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Aboughalia HA, Cheeney SHE, Elojeimy S, Blacklock LC, Parisi MT. Meckel diverticulum scintigraphy: technique, findings and diagnostic pitfalls. Pediatr Radiol 2023; 53:493-508. [PMID: 36323958 DOI: 10.1007/s00247-022-05527-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/24/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
Meckel diverticulum, the most common congenital anomaly of the gastrointestinal tract, results from the aberrant involution of the omphalomesenteric duct and accounts for more than 50% of unexplained lower gastrointestinal bleeding in the pediatric population. The most accurate imaging tool to identify a Meckel diverticulum containing ectopic gastric mucosa is the Technetium-99m pertechnetate Meckel scan, a scintigraphic study with a reported accuracy of 90% in the pediatric population. In addition to depicting a Meckel diverticulum with ectopic gastric mucosa, careful attention to the normal biodistribution of the radiotracer can lead to the identification of unexpected pathology with implications for patient management. This article serves to review the embryological origin and anatomical features of Meckel diverticulum, highlight the role of scintigraphy in evaluating Meckel diverticulum, and discuss the proper imaging technique when performing this test. We will focus on pitfalls that can lead to an erroneous diagnosis as well as incidental findings that can affect patient management.
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Affiliation(s)
- Hassan A Aboughalia
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
| | - Safia H E Cheeney
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA
- Department of Radiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Saeed Elojeimy
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Lisa C Blacklock
- Department of Radiology, University of New Mexico, Albuquerque, NM, USA
| | - Marguerite T Parisi
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA
- Department of Radiology, Seattle Children's Hospital, Seattle, WA, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
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Ferreira CV, Mendes BM, Paixão L, Lima TV, Santos-Oliveira R, Fonseca TC. Calculation of absorbed dose in paediatric phantoms using Monte Carlo techniques for 18F-FDG and 99mTc-DMSA and the new TIAC. Appl Radiat Isot 2022; 191:110526. [DOI: 10.1016/j.apradiso.2022.110526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 09/27/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
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Fernandez N, Villarraga LG, Chavarriaga J, Prada J, Restrepo V, Perez J. Ionizing Radiation Exposure in Children with Vesicoureteral Reflux: Should We Be Alarmed? UROLOGÍA COLOMBIANA 2022. [DOI: 10.1055/s-0041-1740591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Objectives Ionizing radiation imaging is commonly used for diagnosis and follow up in children with vesicoureteral reflux (VUR). We aim to measure the effective dose (mSv) in patients with VUR.
Methods We reviewed our electronic database of patients under 8-years-old with VUR. Primary endpoint was to calculate the effective radiation dose (ED). Absolute frequencies and percentages were reported for global qualitative variables. This study conducted a logistic regression model to calculate the odds ratio for radiation exposure. Analysis was performed using STATA version 14.0 (StataCorp LLC, College Station, TX, EEUU).
Results A total of 140 patients were found, 97 were assessed for eligibility. We included 59 patients in the final analysis. Mean age was 20 ± 17.9 months, 66% were females. Most cases of VUR were bilateral (44%) and high grade (93.4%). The lowest number of studies per patient was two, with a minimum radiation of 5.7 mSv. The highest radiation was estimated at 20.7 mSv corresponding to a total of five studies. Logistic regression showed that highest grades of VUR and age of first UTI episode were associated with higher ED (OR, 1.7; 95% CI, 0.87-3.31), (OR 1.02; 95% CI 0.97-1.07) respectively. A mean ED for children with VUR was estimated of 5.5 ± 3 mSv/year.
Conclusion In our study, the children with VUR were exposed to 5.5 mSv/year without counting the natural background radiation, which is alarming, and we believe should raise awareness worldwide in how we are unnecessarily diagnosing indolent VUR cases and following patients.
