could be validated, then it would be a major gain. With the availability of agents that permit a same-day 2-hour rest/stress SPECT study, this will become the modality of choice. R.D. Lele Israel. In Israel, this technique is still not very popular. The first reason is that sestamibi and tetrofosmin are relatively new. Sestamibi has been approved for clinical use only last year, and tetrofosmin is still under clinical investigation (and should be approved next month). The second reason is that, because this technique necessitates "strong (expensive) computers" and its processing is timeconsuming, private laboratories (where most of the studies are performed and that cannot be charged more for a gated-perfusion study) are not interested in using gated technetium perfusion as a routine technique. I strongly believe that this technique has, in many circumstances, advantages over 2°1T1imaging and that it is only a matter of time until we see gated technetium perfusion as a routine technique in our country. Pierre Chouraqui Italy. Gated perfusion imaging with sestamibi is possible but not popular in my area; very few centers do it and not routinely. I personally think it has a least some potential to adequately address issues of wall motion and perfusion and provide important additional information. Gianfranco Mazzotta Thailand. The popularity of gated myocardial perfusion cannot be accurately judged in Thailand. This is because only two or three institutes are capable of doing gated SPECT, and only one is doing a gated planar myocardial perfusion study. However, in my experience, I think that it is advantageous to gain additional information on wall motion. This is true because it does help in excluding the presence of significant defects when normal wall contraction is evident in the myocardial segments that are suspected to be slightly abnormal. The issue of viability is also a difficult subject because relatively few patients undergo CABG or PTCA. Most of those who go for revascularization have conventional SPECT myocardial perfusion study rather than gated SPECT or gated planar myocardial perfusion studies. In response to the routine use of gated SPECT, I really agree with this new method as a standard addition to testing since there is only additional time and effort required to obtain more information. Moreover, gated SPECT can be useful when intact wall motion is demonstrated in regions having suspicious defects. However, as mentioned above, because only two or three institutes can perform this new methodology, it practically means that routine gated SPECT cannot be generally recommended here. Piyamitr Sritara
192 News update
JOURNALOFNUCLEARCARDIOLOGY March/April 1996
The Netherlands. Regarding gated perfusion imaging, I need to mention that the combination of flow and wall motion is, at the moment, not a very popular option in The Netherlands. Of course, we are aware of its great potential in some patients, but the major limitations for routine use are of a technical and logistic nature. For instance, you must have a second ECG apparatus, it requires some changes in time scheduling, and most important, adequate computer programs for both acquisition and analysis must stillbe installed in most centers. Other drawbacks that must be resolved are the added time for processing and interpretation and the added data storage required. It will also be important how to implement stress in the gated SPECT procedure because all patients must be injected twice. When all those practical and technical questions have more or less been solved, then we believe that every patient should undergo gated SPECT in a standard fashion. One may then later decide whether additional analysis should be performed in the individual patient (e.g., to discriminate between artifacts and real perfusion defects). :
Ernst E. van der Wall
UPCOMING MEETINGS
April 18-20, 1996. The European Society of Cardiology will hold an educational and training program, "Nuclear Cardiology: Evolution from 1976-1996," at The European Heart House in France. For more information, contact: ECOR, ETP Services, The European Heart House, 2035 Route des Colles, Les Templiers-BP 179, 06903 Sophia Antipolis Cedex, France, +33.92,94.76.00 phone, +33.92.94.76.01 fax. May 1-4, 1996. Congress of the Argentine Federation of Cardiology, Cordoba. Dr. Mario Verani is the invited speaker. For more information, contact Dr. Nestor Perez Balino, 54-1-805-1048 fax. May 23-25, 1996. The International Nuclear Cardiology Symposium Will be held in Cesena, Italy. Dr. Pierluigi Pieri has announced that a symposium entitled "Nuclear Cardiology Today: Role in Clinical Decision Making" will be held. The conference will feature stateof-the-art lectures by an international faculty focusing on the impact of nuclear imaging on patient management as
well as proferred papers and poster sessions highlighting new work in the field. The president of the symposium is H. William Strauss, MD, Stanford University, Calif.; copresidents are Pierluigi Pieri, MD, and Pietro Rive, MD, both of the M. Bufalini Hospital, Cesena, Italy (+39-54630-40-10 fax/phone). For more information, contact: Organizing Secretariat, Manuzzi Congress, +39-547-61-1458 phone, +39-547-25522 fax. June 2-6, 1996. The 43rd Annual Meeting of the Society of Nuclear Medicine will take place in Denver, Colorado. For more information, contact: Society of Nuclear Medicine, 1850 Samual Morse Drive, Reston VA 220905316, 703-708-9000 phone, 703-708-9015 fax. June 24-26, 1996. The 1996 International Symposium on Cardiovascular Imaging will be held in Leiden, The Netherlands. Abstracts are due March 1, 1996. For more information, contact: Mrs. B. Smit, Leiden University Hospital, Department of Diagnostic Radiology, RO. Box 9600, 2300 RC Leiden, The Netherlands, +3171-526-3935/2133 phone, +31-71-526-8147/8256 fax, smith @lkeb.medfac.leidenuniv.nl e-mail. June 27-July 3, 1996. The Australian and New Zealand SNM annual meeting will take place in Alice Springs, Australia. For more information, contact Dr. R.G. McLean, Wollongong Nuclear Medicine, RO. Box 5094, Wollongong, NSW, 2500 Australia, [email protected] e-mail September 14-18, 1996. The European Association of Nuclear Medicine Congress will be held in Copenhagen, Denmark. For more information, contact: CONGREX Holland by, Keizersgracht 782, 1017 EC Amsterdam, +3120-626-13-72 phone, +31-20-625-95-74 fax. September 29, 1996. Symposium on Nuclear Cardiology in the Argentine Congress of Cardiology, Buenos Aires. Dr. Abdulmassih S. Iskandrian is the invited speaker. For more information, contact Dr. Nestor Perez Balino, 54-1-805-1048 fax. October 2, 1996. Symposium on Nuclear Cardiology, lbero American Society of Nuclear Cardiology, Pucon, Chile. For more information, contact Dr. Nestor Perez Balino, 54-1-805-1048 fax. November 23-30, 1996. Argentine Association of Nuclear Cardiology Meeting. For more information, contact Dr. Nestor Perez Balino, 54-1-805-1048 fax.