Pediatric Nuclear Medicine Research Articles

Nuclear medicine examinations of children in Russia.

The number and specification of radionuclide examinations, administrated activity and effective doses were collected during 2011-13 for 4944 paediatric patients from 10 nuclear medicine (NM) departments of some Russian regions. The kidney examinations account for about 70 % of paediatric NM examinations in general hospitals. Diagnostics of all other organs contribute from 2 to 8 % each in the total number of paediatric examinations. Administrated activities of radiopharmaceuticals are approximately proportional to the child's age, and variations between different hospitals usually are within the factor of 3-4 and for some types of examination up to 10. The range of the effective dose due to paediatric NM examinations is roughly estimated as 2-6 mSv per examination, approximately the same as in adults. Some examinations (heart, thyroid, whole body) result in doses of younger children that are 2-3 times higher than the doses of adults. Effective doses in paediatric positron emission tomography (PET) diagnostics are in the range of 4-10 mSv per examination and are higher compared with the dose of adult patients. The application of combined radiodiagnostic technologies (single photon emission computer tomography with roentghen computer tomography [SPECT/CT] or PET with roetghen computer tomography [PET/CT]) increases the effective dose of patients by the factor of 1.5-2 for the skeleton or whole body examinations.

Standardization of Administered Activities in Pediatric Nuclear Medicine: A Report of the First Nuclear Medicine Global Initiative Project, Part 1—Statement of the Issue and a Review of Available Resources

The Nuclear Medicine Global Initiative (NMGI) was formed in 2012 and consists of 13 international organizations with direct involvement in nuclear medicine. The underlying objectives of the NMGI were to promote human health by advancing the field of nuclear medicine and molecular imaging, encourage global collaboration in education, and harmonize procedure guidelines and other policies that ultimately lead to improvements in quality and safety in the field throughout the world. For its first project, the NMGI decided to consider the issues involved in the standardization of administered activities in pediatric nuclear medicine. This article presents part 1 of the final report of this initial project of the NMGI. It provides a review of the value of pediatric nuclear medicine, the current understanding of the carcinogenic risk of radiation as it pertains to the administration of radiopharmaceuticals in children, and the application of dosimetric models in children. A listing of pertinent educational and reference resources available in print and online is also provided. The forthcoming part 2 report will discuss current standards for administered activities in children and adolescents that have been developed by various organizations and an evaluation of the current practice of pediatric nuclear medicine specifically with regard to administered activities as determined by an international survey of nuclear medicine clinics and centers. Lastly, the part 2 report will recommend a path forward toward global standardization of the administration of radiopharmaceuticals in children.

S. Ted Treves: Pediatric nuclear medicine and molecular imaging

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Radiation doses for pediatric nuclear medicine studies: comparing the North American consensus guidelines and the pediatric dosage card of the European Association of Nuclear Medicine

Estimated radiation dose is important for assessing and communicating the risks and benefits of pediatric nuclear medicine studies. Radiation dose depends on the radiopharmaceutical, the administered activity, and patient factors such as age and size. Most radiation dose estimates for pediatric nuclear medicine have not been based on administered activities of radiopharmaceuticals recommended by established practice guidelines. The dosage card of the European Association of Nuclear Medicine (EANM) and the North American consensus guidelines each provide recommendations of administered activities of radiopharmaceuticals in children, but there are substantial differences between these two guidelines. For 12 commonly performed pediatric nuclear medicine studies, two established pediatric radiopharmaceutical administration guidelines were used to calculate updated radiation dose estimates and to compare the radiation exposure resulting from the recommendations of each of the guidelines. Estimated radiation doses were calculated for 12 common procedures in pediatric nuclear medicine using administered activities recommended by the dosage card of the EANM (version 1.5.2008) and the 2010 North American consensus guidelines for radiopharmaceutical administered activities in pediatrics. Based on standard models and nominal age-based weights, radiation dose was estimated for typical patients at ages 1, 5, 10 and 15 years and adult. The resulting effective doses were compared, with differences greater than 20% considered significant. Following either the EANM dosage card or the 2010 North American guidelines, the highest effective doses occur with radiopharmaceuticals labeled with fluorine-18 and iodine-123. In 24% of cases, following the North American consensus guidelines would result in a substantially higher radiation dose. The guidelines of the EANM dosage card would lead to a substantially higher radiation dose in 39% of all cases, and in 62% of cases in which patients were age 5 years or younger. For 12 commonly performed pediatric nuclear medicine studies, updated radiation dose estimates can guide efforts to reduce radiation exposure and provide current information for discussing radiation exposure and risk with referring physicians, patients and families. There can be substantial differences in radiation exposure for the same procedure, depending upon which of these two guidelines is followed. This discordance identifies opportunities for harmonization of the guidelines, which may lead to further reduction in nuclear medicine radiation doses in children.