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Affiliation(s)
- Nicolas Fernandez
- Division of Urology, Seattle Children's Hospital, University of Washington, Seattle, WA, United States
| | - Luis-Gabriel Villarraga
- Division of Urology, Hospital San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Julian Chavarriaga
- Division of Urology, Hospital San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Juan Prada
- Division of Urology, Hospital San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Valeria Restrepo
- Division of Urology, Hospital San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Jaime Perez
- Division of Urology, Hospital San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
- Department of Urology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
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Abstract
Nuclear medicine provides methods and techniques in that has benefited pediatric patients and their referring physicians for over 40 years. Nuclear medicine provides qualitative and quantitative information about overall and regional function of organs, systems, and lesions in the body. This involves applications in many organ systems including the skeleton, the brain, the kidneys and the heart as well as in the diagnosis and treatment of cancer. The practice of nuclear medicine requires the administration of radiopharmaceuticals which expose the patient to very low levels of ionizing radiation. Advanced approaches in the estimation of radiation dose from the internal distribution of radiopharmaceuticals in patients of various sizes and shapes have been developed in the past 20 years. Although there is considerable uncertainty in the estimation of the risk of adverse health effects from radiation at the very low exposure levels typically associated with nuclear medicine, some considers it prudent to be more cautious when applied to children as they are generally considered to be at higher risk than adults. Standard guidelines for administered activities for nuclear medicine procedures in children have been established including the North American consensus guidelines and the Paediatric Dosage Card developed by the European Association of Nuclear Medicine. As we move into the future, these guidelines would likely be reviewed in response to changes in clinical practice, a better understanding of radiation dosimetry as applied to children as well as new clinical applications, new advancements in the field with respect to both instrumentation and image reconstruction and processing.
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Affiliation(s)
- S Ted Treves
- Harvard Medical School; Brigham and Women's Hospital.
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Dr. Marilyn Goske: Innovator in pediatric radiation safety and education: One in a series highlighting women recipients of the ACR Gold Medal. Clin Imaging 2020; 72:151-153. [PMID: 33249402 DOI: 10.1016/j.clinimag.2020.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/14/2020] [Indexed: 11/22/2022]
Abstract
Committed to teaching, Dr. Goske developed an academic niche for herself focusing on educational initiatives. She co-created the widely successful Cleveland Clinic Webbased Curriculum for radiology residents, which reached acclaimed success with 65 modules used by 25,000 registrants in 53 countries and over 400 residency programs. With her natural curiosity, enthusiasm and perseverance, Dr. Goske subsequently had the vision to develop a worldwide coalition that included people from all aspects of radiology to broadcast a simple message, image gently. The influential and longstanding campaign, Image Gently, served to educate radiologists, medical physicists, radiologic technologists and most importantly, parents. Dr. Goske wanted to empower parents and the radiology community to improve pediatric patient safety and work towards decreasing radiation exposure in children. She continued her impactful work by establishing the Quality Improvement Registry in CT Scans in children in 2011 and worked as the pediatric radiology representative on the American College of Radiology's Dose Index Registry in 2013. Focused on compassionate patient care, Dr. Goske's overarching goal was to improve the patient experience throughout the many advancements in radiology. Her excellence in patient care, innovative approaches to education and safety, and collaborative ability to bring out the best in radiology led to her being the 2018 recipient of the ACR Gold Medalist, only the ninth woman ever to do so.
