A study that looked at myocardial perfusion imaging orders in a setting where physicians had no motive tied to profit and little fear of litigation found levels of inappropriate testing mirrored those of other clinical settings. After ASNC collaborated on new guidelines for the tests in 2009, inappropriate utilization remained at 10% to 15% two years later. The new research explored the factors driving inappropriate utilization, finding "a lesser role of defensive medicine and self-referral in the inappropriate use of MPI." The researchers suggest medical training and misunderstanding about the benefits of MPI in low-risk cases may be the true culprits.

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