[Use of radiopharmaceuticals in pediatrics: Specificities and recommandations of SoFRa (Société française de radiopharmacie)]

Radiopharmaceuticals are commonly used in children in nuclear medicine. Because of physiological differences in growing children and their radiosensitivity, precautions must be taken throughout the medication use process. The aim of this work is to propose recommendations, under the aegis of the Société française de radiopharmacie (SoFRa), for each subsystem of the process, in order to ensure the safety of pediatric patients. Furthermore, an analysis of two surveys on diagnostic radiopharmaceuticals dosage used in different nuclear medicine departments in France is detailed. Recommendations for therapeutic radiopharmaceuticals are also provided. Specificities of the preparation for pediatric patients are discussed through the example of the radiopharmaceuticals for lung perfusion scintigraphy. The preparation of individual dose and administration are also described. In nuclear medicine, radiopharmacist's expertise is essential for patient safety. A multidisciplinary approach is necessary to secure pediatric radiopharmaceutical use process.

How to work together between nuclear medicine and radiotherapy departments?

Among the available imaging techniques, functional imaging provided by nuclear medicine departments represents a tool of choice for the oncoradiotherapist for targeting tumour activity, with positron emission tomography as the main modality. Before, during or after radiotherapy, functional imaging helps guide the oncoradiotherapist in making decisions and in the strategic choice of pathology management. Setting up a working group to ensure perfect coordination at all levels is the first step. Key points for a common and coordinated management between the two departments are the definition of an organizational logistic, training of personnel at every levels, standardization of nomenclatures, the choice of adapted and common equipment, implementation of regulatory controls, and research/clinical routine continuum. The availability of functional examinations dedicated to radiotherapy in clinical routine is possible and requires a convergence of teams and a pooling of tools and techniques.

[What do we expect from Radiopharmacy software?]

The Radiopharmaceutical Health Products circuit or RHP (radiopharmaceutical drugs, radiopharmaceutical preparation and radioactive implantable medical devices) is a complex process that nowadays requires computerization. This circuit must be in accordance with both the legislation on medicinal products and the legislation on artificial radioelements. It is acknowledged that computerization of the circuit; possibly different within each organization, provides assistance to stakeholders: pharmaceutical analysis of prescription, pharmaceutical preparation and preparation of doses to be dispensed and waste management for example. The software also allows real-time monitoring of the activity and traceability of the various pharmaceutical processes. In addition, they are generally interfaced with equipment used routinely: dose calibrator, dose dispensing equipment. In the absence of any legislation for these software products, which are not considered either as medical devices or as software to assist prescription or dispensation, a working group, under the aegis of the Société Française de Radiopharmacie (SoFRa), has written a minimum set of specifications for these radiopharmaceutical software products. The analyses of the risk maps of different hospital structures allowed a global analysis and synthesis of the different processes, settings, interfaces and requirements for the proper use of these software. The specifications include the very specific requirements of radiopharmacy (notion of radioactive decay, complex preparations with chemical synthesis, traceability.) and will allow software publishers to propose tools adapted to our practice and the RHP circuit.