Medical Isotopes and Imaging Modalities Advisory Committee
The Medical Isotopes and Imaging Modalities Advisory Committee (MIIMAC) consists of representatives from health professions, institutions, regions, ministries of health, the public, and experts in scientific research and methodology. This committee has been convened specifically to provide advice to CADTH on a project that will lead to a guidance document on optimizing the health system use of medical isotopes and other imaging modalities. MIIMAC provides guidance that considers the outputs and impact of CADTH work in meeting the needs of the Canadian health care system.
MIIMAC is an advisory committee of CADTH that reports to the CADTH President and CEO through MIIMAC’s Co-Chairs. Committee members must abide by the Conflict of Interest Guidelines for Committee and Panel members and the CADTH Code of Conduct. An honorarium is paid to MIIMAC members for their preparation and meeting time.
- Patrick Au
- Dr. Robert Beanlands
- Dr. Charles Butts
- Gazira Chan
- Susan Delaney
- Dr. Sandor Demeter
- Dr. Terry Ell
- Dr. Dean A. Fergusson
- Heather Gibson
- Dawn-Marie King
- Dr. Norman Laurin
- Dr. Ted Lyons
- Dr. Gilbert Matte
- Dr. Craig Mitton
- Christine Preece
- Jean Pruneau
- Dr. Terrence D. Ruddy
- Rick Scanlan
- Dr. Lisa Schwartz
- Dr. Éric Turcotte
- Dr. George Wells
Dr. McEwan is currently Chair of the Department of Oncology and the Lead for the School of Cancer, Engineering and Imaging Services within the Faculty of Medicine and Dentistry at the University of Alberta. He is also Medical Director of the Cross Cancer Institute in Edmonton.
Dr. McEwan has been a member of the faculty at the University of Alberta 1986. He has been instrumental in the development of the Positron Emission Tomography (PET) Programme at the Cross Cancer Institute and has a clinical interest in the role of the image as a biomarker in the management of patients with cancer. Dr. McEwan’s major clinical interest is in the field of endocrine tumours and he has developed the largest radioisotope therapy programme in Canada.
He has been special advisor on Medical Isotopes for the Federal Minister of Health. Dr. McEwan is a member of the Canadian Association of Radiopharmaceutical Scientists, the Society of Nuclear Medicine, the European Association of Nuclear Medicine, and the World Radiopharmaceutical Therapy Council. He is also the past president of the Society of Nuclear Medicine.
Conflict of Interest Disclosure: Dr. McEwan has acted as a consultant on Thyrogen for Genzyme Canada. Genzyme also gave funding for travel and speaking engagements. In addition, Dr. McEwan received a research grant from the Western Economic Diversification for Cyclotron. Dr. McEwan has also committed to negotiate a research master agreement with Siemens.
Dr. Martin Reed is the Head of the Department of Radiology at the Children’s Hospital in Winnipeg. Dr. Reed is also a Professor of Radiology and Professor of Pediatrics and Child Health at the University of Manitoba. His main research interest is health services. In particular, he focuses on utilization, guidelines,and Housing and quality improvement. Dr. Reed is the Chair of the Guidelines Working Group of the Canadian Association of Radiologists and Co-convenor of the Guidelines Working Group for the International Radiology Quality Network. He is a member of the Appropriateness Criteria Committee of the American College of Radiology and a member of the Editorial Panel of Diagnostic Imaging Pathways.
Conflict of Interest Disclosure: Dr. Reed has received payment and funding from the Canadian Association of Radiologists for travel, speaking engagements, organizing conferences, and writing articles and editorials as Chair of the Guidelines Working Group. He has also acted as a Consultant on guideline implementation with Medicalis, along with receiving an HHR grant for further research on guideline implementation. Dr. Reed is a Pediatric Radiologist with the Winnipeg Regional Health Authority.
Patrick Au serves as a Project Manager with the Acute and Emergency Services Branch in Saskatchewan’s Ministry of Health. His primary responsibilities cover the medical imaging, service delivery program in the province. Some current and recent projects he has been involved with include: the provincial radiologist information system, picture archival communication system, medical imaging pathway development project, pilot project on medical imaging decision support tool, long-term capital medical imaging equipment replacement strategies, development of urgency classifications for various medical imaging modalities with wait-time targets, demand forecasting, and wait-list / wait-time management. Before joining the Saskatchewan Ministry of Health, Mr. Au worked in the risk management field in the financial industry. He is a graduate of the University of Ottawa and a certified Project Management Professional.
