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Lim R, Kwatra N, Valencia VF, Collins KN, Vali R, Fahey FH, Treves ST. Review of the Clinical and Technical Aspects of 99mTc-Dimercaptosuccinic Acid Renal Imaging: The Comeback "Kit". J Nucl Med Technol 2024:jnmt.123.267185. [PMID: 39137980 DOI: 10.2967/jnmt.123.267185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 07/04/2024] [Indexed: 08/15/2024] Open
Abstract
99mTc-labeled dimercaptosuccinic acid (99mTc-DMSA) imaging is a well-established and highly sensitive method for the diagnosis of several renal cortical disorders affecting children and adults. Beginning in 2014, 99mTc-DMSA availability was severely impaired when it was added to the Drug Shortages List of the U.S. Food and Drug Administration and was commercially unavailable thereafter. The agent shortage negatively impacted practitioners' ability to evaluate renal cortical defects in children and adults and changed renal imaging practice. A survey among pediatric nuclear medicine clinicians confirmed the clinical need for 99mTc-DMSA. Finally, in early 2023 the Food and Drug Administration again approved 99mTc-DMSA in the United States. During the 99mTc-DMSA shortage, established practitioners may not have had the opportunity of using 99mTc-DMSA as they were accustomed in their experience. Also, newer imaging specialists and referring physicians and technologists may not have benefited from having 99mTc-DMSA in their training. Therefore, it is time to bring back 99mTc-DMSA into the armamentarium of imaging methods available to evaluate regional cortical renal function.
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Affiliation(s)
- Ruth Lim
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | - Neha Kwatra
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
- Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | | | - Katelyn N Collins
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Reza Vali
- Department of Radiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and
| | - Frederic H Fahey
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
- Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - S Ted Treves
- Department of Radiology, Harvard Medical School, Boston, Massachusetts;
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
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2
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Lu Y, Kumbhar S, Liu Y, Vo NJ, Lu J, Baker M, Qi J. Assessment of infant gonadal dose irradiated from urine-contaminated diapers during diuretic renal scintigraphy. Nucl Med Commun 2024; 45:45-50. [PMID: 37901921 DOI: 10.1097/mnm.0000000000001783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
OBJECTIVE To estimate the gonadal doses irradiated from urine- contaminated diapers during diuretic renal scintigraphy. METHODS Images of 31 patients (18 males and 13 females) with urine-contaminated diapers during 99m Tc-MAG3 renal scintigraphy were analyzed. The count rate of the diapers was converted into a time-activity curve based on the calibrated factor of the gamma camera system. The cumulative activity was determined from the area under the curve. By incorporating dose per unit cumulative activity pre-calculated from Monte Carlo simulation with 0-year phantom, the gonadal dose irradiated from diaper was calculated. To assess the degree of this additionally introduced dose from diapers, the calculated gonadal dose was compared to the internal gonadal dose from injected radiotracer activity. RESULTS The cumulative activities irradiated from urine-contaminated diapers were 1.12 E04 ± 1.29E04 MBq.s in male infants, which was nearly half of the 1.94 E04 ± 1.80E04 MBq.s ( P = 0.15) in female infants. However, the absorbed doses for testes in male infants were 7.37E-01 ± 8.50E-01 mGy, which was approximately 10 times the 6.38E-02 ± 5.94E-02 mGy for ovaries in female infants ( P < 0.01). The diaper-introduced dose for testes and ovaries was 91.7% and 3.9% of the gonadal doses from the injected activity in patients with normal renal function, and 99.0% and 4.3% of those in patients with abnormal renal function. CONCLUSION Urine-contaminated diapers introduced additional radiation doses to infant patients during 99m Tc-MAG3 renal scintigraphy. The gonadal doses were of significance in male infants who had nearly double the absorbed dose for the testes.
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Affiliation(s)
- Yonggang Lu
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin,
| | - Sachin Kumbhar
- Department of Radiology, Virginia Mason Medical Center, Seattle, Washington,
| | - Yu Liu
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin,
| | - Nghia Jack Vo
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin,
| | - Jerry Lu
- College of Human Ecology, Cornell University, Ithaca, New York and
| | - Marjorie Baker
- Department of Radiology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jing Qi
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin,
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Camoni L, Santos A, Luporsi M, Grilo A, Pietrzak A, Gear J, Zucchetta P, Bar-Sever Z. EANM procedural recommendations for managing the paediatric patient in diagnostic nuclear medicine. Eur J Nucl Med Mol Imaging 2023; 50:3862-3879. [PMID: 37555902 PMCID: PMC10611649 DOI: 10.1007/s00259-023-06357-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/23/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE The manuscript aims to characterize the principles of best practice in performing nuclear medicine procedures in paediatric patients. The paper describes all necessary technical skills that should be developed by the healthcare professionals to ensure the best possible care in paediatric patients, as it is particularly challenging due to psychological and physical conditions of children. METHODS We performed a comprehensive literature review to establish the most relevant elements of nuclear medicine studies in paediatric patients. We focused the attention to the technical aspects of the study, such as patient preparation, imaging protocols, and immobilization techniques, that adhere to best practice principles. Furthermore, we considered the psychological elements of working with children, including comforting and distraction strategies. RESULTS The extensive literature review combined with practical conclusions and recommendations presented and explained by the authors summarizes the most important principles of the care for paediatric patient in the nuclear medicine field. CONCLUSION Nuclear medicine applied to the paediatric patient is a very special and challenging area, requiring proper education and experience in order to be performed at the highest level and with the maximum safety for the child.
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Affiliation(s)
- Luca Camoni
- University of Brescia, 25123, Brescia, Italy.
- Nuclear Medicine Department, University of Brescia, ASST Spedali Civili Di Brescia, P.Le Spedali Civili 1, 25123, Brescia, Italy.
| | - Andrea Santos
- Nuclear Medicine Department, CUF Descobertas Hospital, Lisbon, Portugal
| | - Marie Luporsi
- Department of Nuclear Medicine, Institut Curie, PSL Research University, 75005, Paris, France
- LITO Laboratory INSERM U1288, Institut Curie, 91440, Orsay, France
| | - Ana Grilo
- H&TRC - Health and Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisbon, Portugal
| | - Agata Pietrzak
- Electroradiology Department, Poznan University of Medical Sciences, Poznan, Poland
- Nuclear Medicine Department, Greater Poland Cancer Centre, Poznan, Poland
| | - Jonathan Gear
- Joint Department of Physics, Royal Marsden Hospital and Institute of Cancer Research, Sutton, UK
| | - Pietro Zucchetta
- Nuclear Medicine Department, Padova University Hospital, 35128, Padua, Italy
| | - Zvi Bar-Sever
- Department of Nuclear Medicine, Schneider Children's Medical Center, Tel-Aviv University, Petach Tikva, Israel
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4
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Hara T, Terakawa T, Okamura Y, Bando Y, Furukawa J, Harada K, Nakano Y, Fujisawa M. Real-world analysis of metastatic prostate cancer demonstrates increased frequency of PSA-imaging discordance with visceral metastases and upfront ARAT/docetaxel therapy. Prostate 2023; 83:1270-1278. [PMID: 37316357 DOI: 10.1002/pros.24588] [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: 02/27/2023] [Revised: 05/11/2023] [Accepted: 06/05/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND The objective of this study was to evaluate the background and treatment course of patients with metastatic prostate cancer (PC), with a particular focus on radiographic progression in the absence of prostate-specific antigen (PSA) progression. METHODS The study population consisted of 229 patients with metastatic hormone-sensitive PC (HSPC), who received prostate biopsy and androgen deprivation therapy at Kobe University Hospital between January 2008 and June 2022. Clinical characteristics were retrospectively evaluated using medical records. PSA progression-free status was defined as ≤1.05 times greater than that from 3 months before. Multivariate analyses were performed using the Cox proportional hazards regression model to identify parameters associated with time to progression on imaging without PSA elevation. RESULTS A total of 227 patients with metastatic HSPC without neuroendocrine PC were identified. The median follow-up period was 38.0 months, with a median overall survival of 94.9 months. Six patients exhibited disease progression on imaging without PSA elevation during HSPC treatment, three during first-line castration-resistant PC (CRPC) treatment, and two during late-line CRPC treatment. The rate of disease progression without PSA elevation at 3 years after treatment initiation was 7.4%. Multivariate analysis revealed that organ metastases and upfront treatment with docetaxel or androgen receptor axis-targeted therapy were independent prognostic factors for imaging progression without PSA elevation. CONCLUSIONS Disease progression on imaging without PSA elevation occurred not only during HSPC treatment and first-line CRPC treatment, but also during late-line CRPC treatment. Patients with visceral metastases or those treated with upfront androgen receptor axis-targeted or docetaxel may be more prone to such progression.