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6
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Papadimitroulas P, Balomenos A, Kopsinis Y, Loudos G, Alexakos C, Karnabatidis D, Kagadis GC, Kostou T, Chatzipapas K, Visvikis D, Mountris KA, Jaouen V, Katsanos K, Diamantopoulos A, Apostolopoulos D. A Review on Personalized Pediatric Dosimetry Applications Using Advanced Computational Tools. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2019. [DOI: 10.1109/trpms.2018.2876562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Papadimitroulas P, Erwin WD, Iliadou V, Kostou T, Loudos G, Kagadis GC. A personalized, Monte Carlo-based method for internal dosimetric evaluation of radiopharmaceuticals in children. Med Phys 2018; 45:3939-3949. [PMID: 29920693 DOI: 10.1002/mp.13055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 05/31/2018] [Accepted: 06/12/2018] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Herein, we introduce a methodology for estimating the absorbed dose in organs at risk that is based on specified clinically derived radiopharmaceutical biodistributions and personalized anatomical characteristics. METHODS To evaluate the proposed methodology, we used realistic Monte Carlo (MC) simulations and computational pediatric models to calculate a parameter called in this work the "specific absorbed dose rate" (SADR). The SADR is a unique quantitative metric in that it is specific to a particular organ. It is defined as the absorbed dose rate in an organ when the biodistribution of radioactivity over the whole body is considered. Initially, we applied a validation procedure that calculated specific absorbed fractions (SAFs) from mono-energetic photon sources in the range of 10 keV-2 MeV and compared them with previously published data. We calculated the SADRs for five different radiopharmaceuticals (99m Tc-MDP, 123 I-mIBG, 131 I-MIBG, 131 I-NaI, and 153 Sm-EDTMP) based on their biodistributions at four or five different times; the biodistributions were derived from the clinical scintigraphic data of pediatric patients. We used six models representing male and female patients aged 5, 8, and 14 yr to investigate the absorbed dose variability due to anatomical variations. The GATE Monte Carlo toolkit was used to calculate absorbed doses per organ. Finally, we compared the SADR methodology to that of OLINDA/EXM 1.1 using rescaled masses according to the studied models. Four target organs were considered for calculating the absorbed doses. RESULTS The ratios of SAFs calculated with GATE simulations to those based on previously published data were between 0.9 and 2.2 when the liver was used as a source organ. Subsequently, we used GATE to calculate a dataset of SADRs for the six pediatric models. The SADRs for pediatric models whose total body weights ranged from 20 to 40 kg varied up to approximately 90%, whereas those for models of similar body masses varied less than 15%. Finally, we found absorbed dose discrepancies of approximately 10-150% between the SADR methodology and OLINDA for two different radiopharmaceuticals. Absorbed doses from SADRs and from individualized S-values in the same pediatric model differed approximately 1-50%. CONCLUSIONS Because pediatric radiopharmaceutical dosimetric estimates demonstrate large variation due to the patient's anatomical characteristics, personalized data should be considered. Using our SADR method in a larger population of phantoms and for a variety of radiopharmaceuticals could enhance the personalization of dosimetry in pediatric nuclear medicine. The proposed methodology provides the advantage of creating time-dependent organ dose rate curves.
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Affiliation(s)
| | - William D Erwin
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Vasiliki Iliadou
- Department of Medical Physics, School of Medicine, University of Patras, Rion, GR-26504, Greece
| | - Theodora Kostou
- R&D Department, BET Solutions, 116 Alexandras Ave., Athens, GR-11472, Greece
- Department of Medical Physics, School of Medicine, University of Patras, Rion, GR-26504, Greece
| | - George Loudos
- Department of Biomedical Engineering, University of West Attica, 28 Ag. Spyridonos Street, Egaleo, GR-12210, Greece
| | - George C Kagadis
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Medical Physics, School of Medicine, University of Patras, Rion, GR-26504, Greece
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8
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Abstract
Pediatric Nuclear Medicine (PNM) offers to the pediatrician noninvasive procedures, with high clinical impact and low dosimetry. New techniques have been adapted to children, diminishing doses, always looking for less dosimetry, higher sensitivity and higher resolution images. PNM is and will remain a minority subspecialty, but highly complex for general NM physicians due to the different diagnostics in children and due to the higher technical complexity of the examinations. General NM physicians have to be trained and regularly receive CME in this field.