Pediatric Radiopharmaceutical Administration: Harmonization of the 2007 EANM Paediatric Dosage Card (Version 1.5.2008) and the 2010 North American Consensus guideline

In 2008 the EANM published their paediatric dosage card. In 2011 the North American consensus guidelines recommended a set of administered activities for paediatric nuclear medicine. During the EANM congress in 2012 a working group of the EANM and the SNMMI met to study the possibility of harmonizing these guidelines. The purpose of this work was to identify differences between these guidelines and suggest changes in both guidelines to achieve a level of harmonization. In addition, the new version of the EANM paediatric dosage card (version 01.02.2014) is provided.

Japanese consensus guidelines for pediatric nuclear medicine

The Japanese Society of Nuclear Medicine has recently published the consensus guidelines for pediatric nuclear medicine. This article is the English version of the guidelines. Part 1 proposes the dose optimization in pediatric nuclear medicine studies. Part 2 comprehensively discusses imaging techniques for the appropriate conduct of pediatric nuclear medicine procedures, considering the characteristics of imaging in children.

Paediatric radiopharmaceutical administration: harmonization of the 2007 EANM paediatric dosage card (version 1.5.2008) and the 2010 North American consensus guidelines

In 2008 the EANM published their paediatric dosage card. In 2011 the North American consensus guidelines recommended a set of administered activities for paediatric nuclear medicine. During the EANM congress in 2012 a working group of the EANM and the SNMMI met to study the possibility of harmonizing these guidelines. The purpose of this work was to identify differences between these guidelines and suggest changes in both guidelines to achieve a level of harmonization. In addition, the new version of the EANM paediatric dosage card (version 01.02.2014) is provided.

Estimate the Minimized Effective Dose and Critical Organ in Pediatric Nuclear Medicine

Many techniques and research models on calculating and reducing the nuclear radiation dose on pediatric nuclear medicine procedure have been developed and reported in recent years. However, most those models either utilized simple shapes to present the organs or used more realistic models to estimate the nuclear dose applied on pediatric patients. The former are too simple to provide accurate estimation results, and the latter are too complicated to intensively involve complex calculations. In this study, a simple but practical model is developed to enable physicians to easily and quickly calculate and select the average optimal effective nuclear dose and critical organs for the given age and weight of the pediatric patients. This model is built based on one research result reported by Frederic Fahey et al., and it can be easily implemented in most common pediatric nuclear medicine procedures. This is the first research of using fuzzy inference system (FIS) to calculate the optimal effective dose applied in the nuclear medicine for pediatric patients.

Select the optimized effective dose to reduce nuclear radiations in pediatric nuclear medicine.

Many techniques and research models on calculating and reducing the nuclear radiation dose on pediatric nuclear medicine procedure have been developed and reported in recent years. However, most those models either utilized simple shapes to present the organs or used more realistic models to estimate the nuclear dose applied on pediatric patients. The former are too simple to provide accurate estimation results, and the latter are too complicated to intensively involve complex calculations. In this study, a simple but practical model is developed to enable physicians to easily and quickly calculate and select the average optimal effective nuclear dose for the given age and body-size of the pediatric patients. This model is built based on one research result reported by Frederic Fahey, et al and it can be easily implemented in most common pediatric nuclear medicine procedures. This is the first research of using fuzzy inference system to calculate the optimal effective dose applied in the nuclear medicine for pediatric patients.