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Affiliation(s)
- Takuto Hara
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoaki Terakawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yasuyoshi Okamura
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yukari Bando
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Junya Furukawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenichi Harada
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yuzo Nakano
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masato Fujisawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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Guo R, Xue S, Hu J, Sari H, Mingels C, Zeimpekis K, Prenosil G, Wang Y, Zhang Y, Viscione M, Sznitman R, Rominger A, Li B, Shi K. Using domain knowledge for robust and generalizable deep learning-based CT-free PET attenuation and scatter correction. Nat Commun 2022; 13:5882. [PMID: 36202816 PMCID: PMC9537165 DOI: 10.1038/s41467-022-33562-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
Despite the potential of deep learning (DL)-based methods in substituting CT-based PET attenuation and scatter correction for CT-free PET imaging, a critical bottleneck is their limited capability in handling large heterogeneity of tracers and scanners of PET imaging. This study employs a simple way to integrate domain knowledge in DL for CT-free PET imaging. In contrast to conventional direct DL methods, we simplify the complex problem by a domain decomposition so that the learning of anatomy-dependent attenuation correction can be achieved robustly in a low-frequency domain while the original anatomy-independent high-frequency texture can be preserved during the processing. Even with the training from one tracer on one scanner, the effectiveness and robustness of our proposed approach are confirmed in tests of various external imaging tracers on different scanners. The robust, generalizable, and transparent DL development may enhance the potential of clinical translation. Deep learning-based methods have been proposed to substitute CT-based PET attenuation and scatter correction to achieve CT-free PET imaging. Here, the authors present a simple way to integrate domain knowledge in deep learning for CT-free PET imaging.
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Affiliation(s)
- Rui Guo
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Ruijin Center, Shanghai, China
| | - Song Xue
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jiaxi Hu
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hasan Sari
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
| | - Clemens Mingels
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Konstantinos Zeimpekis
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - George Prenosil
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yue Wang
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Ruijin Center, Shanghai, China
| | - Yu Zhang
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Ruijin Center, Shanghai, China
| | - Marco Viscione
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Raphael Sznitman
- ARTORG Center, University of Bern, Bern, Switzerland.,Center of Artificial Intelligence in Medicine (CAIM), University of Bern, Bern, Switzerland
| | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Biao Li
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Ruijin Center, Shanghai, China.
| | - Kuangyu Shi
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Center of Artificial Intelligence in Medicine (CAIM), University of Bern, Bern, Switzerland.,Computer Aided Medical Procedures and Augmented Reality, Institute of Informatics I16, Technical University of Munich, Munich, Germany
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Venet M, Friedberg MK, Mertens L, Baranger J, Jalal Z, Tlili G, Villemain O. Nuclear Imaging in Pediatric Cardiology: Principles and Applications. Front Pediatr 2022; 10:909994. [PMID: 35874576 PMCID: PMC9301385 DOI: 10.3389/fped.2022.909994] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Nuclear imaging plays a unique role within diagnostic imaging since it focuses on cellular and molecular processes. Using different radiotracers and detection techniques such as the single photon emission scintigraphy or the positron emission tomography, specific parameters can be assessed: myocardial perfusion and viability, pulmonary perfusion, ventricular function, flow and shunt quantification, and detection of inflammatory processes. In pediatric and congenital cardiology, nuclear imaging can add complementary information compared to other imaging modalities such as echocardiography or magnetic resonance imaging. In this state-of-the-art paper, we appraise the different techniques in pediatric nuclear imaging, evaluate their advantages and disadvantages, and discuss the current clinical applications.
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Affiliation(s)
- Maelys Venet
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Mark K. Friedberg
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Luc Mertens
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jerome Baranger
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Zakaria Jalal
- Department of Congenital and Pediatric Cardiology, Hôpital du Haut-Lévêque, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Ghoufrane Tlili
- Department of Nuclear Medicine, Hôpital du Haut-Lévêque, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Olivier Villemain
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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7
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Chen W, Liu L, Li Y, Li S, Li Z, Zhang W, Zhang X, Wu R, Hu D, Sun H, Zhou Y, Fan W, Zhao Y, Zhang Y, Hu Y. Evaluation of pediatric malignancies using total-body PET/CT with half-dose [ 18F]-FDG. Eur J Nucl Med Mol Imaging 2022; 49:4145-4155. [PMID: 35788704 DOI: 10.1007/s00259-022-05893-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/25/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To explore the impact of a true half dose of [18F]-FDG on image quality in pediatric oncological patients undergoing total-body PET/CT and investigate short acquisition times with half-dose injected activity. METHODS One hundred pediatric oncological patients who underwent total-body PET/CT using the uEXPLORER scanner after receiving a true half dose of [18F]-FDG (1.85 MBq/kg) were retrospectively enrolled. The PET images were first reconstructed using complete 600-s data and then split into 300-s, 180-s, 60-s, 40-s, and 20-s duration groups (G600 to G20). The subjective analysis was performed using 5-point Likert scales. Objective quantitative metrics included the maximum standard uptake value (SUVmax), SUVmean, standard deviation (SD), signal-to-noise ratio (SNR), and SNRnorm of the background. The variabilities in lesion SUVmean, SUVmax, and tumor-to-background ratio (TBR) were also calculated. RESULTS The overall image quality scores in the G600, G300, G180, and G60 groups were 4.9 ± 0.2, 4.9 ± 0.3, 4.4 ± 0.5, and 3.5 ± 0.5 points, respectively. All the lesions identified in the half-dose images were localized in the G60 images, while 56% of the lesions could be clearly identified in the G20 images. With reduced acquisition time, the SUVmax and SD of the backgrounds were gradually increased, while the TBR values showed no statistically significant differences among the groups (all p > 0.1). Using the half-dose images as a reference, the variability in the lesion SUVmax gradually increased from the G180 to G20 images, while the lesion SUVmean remained stable across all age groups. SNRnorm was highly negatively correlated with age. CONCLUSION Total-body PET/CT with a half dose of [18F]-FDG (1.85 MBq/kg, estimated whole-body effective dose: 1.76-2.57 mSv) achieved good performance in pediatric patients, with sufficient image quality and good lesion conspicuity. Sufficient image quality and lesion conspicuity could be maintained at a fast scanning time of 60 s with half-dose activity.
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Affiliation(s)
- Wanqi Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Lei Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Yinghe Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Shatong Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Zhijian Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Weiguang Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Xu Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Runze Wu
- Central Research Institute, United Imaging Healthcare Group Co., Ltd, Shanghai, China
| | - Debin Hu
- Central Research Institute, United Imaging Healthcare Group Co., Ltd, Shanghai, China
| | - Hongyan Sun
- Central Research Institute, United Imaging Healthcare Group Co., Ltd, Shanghai, China
| | - Yun Zhou
- Central Research Institute, United Imaging Healthcare Group Co., Ltd, Shanghai, China
| | - Wei Fan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Yumo Zhao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China.
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.
| | - Yizhuo Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China.
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.
| | - Yingying Hu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China.
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.
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Owaki Y, Minamishima K, Nakajima K. Optimization of pediatric FDG-PET/CT examinations based on physical indicators using the SiPM-PET/CT system. Nucl Med Commun 2022; 43:433-441. [PMID: 35045549 DOI: 10.1097/mnm.0000000000001527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to investigate the appropriate Silicon photomultiplier -PET/CT acquisition and image reconstruction conditions for each age group. METHODS The original phantom was developed to reflect the thickness and width of the torso in each age group (neonates, 1-year-olds, 5-year-olds, 10-year-olds, 15-year-olds, and adults). The ratio of hot spheres to background radioactivity was 4:1, and the radioactivity concentration was adjusted according to the Japanese consensus guidelines for appropriate implementation of pediatric nuclear medicine examinations. We evaluated the root mean square error (RMSE) as an assessment/function of the standardized uptake value of each hot sphere, the background variability (N10 mm), the % contrast of the hot sphere (QH, 10 mm/N10 mm), and the noise equivalent counts to determine the optimal reconstruction parameters and the appropriate acquisition time. RESULTS The minimum RMSE was obtained by setting the half-width of the Gaussian filter to 0-2 mm for iteration 1 or 2 and to 2-4 mm for iteration 3 or more. The acquisition times that satisfied the image quality equivalent to 120 s acquisitions in the adult phantoms were 30 s in the neonatal and 1-year-old phantoms, 60 s in the 5- and 10-year-old phantoms, and 75 s in the 15-year-old phantoms. CONCLUSION This study demonstrated that good PET images could be obtained with short acquisition times when the examination is performed under appropriate reconstruction conditions.
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Affiliation(s)
- Yoshiki Owaki
- Office of Radiation Technology, Keio University Hospital
- Department of Radiological Sciences, Tokyo Metropolitan University, Japan
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García Cañamaque L, Field CA, Furtado FS, Plaza DE Las Heras I, Husseini JS, Balza R, Jarraya M, Catalano OA, Mitjavila Casanovas M. Contribution of positron emission tomography/magnetic resonance imaging in musculoskeletal malignancies. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2022; 66:3-14. [PMID: 34881853 DOI: 10.23736/s1824-4785.21.03432-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Positron emission tomography/computed tomography (PET/CT) is a promising hybrid imaging technique for evaluating musculoskeletal malignancies. Both technologies, independently are useful for evaluating this type of tumors. PET/MR has great potential combining metabolic and functional imaging PET with soft tissue contrast and multiparametric sequences of MR. In this paper we review the existing literature and discuss the different protocols, new available radiotracers to conclude with the scarce evidence available the most useful/probable indications of the PET MR for the for musculoskeletal malignancies.