Conflict of Interest Disclosure: Jurisdictional members adhere to their organization’s existing Conflict of Interest policy.
Dr. Rob Beanlands is a Career Investigator (HSFO) and international leader in cardiovascular nuclear imaging, contributing expertise to the application of positron emission tomography (PET) to evaluate metabolic and cellular function in cardiovascular disease and responses to therapy. He is Goldfarb Research Chair and Chief of Cardiac Imaging and founding Director of the National Cardiac PET Centre. He is extensively published and is the PI for the Canadian Institutes of Health Research Team Project, IMAGE-HF. Dr. Beanlands is also Director of the Molecular Function and Imaging training program and he has served on several committees/advisory boards for government, industry and professional organizations, having an impact on health care policies and practice guidelines. He is past-president of the Canadian Nuclear Cardiology Society, co-author of the ASNC Practice Guidelines for PET, and Chair of the Scientific Program Committee for the Canadian Cardiovascular Society.
Conflict of Interest Disclosure: Dr. Beanlands has acted as a consultant on radiotracer work and received funding from Lantheus Medical Imaging and DraxImage. He received in-kind funding from General Electric related to camera manufacturing and from MDS Nordion related to radiotracer distributer work, both toward a matching industry/government research infrastructure grant. Dr. Beanlands received professional revenue from the University of Ottawa Heart Institute, Associates in Cardiology for his work related to the practice of Nuclear Cardiology.
Charles A. Butts is a Medical Oncologist at the Cross Cancer Institute and an Associate Professor at the University of Alberta, Edmonton and the Medical Director for Associate Cancer Centers and Community Oncology for the Alberta Health Services — Cancer Care His main clinical and clinical research interests are in the area thoracic oncology. He graduated from medical school at Dalhousie University and subsequently completed training in Internal Medicine and Medical Oncology at the University of Ottawa in the Ottawa Regional Cancer Centre. He served as the Residency Program Director in Medical Oncology at the Cross Cancer Institute and at the University of Alberta from 2000 to 2006. Dr. Butts is Past President of the Canadian Association of Medical Oncologists.
Conflict of Interest Disclosure: Dr. Charles Butts reports no conflict of interest in accordance with the Conflict of Interest Guidelines.
Gazira Chan is a Municipal Finance and Accountability Specialist with the Ministry of Municipal Affairs and Housing. She has obtained a Bachelor of Accounting Science, and is currently working towards acquiring a Bachelor of Law degree. She has experience working in management roles with various federal, provincial, territorial, and First Nations levels of government. Ms. Chan is currently serving on the Health Care Practitioners’ Special Committee for Audit, the Property Assessment Review Panel, and the Social Assistance Appeal Board. She has previously served as a panel member for the National Cancer Institute of Canada Review Panel and as a member of the Board of Directors for the Canadian Cancer Society in P.E.I.
Conflict of Interest Disclosure: Ms. Chan reports no conflict of interest in accordance with the Conflict of Interest Guidelines.
Susan Delaney is the Director of Diagnostic Imaging at Capital Health in Nova Scotia. She works in partnership with the District Chief of Diagnostic Imaging to ensure the delivery of high quality, patient-centric imaging services. She is a member of the Provincial Advisory Committee to Improve Access to Diagnostic Imaging and the Provincial Breast Imaging Advisory Committee; Co-chair of Capital Health Diagnostic Imaging Executive Committee; member of the Diagnostic Imaging Advisory Working Group; and member of the Canadian Association of Medical Radiation Technologists Rebranding Steering Committee and Continuum of Practice Steering Committee. Ms. Delaney was a member of the MRI Access Committee mandated to develop access guidelines for the use of MRI in Nova Scotia, and she co-chaired a process improvement team to reduce wait times for patients of the QEII Health Sciences Centre Diagnostic Imaging Department. She is a certified member of the Canadian College of Health Service Executives and has a Masters of Health Services Administration.
Conflict of Interest Disclosure: Ms. Delaney reports no conflict of interest in accordance with the Conflict of Interest Guidelines.