Editorial Comment

No AccessJournal of UrologyPediatric Urology1 Sep 2013Editorial Comment Emilio Merlini Emilio MerliniEmilio Merlini More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.03.136AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 190(3), pp. 1026–1027 References 1 : The “well tempered” diuretic renogram: a standard method to examine the asymptomatic neonate with hydronephrosis or hydroureteronephrosis: A report from combined meetings of the Society for Fetal Urology and members of the Pediatric Nuclear Medicine Council–the Society of Nuclear Medicine. J Nucl Med1992; 33: 2047. Google Scholar Division of Pediatric Urology, Regina Margherita Children's Hospital, Citta della Salute a della Scienza di Torino, Turin, Italy© 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 190Issue 3September 2013Page: 1026-1027 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Emilio Merlini More articles by this author Expand All Advertisement PDF downloadLoading ...

WE‐C‐144‐01: The Management of Imaging Procedure Dose 2: Nuclear Medicine

Wesley Bolch: Nuclear Medicine Dose IndicesA main clinical application of nuclear medicine is that of functional imaging of normal and diseased tissue, and the localization of malignant tissue and its potential metastatic spread. In these applications, the amount of administered activity is such that the absorbed dose to both imaged and non‐imaged tissues are typically very low and thus stochastic risks of cancer induction are greatly outweighed by the diagnostic benefit of the imaging procedure. Nevertheless, these tissues doses and their stochastic risks should be quantified for each patient, and placed in context of both their cumulative values received over multiple imaging sessions, and of doses and risks received by other diagnostic imaging procedures they may have (fluoroscopy and computed tomography, for example). The role of internal dosimetry in diagnostic nuclear medicine is thus to provide the basis for stochastic risk quantification. Once this risk is quantified, it may be used to optimize the amount of administered activity in order to maximize image quality while minimizing patient risk. This optimization process is of particular importance for pediatric patients owing to their enhanced organ radiosensitivities and years over which any stochastic effects may become manifest. This optimization should consider, as much as possible, patient age, gender, and body morphometry, and pharmacokinetics, along with all available image acquisition and processing techniques. Unlike other forms of diagnostic imaging, for which dose indices are readily measured, only the administered radioactivity is typically available for “dose tracking”. In this course, we will review data sources for organ and effective dose per unit administered activity for the more common molecular imaging radiopharmaceuticals. Particular attention will be given to sources of individual variability in both organ and effective dose attributed to both physiological and anatomical variations among patients.Learning Objectives:1. Identify the more common radiopharmaceuticals used in functional imaging of normal and diseased tissues.2. Demonstrate understanding of the parameters needed to estimate tissue dose during nuclear medicine imaging and therapy.3. Identify fundamental data sources for organ and effective dose per unit administered activity.4. Demonstrate understanding of the physiological and anatomic sources of individual variability in organ and effective dose per unit administered activity.5. Identify key features of new generation anatomical models that can reduce dose uncertainties through improved matching of patient body morphometry.Fred Fahey: Tracking Doses in the Pediatric PopulationA review of methods for estimating patient dose from pediatric nuclear medicine procedures is presented. Included is a discussion of hybrid imaging and factors that affect radiation dose from CT in PET/CT procedures. Consideration for choice of radionuclide and administered activity for various procedures are detailed, with a focus on the pediatric population. Technological advances allowing the further reduction in radiation dose is also discussed.Learning Objectives:1. List three considerations in estimating the radiation dose from pediatric nuclear medicine.2. Discuss three factors that affect the radiation dose from the CT component of hybrid imaging.3. Describe three factors that can affect the appropriate choice of administered activity for a nuclear medicine study.4. List 2 advances that may lead to further reduction in the administered activity in pediatric nuclear medicine.

