Nuclear cardiology is one of the most widely used non-invasive techniques for the assessment of coronary artery disease and other cardiovascular conditions. It has proved to be a cost effective tool for the evaluation and management of cardiac patients and usually has a decisive role for diagnosis, prognosis and risk stratification. In particular, radionuclide myocardial perfusion imaging (MPI) is used extensively worldwide for the evaluation of known or suspected coronary artery disease, with an estimated 15–20 million procedures performed annually. This publication provides a detailed analysis of all the steps involved in the delivery of nuclear cardiology services, from referrals to reporting, and is intended to serve as guidance for the implementation, homogenization and enhancement of MPI practice in those Member States where the technique is under development.