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Affiliation(s)
- Lina García Cañamaque
- Department of Nuclear Medicine, Madrid Sanchinarro University Hospital, Madrid, Spain -
| | - Caroline A Field
- Department of Nuclear Medicine, Madrid Sanchinarro University Hospital, Madrid, Spain
| | - Felipe S Furtado
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Jad S Husseini
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Rene Balza
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Mohamed Jarraya
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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10
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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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11
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Srivastava MK, Pagala RM, Kendarla V, Nallapareddy K. Technetium-99m methylene diphosphonate bone scan in evaluation of insufficiency fractures - A pictorial assay and experience from South India. World J Nucl Med 2021; 20:355-360. [PMID: 35018150 PMCID: PMC8686751 DOI: 10.4103/wjnm.wjnm_155_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/21/2021] [Accepted: 06/17/2021] [Indexed: 11/04/2022] Open
Abstract
Insufficiency fractures (IFs) can be challenging to diagnose due to varied presentations, and sometimes, it changes the course of treatment, as in cancer patients in whom it has to be differentiated with metastatic disease. We present the role of Technetium 99m methylene diphosphonate (99mTc-MDP) bone scan, which is a low-cost, simple to perform, whole body diagnostic investigation in the diagnosis of IFs. This is a retrospective analysis of all patients who underwent a 99mTc-MDP bone scan in a tertiary care teaching hospital during 2013-2017 and were diagnosed as having an IF on bone scan. The bone scans were performed on a dual-head gamma camera using low-energy high-resolution collimators. Of all the bone scan performed during 2013-2017, a total of 138 patients with a mean age of 57.5 ± 14.7 years were diagnosed as having IFs based on bone scan and final clinical diagnosis. Among them, the most common complaint was regional bony pain in 62% of patients, while the most common cause was osteoporosis in 47% of patients, both postmenopausal and senile osteoporosis. In all, 265 sites of fractures were identified with a fracture average of 1.9/patient, the most common site being dorsolumbar vertebrae, followed by ribs and lower limb bones. Many unusual sites were also identified such as talus, sternum, clavicle, and scapula. 99mTc-MDP bone scan, being noninvasive whole-body imaging, is a useful investigation for evaluation of IFs and in correlation with biochemical analysis and other imaging can be used to determine the etiology of IF.
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Affiliation(s)
- Madhur Kumar Srivastava
- Department of Nuclear Medicine, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Ram Manohar Pagala
- Department of Nuclear Medicine, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Vinodh Kendarla
- Department of Nuclear Medicine, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Kavitha Nallapareddy
- Department of Nuclear Medicine, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
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12
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Earl VJ, Baker LJ, Perdomo AA. Effective doses and associated age-related risks for common paediatric diagnostic nuclear medicine and PET procedures at a large Australian paediatric hospital. J Med Imaging Radiat Oncol 2021; 66:7-13. [PMID: 34110081 DOI: 10.1111/1754-9485.13257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/13/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Effective dose alone cannot be used to specify and communicate the radiation risk for an individual as risks are dependent on many factors including age and gender. There are limited published data regarding age-specific effective doses and the associated lifetime risk of developing cancers for paediatrics. In this study, we have estimated the typical effective doses for six commonly performed paediatric nuclear medicine and positron emission tomography (PET) studies at the Royal Children's Hospital, Melbourne, Australia. Effective doses were used to estimate and categorise associated stochastic risks with commonly used risk terminology. METHODS Paediatric protocols for common nuclear medicine and PET studies and the World Health Organization (WHO) 50th percentile weight-for-age data for females and males aged up to 18 years were used to estimate typical organ and effective doses using ICRP dosimetric tables for radiopharmaceuticals and lifetime risk of cancer incidence using BEIR VII Phase 2 report data. Results were used to determine standardised levels of risk. RESULTS Organ doses, effective doses, corresponding lifetime risk of cancer incidence and level of risk category from six common nuclear medicine and PET studies for paediatric patients were calculated and presented for ease of communication. CONCLUSION Typical effective doses from common paediatric nuclear medicine and PET studies and the associated lifetime risk of cancer incidence and level of risk have been established for our institution. This can be used to convey risks to health professionals, patients and carers in ways that are easy to understand and compare with other everyday risks.
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Affiliation(s)
- Victoria J Earl
- Department of Medical Imaging, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Luke J Baker
- Department of Medical Imaging, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Amanda A Perdomo
- Department of Medical Imaging, The Royal Children's Hospital, Melbourne, Victoria, Australia
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13
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Zhao YM, Li YH, Chen T, Zhang WG, Wang LH, Feng J, Li C, Zhang X, Fan W, Hu YY. Image quality and lesion detectability in low-dose pediatric 18F-FDG scans using total-body PET/CT. Eur J Nucl Med Mol Imaging 2021; 48:3378-3385. [PMID: 33738519 DOI: 10.1007/s00259-021-05304-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the effects of dose reduction on image quality and lesion detectability of oncological 18F-FDG total-body PET/CT in pediatric oncological patients and explore the minimum threshold of administered tracer activity. METHODS A total of 33 pediatric patients (weight 8.5-58.5 kg; age 0.8-17.6 years) underwent total-body PET/CT using uEXPLORER scanner with an 18F-FDG administered dose of 3.7 MBq/kg and an acquisition time of 600 s were retrospectively enrolled. Low-dose images (0.12-1.85 MBq/kg) were simulated by truncating the list-mode PET data to reducing count density. Subjective image quality was rated on a 5-point scale. Semi-quantitative uptake metrics for low-dose images were assessed using region-of-interest (ROI) analysis of healthy liver and suspected lesions and were compared with full-dose images. The micro-lesion detectability was compared among the dose-dependent PET images. RESULTS Our analysis shows that sufficient subjective image quality and lesion conspicuity could be maintained down to 1/30th (0.12 MBq/kg) of the administered dose of 18F-FDG, where good image quality scores were given to 1/2- and 1/10- dose groups. The image noise was significantly more deranged than the overall quality and lesion conspicuity in 1/30- to 1/10-dose groups (all p < 0.05). With reduced doses, quantitative analysis of ROIs showed that SUVmax and SD in the liver increased gradually (p < 0.05), but SUVmax in the lesions and lesion-to-background ratio (LBR) showed no significant deviation down to 1/30-dose. One hundred percent of the 18F-FDG-avid micro-lesions identified in full-dose images were localized down to 1/15-dose images, while 97% of the lesion were localized in 1/30-dose images. CONCLUSION The total-body PET/CT might significantly decrease the administered dose upon maintaining the image quality and diagnostic performance of micro-lesions in pediatric patients. Data suggests that using total-body PET/CT, optimal image quality could be achieved with an administered dose-reduction down to 1/10-dose (0.37 MBq/kg).
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Affiliation(s)
- Yu-Mo Zhao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China
| | - Ying-He Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China
| | - Tao Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China
| | - Wei-Guang Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China
| | - Lin-Hao Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China
| | - Jiatai Feng
- Central research institute, United Imaging Healthcare, Shanghai, China
| | - Chenwei Li
- Central research institute, United Imaging Healthcare, Shanghai, China
| | - Xu Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China. .,Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China.
| | - Wei Fan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China. .,Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China.
| | - Ying-Ying Hu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China. .,Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China.
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14
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Lee DY, Kye YU, Kim HJ, Kim JK, Kang YR. Gonad dose assessment in paediatric kidney nuclear medicine test using Monte Carlo simulation. JOURNAL OF RADIATION RESEARCH 2020; 61:895-902. [PMID: 32930783 PMCID: PMC7674698 DOI: 10.1093/jrr/rraa080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/10/2020] [Accepted: 08/18/2020] [Indexed: 06/11/2023]
Abstract
In this study, we evaluated the effect of radiation dose on gonads during paediatric kidney nuclear medicine tests. Using Monte Carlo simulations, the distribution and effects of radiation were physically evaluated by displaying the distribution path of the source in the human body over time. In particular, the evaluation of doses in children, who are sensitive to radiation during nuclear medicine tests that use internal exposure among several types of medical exposures, was conducted to obtain data for the management of medical exposures. Our results indicated that under normal kidney function, the dose received by the target kidney was 0.430 mGy/mCi, which is ~6% higher than the dose suggested by the International Commission on Radiation Protection (ICRP). Furthermore, when kidney function was compromised, the dose estimated was 0.726 mGy/mCi, which is ~2% lower than the dose suggested by the ICRP. In the male and female gonads, namely the testicles and ovaries, the doses received were 0.359 mGy/mCi and 0.394 mGy/mCi, respectively, under normal kidney function. Similarly, under abnormal kidney function, the doses ranged from 0.187 to 0.353 mGy/mCi and 0.238 to 0.388 mGy/mCi in the male and female gonads, respectively.