Pediatric nuclear medicine and pediatric radiology

To improve clinical practice is our daily duty as specialists in radiology and in nuclear medicine. When a clinician asks us to perform an imaging examination, we have to advise that clinician about the best test or imaging strategy to study the clinical problem. Risk-to-benefit ratio and the ALARA principle have to be weighed, as well as modality and cost. Hybrid imaging is now the standard in nuclear medicine. The use of multimodality cameras such as SPECT/CT, PET/CT and PET/MR has been revolutionary [1–4]. The key is finding the exact location of functional or metabolic lesions. But adding CT increases the dosimetry [5–7], requires more detailed knowledge of imaging anatomy and depends on collaboration between radiologists and nuclear medicine specialists. The level of expertise among imaging specialists (at least in pediatric nuclear medicine) varies too much. In some countries nuclear medicine is an independent specialty, and in other countries radiologists are in charge of nuclear medicine tests. Physicians-in-training in radiology and in nuclear medicine have to receive multimodality training [8–12]. And continuing education in both specialties is vital to ensure that senior specialists are well-versed in the latest techniques. In any case, imaging specialists must be able to discuss the options with referring clinicians and to advise them on the appropriate technique for each clinical situation. Pediatric nuclear medicine can be performed in general nuclear medicine facilities or in dedicated pediatric nuclear medicine departments. The quality of the images has to be diagnostically excellent in pediatric nuclear medicine but superfluous scans must be avoided and doses must be as low as reasonably achievable and adjusted to each child according to international recommendations [7, 13–16]. These goals can be more easily reached in dedicated pediatric facilities. Dose reduction remains important. Contrary to general opinion the radiation dose of most nuclear medicine scans is lower than that of many comparable radiologic studies. The most typical example is abdominal CT, which has a higher dose than the most frequent nuclear medicine studies. Another example is that two-thirds of the radiation dose from PET/CT is from the CT component [12–14]. In the latter case it is possible to perform a diagnostic CT scan during the PET/CT examination rather than a separate diagnostic CT scan. Or a lower-dose CT scan could be performed in a patient who has recently undergone a diagnostic CT scan. The best option for the future in pediatric oncology, however, is PET/MR. In bone scintigraphy or an MIBG scan, performance of an SPECT/CT scan significantly increases the radiation dose [15–17]. A possibility is to use a lower-dose nondiagnostic CT scan in these cases. And the best practice is to report together with the radiologist, comparing the SPECT and the CT or MR images frame-by-frame. In many papers, correlative analysis of PET/CT images in children has been reported to be superior to separate analysis of CT and FDG/PET images. The term “correlative imaging” is the joint interpretation of different imaging modalities – CT, MR, US and scintigraphy [18]. This is the best example yet of why collaboration between radiologists and nuclear medicine physicians is so important.

Dexmedetomidine Offers an Option for Safe and Effective Sedation for Nuclear Medicine Imaging in Children

