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The authors reflect on the appropriateness of referrals for single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in Iran, which is one of the most widely used procedures of nuclear medicine to detect perfusion abnormalities. The authors say that they conducted a study to describe the ordering practices of physicians in Iran. They add that there was no vital difference between governmental and private medicine centers in regard to the level of appropriateness.