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Affiliation(s)
- Dong-Yeon Lee
- Dongnam Institute of Radiological & Medical Sciences, (46033) 40, Jwadong-gil, Jangan-eup, Gijang-gun, Busan, Republic of Korea
| | - Yong-Uk Kye
- Dongnam Institute of Radiological & Medical Sciences, (46033) 40, Jwadong-gil, Jangan-eup, Gijang-gun, Busan, Republic of Korea
| | - Hyo-Jin Kim
- Dongnam Institute of Radiological & Medical Sciences, (46033) 40, Jwadong-gil, Jangan-eup, Gijang-gun, Busan, Republic of Korea
| | - Jeung-Kee Kim
- Dongnam Institute of Radiological & Medical Sciences, (46033) 40, Jwadong-gil, Jangan-eup, Gijang-gun, Busan, Republic of Korea
| | - Yeong-Rok Kang
- Dongnam Institute of Radiological & Medical Sciences, (46033) 40, Jwadong-gil, Jangan-eup, Gijang-gun, Busan, Republic of Korea
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15
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Schmall JP, Surti S, Otero HJ, Servaes S, Karp JS, States LJ. Investigating Low-Dose Image Quality in Whole-Body Pediatric 18F-FDG Scans Using Time-of-Flight PET/MRI. J Nucl Med 2020; 62:123-130. [DOI: 10.2967/jnumed.119.240127] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/07/2020] [Indexed: 12/20/2022] Open
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16
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Dong X, Lei Y, Wang T, Higgins K, Liu T, Curran WJ, Mao H, Nye JA, Yang X. Deep learning-based attenuation correction in the absence of structural information for whole-body positron emission tomography imaging. Phys Med Biol 2020; 65:055011. [PMID: 31869826 PMCID: PMC7099429 DOI: 10.1088/1361-6560/ab652c] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Deriving accurate structural maps for attenuation correction (AC) of whole-body positron emission tomography (PET) remains challenging. Common problems include truncation, inter-scan motion, and erroneous transformation of structural voxel-intensities to PET µ-map values (e.g. modality artifacts, implanted devices, or contrast agents). This work presents a deep learning-based attenuation correction (DL-AC) method to generate attenuation corrected PET (AC PET) from non-attenuation corrected PET (NAC PET) images for whole-body PET imaging, without the use of structural information. 3D patch-based cycle-consistent generative adversarial networks (CycleGAN) is introduced to include NAC-PET-to-AC-PET mapping and inverse mapping from AC PET to NAC PET, which constrains NAC-PET-to-AC-PET mapping to be closer to one-to-one mapping. Since NAC PET images share similar anatomical structures to the AC PET image but lack contrast information, residual blocks, which aim to learn the differences between NAC PET and AC PET, are used to construct generators of CycleGAN. After training, patches from NAC PET images were fed into NAC-PET-to-AC-PET mapping to generate DL-AC PET patches. DL-AC PET image was then reconstructed through patch fusion. We conducted a retrospective study on 55 datasets of whole-body PET/CT scans to evaluate the proposed method. In comparing DL-AC PET with original AC PET, average mean error (ME) and normalized mean square error (NMSE) of the whole-body were 0.62% ± 1.26% and 0.72% ± 0.34%. The average intensity changes measured on sequential PET images with AC and DL-AC on both normal tissues and lesions differ less than 3%. There was no significant difference of the intensity changes between AC and DL-AC PET, which demonstrate DL-AC PET images generated by the proposed DL-AC method can reach a same level to that of original AC PET images. The method demonstrates excellent quantification accuracy and reliability and is applicable to PET data collected on a single PET scanner or hybrid platform with computed tomography (PET/CT) or magnetic resonance imaging (PET/MRI).
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Affiliation(s)
- Xue Dong
- Department of Radiation Oncology, Emory University, Atlanta, GA
| | - Yang Lei
- Department of Radiation Oncology, Emory University, Atlanta, GA
| | - Tonghe Wang
- Department of Radiation Oncology, Emory University, Atlanta, GA
| | - Kristin Higgins
- Department of Radiation Oncology, Emory University, Atlanta, GA
- Winship Cancer Institute, Emory University, Atlanta, GA
| | - Tian Liu
- Department of Radiation Oncology, Emory University, Atlanta, GA
- Winship Cancer Institute, Emory University, Atlanta, GA
| | - Walter J. Curran
- Department of Radiation Oncology, Emory University, Atlanta, GA
- Winship Cancer Institute, Emory University, Atlanta, GA
| | - Hui Mao
- Winship Cancer Institute, Emory University, Atlanta, GA
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Jonathon A. Nye
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Xiaofeng Yang
- Department of Radiation Oncology, Emory University, Atlanta, GA
- Winship Cancer Institute, Emory University, Atlanta, GA
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Saito H, Ito T, Omachi K, Inugami A, Yamaguchi M, Tsushima M, Mariya Y, Kashiwakura I. Effectiveness of the smoothing filter in pediatric 99mTc-dimercaptosuccinic acid renal scintigraphy. Radiol Phys Technol 2020; 13:104-110. [PMID: 31993983 DOI: 10.1007/s12194-020-00553-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/18/2020] [Accepted: 01/20/2020] [Indexed: 11/27/2022]
Abstract
The present study aimed to evaluate whether the use of a smoothing filter would improve the image quality in pediatric 99mTc-dimercaptosuccinic acid (99mTc-DMSA) scintigraphy. We retrospectively reviewed 31 kidneys in 16 consecutive pediatric patients aged 10 months to 14 years. The administered dose was calculated using a weight-based method. Two reviewers randomly evaluated the original planar posterior images and smoothing filter image; they assessed image quality and performed defect evaluations. The evaluation of visual image quality yielded significantly better results for the smoothing filter images than for the original images. Although the smoothing filter images were slightly inferior to the original images in terms of edge sharpness, no significant difference was observed in the defect evaluation. We confirmed that 99mTc-DMSA scintigraphy with a smoothing filter yielded reduced image noise, while maintaining defect evaluation performance and improving image quality.
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Affiliation(s)
- Hitoshi Saito
- Department of Radiology, Akita Kousei Medical Center, 1-1-1 Iijima Nishibukuro, Akita, 011-0948, Japan.
| | - Teruhiro Ito
- Department of Radiology, Akita Kousei Medical Center, 1-1-1 Iijima Nishibukuro, Akita, 011-0948, Japan
| | - Koichi Omachi
- Department of Radiology, Akita Kousei Medical Center, 1-1-1 Iijima Nishibukuro, Akita, 011-0948, Japan
| | - Atsushi Inugami
- Department of Radiology, Akita Kousei Medical Center, 1-1-1 Iijima Nishibukuro, Akita, 011-0948, Japan
| | - Masaru Yamaguchi
- Department of Radiological Life Sciences, Hirosaki University Graduate School of Health Science, 66-1 Hon-cho, Hirosaki, Aomori, 036-8564, Japan
| | - Megumi Tsushima
- Department of Radiological Life Sciences, Hirosaki University Graduate School of Health Science, 66-1 Hon-cho, Hirosaki, Aomori, 036-8564, Japan
| | - Yasushi Mariya
- Department of Radiology, Mutsu General Hospital, 1-2-8 Kogawamachi, Mutsu, Aomori, 035-8601, Japan
| | - Ikuo Kashiwakura
- Department of Radiological Life Sciences, Hirosaki University Graduate School of Health Science, 66-1 Hon-cho, Hirosaki, Aomori, 036-8564, Japan
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18
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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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19
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Rao R, Browne D, Lunt B, Perry D, Reed P, Kelly P. Radiation doses in diagnostic imaging for suspected physical abuse. Arch Dis Child 2019; 104:863-868. [PMID: 30995983 DOI: 10.1136/archdischild-2018-316286] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/21/2019] [Accepted: 03/28/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To measure the actual radiation dose delivered by imaging techniques commonly used in the radiography of suspected physical abuse and to make this information available to health professionals and families. METHODS Data were collected retrospectively on children under 3 years referred for skeletal surveys for suspected physical abuse, non-contrast CT head scan or radionuclide imaging of the bones in Starship Children's Hospital, Auckland, New Zealand from January to December 2015. Patient size-specific conversion coefficients were derived from International Commission on Radiologic Protection tissue weighting factors and used to calculate effective dose. RESULTS Seventy-one patients underwent an initial skeletal survey, receiving a mean effective dose of 0.20 mSv (95% CI 0.18 to 0.22). Sixteen patients had a follow-up survey with a mean effective dose of 0.10 mSv (95% CI 0.08 to 0.11). Eighty patients underwent CT head which delivered a mean effective dose of 2.49 mSv (95% CI 2.37 to 2.60). Thirty-nine patients underwent radionuclide bone imaging which delivered a mean effective dose of 2.27 mSv (95% CI 2.11 to 2.43). CONCLUSIONS In a paediatric centre, skeletal surveys deliver a relatively low effective radiation dose, equivalent to approximately 1 month of background radiation. Non-contrast CT head scan and radionuclide bone imaging deliver similar doses, equivalent to approximately 1 year of background radiation. This information should be considered when gaining informed consent and incorporated in patient education handouts.
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Affiliation(s)
- Raylene Rao
- Te Puaruruhau (Child Protection Team), Starship Children's Health, Auckland, New Zealand
| | - Diana Browne
- Department of Paediatric Radiology, Starship Children's Health, Auckland, New Zealand
| | - Brian Lunt
- Department of Paediatric Radiology, Starship Children's Health, Auckland, New Zealand.,Auckland City Hospital, Department of Nuclear Medicine, Auckland, New Zealand
| | - David Perry
- Department of Paediatric Radiology, Starship Children's Health, Auckland, New Zealand
| | - Peter Reed
- Children's Research Centre, Starship Children's Health, Auckland, New Zealand
| | - Patrick Kelly
- Te Puaruruhau (Child Protection Team), Starship Children's Health, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
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20
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Kuahara L, Corrêa E, Carneiro R, Bezerra R, Potiens M. Influence of the vials radioactive residue in Nuclear Medicine procedure applied to a new “in situ” activimeter calibration methodology. Radiat Phys Chem Oxf Engl 1993 2019. [DOI: 10.1016/j.radphyschem.2018.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Younger C, Wagner M, Douglas C, Warren-Forward H. Describing ionising radiation risk in the clinical setting: A systematic review. Radiography (Lond) 2019; 25:83-90. [DOI: 10.1016/j.radi.2018.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 11/07/2018] [Accepted: 11/09/2018] [Indexed: 10/27/2022]
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22
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Sanchez-Crespo A. Lung Ventilation/Perfusion Single Photon Emission Computed Tomography (SPECT) in Infants and Children with Nonembolic Chronic Pulmonary Disorders. Semin Nucl Med 2019; 49:37-46. [DOI: 10.1053/j.semnuclmed.2018.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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23
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Successful Localization of the Source of Hemorrhage in Patient with Post-Whipple Surgery by 99mTc-Labelled Red Blood Cell Scintigraphy. Case Rep Radiol 2018; 2018:1381203. [PMID: 30186654 PMCID: PMC6114244 DOI: 10.1155/2018/1381203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/31/2018] [Indexed: 11/19/2022] Open
Abstract
Gastrointestinal Bleeding Scintigraphy (GIBS) of 99mTc-labelled red blood cells is a relatively simple examination to perform, with high diagnostic accuracy and a relatively lower radiation dose. A positive scan can either suggest surgery without further investigation or can indicate angiography, a more targeted procedure. Whipple pancreatoduodenectomy is most often performed for tumors of the head of the pancreas. Pancreatoduodenectomy has 30%–40% morbidity and mortality, and while post-pancreatoduodenectomy hemorrhage is seen in less than 10% of patients, it accounts for 11%–38% mortality. The role of imaging in patients to detect relative hemodynamic stability is essential. Computed tomography angiography (CTA) shows the cause, site, and nature of bleeding, while digital subtraction angiography (DSA) has a diagnostic as well as a therapeutic role. We present a patient who presented with active gastrointestinal bleeding (GI) bleeding after undergoing a Whipple procedure, to highlight the role of GIBS in the successful localization of a bleeding site and the guidance of digital DSA in the embolization and control of the active bleeding.