To determine the safety, efficacy, and outcomes of bradycardia, hypotension, and hypertension with dexmedetomidine (DEX), a recently approved sedative used for procedural sedation that has not been described previously for pediatric nuclear medicine imaging. Between March 2005 and August 2011, 669 patients (mean age, 5.7 years ± 4.5 [standard deviation]; median age, 4.5 years; age range, 0.1-22.5 years) received DEX in this HIPAA-compliant study. Sedation was administered with DEX, an α-2 adrenergic agonist, as an intravenous bolus (2 μg per kilogram of body weight) over a 10-minute period; this was followed by continuous infusion at a rate of 1 μg/kg/h until imaging was complete. The bolus could be repeated up to two times, if needed, to achieve the targeted level of a Ramsay sedation score of 4. After institutional review board approval, collected quality assurance data were reviewed. Adequate sedation was achieved within 8.6 minutes ± 4.6 (median, 8.0 minutes; range, 1.0-40.0 minutes) on average in studies that averaged 41.3 minutes ± 25.5 (median, 31.5 minutes; range, 9.0-183.0 minutes). Of 669 studies, 667 (99.7%) were completed successfully. Six children (0.9%) had brief periods of oxygen desaturation below 95%, none of which required airway intervention. Hypotension, hypertension, and bradycardia (all defined as deviations of more than 20% from age-adjusted awake norms), occurred in 58.7% (n = 393), 2.1% (n = 14), and 4.3% (n = 29) of patients, respectively. Both hypotension and bradycardia were related to age (P = .033 and P = .002, respectively); older children tended to experience more of these events. None of these fluctuations required pharmacologic therapy. Discharge criteria (modified Aldrete score ≥ 9) were met, on average, within 41.4 minutes ± 27.9 (median, 36.0 minutes; range, 1.0-220.0 minutes). DEX offers advantages for pediatric sedation for nuclear medicine imaging. DEX produces a condition similar to natural sleep, with no detrimental effect on respiration. The hemodynamic variability anticipated with DEX did not require pharmacologic treatment, and the drug was well tolerated.

Pediatric Nuclear Medicine in Acute Care

Various radiopharmaceuticals are available for imaging pediatric patients in an acute care setting. This article focuses on the common applications used on a pediatric patient in acute care. To confirm the clinical diagnosis of brain death, brain scintigraphy is considered accurate and has been favorably compared with other methods of detecting the presence or absence of cerebral blood flow. Ventilation-perfusion lung scans are easy and safe to perform with less radiation exposure than computed tomography pulmonary angiography and remain an appropriate procedure to perform on children with suspected pulmonary embolism as a first imaging test in a hemodynamically stable patient with no history of lung disease and normal chest radiograph. (99m)Tc pertechnetate scintigraphy (Meckel's scan) is the best noninvasive procedure to establish the diagnosis of ectopic gastric mucosa in Meckel's diverticulum. Hepatobiliary scintigraphy is the most accurate diagnostic imaging modality for acute cholecystitis. (99m)Tc-dimercaptosuccinic acid scintigraphy is the simplest, and the most reliable and sensitive method for the early diagnosis of focal or diffuse functional cortical damage. Bone scintigraphy is a sensitive and noninvasive technique for the diagnosis of bone disorders such as osteomyelitis and fracture. Of recent, positron emission tomography imaging using (18)F-NaF has been introduced as an alternative to bone scintigraphy. (18)F-fluorodeoxyglucose-positron emission tomography has the potential to replace other imaging modalities, such as the evaluation of fever of unknown origin in pediatric patients, with better sensitivity and significantly less radiation exposure than gallium scan.

Factors Predicting Improvement of Renal Function After Pyeloplasty in Pediatric Patients: A Prospective Study

We assessed the specific preoperative sonographic and urinary factors that may be important in predicting renal function outcomes after pyeloplasty. We prospectively studied 52 consecutive patients with ureteropelvic junction obstruction who underwent pyeloplasty at our tertiary care center between September 2009 and January 2011. Mean ± 2 SD patient age was 4.26 years (range 3 months to 18 years), and minimum followup was 6 months. Preoperative ultrasound findings recorded were pelvic anteroposterior diameter, pelvic cortical thickness, pelvic volume and pelvic cortical ratio. Spot urine protein-to-creatinine ratio from the renal pelvis and bladder was measured intraoperatively. Based on changes in differential renal function on diuretic renogram, patients were divided into 3 groups. Group 1 had stable differential renal function with less than 5% change, group 2 had improved differential renal function greater than 5% and group 3 had deterioration of differential renal function greater than 5%. Data were analyzed using SPSS®, version 17 with cross-tabulation, nonparametric tests and logistic regression. On ultrasound only anteroposterior diameter (p = 0.018) and pelvic cortical ratio (p = 0.038) were significantly different among the 3 groups. Difference in bladder sample protein-to-creatinine ratio was not significant (p = 0.69), while pelvic urine protein-to-creatinine ratio was significant (p = 0.001). Anteroposterior diameter, pelvic protein-to-creatinine ratio and pelvic cortical ratio were less than 50 mm, 0.5 and 15, respectively, in all patients with improved renal function. Sonographic and urinary biochemical parameters may predict improvement in renal function after pyeloplasty. Pelvic anteroposterior diameter, pelvic cortical ratio and pelvic urine protein-to-creatinine ratio are the most useful parameters.