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Parisi MT, Bermo MS, Alessio AM, Sharp SE, Gelfand MJ, Shulkin BL. Optimization of Pediatric PET/CT. Semin Nucl Med 2017; 47:258-274. [PMID: 28417855 DOI: 10.1053/j.semnuclmed.2017.01.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PET/CT, the most common form of hybrid imaging, has transformed oncologic imaging and is increasingly being used for nononcologic applications as well. Performing PET/CT in children poses unique challenges. Not only are children more sensitive to the effects of radiation than adults but, following radiation exposure, children have a longer postexposure life expectancy in which to exhibit adverse radiation effects. Both the PET and CT components of the study contribute to the total patient radiation dose, which is one of the most important risks of the study in this population. Another risk in children, not typically encountered in adults, is potential neurotoxicity related to the frequent need for general anesthesia in this patient population. Optimizing pediatric PET/CT requires making improvements to both the PET and the CT components of the procedure while decreasing the potential for risk. This can be accomplished through judicious performance of imaging, the use of recommended pediatric 18fluorine-2-fluoro-2-deoxy-d-glucose (18F-FDG) administered activities, thoughtful selection of pediatric-specific CT imaging parameters, careful patient preparation, and use of appropriate patient immobilization. In this article, we will review a variety of strategies for radiation dose optimization in pediatric 18F-FDG-PET/CT focusing on these processes. Awareness of and careful selection of pediatric-specific CT imaging parameters designed for appropriate diagnostic, localization, or attenuation correction only CT, in conjunction with the use of recommended radiotracer administered activities, will help to ensure image quality while limiting patient radiation exposure. Patient preparation, an important determinant of image quality, is another focus of this review. Appropriate preparative measures are even more crucial in children in whom there is a higher incidence of brown fat, which can interfere with study interpretation. Finally, we will discuss measures to improve the patient experience, the resource use, the departmental workflow, and the diagnostic performance of the study through the use of appropriate technology, all in the context of minimizing procedure-related risks.
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Affiliation(s)
- Marguerite T Parisi
- Departments of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA; Departments of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA.
| | - Mohammed S Bermo
- Department of Nuclear Medicine, University of Washington School of Medicine, Seattle, WA
| | - Adam M Alessio
- Departments of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Susan E Sharp
- Departments of Radiology, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinatti, OH
| | - Michael J Gelfand
- Departments of Radiology, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinatti, OH
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN
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10
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Watanabe H, Ishii K, Hosono M, Imabayashi E, Abe K, Inubushi M, Ohno K, Magata Y, Ono K, Kikuchi K, Wagatsuma K, Takase T, Saito K, Takahashi Y. Report of a nationwide survey on actual administered radioactivities of radiopharmaceuticals for diagnostic reference levels in Japan. Ann Nucl Med 2016; 30:435-44. [PMID: 27154308 PMCID: PMC4925688 DOI: 10.1007/s12149-016-1079-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 04/20/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The optimization of medical exposure is one of the major issues regarding radiation protection in the world, and The International Committee of Radiological Protection and the International Atomic Energy Agency recommend establishing diagnostic reference levels (DRLs) as tools for dose optimization. Therefore, the development of DRLs based on the latest survey has been required for nuclear medicine-related societies and organizations. This prompted us to conduct a nationwide survey on the actual administered radioactivity to adults for the purpose of developing DRLs in nuclear medicine. METHODS A nationwide survey was conducted from November 25, 2014 to January 16, 2015. The questionnaire was sent to all of the 1249 nuclear medicine facilities in Japan, and the responses were collected on a website using an answered form. RESULTS Responses were obtained from 516 facilities, for a response rate of 41 %. 