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24
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Teles P, Costa J, Costa D, Matela N, Vaz P. Activity estimation and biokinetic analysis of 99mTc-DMSA in renal infant patients using a gamma camera. Phys Med 2018; 52:9-17. [PMID: 30139615 DOI: 10.1016/j.ejmp.2018.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/08/2018] [Accepted: 06/09/2018] [Indexed: 10/28/2022] Open
Abstract
Biokinetic data from the administration of radiopharmaceuticals is essential in nuclear medicine dosimetry. It has particular significance in children, as their metabolism is very different from adults. Biokinetic models for paediatric patients could therefore need to be adapted to better reflect their absorption, retention and excretion functions, when compared to adults. Obtaining quality in vivo infant or paediatric biokinetic data is then essential to improve the available reference models, which in turn can lead to the optimization of paediatric procedures and protocols in clinical practice. This study analyses the biokinetic behaviour of 99mTc-dimercaptosuccinic acid (DMSA), in 8 infants aged 4 months to 2 years old, through an imaging study using a gamma camera, and compares the obtained values with those obtained with the reference ICRP biokinetic model. The in vivo data was treated using an adapted methodology from the MIRD 16 pamphlet. Activity curves for the liver, the kidney and the whole body, were built, and new effective absorption, retention and excretion half-lives were estimated, and compared with the reference biokinetic parameters of ICRP 128. The obtained residence time in the kidneys of 2.56 h, has a deviation of 30.8% to the ICRP 128 value of 3.70 h. The obtained maximum uptake in the kidneys was of 0.22/A0, which compares to the value of 0.31/A0 for ICRP. The obtained biokinetic parameters were used to estimate the absorbed dose. The obtained dose values are smaller than the reference ICRP 128 ones by 32.1% in the kidneys, and 18.4% in the liver.
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Affiliation(s)
- P Teles
- Grupo de Protecção e Segurança Radiológica, Centro de Ciências e Tecnologias Nucleares (C2TN), CTN/IST, Pólo de Loures. Estrada Nacional 10 (km 139,7), 2695-066 Bobadela LRS, Portugal.
| | - J Costa
- Grupo de Protecção e Segurança Radiológica, Centro de Ciências e Tecnologias Nucleares (C2TN), CTN/IST, Pólo de Loures. Estrada Nacional 10 (km 139,7), 2695-066 Bobadela LRS, Portugal; Departamento de Física, Faculdade de Ciências e Tecnologias da Universidade Nova de Lisboa, Quinta da Torre, Campus Universitário, 2829-516 Caparica, Portugal
| | - D Costa
- Serviço de Medicina Nuclear, Champalimaud Centre for the Unknown, Av. Brasília, 1400-038 Lisboa, Portugal
| | - N Matela
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências da Universidade de Lisboa, Campo Grande 1749-016 Lisboa, Portugal
| | - P Vaz
- Grupo de Protecção e Segurança Radiológica, Centro de Ciências e Tecnologias Nucleares (C2TN), CTN/IST, Pólo de Loures. Estrada Nacional 10 (km 139,7), 2695-066 Bobadela LRS, Portugal
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Behzadi AH, Raza SI, Carrino JA, Kosmas C, Gholamrezanezhad A, Basques K, Matcuk GR, Patel J, Jadvar H. Applications of PET/CT and PET/MR Imaging in Primary Bone Malignancies. PET Clin 2018; 13:623-634. [PMID: 30219192 DOI: 10.1016/j.cpet.2018.05.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Primary bone malignancies are characterized with anatomic imaging. However, in recent years, there has been an increased interest in PET/computed tomography scanning and PET/MRI with fludeoxyglucose F 18 for evaluating and staging musculoskeletal neoplasms. These hybrid imaging modalities have shown promise largely owing to their high sensitivity, ability to perform more thorough staging, and ability to monitor treatment response. This article reviews the current role of PET/computed tomography scanning and PET/MRI in primary malignancies of bone, with an emphasis on imaging characteristics, clinical usefulness, and current limitations.
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Affiliation(s)
| | - Syed Imran Raza
- Department of Radiology, Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10065, USA
| | - John A Carrino
- Department of Radiology and Imaging, 535 East 70th Street, Hospital for Special Surgery, New York, NY 10021, USA
| | - Christos Kosmas
- Department of Radiology and Imaging, University Hospitals of Cleveland, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Ali Gholamrezanezhad
- Division of Musculoskeletal Radiology, Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA 90007, USA
| | - Kyle Basques
- Department of Radiology and Imaging, University Hospitals of Cleveland, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - George R Matcuk
- Division of Musculoskeletal Radiology, Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA 90007, USA
| | - Jay Patel
- Department of Radiology, Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10065, USA
| | - Hossein Jadvar
- Division of Nuclear Medicine, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, USA
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Khamwan K, O'Reilly SE, Plyku D, Goodkind A, Josefsson A, Cao X, Fahey FH, Treves ST, Bolch WE, Sgouros G. Re-evaluation of pediatric 18F-FDG dosimetry: Cristy-Eckerman versus UF/NCI hybrid computational phantoms. Phys Med Biol 2018; 63:165012. [PMID: 30022768 DOI: 10.1088/1361-6560/aad47a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Because of the concerns associated with radiation exposure at a young age, there is an increased interest in pediatric absorbed dose estimates for imaging agents. Almost all reported pediatric absorbed dose estimates, however, have been determined using adult pharmacokinetic data with radionuclide S values that take into account the anatomical differences between adults and children based upon the older Cristy-Eckerman (C-E) stylized phantoms. In this work, we use pediatric model-derived pharmacokinetics to compare absorbed dose and effective dose estimates for 18F-FDG in pediatric patients using S values generated from two different geometries of computational phantoms. Time-integrated activity coefficients of 18F-FDG in brain, lungs, heart wall, kidneys and liver, retrospectively, calculated from 35 pediatric patients at the Boston's Children Hospital were used. The absorbed dose calculation was performed in accordance with the Medical Internal Radiation Dose method using S values generated from the University of Florida/National Cancer Institute (UF/NCI) hybrid phantoms, as well as those from C-E stylized computational phantoms. The effective dose was computed using tissue-weighting factors from ICRP Publication 60 and ICRP Publication 103 for the C-E and UF/NCI, respectively. Substantial differences in the absorbed dose estimates between UF/NCI hybrid pediatric phantoms and the C-E stylized phantoms were found for the lungs, ovaries, red bone marrow and urinary bladder wall. Large discrepancies in the calculated dose values were observed in the bone marrow; ranging between -26% to +199%. The effective doses computed by the UF/NCI hybrid phantom S values were slightly different than those seen using the C-E stylized phantoms with percent differences of -0.7%, 2.9% and 2.5% for a newborn, 1 year old and 5 year old, respectively. Differences in anatomical modeling features among computational phantoms used to perform Monte Carlo-based photon and electron transport simulations for 18F, and very likely for other radionuclides, impact internal organ dosimetry computations for pediatric nuclear medicine studies.
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Affiliation(s)
- Kitiwat Khamwan
- The Russell H Morgan Department of Radiology and Radiological Science, Johns Hopkins University, School of Medicine, Baltimore, MD, United States of America. Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. Chulalongkorn University Biomedical Imaging Group, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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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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Kasraie N, Jordan D, Keup C, Westra S. Optimizing Communication With Parents on Benefits and Radiation Risks in Pediatric Imaging. J Am Coll Radiol 2018; 15:809-817. [PMID: 29555251 DOI: 10.1016/j.jacr.2018.01.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/19/2018] [Accepted: 01/23/2018] [Indexed: 01/20/2023]
Abstract
Effective radiation risk communication is a core competency for radiology care providers and can prevent and resolve potential conflicts while helping achieve effective public health safeguards. The authors present a synopsis of the challenges to holding such dialogue and review published methods for strengthening and maintaining this discourse. Twelve strategies are discussed in this article that can help alleviate concerns about the iatrogenic risk associated with medical imaging using radiation exposure.