2192 DEVELOPMENT AND EVALUATION OF NEAR INFRARED FLUORESCENT IMAGING AS A SENSITIVE, NON-RADIATING ALTERNATIVE TO SCINTILLOGRAPHY FOR DIAGNOSIS OF PYELONEPHRITIS

You have accessJournal of UrologyImaging/Radiology: Uroradiology II1 Apr 20122192 DEVELOPMENT AND EVALUATION OF NEAR INFRARED FLUORESCENT IMAGING AS A SENSITIVE, NON-RADIATING ALTERNATIVE TO SCINTILLOGRAPHY FOR DIAGNOSIS OF PYELONEPHRITIS Brian M. Rosman, Joao A. Barbosa, S. Ted Trevis, Alan B. Retik, and Hiep T. Nguyen Brian M. RosmanBrian M. Rosman Boston, MA More articles by this author , Joao A. BarbosaJoao A. Barbosa Boston, MA More articles by this author , S. Ted TrevisS. Ted Trevis Boston, MA More articles by this author , Alan B. RetikAlan B. Retik Boston, MA More articles by this author , and Hiep T. NguyenHiep T. Nguyen Boston, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2366AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Imaging with Di-Mercaptosuccinic acid (DMSA) is the current radiographic standard for diagnosing pyelonephritis in children. This test necessitates the injection of a radioactive tracer agent and produces a low-resolution image that requires a high level of training and experience to properly interpret. Near infrared imaging is a modality that does not involve ionizing radiation and has the potential for being highly sensitive for diagnosing various urological conditions. Previous work has demonstrated that Prosense 750 FAST (Perkin Elmer), a near infrared fluorescent imaging agent that is specifically activated by inflammatory enzymes (Cathepsins), can be used to identify pyelonephritis in a swine model. The objective of this study is to determine and compare the sensitivity and specificity of Prosense imaging with that of DMSA and direct histologic evaluation. METHODS Human pathogenic E. coli was cultured in broth and mixed with swine blood. The resultant clot was injected under ultrasound guidance into the parenchyma of a swine kidney to simulate pyelonephritis. Two to five days later, the animal was anesthetized, and imaging with DMSA followed by Prosense 750 FAST was performed. The DMSA scan was interpreted by a pediatric nuclear medicine specialist. Histological evaluation was performed on the represented sections from the infected kidney. RESULTS Imaging with Prosense demonstrated higher sensitivity and specificity for areas of infection/inflammation than DMSA. Fluorescent areas observed in renal cortex on Prosense imaging correlated with histological findings of inflammatory cells, suggestive of an active infection. In contrast, these same areas of inflammation/infection were not detected on the DMSA scan. Only when the infection progressed and became extensive did it become evident on DMSA imaging. CONCLUSIONS Near infrared fluorescent imaging with Prosense 750 FAST is a sensitive and non-radiating alternative to DMSA for the detection of pyelonephritis. Its use may allow for early detection of renal infection and provides a mean of distinguishing between active and prior infection or dysplasia. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e884 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brian M. Rosman Boston, MA More articles by this author Joao A. Barbosa Boston, MA More articles by this author S. Ted Trevis Boston, MA More articles by this author Alan B. Retik Boston, MA More articles by this author Hiep T. Nguyen Boston, MA More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Pédiatrie nucléaire en Europe

The differentiation of paediatric from adult nuclear medicine has developed in Europe over the past thirty years. It coincides with the birth and the growth of the European association of nuclear medicine and its journal. Through Pubmed, it is possible to measure the friendly and constructive competition between North America and Europe, both in search of medical universality. Mankind owes to the child the best it has to give, told the preamble of the Declaration of the Rights of the Child. European paediatric nuclear medicine contributes to this challenge.

