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Stress Thallium-201/Rest Technetium-99m Sequential Dual Isotope High-Speed Myocardial Perfusion Imaging Daniel S. Berman, Xingping Kang, Balaji Tamarappoo, Arik Wolak, Sean W. Hayes, Ryo Nakazato, Louise E. J. Thomson, Faith Kite, Ishac Cohen, Piotr J. Slomka, Andrew J. Einstein, John D. Friedman A novel, reverse dual isotope stress thallium-201 (Tl-201) and rest technetium-99m (Tc-99m) myocardial perfusion protocol was performed in a large number of consecutive patients using a high-speed gamma camera. The study protocol was accomplished within <20 min without sacrificing image quality or confidence in interpretation. When compared with another group of patients undergoing a standard rest and stress Tc-99m agent studies, the extracardiac activity was less on stress Tl-201 and rest Tc-99m studies while the normalcy rate and radiation burden were comparable. Stress Tl-201 and rest Tc-99m protocol offers promise as an efficient, relatively low radiation dose method, in which the superior qualities of Tl-201 for stress imaging and of the Tc-99m agents for rest imaging can be preserved.