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Affiliation(s)
- Nima Kasraie
- Children's Mercy Hospital, Kansas City, Missouri.
| | - David Jordan
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Sjirk Westra
- MassGeneral Hospital for Children, Boston, Massachusetts
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Superiority of 68Ga-DOTATATE over 18F-FDG and anatomic imaging in the detection of succinate dehydrogenase mutation (SDHx )-related pheochromocytoma and paraganglioma in the pediatric population. Eur J Nucl Med Mol Imaging 2017; 45:787-797. [PMID: 29204718 DOI: 10.1007/s00259-017-3896-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 11/21/2017] [Indexed: 01/13/2023]
Abstract
PURPOSE To evaluate and compare diagnostic performance of 68Ga-DOTA(0)-Tyr(3)-octreotate (68Ga-DOTATATE) with 18F-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography-computed tomography (PET/CT) and anatomic imaging using computed tomography and/or magnetic resonance (CT/MR) imaging in detection of SDHx-related pheochromocytomas and paragangliomas (PPGLs) in pediatric patients. METHODS Nine pediatric patients (5:4, girls:boys; 14.6 ± 2.0 years) with an SDHx-related mutation (SDHB:SDHA:SDHD, n = 7:1:1) were included in this retrospective study. At the time of initial diagnosis, 7/9 patients had metastatic disease. They underwent CT/MR imaging along with PET/CT using 68Ga-DOTATATE (n = 9), 18F-FDG (n = 8), and positron emission tomography-magnetic resonance imaging (PET/MR) using 18F-FDG (n = 1). In this manuscript, 18F-FDG PET/CT refers to both 18F-FDG PET/CT and 18F-FDG PET/MR. The per-lesion, per-region, and per-patient detection rates were compared and calculated for each of the imaging modalities. A composite of all functional and anatomic imaging studies served as the imaging comparator. RESULTS Eight out of nine patients were positive for PPGLs on the imaging studies that demonstrated 107 lesions in 22 anatomic regions on the imaging comparator. The per-lesion detection rates for 68Ga-DOTATATE PET/CT, 18F-FDG PET/CT, and CT/MR imaging were 93.5% (95%CI, 87.0% to 97.3%); 79.4% (95%CI, 70.5% to 86.6%); and 73.8% (95%CI, 64.5% to 81.9%), respectively. The per-lesion detection rate for 68Ga-DOTATATE PET/CT was significantly higher than that of 18F-FDG PET/CT (p = 0.001) or CT/MR imaging (p < 0.001). In all of the anatomic regions except abdomen, the per-lesion detection rates for 68Ga-DOTATATE PET/CT was found to be equal or superior to 18F-FDG PET/CT, and CT/MR imaging. The per-region detection rate was 100% (95%CI, 84.6% to 100%) for 68Ga-DOTATATE PET/CT and 90.9% (95%CI, 70.8% to 98.9%) for both 18F-FDG PET/CT and CT/MR imaging. The per-patient detection rates for 68Ga-DOTATATE PET/CT, 18FDG PET/CT, and CT/MR imaging were all 100% (95%CI, 63.1% to 100%). CONCLUSION Our preliminary study demonstrates the superiority of 68Ga-DOTATATE PET/CT in localization of SDHx-related PPGLs in pediatric population compared to 18F-FDG PET/CT and CT/MR imaging with the exception of abdominal (excluding adrenal and liver) lesions, and suggests that it might be considered as a first-line imaging modality in pediatric patients with SDHx-related PPGLs.
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30
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Practices and attitudes towards radiation risk disclosure for computed tomography: survey of emergency medicine residency program directors. Emerg Radiol 2017; 24:479-486. [DOI: 10.1007/s10140-017-1493-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 03/02/2017] [Indexed: 10/19/2022]
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31
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Yoneyama H, Nakajima K, Okuda K, Matsuo S, Onoguchi M, Kinuya S, Edenbrandt L. Reducing the small-heart effect in pediatric gated myocardial perfusion single-photon emission computed tomography. J Nucl Cardiol 2017; 24:1378-1388. [PMID: 27197818 DOI: 10.1007/s12350-016-0518-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 04/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND We compared two reconstruction algorisms and two cardiac functional evaluation software programs in terms of their accuracy for estimating ejection fraction (EF) of small hearts (SH). METHODS The study group consisted of 66 pediatric patients. Data were reconstructed using a filtered back projection (FBP) method without the resolution correction (RC) and an iterative method based on an ordered subset expectation maximization (OSEM) algorithm with the RC. EF was evaluated using two software programs of quantitative gated single-photon emission computed tomography (SPECT) (QGS) and cardioREPO. We compared the EF of gated myocardial perfusion SPECT to echocardiographic measurement (Echo). RESULTS Forty-eight of 66 patients had an end-systolic volume < 20 mL which was used as the criterion for being included in the SH group, and the SH effect led to an overestimation of EF. While significant differences were observed between Echo (66.9 ± 5.0%) and QGS-FBP without RC (76.9 ± 8.4%, P < .0001), QGS-OSEM with RC (76.6 ± 8.6%, P < .0001), and cardioREPO-FBP without RC (72.1 ± 10.0%, P = .0011), no significant difference was observed between Echo and cardioREPO-OSEM with RC (67.4 ± 6.1%) in SH group. CONCLUSIONS In pediatric gated myocardial perfusion SPECT, the SH effect can be significantly reduced when an OSEM algorithm is used with RC in combination with the specific cardioREPO algorithm.
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Affiliation(s)
- Hiroto Yoneyama
- Department of Radiological Technology, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
| | - Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Koichi Okuda
- Department of Physics, Kanazawa Medical University, Kanazawa, Japan
| | - Shinro Matsuo
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Masahisa Onoguchi
- Department of Health Science, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Seigo Kinuya
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Lars Edenbrandt
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
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Fahey FH, Goodkind A, MacDougall RD, Oberg L, Ziniel SI, Cappock R, Callahan MJ, Kwatra N, Treves ST, Voss SD. Operational and Dosimetric Aspects of Pediatric PET/CT. J Nucl Med 2017; 58:1360-1366. [PMID: 28687601 DOI: 10.2967/jnumed.116.182899] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/05/2017] [Indexed: 01/04/2023] Open
Abstract
No consistent guidelines exist for the acquisition of a CT scan as part of pediatric PET/CT. Given that children may be more vulnerable to the effects of ionizing radiation, it is necessary to develop methods that provide diagnostic-quality imaging when needed, in the shortest time and with the lowest patient radiation exposure. This article describes the basics of CT dosimetry and PET/CT acquisition in children. We describe the variability in pediatric PET/CT techniques, based on a survey of 19 PET/CT pediatric institutions in North America. The results of the survey demonstrated that, although most institutions used automatic tube current modulation, there remained a large variation of practice, on the order of a factor of 2-3, across sites, pointing to the need for guidelines. We introduce the approach developed at our institution for using a multiseries PET/CT acquisition technique that combines diagnostic-quality CT in the essential portion of the field of view and a low-dose technique to image the remainder of the body. This approach leads to a reduction in radiation dose to the patient while combining the PET and the diagnostic CT into a single acquisition. The standardization of pediatric PET/CT provides an opportunity for a reduction in the radiation dose to these patients while maintaining an appropriate level of diagnostic image quality.
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Affiliation(s)
- Frederic H Fahey
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts .,Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Alison Goodkind
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Robert D MacDougall
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Leah Oberg
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Sonja I Ziniel
- Section of Pediatric Hospital Medicine, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado; and
| | - Richard Cappock
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Michael J Callahan
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts.,Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Neha Kwatra
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts.,Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - S Ted Treves
- Department of Radiology, Harvard Medical School, Boston, Massachusetts.,Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stephan D Voss
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts.,Department of Radiology, Harvard Medical School, Boston, Massachusetts
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Jaramillo D, Dormans JP, Delgado J, Laor T, St Geme JW. Hematogenous Osteomyelitis in Infants and Children: Imaging of a Changing Disease. Radiology 2017; 283:629-643. [DOI: 10.1148/radiol.2017151929] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Low-dose computed tomography scans with automatic exposure control for patients of different ages undergoing cardiac PET/CT and SPECT/CT. Nucl Med Commun 2017; 38:546-555. [PMID: 28430740 DOI: 10.1097/mnm.0000000000000679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to evaluate the efficacy of automatic exposure control (AEC) in order to optimize low-dose computed tomography (CT) protocols for patients of different ages undergoing cardiac PET/CT and single-photon emission computed tomography/computed tomography (SPECT/CT). METHODS One PET/CT and one SPECT/CT were used to acquire CT images for four anthropomorphic phantoms representative of 1-year-old, 5-year-old and 10-year-old children and an adult. For the hybrid systems investigated in this study, the radiation dose and image quality of cardiac CT scans performed with AEC activated depend mainly on the selection of a predefined image quality index. Multiple linear regression methods were used to analyse image data from anthropomorphic phantom studies to investigate the effects of body size and predefined image quality index on CT radiation dose in cardiac PET/CT and SPECT/CT scans. RESULTS The regression relationships have a coefficient of determination larger than 0.9, indicating a good fit to the data. According to the regression models, low-dose protocols using the AEC technique were optimized for patients of different ages. In comparison with the standard protocol with AEC activated for adult cardiac examinations used in our clinical routine practice, the optimized paediatric protocols in PET/CT allow 32.2, 63.7 and 79.2% CT dose reductions for anthropomorphic phantoms simulating 10-year-old, 5-year-old and 1-year-old children, respectively. The corresponding results for cardiac SPECT/CT are 8.4, 51.5 and 72.7%. CONCLUSION AEC is a practical way to reduce CT radiation dose in cardiac PET/CT and SPECT/CT, but the AEC settings should be determined properly for optimal effect. Our results show that AEC does not eliminate the need for paediatric protocols and CT examinations using the AEC technique should be optimized for paediatric patients to reduce the radiation dose as low as reasonably achievable.