Dr. Demeter is Head of Nuclear Medicine at the Winnipeg Health Sciences Centre as well as the Co-Director of the Winnipeg PET/CT program and Clinical Director of the Diagnostic Imaging Program at the Winnipeg Regional Health Authority. He is the Chair of Radiology at the University of Manitoba, where he is also an Associate Professor with the Faculty of Medicine with joint appointments in Radiology and Community Health Sciences. His main areas of research are health technology assessment, health economics, and health policy, with an emphasis on diagnostic imaging.
Conflict of Interest Disclosure: While working for the Winnipeg Regional Health Authority (WRHA), Dr. Demeter is one of the named collaborators, representing WRHA, relative to a current grant proposal (Natural Resources Canada is the funding source) for alternative ways to produce medical isotopes. The other partners are the University of Winnipeg, and Acsion Industry (private company). Dr. Demeter received payment from General Electric to cover expenses related to his participation and instruction in a general nuclear medicine users group meeting.
Dr. Terry Ell is the Clinical Coordinator of the Nuclear Medicine Program at Foothills Hospital and is a nuclear medicine instructor at the Southern Alberta Institute of Technology. Dr. Ell serves on the Fellow and Fellowship Committee of Canadian Association of Medical Radiation Technologists and is also their representative on the Board of the Canadian Society of Nuclear Medicine. Dr. Ell also recently completed his third term as Councillor for the Alberta College of Medical Diagnostic and Therapeutic Technologists.
Conflict of Interest Disclosure: Dr. Ell reports no conflict of interest in accordance with the Conflict of Interest Guidelines.
Dr. Dean A. Fergusson is the Director and Senior Scientist and Deputy Director of the Clinical Epidemiology Program at the Ottawa Hospital Research Institute. He is also the Director for the University of Ottawa Centre for Transfusion Research, and Associate Professor in the University of Ottawa’s Departments of Medicine, Surgery, and Epidemiology and Community Medicine. Dr. Fergusson is the recipient of several awards, including the New Investigator Award from the Canadian Institutes of Health Research, the Dr. Michael Chrétien Researcher of the Year Award (Ottawa Health Research Institute), and the Michael Smith Promising Scientist Award (OCRI Life Sciences Achievement Awards). Dr. Fergusson’s clinical research interests are mainly in the field of transfusion medicine, focusing on transfusion alternatives and the effectiveness of blood products. His research also extends to the methodology and ethics of clinical trials and systematic reviews, and includes the fields of respirology and nephrology. Dr. Fergusson has been a principal investigator on a number of large, peer-reviewed clinical trials in transfusion medicine.
Conflict of Interest Disclosure: Dr. Fergusson reports no conflict of interest in accordance with the Conflict of Interest Guidelines.
Heather Gibson is the Director of Medical Imaging at Vancouver Island Health Authority (VIHA), where she provides leadership to the Medical Imaging departments on Vancouver Island including 19 sites — eight with radiologist staffing. She is the Project Sponsor for the installation and integration of the Cerner Health Information RadNet System and InteleRad Picture Archiving and Communications Systems (PACS) for all of those sites. Ms. Gibson is also the Chair of the Quality Assurance committee for Medical Imaging. She is co-ordinating the capital equipment prioritization process to achieve a single, agreed upon, capital equipment priority list for the next five years; this involves standardizing capital equipment procurement so that all sites have comparable equipment. Ms. Gibson co-chaired the Isotope Shortage Contingency Planning Committee for British Columbia with the Ministry of Health, she was a participant in the Canadian Institute for Health Information Expert Panel on Isotope Shortages, she was an advisor to the Privacy and Security Subcommittee for e-Health, and she was an advisor to the General Electric Healthcare Ultrasound division.
Conflict of Interest Disclosure: Ms. Gibson reports no conflict of interest in accordance with the Conflict of Interest Guidelines.
Dawn-Marie King is the Director of Medical Imaging at St. Michael’s Hospital. Before joining St. Michael’s, while working with the University Health Network, she contributed significantly by leading several projects for major equipment purchases and installations, and improved work flow efficiency by using LEAN methodology. Ms. King has performed operational reviews for medical imaging departments at institutions across Ontario and has been the lead for cost utilization projects. In addition, she is an Academic Coordinator for the University of Toronto Radiation Sciences Program. Ms. King is the nuclear medicine representative on the College of Medical Radiation Technologist of Ontario’s (CMRTO) Quality Assurance Committee and a member of the Ontario Association of Radiology Managers. She also acts as a coach for the provincial MRI Process Improvement Initiative. Previously, Ms. King spent 11 years on the Canadian Association of Medical Radiation Technologists’ Nuclear Medicine Committee on Education, both as a member and as chair. Ms. King has a Nuclear Medicine Technology Diploma from the Michener Institute.