75th percentile of (99m)Tc-MDP and (99m)Tc-HMDP: bone scintigraphy, (99m)Tc-HM-PAO, (99m)Tc-ECD and (123)I-IMP: cerebral blood flow scintigraphy, (99m)Tc-Tetrofosmin, (99m)Tc-MIBI and (201)Tl-Cl; myocardial perfusion scintigraphy and (18)F-FDG: oncology PET (in-house-produced or delivery) in representative diagnostic nuclear medicine scans were 932, 937, 763, 775, 200, 831, 818, 180, 235 and 252, respectively. More than 90 % of the facilities were within the range of 50 % from the median of these survey results in representative diagnostic nuclear medicine facilities in Japan. Responses of the administered radioactivities recommended by the package insert, texts and guidelines such as 740 MBq ((99m)Tc-MDP and (99m)Tc-HMDP: bone scintigraphy), 740 MBq ((99m)Tc-ECD and (99m)Tc-HM-PAO: cerebral blood flow scintigraphy) and 740 MBq ((99m)Tc-Tetrofosmin and (99m)Tc-MIBI: myocardial perfusion scintigraphy), etc. were numerous. The administered activity of many radiopharmaceuticals of bone scintigraphy ((99m)Tc-MDP and (99m)Tc-HMDP), cerebral blood flow scintigraphy ((99m)Tc-HM-PAO) and myocardial perfusion scintigraphy ((99m)Tc-Tetrofosmin and (99m)Tc-MIBI), etc. were within the range of the EU DRLs and almost none of the administered radioactivity in Japan exceeded the upper limit of SNMMI standard administered radioactivity. CONCLUSIONS This survey indicated that the administered radioactivity in diagnostic nuclear medicine in Japan had been in the convergence zone and nuclear medicine facilities in Japan show a strong tendency to adhere to the texts and guidelines. Furthermore, the administered radioactivities in Japan were within the range of variation of the EU and the SNMMI administered radioactivities.
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Affiliation(s)
- Hiroshi Watanabe
- Department of Radiological Technology, Japan Labour Health and Welfare Organization Yokohama Rosai Hospital, 3211, Kozukue, Kohoku, Yokohama, Kanagawa, 222-0036, Japan
| | - Kazunari Ishii
- Department of Radiology, Kindai University Faculty of Medicine, Ohnohigashi 377-2, Osakasayama, Osaka, 589-8511, Japan.
| | - Makoto Hosono
- Institute of Advanced Clinical Medicine, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Etsuko Imabayashi
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, 4-1-1, Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan
| | - Koichiro Abe
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Women's Medical University, Kawada-cho 8-1, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Masayuki Inubushi
- Division of Nuclear Medicine, Department of Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Kazuko Ohno
- Department of Radiological Technology, Kyoto College of Medical Science, 1-3 Oyamahigashimachi Sonobe-cho Nantan, Kyoto, 622-0041, Japan
| | - Yasuhiro Magata
- Preeminent Medical Photonics Education and Research Center, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Kinya Ono
- Department of Radiology, Kawasaki Municipal Hospital, 12-1 Shinkawadori, Kawasaki-ku, Kawasaki, Kanagawa, 210-0013, Japan
| | - Kei Kikuchi
- Department of Radiology, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Kei Wagatsuma
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, 35-2, Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Tadashi Takase
- Department of Radiology, Showa University Hospital, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Kyoko Saito
- Department of Radiological Technology, Faculty of Health Sciences, Nihon Institute of Medical Science, 1276, Shimogawara, Moroyama-machi, Iruma-gun, Saitama, 350-0435, Japan
| | - Yasuyuki Takahashi
- Department of Nuclear Medicine Technology, Gunma Prefectural College of Health Sciences, 323-1 Kamioki-cho, Maebashi, Gunma, 371-0052, Japan
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Fahey FH, Bom HHS, Chiti A, Choi YY, Huang G, Lassmann M, Laurin N, Mut F, Nuñez-Miller R, O'Keeffe D, Pradhan P, Scott AM, Song S, Soni N, Uchiyama M, Vargas L. Standardization of Administered Activities in Pediatric Nuclear Medicine: A Report of the First Nuclear Medicine Global Initiative Project, Part 2-Current Standards and the Path Toward Global Standardization. J Nucl Med 2016; 57:1148-57. [PMID: 27033894 DOI: 10.2967/jnumed.115.169714] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 03/02/2016] [Indexed: 11/16/2022] Open
Abstract
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 are 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. It was decided to divide the final report of this project into 2 parts. Part 1 was published in this journal in the spring of 2015. This article presents part 2 of the final report. It discusses current standards for administered activities in children and adolescents that have been developed by various professional organizations. It also presents an evaluation of the current practice of pediatric nuclear medicine specifically with regard to administered activities as determined by an international survey of 313 nuclear medicine clinics and centers from 29 countries. Lastly, it provides recommendations for a path toward global standardization of the administration of radiopharmaceuticals in children.