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Teles P, Mendes M, Zankl M, de Sousa V, Santos AI, Vaz P. Assessment of the Absorbed Dose in the Kidney of Nuclear Nephrology Paediatric Patients using ICRP Biokinetic Data and Monte Carlo Simulations with Mass-Scaled Paediatric Voxel Phantoms. RADIATION PROTECTION DOSIMETRY 2017; 174:121-135. [PMID: 27103650 DOI: 10.1093/rpd/ncw096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 03/11/2016] [Indexed: 06/05/2023]
Abstract
The aim of this work is to use Monte Carlo simulations and VOXEL phantoms to estimate the absorbed dose in paediatric patients (aged from 2 weeks to 16 y), with normal renal function, to whom technetium-99m-dimercaptosuccinic acid (99mTc-DMSA) was administered, for diagnostic renal scintigraphy purposes; and compare them with values obtained using the International Commission on Radiological Protection (ICRP) methodology. In the ICRP methodology, the cumulated absorbed dose in the kidneys is estimated by multiplying the administered activity with the corresponding given dose coefficients. The other methods were based on Monte Carlo simulations performed on two paediatric voxel phantoms (CHILD and BABY), and another three phantoms, which were modified to suit the mass of the patients' kidneys, and other anatomical factors. Different S-values were estimated using this methodology, which together with solving the ICRP biokinetic model to determine the cumulated activities, allowed for the estimation of absorbed doses different from those obtained with the ICRP method, together with new dose coefficients. The obtained values were then compared. The deviations suggest that the S-values are strongly dependent on the patient's total body weight, which could be in contrast with the ICRP data, which is provided by age, regardless of other anatomical parameters.
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Affiliation(s)
- P Teles
- Grupo de Protecção e Segurança Radiológica, Centro de Ciências e Tecnologias Nucleares (C2TN), CTN/IST, Pólo de Loures. Estrada Nacional 10 (km 139,7), 2695-066 Bobadela LRS, Portugal
| | - M Mendes
- Grupo de Protecção e Segurança Radiológica, Centro de Ciências e Tecnologias Nucleares (C2TN), CTN/IST, Pólo de Loures. Estrada Nacional 10 (km 139,7), 2695-066 Bobadela LRS, Portugal
| | - M Zankl
- Helmholtz Zentrum München - German Research Center for Environmental Health (HMGU), Department of Radiation Sciences, Research Unit Medical Radiation Physics and Diagnostics, Ingolstaedter Landstr. 1, 85764 Neuherberg, Germany
| | - V de Sousa
- Grupo de Protecção e Segurança Radiológica, Centro de Ciências e Tecnologias Nucleares (C2TN), CTN/IST, Pólo de Loures. Estrada Nacional 10 (km 139,7), 2695-066 Bobadela LRS, Portugal
| | - A I Santos
- Serviço de Medicina Nuclear, Hospital Garcia de Orta, E.P.E. Av. Torrado da Silva, 2801-951 Almada, Portugal
| | - P Vaz
- Grupo de Protecção e Segurança Radiológica, Centro de Ciências e Tecnologias Nucleares (C2TN), CTN/IST, Pólo de Loures. Estrada Nacional 10 (km 139,7), 2695-066 Bobadela LRS, Portugal
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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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Abstract
There is emerging evidence suggesting that PET/MR imaging will have a role in many aspects of musculoskeletal imaging. The synergistic potential of hybrid PET/MR imaging in terms of acquiring anatomic, molecular, and functional data simultaneously seems advantageous in the diagnostic workup, treatment planning and monitoring, and follow-up of patients with musculoskeletal malignancies, and may also prove helpful in assessment of musculoskeletal infectious and inflammatory disorders. The application of more sophisticated MR imaging sequences and PET radiotracers other than FDG in the diagnostic workup and follow-up of patients with musculoskeletal disorders should be explored.
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Estimated cumulative radiation dose received by diagnostic imaging during staging and treatment of operable Ewing sarcoma 2005-2012. Pediatr Radiol 2017; 47:82-88. [PMID: 27815616 DOI: 10.1007/s00247-016-3720-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/29/2016] [Accepted: 09/27/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patients with Ewing sarcoma are subject to various diagnostic procedures that incur exposure to ionising radiation. OBJECTIVE To estimate the radiation doses received from all radiologic and nuclear imaging episodes during diagnosis and treatment, and to determine whether 18F-fluorodeoxyglucose positron emission tomography - computed tomography (18F-FDG PET-CT) is a major contributor of radiation. MATERIALS AND METHODS Twenty Ewing sarcoma patients diagnosed in Norway in 2005-2012 met the inclusion criteria (age <30 years, operable disease, uncomplicated chemotherapy and surgery, no metastasis or residual disease within a year of diagnosis). Radiation doses from all imaging during the first year were calculated for each patient. RESULTS The mean estimated cumulative radiation dose for all patients was 34 mSv (range: 6-70), radiography accounting for 3 mSv (range: 0.2-12), CT for 13 mSv (range: 2-28) and nuclear medicine for 18 mSv (range: 2-47). For the patients examined with PET-CT, the mean estimated cumulative effective dose was 38 mSv, of which PET-CT accounted for 14 mSv (37%). CONCLUSION There was large variation in number and type of examinations performed and also in estimated cumulative radiation dose. The mean radiation dose for patients examined with PET-CT was 23% higher than for patients not examined with PET-CT.
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Owens C, Li BK, Thomas KE, Irwin MS. Surveillance imaging and radiation exposure in the detection of relapsed neuroblastoma. Pediatr Blood Cancer 2016; 63:1786-93. [PMID: 27304424 DOI: 10.1002/pbc.26099] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/10/2016] [Accepted: 05/16/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND More than half of children with high-risk neuroblastoma (NB) will experience recurrence. Radiologic imaging is used for initial staging and during therapy to assess response. However, the role of surveillance imaging in the detection of relapse has not been well studied. Surveillance potentially results in high cumulative exposure to ionizing radiation, which may be associated with an increased risk of developing second malignancies. PROCEDURE We reviewed NB cases at our institution between 2000 and 2011. We calculated radiation exposure due to imaging (during diagnosis, treatment, and posttherapy surveillance) using cumulative effective dose (CED) estimates and determined whether cross-sectional imaging identified recurrences. RESULTS Fifty of 183 patients with NB experienced a recurrence. The median time from diagnosis to relapse was 1.20 years (range: 0.18-6.66 years). Most patients had evidence of metastases and only 4 of 50 patients presented with isolated primary tumor site recurrences. The mean CED prior to relapse was 125.2 mSv (range: 24.5-259.7), 64% of which was from computed tomography (CT) scans. Thirty-seven of 50 patients had clinically evident or measurable disease detected by X-ray (XR), ultrasound (US), or urinary catecholamines (UCats), and the addition of metaiodobenzylguanidine (MIBG) scans identified eight additional recurrences. Thus, cross-sectional imaging (CT/MRI, where MRI is magnetic resonance imaging) was only required to identify 10% (5/50) of cases. CONCLUSION Relapsed disease was detected in most patients by symptoms/exam, MIBG scan, UCats, and/or XR/US, supporting reduced use of CT imaging in posttherapy surveillance, thereby decreasing cumulative radiation dose. Refinement of surveillance imaging may be further guided by risk stratification, disease sites, and potentially biomolecular markers.
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Affiliation(s)
- Cormac Owens
- Division of Haematology-Oncology, Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.,Department of Paediatric Haematology-Oncology, Our Lady's Children's Hospital, Dublin, Ireland
| | - Bryan K Li
- Division of Haematology-Oncology, Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Karen E Thomas
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Meredith S Irwin
- Division of Haematology-Oncology, Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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Siegel JA, Pennington CW, Sacks B. Subjecting Radiologic Imaging to the Linear No-Threshold Hypothesis: A Non Sequitur of Non-Trivial Proportion. J Nucl Med 2016; 58:1-6. [PMID: 27493264 DOI: 10.2967/jnumed.116.180182] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 07/18/2016] [Indexed: 12/11/2022] Open
Abstract
Radiologic imaging is claimed to carry an iatrogenic risk of cancer, based on an uninformed commitment to the 70-y-old linear no-threshold hypothesis (LNTH). Credible evidence of imaging-related low-dose (<100 mGy) carcinogenic risk is nonexistent; it is a hypothetical risk derived from the demonstrably false LNTH. On the contrary, low-dose radiation does not cause, but more likely helps prevent, cancer. The LNTH and its offspring, ALARA (as low as reasonably achievable), are fatally flawed, focusing only on molecular damage while ignoring protective, organismal biologic responses. Although some grant the absence of low-dose harm, they nevertheless advocate the "prudence" of dose optimization (i.e., using ALARA doses); but this is a radiophobia-centered, not scientific, approach. Medical imaging studies achieve a diagnostic purpose and should be governed by the highest science-based principles and policies. The LNTH is an invalidated hypothesis, and its use, in the form of ALARA dosing, is responsible for misguided concerns promoting radiophobia, leading to actual risks far greater than the hypothetical carcinogenic risk purportedly avoided. Further, the myriad benefits of imaging are ignored. The present work calls for ending the radiophobia caused by those asserting the need for dose optimization in imaging: the low-dose radiation of medical imaging has no documented pathway to harm, whereas the LNTH and ALARA most assuredly do.