Conflict of Interest Disclosure: Ms. King reports no conflict of interest in accordance with the Conflict of Interest Guidelines.
Dr. Norman Laurin is Chief of the Nuclear Medicine Department at Centre de Santé et de Services Sociaux de l’Énergie. He is also a member of staff in the Nuclear Medicine Department at the Centre Hospitalier Régional de Trois-Rivières. Dr. Laurin is President-Elect (Vice-President) of the Canadian Association of Nuclear Medicine and he is on the Executive Committee of the Association des Médecins Spécialistes en Médecine Nucléaire du Québec. He is also a Professeur Adjoint d’enseignement clinique at Montreal University and Sherbrooke University.
Conflict of Interest Disclosure: In his roles as Vice-President of the Canadian Association of Nuclear Medicine and as a Board Member (Director) of the Association des Médecins Spécialistes en Médecine Nucléaire au Québec, Dr. Laurin has received grants from industry in support of the two organizations’ annual conferences and educational activities.
Dr. Ted Lyons is a Professor of Radiology, Obstetrics and Gynecology, and Anatomy at the University of Manitoba. He completed his medical education in 1973 at the University of Manitoba and graduated with Canadian and American fellowships in Diagnostic Radiology. Dr. Lyons is a fellow of the American College of Radiology, the American Institute of Ultrasound in Medicine (AIUM), the Royal College of Physicians and Surgeons of Canada, and was awarded the honour of the Joseph Holmes Clinical Pioneer Award of the AIUM in 2003.
Dr. Lyons was Professor and Chairman of the Department of Radiology at the University of Manitoba from 1990 to 1996. He is currently a practising radiologist at the Health Sciences Centre in Winnipeg. He is also the Past President of the Manitoba Association of Radiologists and the Jewish Federation of Winnipeg. In July 2007, he was appointed as an Officer of the Order of Canada. Dr. Lyons is author and coâ€author of 45 articles, 34 chapters, five books, and has presented numerous lectures around the world. In April 2009, Dr. Lyons was elected President of the Canadian Association of Radiologists at the group’s Annual General Meeting in Montréal, Québec.
Conflict of Interest Disclosure: Dr. Lyons reports no conflict of interest in accordance with the Conflict of Interest Guidelines.
Dr. Gilbert Matte is a Pharmacist at the Montreal General Hospital (McGill University Health Centre), and is also involved as a Radiopharmacist at the Capital District Health Authority in Halifax.
Dr. Matte was trained as a Pharmacist at the University of Montreal and continued on to the University of Alberta to obtain a Master of Science (Radiopharmacy). While completing his PhD in Biological Psychiatry from the University of Saskatchewan, he worked as a Radiopharmacist at the Royal University Hospital in Saskatoon. In 1999, he became the Radiopharmacist at the QEII Health Sciences Centre in Halifax. Dr. Matte’s interests are both academic and clinical. He has been involved in many Nuclear Medicine/Radiopharmacy and Pharmacist Associations, including the Canadian College of Radiopharmaceutical Scientists, the Nuclear Medicine Alliance, CNSM, the Canadian Association of Radiopharmaceutical Scientists, and the Canadian Society of Hospital Pharmacists.
Conflict of Interest Disclosure: Dr. Matte received funds from Lantheus Medical Imaging to provide Radiopharmacy instruction to Quebec Nuclear Medicine residents. Lantheus sponsored the teaching in 2008 and it will again sponsor it in January 2011. Dr. Matte also received payment as a Consultant for Bristol-Myers Squibb Medical Imaging/Lantheus Medical Imaging from 2004 to June 2008. He also received payment from Berlex Inc. between 2004 and 2005, acting as a Consultant.
