The goal of this clinical trial is to evaluate an investigational ultralow dose positron emission tomography (PET) imaging technique for known or suspected coronary artery disease (for detecting myocardial ischemia or infarction) detection and monitoring. The main question it aims to answer is:

Can the investigators optimize the timing, scan duration, and image reconstruction to reduce the radiation dose 10-100 fold of the current clinical standard? Participants will be injected with a radioactive tracer called Fluorine-18 (18F)-flurpiridaz and be imaged on a new type of high sensitivity PET scanner for up to 3 hours

This research study aims to evaluate an investigational ultralow dose PET imaging technique for known or suspected coronary artery disease (for detecting myocardial ischemia or infarction) detection and monitoring. "Investigational" means that the procedure or drug being studied is not yet approved by the U.S. Food and Drug Administration (FDA) for the specific use being tested in this research. The PET imaging technique used in this study is considered investigational because it is being tested at an ultralow radiation dose that has not yet been approved for clinical use. The radiotracer, 18F-flurpiridaz, is FDA-approved for detecting prostate cancer at standard doses.

18F-flurpiridaz is often found to be taken up at higher levels in Known or suspected coronary artery disease (for detecting myocardial ischemia or infarction). In this study, investigators will use a very small amount of this tracer (less than 1/20th of the standard dose) along with advanced PET imaging technology to see if it is possible to create clear images while using much less radiation. This study aims to develop a safer imaging technique that could potentially be used more frequently for screening and monitoring Known or suspected coronary artery disease (for detecting myocardial ischemia or infarction).

Investigators will enroll individuals with and without Known or suspected coronary artery disease (for detecting myocardial ischemia or infarction) to evaluate how ultralow dose PET imaging detects 18F-flurpiridaz uptake in different type of tissue.

Approximately 200 people will be enrolled in this study at the Nuclear Imaging Institute.

Inclusion Criteria:

• Age ≥18 years.
• Ability to provide informed consent and comply with study procedures.
• For female participants: Must not be pregnant or breastfeeding; Negative pregnancy test required for women of childbearing potential.

Exclusion Criteria:

• Participants who have exceeded NRC regulation for annual radiation exposure from prior research-related scans, including this study (50 mSv total).
• More than four prior enrollments in this study.
• Participants with severe claustrophobia, chronic pain, or musculoskeletal conditions that prevent completion of the PET scan
• Medication & Prior Treatment Exclusions
• Concurrent PSMA-targeted therapy (e.g., lutetium-177).
• Pregnant or breastfeeding individuals (negative pregnancy test required)
• Inability to provide informed consent
• Any condition that, in the investigator's judgment, may compromise participant safety or study integrity.