Nuclear Cardiology is widely available and a widely accepted tool for diagnosis and management of coronary artery disease both in the US and in Europe. Although the most common indications for nuclear studies are similar in the US and Europe, different social and economical environments may affect the practice of Nuclear Cardiology. The aim of this paper is to identify key issues and to provide some information on the similarities and differences which characterize the practice of Nuclear Cardiology in the US and Europe. This paper takes into account the training requirements, the relationships between different professional societies, the accessibility, the choice of imaging protocols, tracers and stressors, the impact of managed care and the role of cardiologists, nuclear physicians and technologists in nuclear labs. The economical differences which may affect the field of high technology, imply a wide range of variability concerning the availability of nuclear cardiology studies in different countries (1:1/10). Moreover the legislation which regulates the practice of nuclear medicine may differ from country to country. Thus in our opinion there are several important factors both in the US and Europe limiting the development of nuclear cardiology independently of its intrinsic clinical value.