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Affiliation(s)
| | - Charles W Pennington
- NAC International (retired), Norcross, Georgia, and executive nuclear energy consultant, Alpharetta, Georgia; and
| | - Bill Sacks
- U.S. Food and Drug Administration (retired), Green Valley, Arizona
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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, Ziniel SI, Manion D, Baker A, Treves ST. Administered Activities in Pediatric Nuclear Medicine and the Impact of the 2010 North American Consensus Guidelines on General Hospitals in the United States. J Nucl Med 2016; 57:1478-85. [DOI: 10.2967/jnumed.116.172148] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/08/2016] [Indexed: 11/16/2022] Open
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Chaudhry AA, Gul M, Gould E, Teng M, Baker K, Matthews R. Utility of positron emission tomography-magnetic resonance imaging in musculoskeletal imaging. World J Radiol 2016; 8:268-274. [PMID: 27027320 PMCID: PMC4807335 DOI: 10.4329/wjr.v8.i3.268] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/16/2015] [Accepted: 01/11/2016] [Indexed: 02/06/2023] Open
Abstract
Differentiation between neoplastic and nonneoplastic conditions magnetic resonance imaging (MRI) has established itself as one of the key clinical tools in evaluation of musculoskeletal pathology. However, MRI still has several key limitations which require supplemental information from additional modalities to complete evaluation of various disorders. This has led to the development hybrid positron emission tomography (PET)-MRI which is rapidly evolving to address key clinical questions by using the morphological strengths of MRI and functional information of PET imaging. In this article, we aim to review physical principles and techniques of PET-MRI and discuss clinical utility of functional information obtained from PET imaging and structural information obtained from MRI imaging for the evaluation of musculoskeletal pathology. More specifically, this review highlights the role of PET-MRI in musculoskeletal oncology including initial diagnosis and staging, treatment planning and post-treatment follow-up. Also we will review utility of PET-MRI in evaluating musculoskeletal infections (especially in the immunocompromised and diabetics) and inflammatory condition. Additionally, common pitfalls of PET-MRI will be addressed.
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45
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O'Reilly SE, Plyku D, Sgouros G, Fahey FH, Ted Treves S, Frey EC, Bolch WE. A risk index for pediatric patients undergoing diagnostic imaging with (99m)Tc-dimercaptosuccinic acid that accounts for body habitus. Phys Med Biol 2016; 61:2319-32. [PMID: 26930549 PMCID: PMC5736793 DOI: 10.1088/0031-9155/61/6/2319] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Published guidelines for administered activity to pediatric patients undergoing diagnostic nuclear medicine imaging are currently obtained through expert consensus of the minimum values as a function of body weight as required to yield diagnostic quality images. We have previously shown that consideration of body habitus is also important in obtaining diagnostic quality images at the lowest administered activity. The objective of this study was to create a series of computational phantoms that realistically portray the anatomy of the pediatric patient population which can be used to develop and validate techniques to minimize radiation dose while maintaining adequate image quality. To achieve this objective, we have defined an imaging risk index that may be used in future studies to develop pediatric patient dosing guidelines. A population of 48 hybrid phantoms consisting of non-uniform B-spline surfaces and polygon meshes was generated. The representative ages included the newborn, 1 year, 5 year, 10 year and 15 year male and female. For each age, the phantoms were modeled at their 10th, 50th, and 90th height percentile each at a constant 50th weight percentile. To test the impact of kidney size, the newborn phantoms were modeled with the following three kidney volumes: -15%, average, and +15%. To illustrate the impact of different morphologies on dose optimization, we calculated the effective dose for each phantom using weight-based (99m)Tc-DMSA activity administration. For a given patient weight, body habitus had a considerable effect on effective dose. Substantial variations were observed in the risk index between the 10th and 90th percentile height phantoms from the 50th percentile phantoms for a given age, with the greatest difference being 18%. There was a dependence found between kidney size and risk of radiation induced kidney cancer, with the highest risk indices observed in newborns with the smallest kidneys. Overall, the phantoms and techniques in this study can be used to provide data to refine dosing guidelines for pediatric nuclear imaging studies while taking into account the effects on both radiation dose and image quality.
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Affiliation(s)
- Shannon E O'Reilly
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA
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Rubinstein TB, Putterman C, Goilav B. Biomarkers for CNS involvement in pediatric lupus. Biomark Med 2016; 9:545-58. [PMID: 26079959 DOI: 10.2217/bmm.15.26] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
CNS disease, or central neuropsychiatric lupus erythematosus (cNPSLE), occurs frequently in pediatric lupus, leading to significant morbidity and poor long-term outcomes. Diagnosing cNPSLE is especially difficult in pediatrics; many current diagnostic tools are invasive and/or costly, and there are no current accepted screening mechanisms. The most complicated aspect of diagnosis is differentiating primary disease from other etiologies; research to discover new biomarkers is attempting to address this dilemma. With many mechanisms involved in the pathogenesis of cNPSLE, biomarker profiles across several modalities (molecular, psychometric and neuroimaging) will need to be used. For the care of children with lupus, the challenge will be to develop biomarkers that are accessible by noninvasive measures and reliable in a pediatric population.
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Affiliation(s)
- Tamar B Rubinstein
- Department of Pediatrics, Division of Rheumatology, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Avenue, Bronx, NY 10467, USA
| | - Chaim Putterman
- Department of Medicine, Division of Rheumatology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA
| | - Beatrice Goilav
- Department of Pediatrics, Division of Nephrology, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Avenue, Bronx, NY 10467, USA
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Assessment of Sequential PET/MRI in Comparison With PET/CT of Pediatric Lymphoma: A Prospective Study. AJR Am J Roentgenol 2016; 206:623-31. [DOI: 10.2214/ajr.15.15083] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Boutis K, Thomas KE. Radiation dose awareness and disclosure practice in paediatric emergency medicine: how far have we come? Br J Radiol 2016; 89:20160022. [PMID: 26828973 DOI: 10.1259/bjr.20160022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The past decade has brought increasing coverage in the medical literature and lay media of the potential association between low-level radiation from diagnostic imaging and an increased lifetime cancer risk. Both physician and public opinion increasingly favour a greater discussion of benefit and risk with patients and their families when such imaging is being considered. Particular attention has been directed towards CT, its use in children and the emergency department setting. We will review the evolution of radiation dose awareness and knowledge among emergency physicians (EPs) alongside the parallel increase in public awareness. We will then discuss expectations for risk disclosure and the challenges faced by EPs and radiologists as we strive to provide this in a clinically balanced and meaningful way.
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Affiliation(s)
- Kathy Boutis
- 1 Division of Emergency Medicine, Department of Pediatrics, the Hospital for Sick Children, and University of Toronto, ON, Canada
| | - Karen E Thomas
- 2 Department of Diagnostic Imaging, the Hospital for Sick Children, and University of Toronto, ON, Canada
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Grady E. Gastrointestinal Bleeding Scintigraphy in the Early 21st Century. J Nucl Med 2015; 57:252-9. [PMID: 26678616 DOI: 10.2967/jnumed.115.157289] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 12/10/2015] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal bleeding scintigraphy performed with (99m)Tc-labeled autologous erythrocytes or historically with (99m)Tc-sulfur colloid has been a clinically useful tool since the 1970s. This article reviews the history of the techniques, the different methods of radiolabeling erythrocytes, the procedure, useful indications, diagnostic accuracy, the use of SPECT/CT and CT angiography to evaluate gastrointestinal bleeding, and Meckel diverticulum imaging. The causes of pediatric bleeding are discussed by age.
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Affiliation(s)
- Erin Grady
- Section of Nuclear Medicine, Department of Radiology, Christiana Care Health System, Newark, Delaware
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Mattsson S, Nilsson M. On the estimation of radiation-induced cancer risks from very low doses of radiation and how to communicate these risks. RADIATION PROTECTION DOSIMETRY 2015; 165:17-21. [PMID: 25802468 DOI: 10.1093/rpd/ncv037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The article is intended to give a short overview of epidemiological data on cancer risks associated with very low absorbed doses of ionising radiation. The linear no-threshold (LNT) approach to estimate cancer risks involves the use of epidemiological data at higher doses (>100 mSv), but is supported by data from lower exposure of more sensitive population groups like fetuses and children and the presence of rare types of cancer. The International Commission on Radiological Protection (ICRP) concludes that the LNT model, combined with a dose and dose-rate effectiveness (reduction) factor (DDREF) of 2 for extrapolation from high doses, should be used. The numerical value of the DDREF is challenged by the findings from some recent epidemiological studies demonstrating risks per unit dose compatible with the risks observed in the higher dose studies. In general there is very limited knowledge about the cancer risk after low absorbed doses (10-100 mSv), as most of epidemiological studies have limitations in detecting small excess risks arising from low doses of radiation against fluctuations in the influence of background risk factors. Even if there may be significant deviations from linearity in the relevant dose range 0-100 mSv, one does not know the magnitude or even the direction of any such deviations. The risks could be lower than those predicted by a linear extrapolation, but they could also be higher. Until more results concerning the effects of low-dose exposure are available, a reasonable radiation protection approach is to consider the risk proportional to the dose.
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Affiliation(s)
- Sören Mattsson
- Medical Radiation Physics, Department of Clinical Sciences Malmö, Lund University, Skåne University Hospital Malmö, Malmö SE-205 02, Sweden
| | - Mats Nilsson
- Medical Radiation Physics, Department of Clinical Sciences Malmö, Lund University, Skåne University Hospital Malmö, Malmö SE-205 02, Sweden
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