Obese, female patients can be a challenge when attaining a stable ECG. An effective ECG lead placement (after thorough skin prep with alcohol and NuPrep, and the addition of ECG Conductive Gel to a good stress test electrode) is: White lead directly on the bone of the right shoulder, Black lead directly on the bone of the left shoulder, Green lead on the upper sternum, above the breasts. The addition of a tight-fitting sports bra can also be effective for reducing tissue movement and decreasing ECG artifact.