Objective The aim of this study was to evaluate three thyroid blockade regimes to determine which protocol provides the optimal level of thyroidal protection for paediatric 123-I-meta-iodobenzylguanidine (mIBG) imaging and estimate the relative radiation dose inferred from unbound radioiodine. Methods A total of 231 patients were retrospectively evaluated for thyroid uptake and categorised into five subgroups depending upon the protocol of thyroid blockade received. Efficacy of thyroid blockade was established by visual scoring and image quantitation with comparison against a control group. Results Visual Likert scale responses were subjected to the Mann–Whitney U and Kruskal–Wallis tests, respectively. Statistical significance was reached for observed thyroid uptake in potassium perchlorate recipients (U = 1107, P = 0.001). No statistically significant difference was observed in thyroid uptake for iohexol blockade (U = 176, P = 0.71) or potassium iodate blockade despite variations in iodate dosage and duration (χ 2(2) = 0.203, P = 0.93). The analyses were repeated for the image quantitation data. A statistically significantly higher absorbed thyroid dose was observed using potassium perchlorate blockade compared with the control group (U = 719, P = 0.001). The Mann–Whitney U did not reach statistical significance in absorbed thyroid dose for iohexol blockade (U = 126, P = 0.209, r = −0.13). The Kruskal–Wallis test, conducted across the potassium iodate groups, did not reach statistical significance (χ 2(2) = 0.513, P = 0.774). The median absorbed thyroid dose across the iodate groups ranged from 3.58 to 3.91 mGy indicating comparable blockade effectiveness for single-dose potassium iodate. Conclusion Potassium iodate blockade is more efficacious compared with potassium perchlorate within the cohort observed. Both visual and quantitative data indicate that potassium iodate given at 30–60 min before 123I-mIBG injection provides comparable blockade effectiveness to lengthier administrations, suggesting that a single dose is well tolerated and practical.
BackgroundPaediatric urolithiasis is uncommon and severe complications, such as urinary tract infections and renal parenchymal scarring, occur in a minority of children with urinary calculi. The goals of management are to prevent additional renal damage, to expedite the passage of stones, and prevent new stone formation. The standard work-up for paediatric calculi includes ultrasonography followed by an abdominal x-ray. However complex calculi (for example staghorn calculi with extensive ramification in the renal collecting system) present a special diagnostic and therapeutic challenge.MethodsAt Great Ormond Street Hospital for Children a new imaging approach has been proposed in children presenting with complex renal calculi. This involves a Tc-99m-DMSA scan with planar and tomographic images for assessment of renal parenchymal function, followed by a low dose unenhanced CT KUB. The DMSA tomographic images are co-registered to the CT images.ResultsThis technique enables assessment of the function of the renal parenchyma adjacent to the renal stones. It has thus been possible to manage the calculi taking parenchymal function into account. For example, in the case of a horseshoe kidney in which one of the two moieties contained numerous stones, the DMSA scan showed very poor parenchymal function of that moiety: it was therefore decided to surgically resect the moiety instead of extracting the stones individually with percutaneous nephro-lithotomy (PCNL). Conversely, in a duplex kidney with stones in the lower moiety, the DMSA scan showed good parenchymal function of the lower moiety; as a result, this was not resected and the stones were extracted with PCNL. The radiation dose from this approach was no higher than the standard imaging protocol.ConclusionPreliminary results of this imaging approach in a selected patients’ population of more than 30 children with complex paediatric renal stones are encouraging and warrant further evaluation.
BackgroundRepetitive joint bleeding leading to chronic synovitis and progressive arthropathy are the hallmarks of severe haemophilia and a major cause of disability in patients with this coagulopathy. Haemophilic synovitis is usually prevented by prophylactic clotting factor replacement and bypassing agents. However, a small number of patients have inhibitory antibodies to factor replacement and develop one or more target joints with chronic synovitis. Our aim was to set-up a novel radionuclide therapy service (our first at GOSH) using radiation synovectomy as an alternative treatment option to treat children with haemophilic synovitis.MethodsA multi-disciplinary group was formed to develop this service utilising a collaborative approach between haemophilia, physiotherapy and radiology. The intervention involves injecting Re186 into the joint capsule within interventional radiology to cause coagulation necrosis of the synovial tissue through β-irradiation. The λ-emission is then imaged using SPECT CT to assess the bio-distribution of the radio-colloid and detect any extra-articular radioactivity.ResultsThis service development was presented as a QIPP to the CCG. The approval for this therapy was based on its close alignment with efficiency and value strategies in delivering a personalised effective treatment for the patient with minimal inpatient stay, whilst significantly reducing the costs associated with prophylactic clotting factor.ConclusionsThis therapy should be most effective in grade I and II synovitis and it is anticipated that it will reduce the frequency of haemarthrosis and prevent progression to haemophiliac arthropathy. At present, 8 patients have been identified and accepted for this therapy under the referral criteria, with the service due to commence imminently. The intervention outcome parameters will be measured by; 1.Future joint bleed frequency, 2. Pre and post MR imaging to assess synovial thickness, 3. Joint pain scores, and 4.Physical objective and functional measures. Patient reported outcomes (PROMs) will be used to assess impact on quality of life.
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