Study recommends developing standards for pediatric radiopharmaceutical doses

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A review of thirteen pediatric hospitals in North America has revealed a lack of universally applied standards for administering radiopharmaceutical doses to children undergoing nuclear medicine examinations, according to survey results published in the June issue of The Journal of Nuclear Medicine.

"Modern nuclear medicine procedures are sensitive, minimally invasive, painless and safe and thus well suited for the evaluation of pediatric patients. They provide a wealth of unique and useful information that can be used to diagnose and treat many diseases of childhood," said S. Ted Treves, MD, chief of the division of nuclear medicine at Children's Hospital and professor of radiology at Harvard Medical School, both in Boston.

In nuclear medicine, there are well-established guidelines for administering radiopharmaceutical doses for adults, however, the majority of radiopharmaceutical package inserts do not provide guidance on pediatric doses, Treves said.

“In imaging children, physicians typically base dosages on the patient's body weight, the nature and the type of problem being investigated, the equipment available and their own experience. This has led to the variations in dosage that currently exist,” he added.

To document pediatric radiopharmaceutical doses among a group of pediatric hospitals, Treves and his co-authors designed a survey consisting of 16 pediatric nuclear medicine exams. Survey participants were asked to report the minimum and maximum administered activities for each exam as well as the administration schedule based on body weight.

From these data, the authors computed minimum, maximum, median and mean values for each procedure, which confirmed that among the institutions surveyed, the administered doses varied widely, with the greatest disparity noted in the smallest patients for levels of minimum total administered activity.

The study authors recommend establishing guidelines that balance the need for high-quality image resolution and low radiation exposure with each child's unique profile.

"High doses that do not result in improved diagnostic accuracy, or conversely, low doses that do not permit adequate examination, should both be considered unnecessary radiation exposures," said Treves. "This is why it is critical that pediatric radiopharmaceutical doses be determined by the minimal amount necessary to ensure satisfactory examinations."

According to the authors, the findings suggest a clear need to achieve some level of standardization by reaching a broader consensus on pediatric radiopharmaceutical dosimetry. Other recommendations include utilizing new image-processing techniques that have emerged in the last few years that offer advantages over older methods by generating images of vastly improved quality that provide diagnostic information with lower administered radiopharmaceutical doses.

"It is time to take a fresh look at pediatric nuclear medicine dosimetry and an opportunity to reach consensus. There is a need to optimize minimum dosing activity without sacrificing image quality," said Treves. "Nuclear medicine has become indispensible to the diagnosis and treatment of pediatric disorders, especially with its safe and largely non-invasive procedures that produce critical diagnostic information exposing the patient to very small levels of radiation—an extremely important consideration in imaging children."