Dr. Craig Mitton is a Health Economist with the Coastal Health Research Institute in Vancouver. He is also a Senior Scientist at C2E2, and an Associate Professor in the School of Population and Public Health in the Faculty of Medicine at the University of British Columbia (UBC). From 2005 to 2009, Dr. Mitton was at UBC Okanagan, where he held a Canada Research Chair in Health Care Priority Setting. He is on the executive committee of the Michael Smith Foundation for Health Research, Child and Youth Health Research Network. Dr. Mitton focuses his research in the application of health economics to impact decision-making in organizations, and regularly consults with governments and health care organizations worldwide. Dr. Mitton is a member of the International Society on Priorities in Health Care and an Associate Editor of the journal BMC Health Services Research.
Conflict of Interest Disclosure: Dr. Mitton received funding from Pfizer Canada Inc. to provide educational lectures on health care priority setting. Pfizer further provided Dr. Mitton with research funding, also for the topic of health care priority setting.
Christine Preece is the Manager of the Young Adult Team for the Middlesex-London Health Unit. She facilitates a team of nurses and dieticians who work with adolescents and young adults in schools and community settings. Ms. Preece worked as a physical education instructor and coach at Lambton College in Sarnia, Ontario. She has also worked as a Recreation Director and Health Promotion Officer before her current position. Ms. Preece has been an active member of various committees at local, provincial, and national levels. Her work focuses on improving the social determinants of health through the development of environmental supports, community mobilization, and health policy development. She believes in taking a proactive approach to improving health care for Canadians.
Conflict of Interest Disclosure: Ms. Preece is aware of acquaintances with extended family members who work at the Chalk River Laboratories, though she has no personal relationship with them.
Jean Pruneau has been employed with Health Canada since 1992. Mr. Pruneau is a policy generalist who contributed to various policy issues (IM/IT planning, tobacco regulations, drinking water safety, privacy, electronic health records, rural health, mental health, family violence, etc.) in various policy capacities (analyst, advisor, and manager), including working as a Senior Advisor to deputy ministers. He is currently the Acting Executive Director for the Office of Pharmaceuticals Management Strategies, Strategic Policy Branch at Health Canada. Mr. Pruneau holds a B.Sc. in Computer Science Systems (Artificial Intelligence) and an MBA from Queen's University.
Conflict of Interest Disclosure: Jurisdictional members adhere to their organization’s existing Conflict of Interest policy.
Dr. Terrence D. Ruddy is a Nuclear Cardiologist and Clinician Scientist. He holds the Vered Chair in Cardiology and is Head of the Division of Cardiology at the University of Ottawa Heart Institute and the Ottawa Hospital. Dr. Ruddy is also the Director of Nuclear Cardiology at the University of Ottawa Heart Institute, the University Chair of the Departments of Cardiology and Nuclear Medicine, and the Head of Nuclear Medicine at the Ottawa Hospital. In addition, Dr. Ruddy is Professor of Medicine and Radiology at the University of Ottawa. Along with being a member of the Cardiology Council of the Society of Nuclear Medicine, he is past President of both Blood Pressure Canada and the Canadian Society of Nuclear Cardiology. Dr. Ruddy has received specialist certifications in Internal Medicine and Cardiology from the Royal College of Physicians of Canada (FRCPC) and American Board Certification in Internal Medicine, Cardiovascular Disease, Nuclear Cardiology and Clinical Hypertension. He has received peer-reviewed funding from numerous foundations and institutions, including the Heart and Stroke Foundation of Canada, the National Cancer Institute of Canada, and the Ontario Research Fund.
Conflict of Interest Disclosure: Dr. Ruddy has received an Ontario Research Fund from MDS Nordion for stem cell imaging (period from 2008 to 2013). He has also received an Ontario Research Fund from GE Healthcare for imaging on vulnerable plaque (period from 2008 to 2013).
Rick Scanlan is the Regional Manager and Corporate Radiation Safety Officer at Eastern Health, based in St. John’s. He is responsible for the management of the Nuclear Medicine Program and Radiation Safety for the region. Born and raised in Nova Scotia, he worked as a Nuclear Medicine Technologist at the then Victoria General Hospital before moving to St. John’s in 1982, where he has worked as Chief Technologist; supervisor; and later as divisional/regional manager in all city hospitals, with a variety of portfolios in diagnostic imaging. He has taken a leadership role and has been an advocate for Nuclear Medicine, Occupational Health and Safety, and Radiation Safety from early on in his career and sits on regional, provincial, and national committees that address issues in these areas. He was a media spokesperson for Eastern Health during much of the isotope shortage and helped coordinate responses provincially. Mr. Scanlan is the Newfoundland and Labrador member of the federal/provincial/territorial group struck by Health Canada during the isotope shortage and works with the Newfoundland and Labrador Department of Health and Community Services to ensure that timely and accurate information is available. He is also involved with the provincial PET/Cyclotron program being developed at Eastern Health.
