For the numerous cardiology clinical practices in Japan, nuclear cardiology imaging tests are among the most important diagnostic tools. The Japanese nuclear cardiology community has developed a new application using ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET) to diagnose cardiac sarcoidosis, as well as new diagnostic imaging tests using ¹²³I-beta-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) and ¹²³I-metaiodobenzylguanidine (MIBG). These new approaches have become popular worldwide. The Japanese Circulation Society (JCS) and the Japanese Society of Nuclear Cardiology (JSNC) have published clinical imaging guidelines and recommendations showing indications and standards for the new imaging tests. Current nuclear cardiology clinical practices in Japan may provide new insights for nuclear cardiology worldwide.