Abstract
PurposeThe International Atomic Energy Agency (IAEA) decided to initiate a survey to evaluate the current status of the practice of paediatric nuclear medicine worldwide, with the focus mainly on low and middle-income countries specifically in Latin America, Eastern Europe, Africa and Asia. This investigation sought to determine if the practice in paediatric nuclear medicine in these countries differed from that indicated by the survey of the Nuclear Medicine Global Initiative (NMGI) and if nuclear medicine practitioners were following established paediatric nuclear medicine guidelines.MethodsA total of 133 institutes took part in the survey from 62 different IAEA member states within Africa (29), Asia (39), Europe (29) and Latin America (36). The four most frequent conventional (single-photon) nuclear medicine procedures were 99mTc labelled MDP, DSMA, MAG3 and pertechnetate thyroid scans. In addition, 46 centres provided data on FDG PET/CT, including exposure data for the CT component. Nearly half of the sites (48%) perform less than 200 paediatric nuclear medicine studies per year, while 11% perform more than 1000 such studies per year.ResultsAdministered activities largely exceeded the recommendations for most of the sites for DMSA, MAG3 and pertechnetate, while compliance with international standards was somehow better for MDP studies. For FDG PET, the results were more uniform than for conventional nuclear medicine procedures. However, the use of CT in PET/CT for paediatric nuclear medicine revealed a high variability and, in some cases, high, dose-length product (DLP) values. This observation indicates that further attention is warranted for optimizing clinical practice in FDG PET/CT.ConclusionsOverall, in most parts of the world, efforts have been undertaken to comply either with the EANM dosage card or with the North American Consensus Guidelines. However, variability in the practice of paediatric nuclear medicine still exists. The results of this survey provide valuable recommendations for a path towards global standardization of determining the amount of activity to be administered to children undergoing nuclear medicine procedures.
Highlights
This article is part of the Topical Collection on PediatricWürzburg, Germany 5 Division of Nuclear Medicine, Boston Children’s Hospital, Boston, Massachusetts, USANuclear medicine has been shown to be of considerable value when applied in children including its application in urology, orthopaedics, oncology, endocrinology and neurology
This study indicated that all institutions scaled their administered activity for smaller patients, but there was a wide variation in the schema used for such, including the use of the European Association of Nuclear Medicine (EANM) dosage card, the Korean Society of Nuclear Medicine manual and other approaches
8% stated that they utilized the North American Consensus Guidelines (NACG), 4% guidelines specified by the local nuclear medicine society, 31% utilized a combination of these, while 2% used guidelines developed independently
Summary
Nuclear medicine has been shown to be of considerable value when applied in children including its application in urology, orthopaedics, oncology, endocrinology and neurology. This practice requires the administration of radiopharmaceuticals to children exposing them to low levels of ionizing radiation. There is no direct evidence demonstrating adverse health effects in humans for the levels of radiation exposure associated with medical imaging, many consider it prudent to optimize the exposure to patients receiving these studies. Eur J Nucl Med Mol Imaging (2020) 47:1552–1563 thought to be at a higher risk to ionizing radiation than adults. One should pay special attention when these studies involve children
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