Conflict of Interest Disclosure: Mr. Scanlan reports no conflict of interest in accordance with the Conflict of Interest Guidelines.
Dr. Lisa Schwartz is the Arnold L. Johnson Chair in Health Care Ethics at McMaster University, Faculty of Health Sciences. She is an associate professor in the Department of Clinical Epidemiology and Biostatistics, a member of the Centre for Health Economics and Policy Analysis (CHEPA), and an associate member in the Department of Philosophy. She is a founding member of the Ontario Cancer Research Ethics Board, is on the ethics advisory board of the Ontario Health Study, and served as a consultant to Cancer Care Ontario from 2001 to 2005. While she was a Senior Lecturer in the Philosophy of Medicine department for the School of Medicine at the University of Glasgow, Dr. Schwartz created the school's medical ethics teaching theme. Currently, Dr. Schwartz is responsible for the development of an ethics and moral reasoning stream for the medical school at McMaster University. She is a standing member of the Clinical Ethics Committee for Hamilton Health Sciences and a member of the McMaster Research Ethics Board Appeals Committee. She has several research interests in health care ethics and ethics in health care education; research ethics; privacy and access to biosamples; patient advocacy; and global health ethics, especially related to humanitarian health care practices. Dr. Schwartz is a member of the Standing Committee on Ethics for the Canadian Institutes of Health Research.
Conflict of Interest Disclosure: Dr. Schwartz reports no conflict of interest in accordance with the Conflict of Interest Guidelines.
Dr. Éric E. Turcotte, clinician-researcher at the University of Sherbrooke, member of the Expert Panel on medical isotopes that advised the Government on the most viable options for securing a predictable and reliable supply of technetium-99m. Dr. Turcotte is the clinical Head of Sherbrooke Molecular Imaging Centre (CIMS), one of the most recognized positron emission tomography (PET) research centres in Canada. He holds an establishment license from Health Canada to operate one of the most advanced PET radiotracer synthesis facilities in Canada. He is also the leader of eight clinical trial applications with Health Canada to test the diagnostic efficiency of newly developed PET tracers. Their expertise is to translate new tracers from pre-clinical studies to human diagnostic studies. Dr. Turcotte is an Associate Professor at the University of Sherbrooke, where he teaches nuclear medicine and PET imaging to students from Canada and around the world, as well as to many Canadian nuclear medicine specialists seeking special training in PET.
Conflict of Interest Disclosure: Dr. Turcotte reports no conflict of interest in accordance with the Conflict of Interest Guidelines.
Dr. George Wells, MSc, PhD
Professor, Department of Epidemiology and Community Medicine, University of Ottawa
Professor, Department of Medicine, University of Ottawa
Director, Cardiovascular Research Methods Centre, University of Ottawa Heart Institute
Senior Scientist, Ottawa Hospital Research Institute
Dr. George Wells is a Professor in the Department of Epidemiology and Community Medicine at the University of Ottawa and Director of the Cardiovascular Research Methods Centre at the University of Ottawa Heart Institute. He is also a Professor in the Department of Medicine, Senior Investigator at the Ottawa Hospital Research Institute, and Principal Scientist at the Institute of Population Health at the University of Ottawa. Dr. Wells’ research focuses on such topics as the design and analysis of clinical trials, statistical methodology related to disease processes and health care delivery, and the development and assessment of decision support technologies for patients and practitioners. He has worked closely with many national and international research organizations, along with the pharmaceutical and biotechnology industries. Dr. Wells has also been on the executive and steering committees of many national and international research programs, grant review committees, and scientific advisory committees. He is an Associate Editor of the Journal of Clinical Epidemiology and part of the Editorial Committee of the Canadian Medical Association Journal.
Conflict of Interest Guidelines: Dr. Wells received peer-reviewed research funding from the Canadian Institutes of Health Research for Rubidium-82 Radiopharmaceutical for Myocardial Imaging.