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Affiliation(s)
- Frederic H Fahey
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Henry Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun Jeonnam, Republic of Korea
| | - Arturo Chiti
- Department of Biomedical Sciences, Humanitas Research Hospital, Rozzano, Italy
| | - Yun Young Choi
- Department of Nuclear Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - Gang Huang
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Michael Lassmann
- Department of Nuclear Medicine, University Würzburg, Würzburg, Germany
| | - Norman Laurin
- Department of Nuclear Medicine, Centre Hospitalier Affilié Universitaire Régional de Trois-Rivières, Quebec, Canada
| | - Fernando Mut
- Department of Nuclear Medicine, Spanish Association Hospital, Montevideo, Uruguay
| | - Rodolfo Nuñez-Miller
- Section of Nuclear Medicine and Diagnostic Imaging, International Atomic Energy Agency, Vienna, Austria
| | - Darin O'Keeffe
- Department of Medical Physics and Bioengineering, Christchurch Hospital, Christchurch, New Zealand
| | - Prasanta Pradhan
- Department of Nuclear Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Andrew M Scott
- Department of Molecular Imaging and Therapy, Austin Hospital, and Olivia Newton-John Cancer Research Institute and School of Cancer Medicine, La Trobe University, Melbourne, Australia
| | - Shaoli Song
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Nischal Soni
- Department of Nuclear Medicine, Inkosi Albert Luthuli Central Hospital, DurbanKwaZulu, Durban, South Africa
| | - Mayuki Uchiyama
- Department of Radiology, Jikei University School of Medicine, Tokyo, Japan; and
| | - Luis Vargas
- Department of Nuclear Medicine, Xalapa Medical Center, Xalapa, Mexico
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12
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Standardization of pediatric nuclear medicine administered radiopharmaceutical activities: the SNMMI/EANM Joint Working Group. Clin Transl Imaging 2016. [DOI: 10.1007/s40336-016-0170-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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13
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Fahey F, Ted Treves S, Lassmann M. Dose optimization in pediatric nuclear medicine. Clin Transl Imaging 2016. [DOI: 10.1007/s40336-015-0153-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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14
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Abstract
The aim of this guideline is to provide minimum standards for the performance and interpretation of (18)F-NaF PET/CT scans. Standard acquisition and interpretation of nuclear imaging modalities will help to provide consistent data acquisition and numeric values between different platforms and institutes and to promote the use of PET/CT modality as an established diagnostic modality in routine clinical practice. This will also improve the value of scientific work and its contribution to evidence-based medicine.
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15
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Abstract
18F-fluoride PET/CT has been used for a wide variety of indications in children and young adults. Nearly all pediatric 18F-fluoride PET/CTs are performed to evaluate benign conditions. The most common indication is the evaluation of back pain in a wide variety of circumstances, including patients with sports injuries, scoliosis, trauma, and back pain after surgery. The high image quality of 18F-fluoride PET/CT can make it particularly useful for evaluating benign skeletal lesions such as osteoid osteoma and Langerhans cell histiocytosis. Quantitative assessment of bone turnover with 18F-fluoride PET/CT may make it useful for assessing the skeleton in patients with metabolic bone diseases, eating disorders, and avascular necrosis. There is little pediatric experience using 18F-fluoride PET/CT for evaluation of skeletal or soft tissue disease in childhood cancers.
