Administered Activities for Pediatric Nuclear Medicine Procedures and the Impact of the 2010 North American Guidelines on General Hospitals in the United States

We sought to describe the practice of pediatric nuclear medicine at general hospitals in the US and to assess the impact of dose awareness campaigns like Image Gently. METHODS: A web-based survey was developed that requested information regarding hospital type, whether they practiced pediatric nuclear medicine, and their method for determining the administered activity for children. The survey invitation was emailed to a sample of general hospitals with more than 300 beds excluding dedicated pediatric, veterans, psychiatric and rehabilitation hospitals. Data were collected for 5 procedures performed in children: ^99mTc MDP bone scans, ^99mTc MAG3 renograms, ^99mTc DMSA renal cortical scans, ^99mTc based hepatobiliary scans, and ¹⁸F FDG PET scans. The sites reported dosage by weight (MBq/kg), minimum and maximum dosages and the activities that they would administer to 2 hypothetical patients: a 5 year old boy (20 kg, 110 cm tall) and a 10 year old girl (30 kg, 140 cm tall). RESULTS: The invitation was delivered to 196 sites with 121 (61.7%) responding. Eighty-two hospitals (67.8%) performed nuclear medicine in children. All sites scaled administered activity for children, mostly by body weight. Also, 82.4% of sites indicated they were familiar with Image Gently, 57.1% were familiar with the 2010 North American Guidelines for children, and 54.9% altered their protocols because of the Guidelines. The median value for parameters defined by the Guidelines was equal to the Guidelines recommended value for all sites. More than 50% of these sites were compliant with the Guidelines regarding both the acquisition parameters and the administered activities for the two hypothetical patients, particularly sites familiar with the Guidelines. However, there remained a wide variation in practice, sometimes more than a factor of 10, for sites not familiar with the Guidelines. CONCLUSION: Image Gently and the North American Guidelines have had a substantial impact on pediatric nuclear medicine practice in the US. However, a wide variation in practice still exists, particularly for sites not familiar with the Guidelines. Further promotion and dissemination of the Guidelines and best practice is still necessary.

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