Physicians & Radiologists - Nuclear Medicine

“Child-size” the Radiopharmaceutical Doses Administered to Your Patients

Nuclear medicine tests are often essential in diagnosing illness in children, impacting their treatment and improving outcomes. As the nuclear medicine physician or radiologist, you play a key role as an advocate for children. By logging onto this website, you have already demonstrated your commitment to improve radiation protection for kids. It is the collective duty of all members of the healthcare team to ensure that every imaging study in pediatric patients is thoughtful, appropriate and indicated. This website provides simple educational resources to radiology and nuclear medicine practices for improving radiation protection for children.

Be Every Child’s Advocate

There is now a growing awareness of the opportunities to lower radiation dose in children without compromising the diagnostic quality. Encourage parents to ask questions and then direct them to this website.

5 Simple Steps to Improve Patient Care in Your Daily Practice

  • Perform only appropriate exams. Discussing the clinical situation with the referring physician can often be beneficial to choose the right exam for each patient. Embedded decision support in electronic ordering may also reduce inappropriate imaging.
  • Increase awareness within the imaging facility and the institution for the need of lowering radiation dose to children during nuclear medicine procedures.
  • Be committed to make a change in your daily practice by working as a team with your technologists, physicist, referring doctors and parents to decrease the radiation dose!
  • As you work to decrease the administered dose to children, you also reduce the dose to the personnel in the room, thus promoting safety for the entire health care team!
  • Follow expert guidelines:

2014 Update of North American Consensus Guidelines for Pediatric administered Radiopharmaceutical activities

 

Patient Preparation

  • Appropriate patient preparation is crucial for image quality. Any measure that can calm the child prior to start of imaging will help keep the child quiet and still during the imaging study.
  • Different imaging studies warrant certain protocols; please see the following references below for more details.

Treves ST (2007). Introduction. In Treves ST (Ed.), Pediatric Nuclear Medicine/PET, 3rd Edition (pp 1-15). New York: Springer.

Kaste SC (2004). Issues specific to implementing PET CT for pediatric oncology: what we have learned along the way. Pediatr Radiol, 34(3), 205-213.

Alessio, A. M., Kinahan, P. E., Manchanda, V., Ghioni, V., Aldape, L., & Parisi, M. T. (2009). Weight-based, low-dose pediatric whole-body PET/CT protocols. J Nucl Med, 50 (10), 1570-1577

SNM and combined SNM and ACR practice guidelines

List of procedures
Procedure checklist

 

Radiation Dose and Risk

  • Radiation dose may be different in children as compared to adults due to patient size, organ size and orientation and organ distribution of administered radiopharmaceutical.
  • Estimates of critical organ and effective dose in common pediatric nuclear medicine procedures are listed in the table below. However please note that these estimates are averages over a wide range of patients at each age and do not take into consideration individual differences in anatomy and physiology from the standard models.
  • Assessing the risk associated with exposure to ionizing radiation involves applying models that use both epidemiologic and biologic data to extrapolate from the available data to the dosimetric region of interest. Such extrapolation is not straightforward.
  • Much of the current understanding about the risk of exposure to ionizing radiation for humans is based on the Life Span Study of the survivors of the bombings of Hiroshima and Nagasaki as reported by the Radiation Effects Research Foundation.
  • The consensus is to assume that the risk at the lower doses with medical radiation can best be estimated by a linear extrapolation from higher doses for radiation protection purposes.
  • It has become increasingly more important that nuclear medicine practitioners—including physicians, physicists, technologists, and other members of patient care teams effectively communicate with the referring providers and with patients and families about the medical use of radiation, the level of radiation exposure, and the potential risk.

Further Reading
 Outline: Radiation Dose and Risk in Pediatric Nuclear MedicineFrederic H. Fahey, DSc, S. Ted Treves, MD and S. James Adelstein
 Minimizing and Communicating Radiation Risk in Pediatric Nuclear Medicine - Fahey FH, Treves ST, Adelstein SJ. J Nucl Med. 2011; 52:1240-1251.

Additional Reading Material and Resources
SNM and combined SNM and ACR practice guidelines 

Nuclear Medicine Resources

Medical Professionals

Parents

 

Radiation Dose Resources

SNMMI’s Dose Optimization Task Force has created two new online tools to help educate imaging professionals on best practices for pediatric and adult nuclear medicine:

 

The Pediatric Injected Activity Tool reports recommended injected activity for pediatric patients based on the North American consensus guidelines and the European Association of Nuclear Medicine guidelines. With this tool, specify the nuclear medicine procedure and the pediatric patient’s weight to find the recommended administered activity for the patient.

The Nuclear Medicine Radiation Dose Tool provides convenient access to guidelines and radiation dose estimates (effective dose and critical organ dose) for many nuclear medicine exams. With this tool, specify the nuclear medicine procedure, the injected activity, and the patient model (gender, age) to calculate the effective dose for this procedure.

 

 

Acknowledgements

S. Ted Treves, MD, Chair
Image Gently Nuclear Medicine Initiative 

Michael J. Gelfand,  MD, Past-President
SNMMI Pediatric Imaging Council, Cincinnati Children's Hospital Medical Center

Marguerite T. Parisi, MD, MS Ed., Chair
SPR Nuclear Medicine Committee, Seattle Children's Hospital

Larry Binkovitz, MD, President
SNMMI Pediatric Imaging Council, Mayo Clinic

Stephanie Spottswood, MD, Sec-Treasurer
SNMMI Pediatric Imaging Council, Vanderbilt University

Frederic Fahey, DSc, Physicist,
Children's Hospital Boston

Dominique Delbeke, MD, PhD, 2009-10
SNMMI President, Vanderbilt University 

Nanci A. Burchell, MBA, CNMT, FSNMTS
Children's Mercy Hospitals and Clinics, Kansas City, MO

Joanne Louis, CNMT, Children's Hospital Boston
Adam Alessio, PhD, Medical Physicist, Seattle Children's