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Affiliation(s)
- Frederick D Grant
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, and The Joint Program in Nuclear Medicine, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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16
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Grant FD, Gelfand MJ, Drubach LA, Treves ST, Fahey FH. 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. Pediatr Radiol 2015; 45:706-13. [PMID: 25367355 DOI: 10.1007/s00247-014-3211-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 09/05/2014] [Accepted: 10/13/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND 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. OBJECTIVE 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. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Frederick D Grant
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA,
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Beyond current guidelines: reduction in minimum administered radiopharmaceutical activity with preserved diagnostic image quality in pediatric hepatobiliary scintigraphy. Eur J Nucl Med Mol Imaging 2014; 41:2346-53. [DOI: 10.1007/s00259-014-2860-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 07/07/2014] [Indexed: 10/24/2022]
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Xie T, Bolch WE, Lee C, Zaidi H. Pediatric radiation dosimetry for positron-emitting radionuclides using anthropomorphic phantoms. Med Phys 2014; 40:102502. [PMID: 24089923 DOI: 10.1118/1.4819939] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Positron emission tomography (PET) plays an important role in the diagnosis, staging, treatment, and surveillance of clinically localized diseases. Combined PET/CT imaging exhibits significantly higher sensitivity, specificity, and accuracy than conventional imaging when it comes to detecting malignant tumors in children. However, the radiation dose from positron-emitting radionuclide to the pediatric population is a matter of concern since children are at a particularly high risk when exposed to ionizing radiation. METHODS The authors evaluate the absorbed fractions and specific absorbed fractions (SAFs) of monoenergy photons/electrons as well as S-values of 9 positron-emitting radionuclides (C-11, N-13, O-15, F-18, Cu-64, Ga-68, Rb-82, Y-86, and I-124) in 48 source regions for 10 anthropomorphic pediatric hybrid models, including the reference newborn, 1-, 5-, 10-, and 15-yr-old male and female models, using the Monte Carlo N-Particle eXtended general purpose Monte Carlo transport code. RESULTS The self-absorbed SAFs and S-values for most organs were inversely related to the age and body weight, whereas the cross-dose terms presented less correlation with body weight. For most source/target organ pairs, Rb-82 and Y-86 produce the highest self-absorbed and cross-absorbed S-values, respectively, while Cu-64 produces the lowest S-values because of the low-energy and high-frequency of electron emissions. Most of the total self-absorbed S-values are contributed from nonpenetrating particles (electrons and positrons), which have a linear relationship with body weight. The dependence of self-absorbed S-values of the two annihilation photons varies to the reciprocal of 0.76 power of the mass, whereas the self-absorbed S-values of positrons vary according to the reciprocal mass. CONCLUSIONS The produced S-values for common positron-emitting radionuclides can be exploited for the assessment of radiation dose delivered to the pediatric population from various PET radiotracers used in clinical and research settings. The mass scaling method for positron-emitters can be used to derive patient-specific S-values from data of reference phantoms.