Biokinetics and dosimetry of commonly used radiopharmaceuticals in diagnostic nuclear medicine - a review.

PurposeThe impact on patients’ health of radiopharmaceuticals in nuclear medicine diagnostics has not until now been evaluated systematically in a European context. Therefore, as part of the EU-funded Project PEDDOSE.NET (www.peddose.net), we review and summarize the current knowledge on biokinetics and dosimetry of commonly used diagnostic radiopharmaceuticals.MethodsA detailed literature search on published biokinetic and dosimetric data was performed mostly via PubMed (www.ncbi.nlm.nih.gov/pubmed). In principle the criteria for inclusion of data followed the EANM Dosimetry Committee guidance document on good clinical reporting.ResultsData on dosimetry and biokinetics can be difficult to find, are scattered in various journals and, especially in paediatric nuclear medicine, are very scarce. The data collection and calculation methods vary with respect to the time-points, bladder voiding, dose assessment after the last data point and the way the effective dose was calculated. In many studies the number of subjects included for obtaining biokinetic and dosimetry data was fewer than ten, and some of the biokinetic data were acquired more than 20 years ago.ConclusionIt would be of interest to generate new data on biokinetics and dosimetry in diagnostic nuclear medicine using state-of-the-art equipment and more uniform dosimetry protocols. For easier public access to dosimetry data for diagnostic radiopharmaceuticals, a database containing these data should be created and maintained.Electronic supplementary materialThe online version of this article (doi:10.1007/s00259-011-1904-z) contains supplementary material, which is available to authorized users.

Image Gently: progress and challenges in CT education and advocacy

Significant progress has been made in radiation protection for children during the last 10 years. This includes increased awareness of the need for radiation protection for pediatric patients with international partnerships through the Alliance for Radiation Safety in Pediatric Imaging. This paper identifies five areas of significant progress in radiation safety for children: the growth of the Alliance; the development of an adult radiation protection campaign Image Wisely™; increased collaboration with government agencies, societies and the vendor community; the development of national guidelines in pediatric nuclear medicine, and the development of a size-based patient dose correction factor by the American Association of Physicists in Medicine, Task Group 204. However, many challenges remain. These include the need for continued education and change of practice at adult-focused hospitals where many pediatric CT exams are performed; the need for increased emphasis on appropriateness of pediatric imaging and outcomes research to validate the performance of CT studies, and the advancement of the work of the first pediatric national dose registry to determine the "state of the practice" with the final goal of establishing ranges of optimal CT technique for specific scan indications when imaging children with CT.

Minimizing and Communicating Radiation Risk in Pediatric Nuclear Medicine

The value of pediatric nuclear medicine is well established. Pediatric patients are referred to nuclear medicine from nearly all pediatric specialties including urology, oncology, cardiology, gastroenterology, and orthopedics. Radiation exposure is associated with a potential, small, risk of inducing cancer in the patient later in life and is higher in younger patients. Recently, there has been enhanced interest in exposure to radiation from medical imaging. Thus, it is incumbent on practitioners of pediatric nuclear medicine to have an understanding of dosimetry and radiation risk to communicate effectively with their patients and their families. This article reviews radiation dosimetry for radiopharmaceuticals and also CT given the recent proliferation of PET/CT and SPECT/CT. It also describes the scientific basis for radiation risk estimation in the context of pediatric nuclear medicine. Approaches for effective communication of risk to patients' families are discussed. Lastly, radiation dose reduction in pediatric nuclear medicine is explicated.