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Affiliation(s)
- Tianwu Xie
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211 Geneva 4, Switzerland
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Treves ST, Lassmann M. International guidelines for pediatric radiopharmaceutical administered activities. J Nucl Med 2014; 55:869-70. [PMID: 24744446 DOI: 10.2967/jnumed.114.139980] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 03/19/2014] [Indexed: 11/16/2022] Open
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21
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Eissa HM, Allen CE, Kamdar K, Simko S, Dreyer Z, Steuber P, McClain KL, Guillerman RP, Bollard CM, Bollard CM. Pediatric Burkitt's lymphoma and diffuse B-cell lymphoma: are surveillance scans required? Pediatr Hematol Oncol 2014; 31:253-7. [PMID: 24087880 PMCID: PMC4133356 DOI: 10.3109/08880018.2013.834400] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Outcomes in pediatric B-Non-Hodgkin Lymphoma (B NHL) have improved with intensive chemotherapy protocols, with long-term survival now over 80%. However, long-term adverse effects of therapy and poor outcomes for patients who relapse remain challenges. In this study, we aimed to evaluate the potential risks and benefits of routine relapse surveillance imaging after the completion of therapy. We reviewed 44 B NHL patients diagnosed and treated at Texas Children's Cancer Center in the period between 2000 to 2011. All cross-sectional diagnostic imaging examinations performed for disease assessment after completion of chemotherapy were reviewed and cumulative radiation dosage from these examinations and the frequency of relapse detection by these examinations were recorded. Only 3 patients of the 44 relapsed (6.8%), though none of the relapses were initially diagnosed by computed tomography (CT) or fludeoxyglucose positron emission tomography (FDG-PET) scans. Median effective dose of ionizing radiation per patient was 40.3 mSv with an average of 49.1 mSv (range 0-276 mSv). This single-institution study highlights the low relapse rate in pediatric B-NHL with complete response at the end of therapy, the low sensitivity of early detection of relapse with surveillance CT or FDG-PET imaging, and the costs and potential increased risk of secondary malignancies from cumulative radiation exposure from surveillance imaging. We propose that routine surveillance CT or FDG-PET scans for these patients may not be necessary.
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Affiliation(s)
- HM Eissa
- Texas Children’s Cancer Center, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas 77030, USA,Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas 77030, USA
| | - CE Allen
- Texas Children’s Cancer Center, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas 77030, USA,Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas 77030, USA
| | - K Kamdar
- Texas Children’s Cancer Center, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas 77030, USA,Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas 77030, USA
| | - S Simko
- Texas Children’s Cancer Center, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas 77030, USA,Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas 77030, USA
| | - Z Dreyer
- Texas Children’s Cancer Center, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas 77030, USA,Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas 77030, USA
| | - P Steuber
- Texas Children’s Cancer Center, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas 77030, USA,Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas 77030, USA
| | - KL McClain
- Texas Children’s Cancer Center, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas 77030, USA,Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas 77030, USA
| | - RP Guillerman
- Department of Radiology, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas 77030, USA
| | - Catherine M. Bollard
- Texas Children’s Cancer Center, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas 77030, USA,Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas 77030, USA
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Weiser DA, Kaste SC, Siegel MJ, Adamson PC. Imaging in childhood cancer: a Society for Pediatric Radiology and Children's Oncology Group Joint Task Force report. Pediatr Blood Cancer 2013; 60:1253-60. [PMID: 23572212 PMCID: PMC4636336 DOI: 10.1002/pbc.24533] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 02/21/2013] [Indexed: 12/25/2022]
Abstract
Contemporary medical imaging is a cornerstone of care for children with cancer. As 5-year survival rates for children with cancer exceed 80%, imaging technologies have evolved in parallel to include a wide array of modalities. Here, we overview the risks and benefits associated with commonly used imaging modalities and survey the current landscape of medical imaging for children with cancer. We find evidence-based imaging guidelines to assist in protocol development and to guide decision-making for optimal patient care are often lacking. The substantial variation in protocol-based recommendations for imaging both during and following therapy may hinder optimal clinical research and clinical care for children with cancer.
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Affiliation(s)
- Daniel A Weiser
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
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Abstract
Skeletal imaging of children with fluorine-18 ((18)F) NaF harnesses the superior imaging characteristics of positron emission tomography (PET) and the improved biodistribution of the fluoride tracer compared with standard nuclear techniques, resulting in excellent quality images. Bone malignancy in children is less common than in adults, and the evaluation of benign skeletal disorders represents a larger fraction of indications in the pediatric versus adult population. (18)F NaF PET imaging has been successfully applied to various benign disorders, particularly trauma and sports medicine applications.
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Affiliation(s)
- Laura A Drubach
- Department of Radiology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA
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